Convulsions in children
Introduction
Introduction to Pediatric Thriller Convulsions are common emergency in children, especially in infants and young 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. The incidence of convulsions in children is very high. About 5 to 6% of children have had one or more convulsions. Frequent seizures or persistent state of life are life-threatening or can leave serious sequelae in children, affecting children's mental development and health. The incidence of convulsion in children is 10 times that of adults, especially in infants and young children. There are many reasons for brain neurological dysfunction. Infant cerebral cortex development is not perfect, so the analysis and identification and inhibition function is poor; the myelin sheath is not completely formed, the insulation and protection are poor, after stimulation, the excitatory impulse is easy to generalize; the immune function is low, easy to be infected and convulsions The blood-brain barrier function is poor, and various toxins easily penetrate into brain tissue; certain special diseases such as birth injury, brain development defects, and congenital metabolic abnormalities are more common. basic knowledge The proportion of sickness: 0.01% Susceptible people: young children Mode of infection: non-infectious Complications: cerebral palsy, epilepsy, ataxia
Cause
Pediatric convulsion
Infectious convulsions (25%):
Intracranial diseases, viral infections such as viral encephalitis, Japanese encephalitis, bacterial infections such as purulent meningitis, tuberculous meningitis, brain abscess, venous sinus thrombosis, fungal infections such as cryptococcal meningitis, parasites Infections such as cerebral cysticercosis, cerebral malaria, cerebral schistosomiasis, cerebral paragonimiasis, toxoplasmosis; extracranial diseases, febrile seizures, toxic encephalopathy (severe pneumonia, whooping cough, toxic dysentery, sepsis as primary disease) , tetanus, etc.
Non-infectious convulsions of intracranial disease (15%):
Craniocerebral injury such as birth injury, brain trauma, neonatal asphyxia, intracranial hemorrhage, abnormal brain development such as congenital hydrocephalus, cerebral vascular malformation, head large (small) malformation, cerebral palsy and neurocutaneous syndrome, intracranial Diseases such as brain tumors, brain cysts, epileptic syndrome such as major seizures, infantile spasms, degenerative brain diseases such as demyelinating encephalopathy, macular degeneration.
Non-infectious seizures of extracranial disease (15%):
Metabolic diseases such as hypocalcemia, hypoglycemia, hypomagnesemia, hyponatremia, hypernatremia, vitamin B1 or B6 deficiency, genetic metabolic diseases such as glycogen accumulation disease, galactosemia, phenylketonuria, Hepatolenticular degeneration, mucopolysaccharidosis, systemic diseases such as hypertensive encephalopathy, uremia, heart rhythm disorders, severe anemia, food or drugs and pesticide poisoning.
By age stage
Neonatal period: birth injury, asphyxia, intracranial hemorrhage, sepsis, meningitis, tetanus and bilirubin encephalopathy are common, and sometimes brain development defects, metabolic abnormalities, giant cell inclusion disease and toxoplasmosis should be considered.
Infant and child: febrile seizures, toxic encephalopathy, intracranial infection, hand and foot snoring, infantile snoring, and sometimes attention to brain development defects, brain damage sequelae, drug poisoning, hypoglycemia and so on.
Older children: toxic encephalopathy, intracranial infection, epilepsy, poisoning more common, sometimes pay attention to intracranial space-occupying lesions and hypertensive encephalopathy.
Several common diseases that cause convulsions: febrile seizures, intracranial infections, toxic encephalopathy, infantile spasms, hypoglycemia, hypomagnesemia, poisoning, hypocalcemia, etc.
The causes of convulsions in children can be divided into infectious (heat convulsions) and non-infectious (no heat convulsions) according to the presence or absence of infection. The lesions are divided into intracranial and extracranial.
