Epilepsy is a neurological illness in which neuronal discharge of brain becomes aberrant, resulting in seizures or episodes of odd behaviour, feelings, and occasionally loss of awareness. Epilepsy can strike anyone at any time. Males and females of various races, ethnic backgrounds, and ages are affected by epilepsy.
1. Types of Epilepsy/Seizure/Convulsion :
I. Simple partial seizure :
This occurs due to unusual electrical activities in the brain which mainly affects a small area of the brain. Here the seizure does not affects the awareness.
This seizure can be Motor(affecting muscles), Sensory(affecting senses), Autonomic(affecting automaticity), and Psychic(affecting feelings).
II. Complex partial seizure :
This is also known as Focal impaired awareness seizure or Focal impaired awareness seizure. The seizure starts in one hemisphere of the brain and mainly associated with an impairment in consciousness.
III. Absence seizure :
This is also known as Petit mal seizures. This types of seizures are characterised by a short loss and return of consciousness generally not followed by a period of lethargy.
Child mainly presents with :
- Sudden onset and impairment of consciousness.
- Episode of blank stare.
- Upward rotation of eye.
- Interruption of ongoing activities.
IV. Tonic seizure :
Tonic means muscle tone, so as the name implies here the tone of the muscles gets increased. Tonic phase is seen here, which shows random stiffening of legs, arms, abdomen etc.
V. Atonic seizure :
Here the muscle tone gets suddenly decreased. The person may fall to the ground due to a rapid loss of muscle strength or tone. The person is usually awake and does not always fall down. It’s possible that their head will drop, their eyelids will droop, and they’ll drop whatever they’re holding.
VI. Clonic seizure :
Clonus” refers to the repeated tightening and relaxing of a muscle. To put it another way, it’s jerking. Restraining or moving the arms or legs will not stop the movements.
VII. Myoclonic seizure :
Myoclonic seizures are jerks of a muscle or a group of muscles that are short and shock-like. The terms “myo” and “clonus” refer to a muscle’s rapid contraction and relaxation (jerking or twitching). They usually last no more than a second or two. There may be only one, but there may be several in a short period of time.
VIII. Tonic/Clonic seizure :
When most people hear the word “seizure,” they think of this sort of seizure (also known as a convulsion). The term “grand mal” was once used to describe this type of seizure. They mix the characteristics of tonic and clonic seizures, as the name implies. Tonic denotes stiffening, and clonic involves jerking in a rhythmic manner.
2. Causes of Epilepsy/Seizure/Convulsion :
| Neonatal Period | After Newborn Period |
| 1. Birth Asphyxia 2. Developmental malformations 3. Intracranial haemorrhage 4. Pyridoxine dependent seizures 5. Hypoglycemia 6. Hypocalcemia 7. Maternal withdrawal of medications 8. Infections like Meningitis, Septicemia, tetanus neonatorum | 1. Infections like Bacterial and tubercular meningitis, aseptic meningitis, encephalitis, cerebral malaria. 2. Metabolic causes like hypocalcemia, hypomagnesemia. 3. Drug poisoning like Phenothiazines, salicylates, phenytoin, lead, carbon monoxide. 4. Vascular disorders like AV malformations, intracranial thrombosis or haemorrhage. |
3. Diagnosis of Epilepsy/Seizure/Convulsion :
- Loss of consciousness temporarily.
- Blinking eyes and deviated towards upward direction.
- Muscle stiffening.
- Fisting of hand with muscle stiffening.
- Uncontrollable jerking movements of the arms and legs.
- Child may show fear and anxiety.
4. Management of Epilepsy/Seizure/Convulsion :
- Patient presented with Acute seizure : As soon as possible we should start maintaining the Airway, Breathing and Circulation. Next Administering of oxygen is done.
- During making the IV channel we will send blood sample for Serum electrolytes, blood glucose, calcium, magnesium and LFT/RFT.
- First step of drug inducing is done with IV Lorazepam (0.1 mg/kg) or Midazolam (0.1 mg/kg) ; upto 2 doses, 6 minutes apart. Correction of metabolic abnormality like hypoglycaemia by IV infusion of glucose.
- If seizure still continues, then IV phenytoin or fosphenytoin 20 mg/kg IV infusion. Repeat if needed at 10 mg/kg.
- IV sodium valproate 20-40 mg/kg iv infusion.
- IV levetiracetam 20-60 mg/kg infusion at 5 mg/kg/min.
- IV phenobarbitone 20 mg/kg infusion. Repeat if needed up to twice at 10 mg/kg.
- IV midazolam at 15μg/kg/min infusion.
- If coma induced by Phenobarbitone or thiopentone and propofol, then IV ketamine and oral topiramate is given.