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Seizures and Status Epilepticus 

Seizures and Status Epilepticus
Chapter:
Seizures and Status Epilepticus
Author(s):

Michael E. Reznik

, and Jan Claassen

DOI:
10.1093/med/9780199375349.003.0008
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date: 05 April 2020

Seizures are common in the intensive care unit, both in patients with brain injury and those with other forms of critical illness. Many of these are nonconvulsive and have been increasingly recognized with the advent of continuous electroencephalography (EEG) monitoring. When seizures are prolonged or recur without a return to baseline, this is termed status epilepticus (SE)—a true medical emergency. Progression to refractory SE may occur quickly after onset, with a high potential for subsequent permanent neuronal damage. Successful management of SE therefore rests with early recognition and treatment, with a low threshold to begin anesthetic agents if seizures remain refractory to initial therapy. Meanwhile, a concurrent focus should be placed on airway, breathing, and circulation, as well as identifying the etiology of the seizures. Etiology is likely the best determinant of outcomes after SE (with outcomes worst for anoxic brain injury, followed by other newly acquired brain injury), while prolonged and refractory SE also portend a poorer prognosis.

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