Abstracts

Rationale: Status Epilepticus (Continuous Seizure Activity) is suspected to cause brain damage in humans, and known to do so in animals. It has been identified in a higher proportion in critical care patients. It is also more difficult to diagnose, given the fact that these patients are frequently lethargic, unresponsive or sedated. In absence of clinical seizures, subclinical or subtle seizure activity or even status epilepticus may not appear as a change from baseline, and therefore may go without diagnosis and treatment, which could prevent complications from this condition. To further evaluate this condition in the Critical Care population, we decided to perform a retrospective review of electroencephalography (EEG) studies of the Critical Care Unit patient population at our institution. We felt that if the proportion we discovered was sufficiently high, this may result in further rationale for more rigorous monitoring of ICU patients for this condition. Methods: We reviewed the EEGs performed on patients in the intensive care setting in our institution done between 11/07 and 7/08 for presence of status epilepticus and whether this was associated with clinical seizure activity, or was subclinical or subtle status epilepticus. These records were de-identified and recorded in a database. Results: Of the 233 patients in the Medical Intensive Care unit, and Surgical Intensive Care Unit, 9(4%) were found to be in status epilepticus. Of these, 8( 89%) were found to be in non-convulsive electrographic status epilepticus and 1( 11%) were found to have convulsive electrographic status epilepticus. Conclusions: Patients in the critical care setting are more vulnerable to developing seizures, given the fact that they are suffering concurrently from multiple medical problems, often including focal neurologic insults as well as systemic metabolic, infectious and or toxic insults. Seizures in this population are frequently subclinical or subtle, and therefore are not diagnosed and treated unless a high vigilance for seizures and status epilepticus is maintained. Our study once again supports the idea that higher vigilance for this condition is required in this population. These findings suggest a low threshold for video EEG surveillance as well as expedited review of such studies.