Status epilepticus: Having treatment paradigms in place in Neurosurgical settings

Abstract

Status epilepticus (SE) is an emergency situation, which needs immediate and prompt treatment. Lack of early treatment often leads to permanent neuronal damage and poor long-term neurological outcome. Among the known neurosurgical causes of SE are central nervous system (CNS) tumors, subarachnoid and intracerebral hemorrhage (ICH), head trauma and post-operative states. Given the frequency of SE events in neurosurgical wards, it is essential that the neurosurgical teams and intensive care unit staff are adequately sensitized to the prompt detection and management of SE. Uniform, easily understandable and logical algorithms are needed as part of care pathways to enable satisfactory management. Such measures are imperative in improving long-term patient outcome.

Key words

Algorithm - antiepileptic - neurosurgical - refractory - status epilepticus

• References

• 1 Calmeil LF. De l’épilepsie, étudiée sous le rapport de son siège et de son influence sur la production de l’aliénationmentale. Thesis. University of Paris; 1824
• 2 Trousseau A. Lectures on Clinical Medicine Delivered at the Hotel Dieu, Paris. Vol. 1 (PV Bazire, Trans.) London: New Sydenham Society; 1868
• 3 DeLorenzo RJ. Clinical syndromes and epidemiology of status epilepticus. In: Luders HO, Noachtar S. editors Epileptic Seizures: Pathophysiology and Clinical Semiology. Philadelphia: Churchill Livingston; 2000. p 697-710
• 4 Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology 2000; 55: 693-697
• 5 Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology 1993; 43: 483-488
• 6 Scholtes FB, Renier WO, Meinardi H. Generalized convulsive status epilepticus: Causes, therapy, and outcome in 346 patients. Epilepsia 1994; 35: 1104-1112
• 7 Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1981; 22: 489-501
• 8 Lothman E. The biochemical basis and pathophysiology of status epilepticus. Neurology 1990; 40 (05) (Suppl. 02) 13-23
• 9 Walker MC. The epidemiology and management of status epilepticus. Curr Opin Neurol 1998; 11: 149-154
• 10 Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA 1993; 270: 854-859
• 11 Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia 1999; 40: 120-122
• 12 Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: Clinical forms and treatment. Lancet Neurol 2007; 6: 329-339
• 13 Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: Frequency, risk factors, and impact on outcome. Arch Neurol 2002; 59: 205-210
• 14 Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: A critical review of available therapies and a clinical treatment protocol. Brain 2011; 134: 2802-2818
• 15 White PT, Grant P, Mosier J, Craig A. Changes in cerebral dynamics associated with seizures. Neurology 1961; 11 Pt [phone]
• 16 Boggs JG, Painter JA, DeLorenzo RJ. Analysis of electrocardiographic changes in status epilepticus. Epilepsy Res 1993; 14: 87-94
• 17 Meldrum BS, Horton RW. Physiology of status epilepticus in primates. Arch Neurol 1973; 28: 1-9
• 18 Fountain NB, Adams RE. Midazolam treatment of acute and refractory status epilepticus. Clin Neuropharmacol 1999; 22: 261-267
• 19 Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y. et al Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366: 591-600
• 20 Agarwal P, Kumar N, Chandra R, Gupta G, Antony AR, Garg N. Randomized study of intravenous valproate and phenytoin in status epilepticus. Seizure 2007; 16: 527-532
• 21 Abou Khaled KJ, Hirsch LJ. Updates in the management of seizures and status epilepticus in critically ill patients. Neurol Clin 2008; 26: 385-408 viii
• 22 Tripathi M, Vibha D, Choudhary N, Prasad K, Srivastava MV, Bhatia R. et al Management of refractory status epilepticus at a tertiary care centre in a developing country. Seizure 2010; 19: 109-111
• 23 Kellinghaus C, Berning S, Immisch I, Larch J, Rosenow F, Rossetti AO. et al Intravenous lacosamide for treatment of status epilepticus. Acta Neurol Scand 2011; 123: 137-141
• 24 Singhal A, Tripathi M. Refractory status epilepticus. Neurol Asia 2013; 18: 67-71
• 25 Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: A simple name for a complex syndrome. Intensive Care Med 2003; 29: 1417-1425
• 26 Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol or midazolam: A systematic review. Epilepsia 2002; 43: 146-153
• 27 Chandra PS, Gulati S, Kalra V, Garg A, Mishra NK, Bal CS. et al Fourth ventricular hamartoma presenting with status epilepticus treated with emergency surgery in an infant. Pediatr Neurosurg 2011; 47: 217-222
• 28 Ma X, Liporace J, O’Connor MJ, Sperling MR. Neurosurgical treatment of medically intractable status epilepticus. Epilepsy Res 2001; 46: 33-38
• 29 Pandit AK, Ihtisham K, Garg A, Gulati S, Padma MV, Tripathi M. Autoimmune encephalitis: A potentially reversible cause of status epilepticus, epilepsy, and cognitive decline. Ann Indian Acad Neurol 2013; 16: 577-584
• 30 Husain AM, Horn GJ, Jacobson MP. Non-convulsive status epilepticus: Usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry 2003; 74: 189-191
• 31 Rai V, Jetli S, Rai N, Padma MV, Tripathi M. Continuous EEG predictors of outcome in patients with altered sensorium. Seizure 2013; 22: 656-661