Stop the Status: Improving Outcomes in Pediatric Epilepsy Syndromes. Michelle Welborn, PharmD ICE Alliance
|
|
- Edmund Henry
- 5 years ago
- Views:
Transcription
1 Stop the Status: Improving Outcomes in Pediatric Epilepsy Syndromes Michelle Welborn, PharmD ICE Alliance
2 Overview Seizures and Epilepsy Syndromes Seizure Emergencies Febrile Seizures Critical Population for Treatment of Community Based Seizure Emergencies: Epilepsy syndromes in children
3 Seizure Epilepsy Syndrome Facts 2.5 million Americans have epilepsy (defined as 2 or more unprovoked seizures) Children with epilepsy syndromes represent about 15% of the childhood epilepsy population About ½ of the epilepsy syndromes in children are considered catastrophic, drug resistant, and prone to status epilepticus There are approximately 150,000 cases of status epilepticus (seizure > 30 minutes) each year in the US; most cases occur in children 2 and under and the elderly The children with catastrophic epilepsy syndromes often have status epilepticus multiple times per week Epilepsy Foundation of America.: Pellock JM. Hosp Med. 1999;60: DeLorenzo RJ, et al. Epilepsia. 1999;40: Begley CE, et al. Epilepsia. 2000;41:
4 Seizure and Epilepsy Syndrome Facts While most seizures are brief and self-limiting, if a seizure lasts >5 minutes, it is likely to be prolonged and raises the risk of status epilepticus. Status epilepticus is a seizure emergency with a 20% mortality rate at 30 minutes and 40% mortality rate at 2 hours. The longer a seizure lasts, the greater the risk of morbidity and mortality, including permanent neuronal damage leading to developmental delays, behavioral abnormalities, and probability of the need for life-long care. There is an unmet need in the US for community-based treatment of prolonged seizures and status epilepticus. Fulfilling this unmet need will decrease morbidity and mortality of children with epilepsy syndromes. Epilepsy Foundation of America.: Pellock JM. Hosp Med. 1999;60: DeLorenzo RJ, et al. Epilepsia. 1999;40: Begley CE, et al. Epilepsia. 2000;41:342-35
5 Seizure Emergency Definitions Status Epilepticus Operational Definition is seizure duration of 5 minutes or longer. Seizures that last 5 minutes should be treated. Convulsive Status Epilepticus occurs when seizure last 30 minutes or longer OR patient has 2 or more seizures without full recovery between seizures. Acute Repetitive Seizures are multiple seizures within 24 hours for adults (12 hours for children) despite optimal therapy and recognizable by the patient s caregiver as distinguishable from other seizures. Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children last? Ann Neurol 2001;49(5): Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med 1998;338: Mitchell WG Status Epilepticus and Acute Serial Seizures in Children. J Ch Neur 2002;17:S36.
6 Types of Seizure Emergencies Seizure Duration Most Seizures: <1min Usual Prolonged: >5min Unusual Prolonged SE: >30 min SE RSE HRSE > ARS:. Cluster/12-24hrs Usual ARS ARS ARS ARS 1-2 min 2-4 min 5-29 min min 2 hrs hrs hrs Lowenstein DH, Bleck T, Macdonald RL: It s time to revise the definition of status epilepticus. Epilepsia 1999, 40: Mitchell WG Status Epilepticus and Acute Serial Seizures in Children. J Ch Neur 2002;17:S36. 5
7 Who Is at Risk for Seizure Emergencies? Patient History Unstable AED Levels Situational Triggers Acute repetitive seizures Early-onset epilepsy Developmental disabilities Neurologic illnesses or injuries Frequent seizure emergencies Pediatric seizure syndromes and encephalopathies 42% have history of epilepsy 5% of patients with refractory epilepsy have repeat prolonged seizures or SE Treatment noncompliance Missed doses Irregular physician visits Changes to chronic AED therapy Drug-drug interaction/enzyme induction Variations in generic drug formulations may affect blood levels Illness Hormonal changes Travel Stress or anxiety Disruption of sleep patterns Fatigue AED=Antiepileptic drug. Kwan P, Brodie MJ. N Engl J Med. 2000;342: Devinsky O. N Engl J Med. 1999;340: Ramsay RE, et al. J Child Neurol. 2007;22(suppl):53S-60S. Mitchell WG. Epilepsia. 1996;37(suppl 1):S74-S80. Jones RM, et al. Seizure. 2006;15: Patsalos PN, et al. Epilepsia. 2002;43: Kramer G, et al. Epilepsy Behav. 2007;11: Epilepsy Foundation of America. Accessed March 17, Trevorrow T. Seizure 2006;15:
