Health 08/09/2015
Dear readers, today we will talk to you about an important topic: seizures in a child. We will not delve into medicine again, but you must agree that when we encounter and see such a picture in our children, then before the doctor arrives, we all need to get together, know what to do and in no case panic. After all, the health and even the life of a little person depends on us, the adults who are nearby at such a moment.
Therefore, today’s article is devoted to seizures in children, a common phenomenon nowadays. In this article we will look at the most common reasons occurrence of seizures in a child and talk about first aid for the baby if this happens before our eyes. And we must always remember: if such a problem, God forbid, happens, then you should always consult a doctor, find out the cause, and only a doctor will prescribe treatment. Let us be wise, because we are talking about the health of our children. But again, I repeat, often by the time an ambulance arrives or a doctor’s visit, the child’s seizures stop. And UNTIL this moment we remain alone with him and our problem.
In medicine, there is a certain classification of childhood seizures, this is expressed in their external manifestation, but this is purely medical terminology, which I have no right to touch on. But we will look at the causes of seizures in children. It could be
Typically, the occurrence convulsive syndrome associated with birth trauma or pathology of child development. This condition requires constant monitoring and appropriate treatment. Cerebral palsy may be the cause of seizures in children. About a third of children with cerebral palsy experience seizures.
The most common cause of seizures in children that is not associated with epilepsy and does not require treatment is high fever due to infectious diseases. But if convulsions appear in a child during normal temperature- this is always a reason to be very attentive to the baby’s health and it is imperative to identify the cause of the child’s seizures and consult a doctor!
The most common convulsions in young children are those that occur against a background of high fever; such convulsions are medically called febrile convulsions. It is believed that febrile seizures in children are caused by disorders nerve impulses in the brain as a result of not fully formed complex processes, occurring in the nerve cells of the brain.
As a rule, seizures at elevated temperatures can occur in children from 5 months to 6 years, but little man growing, nerve cells his brain returns to normal and the seizures stop.
In order not to provoke the occurrence of a convulsive syndrome, a high temperature in children must be brought down. It is generally accepted that body temperature reaching 38 degrees can cause seizures, but sometimes a slight increase in temperature is enough to trigger seizures, especially in infants. So for young children, elevated body temperature is dangerous.
Febrile convulsions can occur in different ways; the child experiences tension in the body, the head may fall back, and there may be twitching of the arms and legs. In this case, breathing may stop, which is characterized by blueness of the lips and facial skin. Such convulsions, as a rule, do not last long, but for parents it is very scary; the main thing here is not to lose composure and call a doctor.
Typically, during febrile convulsions, the child experiences twitching of the head, twitching of the arms and even the head. Pay attention and remember the picture of the child’s seizures and, when visiting the emergency doctor, very carefully, without missing any details, tell us about it.
If a convulsive attack occurs against the background of a high temperature, it may go away on its own, but you must call ambulance.
Children who are susceptible to febrile seizures should be looked after constant monitoring during any infectious disease , they must not be left unattended and do not allow the temperature to rise above 37.5 degrees .
Such children are contraindicated:
I suggest watching a video from doctors about febrile seizures in children.
Very often, the cause of seizures in infants can be a birth injury that causes bleeding in the brain. In this case, seizures can occur in the first days and even hours of the baby’s life, but they can also appear several months later. In this case, they can be triggered by a vaccination or any infectious disease.
In infants, seizures can occur due to oxygen starvation of the brain, due to high sugar or bilirubin in the blood, due to a lack of potassium, magnesium, calcium, zinc, vitamin B6.
Seizures in infants often occur in cases where women suffer from alcoholism or drug addiction.
U infants With pathology of the development of the circulatory system, a state of suffocation often occurs.
In any case, leg cramps in infants require immediate medical attention.
In children under three years of age with an overly excitable nervous system, this type of seizure is quite common. Convulsions occur against the background of crying, if the child is frightened or hit hard, they can also occur against the background of hysteria. A short-term cessation of breathing occurs, the child’s face turns blue, arms and legs twitch, and the head falls back. As a rule, such convulsions last a few seconds; to quickly restore breathing, you can splash cool water on the child’s face.
Such children should be observed by a neurologist, who will prescribe treatment that reduces nervous excitability.
What to do if a child has seizures? Whatever the cause of seizures in children, you must first call an ambulance and provide first aid to your baby yourself, for this:
In order to identify the cause of the attack, the doctor will need as much information as possible, so pay attention to everything, note the time during which the attack lasted, and if the seizures recur, the time between attacks.
Convulsions in children are a series of sudden involuntary contractions of skeletal muscles, often accompanied by impaired consciousness. Convulsions in children are the body’s response to external or internal stimuli.
Seizures in children most often occur with severe infectious diseases(toxic forms of influenza, severe intestinal infections, neuroinfections, etc.).
Seizures occur much more often in children than in adults. The reason for this is the age-related anatomical and physiological characteristics of the children's nervous system.
How smaller baby, the richer his brain is in water. In young children, the ventricles of the brain are relatively wider than in adults. Frontal lobes and the cerebellum are less developed. The gray matter of the brain is less well differentiated from the white matter. The processes of neurons are shorter, nerve cells interact less well with each other, and nerve fibers actually do not have myelin sheaths. The brain in children is supplied with blood more intensively than in adults, but the reverse flow of blood is reduced, since diploic veins form only when the fontanelles close. As a result, favorable conditions are created for the accumulation of toxic substances.
Children have a relatively high permeability of the blood-brain barrier, which regulates the flow of substances from the blood into the cerebrospinal fluid and vice versa. The spinal cord in children develops faster and is relatively more mature compared to the brain. Cervical and lumbar thickening in spinal cord determined by 3 years of age. The medulla oblongata in children enters the foramen magnum at an angle; this, with the development of cerebral edema, leads to rapid wedging of the brain stem into the foramen magnum.
