Seizures in the ICU – Part 3
There are six types of primary generalized seizures that occur in patients. These seizures arise in the cerebral cortex and diencephalon at the same time and there is an absence of focal deficit. Patients lose consciousnesss. These types are:
Absence seizures – these occur more commonly in children and are marked by acute onset of a blank stare lasting from 5 – 15 seconds with an equally abrupt return to normal. These seizures are particularly associated with children who have Lennox-Gastaut syndrome.
Myoclonic seizures – these are associated with a brief period of bilateral, synchronous jerking with normal or slightly impaired consciousness followed by a generalized convulsion. In the ICU population these seizures are associated with anoxic brain injury and metabolic derangements (i.e, acid/base disturbances or electrolyte abnormalities).
Tonic/Clonic/Tonic-Clonic seizures – these three seizure types represent a continuum of clinical findings combining elements of an initial tonic extension and/or a following bilateral synchronous clonus. These seizures always have a postictal or post-seizure phase with decreased consciousness.
Atonic seizures – these seizures are not characterized by convulsions and in ICU patients who may be sedated or have decreased consciousness from multiple causes can be insidious and easily missed, leading to the state of status epilepticus or SE.
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