Status Epilepticus Adalah Pdf Download

Status Epilepticus Adalah Pdf Download

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Convulsive status epilepticus (CSE) is the most common life-threatening neurological emergency in childhood. These children are also at risk of significant morbidity, with acute and chronic impact on the family and the health and social care systems. The current recommended first-choice, second-line treatment in children aged 6 months and above is intravenous phenytoin (fosphenytoin in the USA), although there is a lack of evidence for its use and it is associated with significant side effects. Emerging evidence suggests that intravenous levetiracetam may be effective as a second-line agent for CSE, and fewer adverse effects have been described. This trial therefore aims to determine whether intravenous phenytoin or levetiracetam is more effective, and safer, in treating childhood CSE.

Convulsive status epilepticus (CSE) is the most common life-threatening neurological emergency in children, with an incidence of 20 per 100,000 children per year [1, 2]. It is the second most common reason for unplanned admission to paediatric intensive care units (PICUs) in the UK, accounting for 5.6% of all PICU admissions [3]. These children are also at increased risk of irreversible morbidity including chronic drug-resistant epilepsy, neurodisability, and learning difficulties, which result in major long-term demands on acute and chronic health and social care resources [4].

Children are excluded if they: 1) present with absence, myoclonic, or non-convulsive status epilepticus, or infantile spasms; 2) are known or suspected to be pregnant; 3) have a known contraindication or allergy to levetiracetam or phenytoin; 4) have known established renal failure; 5) have been given a second-line antiepileptic drug during this episode of CSE prior to eligibility assessment; or 6) are known to have previously been treated in the EcLiPSE study.

We present a case of 15 year old girl with a coma following convulsive status epilepticus which developed after inferior alveolar nerve blockade by a dentist. The patient was admitted to the intensive care unit ICU and recovered within several days.

Several case reports have described such anesthetic toxicity in infants, experimental animals, and even in human adults after local anesthesia of brachial plexus, unintended intracarotid lidocaine injection during carotid endarterectomy surgery as well as after either epidural or caudal anesthetic injection. However, this is the first reported case of a status epilepticus developing after a dental procedure in a previously healthy patient.

No follow up MRI was requested. However, a follow up brain CT scan was performed a week later and was completely normal. Consequently, MRI changes were probably transient changes due to the status epilepticus rather than stroke. Lidocaine induced vasoconstriction following distribution through systemic circulation was another possible mechanism of bilaterally restricted diffusion.

We report the case of a 40-year-old woman referred to our Epilepsy Unit for a history of seizures started at the age of 14, consisting of typical absences with or without eyelid flutter and tonic-clonic seizures. Her family history was positive for migraine without aura. Neurologic examination and neuroimaging study were normal. Several interictal EEG recordings, performed over time, documented the presence of generalized polyspike-and-wave complexes, triggered by active eye closure, often associated with eyelid myoclonia and photosensitivity. A diagnosis of eyelid myoclonia with absences (EMA) was made on the basis of electroclinical and neuroimaging findings. The patient was started on antiepileptic drugs, which led to seizure-freedom for about ten years. In addition, she had always presented sporadic, prolonged tensive headache attacks, rarely accompanied by migrainous features (nausea and visual manifestations). Recently, on waking, the patient complained the sudden onset of a sustained tensive headache, unresponsive to conventional treatment. Because of the persistence of symptoms, after about three hours she came to our attention, and we performed a video-EEG recording, which showed the presence of a subcontinuous epileptic activity consisting of generalized spike-and-wave discharges (GSWDs), clinically correlated with a tensive headache with bilateral and symmetrical eyelid flutter, facilitated by eye closure (Fig. 1). The electroclinical pattern lasted for hours, configuring a non-convulsive status epilepticus (NCSE). During video-EEG monitoring, Diazepam was administered with a gradual improvement of both clinical symptoms and EEG abnormalities. The patient reported complete resolution of the headache attack after about 24 h. Video-EEG recordings performed on the following days were normal (Fig. 2).

