Management Of Seizures In Children Research Articles

Vagus nerve stimulation for the management of seizures in children: an 8-year experience

Background Medication-resistant seizure disorder is a challenging, debilitating, and expensive condition. Although multiple interventions are now available, none is universally effective. In 1997, vagus nerve stimulation (VNS) was approved for treatment of refractory seizures in patients older than 12 years. Vagus nerve stimulation has shown some benefit for these individuals, but less is known about its use in patients younger than 12 years. This review analyzes the safety and efficacy of VNS in young children. Methods From March 2000 to February 2008, patients with medication-resistant seizures were implanted with a neurocybernetic prosthesis. Two weeks later, the device was activated. The children were followed for at least 3 months, and adjustments were made. Retrospective chart review was performed to collect data. Results Of 28 patients, the mean age at implantation was 8 years and 5 months. Twenty-one (75%) children were younger than 12 years. There were no surgical complications. Two children were reimplanted for lead malfunction, and 4 generators were replaced. Two children had transitory adverse effects (hoarseness and stridor). Mean follow-up was 3 years and 5 months. At 1 year, 52% of children had greater than 50% reduction in seizures. Conclusions Although the effectiveness of VNS is variable and unpredictable, safety is high even in young children. Because of the potential benefit for these complex patients, the implantation of this nerve stimulation device should be included in the armamentarium of pediatric surgeons.

Acute Seizure Management in Children

Children with intractable epilepsy have frequent hospital admissions secondary to acute exacerbation of seizures or status epilepticus. Delay in medical management can lead to permanent neurological damage. Randomized clinical trials demonstrate that benzodiazepines are still the cornerstones of the acute management of seizures, but treatment is still evolving owing to the approval of newer medications. A decade ago, approval of fosphenytoin, parental valproate and rectal diazepam made an impact in the acute management of seizures. The use of rectal diazepam and intranasal and buccal midazolam for acute repetitive seizures resulted in reduced hospital admissions. In recent years, intravenous levetiracetum has also had an impact in treating status epilepticus and acute exacerbation of seizures. However, larger, prospective, multicenter trials are required to prove the efficacy of newer agents in acute 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.

Rectal Diazepam Gel in the Home Management of Seizures in Children

This study assessed the utility of rectal diazepam gel in the home management of prolonged or repetitive seizures in children. Thirty-eight children being prescribed rectal diazepam gel by their clinician were prospectively recruited. Seizures, rectal diazepam use, emergency department visits, and quality of life data before and after study entry were recorded. The 38 children included 14 (37%) with complex febrile seizures, and 24 with epilepsy (n = 22) or a single seizure (n = 2). There were 23 (61%) children with prolonged seizures and 15 (39%) with repetitive seizures. During the 6-month follow-up period, 12 children experienced 26 seizures which met the criteria for rectal diazepam administration. Rectal diazepam gel was administered to 8 children on 19 occasions. In 16 (84%) of these episodes, seizures stopped and no emergency department visit was required. Parental stress was decreased between baseline and 6 months in both the overall group and in all the subgroups. Home use of rectal diazepam gel is effective in aborting seizure activity, often avoiding an emergency department visit. Its use reduces morbidity and costs associated with hospital visits and provides parents a treatment option for home management of prolonged or repetitive seizures.

Management of seizures in children with falciparum malaria.

Falciparum malaria is the most common cause of convulsions in children admitted to hospital in malaria endemic areas. Detection of convulsions requires close monitoring and one should be on the look out for signs of subtle convulsions. About a third of acute seizures in children with cerebral malaria, do not manifest as convulsions, but as changes in eye deviation, salivation and/or eye deviation. It is important to terminate convulsions lasting more than 5 min, since prolonged convulsions are associated with neurological deficits in survivors of children with severe malaria. Initial management should include putting the child into the left lateral position, checking the blood glucose and administering oxygen if hypoxic. The benzodiazepines, particularly diazepam, are used as the initial anticonvulsants. Phenobarbital and phenytoin are used as second-line treatments. Prompt and effective management of falciparum malaria associated convulsions may contribute to a better outcome in children with severe malaria.

The management of immediate post-traumatic seizures in children following minor head injury – time for a multicentre study?

Children have a much lower threshold for seizure activity than adults. Consequently, an immediate post-traumatic seizure in a child following a minor head injury does not have the same potentially serious implications as one in an adult. The records of children admitted with a post-traumatic fit occurring within 24 h of a minor head injury and with a normal CT scan of the brain on admission were critically reviewed. Those with previous neurological disorders, especially fits (excepting febrile convulsions), or systemic injuries requiring admission to an intensive care unit were excluded. There were 13 children who were not intubated and ventilated, forming the control group, and 13 children who were intubated and ventilated and formed the study group. All the children in both these groups made a good recovery, and none of them had any neurological deficit either at discharge or at follow-up. The clinical data suggest that children with immediate post-traumatic seizures following a minor head injury whose CT scan shows no major intracranial abnormalities and who have no prior history of neurological disease are at low risk of developing recurrent seizures or neurological complications and can be safely managed without recourse to intubation and ventilation.

