Seizures
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Randomized Trial of Cannabidiol for Medically Refractory Seizures in Dravet Syndrome
In a double-blind study, 120 children and young adults with the Dravet syndrome and medically refractory seizures were assigned randomly to receive either cannabidiol or placebo, as well as their usual antiepileptic drugs/therapies. The primary finding was a significant decrease in convulsive seizure frequency during the 14-week treatment period for patients receiving cannabidiol compared to those receiving placebo.
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Outcomes After Surgical Treatment of Nonlesional Neocortical Epilepsy
In this study of 109 consecutive patients with medically refractory neocortical epilepsy without MRI-identifiable lesions who underwent focal resection at a single hospital from 1995 to 2005, almost 60% of patients achieved long-term seizure freedom, with anti-epileptic drugs being withdrawn successfully in about a third of these patients.
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Does Therapeutic Hypothermia Improve Functional Outcomes After Convulsive Status Epilepticus?
In a multicenter trial in France, patients admitted to the ICU from 2011-2015 for convulsive status epilepticus were randomly assigned to receive standard therapy (control group) or hypothermia plus standard therapy (treatment group). The primary outcome measure was an absence of functional impairment at 90 days after seizure onset, as measured by the Glasgow Outcome Scale (score of 5). There was no significant difference in outcomes between the two groups.
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Relationship Between Spikes and Seizures Using an Implantable Intracranial Detection Device
The authors report the preliminary findings for an implantable ambulatory intracranial recording device for seizure detection in 15 subjects. One of the primary findings was that spike rate significantly changed prior to seizures in nine of 15 subjects. Six of these subjects showed a significant decrease in spiking prior to ictal onset, whereas the remaining three showed a significant increase in spiking and these three subjects had the best seizure prediction results.
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Potential Imaging Biomarkers of SUDEP: Can We Predict Sudden Death in Epilepsy?
The authors retrospectively conducted a voxel-based analysis of T1 MRI scans to compare gray matter volumes in 12 cases of sudden unexpected death in epilepsy (SUDEP) acquired at a median of 2 years before death with patients at high or low risk for SUDEP and with healthy controls, and demonstrated significant anatomical differences between the groups.
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A Modern Epidemiologic View of Status Epilepticus in the United States
In this retrospective review of mortality and hospitalization related to status epilepticus from 1999 to 2010, the authors found that overall mortality remained relatively stable, whereas the rate of related hospitalizations significantly increased, particularly in patients who were intubated and in whom status epilepticus was not the primary diagnosis.
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Neurological Emergencies in Children and Adolescents
Neurological issues in children can take a very dramatic but relatively benign form, or can be subtle but representative of serious underlying illness. Differentiating between high- and low-risk presentations can be challenging, but a thorough understanding of pediatric practice guidelines can help emergency department physicians determine the most appropriate ED interventions and eliminate potential injury to a child from either excessive intervention or the sequelae of a missed diagnosis. This monograph will help ED physicians recognize and appropriately treat seizures in children, and provide advice to worried parents about their child’s potential for seizure recurrence. In addition, physicians will learn how to determine which patients require lumbar puncture and understand the risks of brain CT imaging in the pediatric population. It also covers how to know when to emergently or urgently refer children to pediatric neurology.
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Predictors of Refractory Status Epilepticus
In a combined derivation and validation study, three independent risk factors for refractory status epilepticus were identified — acute symptomatic cause for seizures, stupor or coma, and a low serum albumin < 35 g/L. -
Pharmacology Watch
New recommendations for HPV vaccine; guidelines for treatment of essential tremor; updates on smoking cessation drugs; and FDA actions. -
Rituximab May Be Effective for Refractory Myasthenia Gravis
In a restrospective review, rituximab appeared beneficial for patients with medication-resistant myasthenia gravis.