View source for Convulsion

{{short description|Medical condition where body muscles contract and relax rapidly and repeatedly}}
{{Redirect|Convulse|Finnish death metal band|Convulse (band)}}
{{Infobox medical condition (new)
| name = Convulsion
| field = [[Neurology]], [[Psychiatry]]
| symptoms = [[Muscle spasm]]s,<ref name="MedlinePlusEncyclopedia003200" /> uncontrollable shaking<ref name="MedlinePlusEncyclopedia003200" />
| complications =
| onset =
| duration =
| types =
| causes =
| risks = [[Epilepsy]]
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}

A '''convulsion''' is a medical condition where the body [[muscles]] contract and relax rapidly and repeatedly, resulting in uncontrolled shaking.<ref name="MedlinePlusEncyclopedia003200">{{MedlinePlusEncyclopedia|003200|Seizures}}</ref> Because [[epileptic seizure]]s typically include convulsions, the term ''convulsion'' is often used as a synonym for ''seizure''.<ref name="MedlinePlusEncyclopedia003200" /> However, not all epileptic seizures result in convulsions, and not all convulsions are caused by epileptic seizures.<ref name="MedlinePlusEncyclopedia003200" /><ref name="www.medicalnewstoday.com">{{cite web |date=31 January 2019 |title=Convulsions: Causes, definition, and treatment |url=https://www.medicalnewstoday.com/articles/324330 |website=www.medicalnewstoday.com |language=en}}</ref> Non-epileptic convulsions have no relation with epilepsy, and are caused by [[non-epileptic seizure]]s.<ref name="MedlinePlusEncyclopedia003200" />

Convulsions can be caused by [[epilepsy]], infections (including a severe form of listeriosis which is caused by eating food contaminated by Listeria monocytogenes), brain trauma, or other medical conditions.<ref name=www.medicalnewstoday.com /> They can also occur from an [[electric shock]] or improperly enriched air for scuba diving.<ref name="MedlinePlusEncyclopedia003200" />{{Failed verification|date=January 2023}}

The word ''fit'' is sometimes used to mean a convulsion or epileptic seizure.<ref>[http://www.merriam-webster.com/dictionary/fit%5B3%5D Merriam-Webster: Fit].</ref>

==Signs and symptoms==
A person having a convulsion may experience several different symptoms,<ref name="MedlinePlusEncyclopedia003200" /> such as a brief blackout, confusion, drooling, loss of bowel or bladder control, sudden shaking of the entire body, uncontrollable [[muscle spasm]]s, or temporary cessation of breathing.<ref name="MedlinePlusEncyclopedia003200"/> Symptoms usually last from a few seconds to several minutes, although they can last longer.<ref>{{Cite journal |last=Jenssen |first=Sigmund |last2=Gracely |first2=Edward J. |last3=Sperling |first3=Michael R. |date=2006 |title=How Long Do Most Seizures Last? A Systematic Comparison of Seizures Recorded in the Epilepsy Monitoring Unit |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2006.00622.x |journal=Epilepsia |language=en |volume=47 |issue=9 |pages=1499–1503 |doi=10.1111/j.1528-1167.2006.00622.x |issn=0013-9580|url-access=subscription }}</ref>

Convulsions in children are not necessarily benign, and may lead to brain damage if prolonged.<ref name="pmid4866891" /> In these patients, the frequency of occurrence should not downplay their significance, as a worsening seizure state may reflect the damage caused by successive attacks.<ref name="pmid4866891">{{cite journal |last1=Carter |first1=S |last2=Gold |first2=A |title=Convulsions in children. |journal=The New England Journal of Medicine |date=8 February 1968 |volume=278 |issue=6 |pages=315–7 |doi=10.1056/NEJM196802082780606 |pmid=4866891}}</ref> Symptoms may include:{{Verify source|date=January 2023|reason=Does this source give these symptoms as being specific to children, or generalized? If generalized, perhaps the list should be merged with the previously-listed symptoms.}}
* Lack of awareness
* Loss of consciousness
* Eyes rolling back
* Changes to breathing
* Stiffening of the arms, legs, or whole body
* Jerky movements of the arms, legs, body, or head
* Lack of control over movements
* Inability to respond

