الفهرس 
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Abstract
For many neurologists, seizures in critically ill patients represent a difficult problem. Etiology can be elusive because of the complexity of the environment but in all situations, it is crucial to identify potential causes or contributors, particularly reversible factors, such as metabolic disturbances, fever, hypoxia, and medications.
Epileptic seizures are characterized by a variety of symptoms. The signs and symptoms of epileptic seizures include affection of sensorial sphere, consciousness, motor and\or autonomic spheres. Most seizures involve more than one sphere, however, some like for instance aura (sensorial sphere) or dialeptic seizures (consciousness) involve only one sphere.
Nonconvulsive seizure is accompanied by minimal motor activities. Possible clinical clues may include unexplained fluctuations in consciousness or a paradoxic increase in alertness after intra venous infusion of a benzodiazepine such as lorazepam or diazepam. For all patients with an unexplained altered mental state, an electroencephalographic (EEG) evaluation is an important part of the evaluation and should be done as soonas possible. Continuous EEG recording for many hours is usually the onlyr eliable method to diagnose nonconvulsive seizures, although it is not always available.
cEEG is becoming an important technique for assessing neurologic status in the critically ill patients. Many of these patients, including those with known brain injury such as traumatic brain injury, stroke, or sub arachnoid haemorrhage, as well as patients without structural brain injury, are at high risk for non convulsive seizures or nonconvulsive status epilepticus, which can only be detected by cEEG.
Therefore, cEEG should be considered not only in those with acute brain injury and impaired mental status but also in all ICU patients with unexplained alteration in consciousness, even if they do not have a history of seizures or brain injury, and for providing prognostic information.
The diagnostic evaluation of the patient with partial or generalized seizures is based on laboratory tests, EEG and imaging procedures. CT scan is mainly used in the emergency diagnosis of intracerebral lesions and\or haemorrhage. The use of magnetic resonance imaging (MRI) has been pivotal in elucidating the presence of an epileptogenic pathological alteration that may coexist with the site of seizure onset.
Treatment of seizures in critically ill patients is composed of first aid management and administration of antiepileptic drugs. Also, this should be combined with treatment of the cause as medications, fever, hypoxia, and metabolic imbalances to prevent reoccurrence of seizure.
Antiepileptic medications are divided into conventional and novel types. Conventional antiepileptics are including benzodiazepines, phenobarbital, phenytoin, fosphenytoin and valproate. Novel antiepileptic drugs are including topiramate, gabapentin, vigabatrin, tiagabine, lamotrigine and others.
Early recognition and treatment are essential to obtain maximal response to first line treatment and to prevent neurologic and systemic sequelae. Seizure in the intensive care unit should be treated aggressively and prophylactic antiepileptic drug is also recommended to prevent occurance of seizures.
Complications of seizures in critically ill patients can be acute complications as injuries, aspiration pneumonia, pulmonary edema, cardiac arrhythmias and\or myocardial infarction. Delayed complications can occur as development of epilepsy, memory dysfunction and\or behavioural abnormalities.
Prevention of seizures in critically ill patients can be done by early treatment of any condition causing seizures and administration of prophylactic antiepileptic drugs. Some specific conditions are requiring specific measurements in addition to prophylactic antiepileptic medications as seizures in ischemic stroke, seizures in intracerebral haemorrhage, seizures in subarachnoid haemorrhage and seizures in meningitis patients.