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CONVULSION symptoms and treatment

CONVULSION

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CONVULSION

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 abcess,neurocycticercosis and malaria)

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,metabollic disorders, or toxic ingestions

 Alcohol abuse

Special concerns:

 Eclampsia
 Trauma
 Intracranial hemorrhage
 Alcohol or medication withdrawal (barbiturate, diazepam)
 Drug induced seizures(trycyclic 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
hypoperfusion due to arrhythmia, ECG may identify the following
 Prolonged QTc
 Widened QRS
 Prominent R in aVR
 Heart block
Consider Lumbar Puncture in;
 Immunocompromised
 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.
 A, B, C (airway, breathing, circulation)
 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.

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