Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Status Epilepticus

 

Análisis Clínico y Evolutivo de Pacientes Con Estado Epiléptico Refractario Acorde el Esquema de Tratamiento de Tercera Línea Utilizado. Clinical And Outcome Analysis Of Patients With Refractory Status Epilepticus According To The Third-Line Treatment Scheme Used

Introduction: The evidence available in the treatment of refractory status epilepticus (RSE) is limited.
Objective: Evaluate the clinical and outcome factors in patients with refractory status epilepticus (RSE) according the third line treatment used (midazolam-MDL and/or propofol-PRO).

Methods: Retrospective cohort study included 34 patients treated by RSE during November 2015 to June 2018.Variables: Age, severity and etiology of RSE, pretreatment level of consciousness, anesthetic drugs (MDL-PRO), outcome at hospital discharge and 3 months according Rankin score.

Results: Mean of age of the patients was 51.21±22.3 years and 32.4% (11) had previous history of epilepsy. Super RSE (SSRE) was diagnosed in 35.3% (12) of sample. Mortality reached up 50% of patients and extended to 55.9% at 3 months. Patients treated with MDL had higher rate of vasopressor needs (71.4% vs 50.0%) and the group who received a scheme of combined treatment MDL-PRO included mainly a SSRE patients (p≤0.01), higher rate of tracheostomy (p=0.03), vasopressor drugs (p=0.01) and diminished dosage of anesthetic drugs (p=0.05). Surveillance analysis according Kaplan Meier curve did not found significant differences at 3 months in survival rate between groups. MDL vs PRO (Log Rank=0. 17), MDL vs MDL-PRO (Log Rank=0. 49) y PRO vs MDL-PRO (Log Rank=0. 48).

Conclusion: Patients with RSE had a high mortality, without evidence of increase of mortality in groups according anesthetic drugs used and schemed of treatment applied.

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Palabras clave: Coma terapéutico inducido, Estatus epiléptico, Estatus Epiléptico refractario, Midazolam, Propofol,

Keywords: Induced therapeutic coma, Midazolam, Propofol, Refractory status Epilepticus, Status Epilepticus,

Estado Epiléptico Refractario de Aparición Reciente (NORSE): Revisión y actualización. New-Onset Refractory Status Epilepticus (NORSE): Review and Update

The New-Onset Refractory Status Epilepticus (NORSE) is a rare entity that is defined as a clinical presentation, in a patient without active epilepsy or other relevant neurological disorder, who presents a refractory status epilepticus (RSE) without an acute or active structural, toxic, or metabolic cause. NORSE constitutes a diagnostic challenge that implies high morbidity and mortality in the short and long term. Clinically, NORSE is characterized by a prodromal phase, an acute phase, where seizures with diverse semiology that evolve to an RSE occur, and a chronic phase, with neurological deterioration and drug-resistant epilepsy. After an extensive work-up, the cause of NORSE is identified in only half of the cases. The initial treatment is based on the use of conventional anti-seizure drugs, requiring most of patients the use of anesthetics and mechanical ventilation. Better results have been observed with immunotherapy, more recently with anti-cytokine drugs, such as tocilizumab and anakinra, consistent with the immunological/inflammatory mechanisms proposed for the pathophysiology of NORSE.

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Palabras clave: diagnóstico, estado epiléptico, Estado epiléptico refractario de aparición reciente, fisiopatología, Tratamiento,

Keywords: diagnosis, New-onset refractory status epilepticus, physiopathology, Status Epilepticus, Treatment,

Discapacidad asociada a manifestaciones neurológicas de COVID-19. Disability associated with COVID-19’s neurological manifestations

Introduction: COVID-19 is mainly a respiratory illness, however, with an incidence in nearly a third of patients of neurological manifestations secondary to affection to the central or peripheral nervous system, used to be more frequent in severe illness, having a wide range of disability and mortality.

Clinical case: We present the clinical case of a 39 years old female ,previously healthy, with diagnosis of COVID-19, initiating her illness with encephalitis and status epilepticus, posteriorly longitudinally extensive myelitis and anoxic-ischemic encephalopathy, which, despite of opportune diagnosis and treatment, she had a poor outcome developing persistent vegetative state.

Conclusions: COVID-19’s neurological manifestations could lead to a high risk of disability and mortality, needing an opportune detection and treatment, with a high suspicion of encephalitis and status epilepticus in patients with decrease of alertness and focal motor symptoms.

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Palabras clave: COVID-19, Discapacidad, encefalitis, estado epiléptico, Manifestaciones neurológicas, Mielitis,

Keywords: COVID-19, Disability, encephalitis, myelitis, neurological manifestations, Status Epilepticus,

Epilepsia Como Factor Pronóstico de Refractariedad y Funcionalidad en Estado Epiléptico en Pacientes Mexicanos. Epilepsy As Prognostic Factor Of Refractoriness And Functionality In Status Epilepticus In Mexican Patients.

