PMID- 22844199
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20120823
LR  - 20211021
IS  - 1179-5476 (Electronic)
IS  - 1179-5476 (Linking)
VI  - 5
DP  - 2012
TI  - Typical Spike-and-Wave Activity in Hypoxic-Ischemic Brain Injury and its 
      Implications for Classifying Nonconvulsive Status Epilepticus.
PG  - 99-106
LID - 10.4137/CCRep.S9861 [doi]
AB  - INTRODUCTION: Typical spike-and-wave activity (TSWA) in the electroencephalogram 
      (EEG) indicates idiopathic generalized epilepsy (IGE). IGE-related nonconvulsive 
      status epilepticus (NCSE) is typically an absence status epilepticus (ASE). ASE 
      and TSWA respond dramatically to benzodiazepines. Patients with no history of 
      seizure/epilepsy may develop ASE "de novo" in the context of an acute brain 
      disorder. However, we are aware of only one previous case of de novo ASE with 
      TSWA in hypoxic-ischemic brain injury. CASE PRESENTATION: A 65-year-old man, with 
      congestive heart failure and history of substance abuse, survived 
      cardiorespiratory arrest after 18 minutes of cardiopulmonary resuscitation. 
      Post-resuscitation, the patient was in coma with intact brainstem function. 
      Toxicology was positive for cocaine and marijuana. Eyelid myoclonus suggested 
      NCSE, which was initially treated with lorazepam and fosphenytoin. EEG monitoring 
      showed sustained TSWA confirming NCSE and demonstrating de novo ASE (the patient 
      and his family never had seizure/epilepsy). The TSWA was resistant to lorazepam, 
      levetiracetam, and low-dose midazolam; it was eliminated only with midazolam at a 
      dose that resulted in burst-suppression (>/=1.2 mg/kg/hour). CONCLUSION: This is an 
      unusual case of TSWA and hypoxic-ischemic brain injury in a patient with no 
      history of seizure/epilepsy. The TSWA was relatively resistant to benzodiazepines 
      suggesting that cerebral hypoxia-ischemia spared the thalamocortical apparatus 
      generating TSWA but impaired the cortical/thalamic inhibitory circuits where 
      benzodiazepines act to suppress TSWA. Albeit rare, 'post-hypoxic' TSWA offers us 
      some valuable insights for classifying and managing nonconvulsive status 
      epilepticus.
FAU - Mader, Edward C Jr
AU  - Mader EC Jr
AD  - Louisiana State University Health Sciences Center, Epilepsy Center of Excellence, 
      1542 Tulane Avenue, New Orleans, LA 70112, USA.
FAU - Villemarette-Pittman, Nicole R
AU  - Villemarette-Pittman NR
FAU - Kashirny, Sergei V
AU  - Kashirny SV
FAU - Santana-Gould, Lenay
AU  - Santana-Gould L
FAU - Olejniczak, Piotr W
AU  - Olejniczak PW
LA  - eng
PT  - Case Reports
DEP - 20120705
PL  - United States
TA  - Clin Med Insights Case Rep
JT  - Clinical medicine insights. Case reports
JID - 101531893
PMC - PMC3399402
OTO - NOTNLM
OT  - EEG
OT  - de novo absence status epilepticus
OT  - epileptiform
OT  - hypoxic-ischemic brain injury
OT  - nonconvulsive status epilepticus
OT  - typical spike-and-wave activity
EDAT- 2012/07/31 06:00
MHDA- 2012/07/31 06:01
PMCR- 2012/07/05
CRDT- 2012/07/31 06:00
PHST- 2012/07/31 06:00 [entrez]
PHST- 2012/07/31 06:00 [pubmed]
PHST- 2012/07/31 06:01 [medline]
PHST- 2012/07/05 00:00 [pmc-release]
AID - ccrep-5-2012-099 [pii]
AID - 10.4137/CCRep.S9861 [doi]
PST - ppublish
SO  - Clin Med Insights Case Rep. 2012;5:99-106. doi: 10.4137/CCRep.S9861. Epub 2012 
      Jul 5.