Seizures in Critical Care

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Description:

Updated and expanded to provide the neurologic, intensive and critical care communities a comprehensive guide to common critical care illnesses and seizures, this third edition remains the premier resource on seizures in critical care. In addition to covering etiology, pathophysiology, diagnosis, differential diagnosis and treatment options, chapters feature the latest technologies and treatments and integrate current literature. This unique and specialized text offers neurologists, intensivists, neurosurgeons, trauma surgeons, epileptologists, electrophysiologists and residents in various specialties clarity on this challenging set of comorbidities.

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Table of Contents:

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Part I: General Section

1: Status Epilepticus - Lessons and?Challenges from?Animal Models

Introduction

History and?Definition of?SE

Epidemiology

Etiology

Animal Models of?SE

Electrical Stimulation Models

Chemical Models of?SE: Pilocarpine and?Lithium?Pilocarpine

Studies of?the?Transition from?Single Seizures to?SE: GABAAR

Studies of?the?Transition from?Single Seizures to?SE: NMDAR

Chemical Models of?SE: Kainic Acid

Chemical Models of?SE: Nerve Agents

In Vitro Models Used to?Study Basic Physiology of?SE

Brain Slices

4-Aminopyridine Model

Low Magnesium Model

High Potassium Model

Organotypic Slice Culture Model

Other Techniques

Intrinsic Optical Imaging

Dissociated Cultures

Pathophysiological Changes During SE

Lessons from?Animal Models of?SE

SE Is Maintained by?an?Underlying Change in?Limbic Circuit Excitability That Does Not Depend on

The Initiation and?Maintenance Phases of?SE Are Pharmacologically Distinct

Initiation Is Accompanied by?a?Loss of?GABA Inhibition

Maintenance of?SSSE Depends on?the?Activation of?NMDA Receptors

Time-Dependent Development of?Pharmacoresistance

Maladaptive Seizure-Induced Receptor Trafficking Plays a?Role in?the?Development of?Pharmacores

Potentiation of?NMDA Synaptic Responses May Play a?Role in?Maintaining SE

Therapeutic Implications of?Seizure-Associated Receptor Trafficking

The Case for?Polytherapy

If Treatment Is Delayed, Triple Therapy May Be?Needed

Timing of?Polytherapy Is Critical

The Earlier the?Better

Issues Commonly Encountered in?Translational Research

Conclusions

References

2: Impact of?Seizures on?Outcome

Introduction

Continuous Electroencephalogram Monitoring

Terminology

Literature Search Methods

Electrographic Seizures in?the?Intensive Care Unit

Outcome in?Sepsis

Outcome in Traumatic Brain Injury

Outcome in?Subarachnoid Hemorrhage

Outcome in?Stroke

Outcome After Cardiac Surgery

Outcome After Cardiac Arrest

Outcome in Tumors

Pediatric Outcome

Conclusions

References

3: Diagnosing and?Monitoring Seizures in?the?ICU: The?Role of?Continuous EEG for?Detection and

Introduction

How to?Monitor

Data Analysis

Who to?Monitor

EEG Patterns Encountered During?EEG Monitoring

How Long to?Monitor

Cost-Effectiveness

Future Directions

Summary

References

4: Seizures and?Quantitative EEG

Introduction

Overview of?Quantitative EEG Methods

Amplitude-Based Methods

Displays Derived from?Spectrograms

Methods for?Monitoring Burst Suppression

Automated Seizure Detection

Automated Detection of?Other Epileptiform Patterns

Fundamentals of?Spectrograms

Motivation for?Spectral Analysis

Spectral Decomposition: Fourier Transforms and?the??FFT?

Signal Sharpening Manifests as?Amplitude Spectrum Broadening

From Spectra to?Spectrograms

Understanding Spectrograms: Cardinal Patterns from?Synthetic Signals

Technical Considerations: Trade-Offs in?Spectral Estimation

Trade-Off Between?Temporal and?Spectral Resolution

Trade-Off Between Bias and?Variance

Interpretation of?Spectrograms

Case Vignettes with?Example Spectrogram Patterns

Basic Patterns

Combination Patterns

Clinical Utility Of?Quantitative EEG and?Spectrograms

Quantitative EEG Outside?the?Realm of?Seizures

Summary

References

5: Spreading Depolarizations and?Seizures in?Clinical Subdural Electrocorticographic Recordings

