Critical Matters Seizure Management in the ICU
Jan 18, 2024
Dr. Brandon Foreman, an expert in epilepsy and neurocritical care at the University of Cincinnati, shares invaluable insights on managing seizures in the ICU. He discusses the high prevalence of nonconvulsive seizures among critical care patients and the importance of accurate diagnosis. Dr. Foreman details essential diagnostic steps, emphasizes the need for timely treatment to prevent neuronal injury, and explores the role of continuous EEG monitoring. He also highlights the philosophical aspect of clinical care, encouraging diagnostic flexibility and humility.
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Seizures Often Hide In The ICU
- Around 80–90% of ICU seizures are non-convulsive and often clinically silent.
- Observational studies show ~20% seizure incidence in neuro patients and ~10% in comatose/encephalopathic ICU patients.
Rapid Labs And CT Before EEG
- Check finger-stick glucose immediately and send routine labs (electrolytes, calcium, renal/hepatic function).
- Obtain a head CT to rule out acute hemorrhage and then pursue EEG if imaging and labs don’t explain the change.
When To Use Continuous EEG
- Use continuous EEG as the diagnostic gold standard for ICU seizures; record at least 24 hours for abnormal exams and 48–72 hours for comatose patients.
- Use point-of-care or routine EEGs when resources limit continuous monitoring and repeat studies if suspicion remains.
