ICD 10 convulsions of unknown etiology. G13* Systemic atrophies affecting primarily the central nervous system in diseases classified elsewhere. Mechanism of seizure occurrence

Seizure (convulsive) NOS

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single regulatory document to take into account morbidity, reasons for the population’s visits to medical institutions all departments, causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Convulsive syndrome in children - provision of emergency care at the prehospital stage

Convulsive syndrome in children accompanies many pathological conditions of the child at the stage of their manifestation when the vital functions of the body deteriorate. In children of the first year of life, convulsive conditions are observed significantly more.

The frequency of neonatal seizures, according to various sources, ranges from 1.1 to 16 per 1000 newborns. The onset of epilepsy mainly occurs in childhood (about 75% of all cases). The incidence of epilepsy is 78.1 per child population.

Convulsive syndrome in children (ICD-10 R 56.0 unspecified convulsions) is a nonspecific reaction of the nervous system to various endo- or exogenous factors, manifested in the form of repeated attacks of convulsions or their equivalents (shuddering, twitching, involuntary movements, tremor, etc. ), often accompanied by disturbances of consciousness.

According to the prevalence, seizures can be partial or generalized (convulsive seizure), according to the predominant involvement of skeletal muscles, seizures are tonic, clonic, tonic-clonic, clonic-tonic.

Status epilepticus (ICD-10 G 41.9) is a pathological condition characterized by epileptic seizures lasting more than 5 minutes, or repeated seizures, between which the functions of the central nervous system are not completely restored.

The risk of developing status epilepticus increases with a seizure duration of more than 30 minutes and/or with more than three generalized seizures per day.

Etiology and pathogenesis

Causes of seizures in newborns:

• severe hypoxic damage to the central nervous system (intrauterine hypoxia, intrapartum asphyxia of newborns);
• intracranial birth injury;
• intrauterine or postnatal infection (cytomegaly, toxoplasmosis, rubella, herpes, congenital syphilis, listeriosis, etc.);
• congenital anomalies of brain development (hydrocephaly, microcephaly, holoprosencephaly, hydroanencephaly, etc.);
• abstinence syndrome in a newborn (alcohol, drugs);
• tetanus convulsions due to infection umbilical wound newborn (rare);
• metabolic disorders (in premature infants, electrolyte imbalance - hypocalcemia, hypomagnesemia, hypo- and hypernatremia; in children with intrauterine malnutrition, phenylketonuria, galactosemia);
• severe hyperbilirubinemia in kernicterus of newborns;
• endocrine disorders in diabetes mellitus (hypoglycemia), hypothyroidism and spasmophilia (hypocalcemia).

Causes of seizures in children of the first year of life and in early childhood:

• neuroinfections (encephalitis, meningitis, meningoencephalitis), infectious diseases (influenza, sepsis, otitis media, etc.);
• traumatic brain injury;
• unwanted post-vaccination reactions;
• epilepsy;
• volumetric processes of the brain;
• congenital heart defects;
• phakomatoses;
• poisoning, intoxication.

The occurrence of seizures in children may be due to hereditary burden of epilepsy and mental illness in relatives, perinatal damage to the nervous system.

IN general outline in the pathogenesis of seizures, the leading role is played by changes in the neuronal activity of the brain, which, under the influence of pathological factors, becomes abnormal, high-amplitude and periodic. This is accompanied by a pronounced depolarization of brain neurons, which can be local (partial seizures) or generalized (generalized seizure).

On prehospital stage Depending on the cause, there are groups of convulsive conditions in children, presented below.

Seizures are a nonspecific reaction of the brain (epileptic reaction or “random” seizures) in response to various damaging factors (fever, neuroinfection, trauma, adverse reactions during vaccination, intoxication, metabolic disorders) and occur before the age of 4 years.

Symptomatic seizures in diseases of the brain (tumors, abscesses, congenital anomalies of the brain and blood vessels, hemorrhages, strokes, etc.).

Seizures in epilepsy, diagnostic measures:

• collecting an anamnesis of the disease, describing the development of seizures in a child from the words of those present during the convulsive state;
• somatic and neurological examination (assessment of vital functions, identification of neurological changes);
• a thorough examination of the child's skin;
• psycho level assessment speech development;
• determination of meningeal symptoms;
• glucometry;
• thermometry.

For hypocalcemic convulsions (spasmophilia), determination of symptoms for “convulsive” readiness:

• Khvostek's symptom - contraction of the facial muscles on the corresponding side when tapping in the area of ​​the zygomatic arch;
• Trousseau's symptom - “obstetrician's hand” when squeezing the upper third of the shoulder;
• Lyust's symptom - simultaneous involuntary dorsiflexion, abduction and rotation of the foot when the lower leg is compressed in the upper third;
• Maslov's symptom is a short-term cessation of breathing during inspiration in response to a painful stimulus.

Convulsions in status epilepticus:

• status epilepticus is usually provoked by cessation of anticonvulsant therapy, as well as acute infections;
• characterized by repeated, serial seizures with loss of consciousness;
• there is no complete recovery of consciousness between seizures;
• convulsions are of a generalized tonic-clonic nature;
• there may be clonic jerking eyeballs and nystagmus;
• attacks are accompanied by breathing disorders, hemodynamics and the development of cerebral edema;
• the duration of the status is on average 30 minutes or more;
• The prognosis is unfavorable if there is an increase in the depth of disturbance of consciousness and the appearance of paresis and paralysis after convulsions.

• convulsive discharge usually occurs at a temperature above 38 ° C against the background of a rise in body temperature in the first hours of the disease (for example, ARVI);
• the duration of seizures averages from 5 to 15 minutes;
• risk of recurrence of seizures up to 50%;
• the frequency of febrile seizures exceeds 50%;

Risk factors for recurrent febrile seizures:

• early age at first episode;
• family history of febrile seizures;
• development of seizures at low-grade body temperature;
• short interval between the onset of fever and convulsions.

In the presence of all 4 risk factors, repeated seizures are observed in 70%, and in the absence of these factors - only in 20%. Risk factors for recurrent febrile seizures include a history of afebrile seizures and a family history of epilepsy. The risk of transformation of febrile seizures into epileptic seizures is 2-10%.

