Emergency Management Of Seizures Research Articles

Seizures in febrile children with SARS-CoV-2 infection: clinical features, short-term follow-up

BackgroundAs the Omicron variant of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerges, the neurological manifestations correlated with this epidemic have garnered increasing attention. This study was primarily intended to compare seizures in febrile children with and without SARS-CoV-2 infection and to conduct short-term follow-up of the SARS-CoV-2-infected patients.MethodsRetrospective analysis of patients admitted to the Children’s Hospital of Chongqing Medical University for fever and seizures between October 1 and December 30, 2022. Based on the results of SARS-CoV-2 Reverse Transcription-Polymerase Chain Reaction(RT-PCR) at the time of admission, the patients were divided into a Coronavirus disease 2019(COVID-19) positive group and a COVID-19 negative group. Aside from that, we followed up COVID-19-positive patients for 3 months after their discharge from the hospital. The follow-up included monitoring for post-discharge seizures.ResultsCompared with the COVID-19-negative group, the COVID-19-positive group had a higher proportion of seizure duration ≥ 15 min(18.7%VS5.1%;P = 0.001), seizure ≥ 2 time(54.4%VS41.0%; P = 0.024), status epilepticus(15.4%VS5.1%; P = 0.005), and Electroencephalogram (EEG) abnormalities(29.4%VS13.6%; P = 0.016). Among the 161 individuals under follow-up, 21 (13.0%)experienced a recurrence of seizures.ConclusionsAlthough the incidence of seizure duration ≥ 15 min, number of seizures ≥ 2 time, and status epilepticus was higher in the COVID-19-positive group, the majority of patients had a favorable prognosis. Nonetheless, patients with COVID-19 who present with seizures and persistent impaired consciousness need to be alerted to serious neurological disorders such as acute necrotizing encephalopathy. Owing to the consideration that some patients may experience a recurrence of seizures within a short period of time, it is paramount to provide guardians with education about the emergency management of seizures and to follow up with patients over time.

Book review: Paediatric emergency medication book

This book provides a quick, easy-to-access, weight-based guide to resuscitation of infants and children. It includes medication dosing in resuscitation situations, endotracheal tube size and positioning, and emergency management of seizures, asthma, anaphylaxis and electrolyte disorders. The formatting, content and presentation have been carefully considered to achieve this aim and to make it a valuable resource. Weight-based guidelines are presented for 2–80 kg, in a clear colour-coded format. The information for each weight is presented over two pages. It provides everything you need in a resuscitation setting at a glance, including tables for resuscitation, endotracheal tube size, and induction and paralytic drugs. Information on drugs used in severe asthma, status epilepticus and electrolyte abnormalities is also included. Layout is the same irrespective of the weight selected which helps readers to become familiar with this resource. Infusion guidelines are also provided, although many institutions may have these preprogrammed in their infusion pumps. The book is spiral bound with sturdy laminated pages, making it waterproof and durable. It is easy to turn to the weight needed and access the information required in a timely fashion. The first three pages contain Advanced Paediatric Life Support (APLS) algorithms for basic and advanced life support, and status epilepticus. This is an excellent resource for medical and nursing staff working with sick infants and children, be that frequently or occasionally, in an inpatient ward setting, mixed emergency department or paediatric emergency department. It provides clear, easily accessible important information in a visually appealing format. The section on electrolyte abnormalities is particularly useful. It could also be used as a resource for education and specifically simulation – APLS Australia have already adopted it for this use.

Emergency treatment of the seizuring patient

When presented with a seizuring patient, preparation is very important. A systematic approach to history taking, examination and treatment can minimise errors in diagnosis and treatment in a stressful situation. The ABCs — airway, breathing and circulation — must be assessed first unless the patient presents having a tonic-clonic seizure, and any required corrective treatment applied. The cause of the seizure should be determined based on the history and clinical examination. In patients having a tonic-clonic seizure at the time of presentation, rectal diazepam may be given initially and a full examination delayed, otherwise a full clinical and neurological examination should be carried out, with further tests as required to reach a definitive diagnosis. Hypoglycaemia should be considered as a probable, extra-cranial, cause of seizure in young puppies, particularly those of small breeds. Once it is established that a true seizure has occurred (or is occurring), the appropriate treatment must be given, with diazepam or midazolam as the first line treatment. Phenobarbital and levetiracetam can both be used for emergency management of seizures and also for long-term anti-seizure medication. Propofol may be needed for patients that are resistant to benzodiazepines, phenobarbital and levetiracetam.

