Convulsions

Seizures or convulsions are associated with the electrical activity of the brain. They have an impact on major systems of the body and can be fatal if not treated. Seizures are classified predominantly based upon their site of occurrence and the affected organ or system.

Types of Convulsions

General or clonic seizures: In most cases, generalized seizures are also called as tonic-clonic seizures as they involve the entire body. In common parlance, it also referred as epileptic attacks. Patients experience changes in sensations such touch, taste, smell and vision. Hallucinations or auras are also experienced as they begin to influence the emotional balance of a person.

Focal or Partial seizures: These types of seizures are cause because of disturbed electrical activity in the brain which is localized to one part of the brain. It acts on the temporal region of the brain leading loss of memory and balance in extreme conditions.

Petit mal Seizures: These are temporary and their effects are usually limited to 20 seconds. They generate temporary muscle spasms which happen because of electrical imbalances in the brain.

Epilepsy: This type of seizure is closely related to general seizures. The factors associated with the onset of epilepsy may include preexisting conditions such as ischemic heart disease, Alzheimer disease, meningitis and encephalitis.

Fever induced convulsions: These types of seizures predominantly occur in children, infants and toddlers. The initial phase of these convulsions is very intense as they cause much discomfort to the child. They usually subside within a few hours. Most of the fever induced convulsions are caused by viruses and ear infections.

Clinical manifestations

Most convulsions or seizures are characterized by classical muscle spasm symptoms which includes rigorous shaking and frothing with prolonged effects like unconsciousness (blackout). Since the predominant reason associated with convulsions are related to the electrophysiology of the brain, neurological symptoms such as confusion, hallucination, dementia, drooling, lack of bladder control and sudden loss of balance may also be noticed.

Convulsions also have effects on the emotions of a person as many people complain of unprecedented symptoms such as sudden aggression, depression, mood swings, panic, extreme laughter and joy for a temporary period of time. Warning signs often appear before any form of seizure such as dizziness, sensitivity to light, vertigo and nausea.

Seizures can also occur as a result of withdrawal from use of drugs such as barbiturates, valium or benzodiazepines. Drug abuse and alcohol abuse along with preexisting health complications such as end-stage renal disease, renal failure and congenital heart disease can indicate high percentage of seizure onset. Seizures also occur in conditions such as Steven Johnson syndrome, a disease occurring in children. In addition to these clinical manifestations, seizures can occur because of severe brain injury, shock or even during athletic events as result of extreme adrenaline levels in the blood.

Diagnosis and Treatment

Epileptics are diagnosed with a meticulous examination of their history. Various biochemical tests such as sodium levels, SGOT, SGPT and blood glucose levels are analyzed. Electro encephalogram is done to understand the electrophysiology of the brain. In some cases, neurologists recommend MRI and CT scans to understand the presence of any abnormalities or to identify any kind of trauma caused in the brain or the spinal cord.

In most cases seizures are treated with antidepressants as the predominant cause of any form of seizure is depression. Anti epileptic drugs such as sodium channel blockers and GABA transaminase inhibitors are recommended.

CK blood test

A Creatinine Kinase test is a blood test that measures the levels of Creatinine phosphokinase (CPK). It is an enzyme found predominantly in the heart tissue, brain and skeletal muscle. The CK blood test is commonly used to diagnose the existence of heart muscle damage. The CK blood test result shows an increase above normal in a person's blood test about six hours after the start of a heart attack.

It reaches its peak in about 18 hours and returns to normal in 24 to 36 hours. When the total CPK level is substantially elevated, then it is indicative of injury or stress to heart, brain or skeletal areas. The small amount of CPK that is normally in the blood comes from the muscles. The CPK blood test also helps in cost-effective management of people with suspected coronary atherosclerosis. It also evaluates the extent of muscle damage caused by drugs, trauma or immobility.

Abnormal CK-MB (one of three CK isoenzymes) or troponin levels are associated with Myocyte Necrosis and the diagnosis of Myocardial infarction. The Cardiac Markers of Cardiac Myocyte Necrosis (damage to the Cardiac muscle cells), myoglobin, CK, CK-MB and troponin I and T are primarily used to identify acute Myocardial Infarction.

It is used in early detection of dermatomyositis and polymyositis. It is also used to distinguish malignant hyperthermia from a post operative infection. It helps to discover carriers of muscular dystrophy.

The normal range for Creatinine Kinase (CK or CPK) blood test:
Male: 38 - 174 units/L
Female: 96 - 140 units/L

Increased levels of CK also can be found in viral myositis and hypothyroidism. Higher than normal CPK levels is indicative of the following conditions:

• Heart attack
  
• Myocarditis
  
• Convulsions
  
• Delirium Tremens
  
• Electric shock
  
• Muscular dystrophy
  
• Pulmonary infarction
  

CK MB

Serum CKMB levels are tested to check for myocardial injury. It is another important cardiac marker. The primary source of CKMB is myocardium although it is also found in skeletal muscle. Typically CKMB tests have now been replaced by Troponin test. But in cases of abnormal Troponin assay results or suspected re-infarction in the hospital, the CKMB serum test is still used.

High levels of CK MB are noticed in cases of polymyositis and rhabdomyolysis. Patients suffering pulmonary embolism, hypothyroidism, and muscular dystrophy or carbon monoxide poisoning can also show higher levels of serum CKMB. The reference range is about 56.2 pg/mL.

Electrolyte Imbalance

The human body is composed of up to 60 % water. Adequate fluid and electrolyte levels are essential for healthy functioning of all organs and body systems. Electrolytes are found in the blood, urine, tissues and body fluids. Sodium, calcium, potassium, chlorine, phosphate and magnesium play an important role conducting electric charge within the body. These minerals must be maintained in the appropriate ratio for proper functioning of the muscles, nerves, brain and heart. If there is any imbalance in their ratio, which usually occurs due to change in water levels in the body, electrolyte imbalance will occur. The kidneys work as major regulators of the electrolyte balance. Kidney malfunction results in excessive electrolyte retention or excretion resulting in an imbalance.

Symptoms of electrolyte imbalance vary with the electrolyte. Typical symptoms of electrolyte imbalance include fatigue, dizziness, excessive sweating, cold extremities and trembling. Swelling in the feet, ankles, legs, and hands might also be due to a fluid and electrolyte imbalance. There might be nausea, reduced urine output, dark urine, dry skin, aching joints and dry mouth. In cases of severe electrolyte imbalance, there might be convulsions and seizures.

Urine test and blood tests are done to evaluate the electrolyte imbalance. Often kidney ultrasound or EKG might be ordered. Based on the electrolyte that is out of balance, treatment includes dietary changes, fluid intake restrictions and medications to correct the imbalance. Often medication like corticosteroids, laxatives, cough medicines, diuretics and oral contraceptives can cause changes in the electrolyte balance.

Hyponatremia: Imbalance in sodium concentration in the plasma.

Hypokalemiaa: Deficiency of potassium in the bloodstream.

Hypercalcemia: Elevated calcium level in the blood.