Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Dec 9, 2024; 13(4): 97399
Published online Dec 9, 2024. doi: 10.5492/wjccm.v13.i4.97399
In-hospital new-onset seizures in patients admitted to the medical intensive care unit: An observational study and algorithmic approach
Safina Perveen, Arunkumaar Srinivasan, B Saroj Kumar Prusty, Ch V Jyotsna, Shravani Pabba, Ramakrishna Reddy, Kaladhar Sheshala, Kiran Ragavendra Asranna
Safina Perveen, Critical Care Medicine, Amaravathi Institute of Medical Sciences, Guntur 522001, Andhra Pradesh, India
Arunkumaar Srinivasan, B Saroj Kumar Prusty, Ch V Jyotsna, Shravani Pabba, Ramakrishna Reddy, Kiran Ragavendra Asranna, Critical Care Medicine, Virinchi Hospital, Hyderabad 500034, Telangāna, India
Kaladhar Sheshala, Critical Care Medicine, Yashoda Hospital, Malakpet, Hyderabad 500036, Telangāna, India
Co-first authors: Safina Perveen and Arunkumaar Srinivasan.
Author contributions: Perveen S and Srinivasan A contributed equally to this work; Prusty BSK and Sheshala K designed the study; Perveen S and Srinivasan A performed the study; Reddy R and Asranna KR contributed to the data analyses; Srinivasan A, Jyotsna CV, and Pabba S wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by Yashoda Hospital, Malakpet, Hyderabad, India and the Institutional Review Board of Virinchi Hospital, Hyderabad, India.
Informed consent statement: Being an observational study involving no risks as a part of study protocol, consent was waived off upon approval.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated during the current study are available from the authors on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arunkumaar Srinivasan, MBBS, MD, Academic Fellow, Critical Care Medicine, Virinchi Hospital, Banjara Hills Road 1, Hyderabad 500034, Telangāna, India. arundec06@gmail.com
Received: May 29, 2024
Revised: August 17, 2024
Accepted: August 23, 2024
Published online: December 9, 2024
Processing time: 154 Days and 23.7 Hours
Abstract
BACKGROUND

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.

AIM

To study the incidence and patterns of new-onset seizures in patients admitted to the medical ICU.

METHODS

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, χ2 tests, and linear regression.

RESULTS

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.

CONCLUSION

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.

Keywords: Seizures; Intensive care; Hyponatremia; Hypocalcemia; Intensive care unit

Core Tip: Seizures can occur in critically ill patients due to neurological and non-neurological causes and are associated with high morbidity and mortality. This was a multicenter observational study on the incidence and etiology of new-onset seizures in patients admitted to the medical intensive care unit who did not have any known predisposing factors for developing seizures. We found that metabolic derangement-related seizures were the most common followed by tropical infections and other causes. These findings highlight the need for the targeted monitoring and timely evaluation of those at risk of developing seizures.