convulsion

Under supervision

Dr /Athar Ammar

Prepared by
 ‫‪/1‬محمد عيل ابراهمي عبد امحليد‬
‫‪/2‬محمد عيل رساج ادلين‬
‫‪/3‬محمد عيل ضيف هللا محمد‬
‫‪/4‬محمد عامد الس يد امجلل‬
‫‪/5‬محمد عامد كامل ادلين‬
‫‪/6‬محمد معر حفين متويل‬
‫‪/7‬محمد عيد عبدالقادر هامم‬
‫‪/8‬محمد فتح هللا ابو ربع‬
‫‪/9‬محمد فتحي عطيه ابو خرض‬
‫‪/11‬محمد كرم عبدالرسول‬
‫‪/11‬محمد محمد حسني‬
‫‪/12‬محمد محمود سعد حسان‬

‫‪Outlines .‬‬
‫‪1. Introduction‬‬
‫‪2. Definition‬‬
‫‪3. Pathophysiology‬‬
4. Difference between convulsion, seizure and
epilepsy.
5. Types
6. Causes
7. Clinical manifestations
8. Diagnosis
9. Medical management
10. First aid
11. Nursing management
12. Seizure precautions
13. Instructions at home
14. Complications
15. Prevention.
Introduction.
Convulsion is a chronic noncommunicable disease of
the brain that affects people of all ages.
Around 50 million people worldwide have epilepsy,
making itone of the most common neurological
diseases globally.
Nearly 80% of people with epilepsy live in low- and
middle- income countries.It is estimated that up to 70%
of people living with epilepsy could live seizure- free if
properly diagnosed and treated.
The risk of premature death in people with epilepsy is up
to three times higher than for the general
population.Three quarters of people with epilepsy living
in low-income countries do not get the treatment they
need.
In many parts of the world, people with epilepsy
and theirfamilies suffer from stigma and
discrimination.
Definition of convulsions :
A convulsion is a general term that people use to describe
uncontrollable muscle contractions. Some people may use it
interchangeably with the word “seizure,” although a seizure
refers to an electrical disturbance in the brain.
Seizures may cause a person to have convulsions, but this is not
always the case.
In this article, learn more about what convulsions are, as well as
their possible underlying causes.
A convulsion occurs when a person‟s muscles contract
uncontrollably. They can continue for a few seconds or many
minutes.
Convulsions can happen to a specific part of a person‟s body or
may affect their whole body.
Definition of Seizure:
Uncontrolled electrical activity in the brain, which may produce
a physical convulsion, minor physical signs, thought
disturbances, or a combination of symptoms.
The type of symptoms and seizures depend on where the
abnormal electrical activity takes place in the brain, what its
cause is, and such factors as the patient's age and general state of
health.
Definition of Epilepsy :
Epilepsy is a group of non-communicable neurological disorders
characterized by recurrent epileptic seizures. Epileptic seizures
can vary from brief and nearly undetectable periods to long
periods of vigorous shaking due to abnormal electrical activity
in the brain.
Difference between convulsion, seizure and epilepsy:-
Convulsion:- It‟s an episodes of unctrollable movement which is
visible and occurs on the patient as a sudden contract of the
muscles
Seizure: - It‟s invisible electrical activities that occur in the brain
and causes many changes in behavior, movement and loss of
consciousness. Not all seizures cause convulsion but the most
common cause is tonic-seizure.
Epilepsy: - It‟s recurrent and unprovoked central nervous system
disorder (seizure). As if the child has 2 or more than convulsion
without a clear cause, this condition called epilepsy.

Pathophysiology
Neurons are nerve cells, which communicate through membrane
potential. Positive and negative ions in an appropriate balance
inside and outside of a neuron determine if the neuron is at rest
or at work (i.e. sending messages). Ions are chemical
messengers with positive or negative charges that cause an
electrical signal to be sent by the brain. A neuron is at a resting
membrane potential when the charge inside the cell is more
negative than the outside. When a neuron is at work, its action
potential is engaged through the change in balance of positive
and negative ions and an electrochemical message is sent, which
causes the body to voluntarily or involuntarily move, feel, or
behave. Thus, neurons are electrochemical messengers in the
body.
During a seizure episode, the membrane potential of neurons is
altered in a way that causes neurons to be hypersensitive or
overactive due to certain stimuli or triggering events.
Types of convulsion
Classification and clinical manifestation of convulsion
(seizures):

