What are convulsions
The convulsions manifest themselves with involuntary, abrupt and totally uncontrolled contractions of the voluntary skeletal muscles, and constitute the motor variant of a paroxysmal neuronal hypersynchronization . As analyzed in the introductory article, convulsions are heavily influenced by systemic / metabolic factors (hyperpyrexia, hypoglycemia, malignant hypertension, hypomagnesemia, hypoxia, drug poisoning etc.), occasional or recurrent seizures, and many other diseases (eg . cerebral malformations, CNS infections, brain tumor etc.).
The symptoms that accompany convulsive crises can be multiple, differentiated according to the cause. In this concluding article, attention is focused on the different variants of convulsions, on possible diagnostic investigations and on the currently available treatments.
Classification
The classification of the various forms of convulsions can be made based on the main symptoms:
- Tonic fits or tonic seizures: the patient affected by the convulsion loses consciousness, falls to the ground, stiffened and cyanotic. Often in this phase it is possible to observe dyspnea (respiratory difficulty) and / or apneas (respiratory incapacity). Generally, in this phase the patient assumes particular postures: the neck becomes arched, the upper limbs are over-extended or flexed, and the lower limbs are always hyperesthesis. The tonic episode tends to last a minute or less: this phase is very short but extremely dangerous.
- Clonic fits or clonic seizures: these convulsions are involuntary rhythmic and violent contractions, often characterized by the presence of burr or foam in the mouth, cyanosis, loss of feces and urine. Normally, this phase lasts about a couple of minutes; less often it reaches 5 minutes. Clonic convulsions are the most frequent. The clonic seizure often follows a so-called hypotonic phase, associated with a deep sleep. Upon awakening, the patient tends to forget what happened. Clonic convulsions are less dangerous than tonics.
The coexistence of tonic and clonic seizures is often a light turned on by the great evil, a typical convulsion associated with epilepsy
- Respiratory convulsive crisis: the convulsion is characterized by frequent apnea associated with cyanosis. Alongside these symptoms, the patient may experience paroxysmal hyperpnea (increased breathing depth> 500 cc of air per minute) and severe respiratory failure (especially in the newborn).
- Polymorphic seizures: in addition to apneas and the cyanotic state, the patient suffering from polymorphic seizures can also manifest a series of different symptoms and signs: sudden opening of the eyes, fixation of the gaze, abnormal crying, rhythmic movements of arms and legs, assumption of abnormal postures (eg asymmetric tonic neck reaction), vasomotor episodes etc.
These convulsive crises can be isolated phenomena or can be repeated at more or less regular intervals; in the most serious forms, the continuous repetition of similar seizures can degenerate into the so-called "state of evil".
What to do and what not to do
The table shows some indications and useful tips to best assist the patient suffering from convulsions; similarly, some care behaviors to be avoided are also described.
What to do in case of convulsions | What to avoid in case of convulsions |
Prevent the patient from falling to the ground → place the patient's head on a safe surface + free the room from sharp and dangerous objects | Shaking the person: similar behavior could cause harm to the patient, such as tears or fractures |
Place the patient on one side, especially in the case of vomiting → this prevents the vomiting from entering the lungs | Move the medium: this should be done ONLY IF the patient is hit by a convulsion near dangerous places, such as stairs or glass doors |
Loosen tight clothing (shirt, tie, etc.) | Administer medications during seizures |
Call emergency relief 118 | Insert something into the victim's mouth: many people tend to put their fingers in the patient's mouth or other objects (eg handkerchiefs) driven by the belief that a similar procedure can avoid bites |
Always stay close to the patient, until help arrives | Immerse the child suffering from febrile convulsions in a cold water bath |
Whenever possible, monitor the vital signs of the victim (breath frequency, pulse, etc.) | Immobilize the patient |
When convulsions affect infants or young children with fever, it is recommended to cool the patient with sponging with warm or cool water | Slapping the patient to promote the return of consciousness |
Always keep calm | Suddenly raise the patient after the end of the seizure |
Patients with occasional or repeated seizures should avoid certain sports that could seriously endanger their own lives and those of others: for example, climbing, cycling, swimming. Even driving could be a serious danger to people with uncontrolled seizures.
Diagnosis
The diagnosis of a seizure is essential to trace the cause. In particular, a differential diagnosis must be made with fainting, transient ischemic attacks, stroke, panic attacks, sleep disturbances, delirium, febrile syncope and migraine.
The diagnosis is based, essentially, on the physical examination and on the patient's medical history.
The most useful tests for this purpose are:
- Blood tests: useful for ascertaining or denying a blood disease. The recommended tests are: azotemia, blood count, glycaemia, creatininemia, ammoniaemia, transaminases, toxicological screening
- Urinalysis
- EEG (electroencephalogram): this diagnostic test records the cerebral electrical activity by applying special devices on the head. People with epileptic seizures design an altered encephalogram even in the absence of a seizure.
- CT of the head
- MRI of the head
- Rachicentesi (lumbar puncture): should be performed only in cases of suspected meningitis or encephalitis. Again, this diagnostic test can be performed in young children (<6 months) with severe alteration of the state of consciousness.
The neurological examination to which the subject suffering from convulsions is subjected consists in the analysis of: coordination, muscular strength, reflexes, sensory capacity, gait, posture and muscle tone.
In the face of a new evident seizure or a suspected epilepsy, it is necessary to subject the patient to more specific tests.
Care and prevention
Sedative and anticonvulsant therapy is the treatment of choice for controlling seizures. The most used drugs for this purpose are: valproic acid, diazepam, phenytoin, levetiracetam, phenobarbital and oxcarbazepine. Before taking any medication, it is strongly recommended that you consult your doctor. You can take other medicines to calm the secondary symptoms. It must be remembered, however, that the specific drug should be prescribed only after identifying the triggering element (eg viral infections, fever, poisoning, etc.).
Unfortunately, there is no way to prevent seizures; it is however possible to follow some simple tricks to limit, as much as possible, the aggravation of the symptoms. First of all, a person suffering from convulsive seizures - even if occasional - should always carry "emergency medicines", clearly prescribed by the doctor. Sleep quality, stress reduction, exercise and a healthy, balanced diet can also reduce the recurrence of convulsions in some way.
