Convulsion

Last updated
Convulsion
Specialty Neurology, Psychiatry
Symptoms Muscle spasms, [1] uncontrollable shaking [1]
Risk factors Epilepsy

A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. [1] Because epileptic seizures typically include convulsions, the term convulsion is often used as a synonym for seizure. [1] However, not all epileptic seizures result in convulsions, and not all convulsions are caused by epileptic seizures. [1] [2] Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures. [1]

Contents

Convulsions can be caused by epilepsy, infections (including a severe form of listeriosis which is caused by eating food contaminated by Listeria Monocytogenes), brain trauma, or other medical conditions. [2] They can also occur from an electric shock or improperly enriched air for scuba diving. [1] [ failed verification ]

The word fit is sometimes used to mean a convulsion or epileptic seizure. [3]

Signs and symptoms

A person having a convulsion may experience several different symptoms, [1] such as a brief blackout, confusion, drooling, loss of bowel or bladder control, sudden shaking of the entire body, uncontrollable muscle spasms, or temporary cessation of breathing. [1] Symptoms usually last from a few seconds to several minutes, although they can last longer.[ medical citation needed ]

Convulsions in children are not necessarily benign, and may lead to brain damage if prolonged. [4] In these patients, the frequency of occurrence should not downplay their significance, as a worsening seizure state may reflect the damage caused by successive attacks. [4] Symptoms may include:[ verification needed ]

Causes

Most convulsions are the result of abnormal electrical activity in the brain. [2] [note 1] Often, a specific cause is not clear. Numerous conditions can cause a convulsion. [5]

Convulsions can be caused by specific chemicals in the blood, as well as infections like meningitis or encephalitis. Other possibilities include celiac disease, [6] head trauma, stroke, or lack of oxygen to the brain. Sometimes the convulsion can be caused by genetic defects or brain tumors. [1] Convulsions can also occur when the blood sugar is too low or there is a deficiency of vitamin B6 (pyridoxine). The pathophysiology of convulsion remains ambiguous. [4]

Convulsions may also be caused by epileptic seizures, febrile seizures, non-epileptic seizures, or paroxysmal kinesigenic dyskinesia. [2] In rare cases, it may be triggered by reactions to certain medications, such as antidepressants, stimulants, and antihistamines. [2]

Epileptic seizures

Epilepsy is a neuronal disorder with multifactorial manifestations. [7] It is a noncontagious illness and is usually associated with sudden attacks [8] of seizures, which are an immediate and initial anomaly in the electrical activity of the brain that disrupts part or all of the body. [7] Various areas of the brain can be disturbed by epileptic events. [9] Epileptic seizures can have contrary clinical features.[ further explanation needed ] [7] Epileptic seizures can have long-lasting effects on cerebral blood flow. [10]

Various kinds of epileptic seizures affect 60 million people worldwide. [8]

Generalized seizures

The most common type of seizure is called a generalized seizure, also known as a generalized convulsion. This is characterized by a loss of consciousness which may lead to the person collapsing. The body stiffens for about a minute and then jerks uncontrollably for the next minute. During this, the patient may fall and injure themselves or bite their tongue, their eyes roll back, and lose control of their bladder. A familial history of seizures puts a person at a greater risk of developing them. [11] [12] Generalized seizures have been broadly classified into two categories: motor and non-motor. [7]

A generalized tonic-clonic seizure (GTCS), also known as a grand mal seizure, is a whole-body seizure that has a tonic phase followed by clonic muscle retrenchments. [13] [14] GTCSs can happen in people of all ages. [14] GTCSs are very hazardous, and they increase the risk of injuries and sudden unexpected death in epilepsy (SUDEP). [15] SUDEP is a sudden, unexpected, nontraumatic death in patients with epilepsy. [15] Strong convulsions that are related to GTCSs can also cause falls and severe injuries. [15]

Not all generalized seizures produce convulsions. For example, in an absence seizure, also known as a petit mal seizure, the brain experiences electrical disturbances but the body remains motionless and unresponsive. [2]

Febrile convulsion

A common cause of convulsions in children is febrile seizures, a type of seizure associated with a high body temperature. This high temperature is a usual immune response to infection, and in febrile convulsions, the reason for the fever is extra-cranial (such as a body-wide viral infection). [16] In Nigeria, malaria—which can cause sudden, high fevers—is a significant cause of convulsions among children under 5 years of age. [17]

