Convulsions Diagnosis

A convulsion is a term often used interchangeably with seizure. A seizure occurs when muscle contracts and relaxs quickly and uncontrollably. It is usually brief and often occurs without warning. During a seizure, part or all of the brain, muscles and nerves can be affected.

Stages of Seizure

• A convulsive attack occurs in four stages: prodrome, aura, ictus and postictal period. The prodrome period precedes all convulsive attacks and is usually manifested through behavioral or mood changes hours before the attack. Auras are disturbances in perception (visual, olfactory, emotional) that occur immediately before a person convulses. The ictal stage refers to the seizure or convulsive attack itself and is manifested with body jerks or rapid and uncontrolled shakes, often a result of repeated relaxation and contractions of the muscles. The postictal period immediately follows the actual convulsion or ictal period. At this time, the patient becomes confused and disoriented and demonstrates uncertain behaviors.

Pathophysiology of Convulsive Seizures

• Normally, every bodily movement we have is converted into electrochemical energy discharges that are carried by the neurons or nerve cells to the brain. What happens in a convulsion is that every time a cell of our body has to perform a task, it discharges too much electrical impulse, more than what the nerve cells can carry. Sometimes, the cells continue to discharge even before the previous electrical impulses are interpreted by the brain. During the period of repeated anomalous discharge of electrical impulse, the muscles begin to contract and relax repeatedly and certain parts of the body function erratically. All of these are due to the hyperexcitability and hypersynchrony of the nerve cells.

Types and Clinical Manifestations of Seizure

• The clinical manifestations of convulsions depend on where the neurons are discharging the electrical impulse from and they can be narrowed down according to the type of seizure.
  Petit mal includes lip smacking, eye blinking or fluttering of the eyelids, chewing or jerking movement of the mouth, shaking of a finger or hand, jerky movements of the legs, staring, sudden loss of awareness and decreased learning ability.
  Grand mal seizures or tonic/clonic seizures, also known as generalized seizures, include signs and symptoms of loss of consciousness, falling down, intense muscular contractions of major parts of the body lasting 15 to 20 seconds, impaired breathing, loss of bladder control, cyanosis or dusky coloration of the skin secondary to lack of oxygen, backward rolling of the eyeballs, dilated pupils, biting of the tongue and increased heart rate. Confusion, headache, drowsiness and deep sleep follow the convulsive attack. There is also the sign of epileptic cry, which is a result of the tonic contraction of the respiratory muscles with the partial closure of the vocal cords.
  Clinical manifestations of simple partial seizures are muscle contractions in certain parts of the body (finger or hand), unintelligible talk, dizziness, abnormal sensory perceptions (sight, sound, smell and taste) with no loss of consciousness, nausea, flushed skin, sweating and dilated pupils. The victim may also elicit changes in personality and behavior and inappropriate affect and emotions.
  Partial complex seizure involves the signs and symptoms of being immobile for quite some time or automatic movement that are both inappropriate for the current place and situation where the victim is in. The victim also experiences sudden burst of negative emotions like fear anger, anxiety and irritability. There is also no remembrance of the seizure episode after.

Diagnostic Findings

• Diagnostic tests and assessments are done to determine the type of seizure and the part of the brain affected by it. Thorough history taking and physical exam are important in seeking evidence of a preexisting medical condition or injury that might have affected the brain and trigger the attack.
  Computed tomographic (CT) scans and magnetic resonance imaging (MRI) are used to detect any abnormalities or growing lesions in the brain or in blood vessels that supply blood and oxygen to all parts of it, or to find any degenerative changes in the brain. Electroencephalography (EEG) is another diagnostic tool for seizures. It studies the electrical waves of the brain and determines whether there is a deviation from the normal wave pattern.

Management of Seizure

• There are two approaches to dealing with convulsive seizures: medical and surgical treatment. The medical treatment for convulsion or seizure varies on a case-by-case basis. The goal for the medical treatment is total control of the seizure attack. Medications cannot "cure" seizures but control their occurrence and are given according to the type of seizure the patient is having. Some drugs given are clonazepam, carbamazepine, phenytoin, phenobarbital, gabapentin, lamotrigine and topiramate. Surgical management is rendered if the underlying cause of the seizure attack is mainly due to tumors, abscess, cysts or abnormalities in the blood vessels.