Abstract
Seizures and status epilepticus (SE) occur frequently in the neurocritical care setting. Status epilepticus has been reported in 10–25% of critically ill comatose patients depending on the underlying diagnosis. Therefore, it is important to understand how to detect, evaluate, and manage patients with this disorder. Status epilepticus is defined as 5 or more minutes of continuous clinical and/or electrographic seizure activity, or recurrent seizure activity without recovering to baseline between seizures. The history and neurological exam are essential to initial detection of SE. Some patients may present with overt convulsions, while others show more subtle signs of seizures such as eye deviation or nystagmus. Care must be taken to perform a detailed clinical exam to identify subtle or subclinical seizures. Additionally, some comatose patients will have only electrographic seizures. Therefore, a high level of suspicion for nonconvulsive SE is helpful when evaluating patients with abnormal mental status. Electroencephalography is the gold standard for detection of seizures and SE. It is an essential part of any workup for known or suspected SE. The differential diagnosis of patients with known or suspected SE includes structural intracranial lesions, metabolic derangements, intoxications, and organ failure. Therefore, the initial workup includes imaging and laboratory examination to detect an underlying pathology. The rapid management of seizures and SE is of utmost importance. The longer SE continues, the more difficult it is to treat. The initial management includes benzodiazepine therapy to stop the epileptiform activity, followed by an anticonvulsant to prevent its recurrence. If seizures persist, developing into SE, then continuous infusion of anesthetic medications is necessary. The choice of specific agents used will depend on patient factors such as renal and hepatic function and hemodynamic stability.