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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sedation is being used increasingly in children to allay anxiety and discomfort. Sedation can also increase the efficiency of performing both diagnostic and therapeutic procedures in children. There are a wide array of available sedation methods that are used by radiologists, gastroenterologists, hematologists/oncologists and emergency room physicians everyday. Indiscriminate use of sedatives has led to seizures, respiratory arrests and death in a variety of practice settings. With improved monitoring capability, more potent drugs and better understanding of the pharmacokinetics in children, it is possible to provide batter care.
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PMID:Sedation in pediatric patients. 1082 60

Advanced prehospital emergency medical care of patients with a severe head injury must essentially focus on the impact of secondary cerebral insults of systemic origin on the outcome. The first objective of prehospital care is to prevent hypoxaemia and hypercapnia. Therefore, all patients with a Glasgow Coma Scale score equal to or lower than 8 must be treated with endotracheal intubation and controlled ventilation under continuous monitoring of SpO2 and PETCO2. Treatment is similar in head-injured patients with significant deterioration of consciousness level, seizures, respiratory distress, or severe facial and thoracoabdominal injuries. The endotracheal tube is inserted by the orotracheal route under direct laryngoscopy, after a rapid induction sequence of anaesthesia and immobilization of the cervical spine in neutral position. For the induction of anaesthesia in these high-risk patients (full stomach, unknown medical history, deteriorated haemodynamic status), etomidate and suxamethonium are the preferred agents. Sedation is maintained with an hypnoticopioid association (fentanyl). Simultaneously, the main goal is the maintenance of an optimal cerebral perfusion pressure, as arterial hypotension severely worsens cerebral ischaemia. Volume loading is accomplished with 0.9% saline and hydroxyethyl starch.
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PMID:[Prehospital management of patients with severe head injuries]. 1083 14

Among new researches bearing on cerebral palsy are the growth of brain cells in tissue cultures for experimentation; the use of polysaccharides to prevent the formation of a glial barrier to nerve growth after injury; observation of changes in reactions of neurons at various stages of development; the finding of hypernatremia and hyperchloremia in lesions of the frontal lobe and the thalamus; stimulation of cerebral blood flow by injection of sodium bicarbonate and retardation with ammonium chloride; and studies of serial sections of brains of palsied children who died. Study of development in the early months of life has made possible the detection of significant abnormalities in behavior early in life. Loss of hearing may be tested in very young children by measuring minute variations in electrical resistance of the skin upon auditory stimulation of the sympathetic nervous system. Conditions which have been described as having been confused with cerebral palsy are dislocation of a cervical vertebra, hereditary spastic paraplegia, transverse myelopathy, injury to the spinal cord or cauda equina by anomalous growths of the spine, and also encephalitis and meningitis. Sedation has proved a valuable adjunct to electroencephalographic study of cerebral palsy. Better criteria for abnormality in the young child should be determined and the application of them more clearly standardized. Simple exercises are useful for early training of palsied children to stimulate development. "Crossed laterality"-the dominant eye being contralateral to the preferred hand-has been counteracted by special training with great success in eliminating emotional and behavior problems and accelerating development.Recent studies indicate that only 50 per cent of cerebral palsy patients have normal or better intelligence. Subluxation of the hip joint, a common deformity associated with cerebral palsy, can sometimes be corrected by operation if detected at an early stage. Radical ablation of epileptogenic foci in the cortex is also being done in young patients if drug control of seizures fails. Frontal topectomy, cingulate gyrectomy or prefrontal labotomy may be advisable in cases in which proper response to drug therapy is not obtained. Improvement in behavior as well as control of seizures may follow the use of Benzedrine,(R) Dexedrine,(R) Dilantin(R) sodium, Mebaral(R) and phenobarbital. Alcohol, paraldehyde and chloral hydrate have been effective as relaxants.
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PMID:What's new in cerebral palsy. 1310 11

