Prolonged treatment may be associated with infections or sepsis, thrombophlebitis, and pulmonary emboli. Basic Considerations Cellular Physiology of Status Epilepticus Omotola Hope and Hal Blumenfeld Cellular Damage and the Neuropathology of Status Epilepticus Nathan B. There are probably several pathophysiologic mechanisms that facilitate the continuation of seizures, and in some seizures, the balance of electrochemical function appears to shift, unfavorably, toward excessive excitatory activity as seizures progress. The general concept is very attractive, with chapters encompassing a wide range of aspects. This should almost always be followed by i. B: Continuation of the seizure in A.
Status Epilepticus in Neonates John N. Kaplan Types of Status Epilepticus: Definitions and Classification Frank W. It provides all necessary data to treat status epilepticus and has sufficient background to explain the choices made. Violent muscle contractions increase lactate levels, contributing to a systemic acidosis, and systemic temperatures often rise significantly. Waterhouse The Electroencephalogram in Status Epilepticus Susan T. Slower rhythmic activity, with admixed spike and wave discharges, gradually becomes obscured by muscle activity.
Bromfield Epidemiology of Status Epilepticus Elizabeth J. Hyperthermia may be due to continued convulsions or infection, for which the underlying cause must be sought and treated. The patient is then flaccid, but there may be a large generalized myoclonic jerk at the end of the motor phase. Generalized Convulsive and Focal Status Epilepticus Generalized Convulsive Status Epilepticus: Causes, Clinical Manifestations, and Consequences Bernard S. Despite this prevalence, Nonconvulsive Status Epilepticus is the first comprehensive clinical text to cover its diagnosis and management. With antiepileptic drugs, almost all had control of clinical seizures, and most improved in mental status.
Stage 5: Somewhat periodic epileptiform discharges on a low-voltage background. Treatment Treatment of Generalized Convulsive Status Epilepticus Tina Shih and Carl W. It may begin as primary generalized convulsive seizures or evolve from a focal or complex partial seizure and progress to generalized convulsions. Recurrence is higher in patients with progressive neurologic disorders. Kaplan Cognitive Manifestations of Status Epilepticus: Ictal Aphasia, Amnesia, and Psychosis Michael Benatar Nonconvulsive Status Epilepticus: Morbidity and Consequences Frank W. Within seconds, as the initial tonic contraction occurs, generalized rhythmic electrographic seizure activity, including rapid spike discharges, gradually increases in voltage and decreases in frequency to approximately 10 Hz.
Stage 4: Discontinuous ictal activity with intervening periods of a flat background. The emphasis is on the disease as encountered by the clinician in the field and the importance of correct recognition and diagnosis. The general concept is very attractive, with chapters encompassing a wide range of aspects. Kaplan Cognitive Manifestations of Status Epilepticus: Ictal Aphasia, Amnesia, and Psychosis Michael Benatar Nonconvulsive Status Epilepticus: Morbidity and Consequences Frank W. The incidence was higher in African Americans and also likely higher because of ascertainment in an urban medical setting.
Nonconvulsive Status Epilepticus Clinical Presentations of Nonconvulsive Status Epilepticus Peter W. Chang Focal Status Epilepticus Donald L. Typically, convulsive activity consists of paroxysmal or continuous bilateral, usually rhythmic, tonic movements or clonic shaking of the limbs, commonly with facial and truncal manifestations as well, and with loss of consciousness. Repeated seizures also diminish in duration and intensity over time ,. For general neurologists,Bujarski and Sperling's chapter describing how nonconvulsive status can mimic other neurologic disorders with detailed differential diagnoses will be of particular interest.
General Topics History of Status Epilepticus Peter W. Sometimes movements are more subtle, and there may be a faster quivering. D: The seizure ends and is followed by diffuse background voltage attenuation. Bazil Treatment of Refractory Status Epilepticus Teresa L. It provides all necessary data to treat status epilepticus and has sufficient background to explain the choices made. Conclusions: Focal status epilepticus may be seen with a wide variety of clinical seizure types or without obvious clinical seizures.
Metabolic complications include electrolyte disturbances such as hyponatremia. It has been impossible to separate duration beyond the first hour conclusively from the influence of etiology. The diagnosis is often delayed or missed and should be considered after strokes or clinical seizures when patients do not stabilize or improve as expected. Nonconvulsive Status Epilepticus Clinical Presentations of Nonconvulsive Status Epilepticus Peter W. Following initiation, almost half of seizures lasting from 10 to 29 minutes cease spontaneously, without treatment , and most individual secondarily generalized convulsions cease on their own in under 2 minutes and the patient recovers thereafter.
Etiology is overwhelmingly the most important prognostic factor. Blood pressure and glucose concentrations increase early but return to baseline levels after several minutes and may even decrease further. Although without a definite scientific basis, 30 minutes has been the standard criterion for duration in most clinical studies. Most have no history of seizures and are often older adults with acute and severe medical or neurologic illnesses. Still others begin as focal-onset seizures and generalize rapidly. Tachycardia, hypertension, and other autonomic changes are common.
General Topics History of Status Epilepticus Peter W. The discussion of presentations in critically ill patientsis another area of strength, useful to those providing care in the intensivecare setting. Later, inflammation, glial cell changes, and neuronal sprouting or cell loss may contribute to the refractoriness of subsequent seizures. Disseminated intravascular coagulation can lead to multiorgan failure. Bazil Treatment of Refractory Status Epilepticus Teresa L. Clinical findings were determined by chart review. Waterhouse The Electroencephalogram in Status Epilepticus Susan T.