Page 26 - Learnwell EVS
P. 26
zures
I M ro ute m ay be an alternative wh en an I V ( o r intrao sseo us) access canno t be
o btained .
T here is a high risk o f resp irato ry d ep ressio n and hy p o tensio n, esp ecially in child ren
and eld erly p atients. Never ad m inister p heno barbital by rap id IV injectio n. M o nito r
clo sely resp iratio n and blo o d p ressure. E nsure that resp irato ry sup p o rt (A m bu
bag
via face m ask o r intubatio n) and IV so lutio ns fo r fluid rep lacem ent are read y at hand .
Further treatment
– Febrile seizures
D eterm ine the cause o f the fever. G ive paracetamol (see Fever, p age 2 6 ), und ress the
p atient, wrap in d am p clo th.
I n child ren und er 3 y ears, there is usually no risk o f later co m p licatio ns after sim p le
febrile seiz ures and no treatm ent is required after th e crisis. F o r furth er febrile
ep iso d es, give paracetamol P O .
– Infectious causes
S evere m alaria ( p age 1 3 1 ) , m eningitis ( p age 1 6 5 ) , m eningo - encep h alitis, cerebral
to xo p lasm o sis (p ages 2 1 7 and 2 1 8 ), cy sticerco sis (p age 1 5 3 ), etc.
– Metabolic causes
H y p o gly caem ia: ad m inister gluco se by slo w I V injectio n ( fo r ad m inistratio n, see
p age 2 3 ) to all p atients wh o d o no t regain co nscio usness, to p atients with severe
m alaria and to new bo rns and m alno urish ed ch ild ren. W h en p o ssible, co nfirm
hy p o gly caem ia (reagent strip test).
– Iatrogenic causes
W ithd rawal o f antiep ilep tic therap y in a p atient being treated fo r ep ilep sy sho uld be
m anaged o ver a p erio d o f 4 - 6 m o nths with p ro gressive red uctio n o f the d o ses. A n
abrup t sto p o f treatm ent m ay p ro vo k e severe recurrent seiz ures.
– Epilepsy
• A first brief seiz ure d o es no t need further p ro tective treatm ent. O nly p atients with
ch ro nic rep etitive seiz ures require furth er regular p ro tective treatm ent with an
antiep ilep tic d rug, usually o ver several y ears.
• O nce a d iagno sis is m ad e, abstentio n fro m treatm ent m ay be reco m m end ed d ue to
the risk s asso ciated with treatm ent. H o wever, these risk s m ust be balanced with the
risk s o f aggravatio n o f the ep ilep sy , ensuing seiz ure-ind uced cerebral d am age and
o ther injury if the p atient is no t treated .
• It is alway s p referable to start with m o no therap y . T he effective d o se m ust be reached
p ro gressively and sy m p to m s and d rug to lerance evaluated every 1 5 to 2 0 d ay s.
• A n abrup t interrup tio n o f treatm ent m ay p ro vo k e status ep ilep ticus. T he rate o f
d o se red uctio n varies acco rd ing to the length o f treatm ent; the lo nger the treatm ent
p erio d , th e lo nger the red uctio n p erio d (see iatrogenic causes, abo ve). In the sam e
way , a ch ange fro m o ne antiep ilep tic d rug to ano ther m ust be m ad e p ro gressively
with an o verlap p erio d o f a few week s.
• F irst line treatm ents fo r generalised to nic-clo nic seiz ures in child ren und er 2 y ears
are carbam az ep ine o r p heno barbital, in o ld er child ren and ad ults so d ium valp ro ate
coarbcaamrbazaempinaezPepOine. F o r info rm atio n:
C hild ren: initial d o se o f 2 m g/ k g/ d ay in 1 o r 2 d ivid ed d o ses; increase every week
until th e o p tim al d o se fo r th e ind ivid ual h as been reach ed ( usually 1 0 to
2 0 m g/ k g/ d ay in 2 to 4 d ivid ed d o ses).
A d ults: initial d o se o f 2 0 0 m g/ d ay in 1 o r 2 d ivid ed d o ses; increase by 2 0 0 m g
every week until th e o p tim al d o se fo r the ind ivid ual has been reached (usually
8 0 0 to 1 2 0 0 m g/ d ay in 2 to 4 d ivid ed d o ses).
