Pub Date : 2023-09-27DOI: 10.1007/s10309-023-00629-6
Ingo Borggraefe, Moritz Tacke, Mathias Kunz, Christian Vollmar, Jan Rémi
Abstract The mainstay of status epilepticus (SE) treatment is pharmacotherapy with anti-seizure medications (ASM). In refractory status epilepticus (RSE), when additional ASM are not effective, high-dose suppressive therapy with either benzodiazepines, thiopental, phenobarbitone, or propofol is used to suppress clinical and EEG seizure activity. However, in selected eligible cases of RSE or in super-refractory cases, epilepsy surgery may be the treatment of choice to terminate SE. Here, we review epilepsy surgery including deep brain stimulation (DBS) for treatment for RSE with emphasis on special aspects of presurgical evaluation, patient selection, and outcome. We focus on surgical treatment options for patients in the acute phase of RSE, who have received high-dose suppressive therapy prior to surgery in the majority of the cases.
{"title":"Epilepsiechirurgie beim therapierefraktären Status epilepticus des Kindesalters","authors":"Ingo Borggraefe, Moritz Tacke, Mathias Kunz, Christian Vollmar, Jan Rémi","doi":"10.1007/s10309-023-00629-6","DOIUrl":"https://doi.org/10.1007/s10309-023-00629-6","url":null,"abstract":"Abstract The mainstay of status epilepticus (SE) treatment is pharmacotherapy with anti-seizure medications (ASM). In refractory status epilepticus (RSE), when additional ASM are not effective, high-dose suppressive therapy with either benzodiazepines, thiopental, phenobarbitone, or propofol is used to suppress clinical and EEG seizure activity. However, in selected eligible cases of RSE or in super-refractory cases, epilepsy surgery may be the treatment of choice to terminate SE. Here, we review epilepsy surgery including deep brain stimulation (DBS) for treatment for RSE with emphasis on special aspects of presurgical evaluation, patient selection, and outcome. We focus on surgical treatment options for patients in the acute phase of RSE, who have received high-dose suppressive therapy prior to surgery in the majority of the cases.","PeriodicalId":500484,"journal":{"name":"Clinical Epileptology","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135580048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.1007/s10309-023-00627-8
Isabelle Arnet, Fine Dietrich, Stephan Rüegg, Samuel S. Allemann
Abstract Background One important cause of epileptic treatment failure and emergency department visits is due to non-adherence. Medication adherence is a complex behavior that describes the association between recommended and actual medicine use. Numerous modifiable and unmodifiable factors may affect medication adherence in patients with epilepsy. Other factors, such as pharmacogenetics, need to be considered and may provide opportunities in the future treatment of epilepsy. Method We present the case of a patient with newly diagnosed epilepsy and sub-therapeutic levels for antiseizure medication due to suspected non-adherence. We delineate the main challenges while elucidating the reasons for unmet seizure control, and suggest interventions for adherence management. Results In the case of unmet therapeutic goals, distinguishing non-response, pharmacoresistance, and non-adherence remains a challenge. We suggest first double-checking therapy-related factors (interaction, contra-indication) and adapting them. Then, behavior-related reasons should be elucidated depending on the treatment phase (initiation, implementation, persistence). Improving adherence through modifiable factors targets forgetfulness, medication management, beliefs/concerns, and costs. The intervention should be tailored to the modifiable factors. Pharmacogenetic tests can be used to predict how an individual may respond to a specific pharmacotherapy, but only in specific situations and in combination with other information. Conclusion Non-adherence should be considered as a common cause of epileptic treatment failure. We recommend elucidating the modifiable reasons systematically alongside therapeutic and behavioral factors.
{"title":"Non-adherence and epileptic emergency—reasons and solutions","authors":"Isabelle Arnet, Fine Dietrich, Stephan Rüegg, Samuel S. Allemann","doi":"10.1007/s10309-023-00627-8","DOIUrl":"https://doi.org/10.1007/s10309-023-00627-8","url":null,"abstract":"Abstract Background One important cause of epileptic treatment failure and emergency department visits is due to non-adherence. Medication adherence is a complex behavior that describes the association between recommended and actual medicine use. Numerous modifiable and unmodifiable factors may affect medication adherence in patients with epilepsy. Other factors, such as pharmacogenetics, need to be considered and may provide opportunities in the future treatment of epilepsy. Method We present the case of a patient with newly diagnosed epilepsy and sub-therapeutic levels for antiseizure medication due to suspected non-adherence. We delineate the main challenges while elucidating the reasons for unmet seizure control, and suggest interventions for adherence management. Results In the case of unmet therapeutic goals, distinguishing non-response, pharmacoresistance, and non-adherence remains a challenge. We suggest first double-checking therapy-related factors (interaction, contra-indication) and adapting them. Then, behavior-related reasons should be elucidated depending on the treatment phase (initiation, implementation, persistence). Improving adherence through modifiable factors targets forgetfulness, medication management, beliefs/concerns, and costs. The intervention should be tailored to the modifiable factors. Pharmacogenetic tests can be used to predict how an individual may respond to a specific pharmacotherapy, but only in specific situations and in combination with other information. Conclusion Non-adherence should be considered as a common cause of epileptic treatment failure. We recommend elucidating the modifiable reasons systematically alongside therapeutic and behavioral factors.","PeriodicalId":500484,"journal":{"name":"Clinical Epileptology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134911968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-14DOI: 10.1007/s10309-023-00618-9
O. Kukhlenko, R. Kukhlenko, C. Tempelmann, O. Speck, H. Hinrichs, H.-J. Heinze, M. Heers, P. M. House, F. G. Woermann, S. Knake, H. Urbach, H.-J. Huppertz, A. Haghikia, F. C. Schmitt
Abstract The diagnostic yield of magnetic resonance imaging (MRI) postprocessing using 7‑T data for patients with nonlesional epilepsy has been rarely evaluated, but has shown acceptable diagnostic outcomes. However, to date there have been no prospective clinical studies comparing MP2RAGE sequences in 3‑T and 7‑T MRI in parallel using the same protocol for morphometric analysis. We present a study protocol developed to address the hypothesis that application of 7‑T structural MRI increases the rate of detection of structural lesions with morphometric analysis when compared with parallel coherent study protocols in 3‑T MRI. The 7‑T MRI study protocol is designed to supply data showing the clinical practicability and proof of principle for increasing the detection rate of subtle epileptogenic lesions.
