Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-4: Seizures and Status Epilepticus (Jose J. Provencio, MD, FCCM)

Video Transcription

Video Summary

Seizures and status epilepticus were once believed to be caused by various factors such as visitations from demons or changes in the body. However, our understanding of seizures has evolved significantly. A seizure is an abnormal, hyper-synchronous, paroxysmal activity of the cerebral cortex, while epilepsy is the tendency to have repeated, unprovoked seizures due to a brain disorder. Seizures can be categorized as partial seizures, which stay in one area of the brain, or generalized seizures, which involve both sides of the brain simultaneously. In the ICU, it can be challenging to diagnose seizures, but continuous EEG monitoring can help in detecting them. Roughly 10% to 25% of patients with altered mental status in the ICU may have seizures or epileptiform discharges. Status epilepticus, which is when seizures do not stop, is a medical emergency. The prognosis depends on the underlying cause and time spent in status. Treatment involves stopping the seizure, managing the underlying cause, and preventing seizure recurrence. Lorazepam is the recommended first intravenous dose for convulsive status epilepticus. If seizures persist, second-line medications such as valproate or leviteracetam can be used. In refractory cases, aggressive treatment with sedative agents like propofol or pentobarbital may be necessary. Continuous EEG monitoring is becoming increasingly important in the management of status epilepticus patients.

Keywords

Seizures

Status epilepticus

Cerebral cortex

Epilepsy

ICU

Continuous EEG monitoring

Lorazepam

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