• Focal seizure
lb Generalized seizure
l-Partial seizure
1- Simple Partial seizure with motor signs:
• Most common in children
• Eye and face turned away of the body
• Tonic -colonic movements may occur especially in the
 face
• Salivation
• Loss of consciousness may occurs
• Arrested speech.
Simple partial Seizure with sensory signs .
 Un common in children less than 8 years .
 Numbness , tingling .
 Motor phenomenon such as hypertonia.
 Visual sensation .

3- Complex Partial seizure (psychomotor seizure):

• Common in children from 3 years through adolescence
• Altered behavior can occurs
• inability to respond to the environmentimpaired
consciousness '
• drowsiness or sleep following seizure
• unpleasant odor or taste
• auditory or visual hallucinations

IbGenerelized seizure:

1- Tonic – Colonic seizure (Grand mal seizure): is most

common.

• It occurs abruptly without warning in the form of

specific phases.
• Tonic phase Lasts approximately 10-20 seconds
 Manifestations.**

• Eye roll upward

• Immediate loss of consciousness

• The child entire body becomes stiff.

• Salivation
• Cyanosis with apnea

b-C olonic phase varies from 30 seconds to 30 minutes or

longer.

Manifestations:-

• Pale face with eyes fixed in one position

• Violent jerking movements: contraction and relaxation
of trunk and extremity
• The child may become incontinent and bit his tongue
or check.
• It needs emergency intervention because it can lead to
respiratory fathjfia
• Death.

Poet convulsive sate of the child.-

 • The child is sleepy or exhausted
• May complains of headache
• Often performs relatively automatic tasks without
being able to do it.
• Electroencephalogram (EEG) shows multiple high
voltage spike discharge.

Status Epileptcus phase:- is a series of seizures at

interval too brief to

• child to regain his consciousness.

• Signs and symptoms include ataxia, asphyxia, and
mental sluggishness
• It can lead to also respiratory failure and death
• Irreversible brain damage may occurs due to
prolonged hypoxia so it emergency intervention.

Absence Seizures : onset between 4-12 years and

usually cease at puberty. More common in girsthan boys

Manifestation .

 Duration is 5-10 seconds

 Brief loss of consciousness( the child may appear day
dreaming) Occurs without waming
  Slighty loss of muscles tone cause child to drop
objects falls Minor movements of lips, hands and
twitching of eyelids.
 Post convulsions the child experiences amnesia of the
onset and appears normal
 And not aware of having convulsions

Manifestations
 Sudden loss of muscles tone cause the child to fall in
the floor

Atonic seizures (known as drop attack onset usually.25

years of age.

 Loss of consciousness may momentary

Myoclonic seizures: may be isolated a benign or in

association with other seizures.

Manifestations:

 Sudden contraction of a muscle or group of muscles

 May or may not loss of consciousness

4infantile spasm: most common during 6-8 months of age

and twice as common in boys as in girls.
Manifestation:
 The child experienced sudden brief symmetric
muscular contractions
 Head flexed, arm extended and leg drawn up
 Eyes rolling upward or inward
 May or may not loss of consciousness
 Flashing pallor or cyanosis
 Followed by cry or giggling

Causes
Etyological causes
 Acute non recurrent convulsion
 Febrile seizure or convulsion:-

 Definition :- it is a convulsion in a child that is caused by

fever.

 _febrile convulsion is a most common cause of convulsion.

 _it occure from 6m for 6year of age.

 _febrile convulsion is associated with extra cranial

infections most commonly with throat infection,GIT
infection,otitis media, pyelonephritis.
  _febrile convulsion can caused by viral or bacterial
infections but viral infections most commonly than
bacterial infections as the flu (influenza)virus and the virus
that causes roseola.
 _febrile convulsion never occure before 6m.
 _febrile convulsion occures only during elevated body
temperature.
 _febrile convulsion is not epilepsy and ashort-lived fit will
not cause brain damage ,even if a long fit almost never
cause a harm.
 _febrile convulsion is most common in man than women .
 _the attack in febrile convulsion may be short in duration
(less than 15 minutes),(good prognosis).
Clinical manifestations of febrile convulsion-:
1-have a fever higher than 100,4f,or 38c.
2- loss of consciousness.
3- shak or jerk the arms and legs.
Febrile convulsion may classified as Simple and complex:-
1- simple febrile convulsion:- it is the most common type lastes
from a few seconds to 15m .
_simple febrile convulsion don't recur within 24h period and
aren't specific to one part of the body.
2- complex febrile convulsion:-
This type lastes more than 15 minutes occur more than once
within 24h or is confined to one to one side of the body.

