general characteristics
Various convulsive syndromes rank third in terms of overall incidence in the population after cardiovascular pathology and diabetes mellitus.
They account for 20% of all neurological disorders. Pathological symptoms more often occur in children (up to 15 years) and old age. Cramps are felt as involuntary spastic contractions of skeletal muscles - individual muscle groups or the entire body - of varying intensity, short-term or long-term. They arise spontaneously or are provoked by acute pathology or the action of external factors. Severe convulsive twitching of the muscles of the limbs and torso disrupts musculoskeletal function, leading to falls and injuries. Spastic tension is painful, often accompanied by arching or turning of the body, deviation of the head and eyes to one side. Tonic-clonic seizures are manifested by disturbances of consciousness and breathing, urinary incontinence, some are preceded by focal neurological symptoms. Single episodes have a favorable prognosis, but frequent seizures disrupt habitual activity and reduce the patient’s quality of life.
Classification
According to the mechanism of formation, convulsions are classified as rapid hyperkinesis, in the structure of which the phasic component predominates. They are divided into epileptic and non-epileptic, primary (idiopathic) and symptomatic (secondary). Depending on the nature of the predominant involvement of skeletal muscles, there are several types of convulsive contractions:
- Tonic
. Sharp and prolonged (up to several tens of seconds) muscle tension caused by the arrival of a nerve impulse of long duration. Leads to “freezing” of the limbs or body in a forced position. - Clonic
. Muscle spasms are short-term and irregular in nature, with rapid alternation of periods of contraction and relaxation. They have a locomotor effect, accompanied by motor acts. - Mixed
. Convulsive attacks characterized by a change from a tonic component to a clonic one or vice versa are called mixed. In most cases they are generalized (widespread) in nature.
Tonic spasms underlie athetosis; a type of clonic spasms is myoclonus - sudden and sharp (lasting up to a second) contractions of the flexor muscles. Based on the group of muscles affected, cramps can be flexor (flexor), extensor (extensor), or mixed. An important criterion that has found a place in the clinical classification is the prevalence of seizures, which allows us to distinguish two types of paroxysms:
- Partial (focal)
. They arise due to local activity involving a group of motor neurons. Accompanied by clonic or tonic contractions. They can be simple (without loss of consciousness), complex, secondary generalized. - Generalized
. Excitation immediately covers the entire cortex without the presence of an isolated focus, so the muscles of the entire body are involved in a seizure. Paroxysms are clonic, tonic, tonic-clonic. Myoclonic and atonic seizures are also distinguished.
Some conditions combine signs of focal and generalized paroxysms or are of an unspecified nature. In pediatric practice, afebrile and febrile convulsions, neonatal and infantile paroxysms are distinguished. The international classification for some seizures takes into account the prognosis (benign, severe).
Treatment of seizures
For any seizure, regardless of its severity, you must call an ambulance.
Only an experienced doctor can distinguish a hysterical attack from a true convulsive one. In all other cases, it should be considered as possible epileptic and the patient’s condition should be taken with complete seriousness and responsibility.
First of all, the patient should be protected from injury and damage during a seizure. To do this, place a soft pillow or folded clothing under your head. You also need to place something soft under your feet and hands.
In no case should foreign objects be placed between the patient’s teeth - spoons, forks, etc., since at the time of convulsions they can provoke respiratory arrest or lead to the entry of a foreign body into the respiratory tract (a broken tooth crown, etc.).
If a child has a seizure, then before the ambulance arrives, it is necessary to apply a cold compress to his forehead and in the area of the right hypochondrium. It is also allowed to give the child an antipyretic drug.
Why do seizures occur?
