CONVULSIONS (SEIZURES)

PROTOCOL # 12

BY:EMD Jawad Ahmed

Definition:-
A seizure is the clinical event that result from abnormal excessive
neuronal activity.
Etiology (Causes):-
-Alteration of consciousness, motor activity, behavior, sensation or
autonomic function.
-It may be viewed as a symptom of an underlying disease process.
Classification:-
• Acute non recurrent convulsions:-
One or more convulsive fits that occur during the same acute illness & do not
recur after recovery:-
– Febrile convulsions (caused by fever) – hypertensive
encephalopathy.
– CENRAL NERVES SYS.(CNS) infections:- meningitis,
encephalitis.
– Intra cranial Hemorrhage: spontaneous, or traumatic
– Toxic:- e.g tetanus.
– Intracranial tumors.
– Anoxic (Lack Of Oxygen):- sudden severe asphyxia.
– Metabolic:- hypoglycemia, hypocalcaemia, hypo or
hypernateremia.
• Chronic recurrent convulsions:-
Recurrent attacks of convulsions with symptoms free intervals:-
*Epilepsy:
-- Idiopathic (unknown cause).
– post- infection, post- traumatic, post- hypoxic, post-
toxic.
*Degenerative brain disease.
*Congenital (by birth) cerebral malformation.
Seizures
 Epilepsy
Defined as Increased/Recurrent Neuronal Convulsions
•  

• Partial:- Epileptic focus start localized and

remain localized:
Classified according to level of consciousness:
– No loss of consciousness:
Motor – Sensory – Autonomic.
– Loss of Consciousness: Temporal lobe epilepsy.
• Generalized:- Epileptic focus start localized then
become generalized.
– Febrile - Status epilepticus – Myoclonic
– Clonic – Atonic.- (typical and atypical) – Tonic.
• Unclassified
Electrical rhythm in epilepsy
 Generalized tonic clonic

The commonest form of childhood convulsions 60%:-

-An aura:- unusual behaviors recognized by the mother.
-Tonic phase:- powerful sustained contraction(5 minutes):-
– The patient falls to the ground stiff due to powerful
sustained contraction of all muscles.
– Arm flexed - Legs extended.
-Clonic phase:- Rhythmical contraction and relaxation of muscles
of limbs and face: (Biting the tongue)
-Duration of attack is variable but if exceed 20 minutes it
considered status epilepticus.
-Post epileptic phase:- The child falls in deep sleep and
afterwards he may be confused or irritable.
Epilepsy has good prognosis(RECOVERY) if the first
attack start after the age of 3years and the mental
development is normal.

Febrile convulsion
Definition:- Generalized tonic clonic convulsions which
occasionally occur at the onset of FEVER.
Incidence:- 3-5% in all children.
Etiology (causes):-
- Febrile seizures may signify a serious underlying acute
infections.
- In association with high environmental temp.
Clinical picture:-
Criteria for diagnosis of simple febrile convulsions:-
– Patient type:- Age: 6month to 6years. -
Sex: male more than female.
– Family history: Strong positive.
- Neurologically & metabolically free.
Investigation
Laboratory:-
CSF (cerebral spinal fuild) analysis: Indicated if any
doubt exist regarding the possibility of
meningitis.
EEG:- Indicated in atypical febrile seizure persists for more
than 15 minutes or recurrent more than 3 time/day, or
focal seizures.
A child at risk for developing epilepsy:-
– Positive family history of epilepsy
– Initial febrile seizures before the age of 6 months.
– A febrile seizure.
– Delayed developmental milestone.
– Associated Respiratory Problems (cyanosis).
Prognosis:- Risk for developing epilepsy is 1% in
children without risk factors,9% with risk factors.
Treatment:-
– Immediate first aid measures.
– Measures to lower the temperature:-
Cold fomentation(therpy) / Antipyretics.
– Treatment of the cause of fever e.g Antibiotics
– Short acting anticonvulsant:- Diazepam (valium)
0.25mg/kg/dose.
 Generalized absence (Effects)
- The commonest age 5-9 years.
- Rare below 2years and never continue after 15 years.
- Short sudden loss of consciousness.
- The child suddenly stops talking and stares for few
seconds.
- Recovery is immediate and child resumes talking.
- Not associated with limb movement.
- Recurrent up to more than 100 times/day.
- May affect school performance.
Myoclonic epilepsy
- Occurs at any age but is more seen in infants and young
children.
- Usually associated with mental retardation.
-The attack which is very frequent, present with sudden
symmetrical mass jerking involving all limbs.
 Status epilepticus
Definition:-
Continuous convulsion or repeated convulsions
without return of the level of consciousness more
than 20 min.
Causes:-
-Sudden withdrawal of anticonvulsant.
-Febrile convulsion in poorly controlled epileptic
patient.
-Metabolic or toxic.
• Advice to parents & child:-
– Give full information about the drug therapy
and stress on not to stop the drug without
medical advice.
– Allow normal activities:- the child should be
attended by a responsible adult while bathing
or swimming.
– Give clear instructions about the first-aid
measures in case the seizures:
1. Ensure patent airway.
2. Avoid biting the tongue
3. Putting the child in the prone or side position
with head down.
THANK YOU

REGARDS,
AHMER NADEEM
(EMD)