Seizures, Status Epilepticus, and Continuous EEG in the Intensive Care Unit

Rosenthal, Eric S.

doi:10.1212/con.0000000000001012

Cited by 13 publications

(15 citation statements)

References 103 publications

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“…Currently, no data are available on whether continuous EEG or anticonvulsant use affects SAH outcome. For more information on the use of continuous EEG in the management of SAH, refer to the article “Seizures, Status Epilepticus, and Continuous EEG in the Intensive Care Unit” by Eric S. Rosenthal, MD, 113 in this issue of Continuum .…”

Section: Acute Complications Of Subarachnoid Hemorrhage and Critical ...mentioning

confidence: 99%

Subarachnoid Hemorrhage

Chou¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW Subarachnoid hemorrhage (SAH) remains an important cause of mortality and long-term morbidity. This article uses a case-based approach to guide readers through the fundamental epidemiology and pathogenesis of SAH, the approach to diagnosis and management, the results of clinical trials and evidence to date, prognostic considerations, controversies, recent developments, and future directions in SAH. RECENT FINDINGS Historically, management of SAH focused on prevention and treatment of subsequent cerebral vasospasm, which was thought to be the primary cause of delayed cerebral ischemia. Clinical and translational studies over the past decade, including several therapeutic phase 3 randomized clinical trials, suggest that the pathophysiology of SAH-associated brain injury is multiphasic and multifactorial beyond large vessel cerebral vasospasm. The quest to reduce SAH-associated brain injury and improve outcomes is shifting away from large vessel cerebral vasospasm to a new paradigm targeting multiple brain injury mechanisms, including early brain injury, delayed cerebral ischemia, microcirculatory dysfunction, spreading cortical depolarization, inflammation, and the brain-body interaction in vascular brain injury with critical illness. Despite multiple negative randomized clinical trials in search of potential therapeutic agents ameliorating the downstream effects after SAH, the overall outcome of SAH has improved over recent decades, likely related to improvements in interventional options for ruptured cerebral aneurysms and in critical care management. Emerging clinical evidence also suggests potential harmful impact of historic empiric treatments for SAH-associated vasospasm, such as prophylactic induction of hypertension, hypervolemia, and hemodilution (triple H therapy). With decreasing mortality, long-term SAH survivorship and efforts to reduce chronic morbidity and to improve quality of life and patient-centered outcome are growing areas of unmet need. Despite existing guidelines, significant variabilities in local and regional practices and in scientific terminologies have historically limited advancement in SAH care and therapeutic development. Large global collaborative efforts developed harmonized SAH common data elements in 2019, and studies are under way to examine how existing variabilities in SAH care impact long-term SAH outcomes. SUMMARY Although the overall incidence and mortality of SAH is decreasing with advances in preventive and acute care, SAH remains a major cause of long-term morbidity in survivors. Significant variabilities in care settings and empiric treatment protocols and inconsistent scientific terminologies have limited advancement in patient care and therapeutic clinical studies. Large consensus efforts are under way to introduce clinical guidelines and common data elements to advance therapeutic approaches and improve patient outcome.

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Section: Acute Complications Of Subarachnoid Hemorrhage and Critical ...mentioning

confidence: 99%

Subarachnoid Hemorrhage

Chou¹

2021

CONTINUUM: Lifelong Learning in Neurology

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“…Compared with traditional nursing methods, predictive nursing is more systematic, comprehensive, and individualized and has more advantages [ 23 ]. Some scholars have applied predictive nursing to the transfer nursing of emergency patients and patients with severe traumatic brain injury, which has greatly shortened the transfer time, reduced the incidence of transfer accidents, and improved nursing safety [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Algoplaque Hydrocolloid Dressing Combined with Nanosilver Antibacterial Gel under Predictive Nursing in the Treatment of Medical Device-Related Pressure Injury

Chen

You

2022

Computational and Mathematical Methods in Medicine

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It was aimed at the clinical value of predictive nursing and Algoplaque hydrocolloid dressing (AHD) combined with nanosilver antibacterial gel in treating medical device-related pressure injury (MDRPI). 100 patients, who underwent surgery in Chongqing Qijiang District People’s Hospital from February 2019 to February 2020, were selected as the research objects and were randomly divided into the experimental group (50 cases) and the control group (50 cases). For the characterization test, a nanosilver antibacterial gel was created first. Patients in both groups received predictive nursing, but those in the experimental group received AHD and nanosilver antibacterial gel, and those in the control group received gauzes. MDRPI incidence, pressed skin injury severity, comfort level, clothing changes, nursing satisfaction, and other factors were all compared. The particle size of the nanosilver gel was 45-85 nm, with a relatively homogeneous distribution with the medium size, according to the findings. The incidence of MDRPI in the experimental group was lower than that in the control group significantly (6% vs. 30%, P < 0.05 ). The degree of injury of pressured skin in the experimental group was milder than that in the control group ( P < 0.05 ), the degree of comfort and nursing satisfaction was higher in the experimental group than in the control group ( P < 0.05 ), and dressing change count was lower than that in the control group ( P < 0.05 ). In the treatment of MDRPI, predictive nursing and AHD using nanosilver antibacterial gel showed high clinical application value.

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“…Nonconvulsive SE can occur in up to 10% of medical and surgical intensive care unit (ICU) patients in coma that undergo continuous EEG monitoring. After acute brain injury, prevalence of NCSE can be even higher 49 , 50 .…”

Section: Nonconvulsive Sementioning

confidence: 99%

Status epilepticus: review on diagnosis, monitoring and treatment

Pinto

Oliveira

Midon

2022

Arq. Neuro-Psiquiatr.

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Status epilepticus (SE) is a frequent neurological emergency associated with high morbidity and mortality. According to the new ILAE 2015 definition, SE results either from the failure of the mechanisms responsible for seizure termination or initiation, leading to abnormally prolonged seizures. The definition has different time points for convulsive, focal and absence SE. Time is brain. There are changes in synaptic receptors leading to a more proconvulsant state and increased risk of brain lesion and sequelae with long duration. Management of SE must include three pillars: stop seizures, stabilize patients to avoid secondary lesions and treat underlying causes. Convulsive SE is defined after 5 minutes and is a major emergency. Benzodiazepines are the initial treatment, and should be given fast and an adequate dose. Phenytoin/fosphenytoin, levetiracetam and valproic acid are evidence choices for second line treatment. If SE persists, anesthetic drugs are probably the best option for third line treatment, despite lack of evidence. Midazolam is usually the best initial choice and barbiturates should be considered for refractory cases. Nonconvulsive status epilepticus has a similar initial approach, with benzodiazepines and second line intravenous (IV) agents, but after that, aggressiveness should be balanced considering risk of lesion due to seizures and medical complications caused by aggressive treatment. Usually, the best approach is the use of sequential IV antiepileptic drugs (oral/tube are options if IV options are not available). EEG monitoring is crucial for diagnosis of nonconvulsive SE, after initial control of convulsive SE and treatment control. Institutional protocols are advised to improve care.

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Seizures, Status Epilepticus, and Continuous EEG in the Intensive Care Unit

Cited by 13 publications

References 103 publications

Subarachnoid Hemorrhage

Subarachnoid Hemorrhage

Effect of Algoplaque Hydrocolloid Dressing Combined with Nanosilver Antibacterial Gel under Predictive Nursing in the Treatment of Medical Device-Related Pressure Injury

Status epilepticus: review on diagnosis, monitoring and treatment

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