Diagnosis and Treatment: Management of the Child Who Has Had One Convulsion

FOR MOST PARENTS their child's first convulsion is a dramatic, frightening event which demands immediate medical attention. The physician, on the other hand, may see the patient after recovery from the attack and may tend to minimize the severity of the situation and assume a wait-and-see attitude before investigation and treatment are initiated. The convulsion is a symptom that indicates a disturbance of cerebral neurones. This disturbance may be the result of underlying organic disease of the brain, either fixed or progressive, or it may be an indication of a functional disturbance related to a circulatory or metabolic disorder. The first attack may be so mild that the child is unaffected but subsequent attacks may be prolonged, or result in status epilepicus, and produce a mild or severe degree of mental impairment. There is considerable evidence to indicate that anoxia associated with convulsions can cause brain damage and for this reason every child who has had a convulsion should be investigated and, with rare exception, placed on prophylactic daily anticonvulsant medication when no specific treatable condition is discovered. EVALUATION The first step in the study of a child who has a convulsion is to document its occurrence. Anxious parents are, as a rule, poor witnesses. Despite this, every effort should be made to obtain a description of the seizure, particularly premonitory symptoms, loss of consciousness, convulsive movements, duration of the attack, and the state of the patient following the attack. In infants breath-holding spells may simulate convulsive seizures. In breath-holding spells there is always a precipitating factor, usually a slight injury or some emotional disturbance which results in violent crying, ending suddenly in respiratory apnea. The cyanosis in such attacks appears before the loss of consciousness and convulsive movements.