Impact of Epileptic Seizures in the Neurological Intensive Care Unit (NICU) on Glasgow Coma Scale (GCS)

Aims: To determine the frequency, magnitude, range, and duration of change in GCS in the aftermath of seizures occurring in the neurological intensive care unit.

Methods: Subjects were enrolled if they had a seizure during admission to a neurological intensive care unit. Their last recorded GCS prior to the seizures was extracted from chart review and GCS monitored prospectively at 2, 4, 8, 24, and 48 hours after the seizure. For comparison, subjects with matching GCS scores were also monitored for 48 hours to document fluctuations in their scores.

Results: Mean preseizure GCS in cases (n = 50) was (10 ± 4) and was similar to controls (n = 50) (10 ± 4). Immediately after the seizure, the mean GCS fell to (6 ± 3) and thereafter increased progressively at 2 hours (8 ± 4), 4 hours (9 ± 4), 8 hours (9 ± 4.), 12 hours (9 ± 5), 24 hours (9 ± 5), and 48 hours (9 ± 5). However, the mean GCS did not return to preseizure values even after 48 hours. No deviations were noted in the control group. At the end of 2 hours, 37 cases still had deranged GCS; end of 4 hours, 26 patients had deranged GCS; at 8 hours, 18 patients had deranged GCS; at 12 hours and 24 hours, 16 patients; and finally, at 48 hours, 13 patients still had deranged GCS.

Conclusion: Seizures in the ICU lead to drop in GCS of those affected and this drop may persist even up to 48 hours. This may confound the assessment of GCS.