Seizure medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Medical Therapy
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.
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.
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 midazolam in order to rapidly end the seizure.
Safety
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.
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.
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.[1]
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:[2]
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:
- 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:
Antiepileptic Drugs (AEDs)
Antiepileptic drugs (AEDs) commonly used in treating focal and generalized epilepsies include:[3]
- Focal and generalized epilepsies (broad Spectrum):
- Generalized epilepsy:
For more information about antiepileptic drugs (AEDs) in the therapy of epilepsies, click here.
For more information about antiepileptic drugs (AEDs), click here.
References
- ↑ Dalziel D, Uthman B, Mcgorray S, Reep R (2003). "Seizure-alert dogs: a review and preliminary study". Seizure. 12 (2): 115–20. PMID 12566236.
- ↑ 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.