How to manage convulsions in a 5-year-old boy?

From the Guidelines

Managing convulsions in a 5-year-old boy requires immediate action to ensure safety and stop the seizure, with the most recent guidelines from 2024 suggesting that the person having the seizure should not be restrained and nothing should be put in the mouth 1. To manage convulsions, first, place the child on his side on a flat surface away from harmful objects, loosen any tight clothing around his neck, and don't put anything in his mouth. For an active seizure, administer benzodiazepines: rectal diazepam (Diastat) 0.5 mg/kg, or buccal/intranasal midazolam 0.2-0.3 mg/kg, as recommended by previous guidelines 1. If emergency medications aren't available, call emergency services immediately if the seizure lasts more than 5 minutes or if multiple seizures occur without recovery. Some key points to consider in managing seizures include:

• Keeping the child safe during the seizure
• Administering appropriate medications to stop the seizure
• Calling emergency services if the seizure lasts more than 5 minutes or if multiple seizures occur without recovery
• After the seizure, the child will need medical evaluation to determine the cause, as seizures can occur due to various reasons such as infections, trauma, or underlying neurological conditions 1. If the child has diagnosed epilepsy, maintenance medications like valproic acid (30-60 mg/kg/day divided twice daily), levetiracetam (20-60 mg/kg/day divided twice daily), or carbamazepine (10-20 mg/kg/day divided twice daily) may be prescribed, with the choice of medication depending on the specific type of epilepsy and the child's response to treatment 1. It's also important to keep a seizure diary noting duration, characteristics, and potential triggers, as this can help in managing the child's condition and preventing future seizures. Seizures occur when abnormal electrical activity disrupts normal brain function, and while frightening, most childhood seizures are brief and self-limiting, with febrile seizures being common in this age group and typically not requiring long-term medication 1.

From the FDA Drug Label

The safety of lorazepam in pediatric patients has not been established.

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 management of convulsions in a 5-year-old boy is not directly addressed in the provided drug label, as the safety and dosage of lorazepam in pediatric patients have not been established. No specific dosage or administration guidelines are provided for pediatric patients. Therefore, caution should be exercised and alternative treatments or consultations with a specialist, such as a neurologist or pediatrician, should be considered 2.

From the Research

Management of Convulsions in a 5-year-old Boy

• The management of convulsions in children can be achieved through various methods, including the administration of diazepam rectally or intravenously 3, 4, 5.
• Rectal administration of diazepam has been shown to be effective in the acute treatment of convulsions in children, with a success rate of 80% in one study 3.
• The therapeutic effect of rectal diazepam is significantly correlated with the duration of convulsions before treatment started, with early treatment (convulsions less than or equal to 15 minutes) having a higher success rate (96%) compared to late treatment (convulsions greater than 15 minutes) (57%) 3.
• Parents can be taught to administer rectal diazepam to their children at home, which can be a useful and secure method to prevent prolonged convulsions and epileptic status 4, 6.
• The dosage of rectal diazepam can range from 0.5 mg/kg, with the possibility of repeated dosages if necessary 4.
• Other anticonvulsant drugs, such as lorazepam, phenobarbitone, phenytoin, and paraldehyde, can also be used to treat acute tonic-clonic convulsions and convulsive status epilepticus in children 7.
• The choice of drug and route of administration may depend on various factors, including the severity and duration of the convulsion, the age and weight of the child, and the availability of medical personnel and equipment.

Prevention of Status Epilepticus

• Rectal diazepam can be used as a prophylactic measure to prevent status epilepticus in children with a history of convulsive disorders 6.
• Parents can be taught to administer rectal diazepam at home, which can decrease hospitalization and increase parental confidence 6.
• However, it is essential to ensure that parents are properly trained and supervised to administer rectal diazepam safely and effectively 6.

Safety and Efficacy

• Rectal diazepam has been shown to be safe and effective in the treatment of convulsions in children, with minimal side effects, such as transient respiratory depression 3, 5.
• The use of rectal diazepam can reduce the need for hospitalization and decrease the risk of complications associated with convulsions 4, 6.
• However, it is crucial to follow proper dosing and administration guidelines to minimize the risk of adverse effects 4, 5.