Paroxysmal or tonic seizures

Introduction Con Vulsion is a common emergency in children. Cerebral nerve dysfunction caused by a variety of reasons. It is characterized by a sudden systemic or local muscle group with tonicity and clonic convulsions, often accompanied by conscious disturbances. Pediatric poisoning can cause paroxysmal or tonic convulsions, and often accompanied by coma, cyanosis, abnormal breathing and other symptoms, must be vigilant, timely diagnosis and treatment. More with both sides of the eyeball upturn, gaze or strabismus, unconscious. Sometimes accompanied by foaming at the mouth or mouth, apnea, complexion, and the attack time is more than 3 to 5 minutes, sometimes repeated, or even continuous.

Cause

Pediatric poisoning is often an accident. It is caused by curiosity, ignorance or parental care, caregivers who are negligent in taking care of drugs, poisons and eating poisonous fruits.

The common reasons are as follows:

1 Eat poisonous animals, plants, such as pufferfish, ginkgo, cassava, peach kernels, almonds, poisonous mites and sprayed pesticides and fruits, vegetables, wild fruits - castor beans, mandala and so on.

2 Drugs or poisons are not strictly stored, and they are poisoned by mistakes, such as misuse of rodenticides (safety, zinc phosphide), aminophylline, contraceptives or even kerosene and gasoline.

3 improper handling of food and toxicity, excessive consumption and poisoning; such as drinking spoiled milk, eating potatoes without buds or uncooked beans and so on.

4 Misuse or misuse of drugs and toxic substances, such as medical staff or parents take the wrong drugs, use the wrong dose, use a larger dose of atropine, isoniazid or nitrite mistaken salt.

5 Others such as organophosphorus (dichlorvos, trichlorfon), organic chlorine (DDT, 666) spray room or clothing is killed by mosquitoes, cockroaches. In the cold season, coal and charcoal are used for heating, and no ventilation or CO poisoning is observed.

an examination

Related inspection

Cerebrospinal fluid meningococcal antigen urinary citrulline

Auxiliary inspection

1) Cerebrospinal fluid examination: suspected intracranial infection should be routine cerebrospinal fluid, biochemical examination, smear staining and culture if necessary, which is an important method for diagnosis and differential diagnosis of central nervous system diseases, diagnosis of intracranial infection and bleeding. Very important. It is especially emphasized that children with first convulsions should seek cerebrospinal fluid examination.

2) Skull image: suspected intracranial hemorrhage, space-occupying lesions and craniocerebral malformations, optional for cerebral angiography, cerebral angiography, skull CT, MRI and other examinations.

3) ECG and EEG examination: suspected cardiogenic convulsions can choose ECG; suspected infantile spasms and other types of epilepsy or brain occupying lesions can do EEG. EEG has important value in the diagnosis of epilepsy. Epilepsy in the EEG is characterized by spikes, spine slow waves and multiple spikes, and paroxysmal high amplitude slow waves. The positive rate of EEG diagnosis of epilepsy is about 60%, and the positive rate can be increased to 70%-80% after induction. However, negative EEG can not rule out the diagnosis of epilepsy.

4) Selective laboratory and other auxiliary inspections

1 blood, urine, stool routine: increased white blood cells with nuclear left shift suggest bacterial infection, but need to pay attention to some viral infections (such as Japanese encephalitis) and simple convulsions can also have increased white blood cells, white blood cells with increased or primitive cells are prompted Meningeal leukemia, eosinophilia in the blood often suggests brain parasitic diseases. When urine is found to have protein, hematuria, and various casts, hypertensive encephalopathy caused by nephritis should be considered when there is high blood pressure in children. It is worth noting that in children with sudden high fever with convulsions and severe systemic symptoms, anal examination or saline enema examination of stool is an important means for early diagnosis of poisoning dysentery.

2 blood biochemical examination: blood sugar, blood calcium, blood magnesium, blood sodium, blood phosphorus, liver function, kidney function and other measurements. Blood electrolytes, liver and kidney function tests can find related causes, such as hypoglycemia or hypoglycemia or Reye's syndrome, blood electrolyte abnormalities may indicate convulsions caused by electrolyte imbalance, neonatal bilirubin encephalopathy (nuclear jaundice) is blood Bilirubin, especially unconjugated bilirubin, is markedly elevated.

3 other special tests: such as biochemistry, histochemistry or chromosomal examination, often used to diagnose genetic metabolic diseases, such as urine ferric chloride test to check phenylketonuria. There are also immunological tests, poison detection, and the like.

