What Are the Most Common Electroconvulsive Therapy Side Effects?
Convulsions are a common pediatric emergency department and the most common pediatric neurological symptom. It is a common acute illness in childhood. It is characterized by clinical rhythmic limb movements (convulsions) and coma. Also known as "convulsions", commonly known as "convulsions" or "shocks." It can occur in any season. It is more common in infants and young children. The younger the child, the higher the incidence. Some tics are potentially life-threatening. Generally short-term seizures have little effect on the brain, but long-term seizures, especially persistent seizures, can cause permanent neurological damage. Febrile convulsions may or may not be accompanied by fever, and those with fever are mostly caused by infectious diseases. Meningitis, brain abscess, encephalitis, and cerebral parasitic diseases are common in intracranial infectious diseases; extracranial infectious diseases The diseases are usually febrile seizures and various serious infections (such as toxic bacillary dysentery, toxic pneumonia, and sepsis). Those without fever are mostly caused by non-infectious diseases. In addition to common epilepsy, there are also water and electrolyte disorders, hypoglycemia, drug poisoning, food poisoning, genetic metabolic diseases, brain trauma, and brain tumors. [1-3]
| Zhong Jianmin | (Chief physician) | Department of Neurology, Jiangxi Children's Hospital |
Convulsion is commonly known as cramps, convulsions, and convulsions, also known as convulsions. Presented as paroxysmal limb and facial muscle twitches, mostly accompanied by eyeballs on both sides, gaze or strabismus, unconsciousness. Sometimes accompanied by foaming in the mouth or twitching of the corners of the mouth, apnea, bluish complexion, the onset time is usually within 3 to 5 minutes, sometimes recurrent, or even persistent. It is a common emergency in children, especially in infants. The incidence of convulsions in children under 6 years of age is about 4% to 6%, which is 10 to 15 times higher than that of adults, and the incidence is higher at younger ages. Frequent seizures or persistence of convulsions can endanger the lives of children or leave them with severe sequelae, affecting children's intellectual development and health.
- Western Medicine Name
- Convulsions
- English name
- convulsion
- Other name
- Cramps, convulsions, convulsions, convulsions
- Affiliated Department
- Internal Medicine-Neurology
- Disease site
- nervous system
- The main symptoms
- Paroxysmal limb and facial muscle twitching, eyeballs on both sides up, gaze or strabismus, unconsciousness
- Main cause
- Infectious factor
- way for spreading
- Infants
Convulsions
Convulsions are a common pediatric emergency department and the most common pediatric neurological symptom. It is a common acute illness in childhood. It is characterized by clinical rhythmic limb movements (convulsions) and coma. Also known as "convulsions", commonly known as "convulsions" or "shocks." It can occur in any season. It is more common in infants and young children. The younger the child, the higher the incidence. Some tics are potentially life-threatening. Generally short-term seizures have little effect on the brain, but long-term seizures, especially persistent seizures, can cause permanent neurological damage. Febrile convulsions may or may not be accompanied by fever, and those with fever are mostly caused by infectious diseases. Meningitis, brain abscess, encephalitis, and cerebral parasitic diseases are common in intracranial infectious diseases; extracranial infectious diseases The diseases are usually febrile seizures and various serious infections (such as toxic bacillary dysentery, toxic pneumonia, and sepsis). Those without fever are mostly caused by non-infectious diseases. In addition to common epilepsy, there are also water and electrolyte disorders, hypoglycemia, drug poisoning, food poisoning, genetic metabolic diseases, brain trauma, and brain tumors. [1-3]
Convulsive pathophysiology
The pathophysiology of pediatric convulsions can be seizures or non-seizures. The former is caused by dysfunction of brain cells caused by various reasons, the excitability of neurons in the brain is too high, and a sudden abnormal large number of neurons are discharged in a super-synchronous manner, which causes motor-induced seizures of the skeletal muscles through the nerves. The latter can be caused by increased excitability of the brainstem, spinal cord, neuromuscular junction, and muscle itself, such as changes in electrolytes in the body (such as increased potassium and sodium or decreased calcium, magnesium, etc.); or emotional changes such as rickets. [4-5]
Convulsive pathogenesis
Infants and young children's cerebral cortex is not fully developed, so the analysis and identification and suppression functions are poor; the part of the outer layer of the nerve fiber called "myelin sheath" in medicine has not been fully formed, and the insulation and protection are poor. Impulses are easy to generalize like a string of telephone lines; low immune function, easy to induce convulsions; poor blood-brain barrier function, various toxins and microorganisms easily enter the brain tissue; some special diseases such as birth injury, brain developmental defects and congenital metabolism Abnormalities are also common in this period, these are the reasons for the high incidence of convulsions in infants and young children. [6-7]
Causes of convulsions
The causes of convulsions can be divided into two categories, infectious and non-infectious, according to the presence or absence of infection; and can be further divided into intracranial and extracranial lesions according to the location of the lesion.
Infectious
(1) Intracranial infection: seen in meningitis, encephalitis, brain abscess, etc., mostly purulent meningitis and viral encephalitis. Viral infections can cause viral encephalitis and Japanese encephalitis; bacterial infections can cause purulent meningitis, tuberculous meningitis, and brain abscesses; fungal infections can cause new cryptococcal encephalitis; parasite infections such as cerebral cysticercosis and brain Malaria, cerebral schistosomiasis, and cerebral pulmonary flukes. Convulsions can also occur in infants with intrauterine infection (TORCH infection) and cytomegalovirus infection.
