Convulsion,new

convullsion
intoduction,definition,incidence,types,etiology,pathophysiology,clinical manifestation ,assessment ,diagnostic evaluation, management ,(medical,surgical,nursing,),prevention ,health education,complication,conclusion

1. CONVULSION Prepared by : Ms. Nimisha Chacko

2. INTRODUCTION The word convulsion (or seizures) describes an involuntary violent spasms, or a series of jerking of face, trunk, or extremities with or without loss of consciousness, sensory, autonomic or behavioural disturbances .

3. DEFINITION Neonatal seizure is defined clinically as “ a paroxysmal alteration in neurological function (i.e. behavioural, motor or autonomic function)either or all three, occurring within 28 days.

4. INCIDENCE 350/1lak in India , Greater in neonatal period.

5. TYPES OF NEONATAL CONVULSIONS Five major types of seizures are seen in neonates, SUBTLE , GENERALIZED TONIC MULTIFOCAL CLONIC FOCAL CLONIC AND MYOCLONIC SEI ZURES .

6. ETIOLOGY OF CONVULSION Developmental neurological problems Perinatal complications Perinatal infections Metabolic problems Drugs

7. PATHOPHYSIOLOGY ETIOLOGICAL FACTORS ALTERED INTEGRITY OF NEURON IN THE EPILEPTOGENIC FOCUS HYPEREXCITABILITY OF NEURONS PARTIAL DEPOLORIZATION

8. IMBALANCED RELEASE OF EXCITATORY AND INHIBITORY NEUROTRANSMITTERS PARTIAL STIMULATIONS OF NEUROTRANSMITTER MOLECULES LOWERED SEIZURES THRESHOLD ABNORMAL SPONTANEOUS SPREAD OF ELECTRICAL DISCHARGE CLINICAL MANIFESTATIONS

9. CLINICAL MANIFESTATION About 50% of all neonatal seizures are subtle type, which may manifest as eye movement ( Blinking, Fluttering, deviation with jerking, eye opening sustained with ocular fixation ), Orobuccolingual movements Screaming Rowing and pedalling, Apneic spells Bradycardia

10. ASSESSMENT   HISTORY TAKING Maternal history Family history Labor and delivery history Baby conditions at birth NEONATAL EXAMINATION General examination

11. DIAGNOSTIC EVALUATION BLOOD GAS ANALYISIS INBORN ERRORS OF METABOLISM CT- SCAN MRI EEG LUMBAR PUNCTURE

12. MANAGEMENT

13. MEDICAL MANAGEMENT GOALS TO CONTROL CONVULSIONS TO TREAT UNDERLYING PATHOLOGY

14. Pharmacological management First line (benzodiazepines ) Diazepam - 0.5mg/kg (max 10 mg) IV slow Lorazepam - 0.05-0.1mg/kg IV per rectum or sublingual Midazolam - 0.1-0.2mg/kg IV or IM

15. SECOND LINE DRUGS (PHENYTOIN AND BARBITURATES Phenytoin - 20mg/kg slow IV ( no faster than 1 mg/kg/min with a maximum of 50 mg/min Phenobarbitone - 15-20 mg/kg slow IV Other drugs Carbamazepine- 10-15mg/kg/day Sodium valproate- 20-60mg/kg/day Felbamate - 15mg/kg/day

16. Non pharmacological management Monotherapy Anticonvulsant therapy Ketogenic diet Vagal nerve stimulation

17. SURGICAL MANAGEMENT Resective surgery Callostomy Multiple subpial transection

18. NURSING MANAGEMENT Nursing Assessment History Physical examination

19. Nursing Diagnosis Risk for trauma or suffocation  related to loss of large or small  muscle co-ordination . Risk for  ineffective airway clearance  related to neuromuscular impairment. Situational low self-esteem  related to stigma associated with the condition. Deficient knowledge  related to information misinterpretation. Risk for injury  related to weakness, balancing difficulties, cognitive limitations or altered consciousness.

20. Nursing Interventions Prevent trauma/injury Promote airway clearance Improve self-esteem Enforce education about the disease

21. PREVENTION Regular ANC check up Treatment of infections during ANC period Correction of anemia and control of Gestational Diabetes Training of local Dais or paramedics about proper delivery and referral system Raising awareness about institutional delivery Manage actively fetal distress Ensuring proper training of neonatal resuscitations

22. HEAT L H EDUCATI O N Parents should be counselled about the relative risks of recurrence of convulsion educated on how to handle a convulsion acutely, and given emotional support Parents should be reassured that convulsion do not lead to neurologic problems or developmental delay .

23. COMPLICATIONS Cranial nerve palsies Raised ICP Subdural effusion Cerebral palsy Hydrocephalus Mental-physical handicaps Learning disability Recurrence

24. C ONCLUSION A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled actions of the body. Because epileptic seizures typically include convulsions, the term convulsion is sometimes used as a synonym for seizure