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Seizures and Status Epilepticus

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Emergency Neurology

Abstract

Seizures are one of the most common neurological emergencies encountered by clinicians. Status epilepticus in particular is one of the most serious forms of seizure emergencies associated with considerable morbidity and mortality. However, much has been learned about the pathophysiology and epidemiology of the condition which has led to a paradigm shift in the definition and management of this condition. This chapter explores the current understanding of seizures with an emphasis on status epilepticus. Epidemiology, etiology, diagnosis, and therapeutic interventions are discussed, and protocols for successful management are outlined.

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References

  1. Pallin DJ, Espinola JA, Leung DY, Hopper DC, Camargo CA Jr. Seizure visits in US emergency departments: epidemiology and potential disparities in care. Int J Emerg Med. 2008;1(2):97–105.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester. Minnesota Mayo Clin Proc. 1996;71:576–86.

    Article  CAS  PubMed  Google Scholar 

  3. Krumholtz A, Wiebe S, Gronseth G, Gloss D, Sanchez A, Kabir A, Liferidge A, Martello J, Kanner A, Shinnar S, Hopp J, French J. Evidence – based guideline: first seizure in adults. Neurology. 2015;84(16):1705–13.

    Article  Google Scholar 

  4. Fields MC, Labovitz DL, French JA. Hospital-onset seizures: an inpatient study. JAMA Neurol. 2013;70(3):360–4.

    Article  PubMed  Google Scholar 

  5. Trousseau A. Lectures on Clinical medicine Delivered at the Hotel Dieu, Paris, 1868. Vol 1 (P V Bazire, trans) London: New Sydenham Society; 1868.

    Google Scholar 

  6. Dodson WE, DeLorenzo RJ, Pedley TA, Shinnar S, Treiman DM, Wannamaker BB. The treatment of convulsive status epilepticus: recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. J Am Med Assoc. 1993;270:854–9.

    Article  Google Scholar 

  7. Trinka E, Cock H, Rossetti AO, Sheffer IE, Shinnar S, Shorvon S, Lowenstein DH. A definition and classification of status epilepticus—report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–23.

    Article  PubMed  Google Scholar 

  8. Trinka E, Hofler J, Leitinger M, Brigo F. Pharmacotherapy for status epilepticus. Drugs. 2015;75:1499–521.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Chen JWY, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5:246–56.

    Article  PubMed  Google Scholar 

  10. Treiman DM, Meyers PD, Walton NY, Collins JF. A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med. 1998;339:792–8.

    Article  CAS  PubMed  Google Scholar 

  11. Lowenstein D, Bleck T, Macdonald R. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40:120–2.

    Article  CAS  PubMed  Google Scholar 

  12. Bleck TP. Refractory status epilepticus. Curr Opin Crit Care. 2005;11:117–20.

    Article  PubMed  Google Scholar 

  13. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46:1029–35.

    Article  CAS  PubMed  Google Scholar 

  14. Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults. Lancet Neurol. 2011;10(10):922–30.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Logroscino G, Hesdorffer DC, Cascino G, Annegers JF, Hauser WA. Time trends in incidence, mortality, and case fatality after first episode of status epilepticus. Epilepsia. 2001;42:1031–5.

    Article  CAS  PubMed  Google Scholar 

  16. Sculier C, Gainza-Lein M, Fernandez IS, Loddenkemper T. Long-term outcomes of status epilepticus: a critical assessment. Epilepsia. 2018;59(Suppl 2):155–269.

    Article  PubMed  PubMed Central  Google Scholar 

  17. DeLorenzo RJ, Pellock JM, Towne AR, Boggs JG. Epidemiology of status epilepticus. J Clin Neurophysiol. 1995;12:316–25.

    Article  CAS  PubMed  Google Scholar 

  18. Hesdorffer DC, Logroscino G, Hauser WA, Cascino G. Risk of and predictors for recurrence in status epilepticus. Epilepsia. 1995;36(Suppl 4):149.

