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2.
N Engl J Med ; 381(22): 2103-2113, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31774955

RESUMO

BACKGROUND: The choice of drugs for patients with status epilepticus that is refractory to treatment with benzodiazepines has not been thoroughly studied. METHODS: In a randomized, blinded, adaptive trial, we compared the efficacy and safety of three intravenous anticonvulsive agents - levetiracetam, fosphenytoin, and valproate - in children and adults with convulsive status epilepticus that was unresponsive to treatment with benzodiazepines. The primary outcome was absence of clinically evident seizures and improvement in the level of consciousness by 60 minutes after the start of drug infusion, without additional anticonvulsant medication. The posterior probabilities that each drug was the most or least effective were calculated. Safety outcomes included life-threatening hypotension or cardiac arrhythmia, endotracheal intubation, seizure recurrence, and death. RESULTS: A total of 384 patients were enrolled and randomly assigned to receive levetiracetam (145 patients), fosphenytoin (118), or valproate (121). Reenrollment of patients with a second episode of status epilepticus accounted for 16 additional instances of randomization. In accordance with a prespecified stopping rule for futility of finding one drug to be superior or inferior, a planned interim analysis led to the trial being stopped. Of the enrolled patients, 10% were determined to have had psychogenic seizures. The primary outcome of cessation of status epilepticus and improvement in the level of consciousness at 60 minutes occurred in 68 patients assigned to levetiracetam (47%; 95% credible interval, 39 to 55), 53 patients assigned to fosphenytoin (45%; 95% credible interval, 36 to 54), and 56 patients assigned to valproate (46%; 95% credible interval, 38 to 55). The posterior probability that each drug was the most effective was 0.41, 0.24, and 0.35, respectively. Numerically more episodes of hypotension and intubation occurred in the fosphenytoin group and more deaths occurred in the levetiracetam group than in the other groups, but these differences were not significant. CONCLUSIONS: In the context of benzodiazepine-refractory convulsive status epilepticus, the anticonvulsant drugs levetiracetam, fosphenytoin, and valproate each led to seizure cessation and improved alertness by 60 minutes in approximately half the patients, and the three drugs were associated with similar incidences of adverse events. (Funded by the National Institute of Neurological Disorders and Stroke; ESETT ClinicalTrials.gov number, NCT01960075.).


Assuntos
Anticonvulsivantes/uso terapêutico , Levetiracetam/uso terapêutico , Fenitoína/análogos & derivados , Estado Epiléptico/tratamento farmacológico , Ácido Valproico/uso terapêutico , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Benzodiazepinas/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Resistência a Medicamentos , Feminino , Humanos , Hipotensão/induzido quimicamente , Infusões Intravenosas , Injeções Intramusculares , Levetiracetam/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fenitoína/efeitos adversos , Fenitoína/uso terapêutico , Ácido Valproico/efeitos adversos , Adulto Jovem
3.
Medicina (B Aires) ; 79 Suppl 3: 48-53, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603844

RESUMO

Antiepileptic drugs are the first treatment option in patients with epilepsy. Drugs developed after 2000 are known as third generation antiepileptic drugs. These medications offer new mechanisms of action and favorable pharmacokinetics, decreasing the occurrence of side effects and drug-drug interactions. Broad spectrum antiepileptic drugs, such as brivaracetam and clobazam are good choices for generalized tonic colonic seizures and are well tolerated.New sodium channel blockers such as lacosamide and eslicarbazepine, have a more "benign" side effect profile than the first or second generation of sodium channel blockers. These new drugs are useful therapies in patients with epilepsy of difficult control. Cannabidiol and fenfluramine are useful in the treatment of Dravet or Lennox Gastaut syndrome. Allopregnenolona and ganaxolone showed good efficacy in status epilepticus and could play an important future role in this clinical scenario.


