Convulsions;: A medical condition characterized by repetitive contraction and relaxation
of body muscles leading to abnormal movements of the body caused by abnormal neuronal discharge in the cerebral cortex.
Causes of Convulsions in child
• Infections
o Meningitis
o Malaria
o Septicaemia
• Metabolic conditions
o Hypoglycaemia
o Hyponatraemia
o Hypomagnesaemia
• Trauma
o Head injury
• Hypoxia
o Birth asphyxia
• Space occupying lesions
o Haemorrhage
o Tumour
o Abscess
o Toxoplasmosis
o Cysticercosis
• Toxins
o Alcohol consumption
o Lead poisoning
o Carbon monoxide poisoning
• Primary Epilepsy.
Types of Convulsion in child
• Febrile convulsions
o Occurs as a result of high fever (temperature 38.5°C and above)
o Common in age group 6 months to 6 years
o Generalized tonic-clonic convulsions
o Occur for less than 15 minutes
o No neurological deficits after the convulsion
o Child is conscious after convulsion
o Cause of fever is outside the central nervous system
• Partial seizures
o Simple
Have motor and sensory signs without loss of consciousness
o Complex
Consciousness is impaired but rarely completely lost
Presence of aura
Motor symptoms include chewing, swallowing and licking
Secondary generalized
Generalization after partial seizure
• Generalized seizures
o Atonic
Sudden loss of muscle tone causing the head or a limb to drop
Often patient falls suddenly to the floor
o Tonic
Sudden sustained muscle contractions
o Tonic clonic (grand mal)
Patient loses consciousness, falls down, sometimes with screams, and develops
general stiffness (tonic phase)
Breathing stops, all muscles are in spasm
Followed by clonic phase- muscles alternatively contract and relax
Patient might bite his tongue, pass urine and faeces, followed by post ictal sleep
• Absence seizures (true, atypical)
o Sudden loss of consciousness lasting for few seconds, but not more than 30 seconds
o Occur in childhood
o Occur many times a day
o Myoclonic
Brief muscle jerking (contractions).
Management of Convulsions in child
Aims of Management
Ensure the airway is clear and the child is breathing
• Position the child to avoid injury
• Stop convulsions
• Prevent and treat hypoglycaemia
• Find and treat cause.
Management Procedure
• Diazepam injection
o Insert syringe 4 to 5 cm into rectum and inject
o Hold buttocks together for a few minutes
o Rectal dose 0.5 mg/kg (IV dose 0.2-0.3 mg/kg)
o Can give up to 3 doses if convulsion continues after 10 to 20 minutes
o Avoid oral medication until convulsion controlled
o Avoid diazepam and use phenobarbitone instead in infants < 2 weeks of age, 5 to 10
mg/kg IV every 15 to 30 minutes
o Diazepam can cause hypotension and respiratory depression
o Acts quickly but does not last long
o Useful for the acutely convulsing child but needs to be followed by a long-acting
anticonvulsant
• Check glucose
o Low = < 2.5 mmol/L in well nourished child, < 3 mmol/L in severely malnourished
child
o If low or unavailable, give 10% dextrose 5 ml/kg
o Recheck in 30 minutes
o If still low repeat bolus