    Google Scholar 

  19. Shinnar S, Maytal J, Krasnoff L, Moshe SL. Recurrent status epilepticus in children. Ann Neurol. 1992;31:598–604.

    Article  CAS  PubMed  Google Scholar 

  20. Corey LA, Pellock JM, Boggs JG, Miller LL, DeLorenzo RJ. Evidence for a genetic predisposition for status epilepticus. Neurology. 1998;50(2):558–60.

    Article  CAS  PubMed  Google Scholar 

  21. Kapur J, Lothman EW. NMDA receptor activation mediates the loss of GABAergic inhibition induced by recurrent seizures. Epilepsy Res. 1990;5:103–11.

    Article  CAS  PubMed  Google Scholar 

  22. Vezzani A, Ravizza T, Moneta D, et al. Brain-derived neurotrophic factor immunoreactivity in the limbic system of rats after acute seizures and during spontaneous convulsions: temporal evolution of changes as compared to neuropeptide Y. Neuroscience. 1999;90:1445–61.

    Article  CAS  PubMed  Google Scholar 

  23. Kamphius W, de Rijk TC, Talamini LM, Lopes da Silva FH. Rat hippocampal kindling induces changes in the glutamate receptor mRNA expression patterns in dentate granule neurons. Eur J Neurosci. 1994;6:1119–27.

    Article  Google Scholar 

  24. Joshi S, Kapur J. Mechanism of status epilepticus: AMPA receptor hypothesis. Epilepsia. 2018;59(Suppl2):78–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Gerfin-Moser A, Grogg F, Rietschin L, Thompson SM, Streit P. Alterations in glutamate but not GABAA receptor subunit expression as a consequence of epileptiform activity in vitro. Neuroscience. 1995;67:849–65.

    Article  CAS  PubMed  Google Scholar 

  26. Kapur J, Macdonald RL. Rapid seizure-induced reduction of benzodiazepine and Zn2+ sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci. 1997;17:7532–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Mazarati AM, Wasterlain CG. N-methyl-D-aspartate receptor antagonists abolish the maintenance phase of self-sustaining status epilepticus in rate. Neurosci Lett. 1999;265:187–90.

    Article  CAS  PubMed  Google Scholar 

  28. Mazarati AM, Baldwin RA, Sankar R, Wasterlain CG. Time-dependent decrease in the effectiveness of antiepileptic drugs during the course of self-sustaining status epilepticus. Brain Res. 1998;814:179–85.

    Article  CAS  PubMed  Google Scholar 

  29. Sloviter RS. Decreased hippocampal inhibition and a selective loss of interneurons in experimental epilepsy. Science. 1987;235:73–6.

    Article  CAS  PubMed  Google Scholar 

  30. Pollard H, Charriaut-Marlangue C, Cantagrel S, et al. Kainate-induced apoptotic cell death in hippocampal neurons. Neuroscience. 1994;63:7–18.

    Article  CAS  PubMed  Google Scholar 

  31. Corsellis JA, Bruton CJ. Neuropathology of status epilepticus in humans. Adv Neurol. 1983;34:129–39.

    CAS  PubMed  Google Scholar 

  32. Nevander G, Ingvar M, Auer R, Siesjö BK. Status epilepticus in well-oxygenated rats causes neuronal necrosis. Ann Neurol. 1985;18(3):281–90.

    Article  CAS  PubMed  Google Scholar 

  33. DeGiorgio CM, Correale JD, Gott PS, et al. Serum neuron-specific enolase in human status epilepticus. Neurology. 1995;45:1134–7.

    Article  CAS  PubMed  Google Scholar 

  34. Lothman E. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990;40(Suppl1):13–23.

    CAS  PubMed  Google Scholar 

  35. Simon RP. Physiologic consequences of status epilepticus. Epilepsia. 1985;26(Suppl 1):S58–66.

    Article  PubMed  Google Scholar 

  36. Treiman DM, DeGiorgio CM, Salisbury S, Wickboldt C. Subtle generalized convulsive status epilepticus. Epilepsia. 1984;25:653.

    Google Scholar 

  37. Treiman DM. Status epilepticus. Ballieres Clin Neurol. 1996;5:821–39.

    CAS  Google Scholar 

  38. Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007;118:1660.