8 Morbidity and Mortality of Status Epilepticus: Every Minute Counts For each minute delay from start of convulsive status epilepticus (seizure lasting five minutes) to time patient arrives at emergency department (ED), there is a 5% added cumulative risk that the seizure will last > 60 minutes. In one prospective study, arrival at ED 40 minutes after onset of convulsive status epilepticus irrespective of pre-hospital treatment with rectal diazepam was associated with a 4.3x increased risk of seizure lasting > 60 minutes compared to arrival at ED within 10 minutes. Delaying treatment with a benzodiazepine causes resistance to benzodiazepine treatment through internalization of benzodiazepine receptors as seizure length increases, making it harder to stop a seizure as time goes on. Chin R et al. Treatment of community onset childhood convulsive status epilepticus: a prospective population based study. LanNeur 2008:7(8): Abend N et al. Medical treatment of pediatric status epilepticus; SemPedNeur2010;173:
9 Delayed Medical Treatment for Status Epilepticus in the US Leads to Increased Morbidity and Mortality Pellock J. J Child Neurol. 2007;22(suppl):9S-13S 8
10 Delayed Medical Treatment for Status Epilepticus in the US Leads to Increased Morbidity and Mortality Community based treatment of children with epilepsy syndromes is imperative, as morbidity and mortality from seizures increases proportionately to time lapse from seizure onset An 85 minute average time to medical treatment from seizure onset is unacceptable in lifethreatening situations such as status epilepticus These children are chronically at high risk of death and brain damage
11 Mortality Associated with Prolonged Seizures and Status Epilepticus DURATION STAGE % INTERVENTIONS SETTING MORTALITY 0-2 min Seizure 100% Supportive measures Community <1% >2 min Prolonged 10% Benzodiazepine Com/Amb/ER <5% >30 min SE 5-7% 1st line: Benzodiazepine ER 10-20% 2nd line: Fosphenytoin/Phenytoin 3rd line: Phenobarbital/Valproate/ Levetiracetam 2 hours RSE 1-2% Continuous Infusion therapy ICU 40% Midazolam/Propofol/Pentobarbital >48 hours HRSE <1% Alternative Continuous Infusion Therapy ICU >60% Novel Therapeutic Options Working Group on Status Epilepticus. JAMA. 1993;270:
12 Potential for Neuronal Injuries Seizure Emergencies and Risk of Seizure Emergencies Recurrent, Unprovoked Seizures Isolated Seizures Prolonged Seizures Neuronal Injuries Acute Repetitive Seizures (ARS) * Seizure Duration Status Epilepticus Estimated to affect ,000 patients in the US Seizures persisting 5-10 minute rarely resolve spontaneously Efficacy of treatment including benzodiazepines decreases as seizure duration increases Early termination of prolonged or repetitive seizures is key to minimizing morbidity History of seizure clusters increases likelihood of experiencing status epilepticus * Also known as cluster, crescendo, multiple recurrent, serial, or sequential seizures. Figure adapted from Pellock J. J Child Neurol. 2007;22(suppl):9S-13S. Mitchell WG. Epilepsia. 1996;37(suppl 1):S74-S80. Shinnar S, et al. Ann Neurol. 2001;49: Cereghino JJ. Curr Treat Options Neurol. 2007;9: Working Group on Status Epilepticus. JAMA. 1993;270:
13 Morbidity of Status Epilepticus in Children Association with development of temporal lobe epilepsy 20-40% risk of developing epilepsy with status epilepticus as first seizure vs. 10% risk in first seizure lasting < 30 minutes Chronic encephalopathy and brain atrophy found in 6-15% of cases Focal neurologic signs in 9-11% of cases of children with SE Fountain N et al. Status Epilepticus: Risk Factors and Complications. Epilepsia, 41(Suppl. 2):S23-S30, Akiyama et al. Long term outcomes in adults with Dravet syndrome. Epilepsia Jun;51(6):
14 Morbidity and Mortality of Status Epilepticus in Children Retrospective and hospital based study concluded the major determinant of intelligence quotient (IQ) in children with generalized idiopathic epilepsy was a history of convulsive status epilepticus Prevention of recurrent episodes of SE are critical to long term seizure prevention and cognitive outcome in certain epilepsy syndromes, such as Dravet syndrome. In a study of 31 adults with Dravet syndrome, seizure freedom in adulthood was correlated to < 3 episodes of convulsive status epilepticus as a child 3-10% Akiyama et al. Long term outcomes in adults with Dravet syndrome. Epilepsia Jun;51(6): Singhi PD, Bansal U, Singhi S, Pershad D.(1992) Determinants of IQ profile in children with idiopathic generalized epilepsy. Epilepsi
15 Febrile Seizures Occurs in 2-4% of children in the US Approximately 25% of initial FS lasts more than 10 minutes and are considered complex 30-50% of patients with an initial FS will have a second FS Occurrence of a prolonged FS increases the risk of Epilepsy (30 % risk with prolonged seizure vs. 10% risk with seizure< 5 minutes) If a child with an initial prolonged FS experiences a second FS it is likely to be prolonged Pellock J. J Child Neurol. 2007;22(suppl):9S-13S.
