Page 1 of 4: 2 mock querries

salman · Credits: 363 My Scrapbook

Question 1): A 3 years old child presented with fever with history of recurrent seizures in the past. To prevent recurrence of seizures, the step to be taken is :
a) Continue diazepam infusion
b) Paracetamol daily plus I.V. Diazepam
c) Phenobarbitone
d) Paracetamol only

> ans given is( D);; but I think ans should be (b)!

2)what happens when 6% CO2 is inhaled?--------ans given apnoea.
but I could find that anoea occurs >7%
so what will be the ans here ?

thanks

doctorgirl78 · Credits: 5504 My Scrapbook

doctorgirl78 · Credits: 5504 My Scrapbook

akanksha · Credits: 41277 My Scrapbook My Reading List 14 Books

salman · Credits: 363 My Scrapbook

so 6% produces hyperentilation ;; but > 7% produces resp. depression;
So the ans here is not apnoea!!

> another wrong-q---cut in trnsectn of pons & medulla=gasping +irregular(not apnoea)

doctorgirl78 · Credits: 5504 My Scrapbook

must be the poor kids "nothing going right days"

anyway please do include the mock test number you picked the question from................

pilgrim · Credits: 957 My Scrapbook

for febrile seizures..

Paracetamol ofcourse should be given to prevent rise of temperature...

Now diazepam as a prophylactic is to be considered only during the time of fever And that too only orally......But it is again a controversial issue...bcos Diazepam can produce ataxia and lethargy (makes it tough o evaluate the child)

Hence My choice will be 4
paracetamol only

salman · Credits: 363 My Scrapbook

hello
pilgrim& supr vetrn&ambitn

> If u do network---Phenobarbitone good choice
> nelson--PHB-norole
> diazepam--everywhere----------so my choice
> think Q picked from Nelson
Pl go thro it

salman

salman · Credits: 363 My Scrapbook

hello
before being lost below, let me give my doubts--
**1)PILGRIM Akanksha& Docgirl78

have u ever found anywhere saying antipyretic can prevent rec . seizures!(seizures r not associated with degree of fever)here it seems , it has no role controlling recc . febrile seizures!can we throw the CROCIN tabs out of the window now?
**

2)nelson says---Phenobarbitone is ineffective preventing;; but everywhere else, ans seems 2 be ---a)-intermittent diazepamPR(suppository/solutn) or oral when fever occurs
b)PHB/valproate continous 1yr

3)can "infusion" may mean PR solution here ?but that too has to be intermittent 2 apply here .-----so (a)not ans;; (b)excluded as I.V. is not the route;;(d) excluded as antipyrtic cannot control rec. seizure
So ans has 2 be (c)-pHbarbitone;; but that alsohas 2 be started continouus ly after the 1st episode,

Another openion---recurrant seizure s cannot b controlled ;; so just contol this fever with paracetamol!

****

<http://www.epilepsy.cc/index.html>
The vast majority of FC will arrive in the ER after the seizure has spontaneously stopped. The child is alert and there is no need for any intervention. Treatment of the acute febrile illness when indicated is the only management required. Under 18 months admission for observation is appropriate for a first FC. Repeated seizures within the same febrile episode account for 16 to 20% of FC. Parental anxiety must be taken into account in the decision to admit or not. Control of the temperature remains advocated. Tylenol to lower the thermostat, followed by cooling the child. There is no evidence that control of the temperature in subsequent febrile illnesses does anything to prevent recurrence of FC. If the child arrives in the ER convulsing, the FC is not simple any more and can be described as prolonged. (In our society, it takes at the best 10 to 15 minutes to reach an ER). One needs to stop the seizure. This by itself has been recognized as a risk factor for later onset of epilepsy as well as recurrence of FC. Rectal valium at the dose of 0.3 mg per kilogram is usually very efficient. See also management of status epilepticus. Antiepileptic Prophylaxis Who? 3 or more risks factors: most likely yes. less than 3 risks factors: maybe no risks factors: no. But this will miss the vast majority of children who will develop non febrile seizures. Furthermore, there is no evidence that prevention of recurrence of FC affects at all the occurrence of non febrile seizures. The recent reports of increased incidence of Mesial Temporal Sclerosis (MTS) in children with repeated FC complicates the problem even further. In fact since we are unable to distinguish within the population of children with "simple" FC who is going to develop non FC or MTS, we are unable to say who should be given prophylaxis. Once more clinical judgment remains the gold standard
. 1) Intermittent prophylaxis: Diazepam (Valium) intrarectally 0.1 to 0.3 mg per Kilogram every 8 hours from the onset to the end of each febrile illness. This a very safe approach. It is not certain that it is very efficient since a lot of FC in fact are the opening event of the febrile illness. Furthermore 2 thirds of FC do not recur and one never knows if the diazepam does anything at all. Although there is a reduction from 26% to 6% in recurrence.
2) Prevention of prolonged seizures or of immediate repeated seizure. Rectal diazepam given after the first FC or if the FC is still occurring when the child presents in ER, is often the most effective management of FC. This can be repeated every 8 hours for the first 24 or 48 hours or until the fever has subsided. It is a safe and effective management.
3) Continuous daily prophylaxis with AED's. Phenobarbital or Valproate are the only two AED's proven to prevent febrile seizures. Note that Phenytoin (Dilantin) and Carbamazepine (Tegretol) do not prevent febrile seizures. The balance of risk vs. benefit does not seem to favour continuous prophylaxis. PHB has immediate side effects such as hyperactivity, and long term side effects such as loss of IQ points, that makes this drug difficult to prescribe. It remains however the drug of choice in younger children on whom prophylaxis has been decided. VPA is much better tolerated but it has been associated with fatal liver damage and is not recommended in younger children. After 2 or 3 years of age it is probably the drug of choice in cases selected for prophylaxis. The doses should be individualized to obtain control. (see drug dosage sheet). When daily prophylaxis has been decided it should be continued for 2 years free of seizures.

