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4.
Ann Clin Transl Neurol ; 7(7): 1240-1244, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32407609

RESUMO

Neurological complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. We present a single-center retrospective case series reporting the EEG and outcome of de novo status epilepticus (SE) in two African-American women with laboratory-confirmed SARS-CoV-2 virus. SE was the initial presentation in one asymptomatic individual. Patient 2 had COVID-19 pneumonia, and fluctuating mental status that raised the suspicion of subclinical SE. The patient with older age and higher comorbidities failed to recover from the viral illness that has no definitive treatment.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Estado Epiléptico/etiologia , Afro-Americanos , Idoso , Anticonvulsivantes/uso terapêutico , Betacoronavirus , Eletroencefalografia , Feminino , Humanos , Levetiracetam/uso terapêutico , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico
5.
Brain ; 143(4): 1143-1157, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32268366

RESUMO

Intravenous third-line anaesthetic agents are typically titrated in refractory status epilepticus to achieve either seizure suppression or burst suppression on continuous EEG. However, the optimum treatment paradigm is unknown and little data exist to guide the withdrawal of anaesthetics in refractory status epilepticus. Premature withdrawal of anaesthetics risks the recurrence of seizures, whereas the prolonged use of anaesthetics increases the risk of treatment-associated adverse effects. This study sought to measure the accuracy of features of EEG activity during anaesthetic weaning in refractory status epilepticus as predictors of successful weaning from intravenous anaesthetics. We prespecified a successful anaesthetic wean as the discontinuation of intravenous anaesthesia without developing recurrent status epilepticus, and a wean failure as either recurrent status epilepticus or the resumption of anaesthesia for the purpose of treating an EEG pattern concerning for incipient status epilepticus. We evaluated two types of features as predictors of successful weaning: spectral components of the EEG signal, and spatial-correlation-based measures of functional connectivity. The results of these analyses were used to train a classifier to predict wean outcome. Forty-seven consecutive anaesthetic weans (23 successes, 24 failures) were identified from a single-centre cohort of patients admitted with refractory status epilepticus from 2016 to 2019. Spectral components of the EEG revealed no significant differences between successful and unsuccessful weans. Analysis of functional connectivity measures revealed that successful anaesthetic weans were characterized by the emergence of larger, more densely connected, and more highly clustered spatial functional networks, yielding 75.5% (95% confidence interval: 73.1-77.8%) testing accuracy in a bootstrap analysis using a hold-out sample of 20% of data for testing and 74.6% (95% confidence interval 73.2-75.9%) testing accuracy in a secondary external validation cohort, with an area under the curve of 83.3%. Distinct signatures in the spatial networks of functional connectivity emerge during successful anaesthetic liberation in status epilepticus; these findings are absent in patients with anaesthetic wean failure. Identifying features that emerge during successful anaesthetic weaning may allow faster and more successful anaesthetic liberation after refractory status epilepticus.


Assuntos
Anestésicos/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Eletroencefalografia , Modelos Neurológicos , Estado Epiléptico/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Epilepsia Resistente a Medicamentos/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Epiléptico/fisiopatologia , Adulto Jovem
9.
Zhonghua Er Ke Za Zhi ; 58(4): 295-300, 2020 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-32234136

RESUMO

Objective: To investigate the effectiveness of ketamine in the treatment of refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) in children. Methods: A retrospective study was conducted to collect and analyze the medical data of 18 children with RSE or SRSE who received ketamine in intensive care unit of Beijing Children's Hospital from January 2016 to December 2018. According to the different regimen of ketamine, all children were divided into the loading-maintenance group (7 cases) and the maintenance group (11 cases). According to the control of status epilepticus, the patients were divided into controlled group (11 cases) and non-responsive group (7 cases).Wilcoxon's rank sum test or Fisher's exact test were used to compare the effectiveness between groups. Results: There were 9 males and 9 females in the study group, aged 6.7 (4.5, 9.0) years. Seven cases had RSE and the remaining had SRSE. Four cases died during hospitalization. After the initiation of ketamine treatment, RSE and SRSE were controlled in 11 children. The duration of ketamine administration was 4 (2, 11) days. The dose was 2.2 (1.2, 5.3) mg/(kg·h) in all patients, and 2.4 (1.3, 6.0) mg/(kg·h), 2.0 (1.0, 4.0) mg/(kg · h) in the controlled and non-responsive group, respectively (Z=-0.272, P=0.791). The RSE or SRSE were terminated in all the 7 patients who received loading dose of ketamine, with the dose of 1.5 (0.3,1.6) mg/kg. In the 11 patients who only received maintenance treatment, 4 had the RSE and SRSE terminated, which showed a significantly lower effectiveness than in loading-maintenance group (7/7 vs. 4/11, P=0.01). Regarding the adverse reactions, saliva secretion increased in 8 children during the ketamine administration, otherwise unremarkable. Conclusion: Loading dose followed by maintenance of ketamine can control children's RSE and SRSE well, without significant adverse reactions.


