Seizures anticonvulsant therapy

I with seizures and require anticonvulsant therapy. Phenytoin is the most frequently used agent, with a loading dose of 15 mg/kg followed by 300 mg by mouth daily (titrated to therapeutic levels between 10 and 20 mcg/mL). Diazepam 5 mg intravenously may be used for rapid control of persistent seizures. Prophylactic anticonvulsants have been used frequently, but a recent meta-analysis did not support their use.23 Thus, because adverse effects and drug interactions are common, the routine use of prophylactic anticonvulsants is not recommended. 

When an isolated seizure occurs, a dosage decrease is recommended, and anticonvulsant therapy is usually not recommended. 

The brief duration of a single epileptic fit makes acute drug treatment unfeasible. Instead, antiepileptics are used to prevent seizures and therefore need to be given chronically. Only in the case of status epilepticus (a succession of several tonic-clonic seizures) is acute anticonvulsant therapy indicated — usually with benzodiazepines given i.v. or, if needed, rectally. 

Always carry an identification card or wear an identification bracelet that displays seizure disorder and anticonvulsant therapy... 

It is not surprising that infant L. suffered diffuse encephalopathy (brain disorder), a cerebral infarction, and seizures during the neonatal period (Yager, 2002). Both asphyxia and hypoglycemia are injurious to the brain. The treatment for seizures consists of providing normal metabolic substrates (e.g., glucose) and appropriate anticonvulsant therapy (phenobarbital), as was done in the present case. The long-term treatment for the child s developmental disabilities is complex and involves the skills of many members of the health care team. 

There is an increased risk of drug-induced seizures in all patients treated with antipsychotics. The highest risk for antipsychotic-induced seizures is with the use of CPZ or clozapine. Seizures are more likely with initiation of treatment and with the use of higher doses and rapid dose increases. When an isolated seizure occurs, a dosage decrease is recommended, and anticonvulsant therapy is usually not recommended. 

Victims of certain chemical exposures will experience seizure activity. Patients must be protected from harm. Benzodiazepines are the mainstays in seizure treatment. Liberal doses are required titrate to effect. Termination of seizure activity may reflect onset of flaccid paralysis from the nerve agent rather than adequacy of anticonvulsant therapy. A bedside electroencephalograph (EEG) may be required to assess ongoing seizure activity. 

Seizures occur more infrequently in horses than in dogs and cats. Seizures are seen in adult horses from brain trauma, bacterial meningitis, viral encephalitis and, rarely, hepatic encephalopathy or vascular accidents. Convulsions are seen in young neonatal foals with NMS as a result of brain hypoxia and in Arabian foals aged 3-9 months (idiopathic Arabian epilepsy). Anticonvulsant therapy is used to prevent the spread of the seizure focus, increase (raise) the seizure threshold and decrease the electrical excitement of abnormal... 

Treatment is symptomatic. Activated charcoal as a slurry has been reported to absorb aldrin and increase its rate of excretion after oral exposure. Emesis is not recommended due to potential CNS depression or seizures. Diazepam or phenobarbital is used when anticonvulsant therapy is necessary. 

The mainstay of treatment is supportive care. Fluid and electrolyte replacement may be needed in patients manifesting gastrointestinal signs and symptoms. Seizures can be managed with common anticonvulsant therapy. Pregnant patients should be monitored for premature uterine contractions. 

Most patients who ingest these mushrooms require no treatment other than observation. In recent, accidental ingestions, activated charcoal may be administered, although the efficacy of this treatment is unknown. In severe cases, when seizures occur, benzodiazepine therapy may be required. Long-term anticonvulsant therapy should not be required because the effects of the mushroom are short-lived. All other treatment is supportive and symptomatic in nature. Atropine should not be administered because these mushrooms, despite their name, contain only trace to no amounts of muscarine or other cholinergic substances. 

Patients with acnte neurologic events must be hospitalized and monitored closely. Physical and neurologic examination should be performed every 2 hours. Acute treatment for children should include exchange transfusion or simple transfusion to maintain Hgb at approximately 10 g/dL and HbS less than 30%, anticonvulsants for patients with a history of seizure, and therapy for increased intracranial pressure if needed. Chronic transfusion therapy should be initiated for children with ischemic stroke as discussed above. In adults presenting with ischemic stroke, thrombolytic therapy should be considered if less than 3 hours since onset of symptoms. " ... 