Exchange spasms in spasmophilia. These convulsions are characterized by the presence of pronounced musculoskeletal symptoms of rickets (in 17% of cases) associated with hypovitaminosis D, decreased function of the parathyroid glands, which leads to an increase in phosphorus content and a decrease in calcium content in the blood, alkalosis and hypomagnesemia develop.

Paroxysm begins with spastic cessation of breathing, cyanosis, general clonic convulsions, apnea for several seconds are observed, then the child takes a breath and regresses pathological symptoms with restoration of the original state. These paroxysms can be provoked by external stimuli - a sharp knock, bell, scream, etc. During the day they can be repeated several times. On examination there are no focal symptoms, noted positive symptoms to “convulsive” readiness.

Affective-respiratory convulsive states. Affective-respiratory convulsive conditions are “blue type” attacks, sometimes called “anger” convulsions. Clinical manifestations can develop starting from 4 months of age and are associated with negative emotions (lack of child care, untimely feeding, changing diapers, etc.).

A child who expresses his dissatisfaction by prolonged screaming develops brain hypoxia at the height of affect, which leads to apnea and tonic-clonic convulsions. Paroxysms are usually short, after which the child becomes drowsy and weak. Such convulsions can occur rarely, sometimes 1-2 times in a lifetime. This variant of affective-respiratory paroxysms must be differentiated from the “white type” of similar convulsions as a result of reflex asystole.

We must remember that epileptic paroxysms may not be convulsive.

Assessment of general condition and vital signs important functions: consciousness, breathing, blood circulation. Thermometry is carried out, the number of respirations and heartbeats per minute is determined; measured arterial pressure; mandatory determination of blood glucose levels (the norm in infants is 2.78-4.4 mmol/l, in children 2-6 years old - 3.3-5 mmol/l, in schoolchildren - 3.3-5.5 mmol/l); examined: skin, visible mucous membranes of the oral cavity, chest, abdomen; Auscultation of the lungs and heart is performed (standard somatic examination).

A neurological examination includes determination of general cerebral, focal symptoms, meningeal symptoms, assessment of the child’s intelligence and speech development.

As is known, in the treatment of children with convulsive syndrome, the drug diazepam (Relanium, Seduxen) is used, which, being a minor tranquilizer, has therapeutic activity for only 3-4 hours.

However, in developed countries of the world, the first-line antiepileptic drug of choice is valproic acid and its salts, duration therapeutic action which is hours. In addition, valproic acid (ATX code N03AG) is included in the list of vital and essential medicines for medical use.

Based on the above and in accordance with Order of the Ministry of Health of Russia dated June 20, 2013 No. 388n., the following algorithm is recommended urgent measures with convulsive syndrome in children.

Urgent Care

• ensuring airway patency;
• inhalation of humidified oxygen;
• prevention of head and limb injuries, prevention of tongue biting, aspiration of vomit;
• glycemic monitoring;
• thermometry;
• pulse oximetry;
• if necessary, provide venous access.

Medication assistance

• Diazepam at the rate of 0.5% - 0.1 ml/kg intravenously or intramuscularly, but not more than 2.0 ml once;
• in case of short-term effect or incomplete relief of convulsive syndrome, re-introduce diazepam at a dose of 2/3 of the initial dose, the total dose of diazepam should not exceed 4.0 ml.

• Sodium valproate lyophysate (Depakine) is indicated in the absence of a pronounced effect from diazepam. Depakine is administered intravenously at a rate of 15 mg/kg as a bolus over 5 minutes, dissolving every 400 mg in 4.0 ml of solvent (water for injection), then the drug is administered intravenously at a rate of 1 mg/kg per hour, dissolving every 400 mg in 500 .0 ml of 0.9% sodium chloride solution or 20% dextrose solution.

• Phenytoin (diphenin) is indicated if there is no effect and status epilepticus persists for 30 minutes (in the context of a specialized resuscitation ambulance team) - intravenous administration of phenytoin (diphenin) at a saturation dose of 20 mg/kg at a rate of no more than 2.5 mg/min ( the drug is diluted with 0.9% sodium chloride solution):
• according to indications - it is possible to administer phenytoin through a nasogastric tube (after crushing the tablets) in doses of 1 mg/kg;
• repeated administration of phenytoin is permissible no earlier than after 24 hours, with mandatory monitoring of the drug concentration in the blood (up to 20 mcg/ml).

• Sodium thiopental is used for status epilepticus, refractory to the above types of treatment, only in the conditions of a specialized emergency medical resuscitation team or in a hospital;
• sodium thiopental is administered intravenously via micro-jet at 1-3 mg/kg per hour; maximum dose - 5 mg/kg/hour or rectally for 1 year of life (contraindication - shock);

In case of impaired consciousness, to prevent cerebral edema or hydrocephalus, or hydrocephalic-hypertensive syndrome, Lasix 1-2 mg/kg and prednisolone 3-5 mg/kg are prescribed intravenously or intramuscularly.

For febrile convulsions, a 50% solution of metamizole sodium (analgin) is administered at a rate of 0.1 ml/year (10 mg/kg) and a 2% solution of chloropyramine (suprastin) at a dose of 0.1-0.15 ml/year of life intramuscularly, but no more than 0.5 ml for children under one year of age and 1.0 ml for children over 1 year of age.

For hypoglycemic convulsions, a 20% dextrose solution is administered intravenously at a rate of 2.0 ml/kg, followed by hospitalization in the endocrinology department.

For hypocalcemic convulsions, a 10% solution of calcium gluconate is slowly administered intravenously - 0.2 ml/kg (20 mg/kg), after preliminary dilution with a 20% dextrose solution by 2 times.

With ongoing status epilepticus with manifestations of severe hypoventilation, increasing cerebral edema, for muscle relaxation, with signs of brain dislocation, with low saturation (SpO2 no more than 89%) and in the conditions of the work of a specialized emergency medical team - transfer to mechanical ventilation with subsequent hospitalization in intensive care unit.

