This is one of the commonest causes of referral of children to hospital emergency departments. There is a high incidence of convulsive disorders in children during the first year of life.Young infants are highly vulnerable to disease and death. They contribute about 40% of childhood deaths. They can become sick and die very quickly from serious bacterial infections. They have only general signs which can indicate serious disease.It is very important if the patient has history of Convulsions.

Causes of Convulsions:

1. Febrile convulsions

2. Idiopathic epilepsy

3. Central nervous system infections
a. Pyogenic meningitis
b. Viral meningo-encephalitis
c. Tuberculous meningitis

4. Post-infectious or post-vaccinal encephalopathy
a. Post-pertussis encephalopathy
b. Post-measles encephalopathy

5. Metabolic causes
a. Hypoglycemia
b. Hypocalcaemia
c. Hypomagnesaemia
d. Dehydration with electrolyte imbalance

6. Space occupying lesions
a. Neoplasm
b. Brain abscess
c. Tuberculoma

7. Miscellaneous
a. Head injury
b. Cerebral malaria
c. Acute cerebral edema (hypertensive encephalopathy)
d. Poisoning:
i. Phenothiazines
ii. Antidepressants
e. Breath holding attacks
f. Heat stroke

8. Neonatal convulsions, which will be discussed in another chapter.

Management:

One of the primary objectives is to control the seizure and to minimize anoxic brain damage.

Emergency Treatment:

1. Clear and maintain the airway.
2. Administer oxygen if cyanosis is present.
3. Administer anti-convulsing drugs.

Drugs used to control convulsions:

1. IV diazepam 0.3 mg/kg slat and this may be repeated after 2-4 hours. Diazepam may also be given per rectally with 0.5mg/kg/dose.
2. Cardinal Sodium (phenobarbitone) 5-8 mg/kg 1M
3. IV phenytoin 15-20 mg/kg/dose.
4. Paraldehyde 0.3 ml/kg per rectal or deep IM (IV is to be avoided).

Subsequent management:

1. A detailed history and physical examination should be carried out to arrive at a tentative diagnosis.
2. CSF examination is indicated if infection of the CNS is suspected.This should include cytology, biochemistry, Gram stain and culture sensitivity.
3. Investigations should be made to exclude underlying metabolic disorders.They should include blood sugar, serum calcium, serum electrolytes and serum magnesium.
4. The importance of continuous,uninterrupted treatment with anticonvulsants should be stressed to the parents.

FEBRILE CONVULSIONS:

Febrile convulsions arc a common cause of admission to hospital. Approximately 3-5% of all children will have a febrile convulsion at some stage in their lives. Fortunately, febrile seizures aren't as dangerous as they may look. A seizure triggered by a sudden fever is usually harmless and typically doesn't indicate a long-term or ongoing problem. Often, a febrile seizure occurs before parents even realize that their child is ill.

Features:

1. Age 9 months to 5 years; the peak age of onset is approximately 14 to 18 months of age.
2.Associated with fever and infection elsewhere than in the CNS.
3.Seizures do not last more than 10 minutes, followed by a brief postictal period of drowsiness.
4.It is not the height of temperature attained, but the rapidity of rise which is important in the causation of febrile convulsions which usually develops when the core temperature reaches 39°C or greater.
5. The seizures are always generalized but leave no permanent neurological deficit.
6. There is likely to be a family history of febrile convulsions.

Features of atypical febrile seizures:

1. Seizures persisting for more than 15 minutes
2. Repeated convulsion for several hours or days
3. A focal seizures
4. These are basically predisposed to idiopathic epilepsy

Management:

1. Assure the parents and explain the mechanism of the seizures.
2. Promptly institute measures to control temperature:
a. Antipyretics such as aspirin and paracetamol
b.Tepid sponging
3. Anticonvulsants: Diazepam

Using a group of mice that had been chemically induced to have convulsions, the researchers injected the normal molecule into the mice. This had no effect on their convulsions. When a vitamin C modified version of the drug was injected, convulsions were delayed, demonstrating the improved performance of the drug, the researchers say.

A study shown that postictial mean serum prolactin level was slightly higher in febrile convulsions than the non-specific febrile group and the control group ,this increase was within the normal ranges for their ages and was thus statistically insignificant .

If your child is prone to febrile seizures, you might be able to prevent them by treating a fever early. However, most febrile seizures develop suddenly and without warning.Adults should contact their health care provider if they have high fever and symptoms of convulsion .

This is notable because high fevers and febrile convulsions in infants and children can retard brain development, often resulting in impairments in high-order cognitive function such as planning, decision-making, self-awareness, and social sensitivity.

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