The spinal cord in young children is longer (relatively) than in adults. The volume of cerebrospinal fluid is smaller, its pressure is lower. Cerebrospinal fluid contains more protein and less sugar. In children, the brain's need for oxygen is much higher than in adults. The imperfection and incompleteness of all mechanisms of central regulation are typical for the children's central nervous system.
Seizures in children CausesSeizures in children are divided into non-epileptic and epileptic.
1. Convulsions as a response of the brain to various harmful agents and irritants(this could be an increase in body temperature, neuroinfection, trauma, pathological reaction to vaccination, intoxication, metabolic disorders). Such convulsions occur in children under 4 years of age.
2. Symptomatic seizures in brain diseases
The most severe manifestation of seizures is status epilepticus, which disrupts consciousness and the functioning of the cardiovascular and respiratory systems.
If convulsions continue for more than 5 minutes in a row or a series of convulsive seizures is observed over a short period of time, between which the functions of the nervous system are not fully restored, this condition is called status epilepticus.
Status epilepticus is characterized by repeated convulsions between which consciousness is not fully restored, during attacks breathing is impaired, and cerebral edema develops. If, after a convulsive seizure, impairment of consciousness increases and paresis and paralysis appear, these are prognostically unfavorable symptoms.
Status epilepticus (SE) can be triggered by withdrawal of anticonvulsant medications or acute illness.
Status epilepticus occurs less frequently in children than in adults. Status epilepticus can be a manifestation of the disease epilepsy or be symptomatic of other diseases of the central nervous system. Status epilepticus is an extremely life-threatening condition for a child that requires emergency medical attention.
There are separate articles about x and x. Read below about other types of seizures in children.
Convulsions in children with spasmophiliaThis is a type of metabolic cramp. They are characterized by
Disturbances in blood glucose levels - hyperglycemia, hypoglycemia, disturbances in the metabolism of electrolytes: sodium, potassium, can lead to impaired consciousness and be accompanied by convulsions.
Cardiac syncope occurs due to disturbances heart rate, paroxysmal tachycardia, birth defects hearts. Their manifestations may be loss of consciousness, and sometimes convulsions, due to developed hypoxia of the brain. These are life-threatening conditions and require emergency care from an anesthesiologist-resuscitator!
Children with epilepsy, acute situational seizures, as well as seizures due to somatic diseases, including cardiogenic, and children with endocrine diseases need careful observation and adequate treatment.
There is a table to distinguish epilepsy from other conditions accompanied by seizures and loss of consciousness.
|
Sign |
Pathological condition |
||
|
Epilepsy |
Syncope |
Conversion states (hysterical neurosis) |
|
|
Patient age |
Any |
Most often teenage |
Not typical for children early age |
|
Body position at the onset of an attack |
Any |
Vertical |
Any |
|
Premonition of an attack |
Aura |
Swoon |
Non-specific |
|
Kinematics of an attack |
Stereotypical, synchronized movements |
Going limp; isolated clonic jerks are possible |
Chaotic artsy asynchronous movements; opisthotonus |
|
Availability of automatisms |
Characteristic |
Doesn't happen |
Doesn't happen |
|
Consciousness during an attack |
Turned Off, Changed or Saved |
Always off |
Saved, in rare cases changed |
|
Urination during an attack |
Characteristic |
Extremely rare |
Extremely rare |
|
Time of occurrence of attacks |
Any |
While awake |
Usually while awake |
|
Provocation of attacks |
Hyperventilation, photostimulation |
Stuffiness, fear, prolonged vertical position |
Psychogenic factors |
|
Intelligence |
Often reduced |
Norm |
Norm |
|
Electroencephalogram |
Epiactivity |
Norm |
Norm |
Before the ambulance arrives, the room should be ventilated. To prevent head injuries, place the child on his side. Fix the tongue. Measure the temperature.
The assessment plan for a child with any seizures is similar to that for febrile seizures.
Forecasts favorable with typical febrile convulsions, with affective-respiratory attacks.
Unfavorable prognosis for quality of life in the future if the child has frequent epileptic seizures or status epilepticus with encephalopathy. The prognosis depends on the cause of the seizures.
All children after any seizures are observed by a neurologist, with mandatory EEG (electroencephalography). According to indications, prescribed anticonvulsants. It is necessary to prevent provoking factors and stress.
This is all about seizures in children. I wish you good health!
Seizures in a child can occur at any age. Sometimes this does not pose any threat to his health. But there are cases when such manifestations threaten not only normal development nervous system, but also the life of the baby. How to recognize dangerous seizures in time and how to solve this problem?
The causes of seizures are quite difficult to accurately determine, because they largely depend on their specific type. If we talk about harmless muscle contractions, they often occur as a result of sending impulses to nerve endings. This includes nighttime shuddering when the child is dreaming or a temporary tic.
As a result, we can identify the following provoking factors for the occurrence of seizures:
A cramp is an involuntary contraction of muscles due to a signal sent through nerve endings. It is quite easy to notice them, because in most cases they have a pronounced character.
How do seizures manifest?
Signs of neuropathy and hyperkinetic syndrome can become alarm signals: muscle tremors, nervous tics, tremors of the limbs.
How to recognize an epilepsy attack:
Muscle contractions are not the same. There are the following types:
In addition, a distinction is made between focal and generalized seizures. In the first case, the spasm occurs on separate area and concentrates locally. In the second, almost all muscle groups are involved, which leads to complete paralysis for a certain time. There are also groups of febrile and non-febrile spasms.
Febrile seizures often occur in children during a cold or flu. Muscle contraction occurs at high temperatures.
This side effect feverish condition. Of course, their occurrence is not the norm, but such short-term seizures do not pose any particular danger. They go away together with the cause of their occurrence - an infectious or viral disease, so treatment should be directed specifically at it.
It’s not just temperature that can cause convulsions. Not febrile seizures arise due to a temporary disruption of adequate brain functioning. Often such phenomena are isolated.
