A new article published in the February edition of Australian Prescriber gives an update on the treatment of prolonged seizures (status epilepticus) in children.
Most convulsive seizures don’t last longer than five minutes, and will stop by themselves without medical intervention, say Dr Rob Smith and clinical nurse consultant Janis Brown of John Hunter Children’s Hospital, Newcastle. However, any convulsive seizure lasting longer than five minutes is considered a ‘prolonged’ seizure and should be treated.
“The first medicine usually given in an emergency situation when a child is having a convulsive seizure is midazolam, which is a benzodiazepine,” says Dr Smith.
Midazolam works best when it is given soon after the seizure passes the five-minute mark but before the seizure has gone on for 15 minutes.
Midazolam would usually be given by an ambulance officer or paramedic, or in the hospital emergency department, but can also be given by parents and carers after they have had training. This is available from specialist epilepsy nurses through patient support organisations like Epilepsy Action and Epilepsy Australia.
Although midazolam is now the first-line treatment for prolonged seizures, its use is actually an ‘off-label’ practice meaning it is not approved for this situation. However, midazolam has recently been added to the list of emergency drug supplies that GPs can obtain on the Pharmaceutical Benefits Scheme, also known as the ‘doctor’s bag’.
The Australian Prescriber article outlines more information about giving midazolam—which can be administered in various ways including as an injection, or as drops on the inside of the cheek or in the nose—as well as details about the safety and side effects of the medicine.
Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice.
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