Management Of Seizures In Children Research Articles

Sources of pharmacokinetic and pharmacodynamic variability and clinical pharmacology studies of antiseizure medications in the pediatric population.

Multiple treatment options exist for children with epilepsy, including surgery, dietary therapies, neurostimulation, and antiseizure medications (ASMs). ASMs are the first line of therapy, and more than 30 ASMs have U.S. Food and Drug Administration (FDA) approval for the treatment of various epilepsy and seizure types in children. Given the extensive FDA approval of ASMs in children, it is crucial to consider how the physiological and developmental changes throughout childhood may impact drug disposition. Various sources of pharmacokinetic (PK) variability from different extrinsic and intrinsic factors such as patients' size, age, drug-drug interactions, and drug formulation could result in suboptimal dosing of ASMs. Barriers exist to conducting clinical pharmacological studies in neonates, infants, and children due to ethical and practical reasons, limiting available data to fully characterize these drugs' disposition and better elucidate sources of PK variability. Modeling and simulation offer ways to circumvent traditional and intensive clinical pharmacology methods to address gaps in epilepsy and seizure management in children. This review discusses various physiological and developmental changes that influence the PK and pharmacodynamic (PD) variability of ASMs in children, and several key ASMs will be discussed in detail. We will also review novel trial designs in younger pediatric populations, highlight the role of extrapolation of efficacy in epilepsy, and the use of physiologically based PK modeling as a tool to investigate sources of PK/PD variability in children. Finally, we will conclude with current challenges and future directions for optimizing the efficacy and safety of these drugs across the pediatric age spectrum.

Management of seizures in children in primary health care

Sudden health states accompanied by seizures require proper diagnosis and appropriate treatment. A seizure in the paediatric population may turn into a life-threatening condition, especially when it is misdiagnosed and appropriate management is initiated too late. The article presents the classification of seizures proposed by the International League Against Epilepsy and seizure time intervals when appropriate treatment should be implemented. The main part of this work is the description of non-pharmacological treatment. In this paper, the management of seizures in the paediatric population was based on the guidelines proposed by several recognised organisations. The American Epilepsy Foundation is one of the bodies publishing guidelines for the management of seizures in the paediatric population. This organisation recommends treatment based on the STAY-SAFE-SIDE strategy. According to these guidelines, the patient should not be left alone, all objects that may injure the patient during the seizure should be moved away, and the patient should be placed on their side. An important element of these activities is also recording seizure duration, which is associated with appropriate pharmacological treatment. Pharmacological management of seizures is based on benzodiazepines. The type of drug, dosage and route of administration are described in detail. The article also mentions guidelines explaining in which cases it is advisable to continue diagnosis and treatment in an Emergency Department setting, and which cases require calling the Emergency Medical Services.

Prehospital Seizure Management in Children: An Evaluation of a Nationally Representative Sample

To describe the characteristics and emergency medical services (EMS) interventions, appropriateness of medication dosing, and factors associated with use of any or multiple doses of benzodiazepines for children with seizures in the prehospital setting from a nationally representative dataset. We performed a retrospective study of EMS encounters within the National EMS Information System between 2019 and 2021, including children (<18years) with an impression of seizures. We identified (1) factors associated with the use of benzodiazepines in a logistic regression model and (2) factors associated with multiple doses of benzodiazepines in an ordinal regression model. We included 361 177 encounters for seizure. Among transports with an Advanced Life Support clinician, 89.9% were given no benzodiazepines and 7.7%, 1.9%, and 0.4% were given 1, 2, and≥3 doses of benzodiazepines, respectively. Encounters given more doses of benzodiazepines had increased use of supplemental oxygen. A high proportion (43.4%) of EMS-provided initial benzodiazepine doses were inappropriately low. EMS-provided benzodiazepine use was associated with use of benzodiazepine prior to EMS arrival. Provision of multiple doses of EMS-provided benzodiazepines was associated with use of a low initial dose of benzodiazepine and use of lorazepam or diazepam compared with midazolam. A large proportion of prehospital pediatric patients with seizure are given inappropriately low dose of benzodiazepines. Use of a low dose of benzodiazepine and use of benzodiazepines other than midazolam are associated with additional benzodiazepine usage. Our findings have implications for future research and quality improvement needs in pediatric prehospital seizure management.