Knowledge and attitudes of school teachers, preschool teachers and students in teacher training about epilepsy and emergency management of seizures

ProblemSchool and preschool teachers play a key role in the care of children with epilepsy. Yet, data about their knowledge on epilepsy are scarce.MethodsAssessment of knowledge and attitudes towards epilepsy...

Bioavailability of Intranasal vs. Rectal Diazepam

There remains an unmet medical need in the out-of-hospital management of seizure emergencies because older children and adults often refuse treatment with diazepam rectal gel due to social objections. We have previously reported that intranasal diazepam (DZP) administration is feasible, with maximum plasma concentrations (C(max)) and time to maximum concentration (T(max)) that are comparable to rectal DZP; but tolerability was poor. In the present study, the tolerability and pharmacokinetics of two investigational nasal formulations were compared with DZP rectal gel. Twelve healthy volunteers were enrolled into an active-control, double-blind, four-period, crossover pharmacokinetic and tolerability study. Three intranasal treatments (Nas-A 10mg, Nas-B 10mg and Nas-B 13.4 mg) were compared to a 10mg dose of the rectal gel. A single dose of each formulation was administered followed by at least a 14 day washout period. Blood samples for plasma DZP concentration-time characterization were collected pre-dose and at regular intervals to 240 h post-dose. Tolerability and sedation were assessed using visual analog scales. Mean DZP C(max) (±SD) was 181.8 ± 84.16, 151.3 ± 108.1 and 180.7 ± 82.1 ng/mL for Nas-A 10mg, Nas-B 10 and Nas-B 13.4 mg respectively; in comparison the C(max) for the rectal gel was 160.9 ± 109.4 ng/mL. Median T(max) was 0.75 h for all treatments. Both intranasal formulations were well tolerated and exhibited relatively rapid, but variable, absorption with bioavailability of 70-90% relative to DZP rectal gel. This study shows that the development of a well-tolerated nasal formulation is possible and that the rate and extent of absorption approximates that of DZP rectal gel. We conclude that intranasal DZP offers a viable alternative to rectal administration, but enhancement of formulations is needed to improve the extent and consistency of absorption.

Rescue Therapies for Seizures

Most medical therapies for epilepsy consist of daily (or multiple-daily) dose, fixed-schedule, pharmacologic oral agents. Despite adherence, many patients continue to experience seizures. Various products have been discovered, designed, and marketed to serve as seizure-abortant therapies. These agents can be administered rapidly, as a "rescue" therapy, once a clinical seizure or cluster of seizures starts. Rescue medications are given as needed in an attempt to disrupt progression of a given seizure, and forestall what would otherwise be a more prolonged or more severe clinical event. Seizure-abortants also serve to aid in the management of seizure emergencies, such as prolonged, repetitive seizures, or status epilepticus. These compounds are not appropriate for all patients. Nevertheless, they do provide therapeutic benefit to several groups of patients: 1) those who perceive the onset of their seizures and have time to perform a self-intervention, 2) patients' caregivers who administer the therapy when they witness the onset of an ictal event, and 3) patients who are in the midst of an out-of-the-hospital seizure emergency (a seizure cluster or status epilepticus). In this article we will review currently available and future rescue therapies for seizures: US Food and Drug Administration (FDA) approved and FDA nonapproved drugs, nonpharmacologic behavioral treatments, the vagus nerve stimulator and the NeuroPace RNS® System (Mountain View, CA).

