Management of seizure disorders: Selected aspects. Part I (original) (raw)
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Treatment of seizure emergencies: Convulsive and non-convulsive status epilepticus
Epilepsy Research, 2006
Status epilepticus (SE), defined as recurrent epileptic seizures without complete recovery between seizures, is one of the most serious manifestations of epilepsy. Generalized convulsive status epilepticus (GCSE) is the most common and most lifethreatening form of SE, and aging increases the mortality risk. In a recent study of treatment of GCSE, 226 of 518 evaluable patients (43.6%) were of age 65 or older. In the 157 elderly patients with overt GCSE, phenobarbital was successful as first-line treatment in 71.4%, lorazepam in 63%, diazepam and phenytoin in 53.3%, and phenytoin alone in 41.5%. Phenobarbital and lorazepam were more successful than phenytoin alone. In the 69 elderly patients with subtle GCSE, success as the first treatment was 30.8% for phenobarbital, 14.3% for lorazepam, 11.8% for phenytoin, and 7.7% for diazepam and phenytoin. Overall, the results were similar to those reported for the entire study. Lorazepam, because of ease of use, is probably the best drug for the initial treatment of overt GCSE in the elderly; phenobarbital may be the best drug for subtle GCSE in this group, but more data are needed. The term "nonconvulsive SE" has been used to include complex partial SE and absence SE-both of which present as an "epileptic twilight state"-and SE in comatose patients. The diagnosis can be challenging, particularly in the elderly, as overlapping clinical features and electroencephalogram patterns can be seen in SE and in a variety of encephalopathic conditions. There is a suggestion that aggressive treatment of elderly patients with nonconvulsive SE may worsen prognosis. Clearly, there is a need for more data to better understand management of elderly patients with both convulsive and nonconvulsive SE.
Modern management of seizures and epilepsy
Swiss Medical Weekly, 2016
Alcohol Benzodiazepine Barbiturate Rarely vitamin B12, Vitamin B 6 (young children) Other Posterior reversible encephalopathy syndrome Cerebral anoxia Eclampsia Multiple sclerosis within 7 d of relapse Adapted from [1, 2].
Overview of Seizure and Epilepsy Syndromes and Their Multidisciplinary Management
Reviews in Clinical Medicine, 2018
Abnormal hyperexcitable electrical discharges of the cerebral cortex lead to the disturbance between the inhibitory and excitatory balance of the neural network. Seizure is caused by four main mechanisms, including metabolic, structural, inflammatory, and infectious mechanisms. Seizures are classified as partial and generalized based on the isolation in a specific area in one brain hemisphere or passing through the nerve fibers and spreading to the other hemisphere as well. Epilepsy is defined as the occurrence of more than two unprovoked and unpredicted repeated seizures. Epilepsy affects more than three million individuals in the United States and approximately 50 million individuals worldwide. Epilepsy may be of an unknown origin, while it could also be associated with certain syndromes. General and specific approaches to seizure treatment encompass a wide range of factors. The general approach should be focused on reassurance and raising the awareness of the patients and their f...
General Principles of the Medical Management of Epilepsy in Children: A Literature Review
Reviews in Clinical Medicine, 2018
The primary aim of epilepsy treatment is seizure control, and the treatment is principally prophylactic. Although complete seizure control is the most important predictor of improved quality of life, antiepileptic drugs (AEDs) could cause severe side effects in the patients. Therefore, the risk-benefit ratio must be considered before the initiation of AED treatment. Accurate recognition and differentiation of epileptic and non-epileptic paroxysmal events and the diagnosis of the seizure type and epilepsy syndrome are essential procedures before AED treatment. It is often recommended that AED treatment start after two seizures, and being seizure-free for a minimum of two years is a prerequisite for treatment withdrawal. The AED treatment process must be initiated with a single drug at a low maintenance dose, along with further upward titration. Overall, the first attempt in AED treatment has been reported to effectively control seizures in 50-70% of the cases. Moreover, there is a co...
