Simple febrile seizuresBasic diagnosis:Febrile seizures with no seizure frequency of more than 1 time in 24
hours, seizures are common, long seizure <15 minutes and no
neurological abnormalities before and after seizures.Treatment and follow-up:- All patients who come in a state of seizure overcome with diazepam- Administration of antipyretics and appropriate causal therapy causes heat- Rectal temperature ³ 39,50C- Recurrent seizures- If the rectal temperature <39,50C, the patient returned with
equipped antipyretic drugs and anticonvulsants diazepam oral / rectal
intermittent treatment- Advice: when a seizure again, back to the hospital
Complex febrile seizuresBasic diagnosis:Long febrile seizure with convulsions> 15 minutes, focal seizures or generalized seizures with a frequency of> 1 times in 24 hours.Treatment and follow-up after the seizure could be addressed:Determine whether it is necessary or intermittent treatment rumat- When a child with a long spasm given corticosteroids to 12 hours free of seizures- Give antipyretics and antibiotics according to the cause of the rise in body temperature
when heat antipyretic (paracetamol / ibuprofen)
- Paracetamol: 10-15 mg / kg / times (4 doses)- Ibuprofen: 10 mg / kg / times (3 doses)
Canal drug phenobarbital (3 -5 mg / kg / day) or valproic acid (10-40 mg / kg / day) is given when there is a risk factor below:
- There is a history of febrile seizures without parents or siblings- There is a neurological deficits before and after seizures are transient or permanent (serebralis palsy, mental retardation, and microcephaly)- There is a focal seizures- Long seizure of more than 15 minutes- Recurrent seizures
Intermittent drug:
- Oral diazepam: 0.3 -0.5 mg / kg / day every 8 hours during fever- Diazepam rectal: 0.5 mg / kg / times (3 doses)
- The use of phenobarbital every day can cause behavioral disorders and learning difficulties.The use of valproic acid in less than 2 years of age may lead to impaired liver function, if necessary, examination SGOT and SGPT after 2 weeks, 1 month and then 3 months.Febrile convulsion11 September 2012 16:24
Limitation:Febrile seizures are seizures that occur in the increase in body temperature (rectal temperature above 380C), which is caused by an extracranial process.
TREATMENT AT THE MOMENT Seizures
Diazepam rectal can be given at home. Diazepam rectal dose is:· 5 mg for children under the age of 3 years or a dose of 7.5 mg for children over the age of 3 years, or
5 mg to weigh less than 10 kg and 10 mg for body weight over 10 kg, or 0.5 to 0.75 mg / kg / times
At home, given a maximum of two times in a row with a distance of 5 minutes. Careful respiratory depression can occur.Diazepam may also be given by intravenous suntukan as much as 0.2 to 0.5 mg / kg. Give slowly, at a rate of 0.5 -1 mg per minute. When the seizures stopped before the dose runs out, stop the injection. Diazepam can be administered 2 times the distance of 5 minutes if the child seizures. Diazepam should not be given intramuscularly because it is not well absorbed.When still a seizure, give phenytoin intravenously as much as 15 mg / kg slowly. If still seizures, hospitalization in the intensive care unit, give penobarbital and attach a ventilator if necessary.
After Seizures Stop
If the seizure has stopped, determine whether the child is included in febrile seizures requiring rumat treatment or intermittent treatment enough when the fever.
