Can endotracheal intubation be the first step in management of nonconvulsive status epilepticus?

Can endotracheal intubation be the first step in management of nonconvulsive status epilepticus? AbstractRationale:Nonconvulsive status epilepticus (NCSE) is prolonged seizure activity without motor manifestations. Clinically, there are certain examination findings, in addition to elements of history, that help differentiate it from other encephalopathies. When diagnosing NCSE, the physician faces significant difficulties due to inconsistent clinical presentation and somewhat nonspecific electroencephalogram (EEG) criteria.Patient concerns:To highlight the problems faced when dealing with such a patient, a case of a 29-year-old male who presented with an altered state of consciousness is put forth for the reader. Only after an extensive laboratory and radiological workup had ruled out other causes, an eventual diagnosis was established when clinical features were correlated with suggestive EEG results.Diagnoses:The diagnosis that was reached was NCSE.Interventions:The initial therapeutic interventions generally deployed in such a scenario ultimately failed and consequently the patient had to be sedated and intubated, while being kept on antiepileptic medication.Outcomes:This measure resulted in satisfactory recovery.Lessons:Accordingly, we recommend consideration of NCSE in any unconscious patient whose presentation cannot be explained by other disorders. Furthermore, we suggest moving directly to utilizing anesthetic agents and endotracheal intubation, together with anti-epileptic drugs, in the treatment regimen in order to optimize patient outcomes. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Medicine Wolters Kluwer Health

Can endotracheal intubation be the first step in management of nonconvulsive status epilepticus?

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Publisher
Wolters Kluwer
Copyright
Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
ISSN
0025-7974
eISSN
1536-5964
D.O.I.
10.1097/MD.0000000000009950
Publisher site
See Article on Publisher Site

Abstract

AbstractRationale:Nonconvulsive status epilepticus (NCSE) is prolonged seizure activity without motor manifestations. Clinically, there are certain examination findings, in addition to elements of history, that help differentiate it from other encephalopathies. When diagnosing NCSE, the physician faces significant difficulties due to inconsistent clinical presentation and somewhat nonspecific electroencephalogram (EEG) criteria.Patient concerns:To highlight the problems faced when dealing with such a patient, a case of a 29-year-old male who presented with an altered state of consciousness is put forth for the reader. Only after an extensive laboratory and radiological workup had ruled out other causes, an eventual diagnosis was established when clinical features were correlated with suggestive EEG results.Diagnoses:The diagnosis that was reached was NCSE.Interventions:The initial therapeutic interventions generally deployed in such a scenario ultimately failed and consequently the patient had to be sedated and intubated, while being kept on antiepileptic medication.Outcomes:This measure resulted in satisfactory recovery.Lessons:Accordingly, we recommend consideration of NCSE in any unconscious patient whose presentation cannot be explained by other disorders. Furthermore, we suggest moving directly to utilizing anesthetic agents and endotracheal intubation, together with anti-epileptic drugs, in the treatment regimen in order to optimize patient outcomes.

Journal

MedicineWolters Kluwer Health

Published: Feb 1, 2018

References

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