Febrile seizures fall into two categories: simple and complex. [18] A simple febrile seizure is generalized, occurs singularly, and lasts less than 15 minutes. [18] A complex febrile seizure can be focused in an area of the body, occur more than once, and lasts for more than 15 minutes. [18] Febrile seizures affect 2–4% of children in the United States and Western Europe, it is the most common childhood seizure. [18] The exact reason for febrile convulsion is unidentified, though it might be the outcome of the interchange between environmental and genetic factors. [16]

Psychogenic non-epileptic seizures

Psychogenic non-epileptic seizures (PNES) are described as neurobehavioral conditions [19] or "psychogenic illnesses" which occur not due to the electrical disturbances in a person's brain but due to mental and emotional stress. [2] PNES are an important differential diagnosis and a common occurrence in epilepsy centers. [20] According to the 5th Edison of Diagnostic and Statistical Manual of Mental Disorders (DSM 5), PNES is classified as a "conversion disorder" or Functional Neurologic Symptom Disorder characterized by alterations in behavior, motor activity, consciousness, and sensation. [21] A few neuroimaging (functional and structural) studies suggest that PNES may replicate sensorimotor alterations, emotional regulation, cognitive control, and integration of neural circuits. [22]

Paroxysmal kinesigenic dyskinesia

There is a linkage between infantile convulsion and paroxysmal dyskinesia. [23] Paroxysmal kinesigenic dyskinesia (PKD) is characterized by sudden involuntary movement caused by sudden stress or excitement. [24] The relationship between convulsion and PKD is mainly due to the common mechanism of pathophysiology. [23]

Notes

  1. ↑ However, some seizures are not due to electrical disturbances in the brain, such as psychogenic non-epileptic seizures. [2]

Related Research Articles

<span class="mw-page-title-main">Epilepsy</span> Group of neurological disorders causing seizures

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, purposeless and synchronized electrical discharge in the brain cells called neurons. The occurrence of two or more unprovoked seizures defines epilepsy. The occurrence of just one seizure may warrant the definition in a more clinical usage where recurrence may be able to be prejudged. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly such as broken bones or through causing accidents. In epilepsy, seizures tend to recur and may have no immediate underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.

<span class="mw-page-title-main">Seizure</span> Period of symptoms due to excessive or synchronous neuronal brain activity

An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. Most of the time these episodes last less than two minutes and it takes some time to return to normal. Loss of bladder control may occur.

<span class="mw-page-title-main">Febrile seizure</span> Seizure associated with high body temperature

A febrile seizure, also known as a fever fit or febrile convulsion, is a seizure associated with a high body temperature but without any serious underlying health issue. They most commonly occur in children between the ages of 6 months and 5 years. Most seizures are less than five minutes in duration, and the child is completely back to normal within an hour of the event. There are two types: simple febrile seizures and complex febrile seizures. Simple febrile seizures involve an otherwise healthy child who has at most one tonic-clonic seizure lasting less than 15 minutes in a 24-hour period. Complex febrile seizures have focal symptoms, last longer than 15 minutes, or occur more than once within 24 hours. About 80% are classified as simple febrile seizures.

A headache is often present in patients with epilepsy. If the headache occurs in the vicinity of a seizure, it is defined as peri-ictal headache, which can occur either before (pre-ictal) or after (post-ictal) the seizure, to which the term ictal refers. An ictal headache itself may or may not be an epileptic manifestation. In the first case it is defined as ictal epileptic headache or simply epileptic headache. It is a real painful seizure, that can remain isolated or be followed by other manifestations of the seizure. On the other hand, the ictal non-epileptic headache is a headache that occurs during a seizure but it is not due to an epileptic mechanism. When the headache does not occur in the vicinity of a seizure it is defined as inter-ictal headache. In this case it is a disorder autonomous from epilepsy, that is a comorbidity.

Psychogenic non-epileptic seizures (PNES), which have been more recently classified as functional seizures, are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND), also known as conversion disorders. These are typically treated by psychologists or psychiatrists. PNES has previously been called pseudoseizures, psychogenic seizures, and hysterical seizures, but these terms have fallen out of favor.

Non-epileptic seizures (NES), also known as non-epileptic events, are paroxysmal events that appear similar to an epileptic seizure but do not involve abnormal, rhythmic discharges of neurons in the brain. Symptoms may include shaking, loss of consciousness, and loss of bladder control.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

In the field of neurology, seizure types are categories of seizures defined by seizure behavior, symptoms, and diagnostic tests. The International League Against Epilepsy (ILAE) 2017 classification of seizures is the internationally recognized standard for identifying seizure types. The ILAE 2017 classification of seizures is a revision of the prior ILAE 1981 classification of seizures. Distinguishing between seizure types is important since different types of seizures may have different causes, outcomes, and treatments.

