Mary Grace V.
Mejos BSN-III
Status epilepticus in adults
Abstract
Status epilepticus is a common neurological emergency with considerable associated
health-care costs, morbidity, and mortality. The definition of status epilepticus as a
prolonged seizure or a series of seizures with incomplete return to baseline is under
reconsideration in an effort to establish a more practical definition to guide management.
Clinical research has focused on early seizure termination in the prehospital setting. The
approach of early escalation to anaesthetic agents for refractory generalised convulsive
status epilepticus, rather than additional trials of second-line anti-epileptic drugs, to avoid
neuronal injury and pharmaco-resistance associated with prolonged seizures is gaining
momentum. Status epilepticus is also increasingly identified in the inpatient setting as the
use of extended electroencephalography monitoring becomes more commonplace.
Substantial further research to enable early identification of status epilepticus and efficacy
of anti-epileptic drugs will be important to improve outcomes.
Reference:
Dr John P Betjemann, Dr Daniel H Lowenstein. Incidence of status epilepticus in
Rochester, Minnesota, 1965–1984. Neurology. 2016; 50: 735–741
Insights:
According to my research, Status epilepticus (SE) is a medical emergency
associated with significant morbidity and mortality. Status epilepticus is defined as a
continuous seizure lasting more than 30 min, or two or more seizures without full recovery
of consciousness between any of them; Status epilepticus is generally defined as 30
minutes of either continuous seizure activity or repetitive seizures without recovery.
Convulsive status epilepticus is a medical emergency. Delay in treatment may result in
difficult seizure control and poor outcome. Given these risks, aggressive therapy is
appropriate for any convulsion lasting >5 minutes. After a convulsion has ended, the
patient should be carefully assessed for the possibility of nonconvulsive or subtle ongoing
seizures.
And there are possible causes of status epilepticus and it includes low blood sugar,
HIV, head trauma, heavy alcohol or drug use and kidney or liver failure. In order to avoid
this kind of phenomenon, we must consider having a healthy lifestyle to prevent status
epilepticus.
In developing countries where facilities for assisted ventilation are not readily
available, it may be helpful to use no sedating antiepileptic drugs (such as sodium
valproate, levetiracetam, or topiramate) at this stage. It is important to recognize Status
epilepticus and institute treatment as early as possible in order to avoid a refractory state.
It is equally important to attend to the general condition of the patient and to ensure that
the patient is hemodynamically stable.
Interictal dysphoric disorder: Further doubts about its epilepsy-specificity and its
independency from common psychiatric disorders
Abstract
Purpose.The interictal dysphoric disorder (IDD) is a proposed epilepsy-specific
psychiatric condition characterized by a conglomerate of symptoms such as depression,
irritability, euphoria, and anxiety. However, there are doubts about IDD as an independent
entity and about its presumed epilepsy-specific nature.
Methods.Here, we investigated the association between psychiatric disorders and IDD
in 120 patients with epilepsy, also analyzing potential associations between IDD
symptoms and epilepsy-related variables. To test the epilepsy-specificity of IDD, we also
studied IDD rates in 28 patients with pure psychogenic non-epileptic seizures. For the
assessment of psychopathology, we used a structured clinical interview to determine the
presence and nature of Axis I disorders and clinical questionnaires to assess
psychopathological symptoms (anxiety, depression and severity of global distress). In
accordance with most previous studies, we used the Interictal Dysphoric Disorder
Inventory to assess IDD symptoms.
Results.In our epilepsy group, we observed an IDD in 33% (42 of 120) of the patients.
We diagnosed IDD in 39% (11 of 28) of the patients with psychogenic non-epileptic
seizures without epilepsy. The majority of the patients with epilepsy with IDD have or had
a psychiatric disorder (33 with a current, 6 with a past Axis I diagnosis). Patients with
epilepsy with IDD had higher scores on all psychopathology questionnaires compared to
the epilepsy patients without IDD.
Conclusion.Our findings suggest that IDD is not epilepsy-specific in nature, but occurs
with the same frequency and the same pattern of symptoms in a purely psychiatric
sample. We found a large overlap of IDD and common psychiatric comorbidities, mainly
depression and anxiety disorders. This result calls the presumed
nosological independency of IDD into question.
Reference:
Kirsten Labudda, Dominik Illies, Christian G. Bien, Frank Neune. Epilepsy research in
Rochester, Minnesota, Pages 111-190 (July–December 2017)
Insights:
Epilepsy is a central nervous system (neurological) disorder in which brain activity
becomes abnormal, causing seizures or periods of unusual behavior, sensations, and
sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males
and females of all races, ethnic backgrounds and ages.
Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a
few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a
single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are
generally required for an epilepsy diagnosis.
Treatment with medications or sometimes surgery can control seizures for the majority of
people with epilepsy. Some people require lifelong treatment to control seizures, but for
others, the seizures eventually go away. Some children with epilepsy may outgrow the
condition with age.
PACAP in hypothalamic regulation of sleep and circadian rhythm: importance for
headache
Abstract
The interaction between sleep and primary headaches has gained considerable interest
due to their strong, bidirectional, clinical relationship. Several primary headaches
demonstrate either a circadian/circannual rhythmicity in attack onset or are directly
associated with sleep itself. Migraine and cluster headache both show distinct attack
patterns and while the underlying mechanisms of this circadian variation in attack onset
remain to be fully explored, recent evidence points to clear physiological, anatomical and
genetic points of convergence. The hypothalamus has emerged as a key brain area in
several headache disorders including migraine and cluster headache. It is involved in
homeostatic regulation, including pain processing and sleep regulation, enabling
appropriate physiological responses to diverse stimuli. It is also a key integrator of
circadian entrainment to light, in part regulated by pituitary adenylate cyclase-activating
peptide (PACAP). With its established role in experimental headache research the
peptide has been extensively studied in relation to headache in both humans and animals,
however, there are only few studies investigating its effect on sleep in humans. Given its
prominent role in circadian entrainment, established in preclinical research, and the ability
of exogenous PACAP to trigger attacks experimentally, further research is very much
warranted. The current review will focus on the role of the hypothalamus in the regulation
of sleep-wake and circadian rhythms and provide suggestions for the future direction of
such research, with a particular focus on PACAP.
Reference:
The Journal of Headache and PainOfficial Journal of the "European Headache
Federation" and of "Lifting The Burden - The Global Campaign against
Headache"201819:20
https://doi.org/10.1186/s10194-018-0844-4
© The Author(s). 2018
Insights:
We all know that headaches are one of the most common medical complaints;
most people experience them at some point in their life. They can affect anyone
regardless of age, race, and gender.
A headache can be a sign of stress or emotional distress, or it can result from a
medical disorder, such as migraine or high blood pressure, anxiety, or depression. It can
lead to other problems. People with chronic migraine headaches, for example, may find
it hard to attend work or school regularly.
A headache can occur in any part of the head, on both sides of the head, or in just
one location. And for sure all of us had already experienced having a headache.
