Medical Pediatric Area GB1

Convulsions
Under supervision

Dr Yasemin Gamal
Prepared by :
1-Menna Ahmed Osman El Saeed Ebrahim .
2-Menna Osama Abd El maged Khalil.
3-Menna Alla Belal Mouhmed Zaki.
4-Menna Alla Refat Youssef El Sawey.
5-Menna Alla Samy Zakaria Saeed Ahmed.
6-Menna Alla Seyam Sehata Youssef El Shazly.
7-Menna Alla Labib Mouhmed Nasser.
8-Menna Alla Mouhmed Abo EL fetoh Saeed.
9-Menna Alla Mahmoud Abdo Omar.
10-Menna Alla Mahmoud Mouhmed Harhash.
11-Mona Ebrahim Yousry Said Mahmoud.
12-Mona Reda Mouhmed Gemil.
Outlines :

1. Introduction
2. Definition
3. Causes and risk factors.

4. Types
5. Prevention

6. Treatment
7. Nursing interventions.

8. Health education
Introduction convulsion is an episode in which you
experience rigidity and uncontrolled muscle spasms
along with altered consciousness. The spasms cause
jerky motions that generally last a minute or two.

Convulsions can occur during certain kinds of epileptic

seizures, but you can have convulsions even though you
don’t have epilepsy. Convulsions can be a symptom of a
number of conditions, including a sudden fever spike,
tetanus, or very low blood sugar.

Definition of convulsion : Is a condition of

uncontrollable movement caused by sudden contraction
of the muscle
Definition of seizure : Is a transient occurrence
of signs or symptoms resulting from abnormal excessive
or synchronous neuronal activity in the brain .

Definition of epilepsy : It is defined as recurrent

, unprovoked seizures it occurs when child has repeated
seizures over time without a clear cause .

Causes:-
 in children
Seizures can take a wide variety of forms, depending in
part on what part of the brain has the abnormal
electrical activity. Many different diseases and injuries
can cause children to have seizures. These include:
head injuries
birth trauma
congenital conditions (conditions that your child is
born with)
poisoning
 fever or infection
brain tumors
maternal illness during pregnancy
heredity
degenerative brain disorders
stroke
metabolic problems and chemical imbalances in the
body
alcohol

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 .
Types
 Classification of convulsion in children :

1 - Etiological classification :

A- Acute Non - recurrent seizures

B- Fever ( Febrile Convulsions )

This is the most common cause of convulsions from 6m -
6 years of age .

 Chronic or Recurrent Convulsions :

1 - Idiopathic epilepsy
2 - Epilepsy Secondary to :

•Trauma
•Hemorrhage
•Toxins

 Classification according clinical manifestation .

1 Partial seizure :( focal )

 2 Generalized seizure

 Classification and Clinical Manifestations of

convulsion :-
There are many different types of seizures, and each
has unique clinical manifestations. Seizures are
classified into two major categories
Partial seizures, which have a local onset
and involve a relatively small location in the
brain

 Simple Partial Seizures with Motor Signs

Characterized by: Localized motor symptoms
Common in children
Abnormal discharges remaining unilateral

Manifestations
Aversive seizure (most common motor seizure in
children): Eye or
Eyes and head turn away from the side of the focus
loss of consciousness:
Tonic-clonic movements involving the
Face, salivation, arrested speech; most common
during sleep clonic movements beginning in a foot,
hand, or face and moving ,Or
“marching” to adjacent body part
Simple partial seizures with Sensory Signs:
Uncommon in children younger than 8 years old
Characterized by various sensations, including
Numbness, tingling, prickling, paresthesia, or pain
originating in One area (e.g., face or extremities)
and spreading to other parts of The body
Visual sensations or formed images
Motor phenomena, such as posturing or hypertonia
( Complex Partial Seizures (Psychomotor Seizure
Observed more often in children from 3 years old
through adolescence Characterized by
Period of altered behavior
Inability to respond to environment

Impaired consciousness during event

Drowsiness or sleep usually following seizure
Confusion and amnesia possibly prolonged
accompanied by unpleasant odors or tastes
Complex auditory or visual hallucinations
 Generalized epilepsy involves seizures
produced by abnormal electrical activity
throughout the brain. The seizures can result
from a genetic predisposition in an otherwise
healthy person or as a consequence of
widespread disturbance of brain function. You
may experience different types of generalized
seizures or the type may vary from one seizure
to another.

 "Grand Mal" or Generalized Tonic-Clonic

Typical Symptoms: Loss of consciousness,
rigid muscles, whole-body convulsions; can
cause a fall if you are standing

 Absence
Typical Symptoms: Staring with brief loss of
consciousness; fluttering eyelids

 Myoclonic
Typical Symptoms: Sporadic or repeated, brief
jerks of the limbs
 Colonic
Typical Symptoms: Repetitive, rhythmic
jerking movements of head or limbs

 Tonic
Typical Symptoms: Loss of consciousness,
stiffness and rigidity of the whole body; can
cause a fall if you are standing

 Atonic
Typical Symptoms: Loss of muscle tone in
head or body; can cause a fall if you are
standing
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. 7Call
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.
Treatment
In many cases no treatment is necessary , and seizures
stop on their own . However , in some cases , the cause of
the seizure may be treated . Depending on the child's
condition , treatment may include :

1- Ketogenic diet : Giving foods that are low in

carbohydrates and high in fat
2- Anticonvulsants drugs : . Medicines to prevent or
control future seizures .
Such as Phenobarbitone 5mg / kg .
Paraldehyde 0.2 ml / kg . Diazepam 0.2 mg / kg .
Depakine ( Valproic acid ) . .
3 - Vagus nerve stimulation . In this procedure , a device
is inserted under the collarbone . The device sends out
electrical signals that may block seizures .
4- Surgery when seizures aredetermined to be caused by
a hematoma , vascular malformations or tumer,
surgical removal is be recommended.
5- in febrile convulsion Treatment of the cause (fever) by
Antipyretics
 Nursing intervention
 Nursing Diagnosis
Risk for trauma or suffocation related to loss of
large or small muscle coordination.
Risk for ineffective airway clearance related to
neuromuscular impairment
Situational low self-esteem related to stigma
associated with the condition.
Deficient knowledge related to information
misinterpretation
Risk for injury related to weakness, balancing
difficulties, cognitive limitations or altered
consciousness.

 First aid
1- Airway: a patented airway ; aspirate secretion,
loosening tight clothing, especially around a
person's neck.
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 interventions During the Seizure 1-Remain
calm.
2-If child is standing or seated, ease child down to
the floor.
3-Turn child to one side.
4-Place pillow or folded blanket under child's head.
5-Loosen restrictive clothing.
6-Remove eyeglasses.
7-Clear area of any hazards or hard objects.
8-Allow seizure to end without interference.
9-Do not restrain the child's movements.
10-Remove harmful objects from area.

11-Redirect to safe area. Talk in calm, reassuring

manner.
12-Do not expect child to follow instructions. And
Watch to see if seizure generalizes. -After the Seizure
Stay with child and reassure until fully conscious.
 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.
 References
1.https://www.medicalnewstoday.com/

2.https://www.ncbi.nlm.nih.gov/books/NB
 K100608/

3.https://www.practo.com/healthwiki/seiz
ures-symptoms-

4.https://www.healthline.com/health/type s-
of-seizures#gener