It should be noted that in children infancy and status epilepticus anticonvulsants may cause respiratory arrest!

Indications for hospitalization:

• children of the first year of life;
• convulsions that occurred for the first time;
• patients with seizures of unknown origin;
• patients with febrile seizures against the background of a complicated medical history ( diabetes, UPS, etc.);
• children with convulsive syndrome due to an infectious disease.

Coding of convulsive syndrome according to ICD-10

The occurrence of seizures in an adult or a child is a signal of serious pathological process in organism. When making a diagnosis, the doctor uses the ICD 10 seizure syndrome code to correctly complete medical documentation.

The International Classification of Diseases is used by doctors of various specialties around the world and contains all nosological units and premorbid conditions, which are divided into classes and have their own code.

Mechanism of seizure occurrence

Convulsive syndrome occurs against the background of unfavorable internal and external environment, is especially common in idiopathic epilepsy (epileptic seizure). The development of convulsive syndrome can also be provoked by:

• traumatic brain injuries;
• congenital and acquired diseases of the central nervous system;
• alcohol addiction;
• benign and malignant tumors of the central nervous system;
• high fever and intoxication.

Disturbances in the functioning of the brain are manifested by paroxysmal activity of neurons, due to which the patient experiences repeated attacks of clonic, tonic or clonic-tonic seizures. Partial seizures occur when neurons in one area are affected (they can be localized using electroencephalography). Such violations can occur for any of the above reasons. However, in some cases, when making a diagnosis, it is not possible to accurately identify the cause of this severe pathological condition.

Features in childhood

The most common manifestation of convulsive syndrome in children is febrile seizures. Newborns and children under 6 years of age are most at risk of developing an attack. If seizures recur in older children, then it is necessary to suspect epilepsy and consult a specialist. Febrile seizures can occur with any infectious or inflammatory disease that is accompanied by sharp increase body temperature.

IN international classification diseases of the tenth revision, this pathology is coded R56.0.

If your baby has convulsive muscle twitching due to fever, then you need to:

• call an ambulance;
• lay the child on a flat surface and turn his head to the side;
• after the seizure stops, give an antipyretic;
• provide a flow of fresh air into the room.

You should not try to open your child's mouth during an attack, as you may injure both yourself and him.

Features of diagnosis and treatment

In ICD 10, convulsive syndrome is also coded R56.8 and includes all pathological conditions that do not relate to epilepsy and seizures of other etiologies. Diagnosis of the disease includes a thorough history taking, an objective examination, and an electroencephalogram. However, the data from this instrumental research not always accurate, so the doctor must also focus on clinical picture and medical history.

Treatment should begin with the elimination of all possible factors predisposing to the disease. It is necessary to stop alcohol abuse, remove surgically CNS tumors (if possible). If it is impossible to accurately determine the cause of seizures, then the doctor prescribes symptomatic therapy. Anticonvulsants, sedatives, tranquilizers, and nootropic drugs are widely used. Early seeking qualified medical help can significantly increase the effectiveness of treatment and improve the prognosis for the patient’s life.

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ICD-10 R56: convulsive syndrome in children, not elsewhere classified

The manifestation of convulsive syndrome in children can seriously frighten any adult, especially an unprepared one. Various reasons can cause a seizure in a young child.

And parents need to know why this happened and how to prevent such situations in the future.

Etiology

Convulsive syndrome is a process of involuntary contraction of skeletal muscles caused by a strong external or internal stimulus. Most often it manifests itself against the background of loss of consciousness. Young children are most susceptible to the manifestations of such convulsions, because their central nervous system is not yet fully strengthened and formed. How younger child, the higher his convulsive readiness. And it is precisely for the immature children’s brain that seizures are most dangerous.

Classification and reasons

Seizures are classified depending on various factors.

• epileptic;
• non-epileptic (can turn into epileptic).

Depending on clinical manifestations:

Depending on the involvement of different brain structures, they may differ in nature:

• tonic;
• clonic;
• clonic-tonic.

The latter type of seizures is most often observed. It first combines prolonged muscle contractions of a specific muscle group, and then fast rhythmic or arrhythmic contractions of all muscles (starting with the facial ones) with short pauses between them.

The first phase, as a rule, lasts no more than 1 minute, but it is the duration of the second phase that is important factor in further forecasts.

The causes of the syndrome can be very different. The nature of the seizures is diagnosed by the doctor, conducting all the necessary studies.

Infectious

Attacks can occur in various infectious diseases. This is due high temperature body (more than 38.8 degrees). Manifestations of the syndrome are possible in diseases such as otitis media, influenza, pneumonia and colds. Seizures also often occur when food poisoning and diarrhea, as the body becomes significantly dehydrated.

Tetanus, meningitis and encephalitis can also cause a seizure.

Sometimes such an attack is a child’s reaction to preventive vaccination. Mostly occurs in children under 1.5 years of age.

Metabolic

Severe rickets due to decreased levels of vitamin D and calcium can cause seizures.

They are also observed in children with diabetic hypoglycemia after long fasting and intense physical activity.

Children with work problems thyroid gland, as well as those who have undergone surgery on it, often experience these types of attacks.

Epilepsy

A disease such as epilepsy itself can cause involuntary muscle contractions. Knowing about your predisposition to this disease, and especially having diagnosed it, you need to be prepared for possible attacks and be able to provide first aid.

Hypoxic

Oxygen deficiency can occur both with low levels of oxygen in the surrounding atmosphere and with pathological conditions. It leads to disruption of the body's functioning due to a malfunction of metabolic processes.

Hypoxia occurs quite often and serves as a concomitant symptom of many diseases.

In a child with increased nervous excitability, this may manifest itself at a moment of pronounced joy or anger. Strong screaming or crying can cause this phenomenon.

Structural

Structural causes include brain damage:

Symptoms

The syndrome develops suddenly and is manifested by various symptoms, but they all have a common character:

• motor excitement appears, muscles involuntarily contract (typically flexion of the upper and straightening of the lower extremities);
• the head is thrown back;
• jaws close;
• high probability of respiratory arrest;
• bradycardia appears;
• skin color becomes very pale;
• breathing becomes noisy and very rapid;
• the vision becomes cloudy, the child is not aware of what is happening and loses touch with reality;
• Foaming at the mouth may occur.

