Convulsions(Fits)-Medicine For Treatment,Dosage.
Convulsions are seizures that happens when someone or a person’s muscles contrast in an uncontrollable manner.
We say a person has a convulsion (fit) when he or she suddenly loses consciousness and makes strange, jerking movements. These are caused by a problem in the brain.
In small children, common causes of convulsions are high fever and malaria in the brain, meningitis or poisoning. A person who often has convulsions may be having the fits of epilepsy.
THINGS TO DO DURING CONVULSION
- Try to figure out the cause of a fit and treat if possible.
- If the child has a fever, lower it at once with cool water.
- If the child is dehydrated, give an enema of Rehydration Drink slowly. Send for medical help immediately. Give nothing by mouth during the fit.
- If there are signs of meningitis, begin treatment and seek for medical help.
- If you suspect cerebral malaria, inject chloroquine but first weigh the child if you can. Do not exceed the correct dose for weight. Over dosage can cause death.
- Epilepsy causes fits in people who otherwise seem fairly healthy. Fits may come hours, days, weeks or months apart. In some persons, they cause loss of consciousness and violent movements.
- The eyes often roll back. In mild types of epilepsy, the person may suddenly blank out for a moment, make strange movements or behave oddly. Epilepsy is more common in some families (inherited). Or it may come from brain damage at birth, high fever in infancy or tapeworm cysts in the brain.
- Epilepsy is not an infection. It is a disease like other diseases. It is not a disgrace or shame upon the family. Loving care and understanding should be offered by the health worker. It is often a life-long problem. Infants sometimes get over it.
WHEN A PERSON IS HAVING A FIT
- Try to keep the person away from hurting him or herself, remove all hard or sharp objects.
- If the teeth are clamped tightly together, do not force the jaw open as this may only break the teeth.
- After the fit, the person may be dull and sleepy. Let him or her sleep.
- If fits last a long time, inject diazepam (Valium) or phenobarbital. If the fit still has not stopped after 15 minutes, give a second dose.
- If the medicines cannot be injected and cannot be taken by mouth, the fluid from an ampule or tablets crushed up in water, can be inserted up the rectum using a plastic syringe without a needle.
MEDICINES TO PREVENT EPILEPTIC FITS
NOTE : These do not cure epilepsy, they help prevent fits. Often the medicine must be taken for life.
- Phenobarbital often controls epilepsy. It must be given in sufficient dosage to control the fits and continued regularly for many months. If treatment is only occasional, attacks will go on occurring.
- Diphenylhydantoin may work when phenobarbital does not work. Sometimes both medicines are needed together. Use the lowest possible dose that prevents fits.
This seizure or muscle contraction always happen to young children which can last for few minutes if immediate medical attention is given to the child.
Phenobarbital and phenytoin are common medicines used to prevent fits or convulsions of epilepsy. Other more expensive medicines are sometimes available and doctors often prescribe two or more medicines.
However, usually a single medicine works as well or better with fewer side effects. Medicines to prevent fits or convulsion are best taken at bedtime because they often cause sleepiness.
Diazepam can be given to stop a long lasting epileptic fit but it is not usually taken daily to prevent fits.
This medicine often comes in tablets of 30 mg. ampules of 200 mg in 1 ml. Phenobarbital can be taken by mouth to help prevent the spasms of tetanus. Low doses can be used to help lessen the cough of whooping cough or to help control severe vomiting.
A few doses at night may also help to promote sleep for those having reaction to the treatment for onchocerciasis.
For epilepsy, phenobarbital needs to be taken regularly for many months or years or even for life. The dose should be high enough to prevent convulsions, but no higher than necessary.
The daily dose should be divided so that the effect will last until getting up time in the morning. If convulsions still keep on coming, the dose may be increased to the highest allowed by the person’s weight; or the phenobarbital may be taken in combination with diphenylhydantoin.
WARNING : Too much phenobarbital can slow down or stop breathing. Its action begins slowly and lasts a long time (up to 24 hours or longer if the person is not urinating). Be careful not to give too much.
Dosage of phenobarbital
3 to 6 mg/kg/day -using tablets of 30 mg. Give tablets by mouth, well spaced out, 3 times a day; for example at 6.00 am, 2.00 pm and 10.00 pm.
