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Commentary By definition, critically ill patients are expected to have a complex clinical picture, with multiple immediate life-threatening concerns ranging from major systemic dysfunctions to devastating acute neurological injuries. So, in the extreme environment of an intensive care unit (ICU), survival is the goal and seizures/status epilepticus represent “yet another problem” to rule out and treat so that acute encephalopathy can resolve and the patient can regain independent control of basic life functions. Eventually, though, as imminent concerns gradually resolve, the bigger picture emerges and the main questions about which parents and family members obsess are: “what next? Is my loved one going to be normal again or does he/ she have to carry consequences of this major traumatic experience with them for the rest of his/her life?” These questions are particularly difficult if the patient was neurodevelopmentally intact prior to the ICU stay. Let’s review some of the answers as provided by the current literature, including the work highlighted here by Wagenman et al. and by others. First, status epilepticus (SE) is associated with increased mortality following an ICU stay in both adults (1) and children (2). This increased mortality risk seems to be less relevant for isolated seizures in this setting. Of 49 adult patients with nonconvulsive seizures studied with continuous EEG monitoring, the overall mortality was 33%, with an odds ratio of 1.13 for every additional hour of uncontrolled seizures (1). Of 550 children evaluated with continuous EEG monitoring in an ICU setting, 25% died if they had SE as opposed to 12% in either those who had seizures without SE or those without seizures (2). Second, seizures in the ICU are associated with worse functional outcomes, across various etiologies. In one retrospective cohort study of 42 consecutive patients (of all ages) with primary central nervous system infection who underwent continuous EEG monitoring, electrographic seizures with or without clinical symptoms were associated with a poor outcome at discharge (severe disability, vegetative state, or death): 52% of the patients with a poor outcome at discharge had recorded seizures as opposed to only 16% of those with a favorable outcome (3). In another study of 201 adults admitted to the medical ICU, mostly with sepsis, 89% of patients with electrographic seizures died or had a severe disability upon discharge versus 39% otherwise (4). The study at hand by Electrographic Status Epilepticus and Long-Term Outcome in Critically Ill Children.

Consequences of Status Epilepticus in the Intensive Care Unit: What We Know and What We Need to Know