Abdominal epilepsy is a rare condition most frequently found in children, consisting of gastrointestinal disturbances caused by epileptiform seizure activity. Though a few cases of it have been reported in adults too. It has been described as a type of temporal lobe epilepsy. Responsiveness to anticonvulsants can aid in the diagnosis. Distinguishing features of abdominal epilepsy include (1) Abnormal laboratory, radiographic, and endoscopic findings revealing paroxysmal GI manifestations of unknown origin (2) CNS symptoms (3) Abnormal EEG. Most published medical literature dealing with abdominal epilepsy is in the form of individual case reports. A 2005 review article found a total of 36 cases described in the medical literature.

<span class="mw-page-title-main">Generalized epilepsy</span> Epilepsy syndrome that is characterised by generalised seizures with no apparent cause

Generalized epilepsy is a form of epilepsy characterised by generalised seizures with no apparent cause. Generalized seizures, as opposed to focal seizures, are a type of seizure that impairs consciousness and distorts the electrical activity of the whole or a larger portion of the brain.

Ohtahara syndrome (OS), also known as early infantile epileptic encephalopathy (EIEE) is a progressive epileptic encephalopathy. The syndrome is outwardly characterized by tonic spasms and partial seizures within the first few months of life, and receives its more elaborate name from the pattern of burst activity on an electroencephalogram (EEG). It is an extremely debilitating progressive neurological disorder, involving intractable seizures and severe intellectual disabilities. No single cause has been identified, although in many cases structural brain damage is present.

SCN1A Protein-coding gene in the species Homo sapiens

Sodium channel protein type 1 subunit alpha (SCN1A), is a protein which in humans is encoded by the SCN1A gene.

<span class="mw-page-title-main">Rolandic epilepsy</span> Most common epilepsy syndrome in childhood, usually subsiding with age

Benign Rolandic epilepsy or self-limited epilepsy with centrotemporal spikes is the most common epilepsy syndrome in childhood. Most children will outgrow the syndrome, hence the label benign. The seizures, sometimes referred to as sylvian seizures, start around the central sulcus of the brain.

<span class="mw-page-title-main">Paroxysmal kinesigenic choreoathetosis</span> Medical condition

Paroxysmal kinesigenic choreoathetosis (PKC) also called paroxysmal kinesigenic dyskinesia (PKD) is a hyperkinetic movement disorder characterized by attacks of involuntary movements, which are triggered by sudden voluntary movements. The number of attacks can increase during puberty and decrease in a person's 20s to 30s. Involuntary movements can take many forms such as ballism, chorea or dystonia and usually only affect one side of the body or one limb in particular. This rare disorder only affects about 1 in 150,000 people, with PKD accounting for 86.8% of all the types of paroxysmal dyskinesias, and occurs more often in males than females. There are two types of PKD, primary and secondary. Primary PKD can be further broken down into familial and sporadic. Familial PKD, which means the individual has a family history of the disorder, is more common, but sporadic cases are also seen. Secondary PKD can be caused by many other medical conditions such as multiple sclerosis (MS), stroke, pseudohypoparathyroidism, hypocalcemia, hypoglycemia, hyperglycemia, central nervous system trauma, or peripheral nervous system trauma. PKD has also been linked with infantile convulsions and choreoathetosis (ICCA) syndrome, in which patients have afebrile seizures during infancy and then develop paroxysmal choreoathetosis later in life. This phenomenon is actually quite common, with about 42% of individuals with PKD reporting a history of afebrile seizures as a child.

<span class="mw-page-title-main">Paroxysmal exercise-induced dystonia</span> Medical condition

Paroxysmal exercise-induced dystonia or PED is a rare neurological disorder characterized by sudden, transient, involuntary movements, often including repetitive twisting motions and painful posturing triggered by exercise or other physical exertion. PED is in the class of paroxysmal dyskinesia which are a group of rare movement disorders characterized by attacks of hyperkinesia with intact consciousness. The term paroxysmal indicates that the episodes are sudden and short lived and usually unpredicted, and return to normal is rapid. The number of reported cases of people with PED is very small leading to difficulty in studying and classifying this disease and most studies are limited to a very small number of test subjects.

