The diagnosis and management of seizures in the critically ill patient can sometimes present a unique challenge for practitioners due to lack of exposure and complex patient comorbidities. The reported incidence varies between 8% and 34% of critically ill patients, with many patients often showing no overt clinical signs of seizures. Outcomes in patients with unidentified seizure activity tend to be poor, and mortality significantly increases in those who have seizure activity longer than 30 min. Prompt diagnosis and provision of medical therapy are crucial in order to attain successful seizure termination and prevent poor outcomes. In this article, we review the epidemiology and pathophysiology of seizures in the critically ill, various seizure monitoring modalities, and recommended medical therapy.

Levetiracetam is an antiseizure drug commonly utilized in the neurocritical care (NCC) environment for the treatment of seizures, status epilepticus, and as a prophylactic therapy in certain situations.Levetiracetam's exact mechanism of action is unknown; however, its main antiseizure effect is proposed to be neurotransmitter modulation through binding to synaptic vesicle glycoprotein 2A. 1,2 Levetiracetam has also been shown to have modulating effects at the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor. 3 While efficacious, levetiracetam treatment has also been associated with the risk of developing behavioral adverse events