Assuntos
Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Anticonvulsivantes/classificação , Interações de Medicamentos , Humanos , Estado Epiléptico/tratamento farmacológico
4.
Med. infant ; 26(3): 267-271, sept. 2019. Tab
Artigo em Espanhol | LILACS | ID: biblio-1023724

RESUMO

Introducción: El estado epiléptico (EE) es la emergencia neurológica más frecuente en pediatría. Los pacientes que no responden al tratamiento estándar con dosis adecuadas de benzodiacepinas seguido de una droga antiepiléptica aceptable son definidos como Estado epiléptico Refractario (ER). Objetivo: caracterizar la población de niños con EE que ingresan a UCIP y determinar qué factores son predictores de refractariedad en esta población. Métodos: Estudio de casos y controles, retrospectivo. Población: niños con EE internados en UCIP desde Febrero 2015 a Febrero 2017. Casos: Estado epiléptico Refractario (ER). Controles: Estado epiléptico No Refractario (ENR). Se calculó el Odds Ratio (OR) individual para las distintas variables en Med Calc. Resultados: Se internaron 35 pacientes de los cuales 12 fueron casos y 23 controles. Hubo fiebre en 77% de los pacientes. En el total de niños estudiados hubo 11% con antecedente de convulsión febril, 11% con antecedente de epilepsia y 9% con antecedente de malformación del SNC. Los niños con antecedente de convulsión febril tuvieron 2,5 veces mayor riesgo de ER (OR: 2,58; IC 95%: 1,17-5,68). Los niños con EE que tenían antecedentes de enfermedad neurológica previa presentaron riesgo de ER 2,6 veces mayor que el grupo control (OR 2,60; IC 95%: 1,24-5,42). Discusión: Dado el aumento en la mortalidad de los pacientes con ER sería importante disponer de más herramientas para predecir este desenlace e iniciar tratamiento oportuno. Resultaría útil entrenar a los padres de niños con antecedente de convulsión febril en la aplicación de medicación antiepiléptica prehospitalaria, esto podría prevenir la farmacorresistencia, el daño neurológico y las complicaciones que acarrea el ingreso a UCIP. (AU)


Introduction: Status epilepticus (SE) is the most common neurologic emergency in children. Patients that do not respond to standard treatment with adequate doses of benzodiazepines followed by an acceptable antiepileptic drug are defined as having refractory status epilepticus (RSE). Objective: To characterize the population of children with SE admitted to the PICU and to determine predictive factors for refractoriness in this population. Methods: A retrospective case-control study was conducted. Population: Children with SE admitted to the PICU between February 2015 and February 2017. Cases: Refractory status pilepticus (RSE). Controls: Non-refractory status epilepticus (NRSE). Individual Odds Ratio (OR) was calculated for different variables using Med Calc. Results: 35 patients were admitted of whom 12 were cases and 23 controls. Overall, 77% of the patients had fever. Of all the children, 11% had a history of febrile seizures, 11% had history of epilepsy and 9% had a CNS malformation. Children with a history of febrile seizures had a 2.5-fold higher risk of developing RSE (OR: 2.58; 95% CI: 1.17-5.68). Children with SE that had a history of neurologic disease had a 2.6-fold higher risk of developing RSE than controls (OR 2.60; 95% CI: 1.24-5.42). Discussion: Given the increased mortality in children with RSE, availability of tools to predict this outcome in order to initiate early treatment is important. It would be useful to train the parents of children with a history of febrile seizures in the prehospital administration of antiepileptic drugs as this may prevent pharmaco-resistance, neurologic damage, and complication related to PICU admission (AU)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Estado Epiléptico/complicações , Estado Epiléptico/etiologia , Estado Epiléptico/tratamento farmacológico , Resistência a Medicamentos , Unidades de Terapia Intensiva Pediátrica , Convulsões Febris/tratamento farmacológico , Epilepsia Resistente a Medicamentos/terapia , Anticonvulsivantes/uso terapêutico , Estudos de Casos e Controles , Estudos Retrospectivos
6.
World Neurosurg ; 131: 58-61, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376555

