TABLE 1213 Diagnostic Studies in Seizure Patients

In any group of seizure patients, there is a subgroup in which the seizure is a symptom of an underlying disorder and is not due to idiopathic epilepsy. In such cases, correction of the primary problem makes seizure recurrence unlikely. Thus, the primary goal must be to uncover disorders that are readily identifiable and reversible. Symptomatic seizures of hypoglycemia, hypocalcemia, and electrolyte imbalance can be treated immediately. There is little risk of recurrence and no need for anticonvulsant use. Seizures occurring as a result of intracranial infections and craniocerebral trauma may require only immediate or short-term anticonvulsant use. Symptomatic seizures of systemic lupus erythematosus (SLE), sickle cell anemia, leukemia, arteriovenous malformations, and neoplasms may be the heralding symptoms of a complex, yet treatable, underlying disease. Seizures have been reported in children after topical application of N, N-diethyl-m-toluamide (DEET) and lindane (Kwell). Ingestion of rare and common agents has been associated with new-onset seizures, including camphor, theophylline, isoniazid, tricyclic antidepressants, oral and parenteral meperedine, cyclosporine, stimulants such as methylphenidate, and lead and mercury exposure. These seizures may be brief and self-limiting or may progress to status epilepticus and result in permanent neurologic sequelae and epilepsy. Identification and specific treatment of the underlying problem are most important to achieve full recovery. Aseptic and bacterial meningitis, viral encephalitis, brain abscess, and more uncommon problems such as cat-scratch fever and mycoplasma-related encephalopathy may present with seizures. In a child with a ventriculoperitoneal shunt, seizures are more likely to arise from associated cerebral abnormalities (epilepsy) rather than shunt malfunction.

If the initial seizure is prolonged or emerges into status epilepticus, appropriate therapy and diagnostic workup must be initiated ( Tib.!® 1.2.1-3, Tib.!.® 121-4 and Tib.!.®

121-5.). If seizures are acutely repetitive or occur in the presence of associated or preexisting neurologic deficit and the patient is at a higher risk for recurrence of seizures, then anticonvulsant management can be initiated immediately (Table 121-4). For partial seizures, carbamazepine, phenytoin, and phenobarbital are most commonly used and equally efficacious whereas, in primary generalized seizures, valproate is most commonly used. However, the other AEDs are also effective and may need to be used because of intolerance or ineffectiveness. For the most part, these AEDs can be used interchangeably.

TABLE 121-4 Initial and Maintenance Doses in the First Seizure (Nonstatus Partial and Tonic, Clonic, and Tonic-Clonic Seizures of Childhood)

Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.

Get My Free Ebook


Post a comment