Types of prognosis of febrile convulsion:-

1- good prognosis:- if first attack occur<3years .
2- bad prognosis:-
_If first attack occur>3years.
_EEG change between attack.
_attack long in duration more than 15m.
Treatment
1. Antipyretic to decrease body temperature.
2. -cold compression to low body temperature.
3. -anticonvulsant drug to block episode of febrile convulsion
as depakin .
4. -treatment of cause by giving antibiotics to treat viral or
bacterial infections.
_in the acute setting of febrile convulsion ,IV diazepam and
lorazepam are the drug of choice for aborting convulsion or
terminating continuous febrile convulsion 10.Immediately see
the doctor if febrile convulsion lastes more than 5minuts with
vomiting,stiff neck , breathing problems,extreme sleepines
Intracrainal infection
 • Intracrainal hemorrhage
• Intracrainal space occupying lesion (tumor_abessess)
• Drugs
• Toxins
• Anoxia
• Metabolic alteration
• hypoglycemia
• hyponatremia
• hypernatremia
• hypocalcemia
• hypemagnicemia
• hypoalbilirubinemia
• alkalosis
Chronic recurrent convulsion
1-idiopathic epilepsy
2- epilepsy secondary to
Trauma
• Anoxia
• Connected defects
• Hypoglycemic injury
• Infection
• Toxins
• Hemorrhage
• 3- epilepsy sensory stimulus
 • 4- epilepsy stimulating status
• Narcolepsy
• Psychogeni
• Tetany
• 5-hypoglycemic status
• Uremic

Clinical manifestation:

Unfortunately, it is not always easy to recognize a seizure.

Not all seizures include convulsions or unusual muscle
movements. The child may seem to be just daydreaming
or not paying attention. The seizure may not even last a
minute. Afterward, the child's brain will return to normal.
But over time, if the child keeps having them, untreated
seizures can be dangerous and get in the way of a child's
growth and education.
Recognizing seizures in babies and infants is especially
difficult, because they cannot tell you how they feel or
what they remember.

Manifistation of convulsion :
 • Tremors, convulsions, or jerking movements in the arms
and legs
• Stiffening of the body
• Loss of consciousness
• Breathing problems
• Loss of bowel or bladder control
• Falling suddenly for no apparent reason
• Not responding to noise or words for short periods of
time
• Appearing confused or in a haze
• Extreme sleepiness and irritability when waking up in
the morning
• Head nodding
• Periods of rapid eye blinking and staring
• Vomiting
• Changes in vision, speech, or both.
Risk factors •
• (more likely to develop convulsions in
children) : Family history of epilepsy .
Previous history one tonic - colonic seizure .
• Children who have autism , cerebral palsy or
other brain disorders .
• Children who have had abnormal results from an
electroencephalogram ( EEG ) , This test
measures electrical activity in the brain .
Prevention
Seizure prevention and epilepsy management
depend on taking prescribed medications as
well as maintaining an overall healthy
lifestyle.