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more and more atypical presentations of COVID-19 are being reported. Here, we present and discuss non-convulsive status epilepticus (NCSE) as presenting symptom of SARS-CoV-2 infection at the Emergency Department.

New-onset refractory status epilepticus (NORSE) is a newly defined critical disease entity characterized by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Its etiology is uncertain, but autoimmune encephalitis is a possible candidate for the underlying cause of this condition. Immunotherapies could be considered for this condition, but its efficacy is not established.

A 31-year-old man with no prior history presented with refractory status epilepticus. His seizure persisted even with multiple anti-epileptic drugs and required prolonged general anesthesia under mechanical ventilation. Magnetic resonance imaging and cerebrospinal fluid did not indicate the cause of seizure, and autoantibodies related to encephalitis were not detected. It was speculated that the patient had occult autoimmune encephalopathy because of its acute-onset clinical course preceded by fever, even without definite evidence of an autoimmune mechanism. The patient received intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulin in succession and manifested a favorable outcome after these treatments.

Status epilepticus (SE) is an important neurological condition for emergency physicians and intensivists because it could damage brain function irreversibly unless treated promptly and effectively. Generally, anti-epileptic drugs (AEDs) are used for this condition at first, but it sometimes show resistance to AEDs and requires long-term intensive care, in several weeks to months, including general anesthesia and mechanical ventilation until seizure activities subside. New-onset refractory status epilepticus (NORSE) is characterized by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals [1]. NORSE is a rare but critical neurological condition because it shows considerable high mortality and morbidity. Recently, some case series have suggested the majority of its etiology is autoimmune encephalitis and immunotherapies could be a choice even without evidence of autoantibodies. However, the efficacy of immunotherapies for NORSE is still controversial.

Our patient showed new-onset refractory epileptic seizure subsequent to a febrile episode, which was reluctant to resolve with combination of multiple AEDs and general sedative agents. The clinical course was compatible with NORSE considering prolonged status epilepticus without no prior history of epilepsy and absence of identifiable causative factors. Although NORSE was initially defined as not a proven etiology of epilepsy [1], some recent studies have suggested autoimmune encephalitis may be a common cause of this condition [2, 3]. Based on this estimation, immunotherapies are administered in an increasing number of NORSE cases even without detection of specific antibodies regarding autoimmune encephalitis [3].

The potential utility of IL-1 blockade for seizures has been noted in multiple preclinical studies [7, 8] but to our knowledge has not been reported in patients with idiopathic epilepsy. There is one recent report of a patient with febrile infection-related epilepsy syndrome (FIRES), a rare but devastating encephalopathy occurring after a febrile illness, that had improvement with anakinra while in super-refractory status epilepticus [20]. The patient reported here thus represents the second patient with epilepsy treated with IL-1 blockade (and first treated non-emergently without status epilepticus), suggesting that in selected cases, this treatment might be a profoundly impactful adjunctive medication for certain refractory epilepsy syndromes.

Status epilepticus is said to occur when a seizure lasts too long or when seizures occur close together and the person doesn't recover between seizures. Just like there are different types of seizures, there are also different types of status epilepticus.

Over the last several decades, the length of seizure that is considered as status epilepticus has shortened. Years ago, a seizure needed to last longer than 20 minutes to be considered status epilepticus. In the last few years, it is now defined as any seizure greater than 5 minutes. This makes sense because most seizures do not last longer than 2 minutes. The longer a seizure lasts, the less likely it will stop on its own without medication. Very long seizures (i.e., status epilepticus) are dangerous and even increase the chance of death. It is important that these long seizures are identified early, so they can be treated early.

Epilepsy.com Seizure Emergency Editor Matthew Hoerth MD speaks with Dr. Christopher Kramer, a neurointensive care specialist from the Mayo Clinic, about the importance of recognizing and treating status epilepticus. A paper published in the Neurocritical Care Journal from 2012 nicely outlined guidelines for treating this neurologic emergency. This paper detailed the subtypes of status epilepticus, emphasized the high mortality rates of this condition, and summarized the best medical evidence for treatment. 153554b96e

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