Hardly is there any condition which upsets the parents of a child more than the convulsions of infants. The suddenness of its appearance, the clonic-tonic movements, the struggle, the fear of immediate death all contribute to their loss of mental equilibrium and utter helplessness. No less is the difficulty of the doctor, who has a double duty to perform to find out the cause of the convulsions of his little patient, who, in most cases, is not as yet gifted with the power of giving out his case and to quieten an equally convulsive parents.
As we meet with cases of convulsions of children very frequently in our practice, we should have a thorough knowledge of the diagnosis, prognosis and and treatment of infantile convulsions, so that we may do full justice to them, and that very quickly too when the occasion demands.
Dr. E. Feer, Director of the University Childrens Clinic, Zurich, say, “General convulsions are extremely common during the first two or three years of childhood. The laity recognises them under the term first or spasms, mothers are in great fear of them. The clonic-tonic twitchings are most noticeable in the face, about the mouth and eyes and in the hands and feet. Usually however the entire body is involved. Clinically all the convulsions resemble each other so closely that no diagnosis as to the etiology can be made from one attack only.”.
Both sexes are affected equally. About a third of the cases takes place during the first year of life, two-thirds during the first two years. Apart from Epilepsy, convulsions are rare after the age of 5 or 6. They are of more serious import in infants under 6 months than in older children and also in anaemic and weakly infants. The more common age for convulsion is from the 7th to the 8th month and upwards. It is at this period that we meet not only severe and general convulsions, but many cases of local convulsive spasms or rigidity, e.g. strabismus, laryngismus, tetany or contracture (rigid inturning of thumbs upon the palms and rigid flexion of the feet).
Convulsions may occur in infants a few days or a few weeks old, they are often associated with unnatural drowsiness and very generally pass off in a few days.
In infants of several weeks, they are liable to come on suddenly, occur one after another in quick succession and associated with Pyrexia. These attacks are mostly due to indigestion from casein of the cows milk and a w et-nurse is the proper remedy. Several such attacks that look alarming, do perfectly well by simple attention to diet and a few simple remedies.
General convulsions of infants and children may be seen in the following condition :-.
(1) Hereditary syphilis. (2) Congenital heart disease. (3) Cerebral paralysis. (4) Onset of acute fevers. (5) Meningitis. (6) Drug poisoning. (7) Enlarged thymus. (8) Idiocy. (9) Rickets. (10) Epilepsy (minor and major).
In Hereditary Syphilis, convulsions often prove fatal during the first week of life. For the rest, in about half the patients, rickets is the predisposing cause; in many of the others, some local irritation, such as inflammation of the gums in dentition, of the nose and ears, the presence of irritating food or worms in the intestine, renal or vesical calculus or phimosis, can be found; while convulsions at the onset of acute infectious diseases such as scarlet fever, pneumonia. measles, whooping cough or during their course and in nephritis are not infrequent.
Overdosing with drugs such as strychnine, atropine, santonine, morphia or with alcohol may bring on convulsions. Fright and overstrung emotions are included among the causes of infantile convulsions. How far inheritance, the neurotic or neuropathic taint is responsible for them is uncertain. Convulsions occur in children with enlargement of the thymus gland, the so called Status Lymphaticus and in these not infrequently a fit is a fatal issue. It must be remembered that in any child there may be early evidence of Epilepsy or of organic brain disease. Their diagnosis demands a very careful examination of the child, and also of its diet and the hygiene of its daily life.