INTRODUCTION Convulsions in children are relatively more common than in adults. The clinical presentation of an episode of a convulsion depends on the maturity of a child's brain and her/his threshold level to convulsion. Majority of the convulsions in children are of tonic-clonic nature. Therefore, a careful evaluation is necessary so that the underlying cause can be detected. DETAILED HISTORY OF THE CHILD WITH CONVULSION • Mode of onset of convulsion, character, duration, any similar previous history (chronic/recurring). • Triggering factors- fever, toxic substance or drug, metabolic dis- turbance. • Family history of convulsion, inborn error of metabolism. • Peri-natal/Natal history-birth asphyxia, jaundice, birth trauma, central nervous system (CNS) infection e.g. meningitis, encephalitis etc. • CNS status-cerebral palsy, mental retardation (learning difficulty), any post-convulsive state. CONVULSION IN INFANTS AND OLDER CHILDREN Usually more organized and is of ~pecific pattern. A) Acute/Non-recurring (i) with fever: febrile convulsion, infections e.g. meningitis, encephalitis. . (ii) without fever: poisoning including medicinal overdose, metabolic disturbance e.g. hypoglycaemia, hypocalcaemia and electrolyte imbalance, head injury, brain tumour, epilepsy. B) Chronic/Recurring : (i) with fever: recurrent febrile convulsion, recurrent meningi- tis. (ii) without fever: epilepsy. FEBRILE CONVULSION Predominantly tonic convulsion accompanied by fever affecting 3- 4% of children. Idiopathic epilepsy might be triggered by fever also. A) Simple febrile convulsion • Age: 6 months to 5 years. • Character: generalized convulsion. • Duration: usually less than 15 minutes • Usually not repeated in the same illness. B) Complex febrile convulsion • Age: less that 6 months or more than 5 years. • Character: unilateral or focal. • May be repeated in the same illness. • Common in female or child with Cerebral Palsy (CP). Note : • In febrile convulsion inter-ictal eletro-encephalogram (EEG) is normal. • Neither rate of rise nor height of temperature has any correla- tion in characterization of the initial seizure. Febrile convulsions are usually benign. But severe, prolonged or recur- rent febrile convulsion can result in the development of subsequent epilepsy; neurological disability or mental suboptimality. Two percent (2%) of children with febrile convulsion develop sub- sequent epilepsy. C) Recurrent febrile convulsion Fifty percent (50%) of children with febrile convulsion may have repeated or recurrent febrile convulsion. RECURRENT MENINGITIS Congenital dermal sinus. Communication with para-nasal sinus or middle ear. (post traumatic skull fracture). (Immuno-suppressed child). Source
