The intensive care unit (ICU) presents a potentially treacherous environment for individuals with a history of epilepsy. It is a milieu that commonly precipitates seizures even when there is no prior history. Conditions that can exacerbate epilepsy or cause seizures are relatively common. Some of these are:

• fluid and electrolyte abnormalities
• hypoglycemia
• cerebral edema
• hypoxia
• cerebral hypoperfusion
• metabolic failure
• medications that can lower seizure threshold or cause dramatic changes in the levels of antiepileptic drugs (AEDs)
• sleep deprivation
• poor nutrition

Although estimates of the overall incidence of seizures in the ICU vary, the risk of seizures is higher in this area than in any other place in the hospital, perhaps with the exception of the emergency department.28-30 The risk of seizures for individuals with epilepsy is extremely high. The ICU environment often disrupts stable AED regimens through altered absorption and metabolism, and inability to administer drugs orally.

Endotracheal intubation, paralytic agents, and altered awareness due to critical illness and sedation can make it extremely difficult to assess clinically whether patients are seizing, necessitating close observation and liberal use of the EEG. ICU physicians should understand the nuances of caring for individuals with seizures and concomitant illness in the ICU.

Adapted from: Kolb SJ and Litt B. Management of epilepsy and comorbid disorders in the emergency room and intensive care unit. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;515–535.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised May 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.