Estatus epiléptico no convulsivo / Nonconvulsive status epilepticus

El estatus epiléptico no convulsivo (EENC) es una situación clínica en la cual los pacientes presentan un grado variable de alteración del nivel de conciencia o de su estado mental basal, asociado a descargas o paroxismos electrográficos de forma continua y sin presentar movimientos convulsivos, 0 estos son muy sutiles. Es una entidad de relativamente reciente descripción, que va adquiriendo cada vez una mayor importancia entre las causas de deterioro del nivel de conciencia, siendo en parte, probablemente infradiagnosticada, a lo que contribuye el desconocimiento del clínico, la necesidad de realizar un electroencefalograma (EEG) y la falta de unos criterios diagnósticos consensuados. El objetivo de este artículo es hacer una revisión del EENC haciendo un especial énfasis en aquellas situaciones en las cuales el clínico se pueda enfrentar con dicha patología...

Nonconvulsive status epilepticus (NCSE) is a situation in which patients have a varying degree of altered level of consciousness or mental condition associated with continuously electrographic discharges or paroxysms, without present convulsive movements or that they are very subtle. It is an entity of relatively recent description, which becomes more important as cause of altered level of consciousness, and it was thought likely being underdiagnosed, contributing the ignorance of clinician, the need for an electroencephalogram and lack of consensus diagnostic criteria. The aim of this article is to review the non-convulsive status epilepticus with special emphasis on those situations in which the clinician may face with this pathology...

Estado epiléptico super-refractario resuelto con hipotermia terapéutica / Super-refractory status epilepticus solved with therapeutic hypothermia

El estado epiléptico refractario es definido como la crisis convulsiva que persiste a pesar del tratamiento adecuado con benzodiacepinas y otras drogas anticonvulsivantes, y el estado epiléptico super-refractario, como aquel que persiste luego del uso de agentes anestésicos por más de 24 horas. Toda forma de estado epiléptico debe ser tratada rápidamente para disminuir la morbimortalidad; sin embargo, hay escasa evidencia para escoger un tratamiento específico sobre otros. La hipotermia puede resultar un tratamiento seguro y útil en el manejo de estos pacientes. Se reporta el caso de un paciente de 14 años con estado epiléptico super-refractario, tratado con hipotermia terapéutica en forma exitosa...

Estado de mal epiléptico en pediatría / [Status epilepticus in childhood].

Status epilepticus is a medical emergency which presents seizures by 30 minutes or more of continuous activity, or two or more consecutive crises without full recovery of consciousness between them. Currently, it is considered that a seizure convulsive or not, that last more than 5 minutes should be considered a status epilepticus. Different drugs for the treatment of this disease have been used. There is a general consensus in an aggressive handling should be done to reduce their morbidity and mortality, without forgetting that the cause of status is important for its management, control, and its aftermath.

Actualización en el manejo del estado epiléptico / Update on the management of status epilepticus

El Estado Epiléptico (EE) es una emergencia médica, que requiere intervención de forma inmediata para disminuir la morbimortalidad asociada. Esta incluye el uso de medidas de soporte vital, y un tratamiento específico cuyo objetivo es detener todas las crisis ya sean clínicas o electrográficas y prevenir su recurrencia. En el presente manuscrito revisamos lo más relevante del tratamiento farmacológico en cada estadío del EE y las medidas generales concomitantes, para un manejo adecuado.

Status Epilepticus is a medical emergency requiring immediate intervention to decrease morbidity and mortality. This includes the use of life support measures and specific treatment aimed at stopping all crises either clinical or electrographic and prevents its recurrence. In this manuscript we review the most relevant of drug treatment at each stage of the Status Epilepticus and the concomitant general measures for proper management.

Estado epiléptico en pediatría / Status epilepticus in childhood

El estado epiléptico es la forma de presentación de crisis de epilepsia más alarmante y severa. Es un cuadro clínico de alta morbimortalidad con un alto riesgo de daño cerebral entre los pacientes que sobreviven, cuyo pronóstico está determinado por la edad de presentación, duración de la crisis y etiología subyacente.