Prevention
Pediatric convulsion prevention
Prevention of recurrence is to completely avoid recurrence at the age of prone (before 6 years old), prevent convulsions from continuing, reduce the occurrence of epilepsy, and avoid mental retardation. At present, intermittent medication is used, that is, after the first episode, when the fever occurs, the medication is taken immediately. This method is easy for parents to accept, but if phenobarbital is used, it can not achieve the purpose of preventing recurrence, because phenobarbital can take at least 7 days in order to reach a stable therapeutic concentration in the blood, once phenobarbital It takes 4-6 hours after oral administration to reach the peak of blood concentration. Therefore, this method can not protect the body temperature when it rises suddenly. Therefore, some people try the stable suppository, 5 mg each time, every 8 hours during the fever period. Certain effects, in order to prevent recurrence, some people have also proposed long-term medication, that is, whether or not fever, adhere to medication every day, but the incidence of febrile seizures is high, and serious sequelae are only a few, long-term medication will cause unnecessary burden on most patients And phenobarbital can also cause side effects such as lethargy, excitement, hyperactivity and so on.
Complication
Pediatric convulsion complications Complications, cerebral palsy, epilepsy, ataxia
Neonatal seizure survivors account for about 14% to 61% (average 20%) of sequelae, mainly manifested as cerebral palsy, mental retardation, epilepsy, and other ataxia, hyperactivity, audio-visual disorder, language barrier, mild Brain dysfunction syndrome and the like.
1. Cerebral palsy cerebral palsy is a syndrome of non-progressive central nervous motor dysfunction caused by a variety of causes, and factors associated with cerebral palsy:
1 The lower the Apagaf score 5 minutes after birth, the higher the incidence of cerebral palsy. Among the children with neonatal seizures that need resuscitation 5 minutes after birth, only this one can predict moderate or severe Cerebral palsy.
2 The longer the duration of neonatal seizures, the more likely it is that cerebral palsy will occur later. The incidence of cerebral palsy is 7% for one day and cerebral palsy for 46% for those over three days.
3 The type of neonatal seizures, the relationship between tonic seizures and posterior cerebral palsy is more closely related.
4 Moderate or severe abnormal EEG is associated with a high risk of cerebral palsy.
2. Mental retardation
The mental retardation left after neonatal seizures is related to the following factors.
1 5 minutes of Apgar score 0 to 3 points, 45% have mental retardation; 4 to 6 points, 33% have mental retardation; 7 to 10 points, only 11% have mental retardation.
2 Children who still need resuscitation after 5 minutes of birth are at greater risk of developing mental retardation.
3 The duration of seizures is more than 30 minutes. The duration of myogenic and myoclonic seizures and seizures in neonatal period are closely related to mental retardation.
3. epilepsy
The incidence of epilepsy after episode seizures lasted for 1 day was 11%, 22% for seizures lasting 2 days, 25% for 3 days, 40% for 3 days or more, and 3 cases of tonic seizures and epilepsy. close relationship.
Symptom
Symptoms of convulsion in children Common symptoms Closed consciousness of the jaws, loss of pupil size, respiratory failure, low fever, convulsions, dullness, nystagmus, lethargy
(a) horror
A few pre-existing seizures may have aura: extreme irritability or "sudden jump" from time to time, nervousness; horrified expression, sudden increase in muscle tension in the limbs; sudden suddenness of breath, pause or irregularity; sudden rise in body temperature, dramatic change in face; pupil size; The edges are irregular, and the typical manifestations are sudden onset, loss of consciousness, head tilting back, eyeball fixed upturn or strabismus, foaming at the mouth, closed jaws, facial or limb muscles with clonic or tonic convulsions, severe cases The neck is stiff, the horn is reversed, the breathing is not complete, the bruising or incontinence, the convulsion lasts for a few seconds to several minutes or longer, and then goes to sleepiness or coma. At the time of the attack or shortly after the attack, the pupil is dilated. Signs of slow response to light, positive pathological reflexes, and recovery of consciousness shortly after the onset of cessation, when the calculus of hypocalcemia is convinced, the child can be consciously aware, if the consciousness has not recovered before re-twitching or convulsions are persistent, the condition is indicated. Severe, can die due to cerebral edema, respiratory failure, such as convulsions are limited and constant, often have a sense of positioning, neonatal seizures often appear as Various types of abnormal movements, such as apnea, irregular, two-eyed gaze, paroxysmal pale or purplish, infant convulsions sometimes only show mouth, eye twitching, one limb twitching or bilateral limbs Alternate twitching, neonatal seizures are not many people with systemic twitching, often manifested as irregular or suspended breathing rhythm, paroxysmal bruising or pale, gaze of both eyes, nystagmus, blinking movements or sucking, chewing movements, etc.
