Convulsions

Definition

Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly.

The term "convulsion" is often used interchangeably with "seizure," although there are many types of seizure, some of which have subtle or mild symptoms instead of convulsions. Seizures of all types are caused by disorganized and sudden electrical activity in the brain.

Considerations

Convulsions can be unsettling to watch. Despite their appearance, most seizures are relatively harmless. They usually last from 30 seconds to 2 minutes. However, if a seizure is prolonged, or if multiple seizures happen and the person doesn't awaken in between, this is a medical emergency.

If a person has recurring seizures, and there are no underlying causes that can be identified, that person is said to have epilepsy. Epilepsy can usually be controlled well with medication.

Pay attention to which arms or legs are shaking, whether there is any change in consciousness, whether there is loss of urine or stool, and whether the eyes deviate in any direction.

Causes

• Epilepsy
• Alcohol use
• Barbiturates, intoxication or withdrawal
• Brain illness or injury
• Brain tumor (rare)
• Choking
• Drug abuse
• Electric shock
• Fever (particularly in young children)
• Head injury
• Heart disease
• Heat illness (see heat intolerance)
• Malignant hypertension (very high blood pressure)
• Meningitis
• Poisoning
• Stroke
• Toxemia of pregnancy
• Uremia related to kidney failure
• Venomous bites and stings (see snake bite)
• Withdrawal from benzodiazepines (such as Valium)
• Low blood sugar

Symptoms

• Brief blackout followed by period of confusion
• Sudden falling
• Drooling or frothing at the mouth
• Grunting and snorting
• Breathing stops temporarily
• Uncontrollable muscle spasms with twitching and jerking limbs
• Loss of bladder or bowel control
• Eye movements
• Teeth clenching
• Unusual behavior like sudden anger, sudden laughter, or picking at one's clothing

First Aid

1. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.
2. Cushion the person's head.
3. Loosen tight clothing, especially around the person's neck.
4. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
5. Look for a medical I.D. bracelet with seizure instructions.
6. Stay with the person until recovery or until you have professional medical help. Meanwhile, monitor the person's vital signs (pulse, rate of breathing).

In an infant or child, if the seizure occurs with a high fever, cool the child gradually with tepid water. You can give the child acetaminophen (Tylenol), especially if the child has had fever convulsions before. DO NOT immerse the child in a cold bath. See fever convulsions.

Do Not

• DO NOT restrain the person.
• DO NOT place anything between the person's teeth during a seizure (including your fingers).
• DO NOT move the person unless he or she is in danger or near something hazardous.
• DO NOT try to make the person stop convulsing. He or she has no control over the seizure and is not aware of what is happening at the time.
• DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.

Call immediately for emergency medical assistance if

Call 911 if:

• This is the first time the person has had a seizure.
• A seizure lasts more than 2 to 5 minutes.
• The person does not awaken or have normal behavior after a seizure.
• Another seizure starts soon after a seizure ends.
• The person had a seizure in water.
• The person is pregnant, injured, or has diabetes.
• The person does not have a medical ID bracelet (instructions explaining what to do).
• There is anything different about this seizure compared to the person's usual seizures.

Prevention

People with epilepsy should always take any prescribed medication and wear a medical alert tag.

Also, keep fevers under control, especially in children.

References

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5^th Ed. St. Louis, MO: Mosby; 2002.

Ford, MD, ed. Clinical Toxicology. 1^st Ed. Philadelphia, PA: Saunders; 2001.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology. 2^nd Ed. Philadelphia, PA: Saunders; 2003.

Illustrations

Grand mal seizure

Convulsions - first aid - series

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