Introduction: Status epilepticus is a medical condition which could lead to a great disability and be mortal. Background of epilepsy could prevent a progression to a refractory status epilepticus and predict a good functional prognosis. Nevertheless, in Mexican population there are no studies about that.

Materials and methods: An observational, analytic, retrospective, cohort study was performed with patients with status epilepticus in Specialities Hospital of “Siglo XXI” National Medical Center, in Mexico. It was evaluated the probability of presenting refractory status epilepticus and a good functional outcome in patients with a background of epilepsy, performing Pearson Chi-square.

Results: 40 patients with status epilepticus were included, 32 with refractory status epilepticus and 14 with a background of epilepsy. The probability of presenting a refractory status epilepticus with a background of epilepsy was OR 1.29 (p 0.53), and for a good functional outcome was OR 3.63 (p 0.10).

Conclusions: Background of epilepsy is not a protective factor for preventing the progression to a refractory status epilepticus, neither a factor for predicting a good functional outcome in our study with Mexican population. Nevertheless, further studies with a bigger sample are needed in order to prove these results.

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Palabras clave: Epilepsia, estado epiléptico, factor de riesgo, funcionalidad, Pronóstico, refractariedad,

Keywords: Epilepsy, functionality, Prognosis, refractoriness, risk factor, Status Epilepticus,

Estatus Epiléptico. Factores Asociados a Una Evolución Desfavorable en un Centro Terciario. Status Epilepticus. Prognostic Variables For An Unfavorable Outcome In A Tertiary Center Of Care.

Introduction. Status Epilepticus (SE) is a frequent neurologic emergency. Little research has been done in South America to evaluate the prognostic variables of mortality and disability in patients with SE. Objective. To determine the variables associated to an unfavorable outcome at hospital discharge in the patients who were treated for SE. Methods. A retrospective study was performed during the period of January 2016–June 2017. A total of 26 patients were diagnosed of SE and its different variants. The effects of clinical, radiological, and electroencephalographic features on hospital outcome according Rankin scale were evaluated  Results. Twelve (46.2%) patients had an unfavorable outcome at hospital discharge, while the mortality rate reached 23.1%. There was a predominance of males with a 76.9% of all the patients. The independent variables associated with an unfavorable outcome were the number of comorbidities (p=0.01, OR: 4.27-95%CI1.33-13.6), structural lesions on the Magnetic Resonance Image (MRI) (p=0.04, OR: 3.92-95%CI1.05-14.61) and refractory SE (p=0.01, OR: 12.52-95%CI1.85-84.44). There was also a trend for age (p=0.07 OR: 1.03-95%CI0.99-1.07). While an initial good clinical condition, according to the Glasgow Scale represent a protective factor (p=0.00 OR: 0.49-IC95% 0.29-0.84) of an unfavorable outcome. Conclusions. The unfavorable outcome was marginally associated with patient age, clinical status at the onset of SE according to the Glasgow Coma Scale, as well as brain lesions on brain MRI. Refractory SE and more than 4 comorbidities are predictors of an unfavorable outcome at hospital discharge.

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Palabras clave: Discapacidad, Epilepsia, Estatus epiléptico, Estatus Epiléptico refractario, Mortalidad,

Keywords: Disability, Epilepsy, Mortality, outcome, Refractory status Epilepticus, Status Epilepticus,

Estatus Epiléptico en Colombia: Análisis Descriptivo de Serie de Casos. Status Epilepticus In Colombia: A Case Series Descriptive Analysis.

Status Epilepticus (SE) is a neurological emergency that is by itself a syndrome defined according its clinical presentation and electroencephalographical manifestations, both highly variable. There aren’t any case series about this relatively common neurological emergency in Colombian indexed journals, for which a search for cases was performed in two neurological critical care institutions in the Colombian capital city in the period between 2011-2015. We describe demographical, diagnostic and therapeutic characteristics emphasizing in its clinical and paraclinical presentation, as the treatment applied according international guidelines. We found convulsive SE was three times more common that the non-convulsing time, 1.4 times more common in females that in males, more common in the pediatric group and less common in the geriatric group, the majority of this cases presented SE secondary to a congenital structural injury while adult and elder patients presented SE as a consequence of non-voluntary discontinuation of the therapy, and in 66% of the cases the SE described was not the first of its kind. The therapeutic regime applied corresponded to the stipulated in international guidelines in only 41.67%.

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Palabras clave: Electroencefalografía, Epilepsia, Estatus epiléptico, serie de casos,

Keywords: Case series, Electroencephalography, Epilepsy, Status Epilepticus,
 
 
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