(2) Sustained state of horror
Refers to convulsions lasting more than 30 minutes, or two episodes of intermittent episodes of consciousness can not fully recover, for the critical convulsions, due to excessive convulsions can cause high fever, hypoxic brain damage, cerebral edema and even cerebral palsy.
(3) febrile seizures
Common in children from 6 months to 4 years old, convulsions occur in the early stage of fever, duration is short, rarely in a fever disease multiple episodes, often within 12 hours of fever, recovery after consciousness, no nervous system Positive signs, EEG returned to normal after a week of fever, a simple febrile seizure, good prognosis, complex age of onset of febrile seizures, often occurred 6 months ago or after 6 years of age, initially febrile seizures, after several episodes Convulsions occur when there is low fever or even no heat, sometimes repeated episodes, and a seizure time is longer. After 15 minutes, EEG examination is still abnormal after 2 weeks of seizures, and the prognosis is poor. The possibility of conversion to epilepsy is 15% to 30%.
Examine
Pediatric horror examination
Pediatric convulsion check item:
Urea, alanine, EEG, position, electrocardiogram, blood glucose, urine ferric chloride test.
1. Blood, urine, and feces.
2. Blood and urine special examination: When suspected phenylketonuria, it can be tested for urinary ferric chloride or the blood phenylalanine content.
The urinary ferric chloride test is an auxiliary test used to check if urine is normal. Phenylketonurics (PKU) is a common amino acid metabolic disease caused by an enzyme deficiency in the phenylalanine metabolic pathway, which prevents phenylalanine from being converted to tyrosine, resulting in phenylalanine and its Ketoacid accumulates and is excreted in large quantities from the urine. The main clinical manifestations are mental retardation, seizures and hypopigmentation. Commonly used urine ferric chloride test to check whether phenylalanine is normal. Through this examination, the corresponding symptoms can be judged. Normal value of urine ferric chloride test: The test was negative.
3, blood biochemical examination: blood sugar, blood calcium, blood magnesium, blood sodium, urea nitrogen and creatinine and other measurements.
4, cerebrospinal fluid examination.
5, ECG and EEG examination.
6, other inspections.
Diagnosis
Diagnostic diagnosis of convulsion in children
It is sometimes difficult to determine whether a newborn, especially a premature infant, is convulsed. Any strange transient phenomenon or subtle twitching repetitiveness occurs periodically, especially when it is accompanied by an eyeball upturn or abnormal activity and convulsions. Convulsions, convulsions should be identified with the following phenomena.
(1) Newborn startle
For larger amplitude, higher frequency, rhythmic limb shaking or clonic motion, passive flexion or change of position can be eliminated, without eye movement or cheek movement, common in normal newborns from sleep to waking When exposed to external stimuli or hunger, and convulsions are rhythmic twitching, varying in magnitude, unaffected by stimulation or flexion of the limbs, pressing the twitching limbs to try to stop the episode still feel muscle contraction, often accompanied by abnormal eyes, cheek movement .
(ii) Non-convulsive apnea
The onset is 10-15 seconds/time in full-term children, l0-20 seconds/time in premature infants, with heart rate slowing down more than 40%, and convulsive apnea episodes, full-term infants) 15 seconds/time, premature infants ) 20 seconds / time, without heart rate changes, but with other parts of convulsions and EEG changes.
(3) Rapid eye movement sleep phase
There is eye tremor, short apnea, rhythm. Facial strangeness, smile, body twisting, etc., but disappear after waking up.