24
I M ro ute m ay be an alternative wh en an I V ( o r intrao sseo us) access canno t be
o btained .
T here is a high risk o f resp irato ry d ep ressio n and hy p o tensio n, esp ecially in child ren
and eld erly p atients. Never ad m inister p heno barbital by rap id IV injectio n. M o nito r
clo sely resp iratio n and blo o d p ressure. E nsure that resp irato ry sup p o rt (A m bu
bag
via face m ask o r intubatio n) and IV so lutio ns fo r fluid rep lacem ent are read y at hand .
Further treatment
– Febrile seizures
D eterm ine the cause o f the fever. G ive paracetamol (see Fever, p age 2 6 ), und ress the
p atient, wrap in d am p clo th.
I n child ren und er 3 y ears, there is usually no risk o f later co m p licatio ns after sim p le
febrile seiz ures and no treatm ent is required after th e crisis. F o r furth er febrile
ep iso d es, give paracetamol P O .
– Infectious causes
S evere m alaria ( p age 1 3 1 ) , m eningitis ( p age 1 6 5 ) , m eningo - encep h alitis, cerebral
to xo p lasm o sis (p ages 2 1 7 and 2 1 8 ), cy sticerco sis (p age 1 5 3 ), etc.
– Metabolic causes
H y p o gly caem ia: ad m inister gluco se by slo w I V injectio n ( fo r ad m inistratio n, see
p age 2 3 ) to all p atients wh o d o no t regain co nscio usness, to p atients with severe
m alaria and to new bo rns and m alno urish ed ch ild ren. W h en p o ssible, co nfirm
hy p o gly caem ia (reagent strip test).
– Iatrogenic causes
W ithd rawal o f antiep ilep tic therap y in a p atient being treated fo r ep ilep sy sho uld be
m anaged o ver a p erio d o f 4 - 6 m o nths with p ro gressive red uctio n o f the d o ses. A n
abrup t sto p o f treatm ent m ay p ro vo k e severe recurrent seiz ures.
– Epilepsy
• A first brief seiz ure d o es no t need further p ro tective treatm ent. O nly p atients with
ch ro nic rep etitive seiz ures require furth er regular p ro tective treatm ent with an
antiep ilep tic d rug, usually o ver several y ears.
• O nce a d iagno sis is m ad e, abstentio n fro m treatm ent m ay be reco m m end ed d ue to
the risk s asso ciated with treatm ent. H o wever, these risk s m ust be balanced with the
risk s o f aggravatio n o f the ep ilep sy , ensuing seiz ure-ind uced cerebral d am age and
o ther injury if the p atient is no t treated .
• It is alway s p referable to start with m o no therap y . T he effective d o se m ust be reached
p ro gressively and sy m p to m s and d rug to lerance evaluated every 1 5 to 2 0 d ay s.
• A n abrup t interrup tio n o f treatm ent m ay p ro vo k e status ep ilep ticus. T he rate o f
d o se red uctio n varies acco rd ing to the length o f treatm ent; the lo nger the treatm ent
p erio d , th e lo nger the red uctio n p erio d (see iatrogenic causes, abo ve). In the sam e
way , a ch ange fro m o ne antiep ilep tic d rug to ano ther m ust be m ad e p ro gressively
with an o verlap p erio d o f a few week s.
• F irst line treatm ents fo r generalised to nic-clo nic seiz ures in child ren und er 2 y ears
are carbam az ep ine o r p heno barbital, in o ld er child ren and ad ults so d ium valp ro ate
coarbcaamrbazaempinaezPepOine. F o r info rm atio n:
C hild ren: initial d o se o f 2 m g/ k g/ d ay in 1 o r 2 d ivid ed d o ses; increase every week
until th e o p tim al d o se fo r th e ind ivid ual h as been reach ed ( usually 1 0 to
2 0 m g/ k g/ d ay in 2 to 4 d ivid ed d o ses).
A d ults: initial d o se o f 2 0 0 m g/ d ay in 1 o r 2 d ivid ed d o ses; increase by 2 0 0 m g
every week until th e o p tim al d o se fo r the ind ivid ual has been reached (usually
8 0 0 to 1 2 0 0 m g/ d ay in 2 to 4 d ivid ed d o ses).
24
