แนวทางการรักษาผู้ป่วยเด็กท่มีีไข้และอาการชัก (CPG: …

1 (CPG: Fever and seizure in children) * Complex febrile seizure** - - - - Simple febrile seizure** diazepam EEG Febrile seizure ** # * ** 1.. 12 12-18.

2 - - 5 - (anterior fontanel) 2. ** (recurrence) EEG # > 5 diazepam ./ ../ . 10 . 1. Camfield P, Camfield C, Hirtz D. Treatment of febrile seizures. In: Engle J Jr, Pedley TA, eds. Epilepsy a comprehensive textbook. Philadelphia: Lippincott-Raven Publishers, 1998:1305-9.

3 2. Capovilla G, Mastrangelo M, Romeo A, Vigevano F. Recommendations for the management of febrile seizures : Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia. 2009 ;50 Suppl 1:2-6. 3. Committee on Quality Improvement, subcommittee on Febrile Seizures, American Academy of Pediatrics. Practice parameter: Long-term treatment of the child with simple febrile seizures. Pediatrics 1999;103:1307-9. 4. Mohebbi MR, Holden KR, Butler IJ. FIRST: a practical approach to the causes and management of febrile seizures. J Child Neurol. 2008 ;23:1484-8. 5. Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. I. Prevalence and recurrence in the first five years of life. Br Med J 1985; 290:1307-10. 6. Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth.

4 II. Medical history and intellectual ability at 5 years of age. Br Med J 1985; 290:1311-15. 7. Yucel O, Aka S, Yazicioglu L, Ceran O. Role of early EEG and neuroimaging in determination of prognosis in children with complex febrile seizure. Pediatr Int 2004; 46:463-7. (CPG: Convulsive status epilepticus in children) status epilepticus 30 2 5 5 1 Stage General measures AED treatment Premonitory (0-10 minutes) Diazepam ( or )1 Early (10-30 minutes)

5 2 hypoglycemia 25% glucose 2 ./ . Diazepam ( ) phenytoin ( ) phenobarbital ( )3 sodium valproate ( ) phenytoin phenobarbital 4 Established (30-60 minutes) 5 (phenytoin phenobarbital) phenobarbital ( ) phenytoin ( )3 sodium valproate ( ) phenytoin phenobarbital4 Refractory 6 (>60 minutes) EEG Propofol ( ) midazolam ( ) pentobarbital ( ) Thiopental ( )7 = intravenous, = per return, = intramuscular, inf = infusion 1. Diazepam ./ ../ . 5-10 ( 2 ) diazepam diazepam insulin syringe plastic 2 2 2.

6 Glucose, electrolytes, calcium, magnesium 3. Phenytoin 20 ./ . 1 ./ ./ 10 ./ . ( 30 ./ ) phenytoin phenobarbital 20 ./ . 2 ./ ./ 10 ./ . 4. Sodium valproate 15-20 ./ ../ ./ 1 ./ ./ 24 ./ ./ 6-8 5.

7 Metabolic acidosis, electrolyte imbalance, hypoxia 6. 60 (refractory status epilepticus ) ICU vital signs oxygen saturation 7. Pentobarbital 5-20 ./ . 25 ./ ./ ./ . 3 ./ ./ . burst suppression Thiopental 100-250.

8 50 . 2-3 burst suppression 3-5 ./ ./ . Propofol 1-3 ./ . 5-10 ./ ./ . burst suppression 1-3 ./ ./ . Midazolam ./ ../ ./ . 1 maintenance 24-48 12-24 pyridoxine (vitamin B6) 100 . 1. Abend NS, Marsh E. Convulsive and nonconvulsive status epilepticus in children. Current Treatment Options in Neurology 2009;11:262-72.

9 2. Appleton RE, Sweeney A, Choonara I, Robson J, Molyneux E. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus . Dev Med Child Neurol 1995; 37:682-88. 3. Dihter MA, Brodie M, New anti-epleptic drugs. N Engl J Med 1996; 334:1583-90. 4. Holland KD. Efficacy, pharmacology, and adverse effects of antiepileptic drugs. Neurol Clinic 2001; 19: 313-45. 5. Knake S. Hamer HM, Rosenow F. status epilepticus : A critical review. Epilepsy Behav 2009; 15:10-4. 6. Lowenstein DH. The Management of Refractory status epilepticus : An Update. Epilepsia 2006, 47(Suppl. 1):35 40. 7. Riviello JJ, Holmes. The treatment of status epilepticus : Seminars Pediatric Neurology 2004; 11:129-38. 8. Riviello JJ,Jr, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.

10 Neurology 2006 Nov 14;67(9):1542-1550. 9. Smith BJ. Treatment of status epilepticus . Neurol Clin 2001; 19:347-69. 10. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, et al. A comparison of four treatments for generalized convulsive status epilepticus . Veterans Affairs status epilepticus Cooperative Study Group. 1998 Sep 17;339(12):792-798. 11. Trinka E. The use of valproate and new antiepileptic drugs in status epilepticus . Epilepsia 2007; 48( ) : 49-51.