What is convulsion, signs and treatment

What is convulsion, signs and treatment

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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

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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





References

https://en.wikipedia.org/wiki/Convulsion
https://www.medicalnewstoday.com/articles/324330
https://www.webmd.com/first-aid/convulsions-in-children
https://medlineplus.gov/ency/article/003200.htm
https://www.researchgate.net/publication/216226860_Basics_of_Convulsive_Disorders_Febrile_Seizures
https://www.epilepsysociety.org.uk/sites/default/files/attachments/Chapter08Verity2015.pdf
https://www.sciencedirect.com/topics/medicine-and-dentistry/convulsion
https://jamanetwork.com/journals/jamapediatrics/fullarticle/495848
https://www.sciencedirect.com/topics/medicine-and-dentistry/convulsion

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