A n tico n vulsa n ts

Anticonvulsants are necessary where there are repeated seizures, a single seizure lasts >30 min or there is cyanosis.

• A benzodiazepine (e.g. lorazepam, diazepam) is the usual first line treatment.

• Phenytoin — a loading dose should be given intravenously if the patient has not previously received phenytoin. Phenytoin may not provide immediate control of seizures within the first 24 h.

If seizures continue appropriate anticonvulsants include:

• Magnesium sulphate.

• Clonazepam, which is particularly useful for myoclonic seizures.

• Thiopental or propofol infusion in severe intractable epilepsy.

With all anticonvulsants care should be taken to avoid hypoventilation and respiratory failure. However, mechanical ventilation will certainly be required if thiopental is used, and probably to maintain oxygenation in cases of continued seizures.

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