Assuntos
Epilepsia Resistente a Medicamentos/tratamento farmacológico , Ketamina/administração & dosagem , Estado Epiléptico/tratamento farmacológico , Anticonvulsivantes , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos
10.
Surg Technol Int ; 36: 159-177, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32243562

RESUMO

Status epilepticus during the post-operative period is a rare complication for neurosurgery patients. Acute encephalopathic syndromes can present a diagnostic challenge due to the wide range of possible etiologies, and can also have vastly different outcomes. Posterior reversible encephalopathy syndrome is a rare neurological disorder, usually associated with specific medical conditions, that causes a disturbance of CNS homeostasis, while cortical laminar necrosis (CLN) is an unusual type of infarction characterized by selective necrosis of the cerebral cortex with sparing of the white matter. We present a 45-year-old woman who was operated on for left frontal lesion with radiological features compatible with anterior falx meningioma. Postoperative clinical and electroencephalographic data were compatible with non-convulsive status epilepticus originating from the occipito-mesial area. MRI showed bilateral diffuse temporo-occipital abnormally bright cortex as a consequence of neuronal apoptosis compatible with laminar cortical necrosis, and clinical examination revealed persistent cortical blindness. The pathogenesis of encephalopathic syndromes is still unclear. Non-convulsive status epilepticus should be considered as a possible cause of late recovery of consciousness in neurosurgery patients. Delayed treatment may cause irreversible lesions, including in brain areas far from the surgical field.


Assuntos
Neoplasias Meníngeas , Meningioma , Estado Epiléptico , Córtex Cerebral , Feminino , Humanos , Imagem por Ressonância Magnética , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Pessoa de Meia-Idade , Necrose/etiologia , Síndrome da Leucoencefalopatia Posterior , Complicações Pós-Operatórias
11.
Seizure ; 78: 109-112, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32344366

RESUMO

SARS-CoV-2, a novel zoonotic coronavirus, is currently spreading all over the world, causing a pandemic disease defined coronavirus disease 2019 (COVID-19). The spectrum of COVID-19 ranges from asymptomatic or mild infection to rapidly progressive, acute respiratory distress syndrome and death [1].To the best of our knowledge, status epilepticus has never been described as initial presentation of COVID-19. We report a patient affected by COVID-19 whose primary presentation was a focal status epilepticus.


Assuntos
Infecções por Coronavirus/diagnóstico , Epilepsias Parciais/diagnóstico , Pneumonia Viral/diagnóstico , Estado Epiléptico/diagnóstico , Idoso , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Humanos , Imagem por Ressonância Magnética , Pandemias
12.
Med Clin North Am ; 104(3): 525-538, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312413

RESUMO

Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.


Assuntos
Emergências/epidemiologia , Cuidados Paliativos na Terminalidade da Vida/normas , Planejamento de Assistência ao Paciente/normas , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Diagnóstico Diferencial , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Hipercalcemia/etiologia , Pessoa de Meia-Idade , Neoplasias/complicações , Cuidados Paliativos/normas , Cuidados Paliativos/estatística & dados numéricos , Planejamento de Assistência ao Paciente/tendências , Prognóstico , Fatores de Risco , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/terapia
17.
Medicine (Baltimore) ; 99(13): e19601, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32221081

RESUMO

The aim of this study was to study the predisposing factors and prognosis of status epilepticus (SE) in patients with autoimmune encephalitis (AE).A total of 227 cases of AE were collected from the inpatient department of West China Hospital of Sichuan University from January 2010 to May 2018. All patients met the 2015 criteria for the diagnosis of AE. The binary logistic regression model was used to multivariate and retrospective chart analysis the predisposition factors for SE and its prognostic factors.Of the 227 patients with AE, 50 (22.03%) had SE during hospitalization, and 19 patients with SE had a poor prognosis (modified Rankin score MRS = 3-6), and 7 patients with no SE had a poor prognosis. In the logistic regression model, electroencephalograms (EEGs) abnormalities (P = .000) and head magnetic resonance imaging (MRI) abnormalities (P = .003) were associated with a predisposition to SE, while Glasgow scores <8 (P = .027), abnormal EEG (P = .046), delayed immunotherapy (P = .012), and SE duration at admission lasting >30 minutes (P = .023) were risk factors for a poor prognosis of SE.SE is a common complication in patients with AE. EEG and MRI abnormalities may be predisposing factors for SE. Glasgow scores <8 points, abnormal EEG, delayed immunotherapy, and SE duration lasting >30 minutes at admission are risk factors for a poor prognosis in patients with SE.