In each dose, give :
- Adults : 30 to 120 mg. (1 to 4 tablets)
- Children from 7 to 12 years old : 15 to 30 mg (1/2 to 1 tablet)
- Children under 7 years old : 15 mg (1/2 tablet)
An adult on a dose of 60 mg (2 tablets) 3 times a day will need 180 tablets for a month. Tablets should be pre-packed, 180 per pack and the patient given sufficient packs to last until the next visit.
To control the spasms of tetanus, it may be necessary to give twice the dose of phenobarbital shown above for treating epilepsy. Phenobarbital injections can be given to stop an epileptic fit or the spasms of advanced tetanus.
Dosage for phenobarbital injections
Using ampules with 200 mg in 1 ml. Give 1 injection, intramuscular.
- Adults : 200 mg (1 ml)
- Children between 7 to 12 years old : 150 mg (3/4 ml)
- Children between 2 to 6 years old : 100 mg (1/2 ml)
- Children under 2 years old : 50 mg (1/4 ml)
If the fit does not stop, 1 more dose can be given after 15 minutes but then give no more. For tetanus, repeat the dose 3 times a day and if the spasms are controlled, begin to lower the dose a little at a time.
PHENYTOIN (diphenylhydantoin, Dilantin)
This often comes in capsules of 25 mg, 30 mg and 100 mg. Syrup with 125 mg in 5 ml (1 teaspoon).
This helps prevent the fits or epilepsy. The medicine must often be taken for life. The lowest dosage that prevents fits should be used.
Side Effects : Swelling and abnormal growth of the gums often occur with long-term use of phenytoin. If this is severe, another medicine should be used instead. Gum problems can be partly prevented by keeping the mouth clean and brushing or cleaning the teeth and gums well after eating.
Dosage of phenytoin
For fits (5 mg/kg/day)- using capsules of 100 mg
Start with the following dose once a day at bedtime. In each dose take :
- Adults and children over 12 years old : 100 to 300 mg (1 to 3 capsules)
- Children between 7 to 12 years old : 100 mg (1 capsule)
- Children under 7 years old : 50 mg (1/2 capsule)
If fits are not completely prevented with this dose, up to twice of this dose can be given but but not more.
If fits are prevented, try lowering the dose a little at a time until you find the lowest dose that prevents the fits.
This medicine often comes in injections of 5 mg in 1 ml of liquid or as tablets of 2 mg or 5 mg. The uses of diazepam are similar to those of phenobarbital, but it is more expensive. You can use Diazepam if phenobarbital cannot be obtained.
For stopping long lasting epileptic fits, the adult dose is 5 to 10 mg. Repeat in 2 hours if necessary.
You can use suppositories of diazepam or phenobarbital to put up into the anus if you only have liquid medicine to take by mouth. Put the suppositories up into the anus with a plastic syringe without a needle. Or grind up a pill of diazepam or phenobarbital, mix with water and put up into the anus.
For tetanus, give enough to control most of the spasms. Start with 5 mg (less in children) and give more as needed but not more than 10 mg at a time or 50 mg a day.
If necessary, diazepam can be given together with phenobarbital, but care must be taken not to give too much.
For relaxing muscles and calming pain, 15 minutes before setting broken bone, inject up to 10 mg (in an adult) or give 10 mg by mouth 30 minutes before.
Diazepam may also be useful in cases of extreme fright (hysteria) or anxiety, but its use for these should be very limited.
Dosage for injectable diazepam
Using ampules with 10 mg in 2 ml
- Adults and children over 12 years old : 5 to 10 mg (1 to 2 ml)
- Children between 7 to 12 years old : 3 to 5 mg (2/3 to 1 ml)
- Children between 1 to 6 years old : 1 to 5 mg (1/5 to 1 ml)
- Children under 1 year old : Do not use
Repeat dosage in 3 to 4 hours if necessary
WARNING : Although it is safer to inject diazepam in the muscle (IM) than the vein (IV), it does not work as well or as fast. If you inject in the vein, pick a large vein and inject very slowly.
Too much diazepam can slow down or stop breathing. Be careful not to give too much.
Diazepam is a habit forming (addictive) drug. Avoid long or frequent use and keep it under lock and key.