Seizure medical therapy: Difference between revisions

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Latest revision as of 15:03, 21 April 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD [2]

Overview

In the acute setting, seizures are initially treated with benzodiazepines (lorazepam or midazolam), followed by phenytoin or phenobarbital. Antiepileptic drugs (AEDs) are commonly used in treating focal and generalized epilepsies.

Medical Therapy

Emergency Department

Treatment of seizures in the emergency department may include:^[1]

Patient stabilization by:

Secure airway
Oxygen
Monitor vital signs
Cardiac monitoring
Obtain IV access
Thiamine/ 250 mg/ IV, followed by 50% glucose/ 50 ml/ IV/ over 10 minutes (glucagon/ 1 mg/ IM if IV access is not available)
- If suspicion of hypoglycemia, alcohol abuse, and poor nutrition

Treatment with the following should be started if the seizure persists after 5 minutes:

5–20 minutes:
- Lorazepam/ 0.1 mg/kg (max 4 mg)/ IV over a few seconds
- Diazepam/ 10 mg /IV (0.15 mg/kg) (if lorazepam is not available)
- Midazolam/ 10mg/ buccal (if IV access is not possible)
- If there is no response, repeat this after 10 min
If no response, 20–40 minutes:
- Phenytoin 20/ mg/kg/ IV
- or:
  - Phenobarbital 10–15/ mg/kg/ IV
  - Sodium valproate 30–40/ mg/kg, max dose 3,000 mg/ IV
  - Leveracetam 40–60/ mg/kg, max dose 4,500 mg/ IV
If no response, 40–60 minutes:
- Refractory status epilepticus:
  - Intubate
  - General anaesthesia
  - Admit to intensive care unit (ICU)

Antiepileptic Drugs (AEDs)

Antiepileptic drugs (AEDs) commonly used in treating focal and generalized epilepsies include:^[2]

Focal epilepsy:

Focal and generalized epilepsies (broad spectrum):

Generalized epilepsy:
- Ethosuximide in absence seizures

For more information about antiepileptic drugs (AEDs) in the therapy of epilepsies, click here.

For more information about antiepileptic drugs (AEDs), click here.

References

↑ Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J; et al. (2016). "Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society". Epilepsy Curr. 16 (1): 48–61. doi:10.5698/1535-7597-16.1.48. PMC 4749120. PMID 26900382.
↑ Johnson EL (2019). "Seizures and Epilepsy". Med Clin North Am. 103 (2): 309–324. doi:10.1016/j.mcna.2018.10.002. PMID 30704683.

[pmid26900382-1] Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J; et al. (2016). "Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society". Epilepsy Curr. 16 (1): 48–61. doi:10.5698/1535-7597-16.1.48. PMC 4749120. PMID 26900382.

