Seizures

Abstract

Seizures are common in intensive care patients generally. Cardiac surgery or post-cardiac arrest patients are at particular risk of brain injury. Seizures are an important and potentially reversible cause of prolonged unconsciousness as well as being associated with poorer ICU outcome, although the latter may be multifactorial. Cerebral metabolic rate is greatly increased during seizure activity that may lead to energetic crisis and neuronal injury. Non-convulsive seizures are particularly common in ICU patients and are therefore under-recognised. Electroencephalography (EEG) is therefore an essential ICU investigation the diagnosis of seizures, epileptiform activity and for distinguishing these from other disorders of consciousness, which may have characteristic EEG signatures. Continuous EEG is particularly sensitive for clinically occult seizures and is also helpful for managing seizures refractory to simple treatment. However EEG requires specific expertise to perform and interpret which can be a barrier to its use.