Medicine:Convulsion

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Short description: Medical condition where body muscles contract and relax rapidly and repeatedly
Convulsion
SpecialtyNeurology, Psychiatry
SymptomsMuscle spasms,[1] uncontrollable shaking[1]
Risk factorsEpilepsy

A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking.[1] Because epileptic seizures typically include convulsions, the term convulsion is sometimes used as a synonym for seizure.[1] However, not all epileptic seizures produce convulsions, and not all convulsions are caused by epileptic seizures.[1][2] Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures.[1]

Convulsions can be caused by epilepsy, infections, brain trauma, or other medical conditions.[2] They can also occur from an electric shock or improperly enriched air for scuba diving.[1]

The word fit is sometimes used to mean a convulsion or epileptic seizure.[3]

Signs and symptoms

A person having a convulsion may experience several different symptoms,[1] such as a brief blackout, confusion, drooling, loss of bowel or bladder control, sudden shaking of the entire body, uncontrollable muscle spasms, or temporary cessation of breathing.[1] Symptoms usually last from a few seconds to several minutes, though they can last longer.[4]

Convulsions in children are not necessarily benign, and may lead to brain damage if prolonged.[5] In these patients, the frequency of occurrence should not downplay their significance, as a worsening seizure state may reflect damage caused by successive attacks.[5] Symptoms may include:Template:Verify-inline

  • Lack of awareness
  • Loss of consciousness
  • Eyes rolling back
  • Changes to breathing
  • Stiffening of the arms, legs, or whole body
  • Jerky movements of the arms, legs, body, or head
  • Lack of control over movements
  • Inability to respond

Causes

Most convulsions are the result of abnormal electrical activity in the brain.[2][note 1] Often, a specific cause is not clear. There are numerous conditions that can cause a convulsion.[6]

Convulsions can be caused by specific chemicals in the blood, as well as infections like meningitis or encephalitis. Other possibilities include celiac disease,[7] head trauma, stroke or lack of oxygen to the brain. Sometimes the convulsion can be caused by genetic defects or brain tumors.[1] Convulsions can also occur when the blood sugar is too low or there is a deficiency of vitamin B6 (pyridoxine). The pathophysiology of convulsion remains ambiguous.[5]

Convulsions may also be caused by epileptic seizures, febrile seizures, non-epileptic seizures, or paroxysmal kinesigenic dyskinesia.[2] In rare cases, it may be triggered by reactions to certain medications, such as antidepressants, stimulants, and antihistamines.[2]

Epileptic seizures

Epilepsy is a neuronal disorder with multifactorial manifestations.[8] It is a noncontagious illness and is usually associated with sudden attacks[9] of seizures, which are an immediate and initial anomaly in the electrical activity of the brain that disrupts part or all of body.[8] Various areas of the brain can be disturbed by epileptic events.[10] Epileptic seizures can have contrary clinical features.[8] Epileptic seizures can have long-lasting effects on cerebral blood flow.[11]

Various kinds of epileptic seizures affect 60 million people worldwide.[9]

Generalized seizures

The most common type of seizure is called a generalized seizure, also known as a generalized convulsion. This is characterized by a loss of consciousness which may lead to the person collapsing. The body stiffens for about a minute and then jerks uncontrollably for the next minute. During this, the patient may fall and injure themselves or bite their tongue and lose control of their bladder. A familial history of seizures puts a person at a greater risk for developing them.[12][13] Generalized seizures have been broadly classified into two categories: motor and non-motor. [8]

A generalized tonic-clonic seizure (GTCS), also known as a grand mal seizure, is a whole-body seizure that has a tonic phase followed by clonic muscle retrenchments.[14][15] GTCSs can happen in people of all ages.[15] GTCSs are very hazardous, and they increase the risk of injuries and sudden unexpected death in epilepsy (SUDEP).[16] SUDEP is a sudden, unexpected, nontraumatic death in patients with epilepsy.[16] Strong convulsions that are related to GTCSs can also cause falls and severe injuries.[16]

Not all generalized seizures produce convulsions. For example, in an absence seizure, also known as a petit mal seizure, the brain experiences electrical disturbances but the body remains motionless and unresponsive.[2]

