Patient's question:
At eleven days old, the newborn was shaking their hands while sleeping, and their whole body trembled as if they were very cold (temperature was 37.1°C, no fever, room temperature was around 24-25°C). What could be the reason? Is it a lack of nutrients?Doctor's answer:
Seizures are the most concerning diseases for parents during childhood, partly because the symptoms can be terrifying, and partly because if not treated promptly and appropriately, they can lead to adverse consequences, even death. There are many factors or causes of seizures, and the forms of recurrence are often different. Some seizures are only temporary, with quick recurrence and equally quick disappearance, and there are no long-term adverse effects or repeated occurrences. Such seizures do not require excessive concern from parents. However, other seizures may last longer and occur repeatedly. If not treated early, they can cause significant harm to a child's physical and mental health.This article briefly introduces several diseases that commonly cause seizures in children, providing a reference for parents who may encounter similar conditions. The factors or causes of seizures vary with age. Generally, in the neonatal period after birth, the most common causes are birth injuries and congenital brain malformations. Other common factors include inflammatory brain diseases (such as encephalitis, meningitis, etc.), drug effects, and electrolyte imbalances.
After 6 months until 2 years of age, febrile seizures are the most common, followed by inflammatory brain diseases, with other diseases being less frequent. Between 2 and 6 years of age, inflammatory brain diseases are most common, followed by epilepsy. After 6 years of age, epilepsy is the most common cause. Therefore, based on age differences, we can first consider the most likely disease and make a rapid diagnosis.
Guidelines: Below, we will distinguish the most common diseases at each age based on medical history and symptoms:
1. Birth Injuries: Seizures caused by birth injuries are usually traceable to a history of difficult labor during birth or trauma or cyanosis (bluish discoloration due to lack of oxygen) during delivery. The duration and form of seizure recurrence vary depending on the location, severity, and extent of the injury. Some may lead to epilepsy or affect intelligence, requiring long-term medication for control.
2. Febrile Seizures: These are related to fever, most commonly occurring at the peak of the fever. However, they may also occur during rapid temperature rises or drops. This condition is relatively common in children aged 6 to 18 months and can be triggered by high fevers from conditions like roseola or colds. About 8% of all children experience febrile seizures. The duration of seizures is short, most stopping completely within 15 minutes after recurrence. Repeated episodes are rare, occurring only two or three times at most. Sometimes, there is a family history, with parents having had similar symptoms in childhood. Of course, these seizures do not occur without fever. The prognosis is generally good, with rare long-term effects. However, when a child has a fever and seizures, it is essential to consider the possibility of encephalitis or meningitis. This is particularly important, as patients with encephalitis or meningitis often exhibit neck stiffness. A lumbar puncture can easily diagnose these conditions and provide appropriate treatment.
3. Epilepsy: If a child experiences recurrent seizures without fever or other obvious causes, epilepsy should be the first consideration. Epilepsy has many types, the most important of which can be divided into grand mal seizures, petit mal seizures, and psychomotor seizures, with different forms and locations of recurrence. Grand mal seizures can last over 15 minutes, while petit mal seizures may last only a few seconds. Typical patients have a history of recurrent seizures, and family members often have similar cases. An electroencephalogram (EEG) can confirm the diagnosis. After diagnosis, long-term antiepileptic medication is needed to prevent future recurrences. Sometimes, epilepsy can also cause seizures during fever, making it difficult to distinguish from febrile seizures. In such cases, an EEG can be performed 10 days after the seizure. If it is febrile seizures, the EEG should return to normal within 10 days. If febrile seizures occur only once, long-term medication is not necessary. If they recur, treatment may be needed for several months to several years to prevent future episodes.
4. Brain Tumors: If a brain tumor occurs, the most common symptom is local functional impairment, such as poor vision or hearing in one eye or ear, or partial limb movement issues. Sometimes, local or generalized seizures may also occur. However, these patients often have concurrent symptoms like headaches and vomiting, which worsen over time. In such cases, seizures should not be treated alone, and further examination is necessary.
There are many other factors or causes of seizures, such as lead poisoning from toys, brain vascular malformations, hypertension caused by kidney disease, or cerebral embolism caused by heart disease. The most important principle is that parents should not panic when their child has a seizure. First, ensure the patient's airway is clear. Use a soft but firm object, such as a spoon wrapped in cloth, to gently pry the child's teeth open, removing all saliva, and then immediately take them to the hospital for treatment. The biggest harm from prolonged seizures is due to impaired breathing and oxygen deprivation, which can cause brain cell damage or even death.