Management of Status Epilepticus and Critical Care Seizures

Abstract

There are multiple approaches to the treatment of seizures and status epilepticus (SE) in the intensive care unit (ICU). With only one seizure, the focus should be more on defining the etiology than on treating the patient with antiepileptics; but with more prolonged or recurrent seizures, both approaches should be pursued in parallel. If delayed or untreated, SE carries a grave prognosis, and every ICU should have a protocol for rapid response to this neurological emergency. Continuous electroencephalographic monitoring should become mandatory in the treatment of SE because of the late dissociation between clinical convulsions and electrographic seizures and the inability to use the clinical examination as guide to the treatment. Focal and nonconvulsive SE have etiology and prognosis different from those of generalized convulsive SE and the treatment also differs. Several medications are available for treating seizures, but only few are available for parenteral, fast administration in the treatment of SE. Therefore, the experience from using the newer antiepileptics in the case of resistant SE is limited. Interactions between antiepileptics and common ICU medications may be significant, and concurrent multiorgan failure may alter their metabolism.