==Causes==
Most convulsions are the result of abnormal electrical activity in the [[brain]].<ref name="www.medicalnewstoday.com" />{{NoteTag|However, some seizures are not due to electrical disturbances in the brain, such as [[psychogenic non-epileptic seizures]].<ref name="www.medicalnewstoday.com" /> |group=note}} Often, a specific cause is not clear. Numerous conditions can cause a convulsion.<ref name="What is a convulsion? {{!}} theindependentbd.com">{{cite web |title=What is a convulsion? |url=https://www.theindependentbd.com/magazine/details/105668/What-is-a-convulsion |website=What is a convulsion? {{!}} theindependentbd.com}}</ref>

Convulsions can be caused by specific chemicals in the blood, as well as infections like [[meningitis]] or [[encephalitis]]. Other possibilities include [[celiac disease]],<ref name=""NIDDK-CD2016"">{{cite web |date=June 2016 |title=Definition & Facts for Celiac Disease. What are the complications of celiac disease? |url=https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts |access-date=26 May 2018 |publisher=[[National Institute of Diabetes and Digestive and Kidney Diseases|NIDDK]]}}</ref> [[head trauma]], [[stroke]], or lack of oxygen to the brain. Sometimes the convulsion can be caused by genetic defects or [[brain tumor]]s.<ref name="MedlinePlusEncyclopedia003200" /> Convulsions can also occur when the [[hypoglycemia|blood sugar is too low]] or there is a deficiency of [[vitamin B6]] (pyridoxine). The pathophysiology of convulsion remains ambiguous.<ref name="pmid4866891" />

Convulsions are often caused by epileptic seizures, febrile seizures, non-epileptic seizures, or paroxysmal kinesigenic dyskinesia.<ref name="www.medicalnewstoday.com" /> In rare cases, it may be triggered by reactions to certain medications, such as antidepressants, stimulants, and antihistamines.<ref name="www.medicalnewstoday.com" />

===Epileptic seizures===
[[Epilepsy]] is a neuronal disorder with multifactorial manifestations.<ref name="pmid32577498">{{cite journal |last1=Anwar |first1=H |last2=Khan |first2=QU |last3=Nadeem |first3=N |last4=Pervaiz |first4=I |last5=Ali |first5=M |last6=Cheema |first6=FF |title=Epileptic seizures. |journal=Discoveries (Craiova, Romania) |date=12 June 2020 |volume=8 |issue=2 |pages=e110 |doi=10.15190/d.2020.7 |pmid=32577498|pmc=7305811 }}</ref> It is a noncontagious illness and is usually associated with sudden attacks<ref name="pmid34072232">{{cite journal |last1=Shoeibi |first1=A |last2=Khodatars |first2=M |last3=Ghassemi |first3=N |last4=Jafari |first4=M |last5=Moridian |first5=P |last6=Alizadehsani |first6=R |last7=Panahiazar |first7=M |last8=Khozeimeh |first8=F |last9=Zare |first9=A |last10=Hosseini-Nejad |first10=H |last11=Khosravi |first11=A |last12=Atiya |first12=AF |last13=Aminshahidi |first13=D |last14=Hussain |first14=S |last15=Rouhani |first15=M |date=27 May 2021 |title=Epileptic Seizures Detection Using Deep Learning Techniques: A Review. |journal=International Journal of Environmental Research and Public Health |volume=18 |issue=11 |doi=10.3390/ijerph18115780 |pmc=8199071 |pmid=34072232 |doi-access=free |last16=Nahavandi |first16=S |last17=Acharya |first17=UR}}</ref> of seizures, which are an immediate and initial anomaly in the electrical activity of the brain that disrupts part or all of the body.<ref name="pmid32577498" /> Various areas of the brain can be disturbed by epileptic events.<ref name="pmid32561698">{{cite journal |last1=Moctezuma |first1=LA |last2=Molinas |first2=M |title=Classification of low-density EEG for epileptic seizures by energy and fractal features based on EMD. |journal=Journal of Biomedical Research |date=29 August 2019 |volume=34 |issue=3 |pages=180–190 |doi=10.7555/JBR.33.20190009 |pmid=32561698|pmc=7324275 }}</ref> Epileptic seizures can have contrary clinical features.{{Explain|date=January 2023}}<ref name="pmid32577498" /> Epileptic seizures can have long-lasting effects on [[cerebral blood flow]].<ref name="pmid28665933">{{cite journal |last1=Liu |first1=J |last2=Pourcyrous |first2=M |last3=Fedinec |first3=AL |last4=Leffler |first4=CW |last5=Parfenova |first5=H |title=Preventing harmful effects of epileptic seizures on cerebrovascular functions in newborn pigs: does sex matter? |journal=Pediatric Research |date=November 2017 |volume=82 |issue=5 |pages=881–887 |doi=10.1038/pr.2017.152 |pmid=28665933|pmc=5645245 }}</ref>

