Problems and Controversies in Status Epilepticus: A Review and Recommendations

Status epilepticus (SE) is a neurologic emergency that require immediate vigorous treatment in order to prevent serious morbidity or even death. Several investigators have suggested that the underlying etiology is the primary determinant of outcome. We believe that this may be true in aggressively treated SE, but not when the treatment is less than optimal. In this article, we will discuss the factors that have been implicated in affecting SE outcomes, and argue, on the basis of both human and experimental animal data, that aggressive treatment is necessary and appropriate for all presentations of SE in order to maximize the probability of a successful outcome even when the etiology suggests a poor prognosis

Predictability and Resetting in a Case of Convulsive Status Epilepticus

In this case study, we present evidence of resetting of brain dynamics following convulsive status epilepticus (SE) that was treated successfully with antiepileptic medications (AEDs). The measure of effective inflow (EI), a novel measure of network connectivity, was applied to the continuously recorded multichannel intracranial stereoelectroencephalographic (SEEG) signals before, during and after SE. Results from this analysis indicate trends of progressive reduction of EI over hours up to the onset of SE, mainly at sites of the epileptogenic focus with reversal of those trends upon successful treatment of SE by AEDs. The proposed analytical framework is promising for elucidation of the pathology of neuronal network dynamics that could lead to SE, evaluation of the efficacy of SE treatment strategies, as well as the development of biomarkers for susceptibility to SE