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David M Treiman - One of the best experts on this subject based on the ideXlab platform.
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treatment of experimental Status Epilepticus with the gaba uptake inhibitor tiagabine
Epilepsy Research, 1994Co-Authors: Nancy Y Walton, Sonny Gunawan, David M TreimanAbstract:The potential clinical efficacy of tiagabine for control of Status Epilepticus was evaluated in an experimental model. Tiagabine was administered to cobalt-lesioned rats in which Status Epilepticus was induced by injection of homocysteine thiolactone. Tiagabine was effective in controlling Status Epilepticus in this model; the median effective dose for control of generalized tonic-clonic seizures in the model was 8.3 mg/kg. Tiagabine administration produced an abnormal, hypo-reactive behavioral state which was accompanied by an EEG pattern of high-amplitude, frontally dominant, rhythmic, 3-5-Hz spike-wave activity. This EEG and behavioral syndrome could be reproduced by administration of tiagabine to normal, non-epileptic rats. The exact nature of this syndrome remains unclear, but whether it is an epileptic or encephalopathic phenomenon, further study is clearly required before this drug should be considered for use in the treatment of human Status Epilepticus.
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hippocampal pyramidal cell loss in human Status Epilepticus
Epilepsia, 1992Co-Authors: Christopher M Degiorgio, Uwamie Tomiyasu, Peggy S Gott, David M TreimanAbstract:Summary: A pilot case-control quantitative study of the hippocampus in patients with severe Status Epilepticus was performed to identify specific patterns of pyramidal cell loss. Pyramidal cell densities from five patients who died following Status Epilepticus were compared with five normal controls and five controls matched for age, hypoxialischemia, previous epilepsy, and alcohol abuse. Neuronal densities were greatest in the normal control group and least in patients with Status Epilepticus. Significant reductions were identified in Sommer's sector (prosubiculum and CA1) as well as in CA3 when compared to normal controls. RESUME Les auteurs ont realise une etude quantitative pilote avec cas controles de I'hippocampe chez des patients ayant presente un etat de ma1 epileptique severe, afin d'identifier des modalites specifiques de pertes en cellules pyramidales. Les densites en cellules pyramidales constatees constatees chez 5 patients qui sont decedes au decours d'un etat de ma1 epileptique ont ete cornparees a celles constatees chez 5 controles normaux et chez 5 controles apparies pour I'age, I'hypoxyischemie, I'epilepsie anterieure, el I'alcoolisme. Les densites neuronales etaient maximales dans le groupe des controles normaux, et minimales chez les patients decedes en etat de ma1 epileptique. Des reductions significatives ont ete identifiees au niveau du secteur de Sommer (Prosubiculum et CAI) et au niveau de CA3, par comparaison aux controles normaux. RESUMEN Se ha realizado un estudio cuantitativo piloto y controlado del hipocampo en pacientes con Status Epilepticus severo para identificar 10s patrones especificos de la perdida de celulas piramidales. La densidad de celulas piramidales de 5 pacientes que fallecieron tras un Status Epilepticus, ha sido comparada con 5 controles normales y 5 controles de la misma edad que habian tenido hipoxid/isquemia, epilepsia previa e ingestion de alcohol abusiva. Las densidades neuronales mas elevadas se encontraron en el grupo control normal y las menos elevadas en pacientes con Status Epilepticus. Se encontraron reducciones significativas en el sector de Sommer (prosubiculum y CAI) asi como en el CA3 cuando se compararon con controles normales. ZUSAMMENFASSUNG In einer fallkontrollierten quantitdtiven Pilotstudie des Hippocampus bei Patienten mit schwerem Status Epilepticus wurde das spezifische Muster des Pyramidenzellverlustes untersucht. Die Pyramidenzelldichte von 5 Patienten, die nach einern Status Epilepticus verstarben, wurde mit 5 normalen Kontrollpersonen und 5 Kontrollen, die nach Alter, Hypoxie/Ischamie, vorangehender Epilepsie und Alkoholabusus gematched waren, verglichen. Die neuronalen Dichten waren bei der normalen Kontrollgruppe am groβten und bei den Patienten mit Status Epilepticus am geringsten. Eine signifikante Reduktion wurde im Sommersektor (Prosubiculum und CAI) und im CA3-Gebiet identifiziert.
