Epilepsia
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Comparative Study Clinical Trial Controlled Clinical Trial
Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings.
We compared propofol with high-dose barbiturates in the treatment of refractory status epilepticus (RSE) and propose a protocol for the administration of propofol in RSE in adults, correlating propofol's effect with plasma levels. ⋯ If used appropriately, propofol infusions can effectively and quickly terminate many but not all episodes of RSE. Propofol is a promising agent for use in treating RSE, but more studies are required to determine its true value in comparison with other agents.
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Understanding of mechanisms and the development of interventions to prevent sudden unexpected death in epilepsy (SUDEP) can be enhanced only through multicenter studies. Although current definitions are useful and congruent, there is insufficient guidance to allow others to duplicate studies. A working algorithm should be developed, preferably through review of current series, along with alternative definitions to allow external comparison with cardiovascular studies.
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On the basis of the neuroactive properties of estradiol and progesterone and the menstrually related cyclic variations of their serum concentrations, we propose the existence of three hormonally based patterns of seizure exacerbation. Because previous reports both support and refute the concept of catamenial epilepsy, we test the hypothesis by charting seizures and menses and measuring midluteal serum progesterone levels to estimate the frequency of epileptic women with catamenial seizure exacerbation. ⋯ Charting of seizures and menses and determination of day 22 progesterone levels during each cycle may be sufficient to establish the existence of three distinct patterns of catamenial epilepsy. Approximately one third of women with intractable CPS may have catamenial epilepsy.