Convulsions observed during sleep are often associated with increased brain activity, that is, dreams. However, in the presence of pathologies that provoke their appearance, involuntary urination of a sleeping child may be observed. At the age of up to 3 years, such trouble does not always indicate any disease. But in older children this is beyond the norm.
When the child is awake, such convulsions are much easier to notice. Epilepsy also falls into this category. Non-febrile seizures are often accompanied by loss of consciousness. It can be either complete or partial, when the patient manages to control his body. In this case, stupor or momentary loss coordination.
The most dangerous are generalized convulsive conditions. They are characterized total loss control of the child over his body, loss of consciousness, serious consequences of convulsions.
The consequences of seizures are unpredictable.
During a seizure, the functioning of the brain is paralyzed and the supply of oxygen to its tissues is stopped.
This can provoke necrotic processes, affect the nervous and mental development child. Often such phenomena lead to a lag in psycho-emotional, mental and physical development, decreased intelligence.
At night, cramps are most dangerous, because the child may need help, but there will be no one nearby. They can even cause death, as they provoke the shutdown of vital processes, lead to respiratory arrest, and asphyxia.
There are cases when the victim suffocates due to foamed saliva, vomit, or recessed tongue entering the respiratory tract. Epileptic seizures are dangerous because the child can injure himself or even bite off his tongue.
What should you do if your child suddenly starts having seizures? Here, much depends on the intensity and location of the attack. If his legs cramp, the best way Relieve tension by stretching the limbs and massage. It is also recommended to apply pain to the affected muscle, for example, by pinching or pricking.
If your teeth are clenched tightly, do not try to loosen them. No medications or water should be given until the seizure is over. When the convulsions stop, check the child's pulse and breathing, and the position of the tongue. You definitely need to call an ambulance.
After first aid has been provided, you need to go to the hospital to find out the causes of the seizure and eliminate them. First of all, you need to contact your pediatrician. If the problem lies in a disruption of the central nervous system, in this case it will help narrowly qualified specialist– neurologist or neuropathologist, in case of metabolic disorders – endocrinologist.
If the seizures are of non-febrile origin, an examination must first be carried out. A blood test can indicate a deficiency or excess of certain elements in the body. An important step is the study of the state of the brain. To do this, electroencephalography (EEG) is performed, which allows you to observe particularly active areas of the brain. Subject to availability serious problems A CT or MRI may be needed.
The exact direction of treatment is determined by the final diagnosis. Disorders of the central nervous system are treated with medications, psychotherapy and other methods. Reflexology, massages, exercise therapy, wave and pulse effects on nerve endings and the cerebral cortex can be effective. Severe brain problems may require surgery. In this case, a more detailed study is carried out, and the child is prepared with the help of medications.
The recovery process after serious treatment of diseases that provoke seizures can last from a couple of weeks to several years, it all depends on the specific type of pathology. Some diseases cannot be cured complete cure Therefore, continuous maintenance of therapy is necessary.
Often, a child who has had seizures and treatment for this problem needs rest. Can't be allowed stressful situations, heavy physical and intellectual stress. Creative activities help a lot. IN postoperative period It is mandatory to take medications that are prescribed only by the attending physician.
To monitor the effects of seizures, it is necessary to undergo examination from time to time. This includes not only monitoring the functioning of the brain and nervous system as a whole, but also monitoring cardiac activity, endocrine system and other directions. In the first year, an ECG is a mandatory measure. If you follow the doctor’s recommendations, the child will very soon return to his usual rhythm of life.
Seizures can be either a single manifestation or have an adverse effect throughout the child’s life.
For minor disorders or febrile manifestations severe consequences are extremely rare. The prognosis in such cases is very favorable.
If there are serious problems, the prognosis worsens.
Long-term lack of treatment or progression of the underlying disease can lead to developmental delays, impaired motor function, metabolic processes, cause cerebral palsy and other pathologies.
In order to reduce the likelihood of seizures, you need to take care of the proper mental and physical development of your child. Walking on the river plays an important role in this regard. fresh air, physical activity, frequent contact with parents, especially mother. Older children should do exercises, and adults should help kids with this. It is also necessary to take care of the correct and balanced diet, because a lack of minerals and vitamins can also cause this problem.
Doctor advises
If you notice convulsions in a child, do not ignore them, because it is better to be safe and make sure that everything is in order. It is much better to eliminate the problem before it becomes permanent. And since children are not yet able to take care of their health on their own, the responsibility lies entirely with their parents.
Video for the article
All types of seizures in children have a different nature. Most often, febrile and psychogenic convulsive manifestations are diagnosed. Involuntary muscle contractions are common in epilepsy, brain tumors, hyperthermia, intoxication, eclampsia, tetanus and meningitis. Also, seizures in children can occur against the background of burn shock, cardiovascular and hemorrhagic diseases.
Convulsions in a child are sudden involuntary attacks of tonic-clonic contractions of skeletal muscles, often accompanied by loss of consciousness. This is a nonspecific reaction of the nervous system to various endo- and exogenous factors, especially in young children. Convulsive syndrome in children accounts for about 10% of all pediatric emergency calls. This is due to both the age-related predisposition of the child’s brain to generalized reactions (high tone of the pallidal system, increased activity hippocampus, hydrolability nerve tissue), and the polyetiology of the convulsive syndrome.
In this article you will learn how seizures manifest themselves in children and what to do if a child starts having seizures due to various diseases.
The causes of convulsive syndrome in children are traumatic brain injuries, neuroinfections, brain tumors, congenital degenerative diseases of the nervous system, disorders cerebral circulation, metabolism (acetonemia, hypo- and hyperglycemia, hypocalcemia), liver function, kidneys, endocrine glands, overdose and drug poisoning, etc.
