Seizures and Sepsis: A Narrative Review.

Area of Science:

• Neurology
• Critical Care Medicine
• Infectious Diseases

Background:

• Sepsis-associated encephalopathy (SAE) presents with diverse neurological symptoms, from mild impairment to coma.
• Systemic inflammation and cytokine release in sepsis can trigger electrical abnormalities leading to seizures.
• Both convulsive and nonconvulsive seizures (NCS) occur in SAE, with NCS frequently misdiagnosed.

Purpose of the Study:

• To review the pathophysiology, clinical presentation, diagnosis, and treatment of seizures in sepsis.
• To highlight the prevalence and diagnostic challenges of nonconvulsive seizures in SAE.
• To discuss the role and limitations of electroencephalography (EEG) in seizure detection.

Main Methods:

• This is a narrative review.
• Literature search on pathophysiology, clinical manifestations, diagnostic tools, and therapeutic strategies for seizures in sepsis.

Main Results:

• Seizures, including NCS, are a significant neurological complication of sepsis.
• Continuous EEG (cEEG) is valuable for detecting NCS and mapping seizure origins but its optimal use is not well-defined.
• Long-term seizure risk is elevated in sepsis survivors.

Conclusions:

• Prompt recognition and management of seizures in SAE are essential.
• Further research is needed to establish optimal EEG protocols for SAE patients.
• Effective seizure management involves a stepwise approach, potentially including anesthetic agents for refractory cases.