Convulsion: Causes, Classification, Symptoms, Diagnosis, Complication

Convulsion

Convulsions are episodes of abnormal motor, sensory, autonomic or psychic activity as a consequence of sudden excessive discharge from cerebral neuron.

Causes:

1.     Idopathic

2.     Genetic and developmental defects

3.     Acquired.

4.     Hypoxernia of any cause

5.     Fever (Childhood)

6.     Head injury

7.     Metabolic disorders

8.     Central nervous system infection

9.     Tumors (eg. Brain tumor )

Classification:

Seizures are classified by the origin of the seizure activity.

1.     Simple partial seizure: It is autonomic symptom without impairment of consciousness.

2.     Complex partial seizure: It has a impairment, but not a loss of consciousness

3.     Generalised Seizure: It can have loss of consciousness with convulsive or non-convulsive behaviours.

4.     Unclassified Seizure: There are termed because of incomplete data.

Signs and symptoms:

1.     Seizures may start from a simple starting spell of prolonged convulsive movements with loss of consciousness.

2.     It simple partial seizure: For patient, only a finger on hand may state, or uncontrollable mouth jerk.

3.     The person may talk irrelevantly.

4.     May experience unusual or unpleasant sights, sound and odors or task, but without loss of consciousness.

5.     In complex partial seizure;  The  person  either  remains motion less or moves automatically but inappropriately for time  and  place,  or  may experience  excessive  emotion of fear,  anger,  elation  or  irritability  whatever  manifestations, the person does not remember the episode when it is over.

6.     In Generalised seizure: More commonly referred to as grand mal seizure involves both hemispheres of the brain, causing both sides of the body to react. They may be intense rigidity of the entire body followed by Jerky alteration of muscle relaxation and contraction (generalized tonic- clonic seizures).

7.     The simultaneous contractions of the diaphragm and chest muscles may produce a characteristics epileptic cry. Often the tongue is chewed and the patient is incontinent of urine and stool. After for 2 minutes the convulsive movement begins to subside.

8.     The patient relaxes and lies in deep coma, breathing noisily.

9.     The respirations at this point are chiefly abdominal. In the postical state the patient often is confused and may sleep for hours. Many patients complain of headache or sore muscles.

Diagnosis:

1.     EEG with CT without video monitoring It helps to classify seizure

2.     MRI. scan to identify lesion

3.     Neuropsychologial studies to evaluate behavioral disturbances

Management :

Pharmocotherpahy

1. Carbamayepine

2. Phenytoin

3. Valporic acid

Bio feed back

It is useful in patients with reliable areas.

Surgery

Reserve and pallitive operations (temporal lobotomy, extra temporal resection, corpus colostomy, hemispherectomy)

Psycotheraphy

Nursing intervention:

1. Maintain a patient airway until patient is fully awake after a seizure

2. Provide oxygen during the seizure if color change occurs

3. Stress the importance of taking medication regularly

4. Provide a safe environment by padding side rails and removing clutter.

5. Place a bed in a low position and place a patient on side during a seizure to prevent aspiration.

6. Do not restrain the patient during a seizure

7. Do not put anything in the patient mouth during a seizure.

8. Protect the patient' s head during a seizure

9. Stay with a patient who is ambulating or who is in a confused state during seizure.

10. Provide a helmet to the patient who falls during seizure.

11. Consult with social worker for community resources for vocational rehabilitation, counselors and support groups.

12. Teach stress reduction techniques that will fit into a patient lifestyle.

13. Answer questions related to use of computerized video EEG monitoring and surgery for epilepsy management.

Complication:

1.     Status epileptics

2.     Injuries due to falls.