Refractory status epilepticus in a patient with short bowel syndrome—A microdialysis study

Successful Treatment of Symptomatic Epilepsy with Oral Valproic Acid and Levetiracetam in a Patient with Short-bowel Syndrome

Valproic acid (VPA) and levetiracetam (LEV) are used in epilepsy treatment. However, their use to treat short-bowel syndrome has not been reported. We herein report a 68-year-old man who was hospitalized for symptomatic epilepsy following cerebral infarction. He had a history of superior mesenteric arterial occlusion, and only 30 cm of his jejunum was intact. VPA and LEV were administered, and good blood levels were achieved at clinical doses. This suggests that the gastrointestinal tract absorption of LEV and VPA is good even in patients with short-bowel syndrome and a 30-cm jejunum.

Multimodal invasive monitoring in status epilepticus: what is the evidence it has a place?

The underlying pathophysiology of status epilepticus (SE) remains mostly invisible to the clinician in the intensive care unit (ICU) setting. In animal studies associated hemodynamic and brain neurochemical changes have been well described. In the last decade, bedside invasive neuromonitoring techniques allow the assessments of changes in focal and global cerebral physiology associated with ictal activity on the tissue level in humans. Recent studies demonstrate that laboratory research insufficiently replicates the complexity of the human condition. Herein we summarize the current knowledge gained from human studies integrating cortical electrographic and brain tissue metabolic and hemodynamic information into the current pathophysiologic concept of SE in humans. With increasing experience gained by the use of extended neuromonitoring, we are more and more able to understand associated hemodynamic and brain neurochemical changes in patients with SE. In the future, this information can potentially provide integrated pathophysiologic end points into SE treatment concepts.