Seizures and Sepsis: A Narrative Review.

Federico Bilotta,Rafael Badenes,Francesco Alessandri

doi:10.3390/jcm10051041

Abstract

Patients with sepsis-associated encephalopathy (SAE) can develop convulsive or nonconvulsive seizures. The cytokine storm and the overwhelming systemic inflammation trigger the electric circuits that promote seizures. Several neurologic symptoms, associated with this disease, range from mild consciousness impairment to coma. Focal or generalized convulsive seizures are frequent in sepsis, although nonconvulsive seizures (NCS) are often misdiagnosed and prevalent in SAE. In order to map the trigger zone in all patients that present focal or generalized seizures and also to detect NCS, EEG is indicated but continuous EEG (cEEG) is not very widespread; timing, duration, and efficacy of this tool are still unknown. The long-term risk of seizures in survivors is increased. The typical stepwise approach of seizures management begins with benzodiazepines and follows with anticonvulsants up to anesthetic drugs such as propofol or thiopental, which are able to induce burst suppression and interrupt the pathological electrical circuits. This narrative review discusses pathophysiology, clinical presentation, diagnosis and treatment of seizures in sepsis.

Highlights

Sepsis is a life-threatening condition due to dysregulation of the body’s response to infection that induces damage to its own tissues and organs [1]
In a single center retrospective study that reported data on 201 consecutive patients admitted to ICU without known acute neurologic injury and who underwent continuous EEG (cEEG) for investigation of possible seizures or changes in mental status, electrographic seizures (ESZs) or periodic discharges (PDs) were more common in septic critically ill patients than in those without sepsis (32% vs. 9%) [30]
Considering that 80–95% of NCS can be identified within 24–48 h, a cEEG run in all septic ICU patients is recommended to accomplish at least 24 h, making this monitoring approach a possible standard of care in clinical management [37,38]

Summary

Introduction

Sepsis is a life-threatening condition due to dysregulation of the body’s response to infection that induces damage to its own tissues and organs [1]. Sepsis-associated encephalopathy (SAE) complicates the course of up to 70% of septic patients and can present various clinical pictures: inattention, confusion, delirium, excitation, seizures, stupor and coma [2,3]. Up to 20% of critically ill patients develop seizures, which can present as convulsive (focal or generalized) or nonconvulsive (NCS); the latter represent 90% of the cases [4]. After an episode of generalized convulsive status epilepticus, occurrence of NCS is diagnosed in 48% of patients [3]. The delay in diagnosis or treatment of nonconvulsive status epilepticus (NCSE) in SAE patients associates with an increase in morbidity and mortality [5]. A thorough analysis of immediate (including diagnostic indications and therapeutic options) and long-term (prognosis and prevention) implications of seizures in septic patients is lacking

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