The clinic of convulsive syndrome manifests itself depending on the type of seizure. When classifying, generalized and local, single and serial with transition to convulsive status, clonic and tonic convulsions are distinguished. Clonic ones appear with repeated contraction and relaxation of individual muscle groups (face or limbs) and are caused by irritation of the cerebral cortex; tonic - with prolonged muscle tension, mainly in an extensor position (forced position) and are caused by damage to the brain stem-subcortical structures; clonic-tonic - with a periodic change of tonic and clonic phases.
Emergency laboratory tests for convulsions in children: determination of the level of glucose, calcium, magnesium, sodium, bicarbonates, urea nitrogen, creatinine, bilirubin, arterial blood gas composition; lumbar puncture to detect neuroinfection or hemorrhage.
Regardless of the type and type of convulsions, it is necessary to clear the airways of mucus, establish inhalation of humidified oxygen, and, if necessary, perform mechanical ventilation. If necessary, resuscitation measures (ABC) and monitoring of vital signs are indicated.
The primary task remains the urgent relief of convulsive syndrome in children: for this, in emergency cases, use a 0.5% solution of seduxen 0.1 -0.2 ml/kg intramuscularly or intravenously, slowly in an isotonic sodium chloride solution. Fast action barbiturates: administer intravenously a 1% solution of phenobarbital at 10-15 mg/kg, 1% solution of hexenal at 3-5 mg/kg (if necessary, increase the dose, but not more than 15 mg/kg), intramuscularly 5% solution of hexenal at 3 -5 mg/kg. Anticonvulsant effect when intravenous administration develops “at the end of the needle.” Due to possible depression of the respiratory center, hexenal is best used in the presence of a ventilator.
As first aid, but short-term aid for convulsive symptoms in children, you can use a 25% solution of magnesium sulfate intramuscularly at 0.2 ml/kg, 0.25% solution of droperidol at 0.3-0.5 mg/kg intramuscularly and intravenously. Repeated administration of anticonvulsants is possible after 15-25 minutes, since more early application leads to their accumulation and subsequent respiratory depression.
In severe DN due to hypoxia, anticonvulsants can cause respiratory arrest. In this case, the only way to combat seizures is to transfer the child to mechanical ventilation with intravenous tubocurarine at a dose of 0.2 mg/kg or pipecuronium bromide at a dose of 0.04-0.06 mg/kg intravenously. Muscle relaxation during the administration of tubocurarine lasts 20-25 minutes. For repeated administrations, the dose is reduced by 2 times. The effect of pipecuronium lasts 40-60 minutes.
For febrile convulsions, and they are most often short-lived and pass quickly, antipyretics are prescribed: 50% solution of metamizole sodium, papaverine with dibazole. If after therapy the seizures are not stopped, then benzodiazepines (midazolam, seduxen) are used, and children under one year of age are hospitalized in a hospital according to the nature of the underlying disease.
For persistent convulsions, inhalation anesthesia with nitrous oxide followed by intravenous administration of ketamine at a dose of 1.5 mg/kg is indicated (contraindicated in cerebral edema and epilepsy!). When treating convulsive syndrome, dehydration therapy is mandatory. For this purpose, concentrated plasma (diluted with bidistilled water in a ratio of 2:1) is administered intravenously at the rate of 5-10 ml/kg, 20% glucose solution (20-40 ml), rheopolyglucin (10 ml/kg), mannitol or sorbitol (1 g/kg), lasix (1-2 mg/kg). For the purpose of dehydration, glycerol is injected into the stomach through a tube at a rate of 0.5-1.5 g/kg. Prednisolone is used at a dose of 1-3 mg/(kg day), in exceptional cases the dose can be increased to 5-10 mg/(kg day). In order to reduce vascular permeability, intravenous administration of a 5% solution is indicated ascorbic acid(1-2 ml), calcium preparations (10% calcium gluconate solution at a dose of 1 ml/year of life, but not more than 10 ml).
When providing first aid for convulsive syndrome in children with suspected cerebral edema, a spinal puncture is performed for diagnostic and therapeutic purposes. At the same time, measures are taken to restore vital functions. In case of activity disorder cardiovascular system use cardiac drugs; if necessary - mechanical ventilation.
It is necessary to treat the underlying disease that caused the seizure syndrome ( antibacterial drugs etc.). If a convulsive syndrome has developed as a result of spasmophilia, accompanied by a decrease in the level of calcium in the blood, then, along with the use of anticonvulsants, intravenous administration of a 10% calcium gluconate solution at a dose of 1 ml/(kg day) is necessary - no more than 10 ml for 2-3 injections. As the child’s condition improves, calcium supplements are prescribed orally at a dose of 3-5 g/day. 2-3 days after stopping the convulsive syndrome, vitamin D2 is added to the therapeutic complex at 4000-8000 IU/day to enhance the reabsorption of calcium from the intestine.
In the presence of hypoglycemia, glucose is administered intravenously or intraosseously: for infants - a 10% solution at a dose of 4-5 ml/kg, for older children - a 20% solution at a dose of 2 ml/kg.
According to clinical guidelines For convulsive syndrome in children, the choice of anticonvulsants should be individual (depending on the reasons that caused the development of seizures). When choosing a complex therapeutic measures the doctor must consistently answer three questions: does the child have a breathing disorder, is there a disturbance of consciousness after the end of the attack, what is the etiology of the seizures.