Identification and management of seizures in children

Estimates from epidemiological studies indicate the high global prevalence of seizures in children. They can be associated with different complications that might even be life-threatening. Different risk factors have been reported to increase the risk and severity of seizures, like metabolic disorders, infections, and reduced access to needed care. Therefore, providing appropriate management is essential to enhance the prognosis of these cases. In the present article, we conducted a literature review to shed more light on identifying, diagnosing, and managing seizures in children. The identification process depends on different factors, including obtaining an adequate history from the patient or their caregivers, performing a thorough general and neurological examination, and conducting appropriate investigations whenever needed. It should be noted that in severe cases, these approaches should be made promptly not to delay the management approaches, which can be life-saving. Reassuring family attendants is also recommended. Besides, increasing awareness among these families about the diagnosis, identification, prognosis, reporting, and responding to seizures might reduce the risk of recurrence and enhance the prognosis of seizures. Choosing a treatment strategy is usually based on different factors, including the child's age, epilepsy type, family preferences, the presence of comorbidities, and ability to administer medications. For recurrent seizures, home-based medications, like rectal diazepam or buccal midazolam, might also be used to lower the risk of recurrence and reduce the intensity of seizures.

Sleep disorders and ADHD symptoms in children and adolescents with typical absence seizures: An observational study

ObjectiveTo assess the occurrence of sleep disorders (SD) and attention deficit hyperactivity disorder (ADHD) symptoms in children with typical absence seizures (TAS) compared to control children and to evaluate the impact of epilepsy-related factors on sleep and attention in children with TAS. MethodsThe Sleep Disturbance Scale for Children (SDSC) and the ADHD rating scale were filled in by parents of a cohort composed by 82 children aged from 5 to 15.6 years, 49% of boys (41 with TAS with a syndromic diagnosis of childhood absence epilepsy and 41 controls). For children with TAS, the Pediatric Epilepsy Side Effects Questionnaire was completed. Statistical analyses were conducted in order to compare sleep and attention scores between groups. In children with TAS, a correlation was computed between these scores. Logistics regression models were conducted to identify predictors of excessive diurnal sleepiness and inattention in children with TAS. ResultsCompared to controls, children with TAS had higher total scores for subjective sleep (mean 42.9 vs 38.3, p = 0.05) and attention disorders (mean 16.8 vs 11.6, p = 0.01), especially for excessive diurnal sleepiness (mean 3.9 vs 3.2, p = 0.02) and inattention (mean 9.3 vs 5.6, p = 0.003) components. In children with TAS, sleep problems were significantly under-reported by parents. Sleep disorders symptoms as breathing-related sleep disturbance, excessive diurnal sleepiness or naps at or after 7 years of age were reported. Subjective sleep and attention disorders were significantly correlated (r = 0.43, p = 0.01). Subjective excessive diurnal sleepiness may be the result of a polytherapy (p = 0.05) or a side effect of anti-seizure medication (ASM) (p = 0.03) but children without medication side effects also reported subjective SD. In children with TAS, the risk of inattention symptoms was increased in boys (p = 0.02), with a high BMI (p = 0.05), or with ASM side effects (p = 0.03). ConclusionsThis study demonstrates that children with TAS are at risk of sleep and attention disorder symptoms. If attention disorders in a context of epilepsy are now widely assessed and identified, sleep disorders are still under-estimated. An accurate identification and management of sleep disorders could improve academic performances, quality of life, and seizure management in children with TAS.

What are the effects of prophylactic benzodiazepines, barbiturates, and anticonvulsants for management of febrile seizures in children?

What are the effects of prophylactic benzodiazepines, barbiturates, and anticonvulsants for management of febrile seizures in children?

Epilepsy: recognition and management of seizures in children and young people

A seizure describes the signs and symptoms associated with a sudden surge in brain activity. It is a symptom of either acute brain disturbance, or may indicate a diagnosis of epilepsy, which describes an underlying tendency to have seizures. There are many different seizure types, which account for the wide variation in seizure symptoms. The principles of management remain constant for all seizure types: maintain child safety, ABC support, and arrange emergency assistance and hospital transfer for prolonged episodes. In addition to this, tonic-clonic seizures lasting for more than 5 minutes require treatment with benzodiazepines. Buccal midazolam or rectal diazepam are first-line options when intravenous or intraosseous access is not available. Children and young people with epilepsy should have individualised treatment plans which, if available, further simplify emergency treatment decisions.

A comparison of intravenous midazolam and diazepam in management of status epilepticus in children.

