Status epilepticus in the elderly: etiology, seizure type and outcome

We have studied status epilepticus among 342 patients who had their first seizures after the age of 60 years. One hundred and two patients (30%) had status epilepticus. Cerebrovascular disease (35%) was the leading cause of status, followed by head trauma (21%), multifactorial etiology (11%), metabolic disorders (10%), brain tumors (8%) and CNS infection (2%). The etiology of status remained undetermined in 13 patients (13%). The majority (80%) had partial status or generalized status with focal onset. Overall mortality was 35%.     

Status epilepticus in children: aetiology, treatment, and outcome

This retrospective study includes 65 children treated for status epilepticus at Tampere University Hospital in Finland. Aetiology of the condition, effectiveness of the treatment protocol, including short barbiturate anaesthesia to prevent prolonged status epilepticus episodes, and neurological outcome were evaluated. Symptomatic aetiology was present in 40% of status epilepticus episodes, and 37% of episodes were induced by fever. Neurological sequelae secondary to status epilepticus were identified in 15% of the cases and subsequent epilepsy in 23% during the mean follow-up time of 3.6 years. There were no status epilepticus-related deaths. The cut-off point of status epilepticus duration for significant risk for permanent neurological sequelae was 2 hours. Our treatment protocol, including short barbiturate anaesthesia in refractory cases, was able to abort status epilepticus in less than 2 hours in 75% of cases. We conclude that early and prompt use of barbiturate anaesthesia should be encouraged, and may explain our low morbidity figures.     

Ischemic stroke of unusual cause: clinical features, etiology and outcome

The clinical features, etiology and neurological outcome of ischemic stroke of unusual cause (ISUC) have rarely been reported. We retrospective reviewed all patients with this stroke subtype entered in the Sagrat Cor Hospital of Barcelona Stroke Registry, which includes data from 2000 consecutive first-ever stroke patients admitted to the hospital between 1986 and 1995. Patients with previous ischemia and/or hemorrhagic stroke were excluded. Topographic, anamnestic, clinical and neuroimaging characteristics of ISUC were assessed. Predictors of this stroke subtype were determined by logistic regression analysis. Ischemic stroke of unusual etiology was diagnosed in 70 patients (32 men and 38 women), with a mean +/- SD age of 52 +/- 22.4 years. This stroke subtype accounted for 4.3% of all first-ever strokes and 6% of all first-ever brain infarcts. Etiologies included hematological disorders in 17 cases, infection in 11, migraine stroke in 10, cerebral infarction secondary to venous thrombosis in nine, primary inflammatory vascular conditions in six and miscellaneous causes in 17. In the multivariate analysis after excluding cerebral venous thrombosis (n = 9) and arterial dissection (n = 4), because of typical clinical and radiological features, independent predictors of ISUC included 45 years of age or less (odds ratio [OR] 14.8), seizures (OR 6.8), headache (OR 5.2), hemianopia (OR 2.6) and occipital lobe involvement (OR 3.0). Patients with ISUC presented a lower in-hospital mortality rate (7.1% vs. 14.4%; P < 0.05), were more frequently symptom free at discharge (35.7% vs. 25.80%; P < 0.05) and experienced a longer mean length of hospital stay (23.7 days vs. 18.2 days; P = 0.06) than non-ISUC patients. We conclude that ISUC is infrequent, etiologies are numerous and hematologic disorders are the most frequent cause. We emphasize the better prognosis and the need to distinguish it from other ischemic stroke subtypes which have a different treatment approach and outcome.     

Status epilepticus in children

Status epilepticus is defined as a continuous seizure lasting for at least 30 minutes or recurrent seizures persisting for over 30 minutes, without recovery of consciousness. The estimated incidence in childhood is approximately 20 per 100,000 children per year. The incidence is higher in those under one year of age, with an incidence of approximately 50 per 100,000 per year. Among 1-4 year olds, approximately 30 per 100,000 per year will have an episode of status and in those aged 5-9 years, the incidence is approximately 10 per 100,000 per year. Those aged 10-15 years have the lowest incidence (approximately 2 per 100,000 per year). The mortality associated with status epilepticus in children is estimated at 2.5-5%, and is primarily related to the underlying cause of the episode of status. Neurological morbidity is seen in less than 15% of affected children. In most cases, the episode of status is either a single isolated event or is the first manifestation of epilepsy. Only 12% of cases occur in children with a prior diagnosis of epilepsy. It is essential to have an organized approach for dealing with status epilepticus. There is little data to support the contention that one protocol is better than another. It is recommended that each center should decide on a protocol that is rational and is standard practice for their patients. Most centers initiate therapy with either buccal or intravenous lorazepam. Alternate initial therapies include diazepam or midazolam. Early treatment is generally recommended although, in humans, there is minimal evidence that the length of seizure directly affects outcome. There is however, abundant evidence in animals, which indicates that longer seizures are harmful and result in poorer outcome. Early intervention does, however, increase the likelihood of attaining seizure control in humans. The optimal management of the child in a prolonged seizure therefore demands an understanding of the potential causes, appropriate investigations, and therapy.     