Table “Anticonvulsants for the treatment of seizures in children”:
|
Preparation |
Priority |
Side effects |
Comment |
|
|
Diazepam |
Unknown etiology of seizures, first aid for poisoning - organophosphorus and organochlorine compounds |
IV 0.3 mg/kg or 2.5 mg/kg until effective. B/m or rectally. The dose can be increased 2-3 times |
Respiratory depression. |
Gain respiratory disorders against the background of barbiturates |
|
Midazolam |
IV 0.05-0.2 mg/kg over 2-3 min 1-2 mg/kg/min |
|||
|
Propofol |
IV 2-4 mg/kg |
|||
|
Thiopental |
2.5-3 mg/kg, if mechanical ventilation is possible - up to 5-7 mg/kg |
|||
|
Hexenal |
Seizures with ICH. Poisoning: opiates, xanthines, antihistamines |
5-10 mg/kg or 3-5 mg/kg/h IV 10-20 mg/kg over 20 min |
Respiratory depression |
Excessive accumulation in barbituric coma >24 hours |
|
Oxybutyrate |
Posthypoxic seizures |
100-150 mg/kg slowly at 20 mg/kg/h |
At long-term use- hypokalemia |
|
|
Phenytoin |
Arterial hypotension, bradyarrhythmias, A-V block |
The maximum permissible rate of administration is 49 mg/min. |
||
|
Magnesium sulfate |
Seizures with ICH |
V/m 25% solution. IV 6% solution 50 mg/kg |
Respiratory depression |
IV speed no more than 1 ml/min |
|
Muscle relaxants |
Persistent seizure syndrome |
“Cosmetic” therapy does not change seizure readiness |
Carry out against the background of anticonvulsants |
What seizures of various natures look like in children is described in the table below.
Table “Characteristics of childhood seizures”:
|
Characteristic |
|
|
Post-vaccination |
Allergic seizures Increased body temperature, accompanied by convulsions. Similar to febrile |
|
Infectious diseases |
Convulsions of infectious nature In children younger age seizures occur like epileptic seizures - an epileptic reaction. They resolve quickly with timely treatment. If repeated, there is a danger of the formation of an epileptic focus. Focal seizures indicate focal brain damage due to encephalitis |
|
Tetanus |
Tonic tension of the limbs, spasm of the masticatory muscles, “sardonic” laughter, difficulty swallowing, respiratory distress (individual breaths alternate with breathing stops), weakening of heart sounds, tachycardia. Retention of urination and stool. Duration of attack from several seconds to 20 minutes |
|
Hyperthermia (febrile seizures) |
Tonic-clonic convulsions appear in the first 3 years of life when the temperature rises above 38 ° C due to infectious diseases, more often in boys. May be accompanied by vomiting and general agitation. Local neurological symptoms (stiff neck, pathological reflexes) absent. Duration - from a few seconds to 15-20 minutes. Recurrence of an attack during the course of the disease is rare; in this case or if the duration is more than 1 hour, it is necessary to exclude epilepsy. A family predisposition is suspected. Differential diagnosis carried out with tetany, meningitis, intracranial hemorrhage, venous sinus thrombosis, asphyxia, hypoglycemia, acute glomerulonephritis |
|
Carpopedal spasm |
Seizures due to metabolic disorders Tonic tension of the muscles of the feet and hands: the hands are bent, thumb brought to the palm (“obstetrician’s hand”), feet in a state of plantar flexion. This can go on for hours |
|
Mainly in children who are on artificial feeding, with altered reactivity of the body. The cause of such seizures in children may be a deficiency of calcium salts and vitamin D, or various diseases. Symptoms: a sonorous, groaning cry, difficulty breathing, respiratory arrest as a result of increased excitability of the neuromuscular apparatus of the larynx. Severe pallor, cyanosis of the lips. Motor restlessness or freezing with the head thrown back, tonic tension of the torso and limbs, bulging of the large fontanel. At the end of the attack there are several noisy whistling breaths. The duration of the attack is from a few seconds to 1-2 minutes, attacks can be repeated up to 20 times a day |
|
|
Myoclonus-epilepsy |
Usually observed in children over 10 years of age. Combination of myoclonic hyperkinesis with epileptic seizures. The first manifestation is either myoclonus or an epileptic seizure |
|
Hereditary degenerative diseases |
Usually against the background of delayed psychomotor development, neurological and somatic changes, with Tay-Sachs, Niemann-Pick, Gaucher diseases and other lipidoses, leukodystrophies, aminoacidopathies |
|
Spasmophilia (rachitic tetany) |
Tendency to general or local tonic, less often - clonic convulsions. Symptoms of laryngo- and bronchospasm, mainly during artificial feeding in children over 4 months of age. up to 1.5 years in the winter-spring period. Increased neuromuscular excitability: Khvostek's symptom - contraction of the facial muscles with light tapping with a finger between the zygomatic arch and the corner of the mouth, Trousseau's symptom - tension of the hand in the "obstetrician's hand" position when compressing the neurovascular bundle, Lyust's symptom - raising the outer edge of the foot and abduction legs when tapping in the area of the head of the fibula (at the site of the peroneal nerve). Decreased concentration ionized calcium in blood serum (less than 0.9 mmol/l), respiratory, less often - metabolic alkalosis. Differentiate from other forms of tetany that occur with impaired calcium and magnesium metabolism |
|
Eclampsia |
Clonic seizures due to cerebral dysrhythmia as a result of increased neuromuscular excitability |
|
Affective |
Convulsions of neurogenic nature In children from 6 months. up to 3 years. Short-term. Against the background of crying, inspiratory breath holding occurs, accompanied by asphyxia, loss of consciousness, and severe adynamia. |
|
Hysterical |
For neuroses with increased excitability (it is necessary to exclude organic damage to the central nervous system) |
|
Diseases of the cardiovascular system; heart defects and rhythm disturbances, etc.; blood diseases (leukemia, |
Convulsions in somatic diseases Tonic-clonic seizures as a consequence of cerebrovascular accident and hypoxia of brain tissue. With hypoglycemic, hepatic coma - generalized convulsions, with uremic coma - there may be erratic, asymmetrical contractions |
|
Coagulation system disorders hemorrhagic vasculitis), collagenosis, coma |
individual muscles or muscle fibers (muscle fibrillation). With Reye's syndrome - tonic-clonic convulsions and progressive disorder of consciousness against the background of the catarrhal state of the upper respiratory tract |
|
Brain tumors |
Focal (indicate the localization of a focal lesion) or generalized as a manifestation of cerebral disorders ( intracranial hypertension, cerebral edema). They begin with increased headaches, shortness of breath, vomiting, and bradycardia. With subtentorial tumors, Jackson's seizures occur - convulsive paroxysms, usually of the clonic type, in a limited group of muscles of the limb or face with subsequent spread to the limbs of the same side or facial muscles |
|
Intoxication (poisoning) of various natures |
Convulsions due to injury and poisoning. The comatose state is often accompanied by convulsions. In case of carbon monoxide poisoning - tonic, such as decerebrate rigidity, trismus of the masticatory muscles |
|
Post-traumatic |
Single or serial seizures - after brain contusions, intracerebral hemorrhages, less often after a concussion. More often repeated in the future, less often limited to a period of several hours after the injury |
|
Burn shock |
Tonic or tonic-clonic nature of seizures. As a rule, for deep burns with a lesion of 5-40 % body surface |
Convulsions during organic lesions CNS disorders are possible in patients with congenital abnormalities of brain development (microcephaly, hydrocephalus, spina bifida, hypoplasia of certain brain structures). The causes of such seizures in children may be cerebral palsy, previous meningitis and encephalitis, or a brain tumor.