Emergency Management of Seizures in the School Setting

Effective seizure management in the school setting is a critical issue for students with seizures, as well as their parents, classmates, and school personnel. The unpredictable nature of seizures and the potential outcomes of experiencing a seizure in school are sources of anxiety for students with seizures. The ability to respond appropriately to a seizure is of concern to parents and school personnel. Implementation of a seizure emergency treatment plan empowers school personnel to quickly treat the child. Diazepam rectal gel is commonly used in seizure emergency treatment plans. It is safe and effective in terminating seizures and reduces the time to treatment and the need for emergency department visits when used in the school setting, and can be administered by medical and delegated to trained nonmedical personnel. School nurses should be aware of the laws and professional recommendations that pertain to rectal medication administration in schools for optimal emergency seizure management.

Emergency Management of Seizures in the School Setting

Effective seizure management in the school setting is a critical issue for students with seizures, as well as their parents, classmates, and school personnel. The unpredictable nature of seizures and the potential outcomes of experiencing a seizure in school are sources of anxiety for students with seizures. The ability to respond appropriately to a seizure is of concern to parents and school personnel. Implementation of a seizure emergency treatment plan empowers school personnel to quickly treat the child. Diazepam rectal gel is commonly used in seizure emergency treatment plans. It is safe and effective in terminating seizures and reduces the time to treatment and the need for emergency department visits when used in the school setting, and can be administered by medical and delegated to trained nonmedical personnel. School nurses should be aware of the laws and professional recommendations that pertain to rectal medication administration in schools for optimal emergency seizure management.

Emergency management of seizures in children

There is increasing evidence that prolonged seizures are best stopped with early treatment. Although it is well accepted that benzodiazepines are the first line of therapy, intramuscular paraldehyde is used in many parts of the world when intravenous access is not achieved or available.1 Whilst efficacious, use of intramuscular paraldehyde in neonates and young children can result in sciatic nerve injury, skin sloughing, and sterile abscesses.2 An alternative treatment, transmucosal benzodiazepine, is effective, but there are concerns about potential routes of delivery.

Efficacy and safety of intranasal lorazepam versus intramuscular paraldehyde for protracted convulsions in children: an open randomised trial

In sub-Saharan Africa, rectal diazepam or intramuscular paraldehyde are commonly used as first-line anticonvulsant agents in the emergency treatment of seizures in children. These treatments can be expensive and sometimes toxic. We aimed to assess a drug and delivery system that is potentially more effective, safer, and easier to administer than those presently in use. We did an open randomised trial in a paediatric emergency department of a tertiary hospital in Malawi. 160 children aged over 2 months with seizures persisting for more than 5 min were randomly assigned to receive either intranasal lorazepam (100 microg/kg, n=80) or intramuscular paraldehyde (0.2 mL/kg, n=80). The primary outcome measure was whether the presenting seizure stopped with one dose of assigned anticonvulsant agent within 10 min of administration. The primary analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00116064. Intranasal lorazepam stopped convulsions within 10 min in 60 (75%) episodes treated (absolute risk 0.75, 95% CI 0.64-0.84), and intramuscular paraldehyde in 49 (61.3%; absolute risk 0.61, 95% CI 0.49-0.72). No clinically important cardiorespiratory events were seen in either group (95% binomial exact CI 0-4.5%), and all children finished the trial. Intranasal lorazepam is effective, safe, and provides a less invasive alternative to intramuscular paraldehyde in children with protracted convulsions. The ease of use of this drug makes it an attractive and preferable prehospital treatment option.

Emergency management of seizures: an overview.

The drugs currently used in the emergency management of seizures are chiefly phenytoin, phenobarbital, diazepam, lorazepam, and paraldehyde. The combination of intravenous phenytoin and lorazepam has the advantages of rapid onset of action, sustained efficacy, and freedom from drug interactions. The intermittent oral or rectal administration of diazepam is especially useful for acute home treatment of recurrent seizures. Phenytoin prodrug (ACC-9653), an investigational new drug, is promptly absorbed after intramuscular injection. Unlike phenytoin, it does not require propylene glycol and high alkalinity for solubility and therefore does not produce soft-tissue injury after parenteral administration. It appears to be close to an ideal drug for the emergency management of seizures.