Seizures in the intensive care unit

Abstract

All critically ill patients are prone to neurophysiological stresses that can cause seizures, as well as seizure mimics. In these complex patients, generalized tonic-clonic seizures are rare, but abnormal movements, altered mental status, nonconvulsive seizures, and interictal discharges are far more common. Electroencephalography (EEG) is the key to unlock the answers of these questions. For example, EEG can determine if myoclonus is due to cortical seizure discharges, or because of a metabolic derangement. Continuous EEG (cEEG) can portend improvement or worsening of the patient along the ictal-interictal continuum. The use of trending and quantitative EEG can guide seizure treatment strategies in patients with refractory and super-refractory status epilepticus, and will also help estimate dosages of both acute and long-term antiseizure medication. Complex critically ill patients require complex decision-making tools to diagnose and treat patients with nonconvulsive seizures and nonconvulsive status epilepticus that may be refractory to treatment.