Management of critical care seizures

Abstract

Seizures are encountered frequently in critically ill patients, especially in patients with acute brain injury of various forms. Continuous EEG monitoring is absolutely essential for the diagnosis and management due to the fact that the majority of seizures encountered in this patient population are nonconvulsive. The definition of seizures and status epilepticus in critically ill patients has evolved over time. The definitions of convulsive seizures, nonconvulsive seizures, nonconvulsive status epilepticus, generalized convulsive status epilepticus, established status epilepticus, refractory status epilepticus, and super refractory status epilepticus are described here. Generalized convulsive status epilepticus is a medical emergency and it is recommended that each institution has a protocol for rapid treatment. Due to the lack of available data, there is a great deal of uncertainty regarding the optimal aggressiveness of nonconvulsive seizures and nonconvulsive status epilepticus. Several antiepileptic medications are available for use for the treatment of seizures and status epilepticus. Newer, non-sedating antiepileptic medications may have advantages, some of which have intravenous formulations. Antiepileptic medications may interact with other medications used in the ICU or may need dose adjustments in the setting of renal or hepatic insufficiency.