Perveen Safina, Srinivasan Arunkumaar, Prusty B Saroj Kumar, Jyotsna Ch V, Pabba Shravani, Reddy Ramakrishna, Sheshala Kaladhar, Ragavendra Asranna Kiran
Critical Care Medicine, Amaravathi Institute of Medical Sciences, Guntur 522001, Andhra Pradesh, India.
Critical Care Medicine, Virinchi Hospital, Hyderabad 500034, Telangāna, India.
World J Crit Care Med. 2024 Dec 9;13(4):97399. doi: 10.5492/wjccm.v13.i4.97399.
Seizures are one of the most common neurological complications encountered in the intensive care unit (ICU). They can occur in the background of exacerbation of a known neurological disease or secondary to non-neurological conditions such as sepsis and metabolic disturbances. However, there is a paucity of literature on the incidence and pattern of new-onset seizures in ICUs.
To study the incidence and patterns of new-onset seizures in patients admitted to the medical ICU.
This was a prospective, multicenter, observational study performed in two tertiary care centers in Hyderabad, India over a period of 1 year. Patients upon ICU admission, who developed new-onset generalized tonic clonic seizures (GTCS), were enrolled. Those with a pre-existing seizure disorder, acute cerebrovascular accident, head injury, known structural brain lesions, or chronic liver disease were excluded as they have a higher likelihood of developing seizures. All enrolled patients were subjected to biochemical routines, radiological imaging of either computed tomography or magnetic resonance imaging, and other relevant laboratory tests as per clinical suspicion according to the protocol, and their data were recorded. Statistical analyses were conducted using descriptive statistics, tests, and linear regression.
A total of 61 of 2522 patients developed GTCS. Among all etiologies of seizures, metabolic causes were most frequent (35%) followed by infective causes (27%) and others (new-onset structural, drug withdrawal, drug-induced, toxicology-related, and miscellaneous factors). Logistic regression analysis showed that increased sodium and calcium levels were associated with a lower likelihood of developing seizures.
This study identified the etiology of new-onset seizures developing in critically ill patients admitted to the ICU. These findings highlight the need for targeted monitoring of those at risk of developing seizures.
癫痫发作是重症监护病房（ICU）中最常见的神经系统并发症之一。它们可发生在已知神经系统疾病加重的背景下，或继发于非神经系统疾病，如败血症和代谢紊乱。然而，关于ICU中新发癫痫发作的发生率和模式的文献较少。
研究入住内科ICU患者新发癫痫发作的发生率和模式。
这是一项在印度海得拉巴的两个三级医疗中心进行的为期1年的前瞻性、多中心观察性研究。纳入入住ICU后出现新发全身性强直阵挛性发作（GTCS）的患者。患有既往癫痫病史、急性脑血管意外、头部损伤、已知脑结构性病变或慢性肝病的患者被排除，因为他们发生癫痫发作的可能性更高。所有纳入的患者均按照方案进行生化常规检查、计算机断层扫描或磁共振成像的影像学检查，以及根据临床怀疑进行的其他相关实验室检查，并记录他们的数据。使用描述性统计、检验和线性回归进行统计分析。
2522例患者中共有61例发生了GTCS。在所有癫痫病因中，代谢原因最为常见（35%），其次是感染原因（27%）和其他原因（新发结构性、药物戒断、药物诱导、毒理学相关及其他因素）。逻辑回归分析表明，钠和钙水平升高与癫痫发作可能性降低相关。
本研究确定了入住ICU的危重症患者新发癫痫发作的病因。这些发现强调了对有癫痫发作风险者进行针对性监测的必要性。
