*See the seizure medication table for quick reference.
Head trauma:
- Early seizure – within first 7 days, prevent with 5/mg/kg day phenytoin (valproate has higher mortality)
- No prophylaxis for late seizures.
Emergent:
For emergent seizures, benzos are the drug of choice to stop seizing.
- Lorazepam – onset 2-3 minutes, 0.1 mg/kg up to 4 mg every 5-10 minutes.
- Diazepam – onset rapid, but duration is short. 0.15/mg/kg up to 10 mg every 5 minutes.
- Midazolam – 0.2 mg/kg up to 10 mg/dose
After benzos, start control med:
- Phenytoin 20 mg/kg
- Fosphenytoin
- Phenobarbital 20 mg/kg
- Valproic Acid 20-40 mg/kg
- Levetiracetam 20-30 mg/kg
- Lacosamide 200-400 over 15 minutes
If refractory to above:
- Phenobarbital 5-15 mg/kg over 15 minutes then 0.5 mg/kg/hr
- Thiopental 2-7 mg/kg then 0.5 mg/kg/hr
- Midazolam 0.2 mg/kg then 0.5 mg/kg/hr
- Propofol 1-2 mg/kg then 20-200 mcg/kg/min
*******No Valproic Acid in potentially pregnant patients***********
Also avoid: phenytoin, carbamazepine, and phenobabital, but not as severely. Try to use a single agent.