Status Epilepticus and Refractory Status Epilepticus Management

Abend, Nicholas S.; Bearden, David; Helbig, Ingo; McGuire, Jennifer L.; Narula, Sona; Panzer, Jessica A.; Topjian, Alexis; Dlugos, Dennis J.

doi:10.1016/j.spen.2014.12.006

Cited by 44 publications

(26 citation statements)

References 129 publications

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“…Intravenous lorazepam is preferred, although non-intravenous diazepam or midazolam are suitable alternatives (Abend et al, 2014; Rogalski and Rogalski, 2015). These anti-epileptic drugs (AEDs) enhance GABA-mediated neuronal inhibition by acting as GABA A R positive allosteric modulators.…”

Section: Pharmacological Inhibitorsmentioning

confidence: 99%

Emerging roles of Na+/H+ exchangers in epilepsy and developmental brain disorders

Zhao

Carney

Falgoust

et al. 2016

Progress in Neurobiology

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Epilepsy is a common central nervous system (CNS) disease characterized by recurrent transient neurological events occurring due to abnormally excessive or synchronous neuronal activity in the brain. The CNS is affected by systemic acid–base disorders, and epileptic seizures are sensitive indicators of underlying imbalances in cellular pH regulation. Na+/H+ exchangers (NHEs) are a family of membrane transporter proteins actively involved in regulating intracellular and organellar pH by extruding H+ in exchange for Na+ influx. Altering NHE function significantly influences neuronal excitability and plays a role in epilepsy. This review gives an overview of pH regulatory mechanisms in the brain with a special focus on the NHE family and the relationship between epilepsy and dysfunction of NHE isoforms. We first discuss how cells translocate acids and bases across the membrane and establish pH homeostasis as a result of the concerted effort of enzymes and ion transporters. We focus on the specific roles of the NHE family by detailing how the loss of NHE1 in two NHE mutant mice results in enhanced neuronal excitability in these animals. Furthermore, we highlight new findings on the link between mutations of NHE6 and NHE9 and developmental brain disorders including epilepsy, autism, and attention deficit hyperactivity disorder (ADHD). These studies demonstrate the importance of NHE proteins in maintaining H+ homeostasis and their intricate roles in the regulation of neuronal function. A better understanding of the mechanisms underlying NHE1, 6, and 9 dysfunctions in epilepsy formation may advance the development of new epilepsy treatment strategies.

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Section: Pharmacological Inhibitorsmentioning

confidence: 99%

Emerging roles of Na+/H+ exchangers in epilepsy and developmental brain disorders

Zhao

Carney

Falgoust

et al. 2016

Progress in Neurobiology

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“…In these patients, mechanisms for self‐termination of seizures fail. Thus, seizures can usually last for several minutes with the high possibility of recurrence (Abend et al., ; Reddy & Kuruba, ). Refractory status epilepticus (RSE) is considered as continuing seizures failing to respond to first‐ and second‐line anticonvulsant therapies (Al‐Mufti & Claassen, ).…”

Section: Introductionmentioning

confidence: 99%

“…In some cases, the seizures are so severe that they cannot be suppressed even by third‐line therapy (propofol or phenobarbital) (Wheless & Treiman, ). Unlike phenytoin (Abend et al., ; Misra, Kalita, & Bhoi, ; Tiamkao, Sawanyawisuth, & Chancharoen, ), intravenous sodium valproate (IV VPA) can be used safely against various types of SE especially for patients with cardiorespiratory impairments (Trinka et al., ). This nonsedating drug has high tolerability and does not cause severe hemodynamic instability (Brigo et al., ).…”

Section: Introductionmentioning

confidence: 99%

Sodium valproate compared to phenytoin in treatment of status epilepticus

et al. 2018

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BackgroundStatus epilepticus (SE) is a neurological emergency which can be life‐threatening. Several medical regimens are used in order to control it. In this study, we intended to evaluate the clinical efficacy and tolerability of sodium valproate and intravenous phenytoin (IV PHT) in the control of SE.MethodsOne hundred and ten consecutive patients suffering from benzodiazepine refractory SE who were referred to the emergency ward from March 2014 to March 2015 were randomly divided into two groups. The first group received intravenous sodium valproate, 30 mg/kg as loading dose and then 4–8 mg/kg every 8 hr as maintenance regimen. The second group received IV PHT 20 mg/kg as loading dose and then 1.5 mg/kg for 8 hr as maintenance therapy. All patients were monitored for vital signs every 2 hr up to 12 hr. The patients were also followed up for 7 days regarding drug response and adverse effects.ResultsThe administration of sodium valproate and phenytoin respectively resulted in seizure control in 43 (78.18%) and 39 (70.90%) of the patients within 7 days of drug administration (p = .428). Seven‐day mortality rate was similar in both groups (12.73% vs. 12.73%; p = .612). There was no significant difference in adverse effects between two groups.ConclusionSodium valproate is preferred to IV PHT for treatment and control of SE due to its higher tolerability and lower hemodynamic instability.

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“…Second-line treatment involves anesthetic-induced coma with barbiturates such as pentobarbital (in the US) or thiopental (in Europe). 31 In 1988, Lowenstein et al reported that 14 patients had 100% cessation of seizures with barbiturate-induced burstsuppression EEG pattern. However, nine patients had hypotension and seven of them required vasopressors support.…”

Section: Barbituratesmentioning

confidence: 99%

Febrile Infection-Related Epilepsy Syndrome

et al. 2019

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Febrile infection-related epilepsy syndrome (FIRES) is a subset or variant of new-onset refractory status epilepticus in children. FIRES is characterized by the occurrence of a febrile episode between 24 hours and 2 weeks before the onset of refractory status epilepticus. A infectious cause is rarely identified in FIRES and an inflammatory or autoimmune etiology is implied. Seizures in FIRES are very difficult to control, and treatments include antiepileptic drugs, ketogenic diet, intravenous immunoglobulin, plasmapheresis, and corticosteroid therapy. The prognosis for patients with FIRES is poor, and most children are left with refractory epilepsy and cognitive impairment. The new consensus guidelines on the terminology of FIRES and recent interest in new treatment approaches have been welcome developments for clinicians who face the challenge of diagnosing and managing status epilepticus in a previously healthy child that occurs following a minor febrile episode. This review aims to provide clinicians with an update on the current hypotheses for the etiology, pathogenesis, clinical evaluation, management, and future directions in the diagnosis and treatment of FIRES.

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Status Epilepticus and Refractory Status Epilepticus Management

Cited by 44 publications

References 129 publications

Emerging roles of Na+/H+ exchangers in epilepsy and developmental brain disorders

Emerging roles of Na+/H+ exchangers in epilepsy and developmental brain disorders

Sodium valproate compared to phenytoin in treatment of status epilepticus

Febrile Infection-Related Epilepsy Syndrome

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