This is effective in treating refractory seizure disorders that have not responded to other anticonvulsant therapies. It is also used to control grand mal and partial seizures and a combination of these seizures. 

If seizures are not immediately controlled with usual anticonvulsants, paralyze the patient with a neuromuscular blocker such as pancuronium (see p 472) to prevent hyperthennia, which may induce further seizures, and lactic acidosis, which aggravates cardiotoxicity. Note Paralysis abolishes the muscular manifestations of seizures, but has no effect on brain seizure activity. After paralysis, EGG monitoring is necessary to detennine the efficacy of anticonvulsant therapy. 

A. Pentobarbital is used for the management of status epilepticus that is unresponsive to conventional anticonvulsant therapy (eg, diazepam, phenytoin, or phenobarbital). If the use of pentobarbital for seizure control is considered, consultation with a neurologist is recommended. 

The area of metabolic encephalopathies is unique in that animal models of disease closely mimic the symptoms seen in human disorders, allowing excellent correlative studies. Seizures are an example of this feature. Many animal models of experimentally induced seizures are available for study in mice and rats, and the neurochemical alterations before and after anticonvulsive therapy can be carefully studied. These more or less direct comparisons permit a more rapid application of results from animal studies to humans. 

Given that termination of seizure activity protects against development of neuropathological lesions (especially neuronal necrosis) in brain tissues of experimental animals (Martin et al., 1985 Shih et al., 2003 Marrs and Sellstrom, 2007), focus on anticonvulsant therapy is critical. Reduced potential for permanent brain damage in... 

Generally, anticonvulsants reduce the excitability of the neurons (nerve cells) of the brain. When neuron excitability is decreased, seizures are theoretically reduced in intensity and frequency of occurrence or, in some instances, are virtually eliminated. For some patients, only partial control of the seizure disorder may be obtained with anticonvulsant drug therapy. 

The nurse obtains the vital signs at die time of the initial assessment to provide baseline data. The primary healtii care provider may order many laboratory and diagnostic tests, such as an electroencephalogram, computed tomographic scan, complete blood count, and hepatic and renal function tests to confirm the diagnosis and identify a possible cause of the seizure disorder, as well as to provide a baseline during therapy with anticonvulsants. 

Promoting an Optimal Response to Therapy When administering an anticonvulsant, the nurse must not omit or miss a dose (except by order of the primary health care provider). An abrupt interruption in ther-apy by omitting a dose may result in a recurrence of the seizures. In some instances, abrupt withdrawal of an anticonvulsant can result in status epilepticus. 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

Tapeworm infections (T. saginata and T. solium) are treated with praziquantel 5 to 10 mg/kg as a single dose (use the same dose for adults and pediatric patients).3 The treatment for cysticercosis and neurocysticercosis may include surgery, anticonvulsants (neurocysticercosis can cause seizures), and anthelmintic therapy. The anthelmintic therapy of choice is albendazole 400 mg twice daily for 8 to 30 days. The pediatric dose of albendazole is 15 mg/kg (maximum 800 mg) in two divided doses for 8 to 30 days. The doses for both adults and pediatric subjects can be repeated if necessary. Praziquantel is an alternative therapy.3... 

Benzodiazepines are the drugs of choice for status epilepticus (see above) however, development of tolerance renders them less suitable for long-term therapy. Clonazepam is used for myoclonic and atonic seizures. Clobazam, a 1,5-benzodiazepine exhibiting an increased anticonvulsant/seda-tive activity ratio, has a similar range of clinical uses. Personality changes and paradoxical excitement are potential side effects. 

Anticonvulsant As adjunctive therapy in the management of partial seizures (clorazepate) adjunctively in status epilepticus and severe recurrent convulsive seizures (diazepam IV) adjunctively in convulsive disorders (diazepam oral). Preoperative For preoperative apprehension and anxiety (chlordiazepoxide, diazepam IV) prior to cardioversion for the relief of anxiety and tension and to diminish patient s recall (diazepam IV) adjunctively prior to endoscopic procedures for apprehension, anxiety, or acute stress reactions and to diminish patient s recall (diazepam) ... 

Zonisamide is a sulfonamide anticonvulsant approved for use as an adjunctive therapy in adults with partial-onset seizures. 

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