What is the treatment for new onset acute seizure in a child?

From the Guidelines

The treatment for new onset acute seizure in a child involves immediate administration of anticonvulsant medications if the seizure lasts >5 minutes, and activating EMS for prolonged seizures, respiratory distress, or seizures with associated traumatic injuries. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, seizures are usually self-limited and resolve spontaneously within 1 to 2 minutes. However, seizures lasting >5 minutes may not stop spontaneously and may need emergency medical intervention.

Key Considerations

• For a convulsing child, the first aid provider can prevent unintentional injury by ensuring the child's safety during the seizure.
• The recovery position is intended to reduce the risk of aspiration if the child vomits during the seizure or the postictal period.
• Febrile seizures are a common benign condition in childhood, and antipyretics have not been shown to prevent recurrent febrile seizures in children 1.

Treatment Approach

• If the seizure continues after 5 minutes, emergency medical intervention such as anticonvulsant medications may be necessary.
• Activating EMS is crucial for prolonged seizures, respiratory distress, seizures with associated traumatic injuries, seizures occurring in the water, and seizures associated with choking events.
• Throughout treatment, maintaining the airway, providing oxygen, monitoring vital signs, and checking blood glucose levels are essential.
• After the acute seizure is controlled, a diagnostic workup including neuroimaging, EEG, and laboratory tests should be performed to determine the underlying cause.

Medications

• Although the guidelines do not specify the exact medication, the goal is to stop the seizure and prevent further complications.
• The choice of anticonvulsant medication may depend on the underlying cause of the seizure and the child's medical history.
• It is essential to follow the most recent and highest quality guidelines for the treatment of acute seizures in children, such as those provided by the American Heart Association and American Red Cross 1.

From the FDA Drug Label

For the treatment of status epilepticus, the usual recommended dose of lorazepam injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. The safety of lorazepam in pediatric patients has not been established. Fosphenytoin sodium injection is indicated for the treatment of generalized tonic-clonic status epilepticus and prevention and treatment of seizures occurring during neurosurgery in all pediatric age groups

The treatment for new onset acute seizure in a child may involve fosphenytoin sodium injection as it is indicated for the treatment of generalized tonic-clonic status epilepticus and prevention and treatment of seizures occurring during neurosurgery in all pediatric age groups 2. However, the dose should be individualized and administered at a rate not exceeding 2 mg PE/kg/min (or 150 mg PE/min, whichever is slower) in pediatric patients.

• The safety and efficacy of lorazepam in pediatric patients has not been established, and its use in this population is not recommended 3.
• It is crucial to note that the treatment of status epilepticus requires a comprehensive approach, including observation and management of vital functions, and may involve additional interventions, such as concomitant administration of other antiepileptic agents.

From the Research

Treatment for New Onset Acute Seizure in a Child

• The first-line treatment for acute seizure, including status epilepticus, is benzodiazepines due to their efficacy, tolerability, and rapid onset of action 4, 5, 6.
• Benzodiazepines, such as lorazepam, diazepam, midazolam, and clonazepam, are commonly used for the acute treatment of seizures, with different routes of administration available, including intravenous, intramuscular, rectal, and intranasal 4, 7, 8, 6.
• For acute repetitive seizures, providers should give a proper dose of benzodiazepines based on the patient's weight and needs 5.
• First-phase treatment for convulsive established status epilepticus is the immediate administration of full doses of benzodiazepines, followed by a full loading dose of IV fosphenytoin, levetiracetam, valproic acid, or phenobarbital if necessary 5, 8.
• Non-intravenous routes of midazolam, such as intranasal or intramuscular, can be considered as equally efficacious alternatives to intravenous lorazepam 7, 6.

Administration Routes and Considerations

• Different administration routes for benzodiazepines have been developed, including intranasal administration, which can be used for acute seizure treatment 4, 7.
• The choice of benzodiazepine and route of administration depends on the patient's specific needs, weight, and the clinical setting 5, 8, 6.
• Adverse effects of benzodiazepines, such as sedation, tolerance, and potential for addiction and misuse, should be considered when using these medications for acute seizure treatment 6.