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

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“…The etiologies of seizures in critically ill patients are mentioned [7], as: Exacerbation of preexisting epilepsy, AED withdrawal, acute neurologic insult, cerebrovascular disease: infarct, hemorrhage (including subarachnoid, subdural, parenchymal, intraventricular), vasculitis, Infection: meningitis, encephalitis, brain abscess, head trauma, anoxia, brain tumors, demyelinating disorders, supratentorial neurosurgical procedure, acute systemic insult, electrolytes imbalances: hyponatremia, hypocalcemia, hypomagnesemia, hypophosphatemia (especially in alcoholics), hypoglycemia; hyperglycemia with hyperosmolar state; both can cause focal seizures as well, vitamin de iciency: pyridoxine, Illicit drug use, especially cocaine, toxins, hypertensive encephalopathy/eclampsia/posterior reversible, encephalopathy syndrome, hypotension, organ failure: renal, hepatic, multisystem illness, such as systemic lupus erythematosus, medications: side effects/toxicity, withdrawal (benzodiazepines, barbiturates), alcohol related, and systemic infection/sepsis.…”

“…Abou Khaled et al [7] IV Valproate is a reasonable alternative to fosphenytoin at this point as well (dosing below).…”

“…It can be given quickly and has a duration of antiseizure effect of 12 to 24 hours [7,27]. Leppik and colleagues [7,27] compared lorazepam with diazepam for the treatment of SE in 78 subjects enrolled in a double-blind, randomized trial.…”

“…Leppik and colleagues [7,27] compared lorazepam with diazepam for the treatment of SE in 78 subjects enrolled in a double-blind, randomized trial. These results, combined with the more recent and more de initive VA cooperative study, have led to intravenous lorazepam (0.1 mg/kg) becoming a clear drug of choice for initial treatment of SE [7].…”

“…Treiman and colleagues [6,7] de ined overt convulsive SE as two or more generalized convulsions without full recovery of consciousness between seizures, or continuous convulsive activity for more than 10 minutes. For practical purposes, SE should be considered if a seizure persists more than 5 minutes because very few single seizures last this long.…”