Causes of tonic seizures
Prolonged muscle tension occurs against the background of excessive excitability of cerebral structures, in conditions of disruption of the cortical regulation of segmental functions. Very often, neurons are negatively affected by toxic, metabolic factors, and endocrine and metabolic disorders. The causes of tonic seizures are the following conditions:
- Infections
: tetanus, rabies, febrile syndrome. - Electrolyte disturbances
: hypocalcemia, hyperkalemia, hypomagnesemia. - Endocrine disorders
: hyper- and hypoglycemia, hyperinsulinism. - Hereditary metabolic diseases
: amino acid (leucinosis, phenylketonuria), carbohydrate (glycogenosis, galactosemia), lipid (Gaucher disease, Norman-Wood disease). - Cardiovascular pathology
: complete atrioventricular block, acute hypotension. - Renal and liver failure
: uremia, bilirubin encephalopathy. - Psychogenic disorders
: hyperventilation syndrome, hysteria. - Epileptic syndromes of childhood
: Lennox-Gastaut encephalopathy, Otahara encephalopathy, infantile spasms. - Intoxication
: alcohol, carbon monoxide poisoning, strychnine. - Overdose of drugs
: morphine, antipsychotics. - The effect of physical factors
: severe overheating or hypothermia, electrical injuries, the influence of radiation.
Sometimes painful spasms are of a professional nature, occurring during prolonged muscle tension in stenographers, musicians, and milkmaids. Leg cramps are common among athletes and people whose work involves standing for long periods of time. They are often observed during pregnancy, with vascular pathology of the lower extremities - varicose veins, obliterating atherosclerosis, endarteritis.
Causes of clonic seizures
Pathological impulses that provoke short-term spasms of skeletal muscles are formed in higher cortical centers, the extrapyramidal system or peripheral motor neurons. Some clonic seizures develop due to focal damage to the brain stem or spinal cord due to tumors and strokes. Other causes of such seizures include:
- Focal epileptic seizures
. - Children's infections
: measles, chickenpox, influenza, parainfluenza. - Severe myoclonic epilepsy of infancy (Dravet syndrome)
. - Diffuse damage to gray matter
: Creutzfeldt-Jakob disease, subacute sclerosing panencephalitis. - Neurodegenerative conditions
: Tay-Sachs, Alpers diseases. - Non-progressive encephalopathies
: with Down syndrome, tuberous sclerosis. - Neonatal paroxysms
: “fifth day seizures”, benign familial epilepsy. - Poisoning
: drugs (piperazine, ergotamine), chemicals (formaldehyde, arsenic).
Causes of tonic-clonic seizures
Often in the clinical picture there is a change from tonic convulsive contractions to clonic ones. Generalized mixed seizures are a typical sign of epilepsy and its severe complication - epistatus. The occurrence of paroxysmal electrical activity of brain neurons is caused by a wide range of damaging factors:
- Cerebral pathology
: vascular disorders (CVA, arteriovenous malformations, aneurysms), traumatic brain injuries, tumors. - Infectious diseases
: polio, cholera, neuroinfections (meningitis, encephalitis, abscesses). - Arterial hypertension
: renal eclampsia, convulsive form of hypertensive crisis. - Toxicoses of pregnancy
: eclampsia. - Hereditary pathology
: leukodystrophy. - Intoxication
: nicotinic, narcotic (amphetamine, cocaine), poisoning (organophosphorus compounds, oxalic acid, lead). - Overdose of medications
: caffeine, atropine, amitriptyline, etc.
Local clonic seizures
The reasons for periodic twitching of a particular muscle may be the most unexpected. For example, strong emotional experiences, stress, due to which excitation in our body begins to prevail over inhibition, various neuroses arise.
Or heredity, due to which we inherited easily excitable muscles. If your grandmother or mother often complained of local convulsions, this is from them. An unhealthy diet lacking essential micronutrients (crash diet) can also cause these symptoms. On the one hand, they do not cause serious concern, but they are not easy to get rid of.
What to do? The problem of muscle fasciculations becomes significant for the doctor and the patient when twitching occurs too often and really interferes with life. In this case, you should contact a neurologist. The course of treatment may take some time and include taking vitamins and minerals, medications that affect the nervous system (including sleeping pills and antidepressants), physiotherapy and massage.
Diagnostics
The initial examination of the patient involves the analysis of anamnestic information (time of onset of the disease, the presence of predisