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Essay: Management of uncontrolled convulsions in status epileptics

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  • Published: 20 September 2015*
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  • Words: 612 (approx)
  • Number of pages: 3 (approx)

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Management of uncontrolled convulsions in status epileptics (neurofibromatosis syndrome)
Introduction : Convulsive status epileptics cases are considered an emergency in children especially if convulsions are long lasting without any recovery time between seizures which need immediate management to airway . breathing and circulation to preserve lfe first and then act to control the convulsions which is life threating if prolonged because it may lead to respiratory arrest .
Aim of work : To find a way which can manage the uncontrolled convulsions in status epileptics case .
Methods : I searched the medical sites as pubmed database .cocharne . medscape and others for clinical trials . meta analysis . randomized control studies and researches talking about status epileptics and management should be taken to control the convulsions .
Results : Researchers recommend that after establishment of the patient ABC . we should try to find venous access to give anticonvulent medications .
If there is a venous access we start to infuse 0.1 mg/kg lorazepam as an effective anti convulent ( over 30 : 60 sec ) and then wait .if there is no response within 10 minutes give another dose of lorazepam which is more effective than diazepam and also less respiratory depression . if there is no response within 10 minutes we should turn to phenytoin 18 mg/kg IV and paraldehyd 0.04 ml/kg and wait .
If convulsions persist more than 20 minutes we should use general anesthesia and put the patient on mechanical ventilation in an intensive care unit .
Conclusion : Lorazepam is the best choice anticonvulent and better used in convulsive status epileptics than rectal diazepam if there is a venous access because it has less or even no depressive action on respiration .
If there is no responce or recovery after infusion of different anticonvulsent medications we should save the patient life by using a mechanical ventilator and start other interventions.
References :
1. Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane database Syst Rev [Internet]. 2008 Jan [cited 2014 Apr 19];(3):CD001905. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18646081
2. Capovilla G, Beccaria F, Beghi E, Minicucci F, Sartori S, Vecchi M. Treatment of convulsive status epilepticus in childhood: recommendations of the Italian League Against Epilepsy. Epilepsia [Internet]. 2013 Oct [cited 2014 Mar 23];54 Suppl 7:23’34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24099053
3. Chin RFM, Neville BGR, Peckham C, Wade A, Bedford H, Scott RC. Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol [Internet]. 2008 Aug [cited 2014 Mar 21];7(8):696’703. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2467454&tool=pmcentrez&rendertype=abstract
4. Lee J, Huh L, Korn P. Guideline for the management of convulsive status epilepticus in infants and children. 2011;(August):279’85.
5. Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology [Internet]. 2006 Nov 14 [cited 2014 Apr 17];67(9):1542’50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17101884
6. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain [Internet]. 2011 Oct [cited 2014 Mar 23];134(Pt 10):2802’18. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21914716
7. The S, Party MO, Appleton R, Choonara I, Martland T, Phillips B, et al. The treatment of convulsive status epilepticus in children. Arch Dis Child. BMJ Group; 2000;83(5):415’9.
8. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA [Internet]. 1993 Aug 18 [cited 2014 Apr 19];270(7):854’9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8340986
9. The treatment of convulsive status epilepticus in children. Arch Dis Child [Internet]. 2000 Nov 1 [cited 2014 Apr 19];83(5):415’9. Available from: http://adc.bmj.com/cgi/doi/10.1136/adc.83.5.415

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