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)

    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
    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 
      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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