A pragmatic approach to intravenous anaesthetics and electroencephalographic endpoints for the treatment of refractory and super-refractory status epilepticus in critical care
Status epilepticus is a common neurological emergency, with overall mortality around 20%. Over half of cases are first time presentations of seizures. The pathological process by which spontaneous seizures are generated arises from an imbalance in excitatory and inhibitory neuronal networks, which if unchecked, can result in alterations in intracellular signalling pathways and electrolyte shifts, which bring about changes in the blood brain barrier, neuronal cell death and eventually cerebral atrophy.
We present a case report of a female with severe generalized gingival fibromatosis and hypertrichosis which was treated by conventional gingivectomies under local anesthesia. Postoperative healing was uneventful with a marked improvement in patient's appearance and oral hygiene.
EPILEPSY IS a generic term referring to a condition characterized by recurrent unprovoked seizures.1 The management of epilepsy in the perioperative period is closely related to the management of antiepileptic drugs (AEDs). Of the commonly used AEDs, the perioperative management of phenytoin presents a challenge because of its unique pharmacokinetic properties. Phenytoin binds to neuronal voltage-gated sodium channels while in their inactive state to increase their duration of inactivity. This translates into a reduction in the frequency with which neurons can propagate action potentials.
This article discusses the peri-operative considerations of multiple anti-epileptic medications, recent advances in anesthetic management, and important post-operative concerns.
In this report is described a case of West Syndrome patient affected by multiple caries, gingival enlargement, dental eruption abnormalities, high-arched palate and Molar Incisors Hypomineralization, treated at the dental clinic of University of Bari "Aldo Moro". DISCUSSION: West patients present with multiple oral abnormalities, including altered eruption timing, teeth agenesis, teeth shape and position abnormalities, plaque and calculus accumulation, malocclusions and bad oral habits (mouth breathing, nails biting). West Syndrome patients' oral hygiene is generally bad due to their motor difficulty and to ...
Publication date: Available online 8 November 2019Source: Epilepsy &BehaviorAuthor(s): Sara HockerAbstractThe epidemiology of status epilepticus (SE) and predictors of outcome in particular have been well described with consistent findings around the world. Understanding of the actual causes of death in patients hospitalized with SE is limited. The following is a summary of published information about causes of death in patients hospitalized with SE and a reconciling of conflicting studies examining the influence of continuous intravenous anesthetic drugs on the mortality of SE. A recently published paper was presented...
Status epilepticus (SE) represents a neurological emergency that requires urgent treatment and rapid escalation of care if symptoms do not subside within a short time from onset . The progression to Refractory Status Epilepticus (RSE) is reported in 40% of SE cases (Rossetti and Lowenstein. 2011), often requiring intravenous anaesthetic treatment (IVAT) and critical care admission . RSE, though, still associates with substantial morbidity and mortality [3 –5].
Abstract The epidemiology of status epilepticus (SE) and predictors of outcome in particular have been well described with consistent findings around the world. Understanding of the actual causes of death in patients hospitalized with SE is limited. The following is a summary of published information about causes of death in patients hospitalized with SE and a reconciling of conflicting studies examining the influence of continuous intravenous anesthetic drugs on the mortality of SE. A recently published paper was presented at the Colloquium and is summarized here, along with new data addressing an audience questi...
This article presents a super obese patient (BMI 57 kg/m2) with drug-refractory epilepsy and obstructive sleep apnea who underwent left anterior temporal lobectomy through awake craniotomy to preserve language and memory, using warmed humidified high flow nasal cannula (HFNC) oxygen therapy. Awake craniotomy was facilitated by the use of HFNC, which proved essential to prevent airway collapse by creating continuous positive airway pressure through high flow and facilitated intraoperative neurologic language and memory testing while maintaining adequate oxygenation. PMID: 31686115 [PubMed - as supplied by publisher]
This article is part of the Special Issue “Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures”.
This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures". PMID: 31676239 [PubMed - as supplied by publisher]