Differential diagnosis

1. Neonatal period: Convulsions are often atypical and must be differentiated from the following phenomena or diseases.

1 tremor: the neonatal period often shows systemic or local rapid tremor, similar to clonic motion, can be induced by sudden tactile stimulation, gently changing the position can make the tremor weaken or disappear, this movement is not accompanied by abnormal eye or Mouth and cheek movements, this kind of tremor is a manifestation of imperfect development of neonatal exercise reflexes, which usually disappears 4 to 6 weeks after birth. Neonates with hypoglycemia who are younger than gestational age, have diabetes in their mothers, or newborns who take certain sedatives during pregnancy may also experience tremors. The magnitude of the convulsions is not equal, low frequency, no rhythm twitching, unaffected by stimuli, and often accompanied by abnormal eye or mouth and cheek movements. The two are easier to distinguish.

2 eye movement and irregular breathing during the active sleep period: normal newborn sleep, about half of the time is active sleep. Often appearing at the beginning of sleep or near awakening, the eyeball rotates under the closed eyelids, rhythmic mouth movements, facial smiles or strange faces, head and limbs stretching or twisting, but after waking these movements disappear and no longer Appeared, so it is easy to distinguish from horror. When it is difficult to distinguish, the brainwaves during active sleep can be normal by means of EEG examination.

3 benign neonatal sleep myoclonus: onset within 1 month after birth, myoclonus mainly involves the forearm and hands, but also affect the foot, face, trunk or abdominal muscles. Most of them appear in the NREM stage of sleep, REM period is rare, and even can be induced by sound and other stimuli. Myoclonus can be bilateral, local or multifocal, pulsating rhythm or arrhythmia, often appearing in groups of 1 to 5 times / s for several seconds. This series of myoclonic twitching can occur repeatedly during sleep for 20 to 30 minutes, or up to 90 minutes, and can be mistaken for convulsions. Nervous system examinations and EEG are normal. Occasionally family history. Symptoms are relieved after 2 months of birth and disappear 6 months later. Long-term prognosis is good and no treatment is needed.

4 premature apnea: this apnea generally lasts for 20s or a little longer, often accompanied by a slow heart rate, and due to convulsions of apnea, the heart rate generally remains the same, does not slow down.

2. Infancy and childhood: Convulsions must be differentiated from other paroxysmal diseases.

1 rickety convulsions: seen in older children, more women than men, have emotional incentives, can be expressed as convulsions, often tonic, long duration, no fall and fall, no tongue bites and bowel movements Incontinence, no change in color, no convulsions, heart rate, pulse, breathing, normal blood pressure, normal eye movements, pupils not expanding, normal light reflection, loss of consciousness, no sleep after seizures, normal brain electrical image. The use of mentally suggestive therapy can stop the episode, and it is not easy to stop the episode when someone is around. There is a tendency to renew under emotional factors. Care should be taken to observe the performance at the time of onset and to discreetly diagnose after the organic disease.

2 syncope: neurological temporary cerebral blood flow reduction can cause syncope, mostly in the case of fatigue, nervousness, intimidation, etc., especially when suddenly standing. On the attack, pale, sweating, cold hands and feet, slow heartbeat, decreased blood pressure, short-term loss of consciousness, and even short-lived limbs, hard and sputum, often wake up quickly after lying down, and last for a short time.

3 breath-holding episodes: often caused by emotional reactions, mostly onset at 6 to 12 months of age, mostly disappeared after 3 years of age. Before the attack, there is crying, and then there is breath holding, apnea, cyanosis, and even short-term tonic or clonic, the natural termination of about 1 min, respiratory recovery, cyanosis disappears, and then cry, then fall asleep, the frequency of episodes is different, EEG No abnormality. If there is a sign of attack, you can stop the attack after diverting attention. Some children may experience syncope after being older.

4 Emotional cross-leg syndrome: refers to the cross-friction of the two sides of the episode, while the cheeks are flushed, sweating, gaze in the eyes, secretions in the perineum, and sexual color, often causing parents to panic. It usually occurs before or immediately after waking up, but it can also occur during the day. When the attack occurs, the child's attention is transferred to the interested area, and the episode can be stopped or reduced. Sometimes genital itching or tsutsugamushi is the cause of seizures. There is no specific abnormality in the EEG. Generally, these symptoms last only for a period of time, and can be relieved by themselves. Most of them stop attacking after the elderly. Individual patients may have behavior problems in the future.

5 tic disorder: The main feature is frequent involuntary repetition of rapid paralysis, common blinking, facial muscle twitching and neck, shoulder, upper and lower limb limitations of tics. Stressfulness is a trigger. Conscious control can be paused and disappears during sleep. Consciousness is always clear at the time of attack, there is no fall when twitching, and there is no abnormality in EEG.

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