Skip to main content Accessibility help
×
Home
  • Print publication year: 2011
  • Online publication date: December 2011

27 - Seizures

from Section 4 - Neurointensive care

Summary

Anaesthesia for the posterior fossa provides a unique challenge for anaesthetists and neurosurgeons. Optimal patient positioning should facilitate surgical access without compromising patient safety. The important considerations are surgical access, securing and maintaining the airway, maintenance of adequate anaesthetic depth, haemodynamic stability and oxygenation. Care should be taken to limit the 'blackout state' during which the patient is not monitored or connected to the breathing circuits during patient transfer or positioning on the operating table. The hazards during positioning can be reduced by meticulous planning, careful positioning and vigilance to facilitate early detection of complications. The aim of maintenance of anaesthesia is to reduce the intracranial pressure (ICP) and to maintain haemodynamic stability. Anaesthesia can be maintained with either volatile agents or intravenous agents such as propofol. The choice of the anaesthetic agent is at the discretion of the individual anaesthetist.

Further reading

Abend, N. S. and Dlugos, D. J. (2008). Treatment of refractory status epilepticus: literature review and a proposed protocol. Pediatric Neurol 38, 377–90.
Abend, N. S., Dlugos, D. J., Hahn, C. D., Hirsch, L. J. and Herman, S. T. (2010). Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists. Neurocrit Care 12, 382–9.
Abou Khaled, K. J. and Hirsch, L. J. (2008). Updates in the management of seizures and status epilepticus in critically ill patients. Neurol Clin 26, 385–408, viii.
Alldredge, B. K., Gelb, A. M., Isaacs, S. M. et al. (2001). A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 345, 631–7.
Amantini, A., Fossi, S., Grippo, A. et al. (2009). Continuous EEG-SEP monitoring in severe brain injury. Neurophysiol Clin 39, 85–93.
Chin, R. F. M., Neville, B. G. R. and Scott, R. C. (2004). A systematic review of the epidemiology of status epilepticus. Eur J Neurol 11, 800–10.
Chin, R. F. M., Neville, B. G. R., Peckham, C. et al. (2006). Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 368, 222–9.
Claassen, J. (2009). How I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU. Neurocrit Care 11, 437–44.
Claassen, J., Hirsch, L. J., Emerson, R. G. et al. (2001). Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology 57, 1036–42.
Claassen, J., Mayer, S. A., Kowalski, R. G., Emerson, R. G. and Hirsch, L. J. (2004). Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 62, 1743–8.
Coeytaux, A., Jallon, P., Galobardes, B. and Morabia, A. (2000). Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology 55, 693–7.
Costello, D. J. and Cole, A. J. (2007). Treatment of acute seizures and status epilepticus. J Intensive Care Med 22, 319–47.
DeLorenzo, R. J., Hauser, W. A., Towne, A. R. et al. (1996). A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 46, 1029–35.
DeLorenzo, R. J., Waterhouse, E. J., Towne, A. R. et al. (1998). Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 39, 833–40.
Friedman, D., Claassen, J. and Hirsch, L. J. (2009). Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg 109, 506–23.
Fujikawa, D. G. (1996). The temporal evolution of neuronal damage from pilocarpine-induced status epilepticus. Brain Res 725, 11–22.
Fujikawa, D. G. (2005). Prolonged seizures and cellular injury: understanding the connection. Epilepsy Behav 7 (Suppl. 3), S3–11.
Gilmore, E., Choi, H. A., Hirsch, L. J. and Claassen, J. (2010). Seizures and CNS hemorrhage: spontaneous intracerebral and aneurysmal subarachnoid hemorrhage. Neurologist 16, 165–75.
Hesdorffer, D. C., Logroscino, G., Cascino, G., Annegers, J. F. and Hauser, W. A. (1998). Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology 50, 735–41.
Hirsch, L. J. (2008). Levitating levetiracetam’s status for status epilepticus. Epilepsy Curr 8, 125–6.
Hirsch, L. J., Claassen, J., Mayer, S. A. and Emerson, R. G. (2004). Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs): a common EEG phenomenon in the critically ill. Epilepsia 45, 109–23.
