A systematic review of second line therapies in toxic seizures.

Background: Seizures are a common manifestation of toxic exposures requiring immediate and possibly ongoing management. Guidelines recommend benzodiazepines as first-line therapy for toxic seizures; however, there is a paucity of literature regarding optimal secondary treatment. We systematically evaluated the available literature for second-line treatment of toxic seizures.

Spreading depolarization in acute brain injury inhibited by ketamine: a prospective, randomized, multiple crossover trial.

Objective: Retrospective clinical data and case studies support a therapeutic effect of ketamine in suppression of spreading depolarization (SD) following brain injury. Preclinical data strongly support efficacy in terms of frequency of SD as well as recovery from electrocorticography (ECoG) depression. The authors present the results of the first prospective controlled clinical trial testing the role of ketamine used for clinical sedation on occurrence of SD.

Levetiracetam in toxic seizures.

Background/objectives: The use of levetiracetam (LEV) in the management of drug-induced seizures has not been systematically investigated. Repetitive and continuous seizures that do not respond to benzodiazepines require second line therapy. Levetiracetam has a unique receptor binding site, rapid absorption, no known cardiac effects at therapeutic doses, and is theoretically a good candidate for use in drug-induced seizures.

Psychogenic seizures: a focused clinical review for the emergency medicine practitioner.

Psychogenic seizures sometimes mimic neurogenic seizures and may occur concomitantly. Unlike neurogenic seizures, psychogenic seizures do not have abnormal electrical discharges on electroencephalogram, and their presence generally reflects an underlying psychiatric disorder. No single clinical observation can definitively distinguish psychogenic from neurogenic seizures.