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Global Hypoxia-Ischemia and Critical Care Seizures

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Seizures in Critical Care

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Seizures after cardiopulmonary arrest are a common problem in the intensive care unit, occurring in as many as one-third of these patients during their hospitalization. The etiology, treatment, and prognostic importance of seizures in this setting have not been well-delineated in the literature. Whether seizures exacerbate global hypoxic-ischemic brain injury in humans remains unclear, which raises uncertainty about how aggressively they should be treated. Some pathological data suggest that anoxic brain injury is worsened by generalized tonic-clonic (GTC) status epilepticus (SE). Especially when the prognosis remains uncertain, GTC SE should be treated in the conventional manner. Partial seizures and simple myoclonus are unlikely to exacerbate neuronal damage, and treatment probably should be reserved for seizures that are traumatic to family members or interfere with mechanical ventilation. Status myoclonus (SM) in hypoxic-ischemic coma is particularly troublesome because it can be highly refractory to conventional anticonvulsants and appears to portend an extremely poor prognosis, regardless of its management. Case series that report 100% mortality or vegetative state from this condition have involved only highly selected patient populations. Several cases have been reported of patients with good neurological outcomes despite SM in postanoxic coma. The most prudent course of action is to continue intensive management of patients with SM—including anticonvulsant therapy—and to rely on more precise means of prognostication (clinical exam, electroencephalography, and somatosensory evoked potential) to inform the decision to withdraw supportive care. The decision to use anesthetic agents and paralytics in this setting must be individualized.

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Authors and Affiliations

  1. Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD

    Matthew A. Koenig MD

  2. Department of Anesthesiology and Critical Care Medicine, Neurosciences Critical Care Division, The Johns Hopkins Hospital, Baltimore, MD

    Romergryko Geocadin MD

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  1. Matthew A. Koenig MD
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  2. Romergryko Geocadin MD
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Editors and Affiliations

  1. Neurointensive Care Unit, and Department of Neurology, Medical College of Wisconsin, Milwaukee, WI

    Panayiotis N. Varelas MD, PhD

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Koenig, M.A., Geocadin, R. (2005). Global Hypoxia-Ischemia and Critical Care Seizures. In: Varelas, P.N. (eds) Seizures in Critical Care. Current Clinical Neurology. Humana Press. https://doi.org/10.1007/978-1-59259-841-0_5

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  • DOI: https://doi.org/10.1007/978-1-59259-841-0_5

  • Publisher Name: Humana Press

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