Seizures are reported to occur more frequently among children with diagnoses of autism and pervasive developmental disorder (PDD), and some reports indicate a frequency as high as 30%. Sedation is often necessary to perform diagnostic electroencephalograms (EEGs) in these children, who are known to be difficult to sedate with current available pediatric sedating agents, including chloral hydrate. We used clonidine as a sedative agent in children with autism and PDD, and our findings are presented. In a prospective study, 27 children with autism and PDD diagnoses underwent conscious sedation for EEG recording. Informed consents were obtained, and clonidine was administered orally as a sedating agent in a dose ranging from 0.05 mg to 0.2 mg. Subjects were monitored for pulse rate, respiration rate, blood pressure, and oxygen saturation on a continuous basis by a registered nurse. Study parameters included time to induction, time to recovery, changes in vital signs, and technical quality of EEGs. Sedation was achieved in 23 of 27 patients (85%) per our sedation criteria, and this included five patients who had previously failed to be sedated with chloral hydrate. Two patients did not satisfy the sedation criteria but cooperated enough to allow acceptable EEG tracings, increasing the success rate to 93% (25/27). The mean time to achieve sedation was 58 minutes, and the mean time to recovery was 105 minutes. Two patients (0.07%) experienced an asymptomatic heart rate reduction up to 40%, which was not sustained and recovered promptly without any intervention. Two patients (0.07%) experienced systolic blood pressure reductions of 30% and 40%. They remained asymptomatic, had no changes in other cardiorespiratory parameters, and required no intervention. All EEGs were of good technical quality without any "drug effect." Clonidine is a viable alternative for sedation in children with autism and PDD. It is well tolerated without any significant side effects and is efficacious in children with autism and PDD. The advantages of clonidine include ease of administration, shorter duration of total sedation, lack of EEG drug effect, and high overall success rate.
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PMID:EEG sedation for children with autism. 1508 32

Diazepam rectal gel (Diastat) is the only medication approved by the US FDA for the management of selected, refractory patients with epilepsy, on stable regimens of antiepilepsy drugs, who require intermittent use of diazepam to control bouts of increased seizure activity. An analysis of the safety of diazepam rectal gel reveals that this formulation has certain advantages over intravenous diazepam administration: most notably a very low incidence of respiratory depression, low potential for abuse and the opportunity for out-of-hospital use by non-professional caregivers. Sedation is the most common adverse effect of rectal diazepam treatment, occurring in approximately one-quarter of patients, although drug-induced somnolence is difficult to distinguish from normal post-ictal sedation. Overdosage of diazepam rectal gel is rarely associated with serious clinical consequences, and overdoses of up to 330% of the maximum recommended dosage have been reported without any respiratory or cardiac depression. Under-administration may be a serious safety issue because of morbidity that may result if seizures are not terminated. Chronic administration may cause tachyphylaxis and should be avoided.
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PMID:Safety of Diastat, a rectal gel formulation of diazepam for acute seizure treatment. 1514 32

In this postlicensing surveillance study in a large unselected population, data were collected prospectively on all patients prescribed levetiracetam (LEV) at a regional epilepsy clinic over a 2-year period. Two hundred forty-five (69.2%) patients remained on LEV, with 8.8% achieving remission and some improvement in seizure control in 49.3%. Sedation was the most common adverse effect (10.7%), but mood disturbance was more likely to lead to discontinuation (4.8%). Cumulative probability of remaining on LEV at 12 months was 0.74 (95% CI 0.69 to 0.79). Factors predictive of a poorer retention were a greater number of previous antiepileptic drugs and a faster initial titration regimen.
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PMID:A prospective analysis of the outcome of levetiracetam in clinical practice. 1530 98

The imaging approach to refractory partial epilepsy in children is essentially the same as the one used for any epilepsy at that age, except that surgery being generally proposed, it has to be oriented and complete. Yet there are differences. Sedation introduces a risk. The brain of the young child is still immature, and specially designed sequences are needed for proper imaging. Brain immaturity also modifies the usual image contrast and may conceal (or on the contrary enhance) an area of dysplasia. Repeating studies after a few months has to be considered. Obviously, the brain imaging study has to be closely oriented by the clinical and EEG findings and if necessary, by functional imaging data. The abnormalities are extremely diverse as compared to what is observed in an adult population. The brain may be "normal", or demonstrate only non-specific abnormalities. Among the specific lesions, scars are common, and above all, malformations, especially malformations of cortical development (even diffuse malformations are commonly expressed by partial seizures), including focal cortical dysplasias and their close relatives, dysplastic tumors. In children, the most common lesions in the temporal lobe are scars, tumors/dysplastic lesions and malformative lesions, while mesial sclerosis is significantly less common than in adults. In the event of a simple lesion, the decision for surgery on the basis of morphological data alone is more easily made in children than in adults.
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PMID:[Refractory partial epilepsy: morphological imaging in children]. 1533 56