Accompanying illnesses

Convulsions often appear against the background of acute infectious diseases, poisoning and hereditary diseases.

They can also accompany the following diseases:

• congenital pathologies of the central nervous system;
• focal brain lesions;
• cardiac dysfunction;
• various blood diseases.

Diagnostics

Since there are many causes of the syndrome, the examination should include a comprehensive examination of different specialists(pediatrician, neurologist, endocrinologist and others).

What is important is under what circumstances, how long and what nature the seizure was.

Also, for correct diagnosis it is necessary to provide reliable information about hereditary predispositions, past diseases and injuries.

After all the accompanying circumstances have been clarified, various tests are carried out to determine the nature of the seizures:

• rheoencephalography;
• X-ray of the skull.

To clarify the diagnosis, the following may be useful:

• lumbar puncture;
• neurosonography;
• diaphanoscopy;
• angiography;
• ophthalmoscopy;
• CT scan of the brain.

If the syndrome develops, it is necessary to perform a biochemical study of blood and urine.

Relief of convulsive syndrome in children: treatment

After identifying the cause of the seizures, the doctor prescribes treatment. If the attack was caused by fever or some other infectious disease, then its manifestations will disappear along with the underlying disease.

But if the tests determined more serious reason their occurrence, then drug treatment is prescribed:

• relief of the syndrome with drugs such as Hexenal, Diazepam, GHB, and intramuscular or intravenous administration of magnesium sulfate;
• reception sedatives.

An important factor is the normalization of nutrition for the full recovery of the body.

After the acute condition is relieved, maintenance and preventive therapy is carried out under the constant supervision of a doctor.

First emergency aid: algorithm of actions

If an attack occurs, it is necessary to act quickly and accurately so as not to harm the child or aggravate the situation. Render first aid Any person can do it, the main thing is to accurately determine the nature of the seizures and follow the rules.

1. If the child was standing, try to prevent the fall (a blow from the fall will only make the situation worse).
2. Place it on a hard surface, and you can put something soft under your head.
3. Turn your head or whole body to one side.
4. Free your neck from clothing.
5. Provide fresh air.
6. Place a handkerchief or cloth napkin in your mouth.
7. If the attack is accompanied by crying or hysteria, it is necessary to calm the child - spray cold water, give him a sniff of ammonia and use all possible means to distract his attention.

Correctly provided first aid is an important stage in treatment that will help preserve health or even life.

In most cases, seizures stop with age. But precautions must be taken. To avoid recurrence of the attack, hyperthermia should not be allowed during infectious diseases.

Prevention consists of regular examination by a doctor and timely treatment the underlying disease that triggered the seizures.

If seizures persist for a long time, it can be assumed that the child has developed epilepsy. To do this, it is necessary to conduct a full examination by a doctor and provide the child with complete treatment. With proper prevention, the probability of seizures becoming epileptic is 2-10%, and proper treatment will help completely stop the disease.

Danger and unpredictability

Seizures are a very dangerous phenomenon, as they can cause brain damage, problems with cardiovascular system and stopping breathing. A prolonged and prolonged attack can lead to severe epilepsy, so you should not resort to self-medication or give your child any medications without consulting a doctor.

Remember that timely consultation with a doctor and proper prevention in the future they will help maintain your child’s health and protect his life from the occurrence of such seizures in the future.

I didn’t know how to calm my son down, he didn’t sleep well, he even talked and screamed in his sleep! My mother gave him some herbs.

We also bought a mobile phone, and the child found it interesting to play with it. We ordered online at the mamakupi.ua store.

Children should not take it without consulting a doctor. It could be worse. When my son had diarrhea, we were contacted by a pediatrician.

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Febrile seizures occur in children under 3 years of age when body temperature rises above 38 °C in the presence of a genetic predisposition (121210, Â). Frequency- 2-5% of children. The predominant gender is male.

Code according to the international classification of diseases ICD-10:

• R56.0

Options. Simple febrile convulsions (85% of cases) - one attack of convulsions (usually generalized) during the day lasting from a few seconds, but not more than 15 minutes. Complex (15%) - several episodes during the day (usually local convulsions), lasting more than 15 minutes.

Symptoms (signs)

Clinical picture. Fever. Tonic-clonic seizures. Vomit. General excitement.

Diagnostics

Laboratory research. First episode: determination of the level of calcium, glucose, magnesium, other serum electrolytes, urine analysis, blood culture, residual nitrogen, creatinine. IN severe cases— toxicological analysis. Lumbar puncture - if meningitis is suspected or the first episode of seizures in a child over 1 year old.

Special studies. EEG and CT scan of the brain 2-4 weeks after the attack (performed for repeated attacks, neurological diseases, family history of afebrile seizures or first onset after 3 years).

Differential diagnosis. Febrile delirium. Afebrile seizures. Meningitis. Head injury. Epilepsy in women combined with mental retardation (*300088, À): febrile seizures may be the first sign of the disease. Sudden termination receipt of anticonvulsants. Intracranial hemorrhages. Thrombosis of the coronary sinus. Asphyxia. Hypoglycemia. Acute glomerulonephritis.

Treatment

TREATMENT

Lead tactics. Physical cooling methods. The patient's position is to lie on his side to ensure adequate oxygenation. Oxygen therapy. If necessary, intubation.

Drug therapy. The drugs of choice are paracetamol 10-15 mg/kg rectally or orally, ibuprofen 10 mg/kg for fever. Alternative drugs. Phenobarbital 10-15 mg/kg IV slowly (possible respiratory depression and arterial hypotension) .. Phenytoin 10-15 mg/kg IV (cardiac arrhythmia and arterial hypotension are possible).

Prevention. Paracetamol 10 mg/kg (orally or rectally) or ibuprofen 10 mg/kg orally (at body temperature above 38 °C - rectally). Diazepam - 5 mg up to 3 years of age, 7.5 mg - from 3 to 6 years, or 0.5 mg/kg (up to 15 mg) rectally every 12 hours up to 4 doses - at body temperature above 38.5 ° C. Phenobarbital 3-5 mg/kg/day - for long-term prophylaxis in children at risk with a complicated medical history, multiple repeated attacks, and neurological diseases.

