Definition
The term "convulsion" defines a group of abrupt, violent, uncontrolled and sudden contractions of voluntary musculature. During convulsions, the muscles contract and relax continuously for a variable period of time. The longer the convulsions last, the greater the severity of the clinical picture. In the absence of neurological damage, convulsions do not cause any permanent damage, although they can induce a temporary loss of consciousness.
Causes
Convulsions are not a real illness; rather, they are a symptom of numerous diseases. The most recurrent diseases associated with seizures are: alcoholism, poisoning, brain damage (for example due to encephalopathy or trauma), metabolic disorders, drugs, epilepsy, neuroleptic drugs, fever, viral and bacterial infections, malignant hypertension, electric shock, cancer cerebral. Convulsions also occur in eclampsia.
- Risk factors: rapid increase / decrease of fever, genetic predisposition, viral infections, fever, premature birth
Symptoms
The vast majority of seizures are characterized by some common symptoms: involuntary and uncontrolled agitation of skeletal musculature, cyanosis, respiratory difficulties, failure to control the anal and bladder sphincters, uncontrolled eye movements, loss of consciousness, foaming of the mouth, fainting.
- Complications: in the most serious cases, the convulsion can cause permanent neurological damage or lead to epilepsy
Information on Convulsions - Drugs for the Treatment of Convulsions is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Convulsions - Drugs for the treatment of convulsions.
drugs
The pharmacological treatments aimed at removing or preventing convulsions are the subject of heated debate, since different opinions coexist. From the careful analysis of scientific sources, it is possible to draw some interesting considerations. Until a decade ago, it was believed that taking anticonvulsant drugs (benzodiazepines) as a preventive measure was important to avoid both the transformation of the convulsion into epilepsy, and a possible reappearance of the convulsive crises. Today, this therapeutic approach is discarded: it seems that the possible risks deriving from a similar therapy far outweigh the benefits.
Contrary to what was believed in the past, some convulsions do not require treatment. A classic example is febrile seizures, typical of children aged between 6 months and 6 years: in the absence of neurological damage, simple febrile convulsions should not be treated with any medication, with the exception of therapeutic aids (antipyretic medicines). Some authors consider it appropriate to administer anxiolytics and muscle relaxants (such as diazepam, eg Valium) to the child DURING the convulsion lasting more than three minutes. However, not all scholars approve of this theory: treatment with benzodiazepines is a much debated topic, and is not always a real indication. Clearly, it is essential to isolate the factor that triggered the fever, and the patient should be treated accordingly. When fever is caused by a viral infection, the young patient must take antiviral drugs; if the fever was triggered by bacterial insults, the therapy of choice is antibiotic therapy. The most indicated drug therefore depends on the cause that caused the febrile convulsion. In some circumstances, however, the therapeutic approach must be based on a different method:
- The convulsion occurs in young children, aged less than 6-12 months
- The duration of the convulsion exceeds 15 minutes
- The patient with the convulsion has pre-existing neurological damage
- Genetic predisposition to convulsions / epilepsy
- The febrile convulsion manifests itself with a relatively low fever (<38 ° C)
Let's see more precisely what are the drugs most used to calm convulsions.
Anticonvulsant drugs
- Sodium valproate (eg. Depakin, Ac Valproico); for the treatment of convulsions in adults, the drug should be taken at a dose of 10-15 mg / kg per day, splitting the load into 4 doses. Do not exceed 250 mg a day. The side effects of the drug are dose related. For the child with convulsions, the dose should be reduced. The drug is sometimes used for the prevention of convulsions in adults and children. Consult your doctor.
- Diazepam (eg. Micropam, Ansiolin, Diazepam FN, Valium, Diazepam, Valpinax): for the treatment of convulsions in the ADULT take orally a dose of drug varying from 2 to 10 mg, twice a day. Via the rectum, administer 0.2 mg / kg of drug (round up to unity). If necessary, repeat the dose every 4-12 hours. A similar therapy makes sense when seizures occur at most once every 5 days, for no more than 5 episodes per month. FOR THE CHILD between the ages of 2 and 5 suffering from convulsive seizures (febrile and non-febrile), it is recommended to administer 0.5 mg / kg of drug, rounding off to the unit. For affected children between the ages of 6 and 11, the recommended dose is 0.3 mg / kg. Over the age of 12, administer 0.2 mg / kg of drug. If necessary, repeat the administration every 4-12 hours.
DO NOT give the drug to children under the age of 6 months: similar behavior could cause depression in the CNS. Children aged between 6 months and 2 years could take the drug, but the dose should be carefully determined by the doctor.
- Phenytoin (eg Metinal Idantoin L, Dintoinale, Fenito FN): the drug is used in therapy also for the prevention of tonic-clonic seizures. In general, the dosage for ADULTS envisages taking the drug intravenously at a dose of 10-15 mg / kg for slow injection into a vein (no more than 50 mg per minute). The maintenance dose for adults with seizures suggests taking 100 mg of the IV drug every 6-8 hours. It is not recommended to take the drug intramuscularly: in this case, the absorption of the drug is irregular and unpredictable. It is also possible to take the medicine orally: 1 gram (total), fractionated in a first dose of 400 mg followed by two more doses of 300 mg. Between one dose and another, it is advisable to let 2 hours pass. For CHILDREN with seizures, administer 15-20 mg / kg of drug per os. The loading dose can be taken in three doses administered at 2-4 hour intervals. For the maintenance dose: consult your doctor.