16 Percent Cases With Duration t (time) Duration of Recurrent Seizure as a Function of Duration of Initial Seizure 50 First seizure 30 min (n = 25) First seizure 6 to 29 min (n = 42) First seizure 5 min (n = 115) Total n = Duration of Recurrent Seizure (min) Duration of second seizure highly correlated with duration of initial seizure (p<0.0001). Shinnar S, et al. Ann Neurol. 2001;49:
17 Morbidity in Febrile Status Epilepticus Relationship between prolonged febrile seizures and later temporal lobe epilepsy associated with mesial temporal sclerosis is important, because the incidence of epilepsy following a prolonged febrile seizure may potentially be reduced by stopping the seizure and/or using neuroprotective agents. Raspall-Chaure M, Chin RF, Neville BG, Scott RC. (2006) Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol 5:
18 Have A Plan Have a written plan to treat your child with a benzodiazepine such as rectal diazepam (Diastat) or buccal midazolam (Epistatus available in UK) to prevent status epilepticus If there are intravenous drugs that worsen seizures in your child (such as phenytoin or fosphenytoin in Dravet syndrome), these should be listed as contraindicated on the written plan Don t wait. The seizure should be stopped in under an hour for best outcome.
Lieven Lagae Department of Paediatric Neurology Leuven University Leuven, Belgium. Management of acute seizure settings from infancy to adolescence
Lieven Lagae Department of Paediatric Neurology Leuven University Leuven, Belgium Management of acute seizure settings from infancy to adolescence Consequences of prolonged seizures Acute morbidity and
More informationSeizure remission in adults with long-standing intractable epilepsy: An extended follow-up
Epilepsy Research (2010) xxx, xxx xxx journal homepage: www.elsevier.com/locate/epilepsyres Seizure remission in adults with long-standing intractable epilepsy: An extended follow-up Hyunmi Choi a,, Gary
More informationInappropriate emergency management of status epilepticus in children contributes to need for intensive care
1584 PAPER Inappropriate emergency management of status epilepticus in children contributes to need for intensive care R F M Chin, L Verhulst, B G R Neville, M J Peters, R C Scott... See end of article
More informationRefractory Status Epilepticus in Children: What are the Options?
Refractory Status Epilepticus in Children: What are the Options? Weng Man Lam, PharmD, BCPS, BCPPS PICU Clinical Pharmacy Specialist Memorial Hermann Texas Medical Center November 11, 2017 Objectives 1.
More informationOutline. What is a seizure? What is epilepsy? Updates in Seizure Management Terminology, Triage & Treatment
Outline Updates in Seizure Management Terminology, Triage & Treatment Joseph Sullivan, MD! Terminology! Videos of different types of seizures! Diagnostic evaluation! Treatment options! Acute! Maintenance
More informationNMDOH digital library; keywords searched: pre-hospital, benzodiazepine, emergency medical technician, treatment of seizures, status epilepticus.
Background Literature Review and Recommendations Administration of Benzodiazepines by EMT -I in the pre-hospital setting EMS Bureau Protocol Review Steering Committee Status epilepticus is a recognized
More informationEpilepsy in the Primary School Aged Child
Epilepsy in Primary School Aged Child Deepak Gill Department of Neurology and Neurosurgery The Children s Hospital at Westmead CHERI Research Forum 15 July 2005 Overview The School Age Child and Epilepsy
More informationB GÜRBÜZ, F GÜRBÜZ, A CAYIR, A DE. Key words. Introduction
HK J Paediatr (new series) 2016;21:79-85 Evaluation of Aetiological Causes, Clinical Features, Treatment and Prognosis in Patients Diagnosed with and Treated for Status Epilepticus: An Epidemiological
More informationStatus Epilepticus: Implications Outside the Neuro-ICU
Status Epilepticus: Implications Outside the Neuro-ICU Jeffrey M Singh MD Critical Care and Neurocritical Care Toronto Western Hospital October 31 st, 2014 Disclosures I (unfortunately) have no disclosures
More informationCrackCast Episode 18 Seizures
CrackCast Episode 18 Seizures Episode overview: 1) Define status epilepticus 2) List the doses of common medications used for status epilepticus 3) List 10 differential diagnoses for seizures 4) List 10
More informationEpilepsy. Seizures and Epilepsy. Buccal Midazolam vs. Rectal Diazepam for Serial Seizures. Epilepsy and Seizures 6/18/2008
Seizures and Epilepsy Paul Garcia, M.D. UCSF Epilepsy Epileptic seizure: the physical manifestation of aberrant firing of brain cells Epilepsy: the tendency to recurrent, unprovoked epileptic seizures
More informationFebrile seizures. Olivier Dulac. Hôpital Necker-Enfants Malades, Université Paris V, INSERM U663
Febrile seizures Olivier Dulac Hôpital Necker-Enfants Malades, Université Paris V, INSERM U663 olivier.dulac@nck.aphp.fr Definition Seizures precipitated by fever that is not due to an intracranial infection
More informationSimple Protocol & Bayesian Design: Established Status Epilepticus Treatment Trial (ESETT)
Simple Protocol & Bayesian Design: Established Status Epilepticus Treatment Trial (ESETT) Jaideep Kapur on behalf of ESETT invertigator University of Virginia Status epilepticus is a condition resulting
More informationTurning Up the Heat on the Impact of Febrile Status Epilepticus
Current Literature In Clinical Science Turning Up the Heat on the Impact of Febrile Status Epilepticus MRI Abnormalities Following Febrile Status Epilepticus in Children: The FEBSTAT Study. Shinnar S,
More informationSAGE-547 for super-refractory status epilepticus
NIHR Innovation Observatory Evidence Briefing: April 2017 SAGE-547 for super-refractory status epilepticus NIHRIO (HSRIC) ID: 10866 NICE ID: 8456 Status epilepticus is a single epileptic seizure lasting
More informationC O N F I D E N T I A L ASSESSMENT OF XXX EFFECTS ON RECURRENT SEIZURE ACTIVITY IN THE RAT PILOCARPINE MODEL
C O N F I D E N T I A L ASSESSMENT OF XXX EFFECTS ON RECURRENT SEIZURE ACTIVITY IN THE RAT PILOCARPINE MODEL 6 May 2015 This study was conducted under the terms of a Research Agreement between NeuroDetective
More informationStatus Epilepticus. Ednea Simon, MD Swedish Pediatric Neuroscience Center
Status Epilepticus Ednea Simon, MD Swedish Pediatric Neuroscience Center 1 Status Epilepticus Status epilepticus (SE) is a condition resulting either from failure of the mechanisms responsible for seizure
More informationabstract ARTICLE BACKGROUND AND OBJECTIVES: Convulsive seizures account for 15% of pediatric air transports.
