SYMPTOMS

What are convulsions?

Convulsions refer to sudden, involuntary twitching of limbs and/or muscles throughout the body. They may manifest as localized muscle twitching, single-limb or unilateral limb twitching, or involve all four limbs and the entire body. Most convulsions occur abruptly and stop suddenly, lasting only briefly, though prolonged episodes can sometimes be life-threatening.

Most convulsions are a symptom of epilepsy, caused by abnormal electrical discharges in brain neurons. However, even healthy individuals may experience occasional convulsions due to factors such as colds, fever, electrolyte imbalances, drug overdose, alcohol withdrawal, sleep deprivation, or psychological stress^[1].

What is the difference between convulsions and seizures?

Both convulsions and seizures involve involuntary muscle movements (where patients cannot control their skeletal muscle contractions). The terms are often used interchangeably, but strictly speaking, convulsions have a broader definition than seizures^[1].

Convulsions may involve either generalized or localized twitching (e.g., one leg or facial twitching), with or without loss of consciousness. Seizures, however, are typically generalized and symmetrical, often accompanied by loss of consciousness.

Are there any warning signs before convulsions occur?

Most convulsions occur without warning. Some patients may experience vague or hard-to-describe premonitory symptoms moments before an episode, such as minor localized twitching (e.g., corner of the mouth, fingers/toes), staring, restlessness, unexplained fear, or dream-like sensations, lasting only briefly^[2].

Why do some people let out a cry before convulsions?

Generalized convulsions may begin with a tonic phase, where all skeletal muscles, including those in the throat, contract forcefully. This often causes the person to cry out before collapsing, followed by stiffening and then rhythmic jerking of muscles. Some patients may also vomit due to abdominal muscle tension^[2].

What complications can convulsions cause?

1. Physical discomfort: Most patients experience headaches, body aches, and fatigue after convulsions.
2. Injuries: Sudden falls during an episode may lead to trauma, including intracranial bleeding or fractures. Severe muscle contractions can also cause joint dislocations or spinal/femoral fractures. Tongue biting may occur during the episode.
3. Aspiration pneumonia: Inhaling secretions or vomit during or after convulsions can lead to aspiration pneumonia^[2,3].

Can convulsions affect intelligence or height?

Possibly.

Frequent, long-term convulsions may impair cognitive function, and recurrent episodes in children could potentially affect growth and development^[4].

TREATMENT

What to Do When a Seizure Occurs

Some seizures may stop on their own, but others require medical attention. Therefore, before professional medical personnel arrive, the priority is to minimize potential risks to the patient during the episode^[5].

• Remove hazardous objects:
  • Clear dangerous items near the patient (e.g., hot water bottles, chairs). If the patient wears glasses, remove them if possible.
• Protect the patient from falls or injuries:
  • Do not restrain the patient forcefully, as this may cause harm. Stay calm, wait for the seizure to end, and record the start and stop times.
• Position the patient on their side:
  • After the seizure, maintaining an open airway is critical—airway obstruction can be life-threatening, and vomit during a seizure often causes it. A side-lying position helps drain secretions and prevents aspiration.

Seek immediate medical attention if:

• It’s the patient’s first seizure;
• The seizure lasts over 5 minutes or unconsciousness persists beyond 10 minutes;
• The patient is injured during the seizure;
• The patient is pregnant;
• The patient suffered a head injury in the past week;
• The patient is intoxicated;
• After the seizure, the patient does not resume breathing or exhibits agonal gasping—begin CPR immediately.

Perform CPR as follows:

1. Assess the environment: Ensure the area is safe and move the patient if necessary.
2. Check responsiveness: Shake and shout to determine if the patient is conscious.
3. Check breathing: Lay the patient flat, loosen tight clothing, and observe chest movements for 5–10 seconds.
4. Call emergency services and retrieve an AED: If the patient is unresponsive and not breathing (or only gasping), instruct someone to call 120 and fetch an AED.
5. Begin CPR (30:2 compression-to-ventilation ratio):
   • Chest compressions: Press down 5–6 cm (or 1/3 of chest depth) at the nipple line (mid-lower sternum) 30 times.
   • Open the airway: Clear secretions, tilt the head back, and lift the chin to open the airway.
   • Rescue breaths: Pinch the nose, seal the mouth, and deliver two 1-second breaths, observing chest rise. Complete within 10 seconds.
   • Continue cycles of 30 compressions and 2 breaths until help arrives or the patient revives.
6. Transport to the hospital: Call 120 or take the patient to the nearest hospital promptly.

For infant/child CPR, search within the app.

Should You Press the Philtrum During a Seizure?

No.

Pressing the philtrum does not stop seizures and may cause additional harm.

Should You Put Objects in the Mouth During a Seizure?

No.

Tongue bites during seizures are rarely severe, but inserting objects may damage teeth, the mouth, or cause choking^[2].

What to Do If Foaming at the Mouth Occurs?

After the seizure, position the patient on their side with the mouth slightly downward to let vomit drain naturally, reducing aspiration risk^[2].