(2) Extracranial infections: acute gastroenteritis, toxic bacterial dysentery, sepsis, otitis media, tetanus, pertussis, severe pneumonia and other acute serious infections, caused by high fever, acute toxic encephalopathy and brain microcirculation disorders Cerebral cell ischemia and tissue edema can cause convulsions. Febrile convulsions can occur due to fever at special periods of pediatric brain development. Fever convulsions are the most common type of convulsions in extracranial infections. They occur when the fever is above 38 ° C due to infections other than the central nervous system in children. Convulsions occur in the early stages of upper respiratory infections or certain infectious diseases.
2. Non-infectious
(1) Intracranial diseases: common in craniocerebral injury (such as birth injury, traumatic brain injury), craniocerebral hypoxia (such as neonatal asphyxia, drowning), intracranial hemorrhage (such as late-onset vitamin K1 deficiency, cerebral vascular malformation) Caused by), intracranial space-occupying diseases (such as brain tumors, brain cysts), abnormal brain development (such as congenital hydrocephalus), cerebral palsy, and neurocutaneous syndrome. In addition, there are such as brain degenerative diseases (such as demyelinating encephalopathy, cerebral macular degeneration) and other such as various encephalopathy (such as bilirubin encephalopathy), white matter degeneration, and so on.
(2) Extracranial diseases
epilepsy syndrome: such as epileptic seizures, infantile spasms.
Metabolic abnormalities: congenital glucose metabolism abnormalities such as galactosemia, glycogenopathy, hereditary fructose intolerance, etc .; congenital fat metabolism such as Niemann Pick's disease, Gaucher disease, mucopolysaccharidosis, and white matter malnutrition Disorders; congenital amino acid metabolism disorders such as phenylketonuria, maple diabetes, histidineemia, ornithineemia; copper metabolism disorders such as hepatolenticular degeneration can also cause seizures.
Poisoning: Children often cause convulsions by inadvertently taking poisons, drugs or overdose, direct effects of poisons or metabolic disorders caused by poisoning, hypoxia and other indirect effects on brain function. Common poisons are: carbon monoxide, organophosphorus pesticides, organochlorine pesticides, rodenticides, metals (lead, mercury, tincture), plants (toadstool, mandala, cocklebur), food (ginkgo, bitter almond) Common drugs are: atropine, camphor, chlorpromazine, isoniazid, steroids, aminophylline, stroma, etc.
Water and electrolyte disorders: such as severe dehydration, hypocalcemia, hypomagnesemia, hyponatremia, hypernatremia.
Others: acute cardiac functional ischemic syndrome, hypertensive encephalopathy (acute nephritis, renal artery stenosis, etc.), Reye syndrome, cerebral or meningeal leukemia, withdrawal syndrome, erythrocytosis, vitamin B1 or B6 deficiency , Hysteria convulsions, liver and kidney failure, etc. [8-11]
Convulsive disease causes
Convulsive fever
It is the most common cause of convulsions in childhood, with a high incidence, accounting for 30% of the causes of childhood convulsions. It is a seizure that occurs during the fever of extracranial infectious diseases. It has the following characteristics: The age of onset is 6 months to 3 years, and it rarely occurs under 6 months and over 6 years. Convulsions often occur when the body temperature rises, and the body temperature is usually above 39-40 ° C. The higher the body temperature, the higher the probability of convulsions. 70% occurred in the early stage of upper respiratory tract infection, and the rest occurred in respiratory infection and rash. Systemic convulsions are accompanied by conscious disturbances, but consciousness recovers quickly after the convulsions cease; there are no abnormal signs of the nervous system after the onset, and no abnormalities are found in cerebrospinal fluid examination except for increased pressure. The prognosis is good, and a few can turn into epilepsy. According to clinical characteristics, it is divided into simple and complex febrile seizures (attached table). The latter has a higher risk of epilepsy and the prognosis is significantly different.
Schedule to distinguish between simple and complex convulsions |
|---|
Identification points | Simple febrile seizures | Complex febrile seizures |
Incidence | 80% | 20% |
Seizure form | Generalized seizures | Limited or asymmetric |
Seizure duration | Seizures are short, usually 5 to 10 minutes | Long duration, 15 minutes |
Seizures | Only 1 or 2 episodes in one heat course | Repeated attacks within 24 hours |
Convulsive central nervous system infection
Because the defense and immune functions of children in various parts of the body are weaker than adults, the blood-brain barrier is not yet fully developed, and pathogens easily reach the central nervous system through the blood-brain barrier, which causes central infections. It is a serious infection in childhood, especially in infants and young children. Sexually transmitted diseases. Its characteristics are: before and after the occurrence of convulsions, in addition to the sudden rise in body temperature, there are often accompanied by conscious abnormalities, and often drowsiness, lethargy, irritability, vomiting, delirium, and coma; convulsions often repeated many times, the duration of each seizure is longer Long; Physical examination may be normal when early seizures do not occur, but abnormal signs can be found in those who have convulsions; Cerebrospinal fluid routine and biochemical examination are abnormal.
The pathogens that cause central nervous system infections are different, and their onset characteristics, onset season, and age of onset are also different. Japanese encephalitis: mostly in the summer and autumn, mainly in the form of brain parenchymal damage; epidemic encephalomyelitis: mostly in the winter and spring seasons, there are concentrated incidence and epidemic peaks, but there are also sporadic cases. Fulminant shock is a typical and serious feature; other brain changes (such as caused by pneumococcus, staphylococcus aureus, etc.): regardless of season, more common in infants and young children, especially small infants under 6 months; fungal meningitis: more Seen in immunocompromised, long-term application of antibiotics, fungal direct and large history of contact, often with a process of spontaneous remission, long course, relatively insidious; tuberculous meningitis: young people often have a history of miliary tuberculosis and close history of tuberculosis, The clinical manifestations and changes of cerebrospinal fluid in older children are more typical, and the incidence is 8-10 times higher than that in adults.
Convulsive toxic encephalopathy
It is a kind of central nervous system disease that is more common in infants and young children. Its main clinical manifestation is the sudden emergence of central nervous system symptoms during the primary disease. Its clinical characteristics: common in severe bacterial infections (pneumonia, sepsis, toxic bacterial dysentery, typhoid fever, diphtheria, pertussis, etc.); in addition to the primary disease, often high fever, convulsions, disturbance of consciousness and increased intracranial pressure Many seizures, long duration, whole body or limitation; Physical examination shows changes in consciousness, anterior condylar bulge, pyramidal tract signs and meningeal irritation, and even limb paralysis; Cerebrospinal fluid examination pressure is slightly higher, sometimes protein In addition, there were no other abnormalities; After the primary disease was controlled, the central nervous system symptoms gradually reduced. In mild cases, symptoms disappear within 24 hours, without sequelae; in severe cases, convulsions are frequent, unconscious, and even life-threatening.
Convulsive epilepsy
It is a chronic brain dysfunction syndrome caused by a variety of causes. It is an episodic, sudden, transient brain dysfunction caused by repeated supersynchronized discharge of gray matter neurons in the brain. Therefore, epilepsy is episodic and recurrent. And the characteristics of natural remission, the child between the episodes, everything can be normal. It has multiple types of seizures, which can manifest as convulsive and non-seizures. Patients with secondary epilepsy may have a history of brain injury or a history of complex febrile seizures. Electroencephalography is helpful in identifying the nature and classification of epilepsy.
Convulsive hypocalcemia
It is common in infants under half a year old, and children often have rickets of varying degrees of activity. Typical seizures can occur when serum calcium is lower than 1.75 mmol / L, mainly convulsions, laryngospasm, and hand and foot cramps. The duration of seizures is usually short, which can be as short as a few seconds. A few people have a few minutes. After the seizures stop, their consciousness recovers, they fall asleep and fall asleep. They wake up as usual and have no signs of the nervous system. The frequency of attacks can reach dozens of times a day. Generally without fever, it can be clear when the attack is mild. The ECG showed a prolonged QT interval. [12] [13] [14]
Characteristics of seizures at different ages
Neonatal seizures
Hypoxic-ischemic encephalopathy due to intracranial hemorrhage due to birth injury or asphyxia during labor is the most common, followed by neonatal sepsis, purulent meningitis, neonatal respiratory distress syndrome, nuclear jaundice, neonatal tetanus, neonatal Hand-foot tremor, hypomagnesemia, hyponatremia, hypoglycemia, and other metabolic abnormalities. Common causes 1 to 3 days after birth are asphyxia, intracranial hemorrhage, hypoglycemia, etc. Common causes 4 to 10 days after birth are hypocalcemia, nuclear jaundice, hypomagnesemia, early sepsis, and purulent meningitis, Tetanus and craniocerebral deformities. At this age, congenital brain developmental abnormalities and metabolic disorders should also be considered. Maternal placenta previa, threatened abortion, excessive use of oxytocin or malposition, umbilical cord prolapse, etc. can cause hypoxic brain damage and convulsions. Congenital rubella syndrome, toxoplasmosis, and giant cell inclusion disease should also be considered. In some cases, anesthesia is given prenatally from the placenta to the fetus, and the drug can be interrupted after birth, which can cause convulsions. The cause of a few cases is unknown.
Convulsions in infancy
Fever convulsions, acute infections such as toxic bacillary dysentery, toxic encephalopathy caused by sepsis, suppurative meningitis, and viral encephalitis are the most common. Congenital brain developmental malformations and congenital metabolic disorders are often particularly prominent at this age, such as phenylketonuria and vitamin B6 dependence; some epilepsy syndromes such as infantile spasms and Otahara syndrome also develop during this period. They are generally accompanied by mental retardation; in addition, vitamin D deficiency tetany.
Convulsions preschool, school age
With the continuous improvement of the blood-brain barrier and systemic immune function, the incidence of various intracranial infectious diseases has decreased significantly compared with that of infants and young children. Infections due to systemic infectious diseases (such as bacillary dysentery, lobar pneumonia, etc.)
