Article

Treatment of acute seizures and status epilepticus.

Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Journal of Intensive Care Medicine 11/2007; 22(6):319-47. DOI: 10.1177/0885066607307506
Source: PubMed

ABSTRACT Overt status epilepticus and persistent obtundation after a witnessed clinical seizure are neurologic emergencies. Early recognition and intervention in the electroclinical syndrome of status epilepticus reduces morbidity, although treatment of the underlying etiology is also critical. This review outlines key concepts related to status epilepticus, delineates an approach to the early management of status epilepticus, and highlights novel but practical approaches in the evaluation and treatment of refractory status epilepticus, emphasizing the use of a treatment algorithm. This review is written from the perspective of the intensive care unit clinician, and the approach and opinions expressed stem from clinical experience and review of the current literature. Particular attention is given to an overall approach to the management of convulsive status epilepticus in adults and older children as well as exploring novel approaches and diagnostic tools that may prove useful in difficult-to-control status epilepticus.

0 Bookmarks
 · 
73 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose The significance of periodic EEG patterns in patients with impaired consciousness is controversial. We aimed to determine if treating these patterns influence clinical outcome. Methods We studied all patients who had periodic discharges on their EEG recordings from January 2007 to December 2009. Patients with clinical seizures within the preceding 24 hours, or with unequivocal electrographical seizure activity were excluded. Logistic regression was performed to analyze for factors associated with a) mortality b) functional status c) resolution of EEG pattern. Results Of the 4246 patients who had EEG, 111 (2.6%) had periodic EEG patterns. 64 met inclusion criteria. In adjusted analysis, higher mortality was associated with acute symptomatic etiology (OR 17.74, 95%CI 1.61 to 196.07, p = 0.019), and presence of clinical seizures (OR 4.73, 95%CI 1.10 to 20.34, p = 0.037). For each unit decrement of GCS, the odds of inpatient mortality and a poorer functional state on discharge increased by 23% (95%CI 7% to 37%, p = 0.009) and 33% (95%CI 9% to 51%, p = 0.011) respectively. Administration of abortive therapy was an independent risk factor for poorer functional status on discharge (adjusted OR 41.39, 95%CI 2.88 to 594.42, p = 0.006), while patients with history of pre-existing cerebral disease appeared more likely to return to baseline functional status on discharge (unadjusted OR 5.00, 95%CI 1.40 to 17.86, p = 0.013). Conclusion Treatment of periodic EEG patterns does not independently improve clinical outcome of patients with impaired conscious levels. Occurrence of seizures remote to the time of EEG and lower GCS scores independently predict poor prognoses.
    Seizure 09/2014; 23(8). DOI:10.1016/j.seizure.2014.04.015 · 2.06 Impact Factor
  • Indian Journal of Psychological Medicine 04/2014; 36(2):220-1. DOI:10.4103/0253-7176.131012
  • [Show abstract] [Hide abstract]
    ABSTRACT: An epileptic seizure is an abnormal harmonious neural activity in the brain characterized by the presence of spikes in the electroencephalographic patterns. Petit Mal is a common form of epilepsy (a neurological disorder resulting in recurrent seizures) in children. An automated detection of Petit Mal seizures assists the neurologists in effective diagnosis, thereby enabling proper on-time treatment of epileptic patients. The seizures were mainly detected previously using time-frequency analysis and artificial neural networks. The proposed approach utilizes the abnormality found in the EEG of a Petit Mal patient to create an efficient detection system involving five-level wavelet decomposition based features and adaptive neuro-fuzzy interference system as the classifier. Mean Teager Energy is the only feature used in the proposed method. Unlike previous approaches, the proposed work does not suffer from large noise and sensitivity, thus giving an accuracy of 100% and run-time delay of less than 30 seconds for 100 epochs. This is a tremendous improvement over other methods.
    Advances in Computing, Communications and Informatics (ICACCI), 2013 International Conference on; 01/2013