Seizure Treatment in Children Transported to Tertiary Care: Recommendation Adherence and Outcomes Heather M. Siefkes, MD, MSCI, a, b Maija Holsti, MD, MPH, c Denise Morita, MD, d Lawrence J. Cook, PhD,
More informationCan Status Epilepticus Sometimes Just Be a Long Seizure?
Current Literature In Clinical Science Can Status Epilepticus Sometimes Just Be a Long Seizure? Unprovoked Status Epilepticus: The Prognosis for Otherwise Normal Children With Focal Epilepsy. Camfield
More information11/1/2018 STATUS EPILEPTICUS DISCLOSURE SPEAKER FOR SUNOVION AND UCB PHARMACEUTICALS. November is National Epilepsy Awareness Month
STATUS EPILEPTICUS ALBERTO PINZON, MD, MSBE, PhD November is National Epilepsy Awareness Month DISCLOSURE SPEAKER FOR SUNOVION AND UCB PHARMACEUTICALS 1 SEIZURE A transient occurrence of signs and/or symptoms
More informationResearch and Advances in Epilepsy. Preeti Puntambekar, MD, PHD Epileptologist Northeast regional epilepsy group
Research and Advances in Epilepsy Preeti Puntambekar, MD, PHD Epileptologist Northeast regional epilepsy group Epilepsy History Hippocrateson the sacred disease Galen Avicenna Middle ages Renaissance Paracelcus
More informationStatus Epilepticus: A refresher. Objectives
Status Epilepticus: A refresher Ruben D. Villanueva, Pharm.D., BCPS OU Medical Center Trauma ICU Pharmacist Objectives Define seizures, convulsive and non convulsive status epilepticus, and refractory
More informationThe fitting child. Dr Chris Bird MRCPCH DTMH, Locum consultant, Paediatric Emergency Medicine
The fitting child Dr Chris Bird MRCPCH DTMH, Locum consultant, Paediatric Emergency Medicine What I am not Detail from The Neurologist, Jose Perez The sacred disease Epilepsy comes from the ancient Greek
More informationCONVULSIONS - AFEBRILE
Incidence All Children require Management Recurrence Risk Indications for starting therapy Starting Anticonvulsant medication Criteria for Referral to Paediatric Neurology Useful links References Appendix
More informationRescue medications. What are rescue medications? Ideal rescue medication. Why use rescue medications?
Rescue medications Out-of-hospital treatment of prolonged seizures or acute repetitive seizures What are rescue medications? Medicines used to terminate a prolonged seizure or acute repetitive seizures
More informationManagement of Complex Febrile Seizures
Management of Complex Febrile Seizures An 13 month old girl presents to the ED after having a shaking episode at home. Mom describes shaking of both arms and legs, lasting 20 minutes. The child has no
More informationWhat do we know about prognosis and natural course of epilepsies?
