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Titolo:
Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus
Autore:
Claassen, J; Hirsch, LJ; Emerson, RG; Bates, JE; Thompson, TB; Mayer, SA;
Indirizzi:
Columbia Univ Coll Phys & Surg, Div Crit Care Neurol, Dept Neurol, Neurol Inst, New York, NY 10032 USA Columbia Univ Coll Phys & Surg New York NY USA 10032 w York, NY 10032 USA Columbia Univ Coll Phys & Surg, Inst Neurol, Comprehens Epilepsy Ctr, New York, NY 10032 USA Columbia Univ Coll Phys & Surg New York NY USA 10032 w York, NY 10032 USA
Titolo Testata:
NEUROLOGY
fascicolo: 6, volume: 57, anno: 2001,
pagine: 1036 - 1042
SICI:
0028-3878(20010925)57:6<1036:CEMAMI>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
GENERALIZED STATUS-EPILEPTICUS; CONVULSIVE STATUS EPILEPTICUS; BARBITURATE ANESTHETIC TREATMENT; CLONIC STATUS EPILEPTICUS; INTRAVENOUS MIDAZOLAM; SUPPRESSION; PHENYTOIN; MORTALITY; PROPOFOL; DIAZEPAM;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
37
Recensione:
Indirizzi per estratti:
Indirizzo: Mayer, SA Columbia Univ Coll Phys & Surg, Div Crit Care Neurol, Dept Neurol, Neurol Inst, 710 W 168th St,Unit 39, New York, NY 10032 USA Columbia Univ Coll Phys & Surg 710 W 168th St,Unit 39 New York NY USA 10032
Citazione:
J. Claassen et al., "Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus", NEUROLOGY, 57(6), 2001, pp. 1036-1042

Abstract

Background: Although cIV-MDZ has emerged as a popular alternative to barbiturate therapy for refractory status epilepticus (RSE), experience with itsuse for this indication is limited. Objective: To evaluate the efficacy ofcontinuous intravenous midazolam (cIV-MDZ) for attaining sustained seizurecontrol in patients with RSE. Methods: The authors reviewed 33 episodes ofRSE treated with cIV-MDZ in their neurologic intensive care unit over 6 years. All patients were monitored with continuous EEG (cEEG). MDZ infusion rates were titrated to eliminate clinical and EEG seizure activity; cIV-MDZ was discontinued once patients were seizure-free for 24 hours. Acute treatment failures (seizures 1 to 6 hours after starting cIV-MDZ), breakthrough seizures (after 6 hours of therapy), post-treatment seizures (within 48 hours of discontinuing therapy), and ultimate treatment failure (frequent seizures that led to treatment with pentobarbital or propofol) were identified. Results: All patients were in nonconvulsive SE at the time cIV-MDZ was started; the mean duration of SE before treatment was 3.9 days (range 0 to 17 days). In addition to benzodiazepines, 94% of patients had received at leasttwo antiepileptic drugs (AED) before starting cIV-MDZ. The mean loading dose was 0.19 mg/kg, the mean maximal infusion rate was 0.22 mg/kg/h, and themean duration of cIV-MDZ therapy was 4.2 days (range 1 to 14 days). Acute treatment failure occurred in 18% (6/33) of episodes, breakthrough seizuresin 56% (18/32), posttreatment seizures in 68% (19/28), and ultimate treatment failure in 18% (6/33). Breakthrough seizures were clinically subtle or purely electrographic in 89% (16/18) of cases and were associated with an increased risk of developing posttreatment seizures (p = 0.01). Conclusions:Although most patients with RSE initially responded to cIV-MDZ, over half developed subsequent breakthrough seizures, which were predictive of post-treatment seizures and were often detectable only with cEEG. Titrating cIV-MDZ to burst suppression, more aggressive treatment with concurrent AED, or a longer period of initial treatment may reduce the high proportion of patients with RSE who relapse after cIV-MDZ is discontinued.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/03/20 alle ore 09:43:09