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Potential prophylactic use of benzodiazepines for hemodialysis-associated seizures
F Sönmez1, S Mir, S Tütüncüoğlu
1Department of Pediatrics, Adnan Menderes University, Aydin, Turkey. hmsonmez@adu.edu.tr
Insights
Hemodialysis-associated seizure (HAS) is a common complication. Diazepam prophylaxis effectively prevented seizures in children on hemodialysis, unlike phenobarbital which showed increased risk.
Area of Science:
- Nephrology
- Neurology
- Pediatrics
Background:
- Hemodialysis-associated seizure (HAS) is a frequent complication in patients undergoing hemodialysis.
- The efficacy of anticonvulsant medications for managing or preventing HAS remains unclear.
- Children on long-term hemodialysis are particularly susceptible to HAS.
Purpose of the Study:
- To investigate the occurrence of HAS in pediatric patients undergoing long-term hemodialysis.
- To evaluate the effectiveness of diazepam as a prophylactic treatment for HAS.
- To compare the impact of diazepam versus phenobarbital on HAS recurrence.
Main Methods:
- Retrospective analysis of HAS incidence in children on hemodialysis.
- EEG evaluation to characterize seizure activity and epileptiform discharges.
- Prospective evaluation of diazepam prophylaxis in a small cohort of HAS patients.
Main Results:
- Nine patients experienced HAS, characterized by tonic-clonic seizures and focal slow-wave paroxysms on EEG.
- No correlation found between HAS and age, primary disease, seizure history, dialysis type, duration, anemia, hyperparathyroidism, or erythropoietin.
- Phenobarbital treatment was associated with seizure recurrence in five patients.
- Diazepam prophylaxis in four patients resulted in no seizures during a 6-month follow-up.
- A significant difference in HAS occurrence was observed between phenobarbital and diazepam groups (P=0.009).
Conclusions:
- Diazepam administered orally may be beneficial in preventing recurrent HAS in pediatric patients.
- Phenobarbital's dialyzable nature might increase the risk of HAS, warranting caution.
- Hypertension due to hypervolemia is a potential contributing factor to HAS development.
Abstract:
Hemodialysis-associated seizure (HAS) is a common complication of hemodialysis. The efficiency of anticonvulsant drugs in treating or preventing seizures is poorly defined. In this study, children on long-term hemodialysis were examined for HAS and the effect of diazepam prophylaxis on HAS was investigated. Nine patients with a mean age of 14.1 + 2.8 years had HAS and 4 with a mean age of 13.0 +/- 4.4 years had never experienced HAS. The patients with HAS had tonic-clonic seizures. Four patients had focal slow-wave paroxysms, especially in the parieto-occipital regions; 2 had subcortical epileptiform discharges by electroencephalography. No correlation was observed between HAS and patient age, primary disease, prior history of seizures, type of dialysis, duration of hemodialysis, anemia, hyperparathyroidism, and administration of erythropoietin. Hypertension due to hypervolemia may also play a role in the development of HAS. Five patients with HAS first treated with phenobarbital (PB) had recurrence of seizures. As a dialyzable antiepileptic PB may be associated with an increased risk for HAS. In a preliminary study, we gave diazepam as a prophylactic therapy to 4 patients with HAS. During 6 months of follow-up, these patients had no seizures. The number of HAS was significantly different between the groups receiving PB and diazepam (z=-2,58, P=0.009). In conclusion, administration of diazepam per os to patients with HAS may be of value for preventing recurrence of HAS.