Febrile convulsion

A common cause of convulsions in children are febrile seizures, a type of seizure associated with a high body temperature. This high temperature is a usual immune response to infection, and in febrile convulsions the reason for the fever is extra-cranial (such as a body-wide viral infection).[17] In Nigeria, malaria—which can cause sudden, high fevers—is a significant cause of convulsions among children under 5 years of age.[18]

Febrile seizures fall into two categories: simple and complex.[19] A simple febrile seizure is one that is generalized, occurs singularly, and lasts less than 15 minutes.[19] A complex febrile seizure can be focused in an area of the body, occur more than once, and lasts for more than 15 minutes.[19] Febrile seizures affect 2–4% of children in the United States and Western Europe, it is the most common childhood seizure.[19] The exact reason for febrile convulsion is unidentified, though it might be the outcome of the interchange between environmental and genetic factors.[17]

Psychogenic non-epileptic seizures

Main page: Medicine:Psychogenic non-epileptic seizure

Psychogenic non-epileptic seizures (PNES) are described as neurobehavioral conditions[20] or "psychogenic illnesses" which occur not due to the electrical disturbances in a person's brain but due to mental and emotional stress.[2] PNES are an important differential diagnosis and a common occurrence in epilepsy centers.[21] According to the 5th Edison of Diagnostic and Statistical Manual of Mental Disorders (DSM 5), PNES is classified as a "conversion disorder" or Functional Neurologic Symptom Disorder characterized by alterations in behavior, motor activity, consciousness, and sensation.[22] A few neuroimaging (functional and structural) studies suggest that PNES may replicate sensorimotor alterations, emotional regulation, cognitive control, and integration of neural circuits.[23]

Paroxysmal kinesigenic dyskinesia

There is a linkage between infantile convulsion and paroxysmal dyskinesia.[24] Paroxysmal kinesigenic dyskinesia (PKD) is characterized by sudden involuntary movement caused by sudden stress or excitement.[25] The relationship between convulsion and PKD is mainly due to the common mechanism of pathophysiology.[24]

Management

There are several first-aid applications that someone can do to help patients with convulsions.[4]

  • Place the patient on the floor
  • Tip them onto their side
  • Clear the area of hard or piercing objects
  • Place something soft and flat under their head
  • Remove their glasses
  • Loosen or remove anything around their neck[2]

In the case of febrile convulsion in children, there may be a need for the treatment of the cause of the fever.[4]