Various kinds of epileptic seizures affect 60 million people worldwide.<ref name="pmid34072232" />

===Generalized seizures===
{{main|Tonic-clonic seizures}}

The most common type of seizure is called a generalized seizure, also known as a generalized convulsion. This is characterized by a loss of consciousness which may lead to the person collapsing. The body stiffens for about a minute and then jerks uncontrollably for the next minute. During this, the patient may fall and injure themselves or bite their tongue, may lose control of their bladder, and their eyes may roll back. A familial history of seizures puts a person at a greater risk of developing them.<ref>{{cite web |url=http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms |title=Epilepsy Seizure Types and Symptoms |website=WebMD}}</ref><ref>{{Cite web |url=http://www.mayoclinic.org/diseases-conditions/grand-mal-seizure/basics/causes/con-20021356 |title=Grand mal seizure causes |publisher=Mayo Clinic}}</ref> Generalized seizures have been broadly classified into two categories: motor and non-motor.
<ref name="pmid32577498" />

A generalized tonic-clonic seizure (GTCS), also known as a grand mal seizure, is a whole-body seizure that has a tonic phase followed by clonic muscle retrenchments.<ref name="StatPearls Publishing">{{cite book |last1=Kodankandath |first1=Thomas V. |url=https://www.ncbi.nlm.nih.gov/books/NBK554496/#_NBK554496_pubdet_ |title=StatPearls |last2=Theodore |first2=Danny |last3=Samanta |first3=Debopam |date=2022 |publisher=StatPearls Publishing |chapter=Generalized Tonic-Clonic Seizure |pmid=32119383}}</ref><ref name="medlineplus.gov">{{cite web |title=Generalized tonic-clonic seizure: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/000695.htm |website=medlineplus.gov |language=en}}</ref> GTCSs can happen in people of all ages.<ref name="medlineplus.gov" /> GTCSs are very hazardous, and they increase the risk of injuries and [[sudden unexpected death in epilepsy]] (SUDEP).<ref name="pmid31431400">{{cite journal |last1=Brodovskaya |first1=A |last2=Kapur |first2=J |title=Circuits generating secondarily generalized seizures. |journal=Epilepsy & Behavior |date=December 2019 |volume=101 |issue=Pt B |article-number=106474 |doi=10.1016/j.yebeh.2019.106474 |pmid=31431400|pmc=6944760 }}</ref> SUDEP is a sudden, unexpected, nontraumatic death in patients with epilepsy.<ref name="pmid31431400" /> Strong convulsions that are related to GTCSs can also cause falls and severe injuries.<ref name="pmid31431400" />

Not all generalized seizures produce convulsions. For example, in an [[absence seizure]], also known as a petit mal seizure, the brain experiences electrical disturbances but the body remains motionless and unresponsive.<ref name="www.medicalnewstoday.com" />