Toxic encephalopathy, epilepsy, and craniocerebral trauma are relatively common at this stage.Infrequently, intracranial tumors, brain abscesses, intracranial hematomas, cerebrovascular embolism, and kidney disease cause hypertensive encephalopathy or uremia, hypoglycemia, and diabetic ketones. Bloodemia, food or drug poisoning, etc. [12] [13] [14] [15]
Clinical manifestations of convulsions
Convulsive disease symptoms
A few may have aura before a seizure. If you see any of the following clinical signs, you should be alert to the onset of convulsions: extreme irritability or "shock" from time to time, nervousness, panic, sudden increase in muscle tension in the limbs, sudden shortness of breath, pause or irregularity, sudden rise in temperature , Face changes and so on. Convulsions are mostly sudden.
The typical clinical manifestation of a seizure is a sudden loss of consciousness and a sudden occurrence of systemic or localized, tonic, or clonic facial, limb muscle twitches, often with upturned eyes, gaze, or strabismus. The facial (especially eyelids, lips) and thumb convulsions are prominent parts of the eyes. The eyes are often stared, straightened or turned up, and the pupils are dilated. Convulsions of muscles in different parts can lead to different clinical manifestations: pharyngeal muscle twitching can cause foaming in the mouth, sputum in the throat, and even suffocation; convulsions of the respiratory muscles can cause breathlessness, cyanosis, and hypoxia; bladder, rectal, and abdominal muscles Can cause incontinence; in addition, severe convulsions can cause tongue bites, muscle and joint damage, fall trauma, etc.
The seizures range in duration from seconds to minutes. In some children, the muscles are weak, lethargic, and even weak after waking up. Severe persistent convulsions or frequent convulsions without an awakening period lasting more than 30 minutes are called a state of convulsions, sometimes with temporary paralysis (Todd's paralysis). Neonatal seizures are often atypical and can be manifested as mild localized convulsions such as gaze, eyeball deflection, eyelid tremor, facial muscle twitches, and irregular breathing. Due to the small amplitude, the performance is not typical and is often easily overlooked.
Convulsive disease hazards
Repeated or persistent seizures can cause irreversible damage to the function of the brain, especially children's developmental brain or other organs, leading to severe hypoxic brain damage and neurological sequelae, such as mental retardation, developmental delay or even regression or even life-threatening Wait.
Convulsive complications
The complications caused by convulsions mainly depend on the etiology, such as encephalitis, meningitis may cause subdural effusion, ventricular meningitis, hydrocephalus, paralysis, mental retardation and epilepsy; neonatal ischemic hypoxic encephalopathy may Lead to cerebral palsy, retarded development and epilepsy; only 7% of febrile convulsions can develop into epilepsy; convulsions caused by electrolyte disorders are mostly prognostic with few complications.
Diagnosis of convulsions
Convulsive examination
1) Cerebrospinal fluid examination: Patients with suspected intracranial infection need to perform routine and biochemical examination of the cerebrospinal fluid, and if necessary, smear staining and culture. This is an important method for the diagnosis and differential diagnosis of central nervous system diseases, and the diagnosis of intracranial infection and bleeding. Very important. Particular emphasis is placed on the need for cerebrospinal fluid examination in children with first seizures.
2) Skull imaging: patients with suspected intracranial hemorrhage, space occupying lesions and craniocerebral malformations can be selected for gas-brain angiography, cerebral angiography, skull CT, MRI and other examinations.
3) ECG and EEG examination: ECG can be selected for patients with suspected cardiogenic convulsions; EEG can be used for suspected infantile spasms and other types of epilepsy or brain occupying lesions. EEG is of great value in the diagnosis of epilepsy. Epilepsy appears in the EEG as spikes, slow and multiple spikes, and paroxysmal high amplitude slow waves. The positive rate of EEG in the diagnosis of epilepsy is about 60%, and the positive rate after induction can be increased to 70% to 80%, but the negative EEG cannot rule out the diagnosis of epilepsy.
4) Selective laboratory and other auxiliary inspections
Routine blood, urine, and stool: increased leukocytes with leftward shift of the nucleus suggest bacterial infection, but it should be noted that some viral infections (such as Japanese encephalitis) and simple convulsions may also have increased leukocytes. Leukocytes with increased primary or immature cells are suggested Meningeal leukemia, increased eosinophils in the blood are often a sign of cerebral parasitic disease. When urine, protein, hematuria and various casts are found, especially in children with hypertension, hypertensive encephalopathy caused by nephritis should be considered. It is worth noting that for children with sudden high fever with convulsions and severe systemic poisoning symptoms, anal examination or saline enema examination of stool is an important means of early diagnosis of toxic dysentery.
blood biochemical examination: blood glucose, blood calcium, blood magnesium, blood sodium, blood phosphorus, liver function, renal function and other measurements. Examination of blood electrolytes, liver and kidney functions can find relevant causes, such as hypoglycemia, hypoglycemia or Wright's syndrome, abnormal blood electrolytes may indicate convulsions caused by electrolyte disturbances, and neonatal bilirubin encephalopathy (nuclear jaundice). Bilirubin, especially unconjugated bilirubin, was significantly increased.
Other special tests: such as biochemical, histochemical, or chromosomal tests, which are often used to diagnose genetic metabolic diseases, such as urinary ferric chloride test for phenylketonuria. There are also immunological tests, toxicant tests, etc.
Differential diagnosis of convulsions
1. Neonatal period: Seizures are often atypical and must be distinguished from the following phenomena or diseases.
Tremor: Neonatal period often shows rapid tremor of the whole body or part, similar to clonic movement, which can be induced by sudden tactile stimulus. Gently changing the position can weaken or disappear the tremor. This kind of movement is not accompanied by abnormal eyes or Mouth and cheek movements, this type of tremor, is a manifestation of imperfect development of neonatal motor reflexes and usually disappears 4 to 6 weeks after birth. Neonates who are younger than the gestational age, hypoglycemic newborns whose mothers have diabetes, or newborns who take certain sedatives during pregnancy may also experience tremors. Convulsions range in magnitude, low frequency, arrhythmia, are not affected by irritation, and are often accompanied by abnormal eye, mouth, and cheek movements. The two are easier to distinguish.
Eye rotation and irregular breathing during active sleep: Normal newborns sleep about half of the time during active sleep. It often appears at the beginning of falling asleep or when near awakening, the eyeballs rotate under the closed eyelids, rhythmic mouth movements, facial smiles or weird faces, heads and limbs stretch or twist, but these actions disappear and no longer occur after waking Appears, so it is easy to distinguish from convulsions. When it is difficult to distinguish, you can use the EEG to check that the brain waves during active sleep are normal.
Benign neonatal sleep myoclonus: Onset within 1 month after birth. Myoclonus mainly affects the forearms and hands, and can also affect the feet, face, trunk or abdominal muscles. Most appear in NREM sleep, rare in REM, occasionally induced by sound and other stimuli. Myoclonus can be bilateral, local, or multifocal, with rhythmic or arrhythmic tics, and often appears in series at a frequency of 1 to 5 times per second for several seconds. This series of myoclonic tics can recur in sleep for 20 to 30 minutes, or as long as 90 minutes, and can be mistaken for a convulsive state. Neurological examination and EEG are normal. Occasional family history. Symptoms eased after 2 months of birth and disappeared before 6 months. The long-term prognosis is good and does not require treatment.
Apnea in premature infants: This type of apnea usually lasts for 20s or longer, often accompanied by a slowed heart rate, but due to convulsive apnea, the heart rate generally remains the same, and does not slow down.
2. Infancy and childhood: convulsions must be distinguished from other seizures.
Rickety convulsions: seen in older children, more women than men, have emotional causes, can be manifested as convulsions, often tonicity, last a long time, no falls and injuries, no tongue bites and urination Incontinence, no change in complexion, no cyanosis, normal heart rate, pulse, breathing, blood pressure, normal eye movements, pupils not dilated, normal reflection of light, no loss of consciousness, no post-seizure sleep, and normal EEG icons. The use of mental suggestion therapy can stop the attack, and it is not easy to stop the attack when there are people around. There is a tendency to relapse under emotional factors. Attention should be paid to the performance at the time of the onset, and careful diagnosis should be made after excluding organic diseases.
Syncope: Temporary cerebral blood flow reduction can cause syncope, which usually occurs under fatigue, nervousness, intimidation, etc., especially when suddenly standing. Pale face, sweating, cold hands and feet, slow heartbeat, decreased blood pressure, temporary loss of consciousness, and even stiff limbs and convulsions during a seizure. They often wake up quickly after lying down for a short duration.
Breathing seizures: often caused by emotional reactions, most of which start at 6 to 12 months of age, and mostly disappear after 3 years of age. Before the attack, there were crying, breath holding, apnea, cyanosis, and even short-term stiffness or clonics. The attack stopped naturally after about 1 minute, breathing resumed, the cyanosis disappeared, and then cried, and then fell asleep. The frequency of the attacks was different. EEG nothing unusual. If there is a precursor of an attack, the attack can be stopped after diverting attention. Some children may develop syncope as they age.
Affective cross leg syndrome: Refers to episodic cross-leg rubbing, cheek flushing, sweating, gaze at the eyes, perineal secretions, and sexual color, which often makes parents extremely panic. It usually occurs before bedtime or just after waking up, and it can also occur during the day. At the time of the attack, the child's attention is diverted to the area of interest, which can stop or reduce the attack. Sometimes itching is caused by pruritus or ascariasis. There were no specific abnormalities in the EEG. Generally, these symptoms last only for a period of time, and they can resolve on their own, and most of them stop after the elderly. Individual patients may experience behavior problems in the future.
Tic disorder: The main feature is often involuntary repetitive rapid spasms, common blinks, facial tics, and limited tics of the neck, shoulders, and upper and lower limbs. Stressors are triggers. The conscious control can be paused and disappears during sleep. Consciousness is always clear at the time of the seizure, there will be no fall during the tics, and there is no abnormality in the EEG.
Convulsive disease treatment
Convulsions are emergency symptoms and must be addressed immediately. When the seizures occur, the child should take a lateral position, loosen the collar, and press on the person, gently support the limbs to avoid joint damage and fall. You can tilt your head to one side to prevent aspiration from saliva or vomitus aspiration into the trachea. After the convulsions stopped, the throat secretion was long, the sputum was aspirated with a sputum suctioner, and oxygen was given for a short time. If dyspnea or pauses occur after convulsions, artificial respiration should be performed.