RESUMO

BACKGROUND: Postoperative blindness is a devastating surgical complication. Although usually associated with prolonged cardiac and prone spinal operations, it may follow other procedures as well. Postoperative blindness is most commonly caused by a vascular etiology, but it can more rarely be caused by status epilepticus. We have previously reported a case of this phenomenon following a staged spinal deformity surgery. CASE DESCRIPTION: Here we report 2 additional cases following a skull base procedure and a single stage lumbar spine surgery. In all instances, rapid recognition that the patients' blindness was due to occipital seizures resulted in acute antiepileptiform treatment and full restoration of vision. CONCLUSIONS: Although a rare phenomenon, this syndrome, first recognized and described by Tarik F. Ibrahim, should be considered in any patient with postoperative visual impairment.


Assuntos
Anticonvulsivantes/uso terapêutico , Cegueira/etiologia , Neoplasias Encefálicas/cirurgia , Epilepsias Parciais/tratamento farmacológico , Vértebras Lombares/cirurgia , Lobo Occipital , Complicações Pós-Operatórias/tratamento farmacológico , Estenose Espinal/cirurgia , Estado Epiléptico/tratamento farmacológico , Idoso , Neoplasias Encefálicas/secundário , Eletroencefalografia , Epilepsias Parciais/complicações , Feminino , Humanos , Levetiracetam , Base do Crânio , Estado Epiléptico/complicações
7.
J Stroke Cerebrovasc Dis ; 28(11): 104309, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31402085

RESUMO

A 24-year-old woman was admitted to our hospital after convulsive status epilepticus. A cerebral magnetic resonance venography revealed a persistent fetal falcine sinus. Additionally, the posterior third of the superior sagittal sinus was hypoplastic and the abnormal deep venous drainage was accompanied. These abnormalities had already been detected by magnetic resonance imaging several years ago. In the present scan, we discovered a sinus thrombosis in the hypoplastic superior sagittal sinus. In the cerebral angiography, we observed delayed venous return in the left parieto-occipital lobe and hypothesized that cerebral venous stasis due to the thrombus caused the convulsive status epilepticus. The patient was treated with intravenous administration of heparin along with an antiepileptic drug, and she recovered with no neurological defects. In the present case, the falcine sinus and the anomalous venous return were likely congenital while the status epilepticus was derived from thrombosis in the hypoplastic superior sagittal sinus. Although the falcine sinus functioned as an alternative pathway for the superior sagittal sinus, the hypoplastic superior sagittal sinus itself may also play an important role as a venous drainage channel.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Cavidades Cranianas/anormalidades , Trombose do Seio Sagital/etiologia , Estado Epiléptico/etiologia , Anticoagulantes/uso terapêutico , Anticonvulsivantes/uso terapêutico , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Circulação Cerebrovascular , Cavidades Cranianas/diagnóstico por imagem , Feminino , Humanos , Trombose do Seio Sagital/diagnóstico por imagem , Trombose do Seio Sagital/tratamento farmacológico , Trombose do Seio Sagital/fisiopatologia , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/fisiopatologia , Resultado do Tratamento , Adulto Jovem
8.
Neurosci Lett ; 708: 134363, 2019 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-31276728

