Diagnóstico y tratamiento del estado epiléptico
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OBJETIVO: Revisar la literatura sobre los principios cardinales para el diagnóstico y tratamiento adecuado del estado epiléptico.
DESARROLLO: Se evalúa y enfatiza en los principios cardinales para el manejo adecuado del estado epiléptico: 1) La actualización de los criterios diagnósticos, los subtipos semiológicos y el diagnóstico etiológico de la entidad para obtener una mayor relevancia clÃnica, 2) Las vÃas para agilizar el inicio de la terapia de primera lÃnea con benzodiacepinas y la aplicación inmediata de los restantes tratamientos en las formas refractarias, y 3) Los métodos para el diagnóstico precoz y tratamiento apropiado del estado epiléptico no convulsivo. En el diagnóstico del estado epiléptico se abordan las concepciones con respecto al tiempo de duración de las crisis epilépticas y los tipos de crisis epilépticas englobadas en la definición. Se adoptan los términos y descripciones semiológicas más actuales expresadas por la Liga Internacional contra la Epilepsia (ILAE). En un último acápite se abordan las pautas antiepilépticas iniciales y anestésicas que se indican para controlar las crisis epilépticas lo más rápido posible. También se delinean las medidas para evitar y tratar las complicaciones sistémicas relacionadas con el estado epiléptico y los efectos adversos de los antiepilépticos.
CONCLUSIONES: Se precisan de investigaciones amplias que valoren la efectividad de las terapias individuales acorde al mecanismo de las crisis epilépticas, semiologÃa, duración, causas, complicaciones asociadas y cambios dinámicos que potencian el estado epiléptico y la lesión neuronal.
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Referencias
Shorvon S. Super–refractory status epilepticus: an approach to therapy in this difficult clinical situation. Epilepsia. 2011;52(Suppl. 8):53–6.
Shearer P, Riviello J. Convulsive status epilepticus in adults and children: Treatment guidelines and protocols. Emerg Med Clin N Am. 2011;29:51–64.
Rabinstein AA. Management of Status Epilepticus in Adults. Neurol Clin. 2010;28:853–62.
Knake S, Hamer H, Rosenow F. Status epilepticus: A critical review. Epilepsy Behav. 2009;15:10–4.
Shorvon S. Epidemiology: Status Epilepticus. En: Schwartzkroin P, ed. Encyclopedia of Basic Epilepsy Research. Oxford: Academic Press; 2009. p.1502–9.
Nair PP, Kalita J, Misra UK. Status epilepticus: Why, what, and how. J Postgrad Med. 2011;57:242–52.
Gastaut H. A proposed international classification of epileptic seizures. Epilepsia. 1964;5:297–306.
Maganti R, Gerber P, Drees C, Chung S. Nonconvulsive status epilepticus. Epilepsy Behav. 2008; 12: 572–86.
Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489–501.
Engel J. A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE task force on classification and terminology. Epilepsia. 2001;42(6):796–803.
Arif H, Hirsch LJ. Treatment of status epilepticus. Semin Neurol. 2008;28(3):342–54.
Lowenstein DH, Bleck T, Mcdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40:120–2.
Noachtar S, Peters AS. Semiology of epileptic seizures: A critical review. Epilepsy Beh. 2009;15:2–9.
Shorvon SD. What is nonconvulsive status epilepticus, and what are its subtypes? Epilepsia. 2007;48(Suppl.. 8):35–8.
Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia. 2006;47:1499–1503.
Corral–Ansa L, Herrero–Meseguer J, Falip–Centellas M, Aiguabella–Macau M. Estatus epiléptico. Med Intensiva. 2008;32(4):174–82.
Millikan D, Rice B, Silbergleit R. Emergency treatment of status epilepticus: current thinking. Emerg Med Clin N Am. 2009;27:101–3.
Gómez–Ibáñez A, Urrestarazu E, Viteri C. Estado epiléptico no convulsivo en el siglo xxi: clÃnica, diagnóstico, tratamiento y pronóstico. Rev Neurol. 2012;54:105–13.
Ziai WC, Kaplan PW. Seizures and status epilepticus in the intensive care unit. Semin Neurol. 2008;28:668–81.
