Convulsions - Dr. A. Desai

Convulsions
by Dr. A. Desai

Case Study

Raj, an eight-year-old, told his mother that he was not feeling well. His mother was busy and ignored Raj for a while. However, soon thereafter Raj gave a loud cry, fell on the floor with his eyes rolled up, jaw tightly clenched and tongue caught between his teeth. He was also convulsing in all four extremities with his back arched. His mother, not having seen a convulsion before, was terribly frightened and summoned help from the neighbours for help. They promptly brought onions. One lady brought an old shoe. These things were held before Raj's nose and the convulsions soon ended. Raj was frothing at the mouth. The froth was blood stained because he had bitten his tongue. He had passed urine and soiled his clothes. He was helped to bed. By this time he had recovered consciousness but was dazed. In a short while he asked his mother as to why there were so many persons were around him. He also complained of a severe headache, bodyache and nausea. He could not control himself and vomited on the floor. He then fell asleep. If a person has two or more convulsions like this, he is diagnosed as having epilepsy.

Given such an emergency, what should a mother do:

If by chance the mother is by the side of the child at the time when the child starts to convulse, she should make all attempts to stop the fall, to prevent a serious injury. A handkerchief or a piece of cloth should be inserted in the mouth when the child gives a cry to prevent the child from biting his tongue. NEVER put your fingers in the child's mouth, as they are likely to be bitten. Also do not put a hard object like a spoon, as that will break the child's teeth. If the tongue, cheeks or lips are bitten and if the wound is large, the child may have to be taken, after the fit is over, to the nearest emergency centre for the wound to be stitched.
The convulsions will stop on their own. There is no need to panic or put onions or shoes near the nose. Onions and shoes serve the same purpose as smelling salts (Ammonia salt) which is generally used for hysterical fits. Hysterical fits are psychogenic, while convulsions are organic. The child must be turned to one side so that if he were to vomit, he will not aspirate the same in the lungs. Tight clothing like a tie or a tight collared shirt should be loosened, as breathing will become easier.
In case a convulsion continues for more than a few minutes or the child gets repeated convulsions in the same episode, then it is wiser to summon a doctor or take the child to the nearest hospital.
Instead of panicking and summoning all and sundry, it is important that the mother watches all events minutely. This is important as at times during convulsion a child may stop breathing for a few seconds or longer and at the time the child should be shaken up or turned to other side. This will stimulate respiratory movements again. As and when she consults the doctor, he would like to know the exact chronicle of events. He would like to know as to what exactly the child mentioned when he stated that he is not feeling well. There are many fits that begin with some premonition to the patient, such as something rising up from the stomach, some visual or auditory hallucinations or some frightening or enjoyable psychological feelings or an indescribable bad smell, etc. At the onset, the eyes and head may turn to one side or the mouth may twist. It is important that the mother watches carefully the side to which the eyes and head turns or the mouth twists. The convulsions can occur or begin in one limb or a part of the limb and then gradually involve the entire side or body. It is equally important to note what happens after the convulsions are over. The doctor would like to know how long the dazed period lasted. He would also like to know whether the child was moving one side of the body less than the other or whether there was a transient paralysis on one side.
After the event it is advisable to contact the family physician, who will decide whether a consultation with a specialist is indicated.

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