Epilepsy education in schools

The objective of this study was to assess the effect of an epilepsy education initiative on the management of epilepsy in Southampton schools. A self-completion questionnaire survey was undertaken of staff in 19 Southampton primary schools and ten secondary schools. Changes in knowledge and management of seizures in children with epilepsy were measured following an education session and a recommended implementation of an individual seizure protocol for children with epilepsy. There were significant changes in some areas of seizure management and knowledge. Only a small number (three) of primary schools had a protocol in place. Two primary and four secondary schools were in the process of putting the protocol in place. An improvement in knowledge and seizure management has been demonstrated. Further work is needed to implement an individual seizure protocol for all children with epilepsy.

Clinical issues in acute childhood seizure management in the emergency department.

Generalized tonic-clonic seizure activity in infants and children frequently leads to an emergency department visit, often after emergency medical service personnel, such as paramedics, provide initial evaluation and treatment. Important subsets of patients who present to the emergency department include those with non-seizure-mediated movements, those with nongeneralized seizure activity, those with complications of anticonvulsant therapy, and those with status epilepticus. Recognizing, diagnosing, and treating these conditions and minimizing complications are key issues to be considered in the refinement of emergency department practice. Of the children with seizures who are seen in the emergency department, those with febrile convulsions or exacerbations of underlying seizure disorders predominate, while those with new-onset epilepsy or other seizure disorders account for a smaller proportion. Current issues in the emergency department management of seizures in children include: (1) modifying interventions to stabilize patients and simultaneously minimize the physiologic deterioration accompanying generalized seizures; (2) selection, initiation, administration, and refinement of anticonvulsant therapy; (3) minimizing complications of prolonged seizures and their treatment; (4) rapid recognition and treatment of life-threatening illnesses that underlie seizure presentations; (5) selection of appropriate diagnostic measures; and (6) use of electroencephalography in selected patients.

Decision making and the child with febrile seizures.

Seizures, both febrile and nonfebrile, are the most common neurologic problem seen in children. Most seizure problems can, and should, be managed by the pediatrician. This article, along with the following one, represents a dialogue—one we often have with pediatricians about the evaluation and management of seizures in children. A seizure is defined as a paroxysmal electrical discharge of neurons in the brain resulting in alteration of function or behavior. A febrile seizure is defined as a seizure caused by fever. The diagnosis of a febrile seizure is one of exclusion. Before the diagnosis is made definite, it must be established that there was not another cause for the seizure. Factors Important in the Diagnosis of Febrile Seizures AGE Febrile seizures are most common between the ages of 6 mo and 5 y. Beyond this range, seizures are more likely to have another etiology. However, this does not mean that every child outside of this age range needs a brain scan and an extensive initial evaluation. TEMPERATURE The height of the fever at the time of the seizure is helpful to know. Anyone can have a seizure if his or her temperature is sufficiently high. Therefore, in the absence of other demonstrable causes, the higher the fever, the more likely that an initial seizure, occurring in the typical age range, was precipitated by the fever.

Decision making and the child with afebrile seizures.

Seizures, both febrile and nonfebrile, are the most common neurologic problem seen in children. Most seizure problems can, and should, be managed by the pediatrician. This article, along with the following one, represents a dialogue—one we often have with pediatricians about the evaluation and management of seizures in children. A seizure is defined as a paroxysmal electrical discharge of neurons in the brain resulting in alteration of function or behavior. A febrile seizure is defined as a seizure caused by fever. The diagnosis of a febrile seizure is one of exclusion. Before the diagnosis is made definite, it must be established that there was not another cause for the seizure. Factors Important in the Diagnosis of Febrile Seizures AGE Febrile seizures are most common between the ages of 6 mo and 5 y. Beyond this range, seizures are more likely to have another etiology. However, this does not mean that every child outside of this age range needs a brain scan and an extensive initial evaluation. TEMPERATURE The height of the fever at the time of the seizure is helpful to know. Anyone can have a seizure if his or her temperature is sufficiently high. Therefore, in the absence of other demonstrable causes, the higher the fever, the more likely that an initial seizure, occurring in the typical age range, was precipitated by the fever.