Convulsive symptomatic treatment
Anti-altering: Anti-altering drugs are preferred for rapid stabilization. Diazepam is highly fat soluble and easily enters the brain tissue. It can take effect 1 to 3 minutes after injection, but the duration of the effect is short (15 to 20 minutes), and can be repeated after 15 to 20 minutes if necessary. Or choose 10% chloral hydrate enema. At the same time as or after the administration of diazepam, phenobarbital with a longer acting time can also be used to maintain the anti-altering effect.
For children with typical febrile convulsions, only the primary disease is generally required. Short-term preventive treatment is also available for those with frequent seizures. Only a few complex febrile convulsions can be treated with sodium valproate or phenobarbital. However, no consensus has been reached on the prevention of febrile seizures.
Fever: Fever convulsion is the most common cause of convulsions in children, and attention should be paid to trying to cool down quickly. Drug cooling: Paracetamol or ibuprofen can be applied orally. Physical cooling: warm water bath, ice pack, etc. are all effective cooling measures. Except for small infants under 3 months, which can be used alone, children of other ages may only be effective after the drug is cooled.
Prevention and treatment of cerebral edema: Authors who have recurrent seizures or who have seizures with persistent seizures often have secondary cerebral edema, and 20% mannitol should be added to reduce cerebral edema.
Convulsions
Continuity of convulsions can easily cause irreversible brain damage and should be rescued in a timely manner. Principles: Choose fast-acting and powerful anticonvulsant drugs to control seizures in a timely manner. Diazepam is preferred. Midazolam or load topiramate can also be used. If necessary, general anesthesia can be treated under tracheal intubation. As early as possible, a sufficient amount of the drug, the effect is fast, the action time is long, and the side effects are few. Maintain life function, prevent cerebral edema, acidosis, respiratory failure, maintain airway patency, inhale oxygen, and maintain internal environment stability. In particular, attention should be paid to timely correction of hypoglycemia and acid-base imbalance. Actively find the cause and control the primary disease, and avoid the inducement.
Convulsive etiology treatment
For children with convulsions, the importance of etiology treatment should be emphasized. Infection is a common cause of convulsions in children. As long as bacterial infections cannot be ruled out, antibiotics should be applied early; for patients with central nervous system infection, antibiotics that can easily penetrate the blood-brain barrier should be used. Convulsions due to metabolic reasons (such as hypoglycemia, hypocalcemia, cerebral beriberi, etc.) should be corrected in time to relieve convulsions. In addition, such as tetanus and rabies, the former should neutralize the free tetanus toxin in the lesion and the blood as soon as possible, tetanus antitoxin (TAT) should be given 10,000 to 20,000 U, intramuscular injection, intravenous drip in half; the latter should The timely application of anti-rabies vaccine can be infiltrated around the wound and the bottom of the wound; when poisoning occurs, the poison should be removed as soon as possible, such as emetic, catharsis or promoting the excretion of the poison in the body to reduce the continued damage of the poison.
Prognosis of convulsive disease
The prognosis of convulsions mainly depends on the primary disease that causes the convulsions, and the prognosis of different diseases is also very different. Examples of common diseases are as follows:
1. Fever convulsion: Generally speaking, the prognosis of febrile convulsion is good, and it is rare to have brain damage or sequelae caused by severe convulsions.
Recurrence of febrile seizures: It is generally believed that about 1/3 of febrile seizures have recurrence. 70% of those who relapse within 1 year after the initial attack and 90% of those who relapse within 2 years. The high-risk factors for recurrence of febrile seizures include 5 years of age onset, first-degree relatives with a history of epilepsy, first-degree relatives with a history of febrile seizures, the first occurrence of complex febrile seizures, and children living in kindergartens. For children with simple febrile seizures without the above-mentioned high-risk factors, the recurrence rate after the first episode is 10%; the recurrence rate of those with 1 or 2 high-risk recurrence factors is 25% -50%, and the recurrence rate of those with multiple high-risk factors may be as high as 75% to 100%. Most scholars believe that the main high-risk factors for recurrence are young children with febrile seizures and families with a history of febrile seizures or epilepsy.
Fever convulsions and epilepsy: Will children with febrile convulsions become epilepsy? This is a general concern for parents. Most febrile seizures have a good prognosis, and only a few patients can be converted to epilepsy. The incidence of febrile seizures is 2% to 7%. When children with febrile seizures have the following risk factors, they are more likely to change into epilepsy: (1) Complex febrile seizures, with a duration of about 15 minutes, limited seizures, seizures below 38 ° C, and a fever Continuous attacks. (2) Fever convulsions have repeatedly recurred. (3) Before the febrile seizure, there are abnormalities in the nervous system, abnormal development, mental retardation or abnormalities during the perinatal period. (4) The first episode is under 1 year old. (5) History of epilepsy or febrile seizures at home.
Fever convulsions and intellectual development: Fever convulsions are the most common form of pediatric convulsions. The prognosis is generally good and the incidence of mental retardation is very low. This is because of general simple febrile seizures, with fewer attacks and short duration , Fast recovery, no abnormal neurological signs, so the impact on the brain during a seizure is very small or some people think that there is no damage. There are only a few complex febrile seizures or epilepsy syndromes with febrile seizures that may be combined with mental retardation. There are two explanations for this. One is that severe febrile seizures can cause brain damage, resulting in epilepsy and intelligence. Low, which means that the longer the seizures are, the more recurrent the seizures are, the greater the possibility of brain damage. Another view is that before the febrile seizures, the nervous system has been abnormal. Such children will have mental retardation even if they do not have febrile seizures. That is to say, the neurological symptoms of children with febrile seizures are not caused by the seizures themselves. It exists before the onset of febrile seizures, and febrile seizures and mental retardation are not determined by a causal relationship, but by a common cause.
