Advances in the Management of Seizures and Status Epilepticus in Critically Ill Patients

Khaled, Karine J. Abou; Hirsch, Lawrence J.

doi:10.1016/j.ccc.2006.06.004

Cited by 18 publications

(14 citation statements)

References 96 publications

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“…1 Seizures and status epilepticus (SE) in critically ill patients require aggressive treatment and early intervention. 2,3 An ideal intravenous (IV) anticonvulsant facilitates access to the brain, while posing little risk of serious systemic and neurological adverse effects-traits necessary for patients in neurocritical care settings. 4 Antiepileptic drugs (AEDs) commonly used in emergent cases may complicate therapy by prompting the need for mechanical ventilation, IV fluids, vasopressors, and electroencephalogram (EEG) monitoring.…”

Section: Introductionmentioning

confidence: 99%

The Safety of Lacosamide for Treatment of Seizures and Seizure Prophylaxis in Adult Hospitalized Patients

Luk

Tatum

Patel

et al. 2012

The Neurohospitalist

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Background: Lacosamide (LCM) is a newer antiepileptic drug (AED) with favorable properties for hospitalized patients including intravenous formulation, minimal hepatic metabolism, and no adverse respiratory effects. We sought to determine the safety profile of LCM in hospitalized patients. Methods: We performed a retrospective medical record review of patients who received LCM between July 1, 2009, and January 31, 2010, at Mayo Clinic Hospital. Data included demographics, LCM dosing, concomitant AED therapy, documented seizure activity, hemodynamic variables, electrocardiogram (ECG), and laboratory data. Adverse drug reaction and drug-drug interactions were reviewed. Results: Thirty-two patients were identified. No major hypotension or serious cardiac arrhythmias occurred. Heart rate increased, however, in seizure group compared with the prophylaxis group 2 hours postdrug infusion (median heart rate ¼ 86 vs 164). The ECGs demonstrated a mean PR interval prolongation of about 6 milliseconds (ms) after LCM initiation (mean PR 185.5 ms, compared with baseline ECG mean of 179.3 ms). Laboratory data revealed no clinically significant changes 24 hours after LCM initiation. Three patients developed adverse events (9.4%): One with altered mental state and exceptionally prolonged ECG PR interval (212 vs 178 ms baseline); One with unexplained thrombocytopenia; and a third patient with dizziness, all of which resolved after drug discontinuation. Conclusion: The LCM demonstrated ECG PR prolongation as previously reported without systemic hypotension, with no discernable drug-drug interactions in hospitalized patients. About 9% of patients had transient adverse drug reactions after LCM, namely alteration in mental state, unexplained thrombocytopenia, and dizziness, which stopped after discontinuation of the drug.

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Section: Introductionmentioning

confidence: 99%

The Safety of Lacosamide for Treatment of Seizures and Seizure Prophylaxis in Adult Hospitalized Patients

Luk

Tatum

Patel

et al. 2012

The Neurohospitalist

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“…Overt and subclinical seizures or change of mental status are not unusual consequences of hypo-, or hyperglycemia, hyponatremia, hypocalcemia, drug intoxication or withdrawal, hepatic failure, uremia, sepsis 31 . In the Columbia cEEG study 20% of the primary diagnosed cases of toxic-metabolic encephalopathy had NCSz 5 .…”

Section: Toxic-metabolic Encephalopathymentioning

confidence: 99%

EEG in ICU: A monitoring tool for critically ill patient

Banu

2014

Bangladesh Crit Care J

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Electroencephalographic monitoring provides dynamic information about the brain function that permits early detection of changes in neurologic status, which is especially useful when the clinical examination is limited. Identification of ongoing electrographic seizures, non-convulsive status epilepticus (NCSE), periodic epileptogenic discharges (PED), irreversible cerebral dysfunction i.e., isoelectric tracing would help the care providers in appropriate decision making regarding the management. Non-convulsive seizures (NCSz) are more common than previously recognized and are associated with worse outcome if not treated in time. Majority of seizures at the ICU are not clinically identified because of the disease phenomena or as the patient may remain under sedation. Studies revealed the first NCSz within 1 to 24 hours of EEG monitoring; longer period of monitoring is required in comatose patient and those with PED. Factors associated with an increased risk of NCSz and NCSE include coma, prior clinical seizures, CNS infection, trauma, stroke, hypoxic ischemic encephalopathy, brain tumor, recent neurosurgery, and PED.In resource-poor situation, EEG is frequently requested to confirm brain death, particularly where there is limited information on neurological examination or inconclusive apnea test; or when the patient is in prolonged state of coma. Presence of isoelectric tracing for at least 30 minutes in the EEG along with other clinical evidences is helpful in such situations. Extreme care should be taken for recording and reviewing continuous EEG (cEEG) monitoring at the ICU where sources of electrical noise are present. Patients identified with electrographic seizures and mild to moderate degree encephalopathy, with presence of normal background activities had better outcome compared to those with PED, monorrhythmic alpha beta coma and severe generalized encephalopathy. Real-time detection of ischemia at a reversible state is technologically feasible with cEEG and should be developed into a practical form for prevention of in-hospital infarction. Brain function monitoring with EEG is useful and this is in great demand at the ICU of present time. Such monitoring can help to improve neurological outcome in a variety of ICU settings. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19954 Bangladesh Crit Care J March 2014; 2 (1): 28-34

