Seizures and status epilepticus in critically ill cancer patients

Seizures and status epilepticus (SE) occur more commonly in oncologic patients than the general population. Similarly, seizures are more common in critically ill patients, and thus critically ill oncologic patients are at high risk for having seizures and SE. There are several etiologic factors contributing to SE in critically ill oncologic patients including complications of existing brain tumors, brain metastasis, chemotherapy, radiation therapy, and paraneoplastic limbic encephalitides in addition to the etiologies that trigger seizures in non-tumor patients such as central nervous system (CNS) infections, electrolyte derangements, strokes, and hemorrhages. There is not much literature to guide the evaluation and management of seizures and SE in this specific patient population. However, the principles of management of seizures and SE are identical to the management in non-cancer patients with the primary goal to achieve prompt seizure control. Longterm antiepileptic drug (AED) therapy should be tailored and taking into account the interactions with chemotherapeutic agents and adverse events specific to cancer patients. Non-pharmacologic treatment such as surgical resection and radiation therapy may also be indicated in long-term seizure control. The prognosis of patients with tumor-related SE is worse when compared to patients with non-tumor SE.