TREATMENT RUMAT
Rumat treatment is a treatment administered continuously for a long time.1. rumat Drugs that may decrease the risk of recurrence of febrile seizures only phenobarbital or valproic acid. All other anticonvulsant drugs are not useful for preventing recurrence of febrile seizures.2. valproate dose is 10-40 mg / kg / day divided 2-3 doses while phenobarbital 3-5 mg / kg / day divided into 2 doses.3. Treatment granted rumat enough for one year, except in the case of very selective (recommendation D)4. The use of phenobarbital every day can cause behavioral disorders and learning difficulties. While the use of valproic acid in less than 2 years of age can cause liver dysfunction. When giving valproate, check SGOT and SGPT after 2 weeks, one month, and then every 3 months.5. Treatment rumat only given when a febrile seizure showed one or more of the following symptoms:1. Seizures time> 15 minutes.2. Children with neurologic abnormalities were apparent before or after the seizure, for example hemparesis, Todd paresis, cerebral palsy, mental retardation, hydrocephalus.3. The focal seizures.4. If there is a sibling or parent families who have epilepsy.
Rumat treatment should not be given but can be considered in the circumstances:
Seizures repeated two or more times in 24 hours.
When febrile seizures in infants aged less than 12 months.
Note:
· All the researchers agree that febrile seizures> 15 minutes is indicative rumat treatment.· What is meant by a real neurological disorder for example paralysis, microcephaly. No real neurological disorder eg mild developmental delay is not an indication.· Focal seizures or focal became common shows that children have the organic focus on the contralateral side of the brain.· Not all agree that the seizure 2 times or more in one day is an indication rumat treatment.
Intermittent Treatment
What is meant by intermittent treatment is treatment that is given when the child has a fever, to prevent febrile seizures. Consists of administering antipyretics and anticonvulsants.
Antipyretic
There was no evidence that the use of antipyretics to reduce the risk of febrile seizures. However the Child Neurology agreement states that experience shows that antipirtetik still useful.
Antipyretic can be used are:
Paracetamol or acetaminophen 10-15 mg / kg / times given 4 times.
Ibuprofen 10 mg / kg / time, given 3 times.
Anticonvulsants when fever
The use of diazepam oaral doses from 0.3 to 0.5 mg / kg every 8 hours during the lower the risk of recurrent febrile seizures.
Rectal diazepam can also be given at a dose of 0.5 mg / Kabb / time, given 3 times per day.
Note:
In Indonesia, a dose of from 0.3 to 0.5 mg / kg / 8 hours it often causes sedation is quite heavy. The recommended dose is 0.5 mg / kg / day divided by 4 doses.
Phenobarbital, carbamazepine, phenytoin useless to prevent febrile seizures when given intermten. New small doses of Phenobarbital anticonvulsant effects with stable levels in the blood when it has been given for 2 weeks.Media filesindex.jpgManagement of Seizures11 September 2012 16:24
Seizure management objectives:1. Ensuring oxygenation of brain tissue, as well as heart and lung function.2. Overcoming the seizure as soon as possible and prevent the recurrence of seizures.3. Improving metabolic disorders and water and electrolyte balance.4. Prevent systemic complications.5. Identify and treat the cause of the temperature rise.
To achieve the above objective, the aid measures undertaken are:1. Addressing and preventing the recurrence of seizures. All the children were in a state of convulsions during the examination, whatever the cause, the drug of choice is diazepam, either parenteral or perrektal.2. Common TreatmentWhile seizures, were given help to improve and ensure oxygenation of the brain by way of:a. Giving oxygenb. Loosen tight clothingc. Clear the airway, sucking fluids from the oral cavity and respiratory tractd. The child is placed in a position of semi trendelenberge. To prevent aspiration should position the child's head is tiltedf. Lowering the temperature when the heat by means of:- Blowing cold air- Cool the surrounding air- Compress with ice or alcohol- Antipyretics: paracetamol 30-50 mg / kg / day divided into 3 doses or aspirin 60 mg / years of age / time, 3 times per day
3. When the seizure of more than 30 minutes, then to cope with brain edema that may occur Corticosteroids: Dexamethasone 0.2-0.3 mg / kg / time, 3 times a day, 4-5 days old administration. If there are signs of herniation: irregular breathing, bradipnoe, diminishing consciousness, given mannitol 20% at a dose of 0.25 to 1 g / kg / times intravenously. Given within ½ hour can be repeated every 8 hours. Give fluids with low sodium levels, namely liquid 2: 1 and the amount of fluid on the first day 70% of maintenance needs. If not available mannitol may also be glycerol 10% with a dose of 0.5-1 g / kg / day orally given 4 doses.4. Finding and treating the cause of heat.