What do we know about prognosis and natural course of epilepsies? Dr. Chusak Limotai, MD., M.Sc., CSCN (C) Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC) The Thai Red Cross Society First
More informationDravet syndrome : Clinical presentation, genetic investigation and anti-seizure medication. Bradley Osterman MD, FRCPC, CSCN
Dravet syndrome : Clinical presentation, genetic investigation and anti-seizure medication Bradley Osterman MD, FRCPC, CSCN Objectives Learn about the typical early clinical presentation of Dravet syndrome
More informationEvaluation and management of drug-resistant epilepsy
Evaluation and management of drug-resistant epilepsy Fateme Jahanshahifar Supervised by: Professor Najafi INTRODUCTION 20 to 40 % of patients with epilepsy are likely to have refractory epilepsy. a substantive
More informationEpilepsy and Epileptic Seizures
Epilepsy and Epileptic Seizures Petr Marusič Dpt. of Neurology Charles University, Second Faculty of Medicine Motol University Hospital Diagnosis Steps Differentiation of nonepileptic events Seizure classification
More informationFirst Line Therapy in Acute Seizure Management. William Dalsey, MD, FACEP
First Line Therapy in Acute Seizure Management Case Presentation A 32-year old male intravenous drug user was brought to the ED having had a witnessed generalized tonic-clonic seizure 10 minutes prior
More informationA Comparison of Buccal Midazolam and Intravenous Diazepam for the Acute Treatment of Seizures in Children
Original Article Iran J Pediatr Sep 2012; Vol 22 (No 3), Pp: 303-308 A Comparison of Buccal Midazolam and Intravenous Diazepam for the Acute Treatment of Seizures in Children Seyed-Hassan Tonekaboni 1,2,
More informationMidazolam for seizures: Buccal administration
Midazolam for seizures: Buccal administration Rationale Buccal Midazolam is a convenient and efficient method used to treat prolonged seizures and status epilepticus in children. It can be used in hospital
More informationWHOLE LOTTA SHAKIN GOIN ON
WHOLE LOTTA SHAKIN GOIN ON ADAM M. YATES, MD FACEP ASSOCIATE CHIEF OF EMERGENCY SERVICES UPMC MERCY SEIZURE DEFINITIONS Partial(focal) only involves part of the brain General Involves entire brain Simple
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Pujar SS, Martinos MM, Cortina-Borja M, et
More informationPediatric Epilepsy Care in Milwaukee
Pediatric Epilepsy Care in Milwaukee Priya Monrad, MD Assistant Professor, Pediatric Neurology and Epilepsy Children s Hospital of Wisconsin Disclosures I have no relevant financial relationships to disclose.
More informationWhat Are the Best Non-IV Parenteral Options for a Seizing Patient? William C. Dalsey, MD, MBA, FACEP
What Are the Best Non-IV Parenteral Options for a Seizing Patient? A 32-year old male intravenous drug user was brought to the ED having had a witnessed generalized tonic-clonic seizure 10 minutes prior
More informationJournal of Child Neurology
Journal of Child Neurology http://jcn.sagepub.com Management of Prolonged s and Status Epilepticus in Childhood: A Systematic Review Kalliopi Sofou, Ragnhildur Kristjánsdóttir, Nikolaos E. Papachatzakis,
More informationStatus epilepticus (SE) is a condition that commonly
Status Epilepticus in the Pediatric Emergency Department Joshua Goldstein, MD Status epilepticus (SE) is a common childhood condition often seen by emergency physicians. It occurs at a frequency of between
More informationHope for New Treatments for Acute Repetitive Seizures
Current Literature In Clinical Science Hope for New Treatments for Acute Repetitive Seizures A Double-Blind, Randomized, Placebo-Controlled Trial of a Diazepam Auto-Injector Administered by Caregivers
More informationA. LeBron Paige, M.D. Director, Epilepsy Program UT Erlanger Neurology
A. LeBron Paige, M.D. Director, Epilepsy Program UT Erlanger Neurology Acute NeuroCare Symposium & Expo 10/20/2017 Conflict of Interest Statement Conflict of Interest Declaration: I am a paid consultant
More informationDo seizures beget seizures?
Does MTLE cause progressive neurocognitive damage? Andrew Bleasel Westmead Do seizures beget seizures? The tendency of the disease is toward self-perpetuation; each attack facilitates occurrence of another
More informationLong-term prognosis after childhood convulsive status epilepticus: a prospective cohort study
Long-term prognosis after childhood convulsive status epilepticus: a prospective cohort study Suresh S Pujar, Marina M Martinos, Mario Cortina-Borja, W K Kling Chong, Michelle De Haan, Christopher Gillberg,
More informationPrescribing and Monitoring Anti-Epileptic Drugs
Prescribing and Monitoring Anti-Epileptic Drugs Mark Granner, MD Clinical Professor and Vice Chair for Clinical Programs Director, Iowa Comprehensive Epilepsy Program Department of Neurology University
More informationGABA A Receptor Trafficking during Status Epilepticus December 4, 2010
GABA A Receptor Trafficking during Status Epilepticus December 4, 2010 Howard P. Goodkin, MD, PhD The Shure Associate Professor of Pediatric Neurology University of Virginia Charlottesville, VA American
More informationInformation for Year 1 ITU Training (basic):
Disclaimer: The Great Ormond Street Paediatric Intensive Care Training Programme was developed in 2004 by the clinicians of that Institution, primarily for use within Great Ormond Street Hospital and the
More informationDownloaded from jssu.ssu.ac.ir at 0:37 IRST on Sunday February 17th 2019
-2384 2 *. : 4 :. 2 / 4 3 6/. ( /) : 6 /4. 6. 00 92 6. 0 :. :. 0 :. International league Against Epilepsy (ILAE) First Unprovoked Seizure (FUS) 24 () (2) 20.. 2 3-4. (). : -* - 0 626024: 0 626024 : E-mial:
More informationPersonalizing Drug Delivery
Personalizing Drug Delivery Emilio Perucca, M.D, Ph.D. Clinical Pharmacology unit, University of Pavia & C. Mondino National Neurological Institute, Pavia, Italy Washington, December 7, 2013 1 American
More informationStatus epilepticus. Can the incidence be reduced? ABSTRACT
Original Articles Status epilepticus Can the incidence be reduced? Jumana Y. Al-Aama, RCP(UK), SSC, Ali O. Shaabat, BChB, RCSC. ABSTRACT Objectives: To identify high risk groups for the development of
More informationThe Management of Refractory Status Epilepticus: An Update
Epilepsia, 47(Suppl. 1):35 40, 2006 Blackwell Publishing, Inc. C International League Against Epilepsy The Management of Refractory Status Epilepticus: An Update Daniel H. Lowenstein Department of Neurology,
More informationEpilepsy CASE 1 Localization Differential Diagnosis
2 Epilepsy CASE 1 A 32-year-old man was observed to suddenly become unresponsive followed by four episodes of generalized tonic-clonic convulsions of the upper and lower extremities while at work. Each
More informationPROTOCOL. Francesco Brigo, Luigi Giuseppe Bongiovanni
COMMON REFERENCE-BASED INDIRECT COMPARISON META-ANALYSIS OF INTRAVENOUS VALPROATE VERSUS INTRAVENOUS PHENOBARBITONE IN GENERALIZED CONVULSIVE STATUS EPILEPTICUS PROTOCOL Francesco Brigo, Luigi Giuseppe
More informationRecommendations. for Care of Adults with Epilepsy. Seeking the best treatment from the right doctor at the right time!
