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Acute treatment
Definition
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Acute treatment means treatment of
the actual seizure, in contrast to the usual antiepileptic treatment,
which is prophylactic, in that it attempts to prevent seizures
occurring at all.
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When should acute treatment be given?
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Most epileptic seizures are over
quickly. They last for a few minutes at the most, and stop by
themselves. They therefore need no treatment. Even so, especially
in the case of children, medicine is often given directly into
the rectum during seizures. This medicine takes about 4 minutes
before it begins to work, by which time most seizures would have
stopped by themselves. This is the reason it appears that the
medicine "works well" each time it is used. The only result is
that the child is even more tired and sleepy and sleeps longer
than it otherwise would after a seizure.
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Acute treatment should only be used in
cases of:
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Long lasting seizures (longer than
4-5 minutes).
Repeated seizures.
In cases of status epilepticus.
The most commonly used drugs are:
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Diazepam (Apozepam, Diazemuls, Diazepam
DAK, Hexalid, Stesolid, Valium, Valoxa).
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Mode of administration
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Diazepam can be given in many different
ways. The easiest method is by suppositories, which are inserted
into the rectum. More effective is the injecting of a water-based
solution of the drug, a clysma, in the rectum. This gives faster
absorption compared to suppositories. In the course of 3-4 minutes
the blood concentration is high enough to inhibit the seizure.
This method of giving the drug is used when an injection into
a blood vessel cannot be given because there is no doctor or nurse
present. If injected into a vein, the drug works in about one
minute.
In the case of accumulative seizures
or status epilepticus the drug can be too short-lasting and more
than one dose will have to be given.
Drip
It can then be of advantage to use
a drip. A small plastic tube is inserted in a vein. The drip can
remain there for several days if necessary. The tube is connected
to a bottle containing diazepam in a glucose solution. Treatment
with diazepam is very effective and it is the most commonly used
drug for acute treatment in use today.
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Side effects
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The treatment can have an influence
on respiration. This is often seen when large doses are involved.
When such doses are necessary, one must be prepared to help the
patient to breathe for a short time. Diazepam must never be injected
into a muscle, as the drug has no effect if administered in that
way, when it would only slowly be absorbed from the muscle tissue,
and could cause inflammation of the muscle.
Diazepam in tablet form has no effect,
either acute, or as prophylactic treatment against seizures.
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Phenytoin (Dilantin, Epanutin, Difhydan,
Fenytoin DAK)
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Methods of administration
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Fos-phenytoin can be injected
directly into a vein. When a patient's weight is known the dosage
needed to control the seizure can be calculated. If it is necessary
to continue with preventative treatment, phenytoin tablets can be
used. |
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Side- effects
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Fos-phenytoin should be injected
slowly in order to avoid a fall in blood pressure. Fos-phenytoin
can also be injected into a muscle. |
Phenobarbital (Phenobarbital DAK)
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Method of administration
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Phenobarbital is available for
injecting, both into muscles and into veins. Injections are seldom
used, however, as there is a risk of breathing difficulties occurring,
which can lead to respiration ceasing altogether, and blood pressure
falling. The drug can be given together with diazepam for treating
frequent seizures and status epilepticus. As in the case of phenytoin,
treatment can continue with tablets. As described in the chapter
on chronic side effects, treatment with carbamazepine or valproate
is to be preferred. These drugs cannot, however, be used for the
acute treatment of seizures. |
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