Course and prognosis. A febrile attack does not lead to a delay in physical and mental development or to death. The risk of a second attack is 33%.

ICD-10. R56.0 Convulsions during fever

Pathological reactions that occur in response to physical stimuli include convulsive syndrome. It occurs in children and adults. Symptoms of the pathological process should not be ignored, as they can lead to serious complications. In case of convulsive syndrome, patients are offered complex treatment, which is aimed at eliminating the signs of a painful condition and its root cause.

Convulsive syndrome is the body’s reaction to external and internal stimuli, characterized by sudden attacks involuntary muscle contractions

Convulsive syndrome in men, women and children is a nonspecific reaction of the body to internal and external stimuli. It is accompanied by involuntary contraction of muscle tissue.

The international classification of diseases includes convulsive syndrome. Its ICD-10 code is R56.8. This code is reserved for pathologies that do not relate to seizures of epilepsy or other etiology.

Convulsive syndrome often occurs in newborns. It affects adults of all ages. It is very important to find out the cause of the disorder in order to select an adequate course of therapy.

Reasons for violation

Convulsive syndrome is caused various reasons. Quite often it develops due to congenital anomalies and pathologies of the central nervous system. Common factors also include genetic diseases, tumors in the body and problems with the cardiovascular system.

Common causes that lead to the appearance of the syndrome are presented in the table. They are divided by age groups.

Age	Reasons for violation
Up to 10 years	Convulsions in childhood are caused by diseases of the central nervous system, fever, head injuries, congenital abnormalities in metabolism, cerebral paralysis and epilepsy.
11-25 years	The cause of the disease is head injuries, angioma, toxoplasmosis and neoplasms in the brain cavity.
26-60 years	Pathology can be caused by neoplasms in the brain, inflammatory processes in the membranes of this organ and abuse of alcoholic beverages.
From 61 years old	Seizures may be caused renal failure, drug overdose, Alzheimer's disease and cerebrovascular disorders.

Since convulsive syndrome in an adult or children has many causes, the methods of treating such a disorder differ. To achieve recovery, it is necessary to correctly determine the factor that led to the development of the disease.

Symptoms in children and adults

Convulsive syndrome in children and adults has similar symptoms. Pathology appears suddenly.

A typical seizure is characterized by eye floaters, wandering eyes, and loss of contact with the outside world.

The tonic phase of the attack is characterized by short-term apnea and bradycardia. The clonic phase is characterized by twitching of facial areas on the face.

With alcoholic convulsive syndrome, which often occurs in adults and adolescents, severe intoxication, loss of consciousness, vomiting and foam from the mouth.

Convulsive syndrome in young children and adults is localized or generalized. In the first case, during an attack, they are involved separate groups muscles. In the generalized course of the syndrome, the child may experience involuntary urination and loss of consciousness. Due to pathology, all muscle groups suffer.

Convulsions are characterized by an acute onset, agitation, and changes in consciousness

Why is seizure syndrome dangerous?

Spastic pathology, which is the state of convulsive syndrome, poses a danger to human health and life. If the attack is not suppressed in a timely manner and treatment of the disease is ignored, it will lead to dangerous consequences:

• Pulmonary edema, which threatens complete cessation of breathing.
• Cardiovascular pathologies that can lead to cardiac arrest.

Manifestations of an attack can overtake a person while he is performing actions that require maximum concentration of attention. It's about about driving a vehicle. Even walking can cause serious injury if an adult or child is suddenly affected by the signs and symptoms of a seizure.

Diagnostics

Diagnosis of the disease, which is accompanied by seizures, is carried out in the clinic. The specialist must collect anamnesis and, during the conversation with the patient, determine the optimal algorithm for conducting a study of the body.

The following diagnostic methods help identify seizure syndrome in an adult, newborn or adolescent:

1. Radiography.
2. Electroencephalography.
3. Cerebrospinal fluid analysis.
4. Pneumoencephalography.
5. Blood analysis.

The research results help the doctor determine correct diagnosis the patient, that is, to determine whether he has a convulsive syndrome.

To help the patient, it is necessary to urgently call an ambulance

Convulsive syndrome, which manifests itself in a child or an adult, cannot be ignored. Adequate treatment is required.

Before deciding on therapy, a specialist must find out the cause of the disease. It is for these purposes that diagnostics are used. The therapy offered by attending physicians is aimed at suppressing the symptoms of the pathological process and eliminating the negative factor that led to the development of the syndrome.

Urgent Care

First aid can be provided to a patient at the time of an attack by anyone. He must recognize the obvious symptoms of the disease and quickly respond to them. To avoid injury to the patient during seizures, it is necessary to act accurately and consistently.

First aid to a person with a convulsive syndrome helps him wait for the medical team to arrive and safely survive the painful condition. If infants If teenagers or adults experience symptoms characteristic of an attack, you should immediately call an ambulance. Next you need to do the following:

1. It is necessary to provide the victim with access to fresh air. To do this, if possible, remove tight clothing or unbutton his shirt.
2. It is necessary to place a small towel or scarf in the oral cavity so that the person does not accidentally bite his tongue or break his teeth.
3. The patient's head should be turned to the side. The same must be done with his entire body. This action will prevent him from choking on vomit.

All these actions must be done very quickly. Afterwards, all that remains is to wait for the arrival of doctors who will help the person get rid of the attack.

Drugs

Taking sedatives helps the patient reduce the occurrence of seizures

Emergency care for a person with a seizure disorder may include taking medications. Drug therapy aimed at eliminating the attack and further preventing this state.

For convulsions, agitation and epileptic seizures, patients are prescribed GABA derivatives, barbiturates and benzodiazepines. Medicines help calm the nervous system and reduce muscle tone. For acute conditions, antipsychotics may be prescribed.

For cramps in the limbs, vitamin complexes can be prescribed. This therapy is effective if the attack is triggered by hypovitaminosis.

