Convulsive disorder

INTRODUCTION
◦The word convulsion (or seizures) describes an involuntary
violent spasms, or a series of jerking of face, trunk, or
extremities with or without loss of consciousness, sensory,
autonomic or behavioral disturbances.
◦The word epilepsy describes a syndrome of recurrent
unprovoked, seizure unrelated to fever or to acute “cerebral
insult”.

◦Status epilepticus (SE) ia a severe form of seizure
activity lasting more than 30 minutes or recurrent
seizures with failure to recover consciousness between
repeated attacks.

DEFINATION
◦Neonatal seizure is defined clinically as “ a paroxysmal
alteration in neurological function (i.e behavioral, motor or
autonomic function)either or all three, occurring within 28
days.
◦In general: a convulsive or seizure is a paroxysmal
manifestations of neurological dysfunction.

INCIDENCE
Full term baby- 3 in 1000
Pre-term baby- 60 in 1000
Infants with birth weight <1500g :57.5/1000
Infants with birth weight between 2500g to 3999g : 2.8/1000
12000 are under the age of 18 years
Incidence is higher under 2 years and over age of 65 years.

RISK FACTORS
MAJOR
Age < 1 year
Prolonged fever
Hyper pyrexia
Infections
MINOR
Family h/o of febrile seizures
Family h/o of epilepsy
Complex febrile seizures
Male gender
Electrolytes imbalance

ETIOLOGY
NON RECURRENT (ACUTE)
• Febrile episode
• Intracranial infections
• Intracranial hemorrhage
• Cerebral edema
• Brain tumors
• Anoxia
• Toxins e.g.. Drugs, tetanus, lead
• Metabolic alterations
• Hyperbilirubinemia
RECURRENT (CHRONIC)
◦ Idiopathic
◦ Trauma
◦ Infections
◦ Congenital defects
◦ Parasite brain diseases
◦ Hormonal disorders
◦ Hepatic disorder
◦ Allergy
◦ Sensory stimulus
◦ Migraine

PATHOPYSIOLOGY
RISK FACTORS AND ETIOLOGICAL FACTORS
ALTERED INTEGRITY OF NEURON IN THE EPILEPTOGENIC FOCUS
HYPEREXCITABILITY OF NEURONS
PARTIAL DEPOLORIZATION

PARTIAL STIMULATIONS OF NEUROTRANSMITTER MOLECULES
IMBALANCED RELEASE OF EXCITATORY AND INHIBITORY
NEUROTRANSMITTERS
LOWERED SEIZURES THRESHOLD
ABNORMAL SPONTANEOUS SPREAD OF ELECTRICAL DISCHARGE
CLINICAL MANIFESTATIONS

CONVULSION CLASSIFICATIONS AND
FEBRILE CONVULSIONS
◦It refers to the seizures associated with fever but excluding those
related to CNS infections. Common cause of convulsions in early
childhood (6 months to 5 years of age).
◦It has two types
◦Typical and Atypical

Typical or simple febrile
convulsions
Brief < 15 minutes
Occurs as a solitary event (one
attack/ 24 hours)
Typically generalized tonic-
clonic convulsuions
Followed by a brief period of
postictal drowsiness
EEG are normal after the attack
Atypical febrile or
complex convulsions
Long > 15 minutes
Repeated convulsions for
several hours a day
May be focal or generalized,
tonic-clonic convulsions
Followed by a long period of
postictal drowsiness
EEG show abnormal for 2
weeks after the attack

SEIZURE CLASSIFICATIONS AND
Generalized seizures
1.Tonic-clonical seizures
(grand mal)
2.Absence seizures
3.Atopic seizures
4.Myoclonic seizures
Partial seizures
1. Simple partial seizures
With elementary symptoms
No impaired consciousness
With motors signs (jacksonians)
With somatory-sensory- visual or
auditory
With autonomic manifestations
(abdominal) epilepsy
2. complex partial seizures
Includes psychomotor or temporal lobe
seizures
With impaired consciousness

DIAGNOSTIC EVALUATIONS
HISTORY TAKING
Maternal history
Family history
Labour and delivery history
Baby conditions at birth
NEONATAL EXAMINATION
General examination
Neurological examination
CBG
Spo2
METABOLIC WORK UP
INFECTIONS WORK UP
CBC
CULTURE
Torch
Igm
CRP
BLOOD GAS ANALYISIS
INBORN ERRORS OF METABOLISM
CT- SCAN
MRI
EEG
LUMBAR PUNCTURE

COMPLICATIONS
Cranial nerve palsies
Raised ICP
Subdural effusion
Cerebral palsy
Hydrocephalus
Mental-physical handicaps
Learning disability
Recurrence

PREVENTIONS
Regular ANC check up
Treatment of infections during ANC period
Correction of anemia and control of Gestational Diabetes
Training of local Dais or paramedics about proper delivery and referral system
Raising awareness about institutional delivery
Manage actively fetal distress
Ensuring proper training of neonatal resuscitations

MANAGEMENT
◦MEDICAL
◦GOALS
TO CONTROL CONVULSIONS
TO TREAT UNDERLYING PATHOLOGY
1. Initial stabilization
Establish TABC
Apply O2 and ventilations
Establish IV access
Take samples for initial studies

2. DRUGS
First line (benzodiazepines)
Diazepam- 0.5mg/kg (max 10 mg) IV slow
Lorazepam- 0.05-0.1mg/kg IV per rectum or sublingual
Midazolam- 0.1-0.2mg/kg IV or IM
Dose may be repeated q5minutes up to 3 doses
Monitor respirations

3. SECOND LINE DRUGS (PHENYTOIN AND BARBITURATES
Phenytoin- 20mg/kg slow IV ( no faster than 1 mg/kg/min with a maximum
of 50 mg/min
Phenobarbitone- 15-20 mg/kg slow IV
Monitor blood pressure
4. Other drugs
Carabamzepine- 10-15mg/kg/day
Sodium valproate- 20-60mg/kg/day
Felbamate- 15mg/kg/day

Surgical management
Resective surgery
Callostomy
Multiple subpial transection

BIBLIOGRAPHY
1.Pilliteri. A child health nursing, care of the child and fanmily. New
York: Lippincott willisams and wilkins; 1999.P. 580-84
2.Dutta P. pediatric nursing. 2nd ed. New Delhi: Jaypee brothers,
2009. P. 282-86
3.Jacob A. Paediatric Nursing. 1st ed. Indore: NR Brothers; 1997.P.
257-263

4. Marlow DR, Redding BA. Text book of pediatric nursing.
6th ed. New Delhi: Elseiver. 2011; P.947-56
5. Ghai P.O, Paul K.V, Bagg. A essential pediatrics. 7th ed.
New Delhi: CBS publishers; 2010.P. 1302-08

Convulsive disorder

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Convulsive disorder