Article

Seizures and status epilepticus in the intensive care unit.

Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Seminars in Neurology (Impact Factor: 1.51). 12/2008; 28(5):668-81. DOI: 10.1055/s-0028-1105978
Source: PubMed

ABSTRACT Persistent seizures and failure to regain consciousness following witnessed seizure activity require emergency neurological consultation. Although outcome is largely dependent on underlying cause, early maximal anticonvulsant therapy is critical to reducing morbidity. This review covers important concepts in the clinical and EEG diagnosis of status epilepticus, and discusses treatment algorithms for single and recurrent seizures, emphasizing the need to rationalize therapy depending on the presumed duration of seizure activity. The review takes the perspective of the neurological consultant in the intensive care unit, and considers all pharmacological approaches available to the intensivist as described in the current literature and from clinical experience.

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    ABSTRACT: Status epilepticus (SE) still results in significant mortality and morbidity. Whereas mortality depends mainly on the age of the patient as well as etiology, morbidity often results from a myriad of complications that occur during prolonged admission to an intensive care environment. Although SE is a clinical diagnosis in most cases (convulsant), its treatment requires support by continuous electroencephalographic recording to ensure cessation of potential nonconvulsive elements of SE. Treatment must be initiated as early as possible and consists of benzodiazepine administration and supportive measures for the airway and circulation. These initial interventions are followed by effective intravenous antiepileptic drugs. If the SE becomes refractory, more complex intensive care interventions, such as induction of barbiturate coma, need to be pursued. Data regarding the role of more recently available antiepileptic drugs in treating SE also are discussed in this review.
    Current Neurology and Neuroscience Reports 11/2009; 9(6):469-76. · 3.78 Impact Factor
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    [Show abstract] [Hide abstract]
    ABSTRACT: Status epilepticus (SE) still results in significant mortality and morbidity. Whereas mortality depends mainly on the age of the patient as well as etiology, morbidity often results from a myriad of complications that occur during prolonged admission to an intensive care environment. Although SE is a clinical diagnosis in most cases (convulsant), its treatment requires support by continuous electroencephalographic recording to ensure cessation of potential nonconvulsive elements of SE. Treatment must be initiated as early as possible and consists of benzodiazepine administration and supportive measures for the airway and circulation. These initial interventions are followed by effective intravenous antiepileptic drugs. If the SE becomes refractory, more complex intensive care interventions, such as induction of barbiturate coma, need to be pursued. Data regarding the role of more recently available antiepileptic drugs in treating SE also are discussed in this review.
    Current Neurology and Neuroscience Reports 9(6):469-476. · 3.78 Impact Factor
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    ABSTRACT: BACKGROUND: Admission of patients with status epilepticus (SE) to the neurosciences intensive care unit (NICU) may improve management and outcomes compared to general ICUs. METHODS: We reviewed all patients with SE admitted to the NICU versus the Medical ICU in our institution between 2005 and 2008. We included only patients with definite or probable SE based on pre-defined criteria. We collected demographic and clinical data, including severity of admission scores and adjusted short-term outcomes for admission and management in the two ICUs. RESULTS: There were 168 visits in 151 patients for definite or probable SE, 46 (27 %) of which were in the NICU and 122 (73 %) in the MICU. APACHE II scores were significant higher in the MICU group (17.5 vs 13.4, p = 0.003) and age in the NICU (58.3 vs 51.5 years, p = 0.041). More continuous EEGs were ordered in the NICU (85 vs 30 %, p < 0.001), where fewer patients were intubated, but more eventually tracheostomized. The NICU had a higher rate of complex partial SE and more alert or somnolent patients, whereas the MICU had a higher rate of generalized SE and more stuporous or comatose patients. Admission diagnoses also differed, with the NICU having higher rate of strokes and the MICU higher rate of toxometabolic etiologies (39 vs 12 % and 11 vs 21 %, p = 0.002). After adjustment, no difference was found in mortality, the ICU or hospital length of stay and modified Rankin score at discharge. CONCLUSION: SE treatment revealed increased use of continuous EEG in NICU-admitted patients, but without concomitant reduction in LOS or discharge outcomes compared to the MICU.
    Neurocritical Care 04/2013; · 3.04 Impact Factor

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