Epilepsy and Neurocritical Care

A seizure is a paroxysmal alteration of neurologic function caused by the excessive, hypersynchronous discharge of neurons in the brain. Neurological critical care unit provides care for patients also with seizure disorders. Most seizures in critical ill patients are nonconvulsive and some patients may develop nonconvulsive status epilepticus. Continuous electroencephalography monitoring is commonly used in critically ill patients and can identify nonconvulsive seizures and nonconvulsive status epilepticus. Patients with severe traumatic brain injury and aneurysmal subarachnoid hemorrhage seem to benefit with a short course of antiseizure medications. However, the utility regarding prophylactic use of antiseizure medications in various neurological conditions encountered in the neurocritical care unit, in patients without clinical seizures, with an underlying neurological injury, is somewhat controversial. The treatment of seizures in neurocritical care unit must be individualized. It must depend on the type, frequency, severity, and duration of seizures, and whether episodes have been known to progress to prolonged seizures or seizure clusters or status epilepticus. Control of seizure clusters and status epilepticus in neurocritical care units generally follows the intravenous administration of medications such as benzodiazepine and antiseizure medications.