Convulsions in Adults Flashcards
What is a convulsion?
A convulsion is an involuntary contraction and relaxation of the muscles producing rigidity and violent shaking of the body and limbs. Often associated with reduced consciousness.
What are the common causes of convulsions?
Epileptic seizures Provoked seizures Psychogenic non-epileptic seizures (PNES) Vasovagal Syncope Cardiogenic events
What convulsion related complication can pregnancy give rise to?
Eclampsia
What are epileptic seizures?
Epileptic seizures are caused by abnormal electrical activity in the brain. There are many types and symptom manifestation depends on which part of the brain is affected.
The most common type of epileptic seizure is a bilateral tonic clonic seizure BTCS
What is a Bilateral Tonic Clonic Seizure?
BTCS is an Epileptic seizure characterised by stiffening of while body (tonic) followed by vigorous shaking (clonic). During BTCS patients typically have eyes open and are unresponsive to commands. BTCS typically terminate within 90 seconds with patients being confused and drowsy afterwards.
What is Convulsive Status Epilepticus (CSE)?
Convulsive Status Epilepticus is a Bilateral Tonic Clonic Seizure that has lasted > 5 mins. This is a medical emergency.
Be aware many patients with prolonged convulsions are experiencing PNES not BTCS
What signs favour a BTCS?
- Consistent, repeated, rhythmic myoclonic jerking
- ‘Shock like’ movement
- Arms & legs mostly synchronised symmetrical
- Convulsions may spread from focal to generalised and tonic merging to clonic
- GCS 3
- Lateral tongue biting is common
- Eyes often open
- mouth wide open
- pupils not reacting
- no purposeful movements
- Low sats/ cyanosis
- Typically short <90secs
- pelvic thrusting rare
- arching of head, neck and spine rare
- clonic head movements to one side may occur
- initial scream, then grunting
What signs that favour PNES?
- Fluctuating intensity
- Brief pauses, tremor or slow flexion
- Arms legs not symmetrical
- Convulsions may move from one body area to another
- May respond in some way to speech, blink reflex or to NPA & IV insertion
- Tongue biting rare or is the tip
- Eye mostly shut
- Mouth often shut
- Pupils reacting
- May carry out purposeful movements
- Normal sats and no cyanosis
- May be prolonged > 3mins
- Pelvic thrusting common
- Arching of head, neck and spine common
- Side to side moments of head and body
- Crying during and after convulsion
What signs favour a BTCS post-ictal?
- Gradual slowing down of convulsion
- Gradual post-ictal recovery
- Noisy laboured post-ictal breathing
What signs favour a PNES post-ictal?
- Rapid end to convulsion
- Rapid post-ictal recovery
- Normal post-ictal breathing
Assessment and Management of ongoing convulsions.
ABCDE -Assess and manage immediately life threatening conditions. -Time seizure -Position for patient safety -Take detailed history -Record types of movement -Consider OPA -For BTCS consider O2 -If PNES then no O2 -If CSE consider assisted ventilation -Drug admin - Midazolam & Diazepam C All obs, ECG in particular D GCS, BM, Temp E Injuries, Incontinence , look for rash, pregnant?
