Chapter

GABA<sub>A</sub> Receptor Plasticity during Status Epilepticus

Suchitra Joshi and Jaideep Kapur

in Jasper's Basic Mechanisms of the Epilepsies

Fourth edition

Published on behalf of ©Jeffrey L. Noebels, Massimo Avoli, Michael A. Rogawski, Richard W. Olsen, and Antonio V. Delgado-Escueta

Published in print July 2012 | ISBN: 9780199746545
Published online April 2013 | e-ISBN: 9780199322817 | DOI: http://dx.doi.org/10.1093/med/9780199746545.003.0041

Series: Contemporary Neurology Series

GABAA Receptor Plasticity during Status Epilepticus

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Status epilepticus (SE) is a prolonged, self-sustained seizure that can manifest as a prolonged convulsion, subtle facial or limb twitching, or simply altered mental status, always in association with a persistent electroencephalographic (EEG) seizure pattern. In clinical trials, convulsive seizures lasting longer than 5 min are often treated as SE,1 whereas epidemiological studies have defined 30 min of continuous convulsive seizures or intermittent seizures without recovery of consciousness as SE.2 There are 126,000 to 195,000 episodes of SE associated with 22,000 to 42,000 deaths each year in the United States when SE is defined as 30 min of seizures.2 As many as 50% of patients older than 65 years of age who suffer from SE die within 30 days of the episode. Although mortality is far less common in younger patients, they are at risk for neurological morbidity, such as injury to the hippocampus3 and neuropsychological dysfunction.4 Prolonged seizures can also lead to significant systemic complications, including pulmonary congestion and edema, cardiac arrhythmias, hypotension, elevation of body temperature, hypoglycemia, acidosis, and rhabdomylosis. These systemic complications tend to worsen as more seizures occur.5 It has long been recognized that SE is a dynamic and rapidly evolving condition.5,6 Ongoing seizures rapidly modify neuronal activity and synaptic function.7 This rapid neuronal plasticity is manifest in changes in behavioral seizures, EEG patterns, sensitivity to drugs, and evolution of neuronal injury and death. Although these changes are continuous, it is convenient to divide SE into stages for the purposes of investigation and treatment (Table 41–1).

Chapter.  5354 words.  Illustrated.

Subjects: Neurology

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