Management of seizures in critically ill patients

Panayiotis N. Varelas, Marek A. Mirski

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


For many neurologists, seizures in critically ill patients represent a difficult problem. Etiology can be elusive because of the complexity of the environment, and treatment decisions can be compromised by the paucity of evidence-based guidelines. Emerging data support a higher than previously thought incidence of nonconvulsive epileptic activity in this patient population, which is another important consideration. Although a seizure in the intensive care unit should be treated aggressively, prophylactic antiepileptic drug administration is dependent on the specific etiology, time of onset, and ensuing complications. After ischemic stroke, prophylactic treatment is not generally recommended, and after intracerebral hemorrhage treatment is recommended only after a few weeks. After subarachnoid hemorrhage, prophylactic treatment beyond discharge is also not recommended. Although there is no reason to believe that late seizures after severe head trauma cannot be prevented with prophylactic treatment, such an approach may be useful during the first week after the injury. Physicians, however, have to individualize the treatment to the critical patient after stroke or trauma based on the presence of additional factors that increase the risk for seizures, including structural cortical injuries and medications used in critical illness with epileptogenic potential. A general therapeutic scheme for seizures in the intensive care unit and the role newer antiepileptic drugs can play are also presented in this review.

Original languageEnglish (US)
Pages (from-to)489-496
Number of pages8
JournalCurrent neurology and neuroscience reports
Issue number6
StatePublished - Nov 2004
Externally publishedYes

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


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