In short, if there is a neurological abnormality before febrile seizures, it may lead to mental retardation in the future. Severe seizures can also cause brain damage and affect intelligence.
2. Epilepsy: With the deepening of the understanding of epilepsy, the progress of pathogenesis research, the improvement of diagnostic technology, the discovery of new anti-epileptic drugs, the improvement of treatment methods, and the development of blood concentration monitoring, the prognosis of children with epilepsy is better than before. Great improvement. After reasonable drug treatment, the complete remission rate of pediatric epilepsy can reach 80%. In addition, 15% to 25% of children have significantly reduced seizures after treatment, so the total effective rate of drug treatment is about 80 to 90%. The prognosis of pediatric epilepsy depends on many factors, such as etiology, seizure type, seizure severity, age, EEG changes, and sooner or later treatment.
Etiology and prognosis: Hereditary epilepsy is usually a benign prognosis, such as benign epilepsy in children with spikes in the central temporal region, and children with epilepsy, etc. The antiepileptic drug responds well. The number of seizures decreases with age, and most of them disappear after adolescence. The prognosis of symptomatic epilepsy is closely related to the primary disease. The prognosis of early seizures caused by acute craniocerebral trauma is better, and generally no longer recurs after the acute phase; late seizures should be controlled by long-term application of antiepileptic drugs. Seizures caused by tumors, abscesses, and vascular diseases in the cerebral hemisphere can only be controlled after the primary disease has been cured. The prognosis of epilepsy caused by encephalitis and meningitis varies depending on the severity of the infection and the presence or absence of complications. Epilepsy caused by congenital genetic and metabolic defects, brain degeneration, and congenital brain dysplasia is a poor prognosis, and seizures are often difficult to control. Children with epilepsy with neurological abnormalities and mental retardation also suggest poor prognosis.
Duration and prognosis of seizures: Prolonged seizures can cause convulsive brain damage and systemic complications, and are the most common cause of death in epilepsy. Convulsive brain injury can leave varying degrees of neurological sequelae and can exacerbate seizures.
Age of onset and prognosis: The prognosis of neonatal onset is poor, about 50% die or have sequelae, mainly related to the primary disease causing convulsions. Infant-onset epilepsy has a worse prognosis than older infants, and may be related to the etiology and basic pathology.
Treatment and Prognosis: Starting treatment early after the onset of epilepsy can reduce recurrence, reduce convulsive brain damage, and help improve the prognosis. The length of the course of regular medication can affect the recurrence rate after discontinuation, and the recurrence rate is low when the course of treatment is long. After long-term treatment and discontinuation of epilepsy in adults, about 40% of patients have relapses within 5 years. In children with epilepsy who continue to take medicine for 4 years after seizure control, about 1/5 of the patients relapse. Generally speaking, the duration of disease is short, and the rate of recurrence is low with timely drug treatment; the duration of disease is long, the nervous system is abnormal, the EEG is abnormal, the mental retardation is high, and the recurrence rate of symptomatic epilepsy is high.
In short, if the diagnosis of children with epilepsy is correct and treated properly, most of them have a good prognosis.
Convulsive disease prevention
Fever convulsion is the most common cause of convulsions in children. Here we mainly introduce the prevention of recurrent convulsions. It mainly includes two aspects, the first is children with febrile seizures, pay attention to exercise, improve health, prevent upper respiratory tract infections and other diseases, clear chronic infections, and minimize or avoid acute fever in infants and young children. This is of great significance for reducing the recurrence rate of febrile seizures. The second is the intermittent or long-term use of anticonvulsants to prevent the recurrence of febrile seizures.
1. Intermittent short-course preventive treatment: that is, only in the early stages of fever in each child, when the body temperature has risen as high as 37.5 ° C, diazepam solution is injected into the rectum or given diazepam or diazepam suppository, the dose is 0.5mg / kg , The maximum dose for older children is 10mg. If fever persists after 8 hours, rectal infusion or oral stabilization once, and if necessary, repeat the administration 3 times after 8 hours. Because febrile convulsions occur mostly during the early part of the heat course, prompt administration is the key to prevent recurrence with intermittent short-course medication. Parents or childcare staff should carefully observe the children, detect febrile diseases early, and immediately treat them with medication to obtain good results. If the stabilization time is too late, it will affect the effectiveness of preventive treatment. Generally prevent 3/4 of febrile seizures. The indications for stable short-term preventive treatment are: Children with first-time febrile seizures but with risk factors for recurrence, including the first onset of age 15 months, first-degree relatives with febrile seizures, and history of epilepsy; but no risk factors for relapse but The author has had repeated febrile seizures.