Notes

  1. ↑ However, some seizures are not due to electrical disturbances in the brain, such as psychogenic non-epileptic seizures.[2]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 MedlinePlus Encyclopedia Seizures
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 "Convulsions: Causes, definition, and treatment" (in en). 31 January 2019. https://www.medicalnewstoday.com/articles/324330. 
  3. ↑ Merriam-Webster: Fit.
  4. ↑ 4.0 4.1 4.2 "Convulsions Are Different from Seizures: Learn What They Mean" (in en). 22 March 2019. https://www.healthline.com/health/convulsions#symptoms. 
  5. ↑ 5.0 5.1 5.2 Carter, S; Gold, A (8 February 1968). "Convulsions in children.". The New England Journal of Medicine 278 (6): 315–7. doi:10.1056/NEJM196802082780606. PMID 4866891. 
  6. ↑ "What is a convulsion?". https://www.theindependentbd.com/magazine/details/105668/What-is-a-convulsion. 
  7. ↑ "Definition & Facts for Celiac Disease. What are the complications of celiac disease?". NIDDK. June 2016. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts. 
  8. ↑ 8.0 8.1 8.2 8.3 Anwar, H; Khan, QU; Nadeem, N; Pervaiz, I; Ali, M; Cheema, FF (12 June 2020). "Epileptic seizures.". Discoveries (Craiova, Romania) 8 (2): e110. doi:10.15190/d.2020.7. PMID 32577498. 
  9. ↑ 9.0 9.1 Shoeibi, A; Khodatars, M; Ghassemi, N; Jafari, M; Moridian, P; Alizadehsani, R; Panahiazar, M; Khozeimeh, F et al. (27 May 2021). "Epileptic Seizures Detection Using Deep Learning Techniques: A Review.". International Journal of Environmental Research and Public Health 18 (11). doi:10.3390/ijerph18115780. PMID 34072232. 
  10. ↑ Moctezuma, LA; Molinas, M (29 August 2019). "Classification of low-density EEG for epileptic seizures by energy and fractal features based on EMD.". Journal of Biomedical Research 34 (3): 180–190. doi:10.7555/JBR.33.20190009. PMID 32561698. 
  11. ↑ Liu, J; Pourcyrous, M; Fedinec, AL; Leffler, CW; Parfenova, H (November 2017). "Preventing harmful effects of epileptic seizures on cerebrovascular functions in newborn pigs: does sex matter?". Pediatric Research 82 (5): 881–887. doi:10.1038/pr.2017.152. PMID 28665933. 
  12. ↑ "Epilepsy Seizure Types and Symptoms". http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms. 
  13. ↑ "Grand mal seizure causes". Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/grand-mal-seizure/basics/causes/con-20021356. 
  14. ↑ Kodankandath, Thomas V.; Theodore, Danny; Samanta, Debopam (2022). "Generalized Tonic-Clonic Seizure". StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554496/#_NBK554496_pubdet_. 
  15. ↑ 15.0 15.1 "Generalized tonic-clonic seizure: MedlinePlus Medical Encyclopedia" (in en). https://medlineplus.gov/ency/article/000695.htm. 
  16. ↑ 16.0 16.1 16.2 Brodovskaya, A; Kapur, J (December 2019). "Circuits generating secondarily generalized seizures.". Epilepsy & Behavior 101 (Pt B): 106474. doi:10.1016/j.yebeh.2019.106474. PMID 31431400. 
  17. ↑ 17.0 17.1 Paul, SP; Rogers, E; Wilkinson, R; Paul, B (May 2015). "Management of febrile convulsion in children.". Emergency Nurse 23 (2): 18–25. doi:10.7748/en.23.2.18.e1431. PMID 25952398. 
  18. ↑ "Management of Convulsion in Children, a Health concern in Nigeria". Public Health Nigeria. October 2018. https://publichealthng.com/management-of-convulsion-in-children-a-health-concern-in-nigeria/. 
  19. ↑ 19.0 19.1 19.2 19.3 Shinnar, S; Glauser, TA (January 2002). "Febrile seizures.". Journal of Child Neurology 17 Suppl 1: S44-52. doi:10.1177/08830738020170010601. PMID 11918463. 
  20. ↑ Anzellotti, F; Dono, F; Evangelista, G; Di Pietro, M; Carrarini, C; Russo, M; Ferrante, C; Sensi, SL et al. (2020). "Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge.". Frontiers in Neurology 11: 461. doi:10.3389/fneur.2020.00461. PMID 32582005. 
  21. ↑ Asadi-Pooya, AA (June 2017). "Psychogenic nonepileptic seizures: a concise review.". Neurological Sciences 38 (6): 935–940. doi:10.1007/s10072-017-2887-8. PMID 28275874. 
  22. ↑ Doss, JL; Plioplys, S (January 2018). "Pediatric Psychogenic Nonepileptic Seizures: A Concise Review.". Child and Adolescent Psychiatric Clinics of North America 27 (1): 53–61. doi:10.1016/j.chc.2017.08.007. PMID 29157502. 
  23. ↑ Huff, JS; Murr, N (January 2022). Psychogenic Nonepileptic Seizures. PMID 28722901. 
  24. ↑ 24.0 24.1 Cloarec, R; Bruneau, N; Rudolf, G; Massacrier, A; Salmi, M; Bataillard, M; Boulay, C; Caraballo, R et al. (20 November 2012). "PRRT2 links infantile convulsions and paroxysmal dyskinesia with migraine.". Neurology 79 (21): 2097–103. doi:10.1212/WNL.0b013e3182752c46. PMID 23077017. 
  25. ↑ Swoboda, KJ; Soong, B; McKenna, C; Brunt, ER; Litt, M; Bale JF, Jr; Ashizawa, T; Bennett, LB et al. (25 July 2000). "Paroxysmal kinesigenic dyskinesia and infantile convulsions: clinical and linkage studies.". Neurology 55 (2): 224–30. doi:10.1212/wnl.55.2.224. PMID 10908896. 

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