The Role of Secondary Brain Insults in Status Epilepticus: A Systematic Review

Abstract

(1) Background: Little is known about the impact of pathophysiological mechanisms that underlie the enhancement of excitotoxicity and the neuronal consequences of status epilepticus (SE), as well as the clinical consequences of secondary brain insults (SBI) in patients with SE on outcome; (2) Methods: Electronic searches were conducted in May 2020 using Medline via PubMed, Embase, and Google Scholar (#CRD42019139092). Experimental studies of animals or randomized, observational, controlled trials of patients with SE in indexed journals were included. There were no language or date restrictions for the published literature included in this review. Information was extracted on study design, sample size, SBI characteristics, and primary and secondary outcomes, including the timing of evaluation; (3) Results: Among the 2209 articles responding to our inclusion criteria, 56 were included in this systematic review. There are numerous experimental data reporting the deleterious effects associated with each of the SBI in animals exposed to SE. In humans, only the effect of target temperature management in hypothermia (32-34 °C) has been explored. (4) Conclusions: There is little experimental evidence that favors the control of secondary brain insult after SE. Further studies are required to assess the neuroprotective interest of secondary brain insult control after SE in humans.

Keywords: animal models; humans; intensive care unit; outcome; status epilepticus/complications; status epilepticus/etiology; status epilepticus/therapy.

Figure 1

Flow chart of study selection.

Figure 2

Synthesis of the evidence of secondary brain insults in experimental status epilepticus. CBF: cerebral blood flow; PaCO₂: arterial partial pressure of carbon dioxide; PaO₂: arterial partial pressure of oxygen; BBB: blood brain barrier. (A) Flow-metabolism coupling and cerebral autoregulation/Mean arterial blood pressure; (B) Arterial partial pressure of carbon dioxide (PaCO2); (C) Arterial partial pressure of oxygen (Pa02); (D) Temperature; (E) Natremia/Osmolality; (F) Glycemia; (G) Hemoglobinemia.