    Article  CAS  PubMed  Google Scholar 

  39. Walker MC. Diagnosis and treatment of nonconvulsive status epilepticus. CNS Drugs. 2001;15(12):931–9.

    Article  CAS  PubMed  Google Scholar 

  40. Pandian JD, Cascino GD, So EL, Manno E, Fulgham JR. Digital video electroencephalographic monitoring in the neurological-neurosurgical intensive care unit: clinical features and outcome. Arch Neurol. 2004;61:1090–4.

    Article  PubMed  Google Scholar 

  41. Yan Liu X, Wong V. Spectrum of epileptic syndromes with electrical status epilepticus during sleep in children. Pediatr Neurol. 2000;22(5):371–9.

    Article  CAS  PubMed  Google Scholar 

  42. Gaspard N, Foreman BP, Alvarez V, et al. New-onset refractory status epilepticus: etiology, clinical features, and outcome. Neurology. 2015;85:1604.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345:631–7.

    Article  CAS  PubMed  Google Scholar 

  44. Silbergleit R, Durkaslski V, Lowenstein D, Conwit R, Pancioli A, colleagues. Intramuscular versus intravenous therapy for prehospital status epilepticus. NEJM. 2012;366:591–600.

    Article  CAS  PubMed  Google Scholar 

  45. McTague A, Martland T, Appleton R. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev. 2018;1:CD001905.

    PubMed  Google Scholar 

  46. Harbord MG, Kyrkou NE, Kyrkou MR, et al. Use of intranasal midazolam to treat acute seizures in paediatric community settings. J Paediatr Child Health. 2004;40:556–8.

    Article  CAS  PubMed  Google Scholar 

  47. McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet. 2005;366:205.

    Article  CAS  PubMed  Google Scholar 

  48. Fakhoury T, Chumley A, Bensalem-Owen M. Effectiveness of diazepam rectal gel in adults with acute repetitive seizures and prolonged seizures: a single-center experience. Epilepsy Behav. 2007;11:357.

    Article  PubMed  Google Scholar 

  49. Giffard RG, Monyer H, Christine CW, Choi DW. Acidosis reduces NMDA receptor activation, glutamate neurotoxicity, and oxygen glucose deprivation neuronal injury in cortical cultures. Brain Res. 1990;506:339–42.

    Article  CAS  PubMed  Google Scholar 

  50. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3.

    Article  PubMed  Google Scholar 

  51. Chapman MG, Smith M, Hirsch NP. Status epilepticus. Anesthesia. 2001;56:648–59.

    Article  CAS  Google Scholar 

  52. Lowenstein DH. The Management of Refractory Status Epilepticus: an update. Epilepsia. 2007;47(Suppl 1):35–40.

    Google Scholar 

  53. Glauser T, Shinnar S, Gloss D, Alldredge B, et al. Proposed algorithm for treatment of convulsive status epilepticus in children and adults. Epilepsy Curr. 2016;16(1):48–61. https://doi.org/10.5698/1535-7597-16.1.48.

  54. Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus Veterans affairs status epilepticus cooperative study group. N Engl J Med. 1998;339:792–8.

    Article  CAS  PubMed  Google Scholar 

  55. (The Collaborative Eclampsia Trialists): Which anticonvulsants for women with eclampsia? Evidence from the Collaborative Eclampsia trial. Lancet. 1995;345:1455–63.

    Google Scholar 

  56. Brown JK, Hussain IH. Status epilepticus. II Treatment. Dev Med Child Neurol. 1991;33:97–109.

    Article  CAS  PubMed  Google Scholar 

  57. Mewasingh LD, Sekhara T, Aeby A, et al. Oral ketamine in paediatric non-convulsive status epilepticus. Seizure. 2003;12:483–9.

    Article  CAS  PubMed  Google Scholar 

  58. Appleton R, Choonara I, Martland T, et al. The treatment of convulsive status epilepticus in children. The status epilepticus working party, members of the status epilepticus working party. Arch Dis Child. 2000;83:415–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Kahriman M, Minecan D, Kutluay E, et al. Efficacy of topiramate in children with refractory status epilepticus. Epilepsia. 2003;44:1353–6.

