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Chapter 2 Index
A. Evaluation by system:
1. General
2. HEENT
3. Cardiopulmonary
4. GI
5. GU
6. Orthopedics
7. Neurological
--Breath-Holding
Spells
--Benign Febrile Seizures |
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Treating Children with Seizures
Introduction: Most children with seizures are followed by
the general pediatrician, not the pediatric neurologist. Of the children
with seizures seen in the most, the most common type would be recurrent
febrile seizures. In general, most adult neurologists are not excited about
seeing children with seizures.
Medications Used to Treat Seizures:
Based on physical findings, EEG (and MRI or CT) findings, the diagnosis of
seizures is usually fairly clear-cut. The ball is then in the
pediatrician’s court.
All pediatricians need to have a familiarity with the following
medications:
INDICATIONS FOR USING DIFFERENT ANTICONVULSANTS
- Phenobarbital: Generalized seizures, partial, and status
- Dilantin: Generalized, partial, status
- Tegretol: partial, secondarily generalized
- Valproate: absence, myoclonic, partial, atypical absence, generalized
- Zarontin: absence
| Name of Medication |
Dosage (mg/k/day) |
Therapeutic level** |
Common Side Effects of Med |
| 1. Phenobarbital |
4-8 mg/kg/day: can give 1x/day |
15-40 ug/ml |
Drowsiness, rash, L.D. hyper,
Stevens Johnson syndrome |
| 2. Dilantin |
4-8 mg/kg/day |
10-20 ug/ml |
gum hypertrophy, ataxia,
lupus syndrome, acne, mental slowing, Stevens-Johnson |
| 3. Tegretol |
10-25 mg/kg/day* |
4-12 ug/ml |
rash, liver abn, aplastic
anemia blurred vision, diplopia |
| 4. Valproic Acid |
20-60 mg/kg/day |
40-150 ug/ml |
liver disease, death,
lethargy, coma, pancreatitis; check ammonia level |
| 5. Zarontin |
15-40 mg/kg/day |
40-100 ug/ml |
rash, nausea, fatigue, headache, dizziness |
* Often Tegretol is started slowly with adding meds over 10 days to 2
weeks until therapeutic level reached; *Levels should always be drawn at the
same time of day
Treatment of Status: (NEJM 98;338:970-976)
- Lorazepam: 0.05-. 01 mg/kg IV over 1-2 minutes, up to 5 mg max; not as
effective when repeated dose given. Preferable over Valium because of
12-24 hr duration. For repetitive seizures, there is a rectal diazepam gel
available that is quite expensive but very effective. (NEJM
1998;338:1969-1974)
- Dilantin (or Fosphenytoin) 20 mg/kg IV at 50 mg/minute with maximum
dose of 1000 mg; Fosphenytoin may be preferable because it causes less
respiratory depression. Can give IM.
- Phenobarbital: 20 mg/kg IV at 50-75 mg/minute; maximum dose 300 mg;
may repeat 5-10/kg
- If above does not work then as a last resort an anesthesiologist can
be called to give Midazolam (Versed) 0.2 mg/kg then. 75 to 10 ug/kg/hr;
or pentobarbital.
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