Daniel B Rubin - One of the best experts on this subject based on the ideXlab platform.
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electrographic predictors of successful weaning from anaesthetics in refractory Status Epilepticus
Brain, 2020Co-Authors: Daniel B Rubin, Brigid Angelini, Maryum Shoukat, Catherine J Chu, Sahar F Zafar, Brandon M Westover, Sydney S Cash, Eric RosenthalAbstract: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.
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anterior temporal lobectomy for refractory Status Epilepticus in herpes simplex encephalitis
Neurocritical Care, 2016Co-Authors: Sarah K Bick, Sahar Zafar, Daniel B Rubin, Eric Rosenthal, Saef Izzy, Emad N EskandarAbstract:Herpes simplex virus (HSV) is a common cause of viral encephalitis that can lead to refractory seizures. The primary treatment of HSV encephalitis is with acyclovir; however, surgery sometimes plays a role in obtaining tissue diagnosis or decompression in cases with severe mass effect. We report a unique case in which anterior temporal lobectomy was successfully used to treat refractory Status Epilepticus in HSV encephalitis. Case report and review of the literature. We report a case of a 60-year-old man with HSV encephalitis, who presented with seizures originating from the right temporal lobe refractory to maximal medical management. Right anterior temporal lobectomy was performed for the purpose of treatment of refractory Status Epilepticus and obtaining tissue diagnosis, with ultimate resolution of seizures and excellent functional outcome. We suggest that anterior temporal lobectomy should be considered in cases of HSV encephalitis with refractory Status Epilepticus with clear unilateral origin.
Eric Rosenthal - One of the best experts on this subject based on the ideXlab platform.
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electroencephalographic seizures in emergency department patients after treatment for convulsive Status Epilepticus
Journal of Clinical Neurophysiology, 2020Co-Authors: Shahriar Zehtabchi, Eric Rosenthal, Robert Silbergleit, James M Chamberlain, Shlomo Shinnar, Jordan J Elm, Ellen Underwood, Thomas P Bleck, Jaideep KapurAbstract:Purpose It is unknown how often and how early EEG is obtained in patients presenting with Status Epilepticus. The Established Status Epilepticus Treatment Trial enrolled patients with benzodiazepine-refractory seizures and randomized participants to fosphenytoin, levetiracetam, or valproate. The use of early EEG, including frequency of electrographic seizures, was determined in Established Status Epilepticus Treatment Trial participants. Methods Secondary analysis of 475 enrollments at 58 hospitals to determine the frequency of EEG performed within 24 hours of presentation. The EEG type, the prevalence of electrographic seizures, and characteristics associated with obtaining early EEG were recorded. Chi-square and Wilcoxon rank-sum tests were calculated as appropriate for univariate and bivariate comparisons. Odds ratios are reported with 95% confidence intervals. Results A total of 278 of 475 patients (58%) in the Established Status Epilepticus Treatment Trial cohort underwent EEG within 24 hours (median time to EEG: 5 hours [interquartile range: 3-10]). Electrographic seizure prevalence was 14% (95% confidence interval, 10%-19%; 39/278) in the entire cohort and 13% (95% confidence interval, 7%-21%) in the subgroup of patients meeting the primary outcome of the Established Status Epilepticus Treatment Trial (clinical treatment success within 60 minutes of randomization). Among subjects diagnosed with electrographic seizures (39), 15 (38%; 95% confidence interval, 25%-54%) had no clinical correlate on the video EEG recording. Conclusions Electrographic seizures may occur in patients who stop seizing clinically after treatment of convulsive Status Epilepticus. Clinical correlates might not be present during electrographic seizures. These findings support early initiation of EEG recordings in patients suffering from convulsive Status Epilepticus, including those with clinical evidence of treatment success.