To compare the efficacy of intravenous midazolam and diazepam in the management of status epilepticus seizures in children. The comparative study was conducted in the paediatric neurological emergency unit of The Children's Hospital and the Institute of Child Health, Multan, Pakistan, from December 15, 2018, to May 14, 2019, and comprised paediatric patients of status epilepticus seizures which were divided into Diazepam and Midazolam groups. Data was analysed using Graph-Pad Prism 5. Of the 164 patients, 82(50%) were in each of the two groups. There was no significant difference between the groups in terms of weight, age, residence area of patients and mean duration of seizures (p>0.05). Status epilepticus seizures subsided after intravenous midazolam administration in 77(93.90%) cases, while success in the diazepam group 64(78.05%) (p<0.05). Mean time taken by midazolam to halt seizures was significantly shorter than diazepam (p<0.05) and less cases of treatment failure were observed with intravenous midazolam (p<0.05). Somnolence was observed after diazepam administration in 47(57.3%) cases (p=0.0001). Intravenous midazolam was found to be superior in efficacy than intravenous diazepam in controlling status epilepticus seizures.

Seizures: Management in children

Epilepsy is a common neurological condition and one that school nurses are likely to deal with due to its prevalence in the population. It is therefore important to know how to manage a child having a seizure in the community. Having an appreciation of the long-term management with antiepileptic drugs to try to prevent and control seizures is useful. Children suffering from epilepsy may experience a seizure at any time, often without warning, so an understanding of the correct first aid measures and the use of emergency medication is key. It is also important to know when further medical help is required as well as when it may not be. This article will give a brief overview of the management of seizures in children, covering both prevention and initial management in the community setting.

What are the effects of prophylactic benzodiazepines, barbiturates, and anticonvulsants for management of febrile seizures in children?

What are the effects of prophylactic benzodiazepines, barbiturates, and anticonvulsants for management of febrile seizures in children?

Meta-analysis Evaluating Efficacy and Safety of Levetiracetam for the Management of Seizures in Children

Meta-analysis Evaluating Efficacy and Safety of Levetiracetam for the Management of Seizures in Children

Recognition and nursing management of reflex anoxic seizures in children.

Reflex anoxic seizures (RAS) present with a transient loss of consciousness and are triggered by an unexpected stimuli. These are paroxysmal, short-lived episodes of pronounced bradycardia or transient asystole; the episodes are self-limiting, lasting between 15 seconds and 1 minute. RAS are an important differential diagnosis of transient loss of consciousness but they are commonly misdiagnosed as epileptic events. An accurate and focused history is key to the diagnosis. They are mostly managed by performing an ECG to rule out other causes of arrhythmia, with subsequent explanation of the condition and reassurance given to parents. Nurses play an important role in eliciting the history and providing support to parents following the diagnosis. This article addresses the epidemiology and pathophysiology of RAS, with suggestions for management. An illustrative case study is included to highlight some of the challenges that health professionals working in different clinical set-ups are likely to come across while managing a child with RAS.

Efficacy and Tolerability of Intravenous Levetiracetam as Monotherapy in Acute Seizure Management in Children (P5.289)

Efficacy and Tolerability of Intravenous Levetiracetam as Monotherapy in Acute Seizure Management in Children (P5.289)

Seizure management in children requiring palliative care: a review of current practice.

Controlling seizures in children approaching death can be difficult, and there is a limited evidence base to guide best practice. We compared current practice against the guidance for seizure management produced by the Association of Paediatric Palliative Medicine (APPM). Retrospective case note review of episodes of challenging seizure management in children receiving end-of-life care over a 10-year period (2006-2015) in the south-west region of England. We reviewed 19 admissions, in 18 individuals. Six (33%) had a malignancy, nine (50%) had a progressive neurodegenerative condition and three (17%) had a static neurological condition with associated epilepsy. Thirteen (72%) died in their local hospice, four (22%) at home, and one (6%) in hospital. Seventeen of 19 episodes involved the use of subcutaneous or intravenous midazolam infusion, for a mean of 11 days (range 3-27). There was a wide range of starting doses of midazolam, and 9/17 (53%) received final doses in excess of current dose recommendations. Six individuals received subcutaneous phenobarbital infusions, with four of these (67%) receiving final doses in excess of current dose recommendations. Plans for adjustments of infusion rates, maximal doses or alternative approaches should treatment fail were inconsistent or absent. In 16/18 (88%) cases seizures were successfully controlled prior to the day of the child's death. Staff found the experience of managing seizures at end of life challenging and stressful. Pharmacological approaches to seizure management in end-of-life care are variable, often exceeding APPM dose recommendations. Despite this, safe and effective seizure control was possible in all settings.

Recognition and management of seizures in children in emergency departments.

