19-§6-Convulsions

• Give diazepam 10 mg IV/IM.
• If still convulsing give again 2-3 times.
• Still convulsing?  Inject phenobarbital…

 

• Main causes of new convulsions (in our hospice) are probably TOXOPLASMOSIS, CRYPTOCOCCOSIS and Cerebral TB.  We cannot treat other usual causes (LYMPHOMA, PML, HIV Dementia…).  But of course patients with prior brain damage can have new convulsions simply from a high fever.  In such cases try to treat the fever and its cause.
• When convulsions appear during a "TOXO test", a "CRYPTO test" or a "TB test" we can consider that the test is a failure, and therefore stop it immediately and try another treatment.
• During a convulsion try to observe if it is symmetrical or not and also the direction of eyes.  (All workers should be taught to observe this).  Focal lesions of the brain (TOXO) often give asymmetrical convulsions and/or eyes looking in a lateral direction… unlike CRYPTO.
• Do not feel guilty if a patient dies while convulsing…  They are often too weak to support long convulsions.  (Other patients will not think you have killed the patient with your injection because they will have seen the spectacular symptoms that were already apparent before you gave any injections.)
• When patient is not convulsing anymore, give prophylaxis (phenytoin 1 tab 3-4x/day) and start a brain therapy.  After 2 weeks, reduce phenytoin…  If convulsions do not occur again, you probably gave the right brain treatment.

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