Convulsions

Question 1

What is a seizure

Answer 1

SEIZURE is a transient occurrence
of signs and or symptoms
resultng from abnormal excessive
or synchronous neuronal actvity
in the brain

Question 2

EPILEPSY

Answer 2

Epilepsy is a disorder
characterized by two or more
unprovoked seizures occurring
more than 24 hours apart beyond
neonatal period

Question 3

CONVULSION

Answer 3

A convulsion is any seizure ( no
necessary epileptc) characterized
by excessive, abnormal muscle
contractons which are usually
bilateral

Question 4

SEIZURES VS EPILESY

Answer 4

SEIZURE
A seizure is the event
EPILEPSY
Epilepsy is the disease associated
with spontaneous recuring
seizures

Question 5

PRE-ICTAL

Answer 5

Was there any warning before the spell ?
• What was the child doing before the spell ?
• What the child asleep or awake ?
• Was there a fever or an illness ?

Question 6

ICTAL

Answer 6

Was the child responding ? What was the Level of consciousness
• What body movements occurred
• How long did the spell last ?
• How many episodes did the child experienced ?
Terminology
- Jerking/ Shaking
- Stfening
- Staring
- Falling

Question 7

POST-ICTAL

Answer 7

• How did the child fell afer the spell?
• Did the child seem confused and tred afer the spell ?
• How long did it take for the child to get back to baseline conditon?
• Did the sufered headache or weakness afer the spell?

Question 8

CLASSIFICATION

Answer 8

FOCAL ONSET
Generalized onset

Question 9

Focal onset

Answer 9

Motor onset
- Tonic
- Clonic
Non-motor onset
- Sensory
- Behavioral
- Emotonal

Question 10

Generalized onset

Answer 10

Motor onset
- Tonic-clonic
- Tonic
- Myoclonic
Non-motor onset ( Absence)

Question 11

EVALUATION

Answer 11

1. Seizures or seizure mimic ?
2. Is it provoked or unprovoked ?
3. Is it generalized or focal ?
4. Etology?
5. Any associated morbidity
6. Any impairment in behaviour, mood and educaton ?
7. Treatment received tll now?

Question 12

SYMTOMATIC SEIZURES

Answer 12

• CNS Infectons
• CNS trauma
• Cerebrovascular Stroke
• Tumors
• Metabolic
• Congenital brain malformatons
• Febrile seizures

Question 13

DIFFERENTIAL DIAGNOSIS

Answer 13

Syncope
• Breath holding
• Apneic of prematurity
• Panic atacks
• Benign neonatal sleep myoclonus
• Jiteriness

Question 14

Neonatal seizures definition

Answer 14

An abnormal synchronous electrical discharge of a group of neurons in
the central nervous system.
Neonatal brain is hyperexcitable and more likely to have seizures

Question 15

CLINICAL MANIFESTATIONS

Answer 15

Clinical manifestaton may be
- Subtle: eye deviaton, eye futering, bucco-lingual
- Pedaling of arms and legs
- Focal: tonic or clonic
- Generalized: multfocal rhythmic jerking, generalized posturing or
myoclonic

Question 16

IMPORTANT CAUSES

Answer 16

• Brain damage form hypoxic –ischemia, bleeding, infract
• Brain malformaton
• Meningits or encephalits
• Hyperbilirubinemia kernicterus
• Hypoglycemia
• Metabolic
• Drug withdrawal

Question 17

INVESTIGATIONS

Answer 17

BLOOD
- Infectons
- Biochemicals
- Metabolic
LUMBAR PUNCTURE
- CSF examinaton
BRAIN IMAGING SUCH AS CRANIAL ULTRASOUND, CT-SCAN OR MRI
EEG

Question 18

If you are with someone having a tonic-clonic seizure (where
the body stifens, followed by general muscle jerking), try to:

Answer 18

Stay calm and remain with the person.
• If they have food or fuid in their mouth, roll them onto their side
immediately.
• Keep them safe and protect them from injury.
• Place something soft under their head and loosen any tight clothing.
• Reassure the person until they recover.
• Time the seizure, if you can.
• Gently roll the person onto their side after the jerking stops

Question 19

If a person has a seizure when they are in a wheelchair, car seat or stroller:

Answer 19

Leave the person seated with the seatbelt on (unless it is causing injury).
• Put the wheelchair brakes on.
• If it’s a tilt wheelchair, tilt the seat and lock in position.
• Support their head until the seizure has ended.
• Lean the person slightly to one side to aid drainage of any fuid in the mouth.
After the seizure, if the person is having trouble breathing or they need to
sleep, take them out of the chair and put them in the recovery position.
If their breathing difculties continue, call for help and ambulance and
closely monitor the person. Be prepared to performCPRif they stop
breathing.

Question 20

When to call for help and ambulance for an epileptic seizure

Answer 20

The seizure lasts for5or more minutes or longer than
what is normal for the person
• A second seizure quickly follows
• The person is not responding for more than 5 minutes
after the seizure ends
• The person has breathing difculties after the jerking stops
• It is the child’s frst known seizure
• The person is injured
• You are in doubt