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electrographic predictors of successful weaning from anaesthetics in refractory Status Epilepticus
Brain, 2020Co-Authors: Daniel B Rubin, Brigid Angelini, Maryum Shoukat, Catherine J Chu, Sahar F Zafar, Brandon M Westover, Sydney S Cash, Eric RosenthalAbstract: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.
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anterior temporal lobectomy for refractory Status Epilepticus in herpes simplex encephalitis
Neurocritical Care, 2016Co-Authors: Sarah K Bick, Sahar Zafar, Daniel B Rubin, Eric Rosenthal, Saef Izzy, Emad N EskandarAbstract:Herpes simplex virus (HSV) is a common cause of viral encephalitis that can lead to refractory seizures. The primary treatment of HSV encephalitis is with acyclovir; however, surgery sometimes plays a role in obtaining tissue diagnosis or decompression in cases with severe mass effect. We report a unique case in which anterior temporal lobectomy was successfully used to treat refractory Status Epilepticus in HSV encephalitis. Case report and review of the literature. We report a case of a 60-year-old man with HSV encephalitis, who presented with seizures originating from the right temporal lobe refractory to maximal medical management. Right anterior temporal lobectomy was performed for the purpose of treatment of refractory Status Epilepticus and obtaining tissue diagnosis, with ultimate resolution of seizures and excellent functional outcome. We suggest that anterior temporal lobectomy should be considered in cases of HSV encephalitis with refractory Status Epilepticus with clear unilateral origin.
Mark S Wainwright - One of the best experts on this subject based on the ideXlab platform.
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pediatric super refractory Status Epilepticus treated with allopregnanolone
Annals of Neurology, 2014Co-Authors: Eileen Broomall, Michael A Rogawski, Joanne E Natale, Michele Grimason, Joshua L Goldstein, Craig M Smith, Celia H Chang, Stephen Kanes, Mark S WainwrightAbstract:Super-refractory Status Epilepticus is a life-threatening condition. Resistance to benzodiazepine and barbiturate treatment for this disorder is thought to be due to internalization of synaptic γ-aminobutyric acid (GABA)A receptors, and withdrawal of benzodiazepines and barbiturates during treatment often triggers seizure recurrence. The neurosteroid allopregnanolone acts as a positive allosteric modulator of synaptic and extrasynaptic GABAA receptors. Here we describe the use of allopregnanolone in 2 pediatric patients with super-refractory Status Epilepticus. This treatment allowed the general anesthetic infusions to be weaned with resolution of Status Epilepticus. This is the first report of allopregnanolone use to treat Status Epilepticus in children.
Nicolas Gaspard - One of the best experts on this subject based on the ideXlab platform.
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new onset refractory Status Epilepticus etiology clinical features and outcome
Neurology, 2015Co-Authors: Nicolas Gaspard, Brandon Foreman, Vincent Alvarez, Christian Cabrera M Kang, John C Probasco, Amy C Jongeling, Emma Meyers, Alyssa R EspineraAbstract:Objectives: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory Status Epilepticus. Methods: Retrospective review of patients with refractory Status Epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale). Results: Of 130 cases, 67 (52%) remained cryptogenic. The most common identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis. Full data were available in 125 cases (62 cryptogenic). Poor outcome occurred in 77 of 125 cases (62%), and 28 (22%) died. Predictors of poor outcome included duration of Status Epilepticus, use of anesthetics, and medical complications. Among the 63 patients with available follow-up data (median 9 months), functional Status improved in 36 (57%); 79% had good or fair outcome at last follow-up, but epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory CSF changes. Conclusions: Autoimmune encephalitis is the most commonly identified cause of new-onset refractory Status Epilepticus, but half remain cryptogenic. Outcome at discharge is poor but improves during follow-up. Epilepsy develops in most cases. The role of anesthetics and immune therapies warrants further investigation.