Status epilepticus in children

We have prospectively reviewed the data on 52 children who presented with status epilepticus. Thirty-four (65%) of the 52 had not had seizures before. Children who were previously abnormal were more likely to present with partial status epilepticus or to have seizures greater than 60 minutes than those who were previously normal. The median age (24 months) of those who presented with status epilepticus was the same as that of children with seizures of shorter duration. The causes were equally distributed among the idiopathic, acute encephalopathic and chronic encephalopathic groups. Three children died and 13 (28%) were left with neurological sequelae. The outcome was favorable for those in the idiopathic category.     

Status epilepticus in children

Status epilepticus is a common, life-threatening medical emergency in pediatric patients. Recent medical literature has focused on identifying risks and treatment options. This article highlights the epidemiology of status epilepticus, both convulsive and nonconvulsive, in children. It also reviews the recommended medications for first-line treatment of status epilepticus and refractory status epilepticus. Emphasis is placed on future pharmacotherapies and consideration of neurosurgical intervention when indicated.     

Status epilepticus: clinical presentation, cause, outcome, and predictors of death in 119 Ethiopian patients

PURPOSE: Status epilepticus (SE) is a common neurological emergency with high morbidity and mortality. There is no study that has been conducted among Ethiopian patients with SE. The purpose of this study was to analyze clinical presentation, causes, complications, outcomes, and predictors of mortality. METHODS: In this retrospective study, patients aged >or=13 year with SE were included. Medical records were reviewed and demographic and clinical data were collected. RESULTS: Records of 119 patients were analyzed; preexisting epilepsy was found in 38.7%. Primarily generalized and focal with secondarily generalized (FWSG) seizures were identified in 60.5% and 36%, respectively. Simple partial SE occurred in 3.4%. Central nervous system (CNS) infection was the most common cause of SE in the whole group as well as in those with new onset seizure. Antiepileptic drug withdrawal (AEDW) was the main cause in those with preexisting seizure. One or more complications were detected in 61%. Intravenous diazepam and oral phenytoin were given to 95% and 97.5%, respectively. Case fatality was 20.2%; poor outcome occurred in 24%. Predictors of mortality were FWSG type, acute symptomatic etiology, stroke, systemic infection, and HIV/AIDS and its CNS complications. Idiopathic and SE due to AEDW were associated with good prognosis. CONCLUSIONS: CNS infection was the most common cause of SE in the whole group and AEDW was the major cause in patients with preexisting epilepsy. Parenteral anticonvulsants, emergency measurement of serum AED level, and electroencephalography for urgent diagnosis and monitoring were unavailable. Mortality was related to underlying etiologies especially HIV/AIDS and its CNS complications.     

Status epilepticus in pregnancy: Etiology,management, and clinical outcomes

BackgroundStatus epilepticus (SE) in pregnancy carries significant risk to both mother and fetus. There is limited literature available on SE occurring in pregnancy world-over, with majority being from obstetric centers.MethodsAll women who developed SE related to pregnancy (gestation, labor, or puerperium) between January 2000 and December 2016 were included in the study. Data were collected from our SE registry, maintained, and archived in the institute. The variables influencing the maternal and fetal outcome were compared using Student's t-test for continuous variables and Fisher's exact test for discrete variables.ResultsDuring the 16-year study period, a total of 348 SE events were recorded in 294 patients. Among these, there were 138 women, of which 17 had SE related to pregnancy. The etiology of SE was remote symptomatic in two and acute symptomatic in 15 patients. The various causes detected after initial evaluation for acute symptomatic SE were eclampsia (n = 4), posterior reversible encephalopathy syndrome due to various causes other than eclampsia (n = 6), cortical venous thrombosis (n = 3), subarachnoid hemorrhage (n = 1), and NMDA receptor antibody-mediated encephalitis (n = 1).13 of 17 women with SE (76%) had good outcome. Majority of the fetuses had good outcomes, i.e., Category 1 (n = 9, 57%). Duration of intensive care unit stay (p = 0.029) and Status Epilepticus Severity Score (p = 0.0324) at admission, were found to be significantly associated with poor outcomes.ConclusionIn any patient presenting with SE occurring in pregnancy, though eclampsia is presumed to be the most common overall cause; it is relevant to consider other etiologies such as posterior reversible encephalopathy syndrome, cortical venous thrombosis, and autoimmune encephalitis especially in cases presenting with refractory SE. Posterior reversible encephalopathy may occur in pregnancy due to diverse etiologies other than eclampsia.     

Hemorrhagic moyamoya disease in children: clinical features and surgical outcome

Objective  

The clinical presentation of moyamoya disease (MMD) typically includes cerebral ischemia in children and intracranial hemorrhage in adults. Because of its rarity, the benefit of surgery in the hemorrhagic type of pediatric MMD has not been clearly established. The purpose of this study was to delineate the clinical features and surgical outcome of hemorrhagic MMD in children.     

