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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, hyercalcemia, hepatic encephalopathy 
  • Toxicological etiologies (alcohol withdrawal, cocaine, isoniazid, theophylline) 
  • Infectious etiologies(meningitis,encephalitis,brain abscess,neurocycticercosis and malaria)

A convulsion is an episode of neurologic dysfunction caused by abnormal neuronal activity


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
  • Trauma 
  • Eclampsia 
  • 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.
3mg/kg over 24 hours, per rectum 500mcgrms/kg up to max of 30g)
                                                        OR
B: Phenobarbitone 20mg/kg 8 hourly. Max. Dose 1.5g
OR
D: Phenytoin 18mg/kg IV stat then 100mg 8 hourly O/IV

What is convulsion, signs and treatment What is convulsion, signs and treatment Reviewed by gafacom on September 05, 2019 Rating: 5

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