Seizures.

The ICU patient who develops seizures presents diagnostic and therapeutic dilemmas for the physician. The diagnostic studies required vary with the underlying disorders of the patient and with the other therapies in progress. For both individual seizures and status epilepticus, electroencephalography is essential, and a brain imaging study is usually necessary. Other diagnostic testing depends on the clinical situation and the results of these initial studies. Therapy for a single seizure or a few seizures remains controversial. Management of the patient in status epilepticus should proceed along parallel approaches to terminating status epilepticus, preventing its recurrence and treating its complications. Lorazepam appears to be the initial drug of choice; phenytoin is commonly used as a second choice. Phosphenytoin will probably replace intravenous phenytoin in this role. Although phenobarbital has long been used as a third-line agent, its utility has fallen into question. Refractory status epilepticus can usually be controlled with extraordinary doses of midazolam, propofol, or pentobarbital. Patients requiring treatment for refractory status epilepticus require excellent, multidisciplinary critical care.