Epilepsia
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The aim of the study was to evaluate the outcome of status epilepticus (SE) in children and to define predictors for morbidity, mortality, and SE recurrence. ⋯ Outcome of SE in children is favorable in most of the cases, but mortality and morbidity rates are still high. Etiology and prior neurologic abnormalities were the main predictors of mortality, whereas the main predictor of morbidity was underlying etiology.
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This retrospective cross-sectional study was carried out to study the association between different levels of hyponatremia and the occurrence of epileptic seizures in patients without a prior epilepsy diagnosis. We identified from the hospital database, 363 inpatients of a Swedish County hospital who between March 2003 and August 2006 were found to have serum sodium levels <125 mM. ⋯ Of 150 patients reviewed with serum sodium levels of 120-124 mM, one had a seizure. Using 120-124 mM as reference, odds ratios (95% confidence interval) for having seizures at serum sodium levels of 115-119 mM was 3.85 (0.40-37.53), 8.43 (0.859-82.85) at 110-114 mM, and 18.06 (1.96-166.86) at <110 mM.
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Comparative Study
Further evidence that pathologic high-frequency oscillations are bursts of population spikes derived from recordings of identified cells in dentate gyrus.
To analyze activity of identified dentate gyrus granular cells and interneurons during pathologic high-frequency oscillations (pHFOs). ⋯ Pilocarpine-treated epileptic mice were anesthetized with urethane and ketamine. Their heads were fixed in a stereotaxic frame. Extracellular unit activity was recoded with glass micropipettes, whereas multiunit and local field activity was simultaneously recorded with attached tungsten microelectrodes. After electrophysiologic experiments, recorded cells were labeled by neurobiotin and visualized by immunohistochemical methods. KEY FINDINGS AND SIGNIFICANCES: pHFOs containing more than three waves were recorded in our experiments, but pathologic single-population spikes also occurred. Identified granular cells discharged preferentially in synchrony with pHFOs and single population spikes, whereas interneurons decreased their discharge frequency during this time. These experiments provide additional confirmation that pHFOs in the dentate gyrus represent single or recurrent population spikes, which in turn reflect summated hypersynchronous discharges of principal cells.
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To analyze what conditions mimic seizures in the intensive care unit (ICU) setting, we reviewed all bedside electroencephalography (EEG)-videos obtained in the adult ICU setting over an 18-month period. Only those studies performed for "possible seizures" due to motor phenomena and whose clinical events were captured on video were analyzed. A total of 52 studies were performed. ⋯ Thirty-eight (73%) had nonepileptic events. These consisted of 12 (23%) with tremor-like movements, 7 (13.5%) with multifocal myoclonic jerks without electrographic changes, 7 (13.5%) with slow semipurposeful movements, and 10 with other movements. Therefore, seizure mimics in the ICU setting were diverse and distinct from the usual differential diagnosis of seizures seen in ambulatory patients.
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Generalized convulsive status epilepticus (GCSE) needs immediate management. Despite guidelines, adherence to management protocols is often poor, this contributing to poor outcome. We aimed to evaluate the usefulness of a management protocol in GCSE. ⋯ GCSE termination and outcome seem clearly associated with adherence to treatment protocol. Results add to the debate on appropriate allocation of resources for out-of-hospital treatment, licensed drugs, and achievement of guideline implementation to improve SE outcome.