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1.4: Convulsion

Table of Contents

A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body. Convulsion is sometimes related to malaria.

 

Differential Diagnoses

Special concerns includes body twitching, body spasms, jerking limbs, head spasms, fits, bladder incontinence, bowel incontinence, loss of consciousness and sleeping after convulsion.

 

Diagnostic Criteria

  • Trauma
  • Epilepsy
  • Intracranial haemorrhage
  • Alcohol or medication withdrawal  Drug induced seizures etc.

 

Investigations:

Some investigations must be ordered:

  • Serum glucose level
  • Serum electrolytes (where appropriate)
  • Exclude pregnancy for women of child bearing age
  • CT scan is indicated as outpatient/inpatient depending on progress of patient after episode of seizure (where appropriate)

 

Pharmacological Treatment

A: Diazepam IV 10–20mg at a rate of 0.5ml (2.5mg) per 30 sec, repeated if necessary after 30–60min; may be followed by IV infusion to max. 3mg/kg over 24 hours or per rectum 500µg/kg up to max of 30mg.

OR

B: Phenobarbitone IV 10mg/kg at less than 100mg/min in adult

 

Note: Look for treatable causes and if present treat them.

 

Referral:

Refer the patient to next facility with adequate expertise and facilities if:

  • Fits do not stop
  • Eclampsia
  • Other complications

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