Introduction

Methods

General

Recording of?the?Neuromonitoring Data

Analysis of?Neuromonitoring Data

Statistics

Results

Case Reports

Comparison Between SD and IEE

Discussion

Comparison of?IEE and?SD

Synergism of?IEE and?SD

Perspective on?Injury and?Plasticity

References

6: Multimodality Monitoring Correlates of?Seizures

Neuro ICU Monitoring Modalities

Intracranial Pressure

Cerebral Perfusion Pressure and?Regional Cerebral Blood Flow

Brain Tissue Oxygenation

Cerebral Microdialysis

EEG as?a?Component of?Multimodality Monitoring

Surface EEG

Quantitative EEG (for an?Extensive Discussion on?qEEG Please Refer to?Another Chapter of?the?B

Automated Seizure Detection Algorithms

Depth EEG

EEG and?Multimodality Monitoring

Multimodality Monitoring Signature of?Seizures

Animal Studies

Studies in?Humans

Seizure Activity on?Depth Electrode Recordings

The Clinical Significance of?Depth and?Surface EEG Seizures

References

7: Management of?Critical Care Seizures

Introduction

Definitions

Convulsive Seizures

Generalized Convulsive Status Epilepticus

Nonconvulsive Seizures

Nonconvulsive Status Epilepticus

Established Status Epilepticus

Refractory Convulsive and?Nonconvulsive Status Epilepticus

Super refractory Status Epilepticus

Incidence of?Critical Care Seizures

Principles of?Seizure Management in?Critically Ill Patients

Concept of?Appropriately Aggressive Treatment

Stages of?Treatment

Emergent Initial Therapy

Urgent Control Therapy

Refractory Status Epilepticus Therapy

General Medical Care

Medications Used to?Control ICU Seizures

Benzodiazepines

Diazepam

Lorazepam

Midazolam

Clonazepam

Phenytoin and?Fosphenytoin

Valproic Acid

Levetiracetam

Lacosamide

Phenobarbital

Options for?Add-on Therapy

Pregabalin

Gabapentin

Topiramate

Clobazam

Other Medications

Antiepileptic Medication Discontinuation

Conclusions

References

8: Management of Status Epilepticus in the Intensive Care Unit

Introduction

Pathophysiology

Goals of?ICU Management and?Treatment Options for?SE

Emergent Medical Management

Prehospital Management

In-Hospital Management in?the?Emergency Department or ICU

General Medical Supportive and?Diagnostic Measures for?SE

Termination of?Seizures During SE

Rationale for?Using Specific Antiepileptic Medications

Medications Used to?Control ICU Seizures and?SE (Table?

8. 4)

Benzodiazepines

Introduction

Diazepam

Lorazepam

Midazolam

Phenytoin and?Fosphenytoin

Valproic Acid (VPA)

Levetiracetam (LEV)

Lacosamide

Barbiturates

Issues with?Barbiturate Infusions in?the?ICU

Depth and?Duration of?Barbiturate Coma

Phenobarbital

Thiopental

Pentobarbital

Propofol

Ketamine

Other Less Commonly Used Medications for?SE

Other Potential Treatment Options for?SRSE (Table?

8. 3, Stage

4. 2)

Hypothermia

Resective Surgery

Brain Stimulation

Immunosuppressive Therapy

Management of?Focal SE

Prevention and treatment of complications

Management of?Seizures and?SE with?Antiepileptics in?ICU Patients with?Organ Dysfunction

Hepatic Failure

Renal failure

Hemato-Poetic Dysfunction

Drug interaction in?the?ICU

References

Part II: Etiology-Specific Section

9: Ischemic Stroke, Hyperperfusion Syndrome, Cerebral Sinus Thrombosis, and?Critical Care Seizures

Introduction

Seizures After Ischemic Stroke

Clinical Studies

Status Epilepticus

Pathophysiology

Seizures Before Stroke: Chicken or Egg First?