Holtkamp, M., Othman, J., Buchheim, K. and Meierkord, H. (2005). Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 76, 534–9.
Iyer, V. N., Hoel, R. and Rabinstein, A. A. (2009). Propofol infusion syndrome in patients with refractory status epilepticus: an 11-year clinical experience. Crit Care Med 37, 3024–30.
Jordan, K. G. and Hirsch, L. J. (2006). In nonconvulsive status epilepticus (NCSE), treat to burst-suppression: pro and con. Epilepsia 47 (Suppl. 1), 41–5.
Kaplan, P. W. (2005). The clinical features, diagnosis, and prognosis of nonconvulsive status epilepticus. Neurologist 11, 348–61.
Kaplan, P. W. (2007). EEG criteria for nonconvulsive status epilepticus. Epilepsia 48 (Suppl. 8), 39–41.
Knake, S., Rosenow, F., Vescovi, M. et al. (2001). Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia 42, 714–8.
Knake, S., Hamer, H. M. and Rosenow, F. (2009). Status epilepticus: a critical review. Epilepsy Behav 15, 10–4.
Kurtz, P., Hanafy, K. A. and Claassen, J. (2009). Continuous EEG monitoring: is it ready for prime time? Curr Opin Crit Care 15, 99–109.
Lhatoo, S. D. and Alexopoulos, A. V. (2007). The surgical treatment of status epilepticus. Epilepsia 48 (Suppl. 8), 61–5.
Logroscino, G., Hesdorffer, D. C., Cascino, G. D. et al. (2002). Long-term mortality after a first episode of status epilepticus. Neurology 58, 537–41.
Lothman, E. (1990). The biochemical basis and pathophysiology of status epilepticus. Neurology 40 (Suppl. 2), 13–23.
Lowenstein, D. H. (1999). Status epilepticus: an overview of the clinical problem. Epilepsia 40 (Suppl, 1), S3–8; discussion S21.
Lowenstein, D. H. and Cloyd, J. (2007). Out-of-hospital treatment of status epilepticus and prolonged seizures. Epilepsia 48 (Suppl. 8), 96–8.
McDaneld, L. M., Fields, J. D., Bourdette, D. N. and Bhardwaj, A. (2010). Immunomodulatory therapies in neurologic critical care. Neurocrit Care 12, 132–43.
Meierkord, H. and Holtkamp, M. (2007). Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 6, 329–39.
Pandian, J. D., Cascino, G. D., So EL, Manno, E. and Fulgham, J. R. (2004). Digital video-electroencephalographic monitoring in the neurological–neurosurgical intensive care unit: clinical features and outcome. Arch Neurol 61, 1090–4.
Robakis, T. K. and Hirsch, L. J. (2006). Literature review, case report, and expert discussion of prolonged refractory status epilepticus. Neurocrit Care 4, 35–46.
Ronner, H. E., Ponten, S. C., Stam, C. J. and Uitdehaag, B. M. (2009). Inter-observer variability of the EEG diagnosis of seizures in comatose patients. Seizure 18, 257–63.
Rosenow, F., Hamer, H. M. and Knake, S. (2007). The epidemiology of convulsive and nonconvulsive status epilepticus. Epilepsia 48 (Suppl. 8), 82–4.
Rossetti, A. O. (2009). Novel anaesthetics and other treatment strategies for refractory status epilepticus. Epilepsia 50 (Suppl. 12), 51–3.
Rossetti, A. O., Logroscino, G. and Bromfield, E. B. (2005). Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol 62, 1698–702.
Shneker, B. F. and Fountain, N. B. (2003). Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology 61, 1066–73.
Shorvon, S. (2007). What is nonconvulsive status epilepticus, and what are its subtypes? Epilepsia 48 (Suppl. 8), 35–8.
Simon, R. P. (1985). Physiologic consequences of status epilepticus. Epilepsia 26 (Suppl. 1), S58–66.
Theodore, W. H., Porter, R. J., Albert, P. et al. (1994). The secondarily generalized tonic–clonic seizure: a videotape analysis. Neurology 44, 1403–7.
Towne, A. R., Pellock, J. M., Ko D and DeLorenzo, R. J. (1994). Determinants of mortality in status epilepticus. Epilepsia 35, 27–34.
Treiman, D. M., Walton, N. Y. and Kendrick, C. (1990). A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res 5, 49–60.
Treiman, D. M., Meyers, P. D., Walton, N. Y. et al. (1998). A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339, 792–8.
Vespa, P. M., Miller, C., McArthur, D. et al. (2007). Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 35, 2830–6.
Wasterlain, C. G. and Chen, J. W. Y. (2008). Mechanistic and pharmacologic aspects of status epilepticus and its treatment with new antiepileptic drugs. Epilepsia 49 (Suppl. 9), 63–73.
Young, G. B., Jordan, K. G. and Doig, G. S. (1996). An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 47, 83–9.