Assuntos
Encefalite/epidemiologia , Doença de Hashimoto/epidemiologia , Estado Epiléptico/epidemiologia , Adolescente , Adulto , Idoso , China/epidemiologia , Eletroencefalografia , Encefalite/mortalidade , Feminino , Doença de Hashimoto/mortalidade , Humanos , Modelos Logísticos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Estado Epiléptico/mortalidade , Adulto Jovem
19.
Lancet ; 395(10231): 1217-1224, 2020 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-32203691

RESUMO

BACKGROUND: Benzodiazepine-refractory, or established, status epilepticus is thought to be of similar pathophysiology in children and adults, but differences in underlying aetiology and pharmacodynamics might differentially affect response to therapy. In the Established Status Epilepticus Treatment Trial (ESETT) we compared the efficacy and safety of levetiracetam, fosphenytoin, and valproate in established status epilepticus, and here we describe our results after extending enrolment in children to compare outcomes in three age groups. METHODS: In this multicentre, double-blind, response-adaptive, randomised controlled trial, we recruited patients from 58 hospital emergency departments across the USA. Patients were eligible for inclusion if they were aged 2 years or older, had been treated for a generalised convulsive seizure of longer than 5 min duration with adequate doses of benzodiazepines, and continued to have persistent or recurrent convulsions in the emergency department for at least 5 min and no more than 30 min after the last dose of benzodiazepine. Patients were randomly assigned in a response-adaptive manner, using Bayesian methods and stratified by age group (<18 years, 18-65 years, and >65 years), to levetiracetam, fosphenytoin, or valproate. All patients, investigators, study staff, and pharmacists were masked to treatment allocation. The primary outcome was absence of clinically apparent seizures with improved consciousness and without additional antiseizure medication at 1 h from start of drug infusion. The primary safety outcome was life-threatening hypotension or cardiac arrhythmia. The efficacy and safety outcomes were analysed by intention to treat. This study is registered in ClinicalTrials.gov, NCT01960075. FINDINGS: Between Nov 3, 2015, and Dec 29, 2018, we enrolled 478 patients and 462 unique patients were included: 225 children (aged <18 years), 186 adults (18-65 years), and 51 older adults (>65 years). 175 (38%) patients were randomly assigned to levetiracetam, 142 (31%) to fosphenyltoin, and 145 (31%) were to valproate. Baseline characteristics were balanced across treatments within age groups. The primary efficacy outcome was met in those treated with levetiracetam for 52% (95% credible interval 41-62) of children, 44% (33-55) of adults, and 37% (19-59) of older adults; with fosphenytoin in 49% (38-61) of children, 46% (34-59) of adults, and 35% (17-59) of older adults; and with valproate in 52% (41-63) of children, 46% (34-58) of adults, and 47% (25-70) of older adults. No differences were detected in efficacy or primary safety outcome by drug within each age group. With the exception of endotracheal intubation in children, secondary safety outcomes did not significantly differ by drug within each age group. INTERPRETATION: Children, adults, and older adults with established status epilepticus respond similarly to levetiracetam, fosphenytoin, and valproate, with treatment success in approximately half of patients. Any of the three drugs can be considered as a potential first-choice, second-line drug for benzodiazepine-refractory status epilepticus. FUNDING: National Institute of Neurological Disorders and Stroke, National Institutes of Health.


Assuntos
Anticonvulsivantes/administração & dosagem , Levetiracetam/administração & dosagem , Fenitoína/análogos & derivados , Estado Epiléptico/tratamento farmacológico , Ácido Valproico/administração & dosagem , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/efeitos adversos , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Lactente , Levetiracetam/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fenitoína/administração & dosagem , Fenitoína/efeitos adversos , Ácido Valproico/efeitos adversos , Adulto Jovem
20.
Lancet ; 395(10225): 735-748, 2020 02 29.
Artigo em Inglês | MEDLINE | ID: mdl-32113502

RESUMO

Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular risk factors might be an important strategy to reduce the probability of developing epilepsy.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/terapia , Procedimentos Neurocirúrgicos/métodos , Idoso , Doença de Alzheimer/complicações , Doenças Autoimunes do Sistema Nervoso/complicações , Neoplasias Encefálicas/complicações , Transtornos Cerebrovasculares/complicações , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto , Disfunção Cognitiva/epidemiologia , Comorbidade , Países Desenvolvidos , Países em Desenvolvimento , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Epilepsia/etiologia , Humanos , Incidência , Transtornos Mentais/epidemiologia , Prevalência , Estado Epiléptico/epidemiologia , Morte Súbita Inesperada na Epilepsia/epidemiologia
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