What is the treatment for acute tonic-clonic seizure in the United Kingdom (UK)?

From the Guidelines

The immediate treatment for an acute tonic-clonic seizure in the UK should involve administering a benzodiazepine, with intravenous lorazepam or diazepam being preferred if IV access is available, as stated in the guidelines 1. When considering the management of acute tonic-clonic seizures, it's crucial to prioritize the most effective and safest treatment options.

• The guidelines recommend that if IV access is available, an IV benzodiazepine (lorazepam or diazepam) should be administered, with lorazepam being preferred over diazepam due to its pharmacokinetic properties and efficacy in terminating seizures 1.
• If IV access is not available, rectal diazepam should be considered as an alternative, given its effectiveness in managing seizures when other routes are not feasible 1.
• It's also important to note that the management of seizures should be tailored to the individual patient, taking into account factors such as the severity of the seizure, the patient's medical history, and the presence of any underlying conditions that may be contributing to the seizure.
• In addition to administering benzodiazepines, maintaining the airway, providing oxygen, and monitoring vital signs are essential components of acute seizure management.
• The guidelines also emphasize the importance of considering the underlying causes of the seizure, such as infection, metabolic disturbances, or head injury, and addressing these underlying conditions as part of the overall management plan 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. If seizures cease, no additional lorazepam injection is required If seizures continue or recur after a 10- to 15-minute observation period, an additional 4 mg intravenous dose may be slowly administered. Parenteral Phenytoin Sodium Injection is indicated for the treatment of generalized tonic clonic status epilepticus Adult loading dose is 10 to 15 mg/kg at a rate not exceeding 50 mg/min. The treatment for acute tonic clonic seizure in the UK may involve the use of:

• Lorazepam (IV): 4 mg given slowly (2 mg/min) for patients 18 years and older, with a possible additional 4 mg dose after a 10- to 15-minute observation period if seizures continue or recur 2.
• Phenytoin (IV): adult loading dose of 10 to 15 mg/kg at a rate not exceeding 50 mg/min 3. Key considerations:
• Lorazepam and phenytoin are both indicated for the treatment of status epilepticus, but the specific treatment approach may vary depending on the individual patient's needs and medical history.
• It is essential to follow the recommended dosing and administration guidelines for each medication to ensure safe and effective treatment.

From the Research

Treatment for Acute Tonic Clonic Seizure in the UK

The treatment for acute tonic-clonic seizures in the UK involves the use of anticonvulsant drugs. The following are some of the key points to consider:

• Benzodiazepines, such as lorazepam, diazepam, and midazolam, are commonly used as first-line treatments for acute tonic-clonic seizures 4, 5, 6.
• Intravenous lorazepam is as effective as intravenous diazepam in stopping acute tonic-clonic convulsions, with fewer adverse events 4, 5.
• Buccal midazolam and rectal diazepam are acceptable first-line anticonvulsants for the treatment of acute tonic-clonic convulsions when intravenous access is not available 5.
• Intranasal lorazepam and intranasal midazolam may be effective alternatives to buccal midazolam and rectal diazepam, but more evidence is needed to support their use 5.

Key Findings

Some key findings from the studies include:

• Intravenous lorazepam is associated with fewer adverse events, such as respiratory depression, compared to intravenous diazepam 4, 5.
• Buccal midazolam is as effective as rectal diazepam in stopping acute tonic-clonic convulsions, with a lower risk of adverse events 4.
• Intranasal lorazepam may be more effective than intramuscular paraldehyde in stopping acute tonic-clonic convulsions, but more evidence is needed to support its use 5.

Antiepileptic Drug Treatment

The treatment of generalized tonic-clonic seizures (GTCSs) involves the use of antiepileptic drugs (AEDs). The following are some of the key points to consider:

• Eight AEDs are approved in Europe and the USA for the treatment of GTCSs, including lamotrigine, levetiracetam, perampanel, and topiramate 7.
• The choice of AED depends on several factors, including efficacy, adverse effects, interactions, adherence, and mechanism of action 7.
• Class 1 evidence supports the efficacy of lamotrigine, levetiracetam, perampanel, and topiramate in controlling primarily GTCSs (PGTCSs) 7.