Recommendations for Care of Adults with Epilepsy Seeking the best treatment from the right doctor at the right time! Contents This booklet is to help adults and their caregivers know when it is appropriate
More informationAPPENDIX K Pharmacological Management
1 2 3 4 APPENDIX K Pharmacological Management Table 1 AED options by seizure type Table 1 AED options by seizure type Seizure type First-line AEDs Adjunctive AEDs Generalised tonic clonic Lamotrigine Oxcarbazepine
More information11/7/2018 EPILEPSY UPDATE. Dr.Ram Sankaraneni. Disclosures. Speaker bureau LivaNova
EPILEPSY UPDATE Dr.Ram Sankaraneni Disclosures Speaker bureau LivaNova 1 Outline New onset Seizure Investigations in patients with epilepsy Medical management of epilepsy Non Pharmacological options in
More informationA Shot in the Arm for Prehospital Status Epilepticus: The RAMPART Study
Current Literature In Clinical Science A Shot in the Arm for Prehospital Status Epilepticus: The RAMPART Study Intramuscular Versus Intravenous Therapy for Prehospital Status Epilepticus. Silbergleit R,
More informationPrevention via Modifiable Risk Factors Saturday, June 23, 2012
Prevention via Modifiable Risk Factors Saturday, June 23, 2012 Dale C Hesdorffer, PhD Gertrude H Sergievsky Center Department of Epidemiology Columbia University Partners Against Mortality in Epilepsy
More informationTreatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room
Original article Epileptic Disord 2007; 9 (1): 43-50 Treatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room Taim Muayqil, Brian H. Rowe, S. Nizam Ahmed
More informationPhenytoin, Levetiracetam, and Pregabalin in the Acute Management of Refractory Status Epilepticus in Patients with Brain Tumors
Neurocrit Care (2012) 16:109 113 DOI 10.1007/s12028-011-9626-4 ORIGINAL ARTICLE Phenytoin, Levetiracetam, and Pregabalin in the Acute Management of Refractory Status Epilepticus in Patients with Brain
More information3/26/2012. Febrile Seizures + Educational needs. Disclosure. Febrile seizures are a common problem: 2% to 5% of all children
Febrile Seizures + Robert J. Baumann, MD Professor of Neurology & Pediatrics University of Kentucky Educational needs Febrile seizures are a common problem: 2% to 5% of all children Febrile Seizures represent
More informationDepartment of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 6
American Epilepsy Society Guideline Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society Tracy
More informationResearch and Advances in Epilepsy. Preeti Puntambekar, MD, PHD Epileptologist Northeast regional epilepsy group
Research and Advances in Epilepsy Preeti Puntambekar, MD, PHD Epileptologist Northeast regional epilepsy group Epilepsy History Hippocrateson the sacred disease Galen Avicenna Middle ages Renaissance Paracelcus
More informationA comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus
Q J Med 2002; 95:225 231 A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus H.R. COCK 1 and A.H.V. SCHAPIRA 1,2 From the 1 Department of Clinical and Experimental
More informationBuccal Midazolam versus Intravenous Diazepam in Prolonged Seizures in Children
Original Article DOI: 10.17354/ijss/2015/306 Buccal Midazolam versus Intravenous Diazepam in Prolonged Seizures in Children Rohit Khandelwal 1, Leeni Mehta Khandelwal 2, Karnail Singh 3 1 Assistant Professor,
More informationPaediatric Epilepsy Update N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y
Paediatric Epilepsy Update 2018 N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y Epilepsy Service CUH ~550 children New diagnosis-education, support, clinic follow up Epilepsy
More informationEpilepsy Care in the School Setting Children s Epilepsy Educational Video Series
Epilepsy Care in the School Setting Children s Epilepsy Educational Video Series Copy right 2017 Children s Healthcare of Atlanta Epilepsy Care in the School Setting Children s Epilepsy Educational Video
More informationEpilepsy and EEG in Clinical Practice
Mayo School of Professional Development Epilepsy and EEG in Clinical Practice November 10-12, 2016 Hard Rock Hotel at Universal Orlando Orlando, FL Course Directors Jeffrey Britton, MD and William Tatum,