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“…Seizures and status epilepticus are common neurologic conditions in various critical care settings 1 , 2 . In general, critically ill patients with seizures/status epilepticus can be divided into 2 broad groups: (a) those who are admitted to the intensive care unit (ICU) for aggressive treatment of continuous or repetitive seizures and (b) those who develop seizures during their critical illness 1 . Status epilepticus affects approximately 150,000 Americans every year, and the incidence of new‐onset seizures is between 0.8%‐3.5% in critically ill patients 3 .…”

mentioning

confidence: 99%

“…Status epilepticus affects approximately 150,000 Americans every year, and the incidence of new‐onset seizures is between 0.8%‐3.5% in critically ill patients 3 . ‐ 5 Although status epilepticus is defined by most as >30 minutes of continuous seizure activity or recurrent seizures without return to consciousness, others define status epilepticus as seizures persisting >5 minutes despite aggressive treatment 1 , 6 …”

mentioning

confidence: 99%

“…Among the common causes of seizures in the ICU are: (a) traumatic brain injury; (b) ischemic brain injury; (c) space‐occupying lesions (ie, hemorrhage or tumor); (d) various infectious processes; (e) systemic metabolic abnormalities (ie, hepatic or uremic encephalopathy, hypoglycemia, hypocalcemia, hyponatremia); and (f) medications 2 , 7 . Medication‐induced seizures can be a result of adverse effects (eg, imipenem or meperidine), drug overdose, drug withdrawal or intoxication (eg, alcohol, cocaine, or amphetamines), or noncompliance with antiepileptic drugs 1 , 2 . Wijdicks et al reported that the most common causes of new‐onset seizures in an ICU were sedative/opioid withdrawal (33%), severe metabolic abnormalities (33%), and drug intoxication (15%) 4 .…”

mentioning

confidence: 99%

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Vitamin B₆ Deficiency

Gerlach

Thomas

Stawicki

et al. 2011

J Parenter Enteral Nutr

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Objective: In children, vitamin B6 (pyridoxine) deficiency has been described as a cause of seizures that are refractory to conventional antiepileptic medications. We describe the clinical presentation of 3 adults with refractory seizures (later diagnosed with vitamin B6 deficiency) that resolved after pyridoxine treatment. Design: Case series. Setting: Tertiary care surgical intensive care unit. Patients: In the first case, a 54‐year‐old male with history of alcoholic cirrhosis developed new‐onset seizures refractory to phenytoin and levetiracetam 8 days after liver transplantation. In the second case, a 59‐year‐old male with hepatitis C infection developed intracranial hemorrhage and new‐onset seizures refractory to phenytoin, levetiracetam, and pentobarbital. The third patient is a 78‐year‐old male with a history of alcohol dependence who was admitted for an intraventricular bleed and developed new onset of refractory seizures. Interventions: Intravenous pyridoxine followed by oral pyridoxine. Measurement and Main Results: In all 3 cases, seizures persisted despite escalation of conventional antiepileptic medications but resolved within 2 days of pyridoxine supplementation. In each case, low serum pyridoxal 5′‐phosphate concentrations normalized with pyroxidine administration. Conclusions: Although refractory seizures caused by vitamin B6 deficiency are rare in adults, it should be considered in critically ill adult patients with refractory seizures.

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Advances in the Management of Seizures and Status Epilepticus in Critically Ill Patients

Cited by 18 publications

References 96 publications

The Safety of Lacosamide for Treatment of Seizures and Seizure Prophylaxis in Adult Hospitalized Patients

The Safety of Lacosamide for Treatment of Seizures and Seizure Prophylaxis in Adult Hospitalized Patients

EEG in ICU: A monitoring tool for critically ill patient

Vitamin B₆ Deficiency

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Advances in the Management of Seizures and Status Epilepticus in Critically Ill Patients

Cited by 18 publications

References 96 publications

The Safety of Lacosamide for Treatment of Seizures and Seizure Prophylaxis in Adult Hospitalized Patients

The Safety of Lacosamide for Treatment of Seizures and Seizure Prophylaxis in Adult Hospitalized Patients

EEG in ICU: A monitoring tool for critically ill patient

Vitamin B6 Deficiency

Contact Info

Product

Resources

About

Vitamin B₆ Deficiency