Convulsion

A fit, seizure or convulsion (the terms are synonymous) is a result of a disturbance in the functioning of the brain. A convulsion may be minor and involve the simple twitching of one limb, or major in which the patient loses consciousness, many muscle groups go into uncontrolled intermittent spasm, the patient falls, sweats profusely, has a rapid heart rate, clamps their jaw shut and loses control of their bladder.

What do I do when someone is having a convulsion or seizure?

A lady helping someone who has had a fit, seizure or convulsionThe main task of anyone present at a seizure is to protect the sufferer from harm. Do not restrict their movements, since the spasms and jerking are automatic and trying to stop them may cause injury. Simply move any objects that may be a danger and, if necessary, remove false teeth (but do not prise the mouth open or force objects into it). Protect the head from banging against the floor by putting something flat and soft (such as folded jacket) under it. If necessary loosen the person’s collar so they can breathe more easily. Artificial respiration will probably be impossible, and the sufferer will breathe normally again at the end of the seizure, generally after a minute or so. The sufferer may fall asleep once the seizure has ended, in which case place them in the coma position (on side with legs bent) and allow them to wake naturally. There may be a card or tag on the person saying what to do in case of a seizure – look for this and follow the instructions.

Although relatively uncommon, and very distressing when they do occur, there are scores of causes for a convulsion that vary from the obvious to the extremely obscure.

Everyone thinks of epilepsy and other serious diseases when fitting occurs, but a simple faint, severe bacterial and viral infections, high fever and a sudden shock or intense fear can trigger a convulsion. Overdoses of numerous prescribed and illegal drugs, as well as alcohol, strychnine and cyanide poisoning may also be responsible.

Children sometimes have convulsions because of a sudden rise in temperature. These febrile convulsions consist of body rigidity, twitching, arched head and back, rolling eyes, a congested face and neck, and bluish face and lips. Generally the seizure will end quite quickly, but the carer should ensure that the airway is clear, turn the child on to the side if necessary, remove clothing, bathe or sponge the child with lukewarm water, and when the convulsion has eased obtain medical attention.

What is epilepsy?

Epilepsy is a condition that causes recurrent seizures (fits). Some people are born with epilepsy, while others acquire the disease later in life after a brain infection, tumour or injury. Brain degeneration in the elderly, removing alcohol from an alcoholic or heroin from an addict, or an excess or lack of certain chemicals in the body can also cause epilepsy.  Fits can vary from very mild absences in which people just seem to lose concentration for a few seconds, to uncontrolled bizarre movements of an arm or leg, to the grand mal convulsion in which an epileptic can thrash around quite violently and lose control of bladder and bowel.

A head injury from any cause may cause immediate or delayed fitting because of injury to the brain, or bleeding into or around the brain. Bleeding may also be caused by the spontaneous rupture of a weakened artery or vein in the skull, and the resultant pressure on the brain can have many varied effects.

marathon dehydration collapse [flickr stephen_shellard]

A marathon runner who has collapsed from dehydration
Image by Stephen Shellard (CC BY 2.0)

The brain is supported and completely surrounded by a three layered membrane (the meninges), which contain the cerebrospinal fluid. If these meninges are infected by a virus or bacteria (meningitis) the patient may experience headache, fever, fits, neck stiffness and in severe cases may become comatose.

Encephalitis is an infection of the brain itself, which may be confused with meningitis. The symptoms include headache, intolerance of bright lights, fever, stiff neck, lethargy, nausea, vomiting, sore throat, tremors, confusion, convulsions, stiffness and paralysis.

Severe dehydration caused by excess sweating and/or lack of fluid in a hot environment, particularly if exercising, may cause collapse and fitting. This may be combined with excessive body temperature (hyperthermia), which aggravates the problem. Marathon runners who collapse and start twitching are often suffering from these problems.

Children who have behaviour problems may have severe temper tantrums, which can appear to be similar to a convulsion. If the child is a very determined breath holder, the end stage may be collapse and fitting due to lack of oxygen reaching the brain, which usually settles quite quickly.

A lack of oxygen from near drowning, suffocation or smoke inhalation may also have adverse effects on the brain that trigger fitting.

What are some other causes of convulsions?

Uncommon causes of convulsions in babies include a tumour or cancer affecting the brain or surrounding structures within the skull, significant liver or kidney disease, hydrocephalus, and a lack of thyroxine (hypothyroidism). Rapid shallow breathing may alter the balance of carbon dioxide and oxygen in the lungs, and thus the blood. The blood becomes more alkali, and irritates small muscles, particularly in the hands, which go into spasm and may appear to be a convulsion. This is known as tetany (totally different to tetanus infection) and patients have fingers and sometimes wrist, forearms and feet, which are pointed in a firm spasm.

Numerous rare syndromes, inherited conditions and congenital abnormalities may also be responsible.

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