Generalized convulsive status epilepticus (SE) is a serious and potentially life- threatening medical emergency that requires prompt intervention. Sociedade Brasileira de Pediatria. Published Diretriz. Protocolos de manejo de estado de mal epiléptico no pronto socorro pediátrico. El estado epiléptico convulsivo o tónico-clónico es una complicación http:// portal7.info%20estrategico%portal7.info
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2 Departamento de Pediatría Campus Norte, Facultad de Medicina, El estado epiléptico es una emergencia de alta morbimortalidad que requiere manejo. Las convulsiones tonicoclónicas y el estado convulsivo epiléptico (actualmente se define como una convulsión tonicoclónica que dura al menos 30 minutos). Manejo del status epilepticus. 5 min. 30 min. Pre. Hospitalario. Unidad de Cuidados intensivos. Departamento emergencia. Diazepam. IR. Lorazepam IV.
Zalan Khan1; Pradeep C. Introduction Epilepsia partialis continua EPC is a rare brain disorder where a patient experiences recurrent and, sometimes, unrelenting focal onset seizures with retained awareness occurring over hours, days, or even years. The pathophysiology of the disease is understood to be complicated. The disease can manifest in a variety of forms such as myoclonic epilepsy, localized myoclonus, Jacksonian epilepsy, and sensorimotor clonic seizures to name a few. Both cortical and subcortical mechanisms have been identified as an etiology.
Neuronal cell loss, astrogliosis, and blood-brain barrier damage brought on by these cytokines may contribute to the underlying hyperexcitability of the cortex. Classically, EPC presents as a focal form of status epilepticus SE with a preserved consciousness that is restricted to one part of the body, occurring for one hour or more, recurrent, and associated with postictal confusion and weakness.
Motor deficits ranging from quadriparesis to subtle soft palate paresis may be noted. Sensory deficits, similarly, are variable but are less common compared to their motor counterparts.
The involvement of the upper extremities is more common. Imaging MRI findings can help in delineating structural lesions.
Focal cortical dysplasia and Rasmussen encephalitis, two common causes of EPC, are more likely to be identified on MRI because of the advancements in imaging quality and technology in recent years. Standard imaging modalities used during neurological workups, such as computed tomography CT and MRI scanning, may show no pathology.
Sometimes, asymmetrical background slowing is noted. Prognostic factors, morbidity and mortality in tonic—clonic status epilepticus: a review.
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Non—convulsive status epilepticus secondary to valproic acid—induced hyperammonemic encephalopathy. Acta Neurol Scand. Propofol treatment in adult refractory status epilepticus.
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A malignant variant of status epilepticus. Urgent, resective surgery for medically refractory, convulsive status epilepticus. Eur J Paediatr Neurol. Efficacy of anti—inflammatory therapy in a model of acute seizures and in a population of pediatric drug resistant epileptics.
PLoS One ; e Basic mechanisms of status epilepticus due to infection and inflammation. Magnesium treatment for patients with refractory status epilepticus due to POLG1—mutations. The ketogenic diet for medically and surgically refractory status epilepticus in the neurocritical care unit.
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Ann Neurol. For every child requiring rescue medication a clear link must be established, ideally through an epilepsy specialist nurse or equivalent, between the doctor who treats the child and the school. Every child with a history of prolonged convulsive seizures should have an individual healthcare plan put in place at his or her school. All the caregivers of a child at risk of suffering prolonged convulsive seizures must receive specific training in the use of rescue medication.
Empirical data are needed for a better understanding of the experience of children who have prolonged convulsive seizures in school, including the perspective of the children, parents and teachers. The need to administer rescue medication rapidly in order to avoid progression to status epilepticus and its complications must be brought to the attention of everyone involved in the chain of care for children with epilepsy, from the specialists who prescribe the rescue medication to all the settings in which children at risk may experience a prolonged convulsive seizure.
Having clear recommendations may make it easier for parents to convey their needs to schools and schools to be provided with the appropriate resources. This information must be an integral part of an overall effort to promote understanding of epilepsy in general. For example, the campaign entitled Conocer la epilepsia nos hace iguales Knowing about epilepsy makes us equal , which was launched in and has reached over 25, children in schools all over Spain, has contributed to fostering awareness of epilepsy in schools and has provided guidance on what to do in the event of a convulsive seizure occurring in school.
However, the campaign does not make specific reference to prolonged convulsive seizures or to their treatment. Providing parents with rescue medication reduces their fears for the safety of their children, and administering treatment at home, as well as limiting the morbidity of prolonged seizures, may reduce ambulance calls, emergency department visits, and hospital admissions, with the resulting decrease in costs.
In the benchmark study by Alldredge et al. However, the prescription of emergency treatment cannot be indiscriminate and must be limited to children with an objective risk of prolonged convulsive seizures.
A history of prolonged seizures is the main risk factor, and the United Kingdom NICE guidelines limit the prescription of rescue medication to children who have had a previous episode. Rectal administration and the need to undress the child make many teachers uncomfortable and represent an additional limitation to achieving appropriate emergency treatment in schools.
Perhaps the reluctance of schools to administer rescue medication may be partly solved by the availability of benzodiazepines that are easy to administer and socially acceptable, such as buccal or intranasal midazolam, which are preferred by patients and their caregivers.
Achieving this requires collaboration between the healthcare and education systems, and the existing care protocols are a first step towards that objective. Extending the principles of the non-binding parliamentary resolution on integration of children with diabetes into schools to children with epilepsy requiring rescue medication would represent an important step forward for this vulnerable group of children.
Conflicts of interest M. Raspall-Chaure, A.