The first year of life. Convulsions in the older infant.

* Hypoxaemia In infants between the ages of 1 month and 1 year convulsions are usually associated with fever. If there is no fever, fits secondary to a structural brain abnormality, hypoglycaemia, and hypocalcaemia should be considered. Fits can be divided into generalised or partial seizures. Generalised seizures include tonic-clonic and myoclonic fits. Partial seizures include focal motor and temporal lobe fits. During some episodes partial seizures may be followed by generalised seizures. Generalised tonic-clonic fits are the most common type. The child may appear irritable or show other unusual behaviour for a few minutes before an attack. Sudden loss of consciousness occurs during the tonic phase, which lasts 20-30 seconds and is accompanied by temporary cessation of respiratory movements and central cyanosis. The clonic phase follows and there are jerky movements of the limbs and face. The movements gradually diminish and the child may sleep for a few minutes before waking confused and irritable. Although a typical tonic-clonic attack is easily recognised, other forms of fits may be difficult to diagnose from the mother's history. Infantile spasms may begin with momentary episodes of loss of tone, which can occur in bouts and be followed by fits in which the head may suddenly drop forward or the whole infant may move momentarily like a frog. Recurrent episodes with similar features, whether they are changes in the level of consciousness or involuntary movements, should raise the possibility of fits. Parents are very frightened by a fit and may fear that their infant is dying.