Ischemic Changes in?Time and?Development of?Seizures

Localization and?Etiology of?Ischemic Stroke and?Seizures

EEG Findings

Neuroimaging

Seizures Post Stroke in?the?Young and?the?Elderly

Treatment of?Post-Ischemic Stroke Seizures

Reperfusion?Hyperperfusion Syndrome

Cerebral Vein and?Dural Sinus Thrombosis

Clinical Studies

Treatment of?Seizures Related to?CVT

References

10: Hemorrhagic Stroke and?Critical Care Seizures

Introduction

Subarachnoid Hemorrhage

Intracerebral Hemorrhage

Arteriovenous Malformations

Cavernous Malformations

Ischemic Stroke with?Hemorrhagic Conversion

Conclusion

References

11: Traumatic Brain Injury and Critical Care Seizures

Introduction

Incidence of?Seizures in?Traumatic Brain Injury

Experimental Approaches to?Post-traumatic Seizures

Pathophysiology of?Post-traumatic Seizures

Diagnosis of?Seizures

Treatment of?Post-traumatic Seizures

Outcome of?Seizures Complicating TBI

Conclusions

References

12: Brain Tumors and Critical Care Seizures

Introduction

Incidence

Clinical Presentation

Pathophysiology

Evaluation of?Patients with?ICU Seizures

Treatment

Prophylactic Administration of?AEDs

Treatment of?Seizures in?the?ICU

Outcome

References

13: Global Hypoxia-Ischemia and?Critical Care Seizures

Introduction

Epidemiology

Pathophysiology

Pathological and?Chemical Changes in?Hypoxic-Ischemic Injury and?Seizures

Myoclonus in?Hypoxic-Ischemic Coma

Lance-Adams Syndrome

Clinical Presentation

Generalized Tonic-Clonic (GTC) Seizures

Focal and?Complex Partial Seizures

Myoclonus

Lance-Adams Syndrome

Laboratory Investigation

Electroencephalography

Electromyography

Somatosensory Evoked Potentials

Brain Imaging

Cerebrospinal Fluid Analysis

Differential Diagnosis

Treatment

General Considerations

Simple and?Complex Partial Seizures

Generalized Tonic-Clonic Seizures

Myoclonus

Nonconvulsive Status Epilepticus

Prophylactic Antiepileptic Drug Use

Supportive Management

Prognosis and?Outcomes

Hypothermia and?Seizures After?Resuscitation from?Cardiac Arrest

The Future of?EEG and?Post-cardiac Arrest Seizures

References

14: Fulminant Hepatic Failure, Multiorgan Failure and Endocrine Crisis and Critical Care Seizures

Introduction

Hepatic Failure

Background

Pathophysiology

Diagnosis

Management

Hepatic Conditions Associated with?Seizures

Wilson?s Disease

Reye?s Syndrome

Hepatic Porphyrias

Renal Failure

Background

Pathophysiology

Diagnosis

Management

Dialysis Disequilibrium Syndrome (DDS)

Sepsis

Background and?Pathophysiology

Diagnosis and?Management

Thyrotoxicosis and?Thyroid Disorders

Background

Diagnosis and?Management

Diabetes Mellitus

Background

Nonketotic Hyperosmolar State (NHS)

Diabetic Ketoacidosis (DKA)

Pituitary Hormones

Antidiuretic Hormone

Sex Hormones

Parathyroid Hormones

Adrenal Hormones

References

15: Organ Transplant Recipients and Critical Care Seizures

Introduction

Initial Patient Evaluation and?Treatment

Seizures in?Transplant Patients: Specific Causes

Drug-Induced Seizures

Acute Metabolic Change

CNS Infections

Post-transplant Malignancy

Posterior Reversible Encephalopathy Syndrome

Cerebrovascular Disease

Seizures in?Transplant Patients: Treatment

Seizures in?Transplant Patients: Significance for?Outcome

References

16: Extreme Hypertension, Eclampsia, and?Critical Care Seizures

Introduction

Hypertension and?Pregnancy

Pre-eclampsia and?Eclampsia

Epidemiology

Pathophysiology

Clinical Presentation

Electrographic and?Radiographic Features

Management

HELLP Syndrome

Hypertensive Encephalopathy

Epidemiology

Clinical Features

Pathophysiology

Electrographic and?Radiographic features

Management of?Hypertensive Encephalopathy

Posterior Leukoencephalopathy Syndrome

Clinical Features

Pathophysiology

Radiological Features

Management

Conclusion

References

17: Infection or Inflammation and Critical Care Seizures

Introduction

CNS Infectious Disorders

Meningitis

Encephalitis

Herpes Simplex Encephalitis

Japanese Encephalitis

West Nile, La Crosse, Eastern Equine, and?St. Louis Encephalitis

Human Immunodeficiency Virus infection and?Seizures

Brain Abscess

Intracranial Extra-axial Pyogenic Infections

Ventriculitis

Inflammatory CNS Conditions

Vasculitides

Necrotizing Vasculitides

Polyarteritis Nodosa

Granulomatosis with?Polyangitis

Churg-Strauss Syndrome

Vasculitides Associated with?Connective Tissue Disease

Systemic Lupus Erythematosus

Rheumatoid Arthritis, Scleroderma, Sjogren?s syndrome, and?Mixed Connective Tissue Disease

