Status epilepticus on the intensive care unit.

Status epilepticus occurs on the intensive care unit, either because the patient has been transferred with refractory status epilepticus or as an incidental finding. Management of refractory status epilepticus on the intensive care unit is necessary for adequate treatment of the physiological compromise that occurs in convulsive status epilepticus. In addition, anaesthesia is sometimes necessary for the treatment of status epilepticus, and provided that the potential benefit of anaesthesia offsets the associated morbidity, then such an approach is warranted. In certain instances of nonconvulsive status epilepticus, especially in the elderly, the risks of anaesthesia outweigh the benefits of such aggressive treatment, and thus some caution must be exercised. Status epilepticus is also under-recognised as a cause of persistent coma on the intensive care unit, though the gain from aggressive treatment in this situation is unknown. In most instances, status epilepticus in coma carries such a poor prognosis that aggressive treatment is probably justified. Myoclonic status epilepticus also occurs on the intensive care unit, usually following cardiorespiratory arrest; this does not necessarily represent an agonal event especially if the initial insult was hypoxia related.