Definition
•
They are defined as a paroxysmal involuntary
disturbance of brain function that may be manifested as an impairment or loss
of consciousness, abnormal motor activity, behavioralabnormalities, sensory
disturbance or autonomic dysfunction. Convulsions are among the most common
pediatric emergencies.
•
Convulsions which chronically recur may be due
to primary epilepsy, or secondary epilepsy following some insult to brain as
post-traumatic, post-anoxic and with some inborn errors of metabolism.
•
Causes of acute seizures in infants and
children
•
1- Fever: febrile convulsions.
•
2- Intracranial infections: meningitis, encephalitis, brain
abscesses.
•
3- Encephalopathies e.g. post-exanthem, post-immunization.
•
4- Metabolic and electrolyte disturbances: hypoglycemia,
hypocalcemia, hypomagnesemia, hyponatremia, hypernatremia, alkalosis,
pyridoxine deficiency.
•
5- Intoxications:
•
· Endogenous: uremia or hepatic encephalopathies.
•
· Exogenous: e.g. acute lead
poisoning.
•
· Therapeutic: e.g theophylline, isoniazid.
•
6- Head trauma: subdural hematoma and intracranial hemorrhage.
•
7- Non-traumatic intracranial
hemorrhage:arterio-venous malformations and bleeding disorders.
•
8- Hypertensive encephalopathy.
•
9- Cerebral ischemia:
•
a- Arterial spasm, thrombosis or embolism.
•
b- Venous thrombosis.
•
c- Circulatory collapse.
•
d- Brain anoxia.
•
Diagnosis
•
The following investigations may help in
diagnosis:
•
1- Urine analysis.
•
2- Tuberculin testing.
•
3- Blood gases and pH.
•
4- Blood picture.
•
5- CSF examination.
•
6- Serum Na, Ca and Mg.
•
7- Coagulation screen.
•
8- Blood, urine and CSF cultures.
•
9- Blood glucose and blood urea/ creatinine.
•
10- Liver function tests.
•
11-Skull x-ray and CT scan.
•
12- EEG.
•
13- Search for toxins and drugs in serum and urine.
•
Treatment of recurrent convulsions
•
Epilepsy:
is the main cause of recurrent convulsions. Epilepsy is suggested by
presence of 2 unprovoked seizures within less than 24 hr. period.
•
Carbamazepine: is highly effective for all partial seizures;
and is highly effective for generalized tonic-clonic seizures. Dosage is 10 to
30 mg/kg/day.
•
Valproate: it is a broad-spectrum anticonvulsant drug. It
mainly used for generalized seizures.
•
It is especially useful for myoclonic and
absence seizures. It is also used in partial seizures. It is given in a dose of
20 to 60 mg/kg/day.
No comments:
Post a Comment