Management of Seizures in Critically Ill Patients

1. Management of Seizures in Critically Ill Patients
Ade Wijaya, MD
November 2017

2. Introduction
• Seizures are a common occurrence in critically ill patients
• Significant mortality and morbidity
• Non-convulsive status epilepticus
• EEG monitoring
Friedman D, Claassen J, Hirsch LJ. Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg. 2009;109:506–23.
Kurtz P, Hanafy KA, Claassen J. Continuous EEG monitoring: is it ready for prime time? Curr Opin Crit Care. 2009;15:99–109
Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.

3. The Goals of Treatment
• Cessation of seizures both clinical and subclinical
• Prevent seizures
Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.

4. Primary non-pharmacological Management
• Secure airways
• Oxygenation
• Fluid therapy
• Vasopressors
• Mechanical ventilation
• Body cooling
Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.

5. Choosing AED
• Side effects ?
• Interaction ?
Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.

6. Special Conditions in Critically Ill Patients
• Hypoalbuminemia  protein binding   free drugs   toxicity
( in AED with high albumin binding)
• Parenteral Nutrition & some drugs  competitively binding with
albumin.
• Enteral food interaction with AEDs  decreased AEDs absorbtion
• Monitoring free drug concentrations
• Drugs doses adjustment in Renal or Liver dysfunctions
Salih, M. R., Bahari, M. B., & Abd, A. Y. (2010). Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients. Nutrition journal, 9(1), 71.

7. Dasgupta A: Usefulness of monitoring free (unbound) concentrations of therapeutic drugs in patient management. Clin Chim Acta 2007, 377:1-13

8. Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.

9. Summary
• Seizures are common in clinically ill patients
• EEG monitoring
• Difficult to manage
• Organ dysfunctions
• Drugs interactions
• Side effects