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Absence seizures, 6 in childhood, 95 Adults, seizures and status epilepticus in, management of, 34 35 with first-time seizures. See Seizure(s),
More informationUpdated advice for nurses who care for patients with epilepsy
NICE BULLETIN Updated advice for nurses who care for patients with epilepsy NICE provided the content for this booklet which is independent of any company or product advertised NICE BULLETIN Updated advice
More informationMeasures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity
Measures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity Seizures in the School Setting Meghan Candee, MD MS Assistant
More informationFEBRILE SEIZURES. IAP UG Teaching slides
FEBRILE SEIZURES 1 DEFINITION Febrile seizures are seizures that occur between the age of 6 and 60 months with a temperature of 38 C or higher, that are not the result of central nervous system infection
More informationORIGINAL CONTRIBUTION. Rectal Diazepam Gel for Treatment of Acute Repetitive Seizures in Adults
ORIGINAL CONTRIBUTION Rectal Diazepam Gel for Treatment of Acute Repetitive Seizures in Adults James J. Cereghino, MD; James C. Cloyd, PharmD; Ruben I. Kuzniecky, MD; for the North American Diastat Study
More informationClinical Study Underestimated Rate of Status Epilepticus according to the Traditional Definition of Status Epilepticus
e Scientific World Journal Volume 2015, Article ID 801834, 5 pages http://dx.doi.org/10.1155/2015/801834 Clinical Study Underestimated Rate of Status Epilepticus according to the Traditional Definition
More informationContemporary Developments in Childhood Epilepsy Management. Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital
Contemporary Developments in Childhood Epilepsy Management Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital Developments in Epilepsy Care Standardised epilepsy care using
More informationJune 30 (Fri), Teaching Session 1. New definition & epilepsy classification. Chairs Won-Joo Kim Ran Lee
June 30 (Fri), 2017 Teaching Session 1 New definition & epilepsy classification Chairs Won-Joo Kim Ran Lee Teaching Session 1 TS1-1 Introduction of new definition of epilepsy Sung Chul Lim Department of
More informationORIGINAL ARTICLE. Prediction of Response to Treatment in Children with Epilepsy
ORIGINAL ARTICLE How to Cite This Article: Ghofrani M, Nasehi MM, Saket S, Mollamohammadi M, Taghdiri MM, Karimzadeh P, Tonekaboni SH, Javadzadeh M, Jafari N, Zavehzad A, Hasanvand Amouzadeh M, Beshrat
More informationSeizures explained. What is a seizure? Triggers for seizures
Seizures explained What is a seizure? A seizure is a sign of a temporary disruption in the brain s electrical activity. Billions of brain cells pass messages to each other and these affect what we say
More informationSeizures Emergency Treatment
Seizures Emergency Treatment Emergency Seizures SEIZURE CLASSIFICATION Cluster seizures - 2 or more generalized convulsive seizures in 24 hours Simon R. Platt BVM&S MRCVS Dipl. ACVIM (Neurology) Dipl.ECVN
More information13th ECE - Programme at a Glance
Neurobiology 14.30-16.00 Sunday 26th August Neonatal Session (5) seizure 14.30-16.00 guidelines 14.00-16.30 Set Up ~ Posters on Display all day ~ Authors present (14.00-14.40) Take Dow Monday 27th August
More information13th ECE Vienna - PROGRAMME AT A GLANCE
Neurobiology 14.30-16.00 Sunday 26th August Neonatal Session (5) seizure 14.30-16.00 guidelines 14.00-16.30 Set Up ~ Posters on Display all day ~ Authors present (14.00-14.40) Take Dow Monday 27th August
More informationEpilepsy management What, when and how?
Epilepsy management What, when and how? J Helen Cross UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London, & National Centre for Young People with Epilepsy, Lingfield, UK What
More informationRetrospective review of pediatric status epilepticus in 116 Saudi patients: predictors of outcome
Retrospective review of pediatric status epilepticus in 116 Saudi patients: predictors of outcome Raid Harb Hommady, a Muhammad Talal Alrifai, b Osama Khaled Mubayrik, a Ruba Salem Alayed, a Muhannad Abdulrahman
More informationRESEARCH ARTICLE IS LUMBAR PUNCTURE ALWAYS NECESSARY IN THE FEBRILE CHILD WITH CONVULSION?