    Article  CAS  PubMed  Google Scholar 

  60. Rossetti AO, Bromfield EB. Determinants of success in the use of oral levetiracetam in status epilepticus. Epilepsy Behav. 2006;8:651–4.

    Article  PubMed  Google Scholar 

  61. Ho C, Lin C, Lu Y, et al. Perampanel treatment for refractory status epilepticus in a neurological intensive care unit. Neurocrit Care. 2019;31(1):24–9.

    Article  PubMed  Google Scholar 

  62. Brigo F, Lattanzi S, Trinka E. Intravenous brivaracetam in the treatment of status epilepticus: A systematic review. CNS Drugs. 2019;33(8):771–81.

    Article  CAS  PubMed  Google Scholar 

  63. Sivakumar S, Ibrahim M, Parker D Jr, et al. Clobazam: an effective add-on therapy in refractory status epilepticus. Epilepsia. 2015;56:e83.

    Article  CAS  PubMed  Google Scholar 

  64. Bartha AI, Shen J, Katz KH, et al. Neonatal seizures: multicenter variability in current treatment practices. Pediatr Neurol. 2007;37:85.

    Article  PubMed  Google Scholar 

  65. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43:146–53.

    Article  CAS  PubMed  Google Scholar 

  66. Walker MC. Treatment of nonconvulsive status epilepticus. Int Rev Neurobiol. 2007;81:287–97.

    Article  PubMed  Google Scholar 

  67. Basha MM, Alqallaf A, Shah AK. Drug-induced EEG pattern predicts effectiveness of ketamine in treating refractory status epilepticus. Epilepsia. 2015;56:e44.

    Article  CAS  PubMed  Google Scholar 

  68. Fujikawa DG. Starting ketamine for neuroprotection earlier than its current use as an anesthetic/antiepileptic drug late in refractory status epilepticus. Epilepsia. 2019;60:373.

    Article  PubMed  Google Scholar 

  69. Khawaja AM, DeWolfe JL, Miller DW, Szaflarski JP. New-onset refractory status epilepticus (NORSE)–the potential role for immunotherapy. Epilepsy Behav. 2015;47:17.

    Article  PubMed  Google Scholar 

  70. Spatola M, Novy J, Du Pasquier R, et al. Status epilepticus of inflammatory etiology: a cohort study. Neurology. 2015;85:464.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Chin RF, Neville BG, Peckham C, et al. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368:222.

    Article  PubMed  Google Scholar 

  72. Kravljanac R, Jovic N, Djuric M, et al. Outcome of status epilepticus in children treated in the intensive care unit: a study of 302 cases. Epilepsia. 2011;52:358.

    PubMed  Google Scholar 

  73. DeLorenzo RJ, Towne AR, Pellock JM, Ko D. Status epilepticus in children, adults and the elderly. Epilepsia. 1992;33(Suppl 4):S15–25.

    Article  PubMed  Google Scholar 

  74. Dodrill CB, Wilensky AJ. Intellectual impairment as an outcome of status epilepticus. Neurology. 1990;40(5 Suppl 2):23–7.

    CAS  PubMed  Google Scholar 

  75. Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Risk of unprovoked seizure after acute symptomatic seizure: effect of status epilepticus. Ann Neurol. 1998;44:908–12.

    Article  CAS  PubMed  Google Scholar 

  76. Annegers JF, Hauser WA, Elveback LR, Kurland LT. The risk of epilepsy following febrile convulsions. Neurology. 1979;29:297–303.

    Article  CAS  PubMed  Google Scholar 

  77. Kapur J, Elm J, Chamberlain J, et al. Randomized trial of three anticonvulsant medications for status epilepticus. NEJM. 2019;381:22.

    Article  Google Scholar 

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Sirven, J.I., Farrugia, L., Rosenow, C. (2021). Seizures and Status Epilepticus. In: Roos, K.L. (eds) Emergency Neurology. Springer, Cham. https://doi.org/10.1007/978-3-030-75778-6_10

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