Seizure is defined as 'a sudden surge of electrical activity in the brain, which usually affects how a person appears or acts for a short time'. Children who have experienced seizures commonly present to emergency departments (EDs), and detailed history taking will usually help differentiate between epileptic and non-epileptic events. ED nurses are often the first health professionals to manage children with seizures, and this is best done by following the ABCDE approach. Treatment involves termination of seizures with anticonvulsants, and children may need other symptomatic management. Seizures in children can be an extremely distressing experience for parents, who should be supported and kept informed by experienced ED nurses. Nurses also play a vital role in educating parents on correct administration of anticonvulsants and safety advice. This article discusses the aetiology, clinical presentation, diagnosis and management of children with seizures, with particular emphasis on epilepsy. It includes two reflective case studies to highlight the challenges faced by healthcare professionals managing children who present with convulsions.

Ketogenic diet for seizure management in children

The ketogenic is a very time and labor-intensive method of treatment for intractable epilepsy. It has seen a big comeback in pediatric epilepsy and although this is not a new treatment as such, in this article we describe the actual behind the scenes work that goes into making the diet a prescription medicine for patients. We describe the working of our own pro- gram, which is the only program for the state of Iowa.

Management of seizures in children

Seizures are common events in children and up to 10% of all children experience at least one seizure during their childhood. They can be triggered by many conditions such as fever, medications or injury. Febrile seizures are the most common types of seizures, affecting 3-4% of children. While epilepsy is typically recurrent and unprovoked, a single, isolated seizure is not epilepsy. Taking a detailed history of the seizure description helps establish the diagnosis. A video recording of the event can also support the diagnosis and rule out non-epileptic seizures that resemble seizures, such as pseudo-seizure. Seeing a child having a seizure, particularly if it is the first one, is usually frightening and distressing for the parents. First seizure should always be evaluated by health professionals because of a possible serious underlying cause. If the seizure occurs at home, the child should be placed in the recovery side position to prevent the swallowing of any vomit. The care of a child who does have epilepsy is best achieved by a community or hospital epilepsy specialist nurse. These nurses play a pivotal role in providing a close link between the epileptic children and their families. Such a nurse is also in an ideal position to establish a link between the doctor and affected families, offering valuable advice and support, and visiting the epileptic child at home.

Evaluation of Adherence to a Convulsion Management Protocol for Children in Rwanda

Inappropriate seizure management may result in high morbidity and mortality. We assessed the adherence of health professionals in southern Rwanda to a national protocol for pharmacological management of seizures in children. A questionnaire featuring a 5-year-old child with generalized prolonged seizures was administered. The questions focused on the choice of initial treatment and the sequence of management following failure of the initial treatment choice. Benzodiazepine was chosen as initial therapy by 93.7% of physicians and 90.9% of nurses. Only 49.2% of physicians and 41% of nurses would repeat the initial treatment in case of failure of the first dose and 47% of doctors would wait 30 min to intervene. In case of refractory status epilepticus, 34% of physicians would give three doses of benzodiazepine, whereas 19% did not know what to do. These results suggest poor adherence to national protocol.

The Ketogenic Diet in Dravet Syndrome

Dravet syndrome is an infantile epilepsy syndrome with intractable pleomorphic seizures, cognitive impairment, and a number of comorbidities including ataxia/gait abnormalities and behavioral issues. Antiseizure medications are only partially effective in controlling seizures. Secondary to the intractable epilepsy, patients are often on multiple antiseizure medications with significant accumulative neurotoxic side effects. Specifically for Dravet syndrome, the medical literature includes both laboratory and clinical research that supports the use of the ketogenic diet. In addition, a review of the children with Dravet syndrome who were treated with the ketogenic diet at our center was undertaken. Thirteen of the 20 children (65%) with Dravet syndrome treated with the ketogenic diet experienced a greater than 50% reduction in seizure frequency. The ketogenic diet is a good alternative to medication for seizure management in children with Dravet syndrome.

Neurodevelopmental disruption in early-onset temporal lobe epilepsy: Evidence from a voxel-based morphometry study

Childhood onset of epilepsy has long been associated with an adverse impact on brain development and cognition. In this study it is proposed that earlier (vs later) onset of temporal lobe epilepsy (TLE) has a negative developmental impact on distant brain structures. One hundred ten patients with TLE were assigned to early (≤ 14 years, N = 58) and late (> 15 years, N = 52) age at onset of epilepsy groups. Voxel-based morphometry revealed onset-dependent abnormalities (in terms of a gray matter excess in the early-onset group), which were found mainly in frontal regions. An excess of gray matter is not a usual finding in TLE. However, within a neurodevelopmental framework, retained gray matter is discussed as reflecting neurodevelopmental disruption. The findings indicate the importance of quantitative MRI for the detection of subtle secondary abnormalities in focal TLE and once more underline the importance of early seizure management in children with intractable TLE.