Clinical picture. With craniostenosis and cerebral vascular diseases, tonic-clonic convulsions most often occur against the background of hypertonicity or spastic paralysis muscles of the trunk and limbs, sometimes with choreic hyperkinesis, usually in combination with focal neurological symptoms. Many children are lagging behind in neuropsychic development.
Diagnostic methods: computer X-ray and NMR tomography, positron emission tomography, color Dopplerography, as well as multi-channel computer EEG (electroencephalographic mapping).
Treatment. A 0.5% solution of seduxen is indicated intramuscularly, intravenously at 0.3-0.5 mg/kg or a 20% solution of sodium hydroxybutyrate - intravenously at 50 mg/kg.
Dehydration therapy: intravenously 20% glucose solution, albumin, mannitol at the rate of 1 g/(kg day), Lasix 1-3 mg/(kg day). A spinal tap is performed. Consultation with a neurosurgeon and treatment of the underlying disease are necessary.
Psychogenic convulsions (hysterical convulsions, pseudoconvulsions) are observed in children with an unstable psyche, more often over the age of 3 years, but are possible at the end of the 1st and 2nd year of life.
Clinical picture. Such affective-respiratory (primitively hysterical) convulsions in children with emotional stress manifest themselves as crying with “sunset” and screaming, followed by holding the breath while inhaling (up to the development of cyanosis). Following this, generalized tonic-clonic convulsions and opisthotonus with involuntary urination occur. The attack ends with general lethargy and drowsiness of the patient. During an affective-respiratory seizure, the development of seizures can be prevented by distracting the child.
Hysterical seizures occur in school-age children and are accompanied by demonstrative behavior, screaming, and crying. Muscle twitching does not reach the level of clonic-tonic convulsions; when simulating tonic seizures, fanciful (worm-like) body movements appear, which intensify in the presence of other people. There are no neurovegetative symptoms of a true convulsive seizure (pallor, drooling, involuntary urination). Pseudoparalysis and pseudocontracture of joints are combined with normal reflexes.
Providing first aid for psychogenic seizures, during a seizure the child is sprayed cold water, pat on the cheeks. Valerian tincture is prescribed (1 drop per 1 year of life), with frequent repetitions: Librium 0.5-1.0 mg/(kg day).
Febrile seizures in children are paroxysms of various durations occurring in the form of tonic or tonic-clonic seizures in the extremities, occurring in infants, early childhood and preschool children at a body temperature of at least 37.8-38.5 ° C (with the exception of seizures induced by CNS infections). The main cause of febrile seizures in children is acute infection with herpes viruses 6 and 7; spasms can also be observed with influenza and other acute respiratory viral infections.
Clinical picture. Focal neurological symptoms There are no febrile seizures. Catarrhal phenomena in the VCP are not always detected. Simple febrile seizures (generalized tonic-clonic, clonic or tonic) last no more than 15 minutes. They disappear with a decrease in body temperature, in particular under the influence of antipyretics (paracetamol, analgin). Complex febrile convulsions are longer (more than 15 minutes), can be repeated throughout the day, have a focal nature (motor focal paroxysms, deviation eyeballs, gaze stop). Convulsive status may develop.
Providing first aid for febrile seizures in children, it is necessary to ensure permeability respiratory tract, oxygen subsidy, if necessary, provide adequate ventilation, carry out resuscitation measures(ABC). Monitoring vital signs is essential. In the presence of hypoglycemia, glucose is administered intravenously or intraosseously: in infants - a 10% solution at a dose of 4-5 ml/kg, in older children - 20%. Solution at a dose of 2 ml/kg.
An attack of febrile seizures is treated according to protocols for the treatment of convulsive syndrome. Typically used are diazepam (Seduxen, Relanium, etc.), lorazepam (Lorafen, Merlit, etc.), phenobarbital, sodium hydroxybutyrate and other anticonvulsants.
In certain conditions, the treatment of febrile seizures in children may require the use of antibacterial therapy and acyclovir.
To reduce body temperature, paracetamol is prescribed at 10-15 mg/kg up to 4-6 times a day, 50% solution of metamizole sodium: children under 1 year 0.01 ml/kg, over 1 year 0.1 ml/year of life ( no more than 1 ml); physical cooling methods are considered advisable to achieve a decrease in body temperature within the subfebrile range (from 37.5 to 38°C).
For complex convulsions and in order to prevent recurrent febrile convulsions, short (during the period of fever) courses of therapy with diazepam at 0.3-0.5 mg/kg 2 times a day or phenobarbital at a dose of 3 mg/(kg day) can be carried out. The use of diphenine and carbamazepine for febrile seizures is often ineffective.