Complex febrile seizuresBasic diagnosis:Long febrile seizure with convulsions> 15 minutes, focal seizures or generalized seizures with a frequency of> 1 times in 24 hours.Treatment and follow-up after the seizure could be addressed:Determine whether it is necessary or intermittent treatment rumat- When a child with a long spasm given corticosteroids to 12 hours free of seizures- Give antipyretics and antibiotics according to the cause of the rise in body temperature
when heat antipyretic (paracetamol / ibuprofen)
- Paracetamol: 10-15 mg / kg / times (4 doses)- Ibuprofen: 10 mg / kg / times (3 doses)
Canal drug phenobarbital (3 -5 mg / kg / day) or valproic acid (10-40 mg / kg / day) is given when there is a risk factor below:
- There is a history of febrile seizures without parents or siblings- There is a neurological deficits before and after seizures are transient or permanent (serebralis palsy, mental retardation, and microcephaly)- There is a focal seizures- Long seizure of more than 15 minutes- Recurrent seizures
Intermittent drug:
- Oral diazepam: 0.3 -0.5 mg / kg / day every 8 hours during fever- Diazepam rectal: 0.5 mg / kg / times (3 doses)
- The use of phenobarbital every day can cause behavioral disorders and learning difficulties.The use of valproic acid in less than 2 years of age may lead to impaired liver function, if necessary, examination SGOT and SGPT after 2 weeks, 1 month and then 3 months.Febrile convulsion11 September 2012 16:24
Limitation:Febrile seizures are seizures that occur in the increase in body temperature (rectal temperature above 380C), which is caused by an extracranial process.
TREATMENT AT THE MOMENT Seizures
Diazepam rectal can be given at home. Diazepam rectal dose is:· 5 mg for children under the age of 3 years or a dose of 7.5 mg for children over the age of 3 years, or
5 mg to weigh less than 10 kg and 10 mg for body weight over 10 kg, or 0.5 to 0.75 mg / kg / times
At home, given a maximum of two times in a row with a distance of 5 minutes. Careful respiratory depression can occur.Diazepam may also be given by intravenous suntukan as much as 0.2 to 0.5 mg / kg. Give slowly, at a rate of 0.5 -1 mg per minute. When the seizures stopped before the dose runs out, stop the injection. Diazepam can be administered 2 times the distance of 5 minutes if the child seizures. Diazepam should not be given intramuscularly because it is not well absorbed.When still a seizure, give phenytoin intravenously as much as 15 mg / kg slowly. If still seizures, hospitalization in the intensive care unit, give penobarbital and attach a ventilator if necessary.
After Seizures Stop
If the seizure has stopped, determine whether the child is included in febrile seizures requiring rumat treatment or intermittent treatment enough when the fever.
TREATMENT RUMAT
Rumat treatment is a treatment administered continuously for a long time.1. rumat Drugs that may decrease the risk of recurrence of febrile seizures only phenobarbital or valproic acid. All other anticonvulsant drugs are not useful for preventing recurrence of febrile seizures.2. valproate dose is 10-40 mg / kg / day divided 2-3 doses while phenobarbital 3-5 mg / kg / day divided into 2 doses.3. Treatment granted rumat enough for one year, except in the case of very selective (recommendation D)4. The use of phenobarbital every day can cause behavioral disorders and learning difficulties. While the use of valproic acid in less than 2 years of age can cause liver dysfunction. When giving valproate, check SGOT and SGPT after 2 weeks, one month, and then every 3 months.5. Treatment rumat only given when a febrile seizure showed one or more of the following symptoms:1. Seizures time> 15 minutes.2. Children with neurologic abnormalities were apparent before or after the seizure, for example hemparesis, Todd paresis, cerebral palsy, mental retardation, hydrocephalus.3. The focal seizures.4. If there is a sibling or parent families who have epilepsy.
