Anticonvulsant medications in the pediatric emergency room and intensive care unit.
Seizures are common in pediatric emergency care units, either as the main medical issue or in association with an additional neurological problem. Rapid treatment prolonged and repetitive seizures or status epilepticus is important. Multiple anti-convulsant medications are useful in this setting, and each has various indications and potential adverse effects that must be considered in regard to individual patients. This review discusses new data regarding anticonvulsants that are useful in these settings, including fosphenytoin, valproic acid, levetiracetam, and topiramate. A status epilepticus treatment algorithm is suggested, incorporating changes from traditional algorithms based on these new data. Treatment issues specific to complex medical patients, including patients with brain tumors, renal dysfunction, hepatic dysfunction, transplant, congenital heart disease, and anticoagulation, are also discussed.
Abend
Nicholas S
NS
Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. abend@email.chop.edu
Huh
Jimmy W
JW
Helfaer
Mark A
MA
Dlugos
Dennis J
DJ
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D020201:Brain Hemorrhage, Traumatic / Q000150:complications; D001930:Brain Injuries / Q000150:complications; D002648:Child; D002986:Clinical Trials as Topic; D019468:Disease Management; D042241:Early Diagnosis; D004569:Electroencephalography; D004630:Emergencies; D004636:Emergency Service, Hospital; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007674:Kidney Diseases / Q000150:complications; D008107:Liver Diseases / Q000150:complications; D009369:Neoplasms / Q000150:complications; D011183:Postoperative Complications / Q000188:drug therapy; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D014180:Transplantation
D000927:Anticonvulsants