What is convulsion, signs and treatment

What is convulsion, signs and treatment


A convulsion is an episode of neurologic dysfunction caused by abnormal neuronal activity that results in sudden change in behavior, sensory perception, or motor activity. For a patient with new onset convulsion the list of possible causes is longer and consists of the following:

CNS pathologies (stroke, neoplasm, trauma, hypoxia, vascular abnormality)
Metabolic abnormalities (hypoglycemia/hyperglycemia, hyponatremia/hypernatremia, hypercalcemia, hepatic encephalopathy 
Toxicological etiologies (alcohol withdrawal, cocaine, isoniazid, theophylline) 
Infectious etiologies(meningitis, encephalitis, brain abscess, neurocycticercosis and malaria)

What is convulsion, signs and treatment

Approach to a patient: 

Ask for history of epilepsy, if yes; compliance to anticonvulsant
History of CNS pathology(stroke, neoplasm, recent surgery)
History of systemic neoplasms, infections, metabolic disorders, or toxic ingestions
Recent trauma

or fall
Alcohol abuse TraumaEclampsia  Intracranial hemorrhage Alcohol or medication withdrawal (barbiturate, diazepam)  Drug induced seizures(tricyclic antidepressant and isoniazid overdose)

Laboratory studies:

Clinical information should guide the specific workup of a patient. Some investigations must be ordered:
Serum glucose level 
Serum electrolyte 
Pregnancy test for women of child bearing age
CT scan is indicated as outpatient/inpatient depending on progress of patient after episode of seizure. For a patient who had previously history of seizure do CT scan brain if;

  • New focal deficits 
  • Trauma 
  • Persistent fever
  • New character or pattern to the seizure

ECG should be considered in some patients. Seizure event can be precipitated by cerebral hypo-perfusion due to arrhythmia, ECG may identify the following

  • Prolonged QTc 
  • Widened  QRS 
  • Prominent R in aVR 
  • Heart block

Consider Lumbar Puncture in; 

  • Immune-compromised
  • Persistent fever 
  • Severe headache 
  • Persistently altered mental status

Treatment and management

Neurological dysfunction is theorized to occur after 20mn of continuous seizure, so aggressive treatment of any seizure should be done in 5 min. always consider the underlying cause until proved otherwise.

  1. A, B, C (airway, breathing, circulation) 
  2. Benzodiazepines 

A:Diazepam 10-20mg IV at a rate of 0.5ml (2.5mg) per 30 sec. Repeat if necessary after 30-60min. May be followed by intravenous infusion to max. OR 3mg/kg over 24 hours, per rectum 500mcgrms/kg up to max of 30g)

B:Phenytoin 18mg/kg IV stat then 100mg 8 hourly O/IV C: Phenobarbitone 20mg/kg 8 hourly. Max. Dose 1.5g



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