Emergency therapy for seizures and seizures
From the position of providing urgent, pathogenetically justified care, it seems expedient to split all seizures by 5groups: the first - convulsions in infectious diseases;the second - with epilepsy;the third - with organic lesions of the central nervous system;the fourth - in violation of metabolic processes;the fifth - psychogenic convulsions.
The first group of seizures - the most significant in the structure of convulsive conditions in children, an essential link in the pathogenesis of which is the development of cerebral edema( swelling).The second combines seizures with various forms of epilepsy, the pathogenetic basis of which is the "phenomenon of discharge."At the heart of seizures of the third group associated with organic lesions of the central nervous system( congenital developmental defects or degenerative changes, tumors, abscesses, etc.) is a violation of the function of a certain area of the brain, expressed in an impulse exceeding physiological boundaries. The convulsions of the fourth group are due to the lowering of the threshold of excitability of the peripheral neuromuscular apparatus, which favors the occurrence of seizures, even under normal impulses. The fifth group of seizures is observed in vasolabile children and in children with an unstable psychoemotional sphere. Based on the above, all convulsive conditions can be conditionally divided into symptomatic, or secondary, or non-epileptic convulsive seizures and true or epileptic seizures. The conditional nature of this division results from the fact that the first convulsions are difficult to attribute to one or the other group, as often non-epileptic seizures in.further may take an epileptic character. This gives the right, with unexplained reasons for convulsive conditions, to diagnose "epileptiform seizures".
It should also be aware that any convulsions, despite the fact that they are predominantly due to any one resolving factor, combine many of the causal components described above( mental disinhibition, impaired hormonal regulation, increased peripheral excitability, etc.), and, therefore, the therapy of these conditions, although they differ in an etiological manner, is largely similar.
Medical personnel who provide emergency care for convulsions should remember that the basis of differential diagnosis, and therefore of differentiated therapy, is mainly a clinical aspect and it is rarely possible to use additional studies( instrumental, laboratory special, etc.).Therefore, the clinical analysis of individual nosological forms, we presuppose a brief semiotics of convulsive conditions in children in general.
When collecting an anamnesis, you should pay attention to the health of parents and close relatives, the condition of the mother during the period of the pregnancy, as well as previous pregnancies and childbirth, the outcomes of the latter;the condition of the child at birth( asphyxia, intracranial trauma, duration of labor, delivery operations, exchange blood transfusions, etc.).It is necessary to find out at what age the first convulsions occurred, which contributed to their occurrence( mental or physical trauma, hyperthermia, medication, vaccinations, hyperinsolation, infectious diseases, etc.), the duration of the attack and how it was managed to stop, whether any additionalstudies and their results, what was the state after the attack( falling asleep, urinating under him, remembering what had happened, etc.).It is especially necessary to clarify the picture of the seizure itself( and the previous one): were there precursors and what were they expressing( the desire for solitude, anxiety, a peculiar cry, etc.), the color of the skin( cyanosis, pallor, sharp reddening, etc.), facial expressionand the posture of the child( disconnection, a fixed look at one point, open indifferent eyes, opisthotopus, a certain position of the upper and lower extremities - the "hand of an obstetrician", "carpopedal spasm", etc.), the nature of seizures( sequence of "muscle", one-sided, bilateral, preobleIt gave whether mixing - tonic form or in the form of common abbreviations twitches - clonic form), etc.
..Essentially helps in differential diagnosis, and therefore in differential treatment, the study of the background or pre-convulsive state. In this regard, it is important to know whether the child suffers from hydrocephalus, craniostenosis, microcephaly, cerebral hernia, rickets( severe form), diabetes, tuberculosis, etc.
Seizures of migraine, trigeminal neuralgia, paroxysmal tachycardia attacks, cyanosis attacks orredness, sudden nausea, hiccough, sensory symptoms. The latter often occur long before the onset of a seizure. The study of them is of great practical importance, since they are in fact the only external expression of the possible occurrence of a seizure. A correct evaluation of them makes it possible to clarify the nature and localization of the affected parts of the central nervous system and, consequently, helps to rationally prevent the seizure attacks. These same and other phenomena can be direct harbingers of convulsive seizures, that is, as if the attack begins. It should be remembered that in infants and young children a number of sensations before the appearance of a seizure remain unrecognized and can only be judged on the basis of "equivalents": anxiety or complaisance, sudden unusual affection, closing or rubbing the eyes, fading, etc.
As a rule,precursors precede a large epileptic fit. This short-term state( aura - 1-2 minutes) consists of various sensations in their nature: premonitions of a fit, auditory, visual and other hallucinations, vegetative, motor, speech and other phenomena. During the aura, children lose consciousness, and older children remember these feelings well and can talk about them. By the nature of the sensations, one can judge the localization of the pathological focus. Aura in some cases may be absent, take place in other conditions, but it is most characteristic of a large epileptic fit.
Seizures are clonic, tonic and clonic-tonic. Clonic convulsions are expressed as a contraction( twitching) of one or more muscles. If the muscle contraction occurs in short intervals and one follows the other so that the last layered on each other, then this form of convulsions is called tetanic. As a rule, there are no clonic seizures. More often, clonic convulsions are the initial stage of an attack, and the short clonic phase passes into a tonic phase. Such a form, mixed in character, is prevalent in the clinic of childhood: hyperthermia, toxicosis, reaction to vaccinations, neuroinfections, etc. In some cases, the initial and predominant phase is tonic and the attack has the character of tonic-clonic seizures( meningitis, intracranial birth trauma, asphyxia of newborns, etc.).Often, the same cramps are only tonic( tetanus, tetany, the final stage of toxicosis, seizures in the hemolytic disease of the newborn, some forms of hydrocephalus, etc.).For general diagnosis it is very important to know which muscle groups are mainly involved in cramps and the sequence of their involvement.
A number of indirect clinical signs are important in the diagnosis: skin color, breathing pattern, cardiovascular system condition, etc. For example, yellow skin color is typical for hepatic lesions( jaundice, liver atrophy, fungal poisoning, etc.);respiration such as Cheyne-Stokes, Kussmaul - for severe forms of intoxication( azotemic uremia, diabetic coma, etc.).When mitral stenosis, embolism of cerebral vessels is observed with the development of convulsive seizure, etc. Studies such as the study of the status of the fundus, clinical and biochemical blood tests( leukocytes, ROE, coagulation system indicators, determination of sugar content, residual nitrogen, calcium, etc.) are important.), studies of cerebrospinal fluid( protein, sugar, chlorides, etc.).Of special research methods, special attention should be paid to electroencephalography, rheoencephalography, ultrasound diagnostics, pennoencephalography, craniography, angiography, etc.
The electroencephalogram takes the leading place in analyzing the nature of convulsive seizures. High lead potentials are pathognomonic for a large epileptic fit, and a combination of high acute waves( "peaks") with slow consecutive oscillations is typical of genoein epilepsy. A special place is given to electroencephalography in the diagnosis of subclinical convulsive manifestations( hypersynchronous potentials, reduced basal rhythm, etc.).However, it should be remembered that in some cases of apparent epilepsy the electroencephalogram remains normal, and therefore this method, for all its importance, refers to auxiliary diagnostic techniques.
Reoentsefalografiya allows you to judge the blood filling of this or that part of the brain, its magnitude. The detected areas of blood supply disorders can be associated with congenital or acquired pathological factors serving as sources of epileptiform seizures.
Ultrasound diagnostics based on obtaining an echo-effect, makes it possible to diagnose the presence of a tumor;hemorrhage, their localization.
With the help of pneumoencephalography, the state of the cerebrospinal fluid, the ventricles( displacement, configuration, volume, etc.) is detected, brain development defects are detected, etc.
Conventional radiography of the skull allows to determine the condition of the joints( calcification, craniostenosis), to judge intracranial pressure(finger impressions, divergence of seams, etc.), reveals calcified areas in the brain tissue, defects of the bones of the skull, etc.
With the help of angiography it is possible to diagnose malformations of cerebral vessels, aneurysms,svenno judge about the presence of a tumor( displacement of the vascular trunk), etc.
Clarification of the etiology and pathogenesis of seizures and seizures is a complex and often difficult task for emergency care, especially with primary patient supervision. Therefore, the chances of a differentiated, pathogenetically targeted therapy are usually minimized. In the situation of emergency and urgent care, the task of the medical worker is primarily to quickly arrest seizures and seizures with the use of drugs that are least harmful to the child's body.
Thus, the general principles of emergency anticonvulsant therapy in children are based on knowledge of the pharmacodynamics of anticonvulsants, the side effects of these drugs, the exact age of the drugs used, the synergy of drugs, the duration of their action.
A doctor who provides emergency care for convulsions and seizures should remember that it should be done quickly, but without haste, to try to understand the origin of the attack, it is desirable to provide sufficient illumination of the room, the presence of the extremely necessary people, the patient's comfortable position, sufficient air flow and tetc. It is necessary to protect the child from bruises. It is important to find out whether the child does not need to clean the respiratory tract( secret, food masses, etc.).In severe respiratory disorders, intubation, controlled breathing, and sometimes tracheotomy should be used.
More on the treatment of :
Treatment for convulsions that occur in infectious diseases
Medical care for epileptic seizures
Treatment for seizures caused by organic lesions of the central nervous system
Treating convulsions caused by metabolic disorders
Treatment of seizures caused by psychogenic disorders
Female Journal www. BlackPantera.en: S. Shamsiev