الفهرس 
Definition and mechanismOnly 14 pages are availabe for public view
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Abstract
Convulsive phenomena are one of the most common
neurologic problem in children. A seizure is the clinical
manifestation of an abnormal neuronal hyperactivity which
usually involve cerebral cortical neurons, primarily
or secondarily, and is manifested in a manner dependent
upon the extent and location of this neuronal hyperactivity.
Classification of epileptic seizures is still a
problem. There is a difficulty of devising a single
code to COver three basically incompatible systems
of classification, ~elating to the clinical features
of the fit, to the anatomical and electrophysiological
evidence of the source of the fit, and to its aetiology
when known.
Causes of convulsive seizures are different for
each childhood age group. In the neonatal period; convulsions
are due to metabolic disorders, intracranial
birth injury, intracranial infections, congenital cerebral
malformations, drugs, and developmental abnormalities.
Perinatal hypoxia and intracranial haemorrhage
are the most common causes of neonatal convulsions
and these account for over 50% of seizures in the neonatal
period.
In infancy, congenital abnormalities of the brain
are a very common cause of convulsions specially between
the age of 2 months and 6 months and acute infections
specially meningitis also become significant. Febrile
seizures are those occuring in children in association
with fever and clinical illness other than those involvi~
ng the brain. Seizures occur between the age of 3 months
and 5 years with an incidence of 3-4% of all children.
In childhood, idiopathic
cause of convulsion.
epilepsy is
Other causes
the most
common include:
trauma, toxic reactions and poisoning, and vascular
causes as hypertensive encephalopathy.
Classification of epileptic: seizures is based on
the most recent internationally revised classification
produced in 1981. This new classification subdivide
seizures on the basis of the clinical features of these
seizures and the ictal and interictal electroencephalographic
features. There are two basic types of seizures,
partial and generalized seizures. Partial seizures
are the manifestation of a focal epileptic discharge
in only a portion of the brain. These seizures are
classified on the basis of whether or not consciousness
is impaired during the attacks. When consciousness
is not impaired, the seizure is classified as a simple
partial seizure and when consciousness is impaired,
the seizures is classified as a complex partial seizure.
In generalized seizures, motor signs are bilateral
and reflect neuronal discharges that are widespread
in both hemispheres. These types of seizures include:
absence, myoclonic, clonic, tonic, tonic-clonic, and
atonic seizures.
Management of
consists of two
2) therapy with
a child with convulsive disorders
phases: 1) aetiologic delineation;
removal of the specific cause or
suppresion of seizures with anticonvulsants. Laboratory
examinations include: EEG, roentgenogram, CSF examination,
blood studies for electrolyte assessment, blood picture
and culture, and urine analysis for heavy metals, drugs
and amino acid analysis. The advent of computerized
tomography has helped greatly in the investigation of epileptic
seizures. Approximately 50% of patients with focal
signs and symptoms and abnormal focus on EEG had abnormal
CT scan.
The objective in the treatment of epileptic patients
is complete control of seizures, or at least reduction
in their frequency to the point at which they no longer
interfere with the physical and social well-being.Emerg_
ency management of neonatal seizures includes a trial
to corret the metabolic deficiency until biochemical
and metabolic disorders are excluded. In a child with
febrile convulsion, fever should be reduced by tepid
water and antipyretics, and treatment of the causative
infection is essential.
Phenobarbitone, diphenYlhYdantoin (epanutin), and
primidone are most often used for generalized tonicclonic
seizures and partial seizures. EthosUximide
is very effective in reducing petit mal (absence)
seizures and excellent results have also been found
with valproic acid. Once seizures are contrOlled, the
anticonvulsant drug should be continued for a prolonged
period without altering its dosage. Generally, children
with epilepsy should be treated for at least 4 seizurefree
years before drug withdrawal.