RESUMO

We previously reported that treatment with levetiracetam (LEV) after status epilepticus (SE) termination by diazepam (DZP) prevents the development of spontaneous recurrent seizures. LEV suppresses increased expression levels of proinflammatory mediators during epileptogenesis after SE, but how LEV acts in neuroinflammatory processes is not yet known. In this study, we examined the effects of LEV on neuroinflammation and phagocytic microglia in vivo and in vitro and compared the effects of LEV with those of representative antiepileptic drugs valproate (VPA) and carbamazepine (CBZ). Repeated treatment with LEV for 30 days after the termination of pilocarpine-induced SE by DZP almost completely prevented the incidence of spontaneous recurrent seizures, while administration of VPA or CBZ showed no effect on the seizures. LEV clearly suppressed phagocytosis of mononuclear phagocytes, and cytokine expression was observed 2 days after SE. VPA attenuated neuroinflammation only, and CBZ showed no effect on changes after SE. Treatment with LEV significantly suppressed BV-2 microglial activation, which was defined by morphological changes, phagocytic activity and cytokine expression. By contrast, VPA and CBZ did not affect BV-2 microglial activity. In summary, LEV directly suppresses excess microglial phagocytosis during epileptogenesis, which might prevent the occurrence of spontaneous recurrent seizures after SE.


Assuntos
Anticonvulsivantes/farmacologia , Carbamazepina/farmacologia , Levetiracetam/farmacologia , Microglia/efeitos dos fármacos , Fagócitos/efeitos dos fármacos , Estado Epiléptico/tratamento farmacológico , Ácido Valproico/farmacologia , Animais , Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Células Cultivadas , Citocinas/metabolismo , Inflamação/tratamento farmacológico , Inflamação/patologia , Levetiracetam/uso terapêutico , Masculino , Camundongos Endogâmicos ICR , Microglia/patologia , Fagócitos/patologia , Estado Epiléptico/patologia , Estado Epiléptico/fisiopatologia , Ácido Valproico/uso terapêutico
9.
Expert Opin Pharmacother ; 20(14): 1755-1765, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31264486

RESUMO

Introduction: Antiseizure drugs (ASDs) play a central and crucial role in the treatment of epilepsy patients, as the majority require anticonvulsant treatment for an extended period of time. Since up to 30% of patients are refractory to medical treatment, new therapeutic options are necessary. Perampanel (PER) and brivaracetam (BRV) are the latest approved ASDs that may be considered in a variety of epilepsy syndromes. PER has a distinct and selective mode of action on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors and is licensed for use in focal and generalized epilepsies. BRV is a derivative of levetiracetam but exhibits a 20-fold higher affinity and a faster brain entry time as a synaptic vesicle glycoprotein 2A (SV2A) ligand. Areas covered: This article reviews the advances in the epileptic treatment and provides a comparison of PER and BRV. Both drugs have shown comparable results in randomized controlled trials, and both are well tolerated. Expert opinion: PER and BRV have the potential to perform as important, broad-spectrum ASDs with significant market shares. BRV's intravenous formulation and fast penetration into the brain and PER's unique mode of action will result in the more frequent use of both drugs in status epilepticus.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Piridonas/uso terapêutico , Pirrolidinonas/uso terapêutico , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/farmacocinética , Ensaios Clínicos como Assunto , Epilepsia/patologia , Meia-Vida , Humanos , Piridonas/efeitos adversos , Piridonas/farmacocinética , Pirrolidinonas/efeitos adversos , Pirrolidinonas/farmacocinética , Receptores de AMPA/química , Receptores de AMPA/metabolismo , Estado Epiléptico/tratamento farmacológico , Resultado do Tratamento
10.
Fortschr Neurol Psychiatr ; 87(6): 357-363, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31261415

RESUMO

Since 2004 several reports on the treatment of status epilepticus with levetiracetam have been published. In this review, the results of a PubMed-based search of publications December 12, 2011 - July 6, 2018 are summarized and compared to those of earlier publications. In total, 28 treatment episodes in case reports, each on one or two cases of treatment episodes, and 412 treatment episodes in case series and prospective studies were analyzed. Case series and prospective studies reported an average success rate for termination of status probably of 55,0 %-59,4 %. Since preclinical data suggest a delayed effect of levetiracetam, its use in the treatment of generalized convulsive status epilepticus appears still questionable. A loading dose of 30 mg / kg seems to be reasonable.