Providing assistance for convulsive syndrome includes the use of oral and external agents. For seizures, the following medications are recommended:

• Vitamins B and D.
• Magnistad.
• Magnerot.

It is strictly forbidden to give a baby or an adult medicine that has not been prescribed by a specialist. Medicines can be taken strictly on the recommendation of the attending physician. Otherwise, such therapy may lead to complications.

External remedies for the treatment of attacks include ointments. For leg cramps, it is customary to prescribe:

• Hermes.
• Troxevasin.
• Venitan.

Ointments and creams reduce the severity of seizures, stimulate blood circulation in the problem area and improve the saturation of tissues with nutrients.

Diet

Diet is of great importance in the treatment of convulsive syndrome. Patients are advised to adhere to a special diet that helps reduce the frequency of attacks to a minimum.

Patients with this diagnosis should exclude baked goods, carbonated drinks, sweets, strong coffee, alcohol and organ meats from their diet. If a person is overweight, then he needs to constantly monitor the number of calories consumed per day.

To cope with painful condition must be included in your diet fresh vegetables and fruits, dairy products and whole grain cereals. It is imperative to monitor drinking regime. Patients are recommended to drink 1.5-2 liters per day clean water. Teas, compotes and drinks are not taken into account in this case.

If a person experiencing cramps is unable to create a menu for the week, he can seek help from a nutritionist. The doctor will select the patient optimal diet, which will allow you to maintain the body’s functioning normally.

Physiotherapy

Therapeutic exercises should be performed every day in conjunction with the prescribed treatment.

Helps cope with seizure syndrome physiotherapy. To achieve results from it, you need to practice regularly. Exercise therapy is also actively used in the prevention of attacks. Simple exercises will help you cope with the painful condition:

• Lifting small objects from the floor using only the toes.
• Rolling with your feet a rubber ball, which is equipped with spikes.
• Pulling your toes towards you while sitting with your legs extended.

Each exercise must be performed for 2-3 minutes. You can increase the duration of the training if the patient’s condition allows it.

If cramps bother you too often, the patient should take barefoot walks on sand or grass. If desired, you can use a special massage mat.

Forecast

If a person suffering from convulsive syndrome was provided with timely medical assistance, then he will have a favorable prognosis. The chances of a successful recovery increase the correct diagnosis and the cause of the development of the pathological process.

At periodic appearance Seizures require mandatory diagnosis in a clinic. Seizures may be a sign dangerous disease, which has not yet had time to fully manifest itself. The study will make it possible to detect pathology and treat it in a timely manner, thereby preventing the development of serious complications that pose a threat to human life.

Ignoring attacks leads to dangerous consequences, including death.

According to the criteria of the International League Against Epilepsy, a first seizure (attack) is one or more first-time seizures that can recur within 24 hours, with full restoration consciousness between them.

reference Information:

Conceptual definition of seizure disorder and epilepsy(ILAE report, 2005) Epileptic seizure (seizure) transient clinical manifestations of pathological excessive or synchronous neural activity of the brain Epilepsy is a brain disorder characterized by a persistent predisposition to epileptic seizures, as well as neurobiological, cognitive, psychological and social consequences of this state. This definition of epilepsy requires the development of at least one epileptic seizure (note: a seizure associated with the influence of some transient factor on the normal brain that temporarily lowers the seizure threshold is not considered epilepsy).

Practical clinical definition of epilepsy. Epilepsy is a brain disease corresponding to any of the following conditions: [ 1 ] at least two unprovoked (or reflex) epileptic seizures > 24 hours apart; [ 2 ] one unprovoked (or reflex) epileptic seizure and the likelihood of recurrent seizures, corresponding overall risk relapse (> 60%) after two unprovoked epileptic seizures over the next 10 years; [ 3 ] diagnosis of an epileptic syndrome (eg, benign epilepsy with centrotemporal spikes, Landau–Kleffner syndrome).

The first attack is distinguished:

[1 ] epileptic - the transient appearance of signs and/or symptoms as a result of pathological or increased activity of brain neurons;
[2 ] acute symptomatic- an attack that develops with severe brain damage or in a clear temporal relationship with documented acute brain damage;
[3 ] long-term symptomatic- an attack that develops without an obvious precipitating factor, but with the presence of a diagnosable serious brain injury preceding the attack, for example, severe trauma or concomitant illness;
[4 ] progressive symptomatic- a convulsive attack that develops in the absence of someone potentially responsible for it clinical condition or outside the time interval for which acute symptomatic seizures are possible, and caused by a progressive disorder (eg, tumor or degenerative disease);
[5 ] psychogenic - transient disturbances behavior without any reason of an organic nature (in the DSM-IV classification such an attack is classified as a somatoform disorder, while according to the ICD-10 classification [WHO, 1992] a similar attack is classified as dissociative seizures and belongs to the group of conversion disorders.

read also the article: Psychogenic nonepileptic seizures(to the website)

Acute symptomatic seizures are episodes that occur in close temporal relationship with acute injuries CNS, which may have metabolic, toxic, structural, infectious or inflammatory nature. The time period is usually defined as the first week after the acute pathological condition, but can be shorter or longer. These seizures are also called reactive, provoked, induced, or situational seizures. For epidemiological studies, a precise definition is necessary, so the International League Against Epilepsy recommends using the term acute symptomatic seizures ( note: an acute symptomatic seizure is a “provoked seizure”, therefore, even with a high risk of recurrence, the diagnosis of “Epilepsy” is not made [see. "Reference information" - Practical clinical definition of epilepsy]).

Epileptic, remote symptomatic, and progressive symptomatic seizures are “unprovoked seizures.” An unprovoked seizure is a seizure or series of seizures that develops within 24 hours in a patient over 1 month of age in the absence of precipitating factors. Unprovoked seizures may be sporadic or recurrent. Although all patients with single unprovoked seizures are likely to develop epilepsy, seizure recurrence occurs in only half of the cases. According to population studies, the risk of seizure recurrence within 1 year was 36 - 37%, within 2 years - 43 - 45%. After the 2nd unprovoked seizure, the risk of developing a 3rd one reaches 73%, and a 4th - 76% (Anne T. Berg, 2008).