===Febrile convulsion===
{{See also|Febrile seizure}}

A common cause of convulsions in children is febrile seizures, a type of seizure associated with a high body temperature. This high temperature is a usual immune response to infection, and in febrile convulsions, the reason for the fever is extra-cranial (such as a body-wide viral infection).<ref name="pmid25952398" /> In Nigeria, [[malaria]]—which can cause sudden, high fevers—is a significant cause of convulsions among children under 5 years of age.<ref name="PublicHealthNigeria">{{cite web|title=Management of Convulsion in Children, a Health concern in Nigeria|url=https://publichealthng.com/management-of-convulsion-in-children-a-health-concern-in-nigeria/|publisher=[[Public Health Nigeria]]|date=October 2018|access-date=18 October 2018|archive-url=https://web.archive.org/web/20181018054917/https://publichealthng.com/management-of-convulsion-in-children-a-health-concern-in-nigeria/|archive-date=18 October 2018}}</ref>

Febrile seizures fall into two categories: simple and complex.<ref name="pmid11918463">{{cite journal |last1=Shinnar |first1=S |last2=Glauser |first2=TA |title=Febrile seizures. |journal=Journal of Child Neurology |date=January 2002 |volume=17 Suppl 1 |pages=S44-52 |doi=10.1177/08830738020170010601 |pmid=11918463|s2cid=11876657 }}</ref> A simple febrile seizure is generalized, occurs singularly, and lasts less than 15 minutes.<ref name="pmid11918463" /> A complex febrile seizure can be focused in an area of the body, occur more than once, and lasts for more than 15 minutes.<ref name="pmid11918463" /> Febrile seizures affect 2–4% of children in the United States and Western Europe. It is the most common childhood seizure.<ref name="pmid11918463" /> The exact reason for febrile convulsion is unidentified, though it might be the outcome of the interchange between environmental and genetic factors.<ref name="pmid25952398">{{cite journal |last1=Paul |first1=SP |last2=Rogers |first2=E |last3=Wilkinson |first3=R |last4=Paul |first4=B |title=Management of febrile convulsion in children. |journal=Emergency Nurse |date=May 2015 |volume=23 |issue=2 |pages=18–25 |doi=10.7748/en.23.2.18.e1431 |pmid=25952398}}</ref>

===Psychogenic non-epileptic seizures===
{{main|Psychogenic non-epileptic seizure}}

Psychogenic non-epileptic seizures (PNES) are described as neurobehavioral conditions<ref name="pmid32582005">{{cite journal |last1=Anzellotti |first1=F |last2=Dono |first2=F |last3=Evangelista |first3=G |last4=Di Pietro |first4=M |last5=Carrarini |first5=C |last6=Russo |first6=M |last7=Ferrante |first7=C |last8=Sensi |first8=SL |last9=Onofrj |first9=M |title=Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge. |journal=Frontiers in Neurology |date=2020 |volume=11 |page=461 |doi=10.3389/fneur.2020.00461 |pmid=32582005|pmc=7280483 |doi-access=free }}</ref> or "psychogenic illnesses" which occur not due to the electrical disturbances in a person's brain but due to mental and emotional stress.<ref name="www.medicalnewstoday.com" /> PNES are an important differential diagnosis and a common occurrence in epilepsy centers.<ref name="pmid28275874">{{cite journal |last1=Asadi-Pooya |first1=AA |title=Psychogenic nonepileptic seizures: a concise review. |journal=Neurological Sciences |date=June 2017 |volume=38 |issue=6 |pages=935–940 |doi=10.1007/s10072-017-2887-8 |pmid=28275874|s2cid=4227746 }}</ref> According to the ''5th Edison of Diagnostic and Statistical Manual of Mental Disorders'' (DSM 5), PNES is classified as a "conversion disorder" or Functional Neurologic Symptom Disorder characterized by alterations in behavior, motor activity, consciousness, and sensation.<ref name="pmid29157502">{{cite journal |last1=Doss |first1=JL |last2=Plioplys |first2=S |title=Pediatric Psychogenic Nonepileptic Seizures: A Concise Review. |journal=Child and Adolescent Psychiatric Clinics of North America |date=January 2018 |volume=27 |issue=1 |pages=53–61 |doi=10.1016/j.chc.2017.08.007 |pmid=29157502}}</ref> A few neuroimaging (functional and structural) studies suggest that PNES may replicate sensorimotor alterations, emotional regulation, cognitive control, and integration of neural circuits.<ref name="x822">{{cite web | last=Huff | first=J. Stephen | last2=Lui | first2=Forshing | last3=Murr | first3=Najib I. | title=Psychogenic Nonepileptic Seizures | publisher=StatPearls Publishing | date=2024-02-25 | pmid=28722901 | url=https://www.ncbi.nlm.nih.gov/books/NBK441871/ | access-date=2024-08-25}}</ref>