See how febrile seizures manifest in children in this video:
Primary encephalitis includes viral diseases- tick-borne (spring-summer), mosquito (summer-autumn), enterovirus (Coxsackie, ECHO), herpetic, influenza; secondary - complications of various diseases (measles, rubella), post-vaccination encephalitis.
Clinical picture. Seizures develop with a significant increase in body temperature and signs increased ICP, intoxication (headache, vomiting, behavioral disturbances, stupor, coma). When the membranes of the brain are involved in the process, signs of meningoencephalitis appear. Generalized seizures. In contrast to neurotoxic syndrome, focal convulsions of the type of Jacksonian epilepsy, spastic paresis and paralysis, conduction sensitivity disorders, and, less often, subcortical and cerebellar disorders, speech disorders can be observed. In the cerebrospinal fluid - lymphocytic cytosis (100-200 cells in 1 μl), later increase in protein content. Glucose levels are within normal limits.
When identifying symptoms of seizures in children, diagnosis is based on the isolation of the virus from the blood and cerebrospinal fluid, data enzyme immunoassay for the content of antiviral antibodies.
Treatment. Prescribe a 0.5% solution of seduxen at 0.3-0.5 mg/kg or a 20% solution of sodium hydroxybutyrate at 50 mg/kg. Also, in the treatment of such seizures in children, immunoglobulins are used intravenously (for epidemic encephalitis, it is better to use immunoglobulin from the blood of donors living in natural foci of infection). For herpetic encephalitis, acyclovir is administered intravenously, 15 mg/(kg day) in 3 doses, for 5-20 days.
To help with such cramps in children, dehydration therapy is indicated: intravenously 20% glucose solution, rheopolyglucin (10 ml/kg), albumin (5-10 ml), mannitol at the rate of 0.5-1 g/kg, Lasix at a dose of 1-3 mg/(kg day), spinal puncture. Dexamethasone (Dexazone, Dexaven) is administered intravenously or intramuscularly at an initial dose of 1 mg/kg, then 0.2 mg/kg every 6 hours. To improve cerebral hemodynamics, use xanthinol nicotinate (15% solution, 0.25 ml/year of life intravenously or intramuscularly), nootropil (piracetam) 30-50 mg/(kg day) in 2-3 doses, chimes (dipyridamole) orally 2-3 mg/(kg day).
Infantile spasms (West syndrome) - this epileptiform syndrome is observed more often at the age of 3-7 months. The reasons why a child has such seizures are brain dysgenesis, hereditary diseases(phenylketonuria, tuberous sclerosis), perinatal infections, hypoxic-ischemic encephalopathies, chromosomal diseases, trauma and brain tumors. In most cases, infantile spasms develop into epilepsy.
Clinical picture. Sudden symmetrical contractions of the muscles of the neck, torso, and limbs (flexor, salaam spasms). With flexor-extensor spasms, sudden flexion of the neck and arms and extension of the legs occur; with extensor spasms, a sharp extension of the neck, torso, and limbs occurs with their abduction. The frequency of such spasms is from 10 to several dozen per day. There is a delay in the child's neuropsychic development.
The EEG during the non-attack period during such convulsions in children shows signs of hypsarrhythmia: high-amplitude slow waves, bursts electrical activity and sharp waves.
Treatment. Infantile spasms are usually resistant to anticonvulsants. Sodium valproate is prescribed - up to 20-50 mg/(kg day), if there is no effect, ACTH is used (synacthen depot intramuscularly at the maximum allowable dose of 40 units/day or 1 ml/day 2-3 times a week). Considering the cause of such seizures in children, when choosing a treatment method, clonazepam and sodium valproate may be prescribed.
Epilepsy is a disease with polygenic inheritance and occurs in children of preschool and school age, although it can begin at an earlier age. Epilepsy may be preceded by recurrent febrile seizures and infantile spasms. Apparently, it is not the disease itself that is inherited, but the convulsive readiness of the brain. Permissive factors can be perinatal encephalopathies, acute infections, severe post-vaccination reactions.
Clinical picture. In partial epilepsy, a seizure attack is preceded by an aura. In younger children, it is expressed by general restlessness or immobility (freezing), sweating, and the appearance of " goose bumps", redness of the face. Young children ask to be held and rub their eyes with their hands. In older children, visual, auditory, gustatory, olfactory hallucinations. The child suddenly screams or moans, loses consciousness, falls, his muscles tense tonically, then clonic muscle spasms of the whole body occur. The complexion changes from pale (at the beginning of the attack) to purple-bluish. Blood-stained foam comes from the mouth. Breathing is noisy and hoarse. The pupils do not react to light, involuntary urination and defecation occur. After the seizure, sleep of varying duration occurs. After waking up, children complain of weakness, headache, they are oppressed. Sometimes only a certain group of muscles in the face or arms is affected by cramps.
In Jacksonian seizures due to damage to the motor area cerebral hemispheres convulsions of the contralateral part of the body are observed. There is no tonic phase. Clonic convulsions occur when consciousness is preserved and gradually spread to all muscles of the body when consciousness is lost. The seizure may be limited to the stage of clonic convulsions without loss of consciousness. Status epilepticus often develops, when convulsive attacks are repeated many times and the child does not regain consciousness for a long time. When status epilepticus lasts more than 1 hour, irreversible necrotic changes in brain cells occur.
Lennox-Gastaut syndrome is a severe form of epilepsy with seizures, mental retardation, hypsarrhythmia on EEG. Often occurs with cerebral palsy.
Children from 2 to 8 years old may experience minor seizures or absence seizures - stopping gaze, short-term episodes of loss of consciousness. The attack is usually short and may go unnoticed.
Providing emergency assistance with such cramps, it is necessary to insert a cotton swab between the child’s teeth to prevent tongue biting (if possible), give the upper body an elevated position, and turn the head to the side.
