Keppra Critical care Use
Using Keppra in special situations All off label ref: Uptodate Craniotomy, seizure prophylaxis 500 mg bid iv, up to 3 gram per day Status epilepticus Loading dose 1 to 3 gram at 5 mg/kg/minute or 50 mg/kg over 15 minutes, up to 4.5 gram followed by maintenance dose Subarachnoid...
Seizure, and pregnancy
Woman who are in child bearing age or desire to get pregnant needs special consideration in using anticonvulsant (antiepileptic drug = AED). The following is a very short synopsis, please refer to numerous full review for information. Before getting pregnant AED interfere with birth control pills, may result in...
Seizures in Seniors
Epilepsy foundation excellent resource Should a first seizure in Senior be treated? Alcohol withdraw, required treatment for withdraw Long term anticonvulsant may not be needed For NONwithdraw seizure 2 year seizure recurrent risk 23-71% higher if abnormal neuro exam or remote brain insult, including stroke Treatment reduce recurrence by...
Anticonvulsants
Nice table from Neurology Residents AED table 1 – side effect, Pregnancy class AED dosage, formulation table Epilepsy Foundation on medications Drugs that lower seizure threshold Antidepressants and seizure incidence Antiepileptic drugs in transplant patients Sharpen your skill in reading EEG...
EEG Learning
Video series by Dr Jeremy Moeller – the best Clear explanation of topic with great graphics and samples View 1 or 2 video everyday, pause and rewind to retain the information at your own pace, start with Basics of EEG Normal awake EEG EEG in normal sleep Interictal abnormalities...
Nonconvulsive Status epilepticus
Coma patients 8% has NCSE in ICU 30% has NCSE in ED 30% after CPR Up to 78% in autoimmune encephalitis 3-13% in Subarachnoid hemorrhage Reference Sutter, et al Nature Reviews 2016...
Status Epilepticus
Initial treatment Assess ABC, check lab: cmp, cbc, Tox screen, anticonvulsant levels Lorazepam 0.1 mg/kg or 4 mg iv at max of 2 mg/min Glucose + thiamine if indicated May need intubation Anticonvulsant loading Levetiracetam: 60 mg/kg, max 4500 mg over 15 minutes Valproate (Depacon): 30 mg/kg, at 10...
PRES
AKA Posterior reversible encephalopathy syndrome (PRES) Reversible posterior cerebral edema syndrome Posterior leukoencephalopathy syndrome Hyperperfusion encephalopathy Brain capillary leak syndrome Symptoms headache altered consciousness/confusion visual disturbance seizure MRI calcarine and paramedian parts of the occipital lobe are usually spared, helping to distinguish RPLS from bilateral posterior cerebral infarctions Involvement...