Engel J. Report of the ILAE Classification Core Group. Epilepsia. 2006;47(9):1558–68.
Huff JS, Fountain NB. Pathophysiology and definitions of seizures and status epilepticus. Emerg Med Clin N Am. 2011;29:1–13.
Lado F, Moshe SL. How do seizures stop? Epilepsia. 2008;49:1651–64.
Basu H, O’Callaghan F. Status epilepticus: Beyond guidelines. Current Paediatrics. 2005;15:324–32.
Schmutzhard E, Pfausler B. Complications of the management of status epilepticus in the intensive care unit. Epilepsia. 2011;52(Suppl. 8):39–41.
Arancibia–Carcamo IL, Kittler JT. Regulation of GABA(A) receptor membrane trafficking and synaptic localization. Pharmacol Ther. 2009;123:17–31.
Meierkord H, Holtkamp M. Non–convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007;6:329–39.
Pitkanen A, Lukasiuk K. Molecular and cellular basis of epileptogenesis in symptomatic epilepsy. Epilepsy Behav. 2009;14 (Suppl. 1):16–25.
Pitkanen A, Lukasiuk K. Mechanisms of epileptogenesis and potential treatment targets. Lancet Neurol. 2011;10:173–86.
Cooper AD, Britton JW, Rabinstein AA. Functional and cognitive outcome in prolonged refractory status epilepticus. Arch Neurol. 2009;66:1505–9.
Vein AA, van Emde Boas W. Kozhevnikov epilepsy: The disease and its eponym. Epilepsia. 2011;52(2):212–8.
Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffi eux C, Bromfi eld EB. Status Epilepticus Severity Score (STESS): a tool to orient early treatment strategy. J Neurol. 2008;255:1561–66.
Fernández–Torre JL. Estado epiléptico no convulsivo en adultos en coma. Rev Neurol. 2010;50:300–8.
Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22:79–91.
Friedman D, Classen J, Hirsch L. Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg. 2009; 109: 506–23.
Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.
Shorvon S, Trinka E. Nonconvulsive status epilepticus and the postictal state. Epilepsy Behav. 2010;19(2):172–5.
Patil B, Oware A. De–novo simple partial status epilepticus presenting as Wernicke's aphasia. Seizure. 2012;21(3):219–22.
Praharaj SK, Sarkhel S, Paul I, Tripathi A, Zia–ul–Haq Katshu M, Sinha VK. Complex partial status epilepticus: an unusual presentation. Epileptic Disord. 2011;13(2):188–92.
Bauer G, Trinka E. Nonconvulsive status epilepticus and coma. Epilepsia. 2010;51:177–90.
Husain AM, Horn GJ, Jacobson MP. Non–convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry 2003; 74: 189–91.
Brenner RP. How useful is EEG monitoring in acutely ill and how to interpret it? Epilepsia. 2009;50(Suppl 12):S34–7.
Hughes JR. Periodic lateralized epileptiform discharges: do they represent an ictal pattern requiring treatment? Epilepsy Behav. 2010;18:162–5.
Tuxhorn IEB, Fischbach HS. Pseudostatus epilepticus in childhood. Pediatr Neurol. 2002;27:407–409.
Neligan A, Shorvon SD. Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review. Arch Neurol 2010;67: 931–40.
Tan RY, Neligan A, Shorvon SD. The uncommon causes of status epilepticus: a systematic review. Epilepsy Res. 2010;91:111–22.
Neligan A, Shorvon SD. Prognostic factors, morbidity and mortality in tonic–clonic status epilepticus: a review. Epilepsy Res. 2011;93(1):1–10.
Shorvon S, Ferlisi M. The treatment of super–refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011;134:2802–18.
Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross HJ, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010;51:676–85.
Shorvon S, Guerrini R. Acute symptomatic seizures—Should we retain the term?. Epilepsia. 2010;51(4):713–24.
Costello DJ, Kilbride RD, Cole AJ. Cryptogenic New Onset Refractory Status Epilepticus (NORSE) in adults—Infectious or not?. J Neurol Sci. 2009;277:26–31.
Vezzani A, Ruegg S. The pivotal role of immunity and inflammatory processes in epilepsy is increasingly recognized: introduction. Epilepsia. 2011;52(Suppl. 3):1–53.