*****anothersite
[color

=blue]http://www.cw.bc.ca/pediatricresidents/index.asp[/color]In most cases no chronic treatment is needed for typical febrile seizures. However, in cases of extreme parental anxiety, lack of medical resources, or recurrent febrile seizures, 0.5 mg/kg of rectal valium every 8 hours for the duration of the fever can be used a prophylaxis. Phenobarbital 4-5mg/kg/day or Valproic Acid 30-40 mg/kg/day may also be used prophylactically but these medications must be given on a continuous basis and not just with fever. Anticonvulsant therapy should be continued for 1 year after the last seizure or a total of 2 years, which ever is shorter. Dilantin and Tegretol are not effective.

****

another site
http://www.indianpediatrics.net/index.htm
From the Division of Pediatric Neurology and Neuro Developmental Unit, Department of Pediatrics, PGIMER , Chandigarh 160 012, India.
Correspondece to: Dr. Pratibha D. Singhi, Chief, Neurology and Neuro Developmental Unit, Department of Pediatrics, PGIMER , Chandigarh 160 012, India.
E-mail:

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<mailto:[email address in profile] pgi.chd.nic.in>

g) Treatment of Fever
Antipyretics are not effective in preventing recurrent febrile seizures, but are useful in making the child more comfortable(32).Long Term Management
The primary goal of long-term manage-ment of febrile seizure is to prevent recurrences. Treatment options include: (a) prolonged daily prophylaxis with phenobarbi-tone or valproate; and (b) intermittent prophylaxis with diazepam or other benzo-diazepines.
Continuous Prophylaxis
Phenobarbital is effective in preventing the recurrence of simple febrile seizures(33). In a controlled double blind study, daily therapy with Phenobarbital reduced the rate of subsequent febrile seizure from 25 per 100 subjects/years to 5 per 100 subjects/year(34). The adverse effects include behavioral problems such as hyperactivity and hyper-sensitivity reactions. Long-term phenobarbital treatment appears to influence cognition and behavior, a large price for prevention of benign condition.
Valproate is as effective as phenobarbitone in preventing recurrent, simple febrile seizures. In randomized, controlled studies, only 4% of children taking valproate as opposed to 35% of control subjects had a subsequent febrile seizure(35). Drawbacks to therapy with valproate include its rare association with fatal hepatotoxicity, thrombocytopenia, weight loss and gain, gastrointestinal disturbances and pancreatitis.
Neither Phenobarbital or Valproate is effective in reducing the risk of epilepsy in children with febrile seizure.
Intermittent Diazepam Prophylaxis
Diazepam administered intermittently either rectally as suppositories, or solution or orally at the onset of fever has been shown to be effective in preventing recurrence of febrile seizures(36). By either route, generally a dose of 0.3 to 0.5 mg/kg (max 10 mg) is used and repeated every 8-12 hours if temperature is 38ºC or more. A maximum of 4-5 doses are given per illness. Intermittent clobazam (1mg/kg/day) given orally has also been found to be useful in preventing febrile seizure recur-rences(37). A potential drawback to inter-mittent medication is that seizure could occur before fever is noticed. Adverse effects of oral diazepam include lethargy, drowsiness and ataxia(36). The sedation associated with this therapy could mask evolving signs of meningitis. It must however be remembered that this therapy does not decrease the incidence of later epilepsy in children with febrile seizures(38).

pilgrim · Credits: 957 My Scrapbook

great info there

So i guess diazepam does help to prevent febrile seizures...
Well in my previous reply i did mention that diazepam can be given.....

But since among the choices..Diazepam is given I.V.
I will go for Paracetamol only.....
Hope the point is taken....
what do the others think?....
what is the answer of the MCQ?

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