Global Hypoxia-Ischemia and critical care Seizures

Matthew A. Koenig, Romergryko Geocadin

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Seizures after cardiopulmonary arrest are a common problem in the intensive care unit, occurring in as many as one-third of these patients during hospitalization. The etiology, treatment, and prognostic importance of seizures in this setting have not been well delineated in the literature. Whether seizures exacerbate global hypoxic-ischemic brain injury in humans remains unclear, which raises uncertainty about how aggressively they should be treated. Some pathological data suggest that anoxic brain injury is worsened by generalized tonic-clonic (GTC) status epilepticus. When the prognosis remains uncertain, GTC status epilepticus should be treated in the conventional manner described elsewhere in this book. Partial seizures and simple myoclonus are unlikely to exacerbate neuronal damage, and treatment should probably be reserved for those seizures that are traumatic to family members or interfere with mechanical ventilation. Status myoclonus in hypoxic-ischemic coma is particularly troublesome because it can be highly refractory to conventional anticonvulsants and appears to portend an extremely poor prognosis, regardless of its management. Care should be taken to distinguish true SM from postanoxic action myoclonus (Lance-Adams Syndrome), which does not carry the same prognostic significance. It is also important to distinguish SM occurring after pure respiratory arrest from cardiac arrest, as there are several case reports of patients making good neurological recoveries after respiratory arrest despite SM. The decision to use anesthetic agents and paralytics in the setting of SM must be individualized.

Original languageEnglish (US)
Title of host publicationCurrent Clinical Neurology
Pages157-178
Number of pages22
DOIs
StatePublished - 2010

Publication series

NameCurrent Clinical Neurology
ISSN (Print)15590585

Fingerprint

Critical Care
Myoclonus
Seizures
Ischemia
Status Epilepticus
Heart Arrest
Brain Injuries
Partial Epilepsy
Coma
Artificial Respiration
Anticonvulsants
Uncertainty
Intensive Care Units
Anesthetics
Hospitalization
Hypoxia
Therapeutics

Keywords

  • Hypoxic
  • Ischemic encephalopathy
  • Postanoxic myoclonus
  • Seizures
  • Status epilepticus

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Koenig, M. A., & Geocadin, R. (2010). Global Hypoxia-Ischemia and critical care Seizures. In Current Clinical Neurology (pp. 157-178). (Current Clinical Neurology). https://doi.org/10.1007/978-1-60327-532-3_6

Global Hypoxia-Ischemia and critical care Seizures. / Koenig, Matthew A.; Geocadin, Romergryko.

Current Clinical Neurology. 2010. p. 157-178 (Current Clinical Neurology).

Research output: Chapter in Book/Report/Conference proceedingChapter

Koenig, MA & Geocadin, R 2010, Global Hypoxia-Ischemia and critical care Seizures. in Current Clinical Neurology. Current Clinical Neurology, pp. 157-178. https://doi.org/10.1007/978-1-60327-532-3_6
Koenig MA, Geocadin R. Global Hypoxia-Ischemia and critical care Seizures. In Current Clinical Neurology. 2010. p. 157-178. (Current Clinical Neurology). https://doi.org/10.1007/978-1-60327-532-3_6
Koenig, Matthew A. ; Geocadin, Romergryko. / Global Hypoxia-Ischemia and critical care Seizures. Current Clinical Neurology. 2010. pp. 157-178 (Current Clinical Neurology).
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