Organ transplant recipients and critical care seizures

Seizures are an unusual and unexpected post-transplant complication but may have multiple potential etiologies including systemic and central nervous system infections, ischemic infarctions, malignancy, metabolic disturbances, and antirejection medication neurotoxicity. Some of these etiologies are more or less unique to the transplant population and must be reversed in order to prevent recurrent seizures. As with any patient, the first course of action is to confirm there has been a seizure by either a compelling history or EEG recording. A single seizure may result in aspiration and other unwanted medical complications and a short course of treatment with levetiracetam is advised. If there has been new major structural brain injury, seizures may become recurrent or refractory despite abortive therapies. The significance, evaluation, and treatment of seizures in the transplant population are reviewed in this chapter.