- Levetiracetam (eg Keppra, Levetiracetam Sun): the drug is not indicated for the treatment of febrile convulsions in young children. For children over the age of 12, suffering from myoclonus seizures, it is recommended to take a dose of 500 mg twice a day. If necessary, increase the dose by 500 mg every 2 weeks, up to a maximum of 1, 500 mg, twice a day. The efficacy of the drug taken at doses above 3 grams per day is not established. Treatment of tonic-clonic seizures in children between the ages of 6 and 16 is expected to take 10 mg / kg of immediate-release drug, twice a day. If necessary, increase the dose by 10mg / kg every 2 weeks, up to a maximum of 30 mg / kg. For partial seizures the dose depends on age: it can vary from a minimum of 7mg / kg per dose (twice a day) for children aged between 1 month and 6 months, up to a maximum of 10 mg / kg per dose (twice a day) for children aged between 4 and 16 years. Eventually, these dosages can be increased no earlier than two weeks after starting treatment. Always consult your doctor before taking the drug or modulating therapy.
- Lacosamide (eg Vimpat): convulsions can be treated by oral or intravenous administration of lacosamide. Begin therapy with a dose of 50 mg, taken twice a day. If necessary, in case of recurrent convulsions, it is possible to increase the dosage up to 100mg / day, at weekly intervals, up to the scheduled maintenance dose at 200-400 mg / day. Take this medicine with or without food.
- Pyridoxine or pyridoxine (eg Benadon): for children with seizures related to pyridoxine-dependent syndrome, it is recommended to take 10-100 mg of the drug intramuscularly or intravenously, followed by 2-100 mg of drug to be taken via oral.
- Zonisamide (eg. Zonegran): this anticonvulsant drug is often used in combination with other drugs, especially in the treatment of partial convulsions. Generally the initial therapy involves taking 100 mg of medicine, once a day for at least two weeks. If necessary, increase the dosage to 200 mg per day for another 2 weeks. In case of need, the dosage can be further increased. The drug is not indicated for the treatment of febrile seizures in children.
- Acetazolamide (eg Diamox): drug of choice in the treatment of the edematous condition caused by heart failure. The drug is also particularly useful for improving pulmonary edema and dyspnea in the context of left heart failure. However, recent studies have shown the effectiveness of this drug also for the prevention of seizures, especially in young patients suffering from mild epileptic seizures. Generally, this benzodiazepine is used in therapy as a complementary treatment to that with the classic summation therapists. In this sense, it is possible to administer 8-30 mg / kg a day of medication, possibly fractionated into 1-4 daily doses. Do not exceed a gram per day. If the patient is already taking other anticonvulsant drugs, reduce the dose of acetazolamide to 250 mg a day. Most often, patients taking the drug alone will respond well to a dose of 375-1000 mg per day. Do not administer to the child's febrile convulsions.
- Magnesium sulfate (eg. Magne So BIN, Magne So GSE): besides exerting laxative effects, magnesium sulfate is also used for the prevention of recurrent seizures in the context of eclampsia (a typically pregnant disease characterized by the appearance of convulsions). In this sense, the recommended dosage for the prevention of seizures in the context of eclampsia involves the intake of 4-5 g of a 5% solution every 4 hours. Alternatively, administer the drug intravenously at a dose of 4 g of a 10-20% solution (do not exceed 1.5 mL / min of a 10% solution). The maintenance dose suggests taking 1-2 grams of the drug every 60 minutes. Do not exceed 30-40 grams per day.
Drugs for the treatment of bacterial / viral seizures
- Benzilpenicillin (eg Benzil B, Penicillin G): indicated to treat seizures dependent on meningococcal and pneumococcal infections. In the first case, an intravenous infusion of 6, 000, 000 IU is recommended every 4 hours (or 24, 000, 000 units per day) for 14 days or until the fever decreases. For the treatment of pneumococcal meningitis, we recommend the administration of penicillin G, a 4, 000, 000 IU aqueous solution, every 4 hours for 2 weeks.
- Rifampicin (eg Rifampic): it is a bactericidal antibiotic to be taken by mouth (600 mg tablets) or intravenously, once a day for 10-14 days. It is indicated in the treatment of convulsions in the context of pneumococcal, meningococcal or Haemophilus influenzae meningitis .
- Aciclovir (eg. Aciclovir, Xerese): indicated in case of convulsions in the context of a suspected Herpes Virus infection. The dosage must be established by a doctor.
Medications for the treatment of febrile convulsions
Paracetamol is the first-line drug to lower fever in the context of febrile seizures in the newborn and in children. As analyzed, the rapid increase or reduction of fever - even if not excessively high - can be a trigger for convulsions in healthy children.
- Paracetamol or acetaminophen (eg. Tachipirina, Efferalgan, Sanipirina, Piros, Tachidol): the administration of this medicine is useful for lowering fever, an omnipresent symptom in a child's febrile convulsions. The recommended dosage depends on the age and weight of the child, therefore it must be established by the doctor.
Paracetamol is the drug of choice used to lower fever in the context of febrile convulsions.
