CONVULSIONS

 

 

Convulsions

Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly.

The term "convulsion" is often used interchangeably with "seizure," although there are many types of seizures, some of which have subtle or mild symptoms instead of convulsions. Seizures of all types are caused by disorganized and sudden electrical activity in the brain.

Considerations

Convulsions can be unsettling to watch. Despite their appearance, most seizures are relatively harmless. They usually last from 30 seconds to 2 minutes. However, if a seizure is prolonged, or if multiple seizures happen and the person doesn't awaken in between, this is a medical emergency.

If a person has recurring seizures, and no causes can be identified, that person is said to have epilepsy. Epilepsy can usually be controlled well with medication.

Pay attention to:

• Which arms or legs are shaking
• Whether there is any change in consciousness
• Whether there is loss of urine or stool
• Whether the eyes move in any direction

Causes

• Alcohol use
• Barbiturates, intoxication or withdrawal
• Brain illness or injury
• Brain tumor (rare)
• Choking
• Drug abuse
• Electric shock
• Epilepsy
• Fever (particularly in young children)
• Head injury
• Heart disease
• Heat illness
• Illicit drugs, such as angel dust (PCP), cocaine, amphetamines
• Low blood sugar
• Meningitis
• Poisoning
• Stroke
• Toxemia of pregnancy
• Uremia related to kidney failure
• Very high blood pressure (malignant hypertension)
• Venomous bites and stings
• Withdrawal from benzodiazepines (such as Valium)

Symptoms

• Brief blackout followed by period of confusion
• Drooling or frothing at the mouth
• Eye movements
• Grunting and snorting
• Loss of bladder or bowel control
• Sudden falling
• Teeth clenching
• Temporary halt in breathing
• Uncontrollable muscle spasms with twitching and jerking limbs
• Unusual behavior like sudden anger, sudden laughter, or picking at one's clothing

The person may have warning symptoms before the attack, which may consist of:

• Fear or anxiety
• Nausea
• Vertigo
• Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes)

First Aid

1. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.
2. Cushion the person's head.
3. Loosen tight clothing, especially around the person's neck.
4. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
5. Look for a medical history or a tag.
6. Stay with the person until he or she recovers, or until you have professional medical help. Meanwhile, monitor the person's vital signs (pulse, rate of breathing).

In an infant or child, if the seizure occurs with a high fever, cool the child gradually with tepid water. You can give the child acetaminophen (Tylenol) once he or she is awake, especially if the child has had fever convulsions before. DO NOT immerse the child in a cold bath.

DO NOT

• DO NOT restrain the person.
• DO NOT place anything between the person's teeth during a seizure (including your fingers).
• DO NOT move the person unless he or she is in danger or near something hazardous.
• DO NOT try to make the person stop convulsing. He or she has no control over the seizure and is not aware of what is happening at the time.
• DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.

Signs and tests

A physical examination (including a detailed neurologic examination) may be normal, or it may show abnormal brain function related to specific areas of the brain.
People with epilepsy will often have abnormal electrical activity seen on an electroencephalograph (EEG). (An EEG is a reading of the electrical activity in the brain.) In some cases, the test may show the location in the brain where the seizures start. EEGs can often be normal after a seizure or between seizures, so it may be necessary to perform a longer test.
Various blood tests and other tests looking for temporary and reversible causes of seizures, may include:

• Blood chemistry
• Blood sugar
• CBC (complete blood count)
• CSF (cerebrospinal fluid) analysis
• Kidney function tests
• Liver function tests
• Tests for infectious diseases

Tests for the cause and location of the problem may include:

• EEG
• Head CT or MRI scan
• Lumbar puncture (spinal tap)

Treatment

If an underlying cause for recurrent seizures (such as infection) has been identified and treated, seizures may stop. Treatment may include surgery to remove a tumor, an abnormal or bleeding blood vessel, or other brain problems.
Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures. These drugs are taken by mouth.

• The type of medicine you take depends on what type of seizures you are having. The dosage may need to be adjusted from time to time.
• Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels.
• It is very important that you take your medication on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct dosage.
• You should not stop taking or change medications without talking to your doctor first.

Some factors increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

• Certain prescribed medications
• Emotional stress
• Illness, especially infection
• Lack of sleep
• Pregnancy
• Skipping doses of epilepsy medications
• Use of alcohol or other recreational drugs

Epilepsy that does not get better after two or three seizure drugs have been tried is called "medically refractory epilepsy."

• Some patients with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures.
• Others may be helped by a vagal nerve stimulator. This is a device that is implanted in the chest (similar to a heart pacemaker). This stimulator can help reduce the number of seizures, but rarely stops the seizures completely.

Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults.
Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.

Please Note

Call your doctor or hospital:

• This is the first time the person has had a seizure.
• A seizure lasts more than 2 to 5 minutes.
• The person does not awaken or have normal behavior after a seizure.
• Another seizure starts soon after a seizure ends.
• The person had a seizure in water.
• The person is pregnant, injured, or has diabetes.
• The person does not have a medical ID bracelet (instructions explaining what to do).
• There is anything different about this seizure compared to the person's usual seizures.

Expectations (prognosis)

Some people with certain types of seizures may be able to reduce or completely stop their seizure medicines after having no seizures for several years. Certain types of childhood epilepsy goes away or improves with age -- usually in the late teens or 20s.
For some people, epilepsy may be a lifelong condition. In these cases, the seizure drugs need to be continued.
Death or permanent brain damage from seizures is rare. However, seizures that last for a long time or two or more seizures that occur close together (status epilepticus) may cause permanent harm. Death or brain damage are most often caused by prolonged lack of breathing, which causes brain tissue to die from lack of oxygen. There are some cases of sudden, unexplained death in patients with epilepsy.
Serious injury can occur if a seizure occurs during driving or when operating dangerous equipment. For this reason, people with epilepsy whose seizures are not under good control should not do these activities.
People who have infrequent seizures may not have any severe restrictions on their lifestyle.

Complications

• Difficulty learning
• Inhaling fluid into the lungs, which can cause aspiration pneumonia
• Injury from falls, bumps, or self-inflicted bites during a seizure
• Injury from having a seizure while driving or operating machinery
• Many epilepsy medications cause birth defects -- women wishing to become pregnant should alert their doctor in advance in order to adjust medications
• Permanent brain damage (stroke or other damage)
• Prolonged seizures or numerous seizures without complete recovery between them (status epilepticus)
• Side effects of medications

Prevention

Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy.
People with epilepsy should always take any prescribed medication and wear a medical alert tag.
Keep fevers under control, especially in children
Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy.
Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.