Friedman A, Dingledine R. Molecular cascades that mediate the influence of inflammation on epilepsy. Epilepsia. 2011;52 (Suppl. 3):33–9.
Prasad K, Al Roomi K, Krishnan PR, Sequeira R. Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev. 2005;4:CD003723.
O’Brien TJ, Cascino GD, So EL, Hanna DR. Incidence and clinical consequence of the purple glove syndrome in patients receiving intravenous phenytoin. Neurology. 1998;51:1034–9.
Alvarez V, Januel JM, Burnand B, Rossetti AO. Second–line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011;52:1292–96.
Velioglu SK, Gazioglu S. Non–convulsive status epilepticus secondary to valproic acid–induced hyperammonemic encephalopathy. Acta Neurol Scand. 2007;116:128–32.
Power KN, Flaatten H, Gilhus NE, Engelsen BA. Propofol treatment in adult refractory status epilepticus. Mortality risk and outcome. Epilepsy Res. 2011;94:53–60.
Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011; 10: 922–30.
Prüss H, Holtkamp M. Ketamine successfully terminates malignant status epilepticus. Epilepsy Res. 2008;82(2–3):219–22.
Holtkamp M, Othman J, Buchheim K, Masuhr F, Schielke E, Meierkord H. A malignant variant of status epilepticus. Arch Neurol. 2005;62(9):1428–31.
Schrader DV, Steinbok P, Connolly M. Urgent, resective surgery for medically refractory, convulsive status epilepticus. Eur J Paediatr Neurol. 2009;13:10–7.
Marchi N, Granata T, Freri E, Ciusani E, Ragona F, Puvenna V, et al. Efficacy of anti–inflammatory therapy in a model of acute seizures and in a population of pediatric drug resistant epileptics. PLoS One 2011;28: e18200.
Vezzani A, Balosso S, Aronica E, Ravizza T. Basic mechanisms of status epilepticus due to infection and inflammation. Epilepsia. 2009;50(Suppl. 12):56–7.
Visser NA, Braun KP, Leijten FS, van Nieuwenhuizen O, Wokke JH, van den Bergh WM. Magnesium treatment for patients with refractory status epilepticus due to POLG1–mutations. J Neurol. 2011;258:218–22.
Cervenka MC, Hartman AL, Venkatesan A, Geocadin RG, Kossoff EH. The ketogenic diet for medically and surgically refractory status epilepticus in the neurocritical care unit. Neurocrit Care. 2011;15(3):519–24.
Nabbout R, Mazzuca M, Hubert P, Peudennier S, Allaire C, Flurin V, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia. 2010;51:2033–7.
Wusthoff CJ, Kranick SM, Morley JF, Christina Bergqvist AG. The ketogenic diet in treatment of two adults with prolonged nonconvulsive status epilepticus. Epilepsia. 2010;51:1083–85.
Wheless JW. Treatment of refractory convulsive status epilepticus in children: other therapies. Semin Pediatr Neurol. 2010;17:190–4.
Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008;9:189–97.
Kamel H, Cornes SB, Hegde M, Hall SE, Josephson SA. Electroconvulsive therapy for refractory status epilepticus: a case series. Neurocrit Care. 2010;12:204–10.
Shin HW, O’Donovan CA, Boggs JG, Grefe A, Harper A, Bell WL, et al. Successful ECT treatment for medically refractory nonconvulsive status epilepticus in pediatric patient. Seizure. 2011;20(5):433–36.
De Herdt V, Waterschoot L, Vonck K, Dermaut B, Verhelst H, Van Coster R, et al. Vagus nerve stimulation for refractory status epilepticus. Eur J Paediatr Neurol. 2009;13(3):286–9.
Hesdorffer DC, Stables JP, Hauser WA, Annegers JF, Cascino G. Are certain diuretics also anticonvulsants?. Ann Neurol. 2001;50(4):458-62.
Haglund MM, Hochman DW. Furosemide and mannitol suppression of epileptic activity in the human brain. J Neurophysiol. 2005;94(2):907-18.
Holtkamp M, Matzen J, Buchheim K, Walker MC, Meierkord H. Furosemide terminates limbic status epilepticus in freely moving rats. Epilepsia. 2003;44(9):1141-4.
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