磁共振成像(MRI)后处理使用7‑T数据对非病变性癫痫患者的诊断率很少评估，但已显示出可接受的诊断结果。然而，到目前为止，还没有前瞻性临床研究将MP2RAGE序列在3 - T和7 - T MRI中平行比较，使用相同的方案进行形态计量学分析。我们提出了一项研究方案，旨在解决与3 - T MRI平行连贯研究方案相比，7 - T结构MRI的应用增加了形态计量学分析对结构性病变的检出率这一假设。7‑T MRI研究方案旨在提供显示临床实用性的数据，并证明提高细微癫痫性病变检出率的原理。
{"title":"Study protocol: value of 7-T MRI with prospective motion correction and postprocessing for patients with nonlesional epilepsy","authors":"O. Kukhlenko, R. Kukhlenko, C. Tempelmann, O. Speck, H. Hinrichs, H.-J. Heinze, M. Heers, P. M. House, F. G. Woermann, S. Knake, H. Urbach, H.-J. Huppertz, A. Haghikia, F. C. Schmitt","doi":"10.1007/s10309-023-00618-9","DOIUrl":"https://doi.org/10.1007/s10309-023-00618-9","url":null,"abstract":"Abstract The diagnostic yield of magnetic resonance imaging (MRI) postprocessing using 7‑T data for patients with nonlesional epilepsy has been rarely evaluated, but has shown acceptable diagnostic outcomes. However, to date there have been no prospective clinical studies comparing MP2RAGE sequences in 3‑T and 7‑T MRI in parallel using the same protocol for morphometric analysis. We present a study protocol developed to address the hypothesis that application of 7‑T structural MRI increases the rate of detection of structural lesions with morphometric analysis when compared with parallel coherent study protocols in 3‑T MRI. The 7‑T MRI study protocol is designed to supply data showing the clinical practicability and proof of principle for increasing the detection rate of subtle epileptogenic lesions.","PeriodicalId":500484,"journal":{"name":"Clinical Epileptology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135214694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-07DOI: 10.1007/s10309-023-00586-0
Iciar Sanchez-Albisua
Abstract This article provides an overview of the management of children with disorders of consciousness. Rapid diagnostics are necessary to identify treatable etiologies and minimize neurological sequelae. The differential diagnosis is extensive. Brief neurological findings include quantification of impaired consciousness using the Glasgow Coma Scale (GCS), testing of the eyes, motor function, and the presence of meningism. Laboratory tests include rapid exclusion of hypoglycemia and, if CNS infection is suspected, CSF examination. An emergency head CT is mandatory in cases of nonreactive unilateral or bilateral pupils before further diagnostic work-up is carried out. We recommend head MRI, especially if encephalitis, vasculitis, ischemic stroke, and sinus vein thrombosis are suspected. An EEG rarely provides clues to the cause of coma but it serves primarily as an objective measure of the severity of encephalopathy, the prognosis, and the effectiveness of therapy.
{"title":"Bewusstseinsstörung auf der pädiatrischen Intensivstation: Ätiologie und Diagnostik – Englische Version","authors":"Iciar Sanchez-Albisua","doi":"10.1007/s10309-023-00586-0","DOIUrl":"https://doi.org/10.1007/s10309-023-00586-0","url":null,"abstract":"Abstract This article provides an overview of the management of children with disorders of consciousness. Rapid diagnostics are necessary to identify treatable etiologies and minimize neurological sequelae. The differential diagnosis is extensive. Brief neurological findings include quantification of impaired consciousness using the Glasgow Coma Scale (GCS), testing of the eyes, motor function, and the presence of meningism. Laboratory tests include rapid exclusion of hypoglycemia and, if CNS infection is suspected, CSF examination. An emergency head CT is mandatory in cases of nonreactive unilateral or bilateral pupils before further diagnostic work-up is carried out. We recommend head MRI, especially if encephalitis, vasculitis, ischemic stroke, and sinus vein thrombosis are suspected. An EEG rarely provides clues to the cause of coma but it serves primarily as an objective measure of the severity of encephalopathy, the prognosis, and the effectiveness of therapy.","PeriodicalId":500484,"journal":{"name":"Clinical Epileptology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135409297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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