2. Long-term application of antiepileptic drugs: for complex febrile seizures, frequent febrile seizures (more than 5 times per year) or persistent febrile seizures, for those who are not effective with intermittent short-course treatment, long-term antiepileptic drugs can be used to prevent seizures. At present, there are only two drugs with evidence-based medicine, namely phenobarbital and sodium valproate, which can prevent the onset of febrile seizures, but it is generally believed that there is no significant effect on the incidence of epilepsy.
Convulsive diet and precautions
1. Diet and mood: During seizures, water and food should not be fed to avoid suffocation and aspiration pneumonia. After the convulsion is relieved, sugar water or nutrient-rich, digestible liquid or semi-liquid juice can be given, such as eggs, milk, flour, noodles, etc. Children with convulsions should not consume excitatory substances such as wine, vinegar, tea, coffee, chocolate and cola; avoid indirect smoking as much as possible, and avoid excessive fatigue or excessive excitement, so as not to induce seizures.
2. Whether children with convulsions can be vaccinated: Case reports of convulsions or epilepsy within a short period (hours to days) after vaccination are not uncommon, but the overall incidence is very low. The pathogenesis of febrile seizures has a complex genetic and environmental background. Although there are many reports of vaccine-related febrile seizures, the current consensus is that there is no difference between the onset of febrile seizures caused by other causes, and that vaccination is only through Some cases may be associated with fever and febrile seizures after vaccination, and the development process and prognosis are no different from those caused by other causes. Therefore, febrile seizures should not be a contraindication to vaccination. In addition, whether children with epilepsy can be vaccinated is a very complicated issue. It is generally believed that as long as the seizure control is stable for children with epilepsy (no seizures for 3 to 6 months), vaccination can be implemented as planned. For those who receive special treatments that may affect the immune status, such as ACTH, prednisone, etc., the vaccination of certain vaccines (especially live vaccines) needs to be more cautious (interval of more than 6 months). At the same time, you should understand the contraindications indicated in the vaccine manual. Parents should carefully consider vaccines with related contraindications such as "neurological disease" or "epilepsy".
3. Family management of seizures: When children have febrile seizures at home, improper management can cause some accidents and aggravate children's injuries and pain. Therefore, parents should learn the emergency treatment method for pediatric convulsions, just in case. Place the child flat on the bed with the head tilted to one side to prevent oral secretions or vomiting from entering the trachea and causing suffocation. Loosen the collar and trousers for children to avoid affecting breathing. Do not hold children tightly in your arms, do not shake and call your children, keep quiet, and prohibit all unnecessary stimulation. Put a small towel or pillow on the shoulder and neck, raise the shoulder and neck slightly, and make the head lean back slightly, which can prevent the root of the tongue from falling back to open the airway. Removes secretions or sputum from the mouth, nose, and throat. Use a toothbrush handle or chopsticks wrapped in a cloth strip or handkerchief between the upper and lower teeth from the corner of the child's mouth to prevent suffocation caused by the back of the child's tongue and prevent biting the tongue during convulsion. Still controversial. Should not be avoided when children's teeth are closed tightly, so as not to damage the teeth. Press the middle point of the child's nose under the nose with the thumb (at the junction of the upper 1/3 and the lower 2/3 of the nasolabial sulcus) and the Hegu point at the two-handed tiger's mouth (the point where the thumb and forefinger divide). You can gently support your hands and feet while your limbs are convulsing, but do not press hard to stop the convulsions, or you will cause injuries to your hands and feet, such as fractures or dislocations. After the convulsion ceases, the child should be immediately sent to the nearby hospital for further examination, the cause should be identified early, and the cause should be treated. Seek treatment near you. While transporting to the hospital, the children should be closely observed, pay attention to exposing the nose and mouth, and straighten the neck to keep the airway open. Do not wrap the child tightly in a quilt. This can easily block the child's mouth and nose, tilt the head and neck forward, bend the airway, cause the airway to be blocked, and even suffocate to death.
Convulsions expert opinion
1. Prevention of febrile seizures: The best prevention of febrile seizures is not fever, but whether antipyretic drugs can prevent febrile seizures after fever has been debated. The current evidence shows that the application of antipyretic drugs alone cannot prevent the onset of febrile seizures, and can only increase the comfort of children. The most admired abroad is the short-range application of butadiene suppositories, but there is no such preparation in China. Domestic use of diazepam or enema, midazolam nose drops, oral isthmus membrane cavity and so on. For patients with low fever and convulsions, long-term use of sodium valproate or phenobarbital can be given orally.
2. Vaccination of children with convulsions: Whether convulsive children can be vaccinated has not been conclusive. In fact, only three vaccines, namely the meningococcal, encephalitis, and diphtheria vaccines, are prohibited in epilepsy patients. For febrile seizures, fever may occur after vaccination, which may lead to febrile seizures, but the incidence is low. Studies have found that measles vaccination may induce febrile seizures 3 to 7 days after vaccination. Therefore, vaccination of children with convulsions is generally not necessary if febrile seizures, especially simple febrile seizures; vaccination is generally suspended for those with complex febrile seizures or frequent seizures or epilepsy has not been controlled, if epilepsy is controlled for six months Above, although it does not increase seizures for most children, only a small number of cases may occur, but if not vaccinated, there is also a risk of corresponding infectious diseases. In this case, patients or parents need Weigh the recurrence of previous convulsions and the risk of possible exposure to the corresponding infectious disease, and consider whether to vaccinate.
