Infantile Convulsions.


Definition.—Convulsions in children, similar to those of epilepsy, are of frequent occurrence, but differ from the latter in that when the cause is removed, the convulsions cease.

Etiology.—The causes giving rise to convulsions are many, and present a wide range in variety; one of the most common being gastro-intestinal irritability, either as a result of inflammation or overeating, especially unripe fruit or other indigestible substances. Dentition is another fruitful source of infantile eclampsia, especially when occurring in nervous children. Intestinal parasites not infrequently are the exciting cause, the ascaris lumbricoides being peculiarly exciting. An exciting cause, frequently overlooked, is an elongated or adherent foreskin, or the clitoris may be the source of the irritation.

The infectious diseases are often announced by a convulsion, cerebro-spinal fever, measles, scarlet fever, small-pox, and pneumonia particularly. Brain lesions, either organic or functional, are commonly preceded or accompanied by convulsions. Spasms occur in many rickety children. Following scarlet fever, uremic convulsions are occasionally seen.

In peculiarly nervous children, a severe fright is sufficient to bring on an attack. Convulsions occasionally occur in the new-born, especially where the delivery has been instrumental.

Pathology.—Unless due to meningeal hemorrhage, tumors, exudates, or hydrocephalus, there are no anatomical changes.

Symptoms.—Frequently there are premonitory symptoms, such as flushed face, general irritability, gritting of the teeth, twitching of the muscles, and closing the fingers over the thumb; or the attack may come on suddenly without any warning. It frequently begins in the right hand, to be followed by general convulsive action. At first there is rigidity, the eyes stare and are fixed, the body is stiff, or the head drawn backward and the respiration almost suspended, the child assuming a cyanotic appearance. This stage is but momentary, when clonic spasms follow, all the voluntary muscles being involved. There is rolling of the eyes, jerking of the limbs, and more or less contortion of the face. During the convulsion, the tongue is frequently bitten, and a bloody froth collects upon the lips. Sometimes the urine and feces are passed involuntarily. The attack usually lasts but for a moment or two, but to the frightened mother it seems an hour. The subsidence of the attack is followed by a sound sleep, or the child passes into coma.

Diagnosis.—This is very easy; in fact, is generally diagnosed by the mother, and announced to the physician by the frightened messenger who is hastily started for the doctor.

Prognosis.—This depends upon the cause. Unless due to organic changes, or occurring after the child has been sick for some time, as in cholera infantum, the prognosis is favorable. A child in good health, taken with convulsion rarely ever dies from an attack.

Treatment.—To overcome the convulsion, a few inhalations of chloroform is the most reliable agent that can be employed. As soon as the convulsion subsides, we commence the administration of remedies to prevent a return of the spasms. If called shortly after a meal, notwithstanding the protestations of the mother that the child has had nothing to eat, it is a good plan to administer an emetic, for it rarely ever fails to give relief. When. due to an overloaded bowel, a dose of castor-oil and a large enema will be followed by good results. When not due to either of the above causes, a careful search must be made for the exciting cause. Gelsemium, lobelia, and passiflora will be the remedies most frequently used when called to a child in convulsions. Where a convulsion announces the onset of a fever or one of the infectious diseases, there is generally no special treatment needed, for the convulsion is rarely repeated.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.