Seizures and Organ Failure

Abstract

Seizures and epilepsy commonly occur in patients with organ system failure, either as a consequence of trophic effects on cerebral function or of therapies used in such conditions. Acute organ failure results in an abrupt, but often reversible, lowering of seizure threshold, whereas chronic organ failure results in more pervasive and indolent cerebral compromise, often permanently altering both the seizure threshold and the physiologic responses to antiepileptic drugs (AEDs). Failure of an organ system is not typically a sudden, all-or-none phenomenon but occurs in stages with variable susceptibility to seizures as the condition worsens or remits. Although the principles of diagnosis and management of seizures in adult and pediatric patients with a specific organ dysfunction are similar, the underlying etiologies and influences of comorbid conditions differ between adults and children. Adult organ failure often involves multiple systems to different extents and is superimposed on other chronic diseases of adulthood. Pediatric organ failure is usually the result of inherited metabolic disorders, infections, and unique pediatric susceptibilities to metabolic effects of medications (Table 1).