In simple terms, a convulsion or a fit refers to
abnormal involuntary movement(s) of the body with or without disturbed consciousness. The movements can involve
almost the whole body or just the finger or any other part of the body. Unconsciousness may be prolonged or may be momentary
and take the form of a stare.
Most causes of convulsions are not serious and disappear as the child grows older. A few types may need
medication for 2 years or more.
MANAGEMENT OF A CONVULSION:
Step
1: As a prolonged convulsion can affect the brain, it makes
sense to control it. Fortunately, most convulsions last a minute
or two and stop on their own. Usually, a drug (diazepam or phenytoin) is injected into the vein of the child to
stop the convulsion. Sometimes, a different drug may be injected
into the muscles.
You must not give the child anything by mouth while he
is having a convulsion.
If your child has a tendency to get convulsions,
especially with high fever, your doctor may advise rectal administration
of diazepam. It is quite effective if used soon after
the child is found to have fever. Diazepam by mouth has also been
found to be helpful to prevent convulsions with fever. It is
also to be started with the onset of fever. However, rectal administration is more effective than oral.
Do not panic when your child has continuous convulsions. It is no use making the child smell a shoe
or onions. If he is still convulsing, put a spoon wrapped
in a piece of cloth in between his teeth to prevent him
biting his tongue. Let him lie with his head a little lower
than his body and turn him to one side to prevent aspiration of
any vomit. (Do not lower the head if there is history of
head injury prior to the onset of the convulsion). It is no
use holding the child to stop the convulsion. Only make sure that he does not hurt himself. If you find that his skin
and lips are turning blue and he has stopped breathing,
start mouth-to-mouth breathing.
Step 2: Note
the condition of the child after the convulsion has stopped or after the effect of the medicine given to
control the convulsion has worn off.
A child may normally sleep for some time after a fit. If
he looks perfectly normal after the fit, we are probably
dealing with a less serious cause of convulsion, for which hospitalisation is not needed. However, a child with
convulsion following a recent head injury often needs observation in a hospital. In any case, let your doctor
take the final decision about hospitalisation.
A child who does not look well after a convulsion or in between two convulsions needs extra attention.
Step 3: Find
out the cause of the convulsion and treat it. A child who had a difficult birth or who has a deficiency
of glucose or calcium in his system may get a convulsion.
One out of 4 children with a sudden rise of fever may get a shortduration
fit between the ages of 6 months and 5 years. These are called febrile convulsions. Some infants
a d toddlers may hold their breath and some of these may also get a fit following a bout of crying. Treatment with iron is
found
to be effective in reducing the incidence of breath-holding
spells in some children.
A few serious causes of convulsions are cerebral
malaria, meningitis, encephalitis, poisoning, brain tumour and
head injury. In some cases, the cause of convulsion cannot be determined and your doctor may make a diagnosis of
epilepsy. If he suspects this diagnosis, he may ask for an EEG (electroencephalogram) and decide to put the child on
a
drug for prolonged use to control the convulsions. Certain
drugs require a blood test to rule out any possible side effect or to know if the dose of the drug being given is optimum. For
certain types of convulsions, your doctor may ask for
other tests including a CT scan of the brain and a lumbar
puncture (spinal tap) to examine the CSF (cerebro-spinal fluid).
For intractable convulsions that don’t respond to drugs, a
part of the brain is removed with good results.
A few newborns and older children get a convulsion once and never again. Hence, it is important not to panic if
your child gets a convulsion. However, as frequent
convulsions can cause harm to the child, it is important to take fits seriously.
Seizures can also manifest as staring spells, mostly between the age of 5 and 12 years. Multiple attacks of
such spells could lead to a decline in scholastic
performance. Some children get staring spells which are not due to epilepsy and do not need any treatment. They are
considered non-epileptic when parents report preserved responsiveness to touch, though the child suffers no limb twitches,
upward movement of eyes, interruption of play or urinary incontinence. However, confirmation is required in such
children on long-term follow-up.
In some children, videogames can induce seizure. Stopping the child from playing videogames may be all
that is required to halt the recurrence of convulsions, but some of these children may need long-term
anticonvulsant drugs.
Step 4: Attend
to psychosocial factors. Meet the school authorities. Tell them that your child is prone to fits.
If required, take a letter from your doctor so that the
teacher knows what to do if the child gets a fit in the
classroom or on the playground. Children who suffer from epileptic fits
can take part in sports like swimming, but under supervision. In general, they should be treated as normal children and
not be overprotected.
