Manejo de primera crisis afebril: Importancia del enfoque clínico / Management of first nonfebrile seizure: Importance of clinical approach

Una crisis epiléptica es un evento traumático físico como psicológico que plantea dificultades en el diagnóstico y muchas interrogantes para el tratamiento agudo y en el largo plazo. La recurrencia de una crisis epiléptica origina aún más serios y costosos problemas en la vida personal, familiar y laboral del individuo afectado. En estas circunstancias, un correcto abordaje del manejo de individuos con una primera crisis afebril debe ser una prioridad de los sistemas de salud con el objetivo fundamental de prevención de recurrencias. La elección de un fármaco antiepiléptico va a depender de una detallada anamnesis del evento clínico y de la información proveniente de estudios o tests neurofisiológicos y por exámenes de imágenes cerebrales.

Seizures or an epileptic crisis is a traumatic event, both of physical and psychological nature that poses difficulties in the diagnostic process and many questions for its immediate and long-term management. The recurrence of an epileptic crisis causes even more serious and costly problems in the personal, family and work life of the affected individual. Due to this, a correct approach to the management of patients with a first afebrile crisis must be a priority of the health systems, with the primary purpose of preventing recurrences. The choice of an anti-epileptic drug will depend on a detailed anamnesis of the clinical event and onthe information from neurophysiological tests and brain imaging studies.

Phenytoin induced Stevens-Johnson syndrome in a 38 year male patient: A Case Report

Adverse drug reactions (ADRs) are one of the leading causes of death among hospitalized patients and occur in 0.3 to 7 per cent of all hospital admissions. These may vary from mild rashes to severe reactions such as Stevens-Johnson syndrome (SJS). Antiepileptic drugs-induced SJS is a life-threatening severe cutaneous adverse reaction. We report here a case of phenytoin induced SJS in a 38 year old male patient presenting at emergency room. The patient responded to the treatment and was prescribed tab. Levetrecitam and remained symptom free since then.

A Comparative Study between Intranasal Midazolam and Intravenous Midazolam In Control Of Seizure In Children

Introduction: Seizures are one of the important reasons for children visiting the hospital. Febrile seizures are the most common type of seizures found in childhood. Earlier Diazepam was widely used for treating all types of seizures but due to short duration of action, newer drugs were tried and found better than diazepam. Aims: To compare midazolam given intranasally with midazolam given intravenously for the treatment of febrile seizures in children. Methods: This prospective study was conducted in children suffering from seizures at the Paediatric Emergency Department of Teerthanker Mahaveer Medical over a period of 12 months. 84 children between the ages of one months to fourteen years with febrile seizures lasting for at least 10 minutes were eligible for inclusion in our study.  Treatment was considered successful if the seizure ceased within one hundred twenty seconds Results: In group A out of 44 patients, 20(45.5%) patients were responded to Intranasal Midazolam, whereas   in group B 40 patients who were treated with IV Midazolam as first line treatment, 36 patients (90%) had responded to it.  Time recorded for the commencement was more in IV Midazolam group (1.598 min) than IN Midazolam group (0.379 min), but average response time was lesser in group B (1.009 min) than group A (3.001 min). Conclusion: Midazolam given intranasally is a safe and effective treatment for prolonged febrile seizures in children and may be used in general practice and, with appropriate instructions, by the parents of children with recurrent febrile seizures at home.

Phenobarbitone induced drug reaction with eosinophilia and systemic symptoms (DRESS): a case report.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a life threatening cutaneous drug reaction with visceral involvement and hematological abnormalities. Being a rare side effect, it is often under-reported and misdiagnosed. The fatal adverse drug reaction is associated most commonly with aromatic anti-epileptics phenytoin, carbamazepine and less frequently with phenobarbitone. Here, we report a case of phenobarbitone induced DRESS in a 1 year old male child. He succumbed to fulminant hepatic failure inspite of being put on steroids, hepatoprotectives, antibiotics and ventilatory support.