Risk factors for seizures include injures which produces intracranial hemorrhage, penetrating head trauma, Glasgow Coma Scale less than 10, or a seizure is seen in the first 24 hours. Seizures increase oxygen and glucose utilization, and release neurotransmitters in regions of brain that are already compromised, potentially leading to further injury. A review of seizure semiology as it pertains to critical care patients, and pertinent details of treatment of the critical care patient will be discussed.

The comatose patient with severe TBI is hypermetabolic, with nitrogen wasting, and can waste as much as 15% of body Nitrogen in a week. Most increased metabolism is from increased muscle tone, with increased metabolism being from 120-140% in unparalyzed patients, and near baseline in patients in propofol or pentobarbatol coma. Enteral (Gastric or Jejunal feeding) or parental regimens are begun by hospital day #7 in most cases.

Presenter, Dr. Diana Abson Kraemer, MD, is a fellow in epilepsy surgery at Harborview Medical Center at the University of Washington. She is also the Principal Investigator on a variety of research projects including: a prospective study of Temporal Lobe Epilepsy in Patients Without Hippocampal Atrophy, the Relationship Between Mesial and Lateral Temporal Lobe Gliosis, and ERSET: Early Randomized Surgical Epilepsy Trial. Dr. Kraemer received her MD from the University of California Los Angeles. She completed her surgical internship at Harbor-UCLA Medical Center, her residency in neurosurgery at Duke University Medical Center, and her clinical fellowship in epilepsy surgery at Yale University School of Medicine. She is a member of American Association of Neurological Surgeons, American Epilepsy Society, and the AANS Section of Stereotactic and Functional Neurosurgeons. She is has authored a number of articles which have appeared in journals such as Epilepsia, Neurology, Brain, and the Journal of Clinical Neurophysiology.

DISCLOSURE:

In accordance with ACCME standards for commercial support of continuing medical education, faculty members have been asked to disclose any relationship they may have with commercial supporters of this CE activity or with companies providing drugs, medical equipment, etc that may have relevance to the content of the presentation. Such disclosure is intended to provide participants with sufficient information to evaluate whether any given presentation has been influenced by the faculty's relationship(s) or financial interests with said companies.

The following faculty reported having no financial interest or affiliation from a commercial supporter(s) or from a corporate organization that: (a) has a direct interest in the subject matter of the presentation or (b) has provided financial support to underwrite this activity: Diana Kraemer, MD.

• Discuss Risk Factors and definition of seizures in Severe TBI
• Discuss the negative effects seizures might have on injured brain
• Discuss the use of prophylactic antiepileptic drugs (AEDs) in early and late post traumatic seizures
• Identify and recognize treatment options for seizures in critical care patients
• Describe the basic metabolic state of the comatose patient with severe traumatic brain injury.
• Discuss the alternative ways to provide nutritional supplementation to the critical care patient.

I. Post Traumatic Seizures (PTS)

a. Why are seizures bad for you?

b. Risk factors

c. Practice Parameters

d. AEDS

e. Treatment

f. Post Traumatic Epilepsy

g. Epileptogenesis

h. Future research

i. Conclusions

j. References

II. Nutrition in the TBI patient

a. Guidelines

b. Metabolism

c. Timing and Methods of feeding

d. Future research

e. Conclusions

f. References