Panayiotopoulos syndrome is a common idiopathic childhood-related seizure disorder that occurs exclusively in otherwise normal children and manifests mainly with autonomic epileptic seizures and autonomic status epilepticus. An expert consensus has defined Panayiotopoulos syndrome as "a benign age-related focal seizure disorder occurring in early and mid-childhood. It is characterized by seizures, often prolonged, with predominantly autonomic symptoms, and by an EEG [electroencephalogram] that shows shifting and/or multiple foci, often with occipital predominance."

<span class="mw-page-title-main">Epilepsy in children</span>

Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, it is one of the most common neurological disorders of the nervous system. As well as, this condition is more common among children than adults affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or genralized seizure.

<span class="mw-page-title-main">Infantile convulsions and choreoathetosis</span> Medical condition

Infantile convulsions and choreoathetosis (ICCA) syndrome is a neurological genetic disorder with an autosomal dominant mode of inheritance. It is characterized by the association of benign familial infantile epilepsy (BIFE) at age 3–12 months and later in life with paroxysmal kinesigenic choreoathetosis. The ICCA syndrome was first reported in 1997 in four French families from north-western France and provided the first genetic evidence for common mechanisms shared by benign infantile seizures and paroxysmal dyskinesia. The epileptic origin of PKC has long been a matter of debates and PD have been classified as reflex epilepsies. Indeed, attacks of PKC and epileptic seizures have several characteristics in common, they both are paroxysmal in presentation with a tendency to spontaneous remission, and a subset of PKC responds well to anticonvulsants. This genetic disease has been mapped to chromosome 16p-q12. More than 30 families with the clinical characteristics of ICCA syndrome have been described worldwide so far.

Idiopathic childhood occipital epilepsy of Gastaut (ICOE-G) is a pure but rare form of idiopathic occipital epilepsy that affects otherwise normal children and adolescents. It is classified amongst benign idiopathic childhood focal epilepsies such as rolandic epilepsy and Panayiotopoulos syndrome.

People with epilepsy may be classified into different syndromes based on specific clinical features. These features include the age at which seizures begin, the seizure types, and EEG findings, among others. Identifying an epilepsy syndrome is useful as it helps determine the underlying causes as well as deciding what anti-seizure medication should be tried. Epilepsy syndromes are more commonly diagnosed in infants and children. Some examples of epilepsy syndromes include benign rolandic epilepsy, childhood absence epilepsy and juvenile myoclonic epilepsy. Severe syndromes with diffuse brain dysfunction caused, at least partly, by some aspect of epilepsy, are also referred to as epileptic encephalopathies. These are associated with frequent seizures that are resistant to treatment and severe cognitive dysfunction, for instance Lennox-Gastaut syndrome and West syndrome.

References

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  3. ↑ Merriam-Webster: Fit.
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  5. ↑ "What is a convulsion?". What is a convulsion? | theindependentbd.com.
  6. ↑ "Definition & Facts for Celiac Disease. What are the complications of celiac disease?". NIDDK. June 2016. Retrieved 26 May 2018.
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  12. ↑ "Grand mal seizure causes". Mayo Clinic.
  13. ↑ Kodankandath, Thomas V.; Theodore, Danny; Samanta, Debopam (2022). "Generalized Tonic-Clonic Seizure". StatPearls. StatPearls Publishing. PMID   32119383.
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  19. ↑ Anzellotti, F; Dono, F; Evangelista, G; Di Pietro, M; Carrarini, C; Russo, M; Ferrante, C; Sensi, SL; Onofrj, M (2020). "Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge". Frontiers in Neurology. 11: 461. doi: 10.3389/fneur.2020.00461 . PMC   7280483 . PMID   32582005.
  20. ↑ Asadi-Pooya, AA (June 2017). "Psychogenic nonepileptic seizures: a concise review". Neurological Sciences. 38 (6): 935–940. doi:10.1007/s10072-017-2887-8. PMID   28275874. S2CID   4227746.
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  22. ↑ Huff, JS; Murr, N (January 2022). "Psychogenic Nonepileptic Seizures". PMID   28722901.{{cite journal}}: Cite journal requires |journal= (help)
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  24. ↑ Swoboda, KJ; Soong, B; McKenna, C; Brunt, ER; Litt, M; Bale JF, Jr; Ashizawa, T; Bennett, LB; Bowcock, AM; Roach, ES; Gerson, D; Matsuura, T; Heydemann, PT; Nespeca, MP; Jankovic, J; Leppert, M; Ptácek, LJ (25 July 2000). "Paroxysmal kinesigenic dyskinesia and infantile convulsions: clinical and linkage studies". Neurology. 55 (2): 224–30. doi:10.1212/wnl.55.2.224. PMID   10908896. S2CID   5755007.
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