Guideline:
Acute seizures and seizure disorder
Bibliographic Source(s)
- Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Acute seizures and seizure disorder. Conroe (TX): University of Texas Medical Branch Correctional Managed Care; 2003 Apr. 4 p. [6 references]
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Acute seizures and seizure disorders. Conroe (TX): Texas Department of Criminal Justice University of Texas Medical Branch; 1998 Mar. 4 p.
Guideline Category
Evaluation
Treatment
Intended Users
Health Care Providers
Physicians
Guideline Objective(s)
To provide appropriate recommendations for the evaluation and treatment of acute seizures and seizure disorder
Target Population
Incarcerated offenders within the Texas Department of Criminal Justice with acute seizures or seizure disorder
Interventions and Practices Considered
Evaluation
- Observation of seizure activity
- Vital signs
- Electrocardiograph (EKG) monitoring
- Laboratory evaluations: glucose finger stick; venous samples for glucose chemistries hematology parameters toxicology screens and antiepileptic drug levels; determination of oxygenation with oximetry or arterial blood gases
Treatment
- Oxygen administration
- Administration of:
- Glucose
- Thiamine
- Oral antiepileptic drugs (AED) (formulary agents: carbamazepine phenytoin primidone valproic acid ethosuximide; non-formulary agents: gabapentin lamotrigine phenobarbitol topiramate tiagabine clonazepam)
- Lorazepam
- Diazepam
- Evaluation of responses to medications and subsequent medication adjustments as appropriate
- Neurology consult as indicated
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
Not stated
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Not stated
Description of Method of Guideline Validation
Not applicable
Major Recommendations
The major recommendations are provided in the form of algorithms for: Acute Seizures and Seizure Disorder.
Seizure Disorder
Most Commonly Used Drugs for Specific Seizure Disorders
Begin treatment with single drug using recommended initial daily dosing. Up to 80% of patients can be managed with monotherapy. Ensure proper medication adherence prior to modifying regimen. Refer to the original guideline document for formulary and non-formulary agents used in the treatment of seizure disorders.
Monitoring Parameters for Formulary Anticonvulsant Medications
Carbamazepine
- Complete blood count (CBC) with platelets at baseline then twice monthly first two months and annually or as clinically indicated
- Blood chemistries with emphasis on hepatic and renal function and electrolytes at baseline then at one month and annually or as clinically indicated
- Electrocardiogram (EKG) at baseline for patients >40 years old and as clinically indicated
- Carbamazepine level weekly for two weeks then at one month and annually or as clinically indicated
Phenytoin
- CBC at baseline and as clinically indicated
- Blood chemistries with emphasis on hepatic and renal functions at baseline annually and as clinically indicated
- EKG at baseline for patients >40 years old and as clinically indicated
- Phenytoin level in one week then in one month and annually or as clinically indicated
Valproic Acid
- CBC with platelets at baseline then twice monthly first two months and annually or as clinically indicated
- Blood chemistries with emphasis on hepatic function at baseline then at one month and annually or as clinically indicated
- Protime international normalized ratio (INR) partial prothrombin time (PPT) at baseline and annually
- Valproic acid level weekly for two weeks then annually or as clinically indicated
Clinical Algorithm(s)
Algorithms are provided for:
Type of Evidence supporting the Recommendations
The guideline was adapted from the following sources:
McAuley JW Biederman TS Smith JC Moore JL. Newer therapies in the treatment of epilepsy. Ann Pharmacother 2002; 36:119-29.
Anderson GD Miller JW. The newer antiepileptic drugs: Their collective role and defining characteristics. Formulary. 2001; 36:114-31.
Baker GA Camfield P et al. Commission on the outcome measurement in epilepsy 1994-1997: final report. Epilepsia. 1998: 39:213-31.
Quality Standards Subcommittee of AAN. Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients – summary statement. Neurology. 1996: 47:600-2.
Working Group on Status Epilecticus Treatment of Convulsive Status Epilecticus. JAMA. 1993; 270:854-859
Potential Benefits
Appropriate evaluation and treatment of acute seizures and seizure disorder
Potential Harms
Adverse effects of drugs
Qualifying Statements
The pathways do not replace sound clinical judgment nor are they intended to strictly apply to all patients.
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
Clinical Algorithm
For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.
IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Bibliographic Source(s)
- Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Acute seizures and seizure disorder. Conroe (TX): University of Texas Medical Branch Correctional Managed Care; 2003 Apr. 4 p. [6 references]
Adaptation
The guideline was adapted from the following sources:
McAuley JW Biederman TS Smith JC Moore JL. Newer therapies in the treatment of epilepsy. Ann Pharmacother 2002; 36:119-29.
Anderson GD Miller JW. The newer antiepileptic drugs: Their collective role and defining characteristics. Formulary. 2001; 36:114-31.
Baker GA Camfield P et al. Commission on the outcome measurement in epilepsy 1994-1997: final report. Epilepsia. 1998: 39:213-31.
Quality Standards Subcommittee of AAN. Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients – summary statement. Neurology. 1996: 47:600-2.
Working Group on Status Epilecticus Treatment of Convulsive Status Epilecticus. JAMA. 1993; 270:854-859
Source(s) of Funding
University of Texas Medical Branch Correctional Managed Care
Guideline Committee
Texas Tech University Managed HealthCare Network Pharmacy & Therapeutics Committee
Composition of Group that Authored the Guideline
Not stated
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Acute seizures and seizure disorders. Conroe (TX): Texas Department of Criminal Justice University of Texas Medical Branch; 1998 Mar. 4 p.
Guideline Availability
Print copies: Available from University of Texas Medical Branch (UTMB) 3009A HWY 30 West Huntsville TX 77340.
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
This summary was updated by ECRI on April 21 2004. This summary was updated by ECRI on November 16 2006 following the FDA advisory on Lamictal (lamotrigine). This summary was updated by ECRI Institute on January 10 2008 following the U.S. Food and Drug Administration advisory on Carbamazepine.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.
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Tools
No Quick Reference tools have been developed.
Details
FDA Warning
- Category:
- Emergency Medicine, Family Practice, Internal Medicine, Neurology
- Conditions:
- Acute seizuresSeizure disorder (simple partial complex partial generalized tonic-clonic absence)
- Published:
- 1998 Mar (revised 2003 Apr)
- Endorsed by:
- University of Texas Medical Branch Correctional Managed Care