Electropositive seizures and non-convulsive status epilepticus in a critically ill patient with prior skull defect

In previously conscious patients seizures are usually easily detected. Critically-ill patients are frequently sedated and a proportion are paralysed with neuromuscular blocking agents, in such patients it may be hard or impossible to detect seizures clinically. An urgent electroencephalogram (EEG) should be obtained whenever seizures are witness or suspected, especially if the patient does not rapidly return to baseline, when non-convulsive status epilepticus must be excluded. Unless the cause of the seizure activity is already known, an urgent CT, or MRI is indicated. If central nervous system infection is suspected a lumbar puncture may be needed. Status epilepticus is diagnosed when there is recurrent or continued seizure activity without intervening recovery. Most seizures are self-limiting and stop after 1–2 minutes, seizures that continue for more than 5 minutes should be treated. Treatment priorities for any seizure are to stop the patient hurting either themselves or anyone else. General supportive measures include attention to the airway, breathing, circulation, exclusion of hypoglycaemia and an EEG to exclude non-convulsive status epilepticus. A variety of drugs can be used to terminate seizures; parenteral benzodiazepines are the most commonly used agents although propofol and barbiturates are alternatives. Emergent endotracheal intubation may well be necessary, hypotension can be expected and may need treatment with intravenous fluids and vasopressors.

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Association of systemic secondary brain insults and outcome in patients with convulsive status epilepticus

Neurology ◽

10.1212/wnl.0000000000010726 ◽

2020 ◽

Vol 95 (18) ◽

pp. e2529-e2541

Author(s):

Candice Fontaine ◽

Virginie Lemiale ◽

Matthieu Resche-Rigon ◽

Maleka Schenck ◽

Jonathan Chelly ◽

...

Keyword(s):

Status Epilepticus ◽

Therapeutic Hypothermia ◽

Critically Ill ◽

Critically Ill Patients ◽

Standard Care ◽

Controlled Trial ◽

Convulsive Status Epilepticus ◽

Open Label ◽

Arterial Blood ◽

Brain Insults

ObjectiveTo evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day 1 and neurologic outcomes 90 days after convulsive status epilepticus.MethodsThis was a post hoc analysis of the Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care (HYBERNATUS) multicenter open-label controlled trial, which randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32°C–34°C for 24 hours) plus standard care or standard care alone between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus.ResultsThe 172 men and 93 women had a median age of 57 years (45–68 years). Among them, 130 (49%) had a history of epilepsy, and 59 (29%) had a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients, and total seizure duration was 67 minutes (35–120 minutes). The 90-day outcome was unfavorable in 126 (48%) patients. In multivariate analysis, none of the systemic secondary brain insults were associated with outcome; achieving an unfavorable outcome was associated with age >65 years (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.20–3.85; p = 0.01), refractory convulsive status epilepticus (OR 2.00, 95% CI 1.04–3.85; p = 0.04), primary brain insult (OR 2.00, 95% CI 1.02–4.00; p = 0.047), and no bystander-witnessed seizure onset (OR 2.49, 95% CI 1.05–5.59; p = 0.04).ConclusionsIn our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus.ClinicalTrials.gov identifierNCT01359332.

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Nonconvulsive status epilepticus induced by acute hypothyroidism in a critically ill patient

Intensive Care Medicine ◽

10.1007/s00134-010-2111-2 ◽

2010 ◽

Vol 37 (3) ◽

pp. 553-554 ◽

Cited By ~ 2

Author(s):

Monica Rocco ◽

Stefano Pro ◽

Elisa Alessandri ◽

Edoardo Vicenzini ◽

Oriano Mecarelli

Keyword(s):

Status Epilepticus ◽

Critically Ill ◽

Nonconvulsive Status Epilepticus ◽

Critically Ill Patient ◽

Acute Hypothyroidism

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Outcomes of seizures, status epilepticus and EEG findings in critically ill patient with COVID-19

Epilepsy & Behavior ◽

10.1016/j.yebeh.2021.107923 ◽

2021 ◽

pp. 107923

Author(s):

Omar A. Danoun ◽

Andrew Zillgitt ◽

Chloe Hill ◽

Deepti Zutshi ◽

David Harris ◽

...

Keyword(s):

Status Epilepticus ◽

Critically Ill ◽

Critically Ill Patient

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Epileptic seizures in critically ill patients

Medicina ◽

10.3390/medicina45060066 ◽

2009 ◽

Vol 45 (6) ◽

pp. 501 ◽

Cited By ~ 1

Author(s):

Virginija Stasiukynienė ◽

Vidas Pilvinis ◽

Dagmara Reingardienė ◽

Liuda Janauskaitė

Keyword(s):

Intensive Care ◽

Status Epilepticus ◽

Critically Ill ◽

Critically Ill Patients ◽

Cortical Neurons ◽

Central Nervous System Infection ◽

Clinical Signs ◽

Convulsive Status Epilepticus ◽

Neurologic Complication ◽

Gamma Aminobutyric Acid

The aim of this article – to review the causes, clinical signs, pathophysiology, consequences, and treatment of seizures and status epilepticus in critically ill patients. Only 25% of people, who have seizures and status epilepticus, have epilepsy as well. In the intensive care settings, seizures and status epilepticus are a common neurologic complication, which is attributable to primary neurologic pathology (stroke, hemorrhage, tumor, central nervous system infection, head trauma) or secondary to critical illness (anoxic brain damage, intoxications, metabolic abnormalities) and clinical management. There are three main subtypes of status epilepticus in intensive care units: generalized convulsive status epilepticus, focal motor status epilepticus, and nonconvulsive status epilepticus. A seizure is a consequence of electrical neurological derangement because of sudden imbalance between the inhibitory and excitatory forces within the network of cortical neurons. The main inhibiting neurotransmitter in the brain is gamma-aminobutyric acid (GABA), which binds to GABA-A and GABA-B receptors. The main excitatory neurotransmitter is glutamate, which binds to N-methyl-D-aspartate receptors. Different ions (Cl–, K+, Na+, Ca2+) also play a role in the pathophysiology of seizures. Prolonged status epilepticus may lead to different systemic and neurologic consequences. Generalized convulsive status epilepticus is one of the most common emergencies encountered in clinical practice, which requires immediate treatment. The first-line drugs are benzodiazepines (lorazepam, diazepam), the second-line ones – phenytoin and fosphenytoin. For the treatment of refractory status epilepticus, barbiturates (phenobarbital, pentobarbital, thiopental), valproate, midazolam, propofol, and isoflurane are used. The dosage of drugs and parameters to monitor are referred in the article. The mortality from generalized convulsive status epilepticus is 15–50%; the main factors, influencing prognosis, are the cause and the duration of status epilepticus and age of a patient.

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