General Nursing©

What You Should Know About Epilepsy?

General Guidelines for Treatment. Determination of appropriate treatment for a child with epilepsy must be individualized based on the specific type(s) of seizure, the child's age, and the likelihood of significant side effects. Anticonvulsant monotherapy is preferred when possible and is effective in a majority of children.

Generalized seizures may be controlled using a variety of medications, including barbiturates, phenytoin, valproic acid, or Ethosuximide.

Phenobarbital may be effective in the treatment of both generalized and simple partial seizures, including status epilepticus. Pediatric maintenance doses average three to five mg/kg/day. Common dose-related side effects include sedation and ataxia and hyperactivity is occasionally evident. Risk for idiosyncratic hepatotoxicity and for rash is probably not dose related.

Phenytoin is also effective in the treatment of both generalized and partial seizures and may be administered intravenously as treatment for status epilepticus. Pediatric maintenance doses average four to seven mg/kg/day. Intravenous infusion of a loading dose (18 mg/kg) should be performed slowly and cautiously due to risk of hypotension. Dose-related side effects may include sedation and ataxia. Long-term use may be complicated by gingival hyperplasia, hirsutism, or lymphadenopathy. Potential idiosyncratic side effects include rash, hepatotoxicity, or a lupus-like syndrome.

Valproic acid is useful in treating a variety of generalized (tonic-clonic, absence) and partial seizure disorders as well as some myoclonic epilepsies. It is particularly useful in treatment of mixed seizure disorders. Pediatric maintenance doses range from 30 to 60 mg/kg/day PO and no intravenous form is available. Dose-related side effects may include sedation, gastrointestinal upset, thrombocytopenia, and hyperammonemia. Fulminant hepatotoxicity is the most feared idiosyncratic complication of therapy; children under 2 years of age and children receiving multiple anticonvulsants appear to be at greatest risk.

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