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New-onset seizures in critically ill patients
1Department of Neurology, Mayo Clinic, Rochester, MN 55905.
Neurology
|May 1, 1993
Summary
Sudden withdrawal of narcotic agents and severe hyponatremia are significant causes of new-onset seizures in critically ill patients. These factors, along with drug toxicity, frequently trigger seizures in intensive care units.
Area of Science:
- Neurology
- Critical Care Medicine
- Clinical Neurophysiology
Background:
- New-onset seizures in intensive care units (ICUs) present diagnostic challenges.
- Identifying triggers is crucial for effective management and improved patient outcomes.
Purpose of the Study:
- To investigate the diverse etiologies of new-onset seizures in medical and surgical ICU patients.
- To determine the frequency and impact of various seizure-precipitating factors.
Main Methods:
- Retrospective analysis of 55 patients admitted to ICUs between 1981 and 1991.
- Review of medical records to identify causes of new-onset seizures, including withdrawal syndromes, metabolic derangements, drug toxicity, and structural CNS abnormalities.
Main Results:
- One-third of seizures were linked to sudden withdrawal of narcotic agents.
- Acute metabolic changes, primarily severe hyponatremia (sodium <= 125 mEq/l), caused seizures in another third of patients.
- Drug toxicity (antibiotics, antiarrhythmics) and unrecognized CNS abnormalities were less common causes.
Conclusions:
- Sudden narcotic withdrawal is a notable cause of new-onset seizures in critically ill patients.
- Metabolic disturbances, particularly hyponatremia, are significant contributors to seizures in the ICU.
- While outcomes were generally favorable (66% survival), metabolic causes were associated with poorer prognosis.