Pregledni rad
https://doi.org/10.26800/LV-145-supl1-30
Pre-hospital treatment of convulsive seizures in children
Igor Prpić
; Klinika za pedijatriju, Klinički bolnički centar Rijeka
Arijan Verbić
Ivana Kolić
Jelena Radić Nišević
Sažetak
Early suppression, termination of seizures is a central pillar in their treatment strategies. The majority
of seizures occur outside of a medical facility, most often in the home environment. Therefore, we created and
proposed this algorithm for the management of motor/convulsive seizures in an outpatient setting, primarily with the aim of providing uniform information and education to parents/caregivers, and to facilitate guidance for primary
care physicians and emergency medical system (EMS). For the purposes of writing this paper, we analyzed
and synthesized the existing guidelines in order to recommend a simple, understandable and rational therapeutic
algorithm, which we advise and apply as the official recommendation algorithm of our institution. In creating it,
we focused on world and national recommended algorithms as well as available studies that are, as far as possible,
evidence based. According to our knowledge, this is the first written national algorithm of its kind, and until now there have been no written guidelines/instructions for the treatment of convulsive seizures, prolonged convulsive seizures, and status epilepticus in an outpatient setting, taking into account the availability, rationality and applicability of individual drugs in outpatient settings, respecting clinical practice in Republic Croatia. Accordingly, the use of benzodiazepines (BZD), clearly defined in time, is considered the first line of treatment for convulsive seizures. Outpatient administration of BZDs, primarily midazolam for oromucosal administration or diazepam for
rectal administration, is associated with a shorter duration of generalized convulsive seizures, a reduction in the likelihood of recurrent seizures, and a reduction in the number of visits to the emergency room. If the seizure lasts >3 minutes, it is definitely necessary to urgently apply one of the BZD, assuming that it is available (oromucosal midazolam – an advantage! or diazepam rectally), and repeat the same in case the seizure continues for more than 5 minutes, and call/alert the EMS. Along with measures to maintain vital functions, it is necessary to insist on intravascular access for repeated BZD administration, but the dose of BZD can also be repeated intramuscularly. In rare cases, phenobarbital can be administered intramuscularly, as well as levetiracetam intravenously, and in
the absence of the same effect, the administration of midazolam in continuous infusion can be started. The availability of appropriate forms of BZD, in accordance with the guidelines, in the outpatient setting as well as their correct use – timely application and appropriate dosage at the onset of seizures – are two key steps towards improving overall health care in children with high-risk for convulsive seizures and children with epilepsy. The above mentioned also presents the timely suppression of prolonged convulsive seizures and prevention of epileptic status.
Ključne riječi
CHILDREN; EPILEPSY; SEIZURES; OUTPATIENTS; STATUS EPILEPTICUS; TREATMENT
Hrčak ID:
300857
URI
Datum izdavanja:
17.4.2023.
Posjeta: 1.560 *