A. Prophylaxis "Intermittent"
From previous research it appears to be a fever seizure relapses at 30 to 40% of patients, especially in children under 18 months. To prevent recurrent seizures in the future, patients suffering from mild fever seizure medication prophylaxis "Intermittent", ie a mixture of medication and Anticonvulsants antipiretika as drug preparations in elderly patients, who should be given to children suffering from fever so it was palpable in the future . Anticonvulsants are given drugs usually phenobarbital, which is known to have the fewest side effects compared with other drugs Anticonvulsants. Rates therapeutic levels in the blood in order to prevent the occurrence of seizures is between 15 to 20 micrograms%. In giving oral phenobarbital, the normal dose, the therapeutic can be achieved within 24 hours, but then would fall back under the line of therapeutic rates.
Included in the rate achieved therapeutic longer and faster, use double doses every 12 hours, then a stable therapeutic dose would be achieved in 24-36 hours. Usual dose is 4-5 mg / kg of body weight per day, and double doses of 80-10 mg / kg / day every 12 hours. This double dose usually given for at least 2 x 24 hours, then continued with the usual dose for the following days. When given the normal dose of phenobarbital with 4-5 mg / kg per day, a steady rate of new therapeutics is achieved only after 10-14 days. Anticonvulsants and antipyretic actually giving as it is considered less accurate, because the cramps are usually mild fever cramps thus arises in the first 16 hours after the child is getting the temperature rise. But in the research of children suffering from mild fever cramps, giving antipiretika without Anticonvulsants than those given antipiretika by Anticonvulsants, it appears the two seizures could be prevented with meaningful results (P <0.02) to obtain better results actually need a higher dose that is 10-15 mg / kg / day, but with this dose of course give side effects like drowsiness, emphasis on the respiratory center. etc..
Drugs which are now widely used to prevent a recurrence of mild fever seizures is rectal diazepam. Diazepam rectal is presumably to help prevent seizures when given as children palpable heat, and even better results with giving oral. How long prophylaxis "Intermittent" is given?
Generally, prophylaxis is given up to the age where the possibility of the child to suffer from mild fever cramps are very small, so until the maximum age limit of the criteria Livingst on.
B. Long-term prophylaxis
Long-term or continuous prophylaxis given to patients who do not meet the stiff one or more criteria from Livingston or suffering from epilepsy provoked by fever. Long-term prophylaxis guarantee a stable therapeutic dose there was an adequate d in the blood of patients to prevent recurrent seizures in the future.
The way the grant is the usual dose. given in two doses per day, given continuously for at least three years are not cramps, kernudian down slowly ("taperring off) for 3-6 months. Consensus with (4) produce some criterion to be used as a guide for medication Anticonvulsants in all seizures fever, which continued prophylaxis is given if there are conditions as follows:
1. There is a nerve growth disorders such as cerebral palsy, retardasi development, or microcephaly.
2. When cramps fever lasts more than 15 minutes, to be focal, or followed by a temporary neurological abnormalities or settled.
3. When there is history of a seizure without any heat on the genetic parents or relatives home.
When observed by one, the third fact is not inconsistent with the standard criteria from Livingston. Drugs used for long-term prophylaxis:
• phenobarbital to prevent the risk of recurrence of seizures likely good enough, although sometimes - sometimes in a provoked epileptic seizures fever fever is sometimes though rarely, is still repeated by provision Anticonvulsants but in this case must be considered is the possibility of the elderly
forget or get bored give Anticonvulsants drugs continuously. Side effects of long-term fenobarbital is changing the nature of children to be hyper active, sleep cycle changes (difficulty sleeping) and sometimes disorders, cognitive function or functions noble.
• Sodium valproat / valproat acid (Epilin, Epanutin, Depakin), may reduce the risk of recurrence of seizures with fever in this group is satisfactory, even more satisfying than with phenobarbital. Given in doses of 20 mg / kg / day in 3 divided doses. Lack of this drug is its price much more expensive compared to phenobarbital, and many report symptoms of nausea foksis form in the stomach, liver damage,
pancreatitis.
• phenytoin (Dilantin) is sometimes given to kids, with his kick to the grant of the nature of phenobarbital hiperaktifitas fear will increase the symptoms, but the results are often unsatisfactory. In general, the prognosis cramps fever prophylactic treatment satisfactory. We recommend that parents be given an adequate explanation to understand all the risks that may occur due to fever, cramps, and are briefed on how the grant of the right drug and the first penangpenanggulangan when children cramped in the house.
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