Antiepileptic Drugs in Critically Ill Patients

Salia Farrokh; Pouya Tahsili-Fahadan; Eva K. Ritzl; John J. Lewin III; Marek A. Mirski


Crit Care. 2018;22(153) 

In This Article


The incidence of seizures in general intensive care units (ICUs) ranges from 3.3% to 34%.[1] Risk factors include common diagnoses such as brain tumor, head trauma, stroke, history of seizure, electrolyte abnormalities, hypoglycemia, infections, and drug overdose or withdrawal.[2] Thus, ICU management of antiepileptic drugs (AEDs) is routinely practiced by intensive care providers.

Selection of the most effective AED with the least adverse events, however, can often be challenging. About a third of patients with seizures fail on monotherapy, necessitating two or more AEDs.[3] Several factors commonly seen in the critical care setting, such as polypharmacy, unpredictable medication pharmacokinetics, and implementation of a variety of nonpharmacological interventions, may lead to drug-drug interactions, elevated risk for drug toxicity, and subtherapeutic drug serum levels; these are discussed in this review.