1. Give child the medication as prescribed:-

Anti-epileptic medications are designed to help
prevent seizures. You should never stop giving
these medications without doctor’s approval —
even if the child condition seems to be
improving.
2- Practice stress management:-
Stress can be a trigger for seizures in epilepsy.
It may help to reduce the risk of seizures if
managed it :
• getting enough sleep
• exercising
• taking time to relax.
3- Maintain a sleep schedule :-
-Waking up and going to bed at the same
time every day can help to maintain a sleep
schedule.
Tiredness and short-term sleep deprivation are
considered triggers for seizures, so regular
sleep can help prevent them.
4- Keep a consistent meal schedule:-
Hypoglycemia from skipping a meal can cause
a seizure, particularly for people with diabetes.
5- Avoid flashing lights:-
According to the Epilepsy Society, it’s
estimated that about 3 percent of people with
 epilepsy have a rare form called photosensitive
epilepsy. With this type of epilepsy, your
seizures may be triggered by flashing lights or
contrasting patterns of light.
6- Protect the child from head injuries:-
Head injuries can lead to a single seizure or
recurrent seizures in someone who doesn’t have
epilepsy.
7- Call a medical professional if your infant
has a high fever:-
Some children between the ages of 6 months
and 5 years may be at risk of developing febrile
seizures. These are triggered by fevers of 101°F
(38°C) or higher and may accompany infections.
• Not every child with a high fever will
develop a febrile seizure, and the episode
may occur hours later.
8- Consider surgery:-
Northwestern Medicine estimates 20 percent
of people with epilepsy may be candidates for
minimally invasive surgery if medications don’t
work to prevent seizures.
• Two possible techniques you may discuss
with your doctor are:
1- laser ablation
2- responsive neurostimulator (RNS) insertion

Diagnosis: -
It’s important to watch the symptoms of seizure carefully to
describe how it looked and how long it lasted.
 Physical examination:- Common physical examination
findings of epileptic seizure include: Automatic behaviors,
upward eye rolling, unconsciousness, drooling, cyanosis,
post ictaldrowsiness, fever, tachycardia, hypertension,
mydriasis, nystagmus, urine and fecal incontinence,
disorientation to persons, place, and time, altered mental
status, automatic behaviors (repetitive muscle
movement), Muscle rigidity and hyper-reflexes.
  Blood test: - By taking blood sample to check blood sugar,
any signs of infection and electrolyte imbalance.
 EEG (Electroencephalography): - It’s the most common
cause used to diagnose seizure. It can be done in doctor’s
office or in the hospital or it may be done at home which
you wear at home while the EEG records seizure activity
over the course of a few days.
 CT scan:- It shows any abnormalities In the structure of the
brain that cause seizure as tumor and by using X-ray.
 MRI: - measures the changes in the blood flow that occur
when specific types of your brain are working by using a
powerful magnets and radio waves for detailed view of the
brain.
 PET: - use a small amount of radioactive material to be
injected into vein to see metabolic activity of the brain to
detect any abnormalities.
 Single-photon emission computerized tomography
(SPECT): - It’s used primarily when ECG and MRI can’t
determine the location of seizure in the brain by injection
of radioactive material in the vein.
 Neurophysiological tests: - In these tests, the doctor
assesses thinking , speech skills and memory to detect the
area where the seizure occur.
 Lumbar puncture: - It’s the removal and testing of fluids
that surrounds the brain and spinal cord.
Medical Management of convulsion :

places children at increased risk of accidents, such as

drowning, head injury from a fall, or choking.Frequent
seizures may create both social and academic
disadvantages for children .
Most people can manage epilepsy. Your treatment plan
will be based on severity of symptoms, your health, and
how well you respond to therapy.
Some treatment options include:
Anti-epileptic (anticonvulsant, antiseizure) drugs:
These medications can reduce the number of seizures you
have. In some people, they eliminate seizures. To be
effective, the medication must be taken exactly as
prescribed.
With some medications, a child will need to have regular
blood tests to ensure that the blood level of the
anticonvulsant drug is within a therapeutic range. The level
may be affected by recent illness, other medications, and
the child's nutritional status.
Most medication used to treat convulsion :
Phenytoin (Dilantin)
In addition to its use as a daily anticonvulsant, phenytoin
(Dylantin) is often given intravenously in the emergency
room to stop an ongoing seizure.
Side effects: Potential side effects include involuntary eye
movements, rashes, balance difficulties, weakened bones,
nausea, and drowsiness. Attention and memory problems
can occur, but are generally less severe than those
associated with phenobarbital.
Overgrowth of the gums (gingival hyperplasia) can also be
associated with phenytoin use. Careful oral hygiene is
necessary to avoid infection, bleeding, and decay.
Phenobarbital
Phenobarbital is one of the oldest and safest
anticonvulsants for children. It is most commonly used for
infants and toddlers. Initially, phenobarbital may cause
drowsiness, but the child usually develops tolerance to this
side effect.
Side effects: After several weeks or months of treatment,
some children may develop hyperactivity, aggression, and
insomnia. These side effects may respond to a decrease in
dosage. However, some children may need to stop taking
this medication.
Vagus nerve stimulator:
This device is surgically placed under the skin on the chest
and electrically stimulates the nerve that runs through your
neck. This can help prevent seizures.
In conventional vagus nerve stimulation, a device is
surgically implanted under the skin on your chest, and a
wire is threaded under your skin connecting the device to
the left vagus nerve. When activated, the device sends
electrical signals along the left vagus nerve to your
brainstem, which then sends signals to certain areas in your
brain.
Mechanism:
Here's how: When someone is extremely stressed, the
vagus nerve can get overstimulated as it works to bring
down heart rate and blood pressure. This may cause
someone's heartbeat to slow down too much. Blood
pressure may now plummet. Under these conditions, too
little blood reaches the head causing someone to faint.
Risks :
For most people, vagus nerve stimulation is safe. But it
does have some risks, both from the surgery to implant the
device and from the brain stimulation.
Surgery risks :
Surgical complications with implanted vagus nerve
stimulation are rare and are similar to the dangers of having
other types of surgery. They include:

 Pain where the cut (incision) is made to implant the

device
 Infection
 Difficulty swallowing
 Vocal cord paralysis, which is usually temporary, but
can be permanent
Side effects after surgery :
Some of the side effects and health problems associated
with implanted vagus nerve stimulation can include:

 Voice changes
 Hoarseness
 Throat pain
 Cough
 Headaches
 Shortness of breath
 Difficulty swallowing
 Tingling or prickling of the skin
  Insomnia
 Worsening of sleep apnea
For most people, side effects are tolerable. They may
lessen over time, but some side effects may remain
bothersome for as long as you use implanted vagus nerve
stimulation.
Adjusting the electrical impulses can help minimize these
effects. If side effects are intolerable, the device can be shut
off temporarily or permanently.
Ketogenic diet:
the ketogenic diet is effective for some individuals with
epilepsy. It is based on the observation that depriving the
body of carbohydrates promotes the release of a class of
blood chemicals, called ketones. Ketones can help prevent
some seizures.

Children must consume a diet composed largely of fat--the

ratio of fat to carbohydrates and protein is typically 4 to 1.
Much of the fat must be taken as heavy cream, mayonnaise,
or butter. The diet requires that the child's foods be
weighed. The proportion of nutrients must be calculated for
each meal. Even the carbohydrate content of the child's
medications are taken into account. Strict compliance is
necessary for the diet to be effective .

Mechanism :

Usually the body uses glucose (a form of sugar) from

carbohydrates (found in foods like sugar, bread or pasta)
for its energy source. Chemicals called ketones are made
when the body uses fat for energy (this is called „ketosis‟).
With the ketogenic diet, the body mostly uses ketones
instead of glucose for its energy source.

The ketogenic diet has been used to reduce seizures since

the 1920s. The mechanism by which the seizures are
controlled are poorly understood. Both the low sugar
component and high fat component uniquely alters the
„excitability‟ of the brain, thereby reducing the tendency to
generate seizures.

Risks of the keto diet :

Staying on the keto diet in the long term may

have including the following:

 low protein in the blood

 extra fat in the liver
  kidney stones
 micronutrient deficiencies
 poor energy and mental function
 increased hunger
 sleep issues
 nausea
 digestive discomfort
 decreased exercise performance
Brain surgery:
Epilepsy surgery is a procedure that removes an area of the
brain where seizures occur.
Epilepsy surgery is most effective when seizures always
occur in a single location in the brain. It is not the first
line of treatment but is considered when at least two anti-
seizure medications have failed to control seizures.
Resective surgery, the most common epilepsy surgery, is
the removal of a small portion of the brain. The surgeon
cuts out brain tissues in the area of the brain where
seizures occur, usually the site of a tumor, brain injury or
malformation
 Risks :
Different areas of the brain control different
functions. Therefore, risks vary depending on
the surgical site andthe type of surgery.

