Predictors of Outcome in Refractory Status Epilepticus

Hocker, Sara E.; Britton, Jeffrey W.; Mandrekar, Jayawant N.; Wijdicks, Eelco F. M.; Rabinstein, Alejandro A.

doi:10.1001/jamaneurol.2013.578

Cited by 215 publications

(130 citation statements)

References 41 publications

(54 reference statements)

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“…Current treatment algorithms utilize intravenous anesthetic agents for 24 h or more to suppress RSE if second and third-line drugs do not stop seizures. If status epilepticus continues or recurs 24 h or more after the initiation of treatment with anesthetic agents, patients are diagnosed with super-refractory status epilepticus (SRSE) (Hocker et al, 2013). As both RSE and SRSE carry high rates of morbidity and mortality (Shorvon and Ferlisi, 2012), ketogenic diet therapy offers a needed adjunct strategy for management of status epilepticus.…”

Section: Efficacy and Indications In Adultsmentioning

confidence: 99%

The role for ketogenic diets in epilepsy and status epilepticus in adults

Williams

Cervenka

2017

Clinical Neurophysiology Practice

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Section: Efficacy and Indications In Adultsmentioning

confidence: 99%

The role for ketogenic diets in epilepsy and status epilepticus in adults

Williams

Cervenka

2017

Clinical Neurophysiology Practice

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“…a Often associated with a temperature of 41.0 °C or greater. b Onset will be later for a small percentage of patients with “central pyrexia”, otherwise this most commonly occurs early during ICU admission [45, 51]…”

Section: Body Temperature Measurement and Definitionsmentioning

confidence: 99%

Pyrexia: aetiology in the ICU

Niven

Laupland

2016

Crit Care

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Elevation in core body temperature is one of the most frequently detected abnormal signs in patients admitted to adult ICUs, and is associated with increased mortality in select populations of critically ill patients. The definition of an elevated body temperature varies considerably by population and thermometer, and is commonly defined by a temperature of 38.0 °C or greater. Terms such as hyperthermia, pyrexia, and fever are often used interchangeably. However, strictly speaking hyperthermia refers to the elevation in body temperature that occurs without an increase in the hypothalamic set point, such as in response to specific environmental (e.g., heat stroke), pharmacologic (e.g., neuroleptic malignant syndrome), or endocrine (e.g., thyrotoxicosis) stimuli. On the other hand, pyrexia and fever refer to the classical increase in body temperature that occurs in response to a vast list of infectious and noninfectious aetiologies in association with an increase in the hypothalamic set point. In this review, we examine the contemporary literature investigating the incidence and aetiology of pyrexia and hyperthermia among medical and surgical patients admitted to adult ICUs with or without an acute neurological condition. A temperature greater than 41.0 °C, although occasionally observed among patients with infectious or noninfectious pyrexia, is more commonly observed in patients with hyperthermia. Most episodes of pyrexia are due to infections, but incidence estimates of infectious and noninfectious aetiologies are limited by studies with small sample size and inconsistent reporting of noninfectious aetiologies. Pyrexia commonly triggers a full septic work-up, but on its own is a poor predictor of culture-positivity. In order to improve culturing practices, and better guide the diagnostic approach to critically ill patients with pyrexia, additional research is required to provide more robust estimates of the incidence of infectious and noninfectious aetiologies, and their relationship to other clinical features (e.g., leukocytosis). In the meantime, using existing literature, we propose an approach to identifying the aetiology of pyrexia in critically ill adults.

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“…The three most important mortality predictors are an acute or potentially fatal etiology (odds ratio [OR]: 6.0), increasing age (OR: 5.5 if >65 years) and a generalized convulsive or comatose SE presentation (OR: 5.8) [25]. The risk of an unfavorable functional outcome seems to correlate with the length of ICU treatment [26], as well as, again, age and etiology [8]. Furthermore, refractory SE is linked to a worse prognosis, both in terms of mortality and morbidity, in comparison with SE responding to the first treatment steps [8].…”

Section: Framing the Problem From The Clinical Sidementioning

confidence: 99%

Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application

Vezzani

Dingledine

Rossetti

2015

Expert Review of Neurotherapeutics

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Status epilepticus (SE) is a life-threatening neurological emergency often refractory to available treatment options. It is a very heterogeneous condition in terms of clinical presentation and causes, which besides genetic, vascular and other structural causes also include CNS or severe systemic infections, sudden withdrawal from benzodiazepines or anticonvulsants and rare autoimmune etiologies. Treatment of SE is essentially based on expert opinions and antiepileptic drug treatment per se seems to have no major impact on prognosis. There is, therefore, urgent need of novel therapies that rely upon a better understanding of the basic mechanisms underlying this clinical condition. Accumulating evidence in animal models highlights that inflammation ensuing in the brain during SE may play a determinant role in ongoing seizures and their long-term detrimental consequences, independent of an infection or auto-immune cause; this evidence encourages reconsideration of the treatment flow in SE patients.

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Predictors of Outcome in Refractory Status Epilepticus

Cited by 215 publications

References 41 publications

The role for ketogenic diets in epilepsy and status epilepticus in adults

The role for ketogenic diets in epilepsy and status epilepticus in adults

Pyrexia: aetiology in the ICU

Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application

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