The etiology of seizures in the Neurosurgical/Neurological Intensive Care Unit (NICU) can be categorized
as emanating from either primary brain pathology, at either macro- or microscopic level, or from physiological
derangements of critical care illness such as toxic or metabolic abnormalities. Particular etiologies at risk
for seizures include ischemic or hemorrhagic stroke and traumatic brain injury. The use of prophylactic antiepileptic
drug administration remains controversial in many situations, with most of the larger studies having used
older antiepileptic drugs prophylactically. If seizures do occur, patients are typically treated with parenteral antiepileptic
drugs. The duration of treatment is unknown in most situations, but it should be individualized depending
on acute and monophasic injury versus chronic process. Late seizures, which occur after the first 2 weeks from
the insult, have a more ominous risk for subsequent epilepsy and should be treated for extended periods of time or
indefinitely. Electrolyte and glucose abnormalities and medications at high or low levels, when corrected, usually
lead to seizure control. This review discusses the risk for seizures with commonly encountered types of brain
injuries in the NICU and ends by examining the treatment algorithms for simple seizures and status epilepticus
and the role newer antiepileptics may potentially play.
Keywords: Antiepileptic drugs, neurosurgical intensive care unit, trauma, brain tumors, stroke, seizures.
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