Assuntos
Levetiracetam/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Humanos , Estudos Prospectivos , Projetos de Pesquisa
11.
BMC Neurol ; 19(1): 166, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315588

RESUMO

BACKGROUND: Acquired epileptiform opercular syndrome (AEOS) with electrical status epilepticus during sleep (ESES) may be recurrent and intractable. The real-time transcranial Doppler ultrasound-sleep-deprived video electroencephalogram (TCD-SDvEEG) can be used to observe the relationships among hemodynamic, electrophysiological, and clinical factors in a patient during therapy. This study reported the case of a healthy 5-year-old boy with AEOS. CASE PRESENTATION: The patient had initial seizures during sleep at the age of 1 year, with the left mouth pouting, left eye blinking and drooling for several seconds, and, sometimes, the left upper-limb flexion and head version to the left, lasting for 1-2 min. The combined antiepileptic drug regimens, including valproate, lamotrigine, and clonazepam, failed in the present case. Therefore, the add-on high-dose methylprednisolone therapy was provided. Also, the serial TCD-SDvEEG was used to monitor the dynamic changes before and after add-on steroid treatment. The results showed less than 15% variation in the range of blood flow fluctuation with spikes during non-rapid eye movement sleep after treatment. This was similar to the outcomes in healthy children and also accorded with the clinical improvements such as seizure control, drooling control, and language ability melioration. However, 95% of spike-wave index (SWI) was still maintained. The improvements in cerebral hemodynamics and clinical manifestations were faster and earlier than the SWI progression. CONCLUSIONS: The real-time TCD-SDvEEG was highly sensitive in detecting therapeutic changes. The findings might facilitate the understanding of the mechanisms underlying neurovascular coupling in patients with AEOS accompanied by ESES.


Assuntos
Eletroencefalografia/métodos , Transtornos do Sono-Vigília/diagnóstico , Estado Epiléptico/diagnóstico , Anticonvulsivantes/uso terapêutico , Pré-Escolar , Humanos , Masculino , Metilprednisolona/uso terapêutico , Convulsões/tratamento farmacológico , Sono/fisiologia , Transtornos do Sono-Vigília/fisiopatologia , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/fisiopatologia , Síndrome , Falha de Tratamento , Ultrassonografia Doppler Transcraniana , Ácido Valproico/uso terapêutico
12.
Cells ; 8(7)2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31331032

RESUMO

Under physiological conditions, microglia are unique immune cells resident in the brain that is isolated from the systemic immune system by brain-blood barrier. Following status epilepticus (SE, a prolonged seizure activity), microglia are rapidly activated and blood-derived monocytes that infiltrate the brain; therefore, the regulations of microglia activation and monocyte infiltration are one of the primary therapeutic strategies for inhibition of undesirable consequences from SE. Roscovitine, a potent (but not selective) cyclin-dependent kinase 5 (CDK5) inhibitor, has been found to exert anti-inflammatory and microglia-inhibiting actions in several in vivo models, although the underlying mechanisms have not been clarified. In the present study, roscovitine attenuated SE-induces monocyte infiltration without vasogenic edema formation in the frontoparietal cortex (FPC), accompanied by reducing expressions of monocyte chemotactic protein-1 (MCP-1) and lysosome-associated membrane protein 1 (LAMP1) in resident microglia, while it did not affect microglia transformation to amoeboid form. Furthermore, roscovitine ameliorated the up-regulation of p38 mitogen-activated protein kinase (p38 MAPK) phosphorylation, but not nuclear factor-κB-S276 phosphorylation. Similar to roscovitine, SB202190, a p38 MAPK inhibitor, mitigated monocyte infiltration and microglial expressions of MCP-1 and LAMP1 in the FPC following SE. Therefore, these findings suggest for the first time that roscovitine may inhibit SE-induced neuroinflammation via regulating p38 MAPK-mediated microglial responses.


Assuntos
Microglia/efeitos dos fármacos , Monócitos/efeitos dos fármacos , Roscovitina , Estado Epiléptico/tratamento farmacológico , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Animais , Barreira Hematoencefálica , Quimiocina CCL2/metabolismo , Lobo Frontal/efeitos dos fármacos , Glicoproteínas de Membrana Associadas ao Lisossomo/metabolismo , Masculino , Microglia/metabolismo , Monócitos/citologia , Monócitos/metabolismo , Ratos , Ratos Sprague-Dawley , Roscovitina/farmacocinética , Roscovitina/farmacologia , Roscovitina/uso terapêutico
13.
Brain Nerve ; 71(8): 901-910, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31346147

RESUMO

We evaluated the efficacy and safety of lorazepam (LZP) 4 mg for adults (age, 16 years old or older) or 0.05mg/kg for children (age, 3 months to less than 16 years) as a slow intravenous injection in 26 Japanese patients with status epilepticus or repetitive seizures. The proportion of patients whose initial seizure stopped within 10 minutes and who continued seizure-free for at least 30 minutes after the completion of initial dose as the primary endpoint was 48.0% (12/25, 95%CI: 27.8%-68.7%). However, the proportion of patients whose seizures stopped within 10 minutes and who continued seizure-free for at least 30 minutes after the completion of either initial or second dose (in 10 to 30 minutes from the initial dose) was 64.0% (16/25, 95%CI: 42.5%-82.0%) in total, and 77.8% and 56.3% in adults and children, respectively. The most common adverse events (AEs) were somnolence (7.7%) and insomnia (7.7%), and almost all AEs were mild or moderate in severity. No patient experienced serious or severe LZP-related AEs. No one discontinued the study due to AEs.


Assuntos
Anticonvulsivantes/uso terapêutico , Lorazepam/uso terapêutico , Convulsões/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Criança , Pré-Escolar , Humanos , Injeções Intravenosas , Lorazepam/efeitos adversos
14.
J Clin Neurosci ; 67: 265-270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239199

RESUMO

Acute hemorrhagic leukoencephalitis (AHL) is a rare and mostly fatal fulminant demyelinating disease. This case describes a 63-year old male in status epilepticus associated with an intracerebral hemorrhage following a one week viral prodrome with rapid decline to coma. He exhibited peripheral leukocytosis, neutrophilic pleocytosis with normal glucose and high protein in cerebrospinal fluid (CSF). Additionally, CSF was positive for herpes simplex virus (HSV) polymerase chain reaction (PCR). Medical decompression, low-dose dexamethasone, antibiotics and acyclovir were initially given. Magnetic resonance imaging (MRI) was suggestive of AHL, thus he was treated with methylprednisolone 1 g/day for 5 days. The patient improved and was discharged with significant neurologic morbidity. This is the first reported case of AHL in the Philippines presenting as a diagnostic dilemma with a protracted clinical course who responded to high dose intravenous steroids.


Assuntos
Encefalite por Herpes Simples/diagnóstico , Leucoencefalite Hemorrágica Aguda/diagnóstico , Estado Epiléptico/diagnóstico , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Diagnóstico Diferencial , Encefalite por Herpes Simples/complicações , Humanos , Leucoencefalite Hemorrágica Aguda/etiologia , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Fármacos Neuroprotetores/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia
15.
J Vet Intern Med ; 33(4): 1714-1718, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31218767