Supratentorial primitive neuroectodermal tumor in children: clinical features, treatment outcome and prognostic factors

To investigate clinical features, treatment outcome and prognostic factors of pediatric supratentorial primitive neuroectodermal tumors(ST-PNETs), 28 ST-PNET cases were retrospectively analyzed. The prognostic importance of age, sex, size of tumor, M stage, extent of surgical resection, histological features, immunohistochemical labelling indices (Ki-67, p53), and apoptotic index were assessed. The mean age at diagnosis was 6.8 years, and the male-to-female ratio was 18:10. The presenting symptoms in 22 cases were increased intracranial pressure and focal neurological deficits. Gross total resection was achieved in 17 cases, near-total (>90%) resection in 3, and subtotal in 7; biopsy was performed in 1 case. The mean duration of follow-up was 37 months. For 25 patients who completed planned adjuvant therapy, the 3-year survival rate was 73%. Univariate analysis showed that the presence of tumor necrosis (P=0.002) and extent of resection (P=0.04) correlated with survival. Patients with a high Ki-67 labelling index (>10%) tended to have shorter survival (P=0.095). In multivariate analysis, tumor necrosis showed statistical significance(P=0.03). Received: 20 September 1998 Revised: 16 November 1998     

Status epilepticus in children with Alpers' disease caused by POLG1 mutations: EEG and MRI features

Purpose:   Refractory convulsive status epilepticus in infancy and childhood is a rare emergency situation. Metabolic disorders frequently underlie this condition, in particular Alpers' disease caused by POLG1 mutations. Status epilepticus may be the first symptom. A pathognomonic electroencephalography (EEG) signature may facilitate diagnosis of Alpers' disease and allow timely avoidance of valproic acid, which is contraindicated in this disorder because it may trigger fatal liver failure.
Patients:   We present five patients with Alpers' disease caused by mutations in POLG1 . Age of onset ranged from 7 months to 10 years. Three of the five children died after 3 to 12 months after onset of status epilepticus. Two of these had liver failure associated with use of valproic acid; liver transplantation in one child did not prevent a fatal neurologic outcome.
Results:   Convulsive status epilepticus was the first obvious sign of Alpers' disease in all children. All had focal clonic and complex-focal seizures; four of them developed epilepsia partialis continua. In four children, initial EEG showed unilateral occipital rhythmic high-amplitude delta with superimposed (poly)spikes (RHADS). Magnetic resonance imaging (MRI) revealed cortical and thalamic involvement in all, although there were only discrete abnormalities in one child. Metabolic investigations remained normal in three children.
Conclusion:   Alpers' disease is an important differential diagnosis in childhood refractory convulsive status epilepticus. Its EEG hallmark of RHADS is important for timely diagnosis, management, and counseling.     

Spontaneous primary intraventricular hemorrhage: clinical data, etiology and outcome

The clinical features, etiology, and neurological outcome in patients with primary intraventricular hemorrhage (PIVH) have rarely been reported. We retrospectively reviewed the clinical data, complementary examinations, outcome, computed tomography (CT) blood amount, and ventricle size of 13 patients (mean age 60 years, five men). We defined PIVH as hemorrhage detected by CT in the ventricular system only. The major symptoms included headache (n = 13), decreased level of consciousness (n = 9), and nausea/vomiting (n = 7). The cause was unknown in five patients; and was associated with arterial hypertension in five, vascular malformations in two, and tumor in one, although arteriography was performed in only five patients. Outcomes were death in three, asymptomatic in six, mild disability in three, and moderate disability in one. Prognosis was not related to clinical or CT data. Clinical features can suggest the diagnosis of PIVH, but cerebral CT is required for confirmation. Received: 2 March 1998 Received in revised form: 16 June 1998 Accepted: 23 July 1998     

Status epilepticus and acute serial seizures in children

Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough to produce a fixed and enduring epileptic condition of 30 minutes or longer. Status epilepticus is a life-threatening condition that often occurs in children. The degree of mortality and neurologic morbidity, as well as the risk for recurrence, is highly dependent on the etiology and duration of the seizures. Although much has been written about pediatric status epilepticus, many issues remain unresolved. A better understanding of the different types of seizures and their etiologies may help in the prevention and treatment of status epilepticus. The vast extent of status epilepticus in both children and adults mandates that new options for prevention and treatment be given a close scrutiny and high priority. This article will review the most current information on convulsive and nonconvulsive status epilepticus, including the potential for neurologic damage, changes in magnetic resonance imaging after status epilepticus, risk for recurrence, and current treatment options available for treating status epilepticus in children.     

脊髓梗死的病因学、临床特征及预后(附3例报告和232例文献分析)

目的分析脊髓梗死的病因、临床特征及预后。方法分析收治的3例脊髓梗死患者及文献报道的232例脊髓梗死病例的病因、临床特征及其预后。结果脊髓梗死呈急性或亚急性起病、病变水平神经根痛、病变节段以下瘫痪和分离性感觉障碍及植物神经功能障碍,MRI可显示病变,治疗原则同脑梗死。恢复期49.1%患者的神经功能缺损无明显改善。结论脊髓梗死临床上少见,依据其临床表现,结合MRI表现,可作出诊断,其预后与起病时神经功能缺损的严重程度密切相关。