How to manage convulsions (seizures) in a 12-year-old boy?

From the Guidelines

To manage convulsions in a 12-year-old boy, first ensure safety by placing him on his side, removing dangerous objects, and never restraining him or putting anything in his mouth. For acute seizure management, medications like diazepam (0.2-0.5 mg/kg rectally or 0.1-0.3 mg/kg IV) or midazolam (0.2 mg/kg intranasally or buccally) can be used 1. If seizures last over 5 minutes or occur in clusters, seek emergency care immediately, as this may indicate status epilepticus, which requires prompt medical attention 1.

Key Considerations

• For long-term management, anticonvulsant medications are typically prescribed based on seizure type - common options include levetiracetam (20-60 mg/kg/day divided twice daily), valproic acid (15-60 mg/kg/day divided twice daily), or carbamazepine (10-35 mg/kg/day divided twice or three times daily) 1.
• Regular medication adherence is crucial, as is avoiding triggers like sleep deprivation, excessive screen time, and skipping meals.
• Keep a seizure diary noting frequency, duration, and potential triggers to help the neurologist optimize treatment.
• Regular follow-ups with a pediatric neurologist are essential to monitor medication effectiveness and adjust dosages as the child grows.
• According to the 2024 American Heart Association and American Red Cross guidelines for first aid, seizures are usually self-limited and resolve spontaneously within 1 to 2 minutes, but seizures lasting >5 minutes may require emergency medical intervention 1.
• The use of antipyretics such as acetaminophen or ibuprofen is not effective in preventing recurrent febrile seizures in children, as demonstrated by two meta-analyses published in 2021 1.

Safety Precautions

• Never restrain the child or put anything in their mouth during a seizure, as this can cause harm 1.
• Ensure the child's airway is clear and they are breathing properly after the seizure.
• If the child has a history of febrile seizures, it's essential to monitor their temperature and seek medical attention if they develop a fever 1.

From the FDA Drug Label

Levetiracetam is indicated as adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy Treatment should be initiated with a dose of 1000 mg/day, given as twice-daily dosing (500 mg BID). Dosage should be increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg.

Management of Convulsions in a 12-year-old boy:

• The recommended initial dose of levetiracetam for a 12-year-old boy is 1000 mg/day, given as twice-daily dosing (500 mg BID).
• The dosage should be increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg.
• It is essential to follow the dosing guidelines and adjust the dose according to the patient's response and tolerance.
• Levetiracetam is given orally with or without food 2.

From the Research

Management of Convulsions in a 12-year-old Boy

To manage convulsions in a 12-year-old boy, it is essential to follow established guidelines and protocols. The primary goal is to stop the seizure as quickly as possible and prevent any potential complications.

Initial Treatment

• Intravenous lorazepam and intravenous diazepam are established as efficacious at stopping seizures lasting at least 5 minutes in children 3.
• Rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective in children 3.
• Intramuscular midazolam has superior effectiveness compared to intravenous lorazepam in adults with convulsive status epilepticus without established intravenous access, but its use in children may vary 3.

Administration of Rescue Medication

• The administration of rescue medication to children with prolonged acute convulsive seizures in the community is crucial, and comprehensive guidelines are needed to ensure that children receive timely treatment 4.
• An individual healthcare plan for every child with a history of prolonged convulsive seizures at their school is essential, and teachers should be trained to administer rescue medication 5, 4.

Potential Risks and Complications

• Benzodiazepines, such as lorazepam and diazepam, may be associated with hypotension and respiratory depression 6, 7.
• The rate of respiratory depression in patients with convulsive status epilepticus treated with benzodiazepines is lower than in patients with convulsive status epilepticus treated with placebo, indicating that respiratory problems are an important consequence of untreated convulsive status epilepticus 3.

Treatment Algorithm

• A treatment algorithm for the management of convulsive status epilepticus in children and adults has been developed, which includes the use of intravenous lorazepam, intravenous diazepam, and other anticonvulsant medications 3.
• The algorithm takes into account the efficacy, tolerability, and safety of different medications and provides guidance for the treatment of convulsive status epilepticus in various settings.