Acute liver failure (ALF) is an uncommon medical emergency whose rapid progression and high mortality demand early diagnosis and expert management, including immediate transfer of any potential case to facilities for intensive care and orthotopic liver transplantation (OLT). All patients with ALF must be screened aggressively for acetaminophen toxicity (history, serum levels, "hyperacute" presentation with renal failure), for other drugs, and viral hepatitis; rare causes of ALF should also be considered. After an acetaminophen overdose, N-acetylcysteine must be given as early as possible, preferably in the emergency room, but any patient with ALF should promptly receive N-acetylcysteine if there is suspicion of acetaminophen toxicity irrespective of the time of ingestion. Supportive care for all patients with ALF includes adequate enteral nutrition, aggressive screening and treatment of infection, prophylactic broad-spectrum antibiotics, and antifungal agents. Sedation with propofol is given for severe agitation or mechanical ventilation. With advanced coma grades, intensive care is needed with hemodynamic monitoring, ventilatory support, continuous renal replacement for renal failure, and intracranial pressure monitoring. Intracranial hypertension is treated with mannitol and/or acute short-term hyperventilation, but if the patient is refractory to treatment, mild-moderate hypothermia is achieved by a cooling blanket that is continued throughout OLT. Barbiturate coma is only used in refractory cases as the last treatment modality. Seizures are aggressively treated with phenytoin, with additional diazepam as needed. Candidacy and activation for OLT should be completed as early as possible in the course of ALF, especially in "hyperacute" cases such as acetaminophen toxicity. The final decision to proceed with OLT is made when a donor organ becomes available. King's College Hospital criteria for OLT are still the best prognostic assessment for fatal outcome in ALF, but the criteria fail to identify some patients who will die.
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PMID:Acute Liver Failure. 1552 12

Although complete seizure control is achievable in 54% to 82% of patients with primary (idiopathic) generalized epilepsy syndromes, there remains a substantial group with inadequate control. Valproate has been considered the drug of choice but is not always effective and might produce unacceptable adverse effects. Several newer drugs have emerged as potential alternatives to valproate, including lamotrigine, levetiracetam, topiramate, and zonisamide. Sedation and tolerance limit the utility of benzodiazepines. For severely refractory patients, drug combinations, vagal nerve stimulation, or felbamate might be considered. Only a few controlled clinical trials have been conducted for these syndromes; more are needed.
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PMID:Treatment of refractory primary generalized epilepsy. 1640 Feb 93

The majority of inhibitory neurotransmission in the brain is mediated by the gamma-aminobutyric acid (GABA) type A (GABA(A)) receptor. The anticonvulsant loreclezole largely acts by potentiating GABA(A) receptors containing beta2 and beta3 subunits. We used a genetically modified mouse containing a loreclezole-insensitive beta2 subunit (beta2N265S) to determine the role of this subunit in mediating the sedative and anticonvulsive effects of loreclezole. Sedation was assessed by measuring spontaneous locomotor activity and beam walking performance, and anticonvulsant efficacy was determined by pentylenetetrazole (PTZ) and amygdala kindling-induced seizures. The beta2N265S mice did not exhibit loreclezole-mediated sedation as shown by normal locomotor activity and beam walking performance. However, loreclezole also failed to provide significant protection against PTZ-induced seizures in the beta2N265S mice. Reduced efficacy against amygdala-kindled seizures, both acutely and over a 13-day chronic dosing study, was also observed in beta2N265S mice. These results suggest that the majority of the sedative effects and a significant proportion of the anticonvulsant efficacy of loreclezole are mediated via beta2-containing GABA(A) receptors.
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PMID:The role of GABAbeta2 subunit-containing receptors in mediating the anticonvulsant and sedative effects of loreclezole. 1688 14


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