RESEARCH ARTICLE IS LUMBAR PUNCTURE ALWAYS NECESSARY IN THE FEBRILE CHILD WITH CONVULSION? MR. Salehi Omrani MD¹, MR. Edraki MD 2, M. Alizadeh MD 3 Abstract: Objective Febrile convulsion is the most common
More information33rd International Epilepsy Congress 2019 Sunday
Saturday 22 June 33rd International Epilepsy Congress 2019 Sunday Monday 23 June 24 June Tuesday 25 June Wednesday 26 June 08.00-08.30 08.30-09.00 09.00-09.30 09.30-10.00 10.00-10.30 10.30-11.00 11.00-11.30
More informationIntracranial Studies Of Human Epilepsy In A Surgical Setting
Intracranial Studies Of Human Epilepsy In A Surgical Setting Department of Neurology David Geffen School of Medicine at UCLA Presentation Goals Epilepsy and seizures Basics of the electroencephalogram
More information5/23/14. Febrile seizures: Who need further workup? Afebrile seizures: Who needs imaging? Status epilepticus: Most effective treatments
Febrile seizures: Who need further workup? Afebrile seizures: Who needs imaging? Status epilepticus: Most effective treatments Andi Marmor, MD, MSEd Associate Professor, Pediatrics University of California,
More informationManagement of Seizures in the School Setting. Patricia Bruno, BSN, RN Pediatric Epilepsy Nurse Coordinator Massachusetts General Hospital Boston, MA
Management of Seizures in the School Setting Patricia Bruno, BSN, RN Pediatric Epilepsy Nurse Coordinator Massachusetts General Hospital Boston, MA Management of Seizures in the School Setting When the
More informationEpilepsy, defined as more than 1 unprovoked
TREATING EPILEPSY: DOES PRESENTATION MATTER? * Lionel Carmant, MD, FRCP (C) ABSTRACT The evidence supporting the use of antiepileptic drugs (AEDs) immediately after a first seizure is ambivalent. A Practice
More informationObjectives. Amanda Diamond, MD
Amanda Diamond, MD Objectives Recognize symptoms suggestive of seizure and what those clinical symptoms represent Understand classification of epilepsy and why this is important Identify the appropriate
More informationShands Jacksonville Department of Pharmacy
Shands Jacksonville Department of Pharmacy Medication Use Evaluation: IV Levetiracetam Evaluation Time Period: 05/27/2013 06/24/2013 Important Aspect of Care: Care of Patients, Medication Use, Prescribing
More informationEpilepsy Syndromes: Where does Dravet Syndrome fit in?
Epilepsy Syndromes: Where does Dravet Syndrome fit in? Scott Demarest MD Assistant Professor, Departments of Pediatrics and Neurology University of Colorado School of Medicine Children's Hospital Colorado
More informationCONSEQUENCES OF STATUS EPILEPTICUS ON COGNITION IN PATIENTS WITH DRAVET SYNDROME
CONSEQUENCES OF STATUS EPILEPTICUS ON COGNITION IN PATIENTS WITH DRAVET SYNDROME Pr David Dufresne, MD Professeur adjoint, département de pédiatrie Service de neurologie pédiatrique Université de Sherbrooke
More information33rd International Epilepsy Congress 2019 Sunday
Saturday 22 June 33rd International Epilepsy Congress 2019 Sunday Monday 23 June 24 June Tuesday 25 June Wednesday 26 June 08.00-08.30 08.30-09.00 09.00-09.30 09.30-10.00 10.00-10.30 10.30-11.00 11.00-11.30
More informationAll patients with a diagnosis of treatment resistant (intractable) epilepsy.* Denominator Statement
MEASURE #7 Referral to Comprehensive Epilepsy Center Measure Description Percent of all patients with a diagnosis of treatment resistant (intractable) epilepsy who were referred for consultation to a comprehensive
More informationRESEARCH ARTICLE EPILEPSY IN CHILDREN WITH CEREBRAL PALSY
RESEARCH ARTICLE EPILEPSY IN CHILDREN WITH CEREBRAL PALSY S.Pour Ahmadi MD, M.Jafarzadeh MD, M. Abbas MD, J.Akhondian MD. Assistant Professor of Pediatrics, Mashad University of Medical Sciences. Associate
More information13th ECE Vienna - PROGRAMME AT A GLANCE
Neurobiology Symposium 14.30-16.00 Sunday 26th August Neonatal Session (5) seizure 14.30-16.00 guidelines 14.00-16.30 Set Up ~ Posters on Display all day ~ Authors present (14.00-14.40) Take Dow Monday
More informationEpilepsy 101. Overview of Treatment Georgette Smith, PhD, APRN, CPNP. American Epilepsy Society
Epilepsy 101 Overview of Treatment Georgette Smith, PhD, APRN, CPNP American Epilepsy Society Overview of Treatment Rescue Therapies Non-Medication Therapies Epilepsy surgery Vagus nerve stimulation Dietary
More informationCHAIR SUMMIT 7TH ANNUAL #CHAIR2014. Master Class for Neuroscience Professional Development. September 11 13, Westin Tampa Harbour Island
#CHAIR2014 7TH ANNUAL CHAIR SUMMIT Master Class for Neuroscience Professional Development September 11 13, 2014 Westin Tampa Harbour Island Sponsored by #CHAIR2014 Clinical Case Challenge: Seizure Emergency
More informationTreatment Following a First Seizure
Treatment Following a First Seizure 6 year old developmentally normal child brought to the ED with a history of a 5 minute generalized tonic seizure in sleep. Seizure occurred about 60 minutes after falling
More informationEpilepsy Specialist Symposium Treatment Algorithms in the Diagnosis and Treatment of Epilepsy
Epilepsy Specialist Symposium Treatment Algorithms in the Diagnosis and Treatment of Epilepsy November 30, 2012 Fred Lado, MD, Chair Montefiore Medical Center Albert Einstein College of Medicine Bronx,
More information