Acute symptomatic seizures differ from epilepsy in a number of important ways. [ 1 ] First, unlike epilepsy, the immediate cause of these seizures is clearly defined. If there is a clear temporal relationship, there is a possibility that the seizure was caused by conditions such as uremia, head trauma, hypoxia, or stroke, which always precede or develop simultaneously with the seizure. A causal relationship is also confirmed in cases where acute disruption of brain integrity or metabolic homeostasis develops in connection with a stroke. In many cases, more severe trauma increases the likelihood of developing seizures. [ 2 ] Secondly, unlike epilepsy, acute symptomatic seizures do not necessarily recur when the conditions that caused them recur. [ 3 ] Third, although acute symptomatic seizures are a clear risk factor for the development of epilepsy, they cannot be included in the definition of epilepsy, which requires the presence of 2 or more unprovoked seizures.

When a seizure develops for the first time, the following examination is recommended::

[1 ] General physical examination. [ 2 ] Neurological examination. Of the variety of symptoms, reliable indicators of the epileptic nature of a convulsive seizure are cyanosis and, to a lesser extent, hypersalivation ( associated symptoms), tongue biting, and confusion (symptoms that occur after a seizure). Eyes closed during the tonic-clonic phase of the seizure indicate a dissociative (psychogenic non-epileptic) seizure with a sensitivity of 96% and specificity of 98%. [ 3 ] Biochemical research blood: general analysis blood, glucose, urea, electrolytes (including calcium), creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase/prolactin; urine toxicology tests (if necessary).

With the exception of children in the first 6 months of life who have hyponatremia (<125 ммоль/л) в 70% случаев сопутствует эпилептическим припадкам, метаболические нарушения (гипер- и гипогликемия, электролитные нарушения и др.) редко обнаруживаются у детей и взрослых при биохимическом/гематологическом скрининге после припадка.

To differentiate epileptic seizures from psychogenic non-epileptic seizures, it is useful to determine the serum prolactin level (two times the basal level or >36 ng/ml suggests either generalized tonic-clonic or complex partial seizures.

[4 ] Conducting an EEG. If a standard EEG recorded during wakefulness is uninformative, it is recommended to record an EEG during sleep. EEG recorded within 24 hours after a seizure is more likely to detect epileptiform activity than recorded in subsequent days. In contrast, the slowing of basal EEG activity 24 to 48 hours after a seizure may be transient and should be interpreted with caution.

read also the article: Video-EEG monitoring(to the website)

[5 ] Carrying out computed tomography(CT) and magnetic resonance imaging (MRI) of the brain. Although pathological changes can be found in almost half of adults and 1/3 of children, the contribution of neuroimaging research methods is limited in patients with existing epileptogenic brain damage and/or partial seizures. There is no evidence that MRI is more informative than CT in emergency conditions, By at least in children. The value of CT examination in the absence of pathological changes in neurological status was 5 - 10%. Although up to 1/3 of children have pathological changes that are detected using neuroimaging, most of these findings do not affect further treatment and management of patients, such as the need for hospitalization or the appointment of further examination.

[6 ] Indications for cerebrospinal fluid (CSF) examination. Because of its high sensitivity and specificity, CSF examination is usually performed in febrile seizures accompanied by meningeal symptoms to rule out brain infection. In children under 6 months of age with impaired and incomplete restoration of consciousness, pathological changes may be observed in the CSF even in the absence of symptoms of meningeal irritation. In contrast, the value of CSF testing in patients with a first nonfebrile seizure has not yet been determined.

Treatment. In the presence of a first acute symptomatic seizure (metabolic encephalopathy, acute CNS injury in patients with a treatable underlying condition), treatment of the underlying disease is recommended. Symptomatic (antiepileptic) therapy for the first unprovoked seizure is inappropriate unless the seizure is status epilepticus. The decision to initiate antiepileptic drug treatment after the first seizure depends largely on the risk of relapse (patients with acute symptomatic seizures and a high risk of relapse should not be treated with antiepileptic drugs (AEDs) on a long-term basis, although such treatment may be justified in the short term while the acute condition was not compensated; in the treatment of acute symptomatic attacks, it is advisable to use injectable forms for intravenous administration AEDs, such as Convulex, Vimpat, Keppra). Although this risk may vary significantly between cases, it is highest in patients with abnormal EEG changes and documented brain injury. Such situations also include a single epileptic seizure at least one month after the stroke, or a single seizure in a child with a structural pathology, or a remote symptomatic seizure in the presence of epileptiform changes on the electroencephalogram (EEG). Another example is a specific epileptic syndrome with a persistent decrease in the seizure threshold, identified after a single seizure. In general, the risk of recurrence is highest during the first 12 months and decreases to almost 0 by 2 years after the seizure. Studies meeting levels of evidence A, C have shown that treatment of the first unprovoked seizure reduces the risk of recurrence in the next 2 years, but does not affect long-term outcomes in both children and adults.

Since acute symptomatic seizures partly reflect the severity of central nervous system damage, it is clear that their occurrence is associated with a poor prognosis of treatment. However, the direct impact of acute symptomatic seizures on prognosis has not yet been proven.

To assess the risk of relapse, carry out differential diagnosis and decide on treatment, it is necessary to consult a neurologist specializing in epilepsy. That is why all patients with a first-time seizure should be consulted in specialized centers or offices (by an epileptologist) within 1 to 2 weeks after the seizure.

Diagnosing epilepsy after a single unprovoked seizure, even with a high risk of relapse, does not always lead to treatment. Suggested practical definition epilepsy (see above) supports initiation of treatment in a patient at high risk of relapse after a single unprovoked seizure. However, the decision to initiate treatment should be made individually, taking into account the patient's wishes, risk-benefit ratio, and available treatment options. The physician must weigh the possibility of preventing attacks against the risk side effects drugs and patient costs for treatment.

