| Abstract [eng] |
Relevance of the topic. Seizures in intensive care units (ICUs) are a common, yet difficult-to-diagnose pathology associated with increased patient mortality and poorer neurological outcomes. A significant portion of seizures occurring in the ICU do not exhibit motor symptoms (are non-convulsive); therefore, identifying them without specific equipment, such as electroencephalography (EEG), is complicated. Objective. To analyse the epidemiological, clinical, diagnostic, and treatment characteristics of seizures and their associations with patient outcomes in the intensive care units of Vilnius University Hospital (VUL) Santaros Klinikos. Methodology. A retrospective descriptive study was conducted, analysing data from 23 patients treated in the ICU who were consulted by a neurologist for (suspected) seizures. The study evaluated etiology, seizure types, time of onset, EEG findings, laboratory indicators, and patient outcomes. Results. The study showed that seizures accounted for 9.7% of all neurological consultations in the ICU. The majority of patients (87%) were 60 years of age or older. The most common identified cause was acute symptomatic seizures (82.6%), primarily caused by post-hypoxic encephalopathy (39.1%) and ischemic stroke (21.7%). In 78.2% of cases, seizures occurred within the first 72 hours of hospitalization. Although EEG was performed for 69.6% of patients, specific signs of status epilepticus were recorded in only 12.5% of those cases. Diazepam and midazolam were most frequently used for first-line treatment. For second-line treatment, levetiracetam was most commonly used (60.9%). Propofol infusion was administered to 39.1% of patients. Overall mortality in the study group reached 30.4%, with the poorest prognosis observed in the post-hypoxic encephalopathy group (50% mortality rate). Conclusions. Seizures in the ICU are most often an early response to acute brain injury, occurring predominantly in elderly patients. While non-convulsive seizures dominate in medical literature, motor phenomena were more frequently recorded in this study sample. This indicates potential under-diagnosis of non-convulsive states due to limited availability of continuous EEG monitoring. The high mortality rate emphasizes the necessity of implementing standardized diagnostic protocols and increasing EEG accessibility for critically ill patients. |