 Memory and language problems that can

affect yourability to understand and use
language
 Visual impairment where the fields of
vision of youreyes overlap
 Depression or other mood changes that
can affectinterpersonal or social well-
being
 Headache
 Stroke

Nursing Management
Nursing care for a patient with febrile seizure
include the following:

Nursing Assessment
Assessment is necessary in order to identify
potential problems that may have lead to the
condition as well as name any episode that
may occur during nursing care.
 Identify underlying cause. Identify the
triggering factors; determination and
management of the underlying cause are
necessary to recovery.
 Assess patient’s vital signs. Monitor the
patient’s HR, BP, and especially the
tympanic or rectal temperature.
 Assess age and weight. Extremes of age
or weight increase the risk for the inability
to control body temperature.
 Assess I&O status. Monitor fluid intake
and urine output; fluid resuscitation may
be required to correct dehydration.
First aid
1-Airway: a patented airway ;
aspirate secretion, loosening
tight cloth
2- Breathing : inhalation of
oxygen.
3- Drug control of convulsions
(give it suppository during the
fit). Phenobarbitone 5
mg/kg intramuscularly, to be
repeated after 30 m if
convulsions persist.
Paraldehyde 0.2 ml/kg. •
Depakine (valproic acid) 4-Do
 not restrain the child during
the

seizure
. 5 - Do not place anything
between the person's teeth
during a seizure (including
your fingers). If available put
a tongue blade or a piece of soft cloth.
6 - DO not move the child
unless he or she is in danger or
near something
hazardous .
7 - DO not give the person
anything by mouth until the
convulsions have stopped and
the person is
fully awake .
8 Give oxygen therapy when
the fit is stopped .
9 - Put the child in semi
fowler position to enhance
breathing

Nursing Diagnoses
Based on the assessment data, the
major nursing diagnoses are:

 Hyperthermia related to antigens or

microorganisms that cause inflammation..
 Ineffective tissue perfusion related to
failure to nourish the tissues at the
capillary level
 Imbalanced nutrition related to an
inability to meet the body’s daily energy
needs.


Nursing Care Planning and Goals

The goals for a patient with febrile seizure are:

 Patient’s temperature will decrease from

[39°C] to normal range of [36.5°C to 37°C].
 Patient will be free of complications and
maintain normal core temperature.
 Patient will identify measures to promote
nutrition and follow the treatment
regimen.
 Patient weight will be within normal
values.
 Patient will demonstrate behavior lifestyle
changes to improve circulation.
  Patient’s S.O. will verbalize understanding
of the condition.
Nursing Interventions
Nursing interventions appropriate for the
patient are:

 Check underlying factors. Assess

underlying condition and body
temperature.
 Monitor vital signs. Monitor and record
vital signs.
 Provide cold compresses. Provide a
description of the family regarding the
provision of compress; cold compresses
can reduce body temperature.
 Wear light clothing. Give light clothing
that can absorb sweat to facilitate the
release of heat into the air.
 Regulate activity. Promote adequate rest
periods to reduce metabolic demands or
oxygen.
 Increase fluid intake. Advice to increase
fluid intake to help decrease body
temperature.
  Discuss diet. Discuss eating habits and
encourage diet for age to achieve health
needs of the patient with the proper food
diet for his disease.
 Improve tissue perfusion. Elevate head
of bed at night to increase gravitational
blood flow.
Evaluation
Goals for the patient are achieved as
evidenced by:

 Patient’s temperature decreased from

[39°C] to normal range of [36.5°C to 37°C].
 Patient is free of complications and
maintain normal core temperature.
 Patient identified measures to promote
nutrition and follow the treatment
regimen.
 Patient’s weight is within normal values.
 Patient demonstrated behavior lifestyle
changes to improve circulation.
 Patient’s S.O. verbalized understanding of
the condition
Health Education
1. Clear the area to prevent
 injury.
2. Poison you on a flat,
carpeted surface, if
possible.
3. Don't try to restrain you.

4. Don't put anything in your

mouth.
5. Turn you onto your side if
you start to vomit.
6. Turn the person on their
side.
7. Do not hold the person
down or restrain the person.
8. stay with you until you
regain consciousness
9. call 911 if the seizure is
longer than 5 minutes, if
there are multiple seizure,
or if you don't start to
wake up are the seizure
stops.