Provide oxygen through a nasal tube or mask. Administer diazepam intravenously or intramuscularly at a dose of 0.25 mg/year of life (children over 5 years of age). The effect of diazepam lasts about 1 hour; convulsions may recur 20-30 minutes after infusion. If the attack does not subside, administer a 1% solution of seduxen at 0.3-0.5 mg/kg intramuscularly or intravenously.
Dehydration therapy: intravenously administer mannitol 1 g/(kg day), Lasix 1-3 mg/(kg day), 20% glucose solution. IN as a last resort resort to inhalation anesthesia nitrous oxide mixed with oxygen (2:1), but this measure is contraindicated in deep coma and vascular collapse.
What else should be done if a child has seizures due to epilepsy? When conducting intensive care monitoring of respiration, ECG, blood pressure, EEG, monitoring of the state of the CBS and the level of gases in the blood are necessary. The EEG identifies the focus from which the convulsive discharges emanate, and this focus is available for intervention. In case of prolonged status epilepticus, it may be necessary to transfer the child to mechanical ventilation. Surgical treatment is indicated for seizures refractory to anticonvulsants.
Anticonvulsant effects may have various substances, weakening excitation processes or enhancing inhibition processes in the central nervous system.
Bromides, magnesium sulfate, barbiturates, especially phenobarbital, chloral hydrate, as well as tranquilizers of the benzodiazepine group (seduxen, phenazepam, mezapam, elenium), etc. are used as anticonvulsants. Under the influence of tranquilizers, the excitability of the subcortical areas of the brain (limbic system, thalamus, hypothalamus) decreases. , responsible for the implementation of emotional reactions, the interaction between these structures and the cerebral cortex is inhibited. Tranquilizers also have an inhibitory effect on polysynaptic spinal reflexes, causing muscle relaxation. Central muscle relaxants and curare-like drugs can also prevent and reduce seizures.
Hexenal causes deep depression of the central nervous system, suppresses seizures. A 1% solution is administered in a dose of no more than 15 mg/kg - slowly intravenously or a 5% solution of 0.5 ml/kg intramuscularly. When administered intravenously, the anticonvulsant effect is observed “at the end of the needle.” Severe respiratory depression and decreased blood pressure are possible.
Release form: in bottles of 1 g.
Droperidol used for psychomotor agitation and hallucinations. A 0.25% solution of droperidol is administered intravenously or intramuscularly at a dose of 0.3-0.5 mg/kg.
Release form: 0.25% solution in ampoules of 5 and 10 ml.
Magnesium sulfate when administered parenterally, it has a calming effect on the central nervous system. Depending on the dose, a sedative, hypnotic or narcotic effect may be observed. Reduces the excitability of the respiratory center; in large doses it can cause respiratory paralysis. Reduces blood pressure. For convulsions, a 25% solution is administered intramuscularly at a dose of 0.2 ml/kg body weight.
Release forms: 25% solution in ampoules of 5, 10 and 20 ml.
Sodium hydroxybutyrate easily penetrates the central nervous system and has a sedative and central muscle relaxant effect, in large doses induces sleep and anesthesia. Gives an antihypoxic effect, increases the body's resistance to oxygen deficiency. A 20% solution at a dose of 50-100 mg/kg in 30-50 ml of a 5% glucose solution is administered slowly intravenously or intramuscularly. With rapid intravenous administration, possible motor excitement, convulsive twitching of the limbs and tongue, respiratory arrest.
Release form: 20% solution in ampoules of 10 ml.
Seduxen (relanium, diazepam) has anticonvulsant activity, causes muscle relaxation, has a calming effect on the central nervous system, gives moderate hypnotic effect. To relieve seizures, use a 0.5% solution - intravenously, intramuscularly at a dose of 0.3-0.5 mg/kg. Available in ampoules of 2 ml.
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In children, convulsive muscle contractions occur due to various reasons. This may include injury during childbirth, the birth of a premature fetus, problems with the functioning of the nervous system, as well as high fever or fright. Your pediatrician will tell you how cramps manifest in a child and what to do to avoid muscle spasms. To monitor your baby's body temperature, you need an accurate thermometer. A large assortment of thermometers can be found in the Daughters and Sons online store.
Signs convulsive state depend on the reasons that provoked the reaction. In cases of nervous system disorders, this phenomenon is accompanied by temporary loss of consciousness. Before this, the legs and arms involuntarily stretch, the facial muscles remain paralyzed for a while, the baby throws his head back and seems to withdraw from the outside world. A seizure can cause twitching of the limbs, excessive salivation and even vomiting. If the baby is acutely ill respiratory disease, febrile convulsions occur.
What do cramps look like when a child has a fever:
The baby can remain in this state for up to 15 minutes, then muscle spasms must pass. To speed up the reaction, it is necessary to lower the temperature (give an antipyretic). Problems arise when the temperature rises above 38 degrees.
Chaotic movements of the legs and arms are characterized by clonic convulsions in children. How to recognize them? During an attack, the baby does not control movements; even the eyelids may twitch. Most often, clonic reactions occur during sleep when children are lying on their stomachs.
In medicine, a distinction is made between tonic and clonic seizures. Tonic manifests itself as muscle tension - spasm. Clonic refers to involuntary muscle twitching that occurs when muscle tone changes.
At epileptic seizures which are accompanied by loss of consciousness, copious discharge saliva and foam, you must call an ambulance. For prevention, it is recommended to give baby water balanced according to mineral composition. To know how to help your baby with this problem, you should definitely consult with your pediatrician.
To monitor body temperature you need an accurate thermometer. A good purchase would be the B.Well WF-5000 infrared non-contact thermometer.
How to identify seizures in a child? They are accompanied by tension in the muscles, legs, arms and face, involuntary movements, throwing back the head and rolling the eyes. The baby may lose consciousness or simply not respond to others. In severe cases, vomiting may occur. To avoid a seizure during a cold, you need to lower your temperature if it rises above 38 degrees.