Vasculitis Associated with?Other Systemic Diseases

Beh?et?s Disease

Sarcoidosis

References

18: Electrolyte Disturbances and?Critical Care Seizures

Introduction

Relationship Between?Electrolytes, The?Acid-?Base Disequilibrium, and?Neuronal Excitability

Transport of?Water and?Electrolytes Across?the?Blood?Brain Barrier and?Regulation of?Extrac

Neuronal Excitability: Membrane Potential, Ion Channels, Neurotransmitters, and?Their Receptors

Water-Sodium Imbalance and?Seizures

Epidemiology and?Causes of?Sodium and?Osmotic Imbalance in?Critically Ill Patients

Mechanisms of?Sodium and?Water Homeostasis

Hyponatremia

Management of?Hyponatremia

Hypernatremia

Management of?Hypernatremia

Calcium and?Seizures

Calcium Homeostasis

Hypocalcemia

Management of?Hypocalcemia

Hypercalcemia

Management of?Hypercalcemia

Magnesium and?Seizures

Magnesium Homeostasis

Hypomagnesemia

Management of?Hypomagnesemia

Acid-Base Disorders and?Seizures

Management of?Acid-Base Disorders

References

19: Alcohol-Related Seizures in?the?Intensive Care Unit

Introduction

Definition and?Diagnosis of?Alcohol Spectrum Disorders

Alcohol Withdrawal Syndrome

Scales for?Monitoring Withdrawal Symptoms

Incidence and?Timeline of?Alcohol-Related Seizures

Pathophysiologyof Alcohol Withdrawal and?Alcohol-Related Seizures

Genetic Influence

Comorbidities in?the?Alcoholic Patient with?Seizures Admitted to?an?ICU

Alcohol-Related Seizures

Electrographic Findings on?EEG Monitoring of?Patients with?Alcohol Abuse and?or Alcohol-Related

Medications Used in?the?Treatment of?Alcohol-Related Seizures

Benzodiazepines

Propofol

Barbiturates

Carbamazepine

Valproic Acid

Topiramate

Pregabalin

Gabapentin

Treatment of?Alcohol Withdrawal and?Related Agitation and?Delirium

Conclusion

References

20: Drug-Induced Seizures in?Critically Ill Patients

Introduction

Epidemiology

Risk Factors

Prevention

Causative Agents

Analgesics

Opioids

Salicylates

Anesthetics

General Anesthetics

Local Anesthetics

Antiepileptic Agents

Antimicrobial Agents

Beta-lactams

Carbapenems

Fluoroquinolones

Isoniazid

Metronidazole

Antiviral Agents

Bronchodilators

Immunosuppressive Agents

Chemotherapeutic Agents

Psychotropic Agents

Antipsychotic Agents

Antidepressants

Tricyclic Antidepressants

Selective Serotonin Reuptake Inhibitors

Monoamine Oxidase Inhibitors

Bupropion

Miscellaneous Antidepressants

Lithium

Stimulants

Drug Withdrawal

Miscellaneous Agents

Treatment

Summary

References

21: Illicit Drugs and Toxins and Critical Care Seizures

Introduction

Epidemiology

Illicit or Abused Drugs

Opiates

Sedatives and?Hypnotics

Stimulants

Solvents

Hallucinogens

Epileptogenic Environmental Toxins

Marine Toxins

Mushroom and?Plant Toxins

Carbon Monoxide (CO)

Heavy Metals

Introduction

Lead

Mercury

Tin

Pesticides and?Other Chemical Toxins

Introduction

Cholinesterase Inhibitors

Cyanide

Other Pesticides

Conclusion

References

22: Seizures and?Status Epilepticus in?Pediatric Critical Care

Introduction

Electrographic Seizure Incidence and?Risk Factors

Continuous EEG Monitoring Duration

Outcome

Clinical Practice and?Guidelines Related to?Continuous EEG Monitoring

Quantitative EEG for?Electrographic Seizure Identification

Status Epilepticus Management Overview

Status Epilepticus Management: Diagnostic Considerations

Status Epilepticus Management: Emergent Benzodiazepine Management

Status Epilepticus Management: Urgent Antiseizure Medication Management

Refractory Status Epilepticus Management

Conclusions

References

Index

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