It should be clarified once again that the diagnosis of epilepsy and the decision to treat are two related but different aspects of the problem. Many epileptologists treat for some time after an acute symptomatic attack (eg, herpetic encephalitis) that is not related to epilepsy. On the contrary, in patients with mild attacks, long intervals between seizures or if treatment is refused, therapy may not be carried out even with an undoubted diagnosis of epilepsy.

read also the article “ First epileptic seizure: to treat or not?» based on materials from the educational course of the European Academy of Neurology, April 27-29, Odessa (medical newspaper “Health of Ukraine” No. 2 (41), June 2017 ) [read ]

Literature:

article “Organization of medical care for patients with a first-time convulsive seizure” Naumova G.I., Center for Paroxysmal States, Vitebsk Regional Diagnostic Center, Republic of Belarus (magazine “Neurology, neuropsychiatry, psychosomatics” No. 2, 2009) [read];

official report of the International League Against Epilepsy "A Practical Clinical Definition of Epilepsy" R.S. Fisher, C. Acevedo, A. Arzimanoglou et al. (magazine “NeuroNEWS: psychoneurology and neuropsychiatry”, collection of clinical recommendations for 2015) [read];

article “Acute symptomatic seizures” Vaichene-Magistris N., Department of Neurology, Lithuanian University of Medical Sciences, Kaunas (journal “Epilepsy and Paroxysmal Conditions” No. 4, 2011) [read];

article “Acute symptomatic attacks: current state problems" B.P. Gladov, P.N. Vlasov, Department of Nervous Diseases, State Budgetary Educational Institution of Higher Professional Education, Moscow State Medical University named after. A.I. Evdokimov (materials of the scientific-practical conference “Current problems of practical neurology and evidence-based medicine» Kursk, 2013, pp. 23 - 29) [read];

article “Acutely occurring symptomatic epileptic seizures and status epilepticus” by L.V. Lipatova, I.G. Rudakova, N.A. Sivakova, T.V. Kapustina; FSBI "St. Petersburg Research Psychoneurological Institute named after. V.M. Bekhterev", St. Petersburg; GBUZ MO "Moscow Regional Research Clinical Institute named after. M.F. Vladimirsky”, Moscow (Journal of Neurology and Psychiatry, No. 4, 2015) [read];

article “Epilepsy: clinical and pathogenetic features of onset in adulthood” Al-Holaidi Mahfud, Vitebsk State medical University, Department of Psychiatry and Neurology (magazine “Bulletin of VSMU” No. 3, 2003) [read];

article “States with epileptic seizures, not requiring a diagnosis of epilepsy S.R. Boldyreva, Children's Hospital No. 1, St. Petersburg, A.Yu. Ermakov, Ph.D., Moscow Research Institute of Pediatrics and Pediatric Surgery, Moscow (Medical Council magazine No. 1 - 2, 2008) [read];

article “Epileptic syndromes in endocrine diseases” by A.A. Dutov, Yu.L. Lukyanova, G.A. Goltvanitsa; Research Institute of Medical Ecology; Chita State Medical Academy; Regional Children's Consultative Clinic, Chita (Journal of Neurology and Psychiatry, No. 3, 2012) [read];

article (review) “Symptomatic epilepsy of vascular origin (review)” B.N. Bain, K.B. Yakushev; FSBEI HE "Kirov State Medical University"; Treatment and Diagnostic Center MIBS, Kirov (magazine “Medical Almanac” No. 5, 2017) [

Febrile seizures occur in children under 3 years of age when body temperature rises above 38 ° C in the presence of a genetic predisposition (121210, Â).

Frequency

- 2-5% of children. The predominant gender is male.

Code according to the international classification of diseases ICD-10:

• R56. 0 - Cramps with fever

Options

Simple febrile convulsions(85% of cases) - one attack of convulsions (usually generalized) during the day, lasting from several seconds, but not more than 15 minutes. Complex (15%) - several episodes during the day (usually local convulsions), lasting more than 15 minutes.

Febrile seizures: Signs, Symptoms

Clinical picture

Fever. Tonicclonic convulsions. Vomit. General excitement.

Febrile seizures: Diagnosis

Laboratory research

First episode: determination of the level of calcium, glucose, magnesium, other serum electrolytes, urine analysis, blood culture, residual nitrogen, creatinine. In severe cases - toxicological analysis. Lumbar puncture - if meningitis is suspected or the first episode of seizures in a child over 1 year old.

Special studies

EEG and CT scan of the brain 2-4 weeks after the attack (performed for repeated attacks, neurological diseases, afebrile seizures in the family history or in the case of the first manifestation after 3 years).

Differential diagnosis

Febrile delirium. Afebrile convulsions. Meningitis. Head injury. Epilepsy in women combined with mental retardation (*300088, À): febrile convulsions may be the first sign of the disease. Sudden cessation of anticonvulsant medications. Intracranial hemorrhages. Thrombosis of the coronary sinus. Asphyxia. Hypoglycemia. Acute glomerulonephritis.

Febrile seizures: Treatment methods

Treatment

Lead tactics

Physical cooling methods. The patient's position is to lie on his side to ensure adequate oxygenation. Oxygen therapy. If necessary, intubation.

Drug therapy

The drugs of choice are paracetamol 10-15 mg/kg rectally or orally, ibuprofen 10 mg/kg for fever. Alternative drugs. Phenobarbital 10-15 mg/kg IV slowly (respiratory depression and arterial hypotension are possible). Phenytoin 10-15 mg/kg IV (cardiac arrhythmia and arterial hypotension are possible).

Prevention

Paracetamol 10 mg/kg (orally or rectally) or ibuprofen 10 mg/kg orally (at body temperature above 38 ° C - rectally). Diazepam - 5 mg up to 3 years of age, 7.5 mg - from 3 to 6 years, or 0.5 mg/kg (up to 15 mg) rectally every 12 hours up to 4 doses - at body temperature above 38.5 ° C. Phenobarbital 3-5 mg/kg/day - for long-term prophylaxis in children at risk with a burdened medical history, multiple repeated attacks, and neurological diseases.

Course and prognosis

A febrile attack does not cause physical or mental retardation or death. The risk of a second attack is 33%.

ICD-10. R56. 0 Convulsions for fever

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