Estado epiléptico en niños: Actualización / Status epilepticus in children: Update

El estado epiléptico es la emergencia médica neurológica más frecuente en la infancia que requiere un diagnóstico y tratamiento inmediato y agresivo. La morbimortalidad está relacionada directamente a la duración del estado epiléptico aunque el pronóstico final depende sobre todo de la causa que lo originó. Se revisan conceptos, características clínicas y tratamiento del estado epiléptico convulsivo, estado epiléptico no convulsivo y del estado epiléptico refractario poniendo énfasis en la necesidad de contar con un monitoreo electroencefalográfico continuo para el manejo adecuado de esta emergencia médica.

Status epilepticus is the most common medical neurological emergency during the infancy that needs an immediately and aggressive diagnostic and treatment. The morbidity and mortality are depending of the duration of the status epilepticus although the final outcome is more related to etiology of the status epilepticus. This review addresses some of the current issues concerning definitions, clinical characteristics and the treatment of the convulsive status epilepticus, non convulsive status epilepticus and refractory status epilepticus. The importance of continuous electroencephalographic monitoring for the adequate management of this medical emergency is emphasized.

Status epilepticus: aetiology and outcome in children

Convulsing Status Epilepticus [CSE] is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus [SE] and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen [12%] patients expired while neurological complications secondary to brain injury developed in 10[8%] cases. Mean seizure duration was 4.92 +/- 9.18 hours in children with normal outcome, 5.93 +/- 5.76 hours in children who died, and 12.85 +/- 12.91 hours in children with abnormal neurological outcome at discharge [p > 0.05]. Correlation between age and duration of seizure was not significant [p > 0.05]. SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE

Childhood status epilepticus: a study on its etiology, management and early outcome

Status epliepticus is a true medical urgency with high mortality. This study was surveyed etiology, management and early outcome of children with status epilepticus. Patients with status epilpeticus who admitted to emergency ward of Tabriz Children's Hospital between 1381 and 1384 were reviewed cross-sectional and analytical study on seizure type and etiology, its management and outcome at discharge from hospital. Among 123 patients with status epilepticus, 50 patients [40.7%] were afflicted with refractory status epilepticus and 73 patients [59.3%] had non - refractory status epilepticus. The most common etiologies in patients with status epilepticus in order of decreasing frequency were related to be prolonged febrile seizure [40.7%], remote symptomatic [28.4%], acute symptomatic [16.2%] and idiopathic [14.6%]. There was significant correlation between age and etiology [P=0.007]. The most common type of seizure was generalized seizure in 70.7% of patients. The median of duration of status epilepticus was 60 [37-146.25] minutes. In 28 patients [22.7%], diazepam with phenytoin or phenobarbital was used. In 40 patients [32.5%], diazepam with phenytoin and phenobarbital and in 50 patients [40.7%], midazolam were used. In 4 patients [3.25%], thiopental was used. Using midazolam, in 82% of patients with refractory status epilepticus lead to control of seizure. 85.9% of patients returned to their condition before status epilepticus. 8.26% of patients died, and in 5.7% of patients a new neurological sequel was established after status epilepticus. There was statistically significant correlation between patient's outcome and etiology of seizure [p=0.001]. The lowest rate of the mortality and morbidity was seen in prolonged febrile seizure [4%] and the most was in acute symptomatic [45%]. Prolonged febrile seizure was the most common etiology in status epilepticus. The highest mortality rate was seen in patients with acute symptomatic etiology. In most cases, intravenous midazolam infusion terminated the refractory status epilepticus

Emergencias y urgencias convulsivas en adultos: diagnóstico y terapéutica agudos basados en evidencia / Emergencies and convulsive urgencies in adults: acute diagnosis and therapeutic based on evidence