===Paroxysmal kinesigenic dyskinesia===
There is a linkage between infantile convulsion and paroxysmal dyskinesia.<ref name="pmid23077017">{{cite journal |last1=Cloarec |first1=R |last2=Bruneau |first2=N |last3=Rudolf |first3=G |last4=Massacrier |first4=A |last5=Salmi |first5=M |last6=Bataillard |first6=M |last7=Boulay |first7=C |last8=Caraballo |first8=R |last9=Fejerman |first9=N |last10=Genton |first10=P |last11=Hirsch |first11=E |last12=Hunter |first12=A |last13=Lesca |first13=G |last14=Motte |first14=J |last15=Roubertie |first15=A |last16=Sanlaville |first16=D |last17=Wong |first17=SW |last18=Fu |first18=YH |last19=Rochette |first19=J |last20=Ptácek |first20=LJ |last21=Szepetowski |first21=P |title=PRRT2 links infantile convulsions and paroxysmal dyskinesia with migraine. |journal=Neurology |date=20 November 2012 |volume=79 |issue=21 |pages=2097–103 |doi=10.1212/WNL.0b013e3182752c46 |pmid=23077017|pmc=3511924 }}</ref> [[Paroxysmal kinesigenic choreoathetosis|Paroxysmal kinesigenic dyskinesia]] (PKD) is characterized by sudden involuntary movement caused by sudden stress or excitement.<ref name="pmid10908896">{{cite journal |last1=Swoboda |first1=KJ |last2=Soong |first2=B |last3=McKenna |first3=C |last4=Brunt |first4=ER |last5=Litt |first5=M |last6=Bale JF |first6=Jr |last7=Ashizawa |first7=T |last8=Bennett |first8=LB |last9=Bowcock |first9=AM |last10=Roach |first10=ES |last11=Gerson |first11=D |last12=Matsuura |first12=T |last13=Heydemann |first13=PT |last14=Nespeca |first14=MP |last15=Jankovic |first15=J |last16=Leppert |first16=M |last17=Ptácek |first17=LJ |title=Paroxysmal kinesigenic dyskinesia and infantile convulsions: clinical and linkage studies. |journal=Neurology |date=25 July 2000 |volume=55 |issue=2 |pages=224–30 |doi=10.1212/wnl.55.2.224 |pmid=10908896|s2cid=5755007 }}</ref> The relationship between convulsion and PKD is mainly due to the common mechanism of pathophysiology.<ref name="pmid23077017" />

== Notes ==
{{NoteFoot}}

==References==
{{reflist}}

{{Medical resources
|  DiseasesDB     =
|  ICD10          = {{ICD10|R|56}}
|  ICD9           = {{ICD9|125.7}}
|  ICDO           =
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|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D012640
}}
{{Cognition, perception, emotional state and behaviour symptoms and signs}}
{{Seizures and epilepsy}}

[[Category:Symptoms and signs: Nervous system]]
[[Category:Medical terminology]]