Rumat treatment should not be given but can be considered in the circumstances:
Seizures repeated two or more times in 24 hours.
When febrile seizures in infants aged less than 12 months.
Note:
· All the researchers agree that febrile seizures> 15 minutes is indicative rumat treatment.· What is meant by a real neurological disorder for example paralysis, microcephaly. No real neurological disorder eg mild developmental delay is not an indication.· Focal seizures or focal became common shows that children have the organic focus on the contralateral side of the brain.· Not all agree that the seizure 2 times or more in one day is an indication rumat treatment.
Intermittent Treatment
What is meant by intermittent treatment is treatment that is given when the child has a fever, to prevent febrile seizures. Consists of administering antipyretics and anticonvulsants.
Antipyretic
There was no evidence that the use of antipyretics to reduce the risk of febrile seizures. However the Child Neurology agreement states that experience shows that antipirtetik still useful.
Antipyretic can be used are:
Paracetamol or acetaminophen 10-15 mg / kg / times given 4 times.
Ibuprofen 10 mg / kg / time, given 3 times.
Anticonvulsants when fever
The use of diazepam oaral doses from 0.3 to 0.5 mg / kg every 8 hours during the lower the risk of recurrent febrile seizures.
Rectal diazepam can also be given at a dose of 0.5 mg / Kabb / time, given 3 times per day.
Note:
In Indonesia, a dose of from 0.3 to 0.5 mg / kg / 8 hours it often causes sedation is quite heavy. The recommended dose is 0.5 mg / kg / day divided by 4 doses.
Phenobarbital, carbamazepine, phenytoin useless to prevent febrile seizures when given intermten. New small doses of Phenobarbital anticonvulsant effects with stable levels in the blood when it has been given for 2 weeks.Media filesindex.jpgManagement of Seizures11 September 2012 16:24
Seizure management objectives:1. Ensuring oxygenation of brain tissue, as well as heart and lung function.2. Overcoming the seizure as soon as possible and prevent the recurrence of seizures.3. Improving metabolic disorders and water and electrolyte balance.4. Prevent systemic complications.5. Identify and treat the cause of the temperature rise.
To achieve the above objective, the aid measures undertaken are:1. Addressing and preventing the recurrence of seizures. All the children were in a state of convulsions during the examination, whatever the cause, the drug of choice is diazepam, either parenteral or perrektal.2. Common TreatmentWhile seizures, were given help to improve and ensure oxygenation of the brain by way of:a. Giving oxygenb. Loosen tight clothingc. Clear the airway, sucking fluids from the oral cavity and respiratory tractd. The child is placed in a position of semi trendelenberge. To prevent aspiration should position the child's head is tiltedf. Lowering the temperature when the heat by means of:- Blowing cold air- Cool the surrounding air- Compress with ice or alcohol- Antipyretics: paracetamol 30-50 mg / kg / day divided into 3 doses or aspirin 60 mg / years of age / time, 3 times per day
3. When the seizure of more than 30 minutes, then to cope with brain edema that may occur Corticosteroids: Dexamethasone 0.2-0.3 mg / kg / time, 3 times a day, 4-5 days old administration. If there are signs of herniation: irregular breathing, bradipnoe, diminishing consciousness, given mannitol 20% at a dose of 0.25 to 1 g / kg / times intravenously. Given within ½ hour can be repeated every 8 hours. Give fluids with low sodium levels, namely liquid 2: 1 and the amount of fluid on the first day 70% of maintenance needs. If not available mannitol may also be glycerol 10% with a dose of 0.5-1 g / kg / day orally given 4 doses.4. Finding and treating the cause of heat.
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