Are you familiar with these 8 seizure myths?
There are several common misconceptions about seizure management, stresses Gregory Henry, MD, FACEP, chief of the department of emergency medicine at Beyer Memorial Hospital in Ypsilanti, MI. Here are eight:
• Myth 1: Febrile seizures in children are frequently a sign of a serious medical problem.
"Almost all febrile seizures in children are not due to a serious medical problem. One to 2% of kids will have those, and very few go on to be diagnosed as epileptic," says Henry.
However, childhood febrile seizures are a psychiatric emergency for the family, stresses Henry. "The near death-like appearance of the child is very frightening to the family," he says. "The family has many concerns and questions that need to be answered. So the nursing role in giving information and providing emotional support aspects is incredibly important."
• Myth 2: Febrile children need to be given continued anticonvulsants.
Virtually no febrile children need to have continued anticonvulsants, Henry maintains. "There’s nothing in the literature that suggests that is useful," he says. "However, the family will want to know what to do, so nurses need to be schooled as to what the response should be. Discharge planning is more than half the battle in febrile seizures."
• Myth 3: A drug abuse panel isn’t necessary with seizures.
"In young adults who have new onset seizures, we have to think about drug use, such as cocaine, alcohol, or stimulant drugs," Henry stresses. "It’s worthwhile to carefully explore those areas, and don’t be dissuaded by the history. A drug abuse panel is not unreasonable to get in any young person with seizures."
• Myth 4: All children with febrile seizures should be worked up for meningitis.
"There is very good data that suggests that if a child wakes up fairly quickly after a febrile seizure, and otherwise looks normal, they do not have worked up for meningitis," says Henry. "There is no higher incidence of meningitis in those kids."
• Myth 5: Put things in the patient’s mouth so he or she wouldn’t bite things.
This step is a waste of time, and it can be dangerous, says Henry. "All you need to do is keep the patient’s head to the side, aspirate vomit, and [keep them from] hitting things," he says. "Keep them protected and cushioned, but don’t hold them down too firmly, because they you can have so much force from the seizure [that] they break bones that way."
If they are not stopping quickly, then it is worthwhile to administer drugs, because prolonged seizing can cause inner cerebral damage, he says.
• Myth 6: Patient needs antiseizure medication instantly.
"If a seizure is going on for more than a couple of minutes, you may want to administer medicine, but almost all patients stop seizing," says Henry. "So the first thing you need to do is not fight with them to get an IV in. You need to protect them first, and then see if the seizures clear."
• Myth 7: Supplemental oxygen is necessary.
This seems like a good idea, but no literature that shows it changes the length of seizing, says Henry. "The problem is not the extraction of oxygen by the lung," he says. "It’s a problem of the patient aspirating, and are they breathing regularly? So the breathing pattern of the patient should be observed."
• Myth 8: The newest antiseizure medications are the most effective.
"The old standbys, such as benzodiazepine drugs for the initial seizing episode, are still perfectly valid," says Henry. "If the situation calls for the sustained use of an antiseizure medication, Dilantin, Phenobarbital, and Tegretol are all still reasonable drugs to use."
More complex drugs should be used only if these basic drugs fail to work, says Henry.
"If simple drugs work, there is no reason to go to a fancier, more expensive drug," he advises.
Sources
For more information about management of seizures, contact:
• Gregory Henry, MD, FACEP, Emergency Physicians Medical Group, 2000 Green Road, Suite 300, Ann Arbor, MI 48105. Telephone: (734) 995-3764.
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