Status Epilepticus in Children

Status epilepticus (SE) is an acute, one of the most common, life threatening emergency condition in children and adolescence. According to the ILAE commission, SE is defined as a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures. Regarding duration, ILAE defines convulsive SE as bilateral tonic–clonic lasting longer that 5 minutes, and absence and focal status epilepticus as exceeding 10 minutes. Children compared to adults are more prone to epileptic seizures and as a consequence to SE, mainly due to age related maturational imbalance between excitatory and inhibitory synaptic mechanisms. The classification into generalised or focal, convulsive and nonconvulsive differ widely in aetiology, management and outcome. Early prehospital intervention with appropriate protective measures and emergency medication of seizure disorder, may prevent perpetuation of seizure recurrence. If first line treatment fails and or event, emergency hospital admission should be provided for more aggressive intravenous therapy, assessment-support

Advances in the Treatment of Status Epilepticus

The management of status epilepticus (SE) emphasizes early identification, support of vital functions, quick implementation of pharmacotherapy, and recognition of acute etiologies. Prompt administration of a benzodiazepine, often followed by an intravenous antiseizure medication, has been supported by multiple high-quality studies. SE evolving into a refractory stage may require the initiation of anesthetic agents, such as midazolam or propofol. The contribution of autoimmune encephalitis to the burden of refractory SE cases has led to the introduction of immune-modulatory agents, such as steroids and IVIG, in the treatment protocols for refractory SE appearing de novo without prior history of epilepsy. This chapter summarizes the pharmacological agents proposed in the treatment of SE and the stepped approach to their implementation

Periodic EEG Patterns in the Intensive Care Unit (ICU): Definition, Recognition and Clinical Significance

Periodic electroencephalographic (EEG) patterns are frequently recorded during ICU EEG monitoring in patients with altered mental status; these EEG features represent electrical discharges, ictal in appearance, occuring at regular intervals. They are known as lateralized periodic discharges (LPDs), bilateral independent periodic discharges (BIPDS), generalized periodic discharges (GPDs), continuous 2/s GPDs with triphasic morphology or triphasic waves (TWs) and Stimulus Induced Evolving Lateralized Rhytmic delta activity or Si-Evolving LRDA (previously SIRPIDS); other periodic, rhythmic patterns are Occasional frontally predominant brief 2/s GRDA (FIRDA previously), Lateralized rhythmic delta activity (LRDA) and Brief potentially ictal rhythmic discharges or B (I)RDs. The role of most (not all) of these EEG patterns is controversial; there is no consensus on which patterns are associated with ongoing seizure injury, which patterns need to be treated, and how aggressively they should be treated. Many authors consider these patterns as an unstable state on an ictal-interictal EEG continuum; the aim of the present chapter is to gain knowledge of these EEG features, show their association with known neurologic pathologies/syndromes and finally how to manage them