El propósito de esta búsqueda y anßlisis bibliogrßfico es revisar el manejo de las convulsiones y del status epiléptico como una situación de emergencia, basado en la evidencia médica disponible, con especial énfasis en sus tiempos y formas. Se han dise±ado tablas y algoritmos para identificar y considerar los principales aspectos del uso racional y eficaz de las medidas diagnósticas y terapéuticas

Status epiléptico convulsivo generalizado, o estado de mal epiléptico generalizado: diagnóstico y tratamiento / Generalized convulsive status epilepticus, or generalised status epilepticus: diagnosis and therapy

El status epiléptico convulsivo generalizado (SECG) constituye una emergencia médica que puede desencadenar injuria neuronal severa. Su mortalidad oscila entre 3 y 35 por ciento. Se presenta frecuentemente en los extremos etarios: jóvenes y adultos ancianos. Ocurre comúnmente en pacientes sin historia previa de epilepsia. Su morbilidad y mortalidad son más altas en edades mayores y en casos de isquemia cerebral aguda (anoxia o stroke). Su terapéutica de primera línea son el diazepam o lorazepan y fenitoina intravenosos. Más de la mitad de los pacientes responden a este tratamiento inicial. El SECG refractario requiere un médico con experiencia en epilepsia. Las opciones farmacológicas incluyen pentobarbital, fenobarbital o anestésicos inhalatorios.

Tratamento do estado de mal peiléptico / Treatment of status epilepticus

O estado de mal epiléptico (ENE) é uma emergência neurológica que necessita um tratamento efetico imediato para o controle da atividade epiléptica e da etiologia da mesma, no sentido de prevenirmos lesões neuronais e outros distúrbios sistêmicos associados...

Bacterial meningitis in children: critical care needs.

Acute bacterial meningitis (ABM) in children is associated with a high rate of acute complications and mortality, particularly in the developing countries. Most of the deaths occur during first 48 hours of hospitalization. Coma, raised intracranial pressure (ICP), seizures, shock have been identified as significant predictors of death and morbidity. This article reviews issues in critical care with reference to our experience of managing 88 children with ABM in PICU. Attention should first be directed toward basic ABCs of life-support. Children with Glasgow Coma Scale (GSC) score < 8 need intubation and supplemental oxygen. Antibiotics should be started, even without LP (contraindicated if focal neuro-deficit, papilledema, or signs of raised ICP). Raised ICP is present in most of patients; GCS < 8 and high blood pressure are good guides. Mannitol (0.25 gm/Kg) should be used in such patients. If there are signs of (impending) herniation short-term hyperventilation is recommended; prolonged hyperventilation (> 1 hour) must be avoided. Any evidence of poor perfusion, hypovolemia and/or hypotension needs aggressive treatment with normal saline boluses and inotropes, if necessary, to maintain normal blood pressure. Empiric fluid restriction is not justified. Seizures may be controlled with intravenous diazepam or lorazepam. Refractory status epilepticus may be treated with continuous diazepam (0.01-0.06) mg/kg/min) or midazolam infusion. Ventilatory support may be needed early for associated pneumonia, poor respiratory effort and/or coma, and occasionally to reduce work of breathing in shock. Provision of critical care to children with ABM may reduce the mortality significantly as experienced by us.

Esclerosis tuberosa: presentación de dos casos / Tuberous sclerosis: two cases

Se reportan dos casos de esclerosis tuberosa (un paciente masculino de 34 y otra de 17 años de edad) tratados en la Unidad De Cuidados Intensivos del Hospital General de Zona Núm. 1 de Tepic, Nayarit. Los dos presentaron convulsiones desde la infancia, manchas blancas y ocre en dorso y cara, retraso mental evolutivo, pequeñas nodulaciones de 2 a 3 mm en posición centrofacial y ortejos. Ambos fueron tratados previamente con diversos anticonvulsivantes con el diagnóstico único de epilepsia evolutiva. Ingresaron a la Unidad de Cuidados Intensivos por status epilepticus que ameritó tratamiento a base de coma barbitúrico