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Drug-Induced Seizures in Critically Ill Patients

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Seizures in Critical Care

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Critically ill patients are prescribed numerous medications during their ICU stay. Some of them have epileptogenic potentials. The most common pathophysiologic mechanism is through GABA receptor blockade and the most commonly used family of ICU drugs, reducing the seizure threshold, is antibiotics. The exact role that these medications play in inducing a clinical or subclinical seizure, in the context of cerebral injury or other multi-organ failure, is in many cases unclear. The best treatment for drug-induced seizures is increased vigilance and prevention. Cautious measures should be used to minimize or eliminate any unwanted drug side effects by attempting to start and keep the patient on the lowest effective dose for the desired therapeutic effect. When upward dosage titration is necessary it is best to increase slowly while keeping a watchful eye on all laboratory and clinical indicators of success or failure. Free levels of antiepileptic or other medications should be considered in the critically ill, due to numerous factors affecting their final action on the pharmacologic target. If a seizure occurs clinicians should always seek a medication as the cause of the witnessed seizure and should consider replacing it with another agent that has less epileptogenic potential. Lastly, a GABAergic receptor agonist antiepileptic drug should be used as first-line antidote in most of the cases.

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  1. Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA

    Denise H. Rhoney (Associate Professor, Clinical Associate Professor) & Panayiotis N. Varelas (Director, Associate Professor of Neurology)

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  1. Dept. Neurology, Henry Ford Hospital, W. Grand Blvd. 2799 , Detroit, 48202-2689, U.S.A.

    Panayiotis Varelas

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Rhoney, D.H., Varelas, P.N. (2010). Drug-Induced Seizures in Critically Ill Patients. In: Varelas, P. (eds) Seizures in Critical Care. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-532-3_13

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