Decision Making and the Child with Febrile Seizures

Seizures, both febrile and nonfebrile, are the most common neurologic problem seen in children. Most seizure problems can, and should, be managed by the pediatrician. This article, along with the following one, represents a dialogue—one we often have with pediatricians about the evaluation and management of seizures in children. A seizure is defined as a paroxysmal electrical discharge of neurons in the brain resulting in alteration of function or behavior. A febrile seizure is defined as a seizure caused by fever. The diagnosis of a febrile seizure is one of exclusion. Before the diagnosis is made definite, it must be established that there was not another cause for the seizure. Factors Important in the Diagnosis of Febrile Seizures AGE Febrile seizures are most common between the ages of 6 mo and 5 y. Beyond this range, seizures are more likely to have another etiology. However, this does not mean that every child outside of this age range needs a brain scan and an extensive initial evaluation. TEMPERATURE The height of the fever at the time of the seizure is helpful to know. Anyone can have a seizure if his or her temperature is sufficiently high. Therefore, in the absence of other demonstrable causes, the higher the fever, the more likely that an initial seizure, occurring in the typical age range, was precipitated by the fever.

Management of hyponatremia seizures in children with hypertonic saline: A safe and effective strategy

Management of hyponatremia seizures in children with hypertonic saline: A safe and effective strategy

The administration of rectal diazepam for acute management of seizures

The emergency management of seizures often involves the use of diazepam as a first-line medication. Intravenous access is difficult in pediatric patients who are having seizures, and for this reason alternate routes of administration have been sought. This paper reviews the recent literature concerning the efficacy of rectal administration of intravenous diazepam solution for the purpose of emergency management of seizures in children. Although intravenous diazepam is the preferred route for the child with active seizure activity, undiluted diazepam intravenous solution administered per rectum is an excellent alternative. The technique of administration is reviewed.

BOOK REVIEW

Book reviewed in this article:Gregory L. Holmes: Diagnosis and management of seizures in children. W. B. Saunders Co., Philadelphia 1987.

Diagnosis and Management of Seizures in Children

Diagnosis and Management of Seizures in Children

Book Reviews

Book reviewed in this article:Rusty's Story. Carol Gino.Snoring and Obstructive Sleep Apnea. David N. F. Fairbanks, Shiro Fujita, Takenosuke Ikematsu, and F. Blair Simmons.The Clinical Neurosciences. Neurology. Neurosurgery. Neuropathology. Neuroradiology. Neurobiology. Roger N. Rosenberg (ed.).Diagnosis and Management of Seizures in Children. Gregory L. Holmes, M.D. W.B. Saunders Company, PhiladelphiaThe Principles and Practice of Medicine. Twenty‐First Edition. A. McGehee Harvey, Richard J. Johns, Victor A. McKusick, Albert H. Owens, Jr., and Richard S. Ross (eds.).The Medical Mind of Shakespeare. Aubrey C. Kail. Williams and Wilkins, BaltimoreDiseases of the Nervous System. Clinical Neurobiology. Volumes I and II. Arthur K. Asbury, Guy M. McKhann, and W. Ian McDonald.The Management of Epilepsy in Dogs. Phyllis G. Croft.Epileptische Anfalle. Phanomenologie, Differential‐diagnose und Therapie. Kazimierz KarbowskiProgress in Neuropathology. Volume 6. Harry M. Zimmerman (ed.).Clinical Trials, Design, Conduct, and Analysis. Curtis L. Meinert.The Biochemical Basis of Neuropharmacology, Fifth Edition. Jack R. Cooper, Floyd E. Bloom, and Robert H. Roth.Guide to Clinical Interpretation of Data. Bert Spilker.

Management of febrile seizures in children may depend on the speciality of the attending physician

Management of febrile seizures in children may depend on the speciality of the attending physician

Acute Management of Seizures in Children

Seizures in children are not uncommon, and more than half of these seizures have no known cause. This discussion and review of seizures covers three types of presentations: the child who presents following an initial seizure; the child who presents with serial seizures or continuous seizures (status epilepticus); and the child who presents following a febrile seizure. The nurse practitioner can play a critical role in the assessment and management of children presenting with each of these three types of seizures. A review of drug management of childhood seizures and a comprehensive review of the critical areas to cover in counseling the child, family and community are included.

Convulsive Disorders of Children

This work covers the diagnosis and management of seizures in children and it is presented in a succinct and straightforward manner. In the introduction the authors have pointed out again that seizures are a manifestation of disordered brain function and that confusion in seizure nomenclature has arisen from limited knowledge about etiology. The suggested system of seizure classifications is presented with appropriate qualifications and will be useful for the clinician. The section on "Benign Febrile Convulsions" (B.F.C.) presents a paradox because the authors give evidence in discussion that convulsions which occur with fever are often first manifestations of more serious conditions which are not truly benign. Although the authors make it clear that they are aware of these diagnostic pitfalls, it seems unwise and misleading to apply the reassuring term, Benign, to this group of patients.