TREATMENT OF
SEIZURE
Ahamed Shameel
ROLL NO 9
CONTENTS
• ACUTE ASYMPTOMATIC SEIZURE
• FEBRILE SEIZURE
• STATUS EPILEPTICUS
• FOCAL ONSET SEIZURE
• TONIC CLONIC SEIZURE
• ABSENCE SEIZURE
• EPILEPTIC SPASM
• MYOCLONIC SEIZURE
• ATONIC SEIZURE
ACUTE ASYMPTOTIC SEIZURE
• Occuring within a week of a/c neurological injury like
stroke, trauma and infection and within 24hrs of acute
metabolic derangements
• Evaluation with s.electrolytes, lumbar puncture and
neuroimaging
TREATMENT
Antiepileptic therapy is initiated and discontinued after 3- 6 months (if
awake and sleep EEG records are normal)
• PREHOSPITAL MANAGEMENT
• •Calming down the family
•Placing the patient in lateral face down position (recovery
position)
•Protecting from injury
To abort seizure- Rectal diazepam 0.5mg/kg or Intranasal midazolam
spray 0.2mg/kg.
FEBRILE SEIZURE
Occur between 6 months and 5 years of age
• Temperature of 38°C ( 100.4˚F ) or higher with CNS
infection or metabolic imbalance
TREATMENT
• An acute episode of seizure at home is terminated by
nasal midazolam or rectal diazepam
• Parents should be counselled about relative risk of
recurrence of febrile seizures and recurrence of epilepsy
• Antipyretics can decrease the discomfort of the child but
not the risk of having a recurrent febrile seizure
• In case the patient presents in status, standard protocol
for management of status epilepticus is followed
STATUS Acute seizure
EPILEPTICUS
Blood,electrolyte,glucos
e,calcium,
magnesium,LFT,RFT,blo
od counts, toxicology (if
indicated)
Maintain ABC
Administer oxygen
• Persisting more than 30 min or
multiple seizures, irrespective
of duration, without regaining IV Lorazepam (0.1mg/kg)or
of consciousness in between Midazolam (0.1mg/kg)
Upto 2 doses,5minutes apart
Correct metabolic
abnormality( IV glucose,if
hypoglycemia)
If seizure
continues,
administer
sequentially
IV phenytoin or Fosphenytoin 20
mg/kg infusion,repeat if needed at
10mg/kg
IV sodium Valproate 20 – 40mg/kg
infusion
IV Levetiracetam 20 – 60mg/kg infusion
at 5mg/kg/min
IV Phenobarbitone 20mg/kg infusion
Repeat if needed,upto twice at 10mg/kg
IV midazolam at 1-30mcg/kg/min infusion
Coma induced by Phenobarbitone (or
thiopentone and propofol) infusion
Consider
IV ketamine and oral Topiramate
Dietary
Immunotherapy therapy
Vagal nerve stimulation Epilepsy
surgery
FOCAL ONSET SEIZURE
• May be motor, sensory, or autonomic
• May or May not ass. with imapired weakness
• TREATMENT
•First choice – Oxcarbamazepine
Carbamazepine
•Second choice – Valproate
Phenytoin
TONIC CLONIC SEIZURE
• Tonic phase lasting atleast 30 seconds and associated with uprolling
of eyeballs, frothing from mouth , tongue bite or incontinence of
stool and urine followed by clinic movement of all limbs
• TREATMENT
•First choice – Valproate
Phenytoin
•Second choice – Levetiracetam
Lamotrigine
ABSENCE SEIZURE
• Brief periods of lapses in awareness lasting 10 – 15 sec occur
without associated loss of tone
• TREATMENT
•First choice – Valproate
Lamotrigine
•Second choice – Levetiracetam
Topiramate
Zonisamide
EPILEPTIC SPASM
• Flexion and extension movements of head, neck and
extremities especially on awakening from sleep
• TREATMENT
•First choice – ACTH or steroids
•Second choice - Vigabatrine
MYOCLONIC SEIZURE
• Sudden , jerky shock like violent contractions involve axial
and appendicular muscles
• TREATMENT
• First choice – Valproate
• Second choice – Levetiracetam
Topiramate
Zonisamide
ATONIC SEIZURE
• Sudden loss of tone involving axial and appendicular muscles
• TREATMENT
•First choice – Valproate
Lamotrigine
•Second choice – Levetiracetam
Topiramate
Zonisamide