A Review on Epilepsy and its Management
Journal of Drug Delivery and Therapeutics
Today, people face various types of stress in everyday fast life and most people in the world suffer from various neurological disorder. Epilepsy is one of the most common neurological disorders of the brain, affecting about 50 million people around the world, and 90% of them are coming from developing countries. Genetic factors and brain infection, stroke, tumors and epilepsy cause high fever. It imposes a great economic burden on the health systems of countries associated with stigma and discrimination against the patient and also his family in the community, in the workplace, school and home. Many patients with epilepsy suffer from severe emotional stress, behavioral disorders and extreme social isolation. There are many different types of seizure and mechanisms by which the brain generates seizures. The two features of generating seizures are hyperexcitability of neurons and a hyper synchronousneural circuits. A variety of mechanisms alters the balance between excitation and inh...
Current approaches to the management of epilepsy
Prescriber, 2007
E pilepsy affects approximately one in 200 children under 16 years of age. The term 'epilepsy' is applied to a host of conditions characterised by a liability to recurrent epileptic seizures. However, no single term can adequately describe the extremely broad spectrum of clinical manifestations and possible seizure patterns encountered in clinical practice, especially in children. Attacks provoked by extracerebral factors are extremely common in children, eg febrile seizures, and are generally not considered to be epilepsy. In recent epidemiological studies epilepsy is defined as occurrence of two unprovoked epileptic seizures, not in the same morbid episode. This is now the accepted definition of epilepsy. This article describes current therapeutic approaches for the treatment of epilepsy in children.
Epilepsia, 2006
The diagnosis and treatment of a first epileptic seizure are made by physicians with different types of expertise. Heterogeneous patterns of care are thus expected, which explain the need for shared patterns of care. These guidelines were developed by a group of experts from the Italian League against Epilepsy (LICE) in accordance with the requirements of evidence-based medicine. An accurate assessment of the seizure is required, with active questioning about circumstances of occurrence, clinical manifestations, and postictal symptoms. For seizures with loss of consciousness, the presence of cyanosis, hypersalivation, tongue biting, and postictal disorientation has a specific diagnostic value. Laboratory tests and toxicological screening should be performed only in the presence of circumstances suggesting a metabolic or toxic encephalopathy. Elevated prolactin levels 10-20 min. after the event help in differentiating generalized tonic-clonic or partial seizures from psychogenic nonepileptic seizures. Except for infants less than six months of age, CSF examination is recommended only when a cerebral infection is suspected. An EEG should be performed within 24 h. after a seizure, particularly in children. If the EEG is normal during wakefulness, a sleep EEG is recommended. A CT scan is strictly indicated when a severe structural lesion is suspected or when the etiology is unknown. MRI may not be indicated in the emergency room, but it should be preferred to CT as part of the diagnostic assessment. The added value of other diagnostic tools (neuropsychological tests, ambulatory EEG, functional MRI, SPECT, and PET) is as yet unknown. These tests may be used on a case-by-case basis. In the presence of an acute symptomatic seizure, treatment of the cause is recommended. Symptomatic therapy is not justified unless the seizure has the characteristics of status epilepticus. Long-term treatment may be considered in patients with abnormal EEG and imaging data and after consideration of the social, emotional, and personal implications of seizure relapse.
Interests in knowledge and assistance of epilepsy
2019
Background: Many problems with differential treatment of epilepsy require further clarification. As far as we are concerned, we have developed therapeutic recommendations which, in our opinion, demonstrated to be effective in certain cases, supporting the results of the treatment of epilepsy at its various stages known in the literature: from premonitory forms to status variants. The main element in the choice of anticonvulsant remedies, besides the clinical markings, was the dynamically derived EEG data as well as the subjective pharmacological response of the patients. The preferential associations of anticonvulsant remedies for various topographies of the epileptic outbreak and oscillation of nicotine paroxysms of sleep-wake cycle were given in the formula and strictly individual dosing. Remarkable advances in the field of perturbation in the last decades of the twentieth century, as well as active research in the uninterrupted process, have made epilepsy now called unequivocally a "hopeful affection". Conclusions: Normal and abnormal neuronal cells are involved in pathological discharges, the exact genesis of this phenomenon is known to be vague and means the involvement of many factors of cellular, vascular and metabolic disorders. Rehabilitation of patients with epilepsy should be gradual, using compliance between drug treatment, psychosocial rehabilitation depending on the dynamics of the disease and the patients' reaction to their own condition. The uptake of concepts and rehabilitation programs introduced into many countries' systems, the formation of the assisted care system, will increase the effectiveness of ambulatory rehabilitation.