[pmid30704683-2] Johnson EL (2019). "Seizures and Epilepsy". Med Clin North Am. 103 (2): 309–324. doi:10.1016/j.mcna.2018.10.002. PMID 30704683.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Seizure}}
-Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+{{CMG}} {{AE}} {{SHA}}
-{{CMG}}
+==Overview==
+In the [[acute]] setting, seizures are initially treated with [[benzodiazepines]] ([[lorazepam]] or [[midazolam]]), followed by [[phenytoin]] or [[phenobarbital]]. [[Antiepileptic drugs |Antiepileptic drugs (AEDs)]] are commonly used in treating focal and generalized [[epilepsies]].
 ==Medical Therapy==
+===Emergency Department===
+[[Treatment]] of seizures in the [[emergency department]] may include:<ref name="pmid26900382">{{cite journal| author=Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J | display-authors=etal| title=Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. | journal=Epilepsy Curr | year= 2016 | volume= 16 | issue= 1 | pages= 48-61 | pmid=26900382 | doi=10.5698/1535-7597-16.1.48 | pmc=4749120 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26900382  }} </ref>
-The first aid for a seizure depends on the type of seizure occurring. Generalized seizures will cause the person to fall, which may result in injury. A tonic-clonic seizure results in violent movements that cannot and should not be suppressed. The person should never be restrained, nor should there be any attempt to put something in the mouth. Potentially sharp or dangerous objects should also be moved from the vicinity, so that the individual is not hurt. After the seizure if the person is not fully conscious and alert, they should be placed in the [[recovery position]].
+Patient [[stabilization]] by:
-It is not necessary to call an ambulance if the person is known to have epilepsy, if the seizure is shorter than five minutes and is typical for them, if it is not immediately followed by another seizure, and if the person is uninjured. Otherwise, or if in any doubt, medical assistance should be sought.
+*Secure [[airway]]
+*[[Oxygen]]
+*Monitor [[vital signs]]
+*[[Cardiac monitoring]]
+*Obtain [[IV]] access
+*[[Thiamine]]/ 250 mg/ [[IV]], followed by 50% [[glucose]]/ 50 ml/ IV/ over 10 minutes ([[glucagon]]/ 1 mg/ IM if [[IV]] access is not available)
+**If suspicion of [[hypoglycemia]], [[alcohol abuse]], and poor [[nutrition]]
-A seizure longer than five minutes is a medical emergency. Relatives and other caregivers of those known to have epilepsy often carry medicine such as rectal [[diazepam]] or [[buccal mucosa|buccal]] [[midazolam]] in order to rapidly end the seizure.
+[[Treatment]] with the following should be started if the seizure persists after 5 minutes:
-===Safety===
+*5–20 minutes:
+**[[Lorazepam]]/ 0.1 mg/kg (max 4 mg)/ [[IV]] over a few seconds
+**[[Diazepam]]/ 10 mg /[[IV]] (0.15 mg/kg) (if [[lorazepam]] is not available)
+**[[Midazolam]]/ 10mg/ [[buccal]]  (if [[IV]] access is not possible)
+**If there is no response, repeat this after 10 min
+*If no response, 20–40 minutes:
+**[[Phenytoin]] 20/ mg/kg/ [[IV]]
+**or:
+***[[Phenobarbital]] 10–15/ mg/kg/ [[IV]]
+***[[Sodium valproate]] 30–40/ mg/kg, max dose 3,000 mg/ [[IV]]
+***[[Leveracetam]] 40–60/ mg/kg, max dose 4,500 mg/ [[IV]]
+*If no response, 40–60 minutes:
+**Refractory [[status epilepticus]]:
+***[[Intubate]]
+***[[General anaesthesia]]
+***Admit to [[Intensive care unit|intensive care unit (ICU)]]
-A sudden fall can lead to broken bones and other injuries. Children who are affected by frequent drop seizures may wear helmets to protect the head during a fall.
+===Antiepileptic Drugs (AEDs)===
+[[Antiepileptic drugs |Antiepileptic drugs (AEDs)]] commonly used in treating focal and generalized [[epilepsies]] include:<ref name="pmid30704683">{{cite journal| author=Johnson EL| title=Seizures and Epilepsy. | journal=Med Clin North Am | year= 2019 | volume= 103 | issue= 2 | pages= 309-324 | pmid=30704683 | doi=10.1016/j.mcna.2018.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30704683  }} </ref>
-The unusual behavior resulting from the chaotic brain activity of a seizure can be misinterpreted as an aggressive act. This may invoke a hostile response or police involvement, where there was no intention to cause harm or trouble. During a prolonged seizure, the person is defenseless and may become a victim of theft.
+*[[Focal epilepsy]]:
+**[[Carbamazepine]]
+**[[Eslicarbazepine]]
+**[[Gabapentin]]
+**[[Lacosamide]]
+**[[Oxcarbazepine]]
+**[[Phenytoin]]
-A [[seizure response dog]] can be trained to summon help or ensure personal safety when a seizure occurs. These are not suitable for everybody. Rarely, a dog may develop the ability to sense a seizure before it occurs.<ref name=Dalziel_2003>{{cite journal |author=Dalziel D, Uthman B, Mcgorray S, Reep R |title=Seizure-alert dogs: a review and preliminary study |journal=Seizure |volume=12 |issue=2 |pages=115-20 |year=2003 |pmid=12566236}}</ref>
+*Focal and generalized [[epilepsies]] (broad spectrum):
+**[[Clobazam]]
+**[[Clonazepam]]
+**[[Lamotrigine]]
+**[[Levetiracetam]]
+**[[Perampanel]]
+**[[Topiramate]]
+**[[Valproate]]
+**[[Zonisamide]]
+*Generalized [[epilepsy]]:
+**[[Ethosuximide]] in [[absence seizures]]
+'''For more information about antiepileptic drugs (AEDs) in the therapy of epilepsies, [[Epilepsy_medical_therapy|click here]].'''
+'''For more information about antiepileptic drugs (AEDs), [[Antiepileptic drugs|click here]].'''
 ==References==
 {{reflist|2}}
-{{WH}}
-{{WS}}
-[[Category:Needs content]]
 [[Category:Neurology]]
 [[Category:Epilepsy]]
-[[Category:Signs and symptoms]]
 [[Category:Emergency medicine]]
 [[Category:Disease]]