In simple terms, a convulsion or a fit refers to abnormal involuntary movement(s) of the body with or without disturbed consciousness. The movements can involve almost the whole body or just the finger or any other part of the body. Unconsciousness may be prolonged or may be momentary and take the form of a stare.
Most causes of convulsions are not serious and disappear as the child grows older. A few types may need medication for 2 years or more.
Management of a Convulsion:
Step 1: As a prolonged convulsion can affect the brain, it makes sense to control it. Fortunately, most convulsions last a minute or two and stop on their own. Usually, a drug (diazepam or phenytoin) is injected into the vein of the child to stop the convulsion. Sometimes, a different drug may be injected into the muscles.
You must not give the child anything by mouth while he is having a convulsion.
If your child has a tendency to get convulsions, especially with high fever, your doctor may advise rectal administration of diazepam. It is quite effective if used soon after the child is found to have fever. Diazepam by mouth has also been found to be helpful to prevent convulsions with fever. It is also to be started with the onset of fever. However, rectal administration is more effective than oral.
Do not panic when your child has continuous convulsions. It is no use making the child smell a shoe or onions. If he is still convulsing, put a spoon wrapped in a piece of cloth in between his teeth to prevent him biting his tongue. Let him lie with his head a little lower than his body and turn him to one side to prevent aspiration of any vomit. (Do not lower the head if there is history of head injury prior to the onset of the convulsion). It is no use holding the child to stop the convulsion. Only make sure that he does not hurt himself. If you find that his skin and lips are turning blue and he has stopped breathing, start mouth-to-mouth breathing.
Step 2: Note the condition of the child after the convulsion has stopped or after the effect of the medicine given to control the convulsion has worn off.
A child may normally sleep for some time after a fit. If he looks perfectly normal after the fit, we are probably dealing with a less serious cause of convulsion, for which hospitalisation is not needed. However, a child with convulsion following a recent head injury often needs observation in a hospital. In any case, let your doctor take the final decision about hospitalisation.
A child who does not look well after a convulsion or in between two convulsions needs extra attention.
Step 3: Find out the cause of the convulsion and treat it. A child who had a difficult birth or who has a deficiency of glucose or calcium in his system may get a convulsion. One out of 4 children with a sudden rise of fever may get a short duration fit between the ages of 6 months and 5 years. These are called febrile convulsions. Some infants a d toddlers may hold their breath and some of these may also get a fit following a bout of crying. Treatment with iron is found to be effective in reducing the incidence of breath-holding spells in some children.
A few serious causes of convulsions are cerebral malaria, meningitis, encephalitis, poisoning, brain tumour and head injury. In some cases, the cause of convulsion cannot be determined and your doctor may make a diagnosis of epilepsy. If he suspects this diagnosis, he may ask for an EEG (electroencephalogram) and decide to put the child on a drug for prolonged use to control the convulsions. Certain drugs require a blood test to rule out any possible side effect or to know if the dose of the drug being given is optimum. For certain types of convulsions, your doctor may ask for other tests including a CT scan of the brain and a lumbar puncture (spinal tap) to examine the CSF (cerebro-spinal fluid). For intractable convulsions that don’t respond to drugs, a part of the brain is removed with good results.
A few newborns and older children get a convulsion once and never again. Hence, it is important not to panic if your child gets a convulsion. However, as frequent convulsions can cause harm to the child, it is important to take fits seriously.
Seizures can also manifest as staring spells, mostly between the age of 5 and 12 years. Multiple attacks of such spells could lead to a decline in scholastic performance. Some children get staring spells which are not due to epilepsy and do not need any treatment. They are considered non-epileptic when parents report preserved responsiveness to touch, though the child suffers no limb twitches, upward movement of eyes, interruption of play or urinary incontinence. However, confirmation is required in such children on long-term follow-up.
In some children, videogames can induce seizure. Stopping the child from playing videogames may be all that is required to halt the recurrence of convulsions, but some of these children may need long-term anticonvulsant drugs.
Step 4: Attend to psychosocial factors. Meet the school authorities. Tell them that your child is prone to fits. If required, take a letter from your doctor so that the teacher knows what to do if the child gets a fit in the classroom or on the playground. Children who suffer from epileptic fits can take part in sports like swimming, but under supervision. In general, they should be treated as normal children and not be overprotected.
What is a Seizure?
Seizures are sudden events that cause temporary changes in physical movement, sensation, behavior or consciousness. They are caused by abnormal electrical and chemical changes in the brain.
There are many different types of seizures. Some last for only a few seconds, while others may last a few minutes. The specific type of seizure a person has depends on where in the brain the seizure starts, how the seizure spreads and how much (and what part) of the brain is involved. Seizures might include:
- Loss of consciousness
- Convulsions (whole body shaking)
- Brief periods of staring
- A sudden feeling of fear or panic
- Uncontrolled shaking of an arm or leg
- Flexing, stiffening, jerking, or twitching of the upper body
- Nodding of the head
What is Epilepsy?
The term epilepsy is used to describe seizures that occur repeatedly over time without an acute illness (like fever) or an acute brain injury. Sometimes, the cause of the recurring seizures is known (symptomatic epilepsy), and sometimes it is not (idiopathic epilepsy).
A doctor would likely diagnose a child with epilepsy if the following were true:
- The child has had one or more unprovoked seizures.
- The doctor thinks the child is likely to have a seizure again
- The child’s seizures are not directly caused by another medical condition, like diabetes, a severe infection or an acute brain injury.