RESUMO

BACKGROUND: Treatment options for at-home management of cluster seizures (CS) and status epilepticus (SE) are limited. The pharmacokinetics of levetiracetam (LEV) after rectal administration in both healthy and epileptic dogs has been investigated recently. HYPOTHESIS/OBJECTIVES: To investigate the clinical efficacy of rectally administered LEV in preventing additional seizures in dogs presented for CS and SE. We hypothesized that rectal administration of LEV in addition to a standard treatment protocol would provide better control of seizure activity as compared with the standard treatment protocol alone. ANIMALS: Fifty-seven client-owned dogs with CS or SE. METHODS: Prospective open-label clinical trial. Patients included in the study were assigned to receive either a standard treatment protocol comprising IV/rectal diazepam and IV phenobarbital q8h (control group) or a standard treatment protocol in association with a single dose of 40 mg/kg LEV rectally (rectal LEV group). Dogs that experienced no additional seizures were defined as responders, whereas those that showed additional seizure activity were classified as nonresponders. RESULTS: Twenty-one dogs were assigned to the rectal LEV group, and 36 to control group. Given the small number of cases of SE, statistical analysis was performed only on patients with CS. The response rate was 94% in the rectal LEV group and 48% in the control group (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Rectally administered LEV combined with a standard treatment protocol provided good control of seizure activity in patients with CS. The validity of these results should be confirmed in a double-blinded, placebo-controlled clinical trial.


Assuntos
Anticonvulsivantes/uso terapêutico , Doenças do Cão/tratamento farmacológico , Levetiracetam/uso terapêutico , Convulsões/veterinária , Estado Epiléptico/veterinária , Administração Intravenosa/veterinária , Administração Retal , Animais , Anticonvulsivantes/administração & dosagem , Diazepam/administração & dosagem , Diazepam/uso terapêutico , Cães , Levetiracetam/administração & dosagem , Masculino , Fenobarbital/administração & dosagem , Fenobarbital/uso terapêutico , Convulsões/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico
16.
Neurodiagn J ; 59(2): 104-111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210608

RESUMO

Aphasia is commonly seen in focal brain lesions. Prolonged aphasia from an ictal state is rarely reported. We report the case of a 62-year-old man with focal motor status epilepticus manifested initially as episodic right cheiro-oral clonic movements with preserved awareness and expressive aphasia for 48 hours. EEG showed left frontal and central lateralized periodic discharges (LPDs) without plus features (rhythmicity, overlying fast) and electrographic seizures that correlated with right clonic movements. Treatment with two seizure medications (levetiracetam and lacosamide) resulted in complete electrographic and clinical resolution of his symptoms, including aphasia. In this case, aphasia was determined to be an ictal semiology, as patient had complete resolution of his symptoms supported by a normal EEG after receiving seizure medications. We suggest keeping high suspicion for an ictal process in patients with sudden-onset aphasia supported by EEG findings of LPDs.


Assuntos
Afasia/etiologia , Estado Epiléptico/complicações , Anticonvulsivantes/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estado Epiléptico/tratamento farmacológico
17.
J Clin Neurosci ; 67: 163-166, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31201049

RESUMO

Metabolic encephalopathy and Non-Convulsive Status Epilepticus (NCSE) have been reported with cephalosporin use, particularly cefepime. We aimed to analyze the clinical and EEG findings in patients with cephalosporin-related neurotoxicity (CRN) at our hospital identified via the hospital EEG database, and to critically review CRN case reports in the literature. A Medline search was performed to identify CRN cases where a representative sample of EEG was provided. EEGs were analyzed using published criteria differentiating NCSE from triphasic waves (TW). Eleven patients at our hospital were identified with CRN (9 cefepime, 2 ceftriaxone): all had an encephalopathy with decreased consciousness and/or confusion. One patient had clinical seizures and 6 had multifocal myoclonus. All patients had abnormal EEGs, all with moderate to severe generalized slowing and 10 also with TW. Recovery was related to cephalosporin withdrawal rather than antiepileptic therapy. Analysis of 37 EEG samples of CRN patients reported in the literature as NCSE (30) or TW (7) revealed that most did not meet criteria for NCSE, with 33 showing TW, 1 showing generalised epileptiform discharges and 3 being uninterpretable. CRN usually produces a toxic encephalopathy rather than NCSE, and is commonly associated with triphasic waves on EEG. In most patients anti-epileptic and/or sedative drugs do not hasten clinical improvement.


Assuntos
Encefalopatias Metabólicas/induzido quimicamente , Cefalosporinas/efeitos adversos , Estado Epiléptico/induzido quimicamente , Anticonvulsivantes/uso terapêutico , Encefalopatias Metabólicas/complicações , Cefepima , Confusão , Transtornos da Consciência , Eletroencefalografia , Feminino , Humanos , Masculino , Mioclonia , Síndromes Neurotóxicas , Convulsões , Estado Epiléptico/tratamento farmacológico
18.
Epileptic Disord ; 21(S1): 76-81, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31172954

RESUMO

The major goal of therapy in patients with Encephalopathy related to Status Epilepticus during slow Sleep (ESES) is to prevent or reduce associated cognitive deficits. Whether or not the EEG pattern of ESES should be completely suppressed to improve cognition is unknown. In clinical practice, there are two major challenges: to establish the optimal treatment strategy in patients with ESES, and to identify the patients who will benefit most from therapy, including atypical cases. Here, we provide a comprehensive overview of the current literature on treatment efficacy in patients with ESES.


Assuntos
Encefalopatias/tratamento farmacológico , Transtornos Cognitivos/fisiopatologia , Sono/fisiologia , Estado Epiléptico/tratamento farmacológico , Encefalopatias/fisiopatologia , Criança , Eletroencefalografia/métodos , Humanos , Estado Epiléptico/fisiopatologia , Resultado do Tratamento
20.
Neurology ; 92(20): e2339-e2348, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31068480

RESUMO

OBJECTIVE: Compare the cost and effectiveness of nonbenzodiazepine antiepileptic drugs (non-BZD AEDs) for treatment of BZD-resistant convulsive status epilepticus (SE). METHODS: Decision analysis model populated with effectiveness data from a systematic review and meta-analysis of the literature, and cost data from publicly available prices. The primary outcome was cost per seizure stopped ($/SS). Sensitivity analyses evaluated the robustness of the results across a wide variation of the input parameters. RESULTS: We included 24 studies with 1,185 SE episodes. The most effective non-BZD AED was phenobarbital (PB) with a probability of SS of 0.8 (95% confidence interval [CI]: 0.69-0.88), followed by valproate (VPA) (0.71 [95% CI: 0.61-0.79]), lacosamide (0.66 [95% CI: 0.51-0.79]), levetiracetam (LEV) (0.62 [95% CI: 0.5-0.73]), and phenytoin/fosphenytoin (PHT) (0.53 [95% CI: 0.39-0.67]). In pairwise comparisons, PB was more effective than PHT (p = 0.002), VPA was more effective than PHT (p = 0.043), and PB was more effective than LEV (p = 0.018). The most cost-effective non-BZD AED was LEV (incremental cost-effectiveness ratio [ICER]: $18.55/SS), followed by VPA (ICER: $94.44/SS), and lastly PB (ICER: $847.22/SS). PHT and lacosamide were not cost-effective compared to the other options. Sensitivity analyses showed marked overlap in cost-effectiveness, but PHT was consistently less cost-effective than LEV, VPA, and PB. CONCLUSION: VPA and PB were more effective than PHT for SE. There is substantial overlap in the cost-effectiveness of non-BZD AEDs for SE, but available evidence does not support the preeminence of PHT, neither in terms of effectiveness nor in terms of cost-effectiveness.


Assuntos
Anticonvulsivantes/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Anticonvulsivantes/economia , Benzodiazepinas/uso terapêutico , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Humanos , Lacosamida/economia , Lacosamida/uso terapêutico , Levetiracetam/economia , Levetiracetam/uso terapêutico , Fenobarbital/economia , Fenobarbital/uso terapêutico , Fenitoína/análogos & derivados , Fenitoína/economia , Fenitoína/uso terapêutico , Falha de Tratamento , Ácido Valproico/economia , Ácido Valproico/uso terapêutico
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