Why Muscle Soreness After a Seizure? How to Relieve It?

Seizures involve intense muscle contractions, similar to strenuous exercise, leading to soreness. Rest and gentle massage usually help^[2].

Is Fatigue or Sleepiness Normal After a Seizure? How to Manage?

Mild fatigue, drowsiness, or exhaustion are normal—rest is sufficient^[2].

Can Calcium Supplements Prevent Seizures?

No.

While calcium deficiency may trigger seizures in some children, most seizures (especially in adults) are unrelated. Calcium supplements are ineffective for prevention^[4].

Can Medications Prevent Seizures?

Some cases.

For epilepsy-related seizures, antiepileptic drugs (e.g., carbamazepine, oxcarbazepine) may help prevent episodes. However, they must be taken as prescribed, without skipping doses, and require regular follow-ups^[3].

DIAGNOSIS

When should you seek medical attention for convulsions?

Immediate hospital care is required if convulsions are accompanied by the following symptoms or conditions:

1. First-time seizure of unknown cause;
2. For those with a prior epilepsy diagnosis, if the seizure lasts longer than 3–5 minutes or consciousness does not return afterward, suggesting status epilepticus;
3. Seizures accompanied by other severe complications (e.g., loss of consciousness, cardiac arrest, etc.);
4. The patient is pregnant;
5. Even for patients with a confirmed epilepsy diagnosis and recurrent seizures, medical attention should be sought if seizure frequency increases or symptoms worsen compared to previous episodes^[1,3].

Do convulsions require CT or MRI scans?

Some cases do.

For first-time seizures, unexplained causes, or significantly worsened episodes, a head CT/MRI should be performed to assess intracranial conditions^[1].

Is a lumbar puncture necessary for convulsions?

Some cases require it.

For seizures suspected to be caused by organic diseases such as intracranial infections, subarachnoid hemorrhage, encephalitis, or abnormal intracranial pressure, a lumbar puncture is needed to assist in diagnosis^[1].

What tests are commonly required for convulsions? What is their significance?

1. Routine tests: For patients with unexplained convulsions, vital sign monitoring, blood tests (e.g., complete blood count, liver/kidney function, cardiac function, blood glucose, infection markers) are necessary to preliminarily diagnose the cause.
2. Imaging tests: Brain imaging (CT/MRI/functional MRI, etc.) helps evaluate intracranial organic diseases. For suspected epilepsy, electroencephalography (EEG) or long-term EEG monitoring is needed to assess abnormal brain activity.
3. Genetic testing: In rare cases where hereditary factors are suspected, genetic testing may be required^[1].

These tests help identify the underlying cause and guide targeted treatment.

POTENTIAL DISEASES

What are the possible causes of convulsions?

The potential causes of convulsions vary across different age groups, as detailed below:

Neonatal period: Mostly caused by congenital developmental malformations, perinatal brain injury (from 28 weeks of gestation to one week postpartum), or bilirubin encephalopathy.

Infancy: Genetic factors, vitamin D deficiency, or febrile seizures.

Childhood and adolescence: Epilepsy syndromes due to genetic factors/idiopathic epilepsy, brain injuries from various causes, or metabolic disorders such as peroxisomal diseases.

Adulthood: Can be broadly categorized into those secondary to brain diseases and those secondary to systemic diseases:

1. Brain diseases:

   • Infections: Such as encephalitis, meningitis, brain abscess, cerebral tuberculoma, or poliomyelitis.
   • Trauma: Such as head injury.
   • Tumors: Including primary brain tumors or metastatic brain tumors.
   • Vascular diseases: Such as vascular malformations, cerebral hemorrhage, subarachnoid hemorrhage, hypertensive encephalopathy, cerebral embolism, or cerebral thrombosis.
   • Parasitic diseases: Such as cerebral malaria, cerebral schistosomiasis, cerebral echinococcosis, or neurocysticercosis.
   • Others: Congenital brain developmental disorders; idiopathic brain degeneration, such as tuberous sclerosis or multiple sclerosis.

2. Systemic diseases:

   • Metabolic disorders: Such as hypoglycemia, hypocalcemia, hypomagnesemia, acute intermittent porphyria, eclampsia, or vitamin B deficiency. Hypocalcemia may present as typical tetany.
   • Infections: Such as acute gastroenteritis, toxic bacillary dysentery, streptococcal sepsis, otitis media, pertussis, rabies, or tetanus.
   • Toxic factors: Endogenous causes like uremia or hepatic encephalopathy; exogenous causes like poisoning from alcohol, benzene, lead, arsenic, mercury, chloroquine, atropine, camphor, ginkgo seeds, or organophosphates.
   • Cardiovascular diseases: Such as Adams-Stokes syndrome.
   • Rheumatic diseases: Such as systemic lupus erythematosus or cerebral vasculitis.
   • Others: Sudden withdrawal of sedatives (e.g., estazolam, alprazolam) or antiepileptic drugs (e.g., carbamazepine, phenobarbital); may also occur in heat stroke (a severe form of heat illness), drowning, or electric shock.