[Epileptic seizures in critically ill patients]

Area of Science:

• Neurology
• Critical Care Medicine
• Neuroscience

Background:

• Seizures and status epilepticus are frequent neurological complications in intensive care settings.
• These events can stem from primary neurological issues (stroke, trauma) or secondary causes related to critical illness (hypoxia, metabolic disturbances).
• Epilepsy is present in only 25% of individuals experiencing seizures and status epilepticus.

Purpose of the Study:

• To comprehensively review the etiology, clinical manifestations, pathophysiology, outcomes, and therapeutic strategies for seizures and status epilepticus in critically ill patients.
• To highlight the different subtypes of status epilepticus encountered in intensive care units.
• To discuss the neurochemical and ionic mechanisms underlying seizure generation.

Main Methods:

• Literature review of causes, clinical signs, pathophysiology, consequences, and treatment of seizures and status epilepticus in critically ill patients.
• Categorization of status epilepticus into generalized convulsive, focal motor, and nonconvulsive subtypes.
• Discussion of first-line, second-line, and refractory treatment options, including specific drug classes and agents.

Main Results:

• Generalized convulsive status epilepticus is a medical emergency requiring immediate intervention.
• Treatment involves a stepwise approach: benzodiazepines (lorazepam, diazepam) as first-line, followed by phenytoin/fosphenytoin.
• Refractory cases may necessitate barbiturates, valproate, midazolam, propofol, or isoflurane.

Conclusions:

• Seizures and status epilepticus in the critically ill are complex neurological events with significant morbidity and mortality.
• Effective management hinges on prompt diagnosis and appropriate, often multi-drug, therapeutic interventions.
• Prognosis is influenced by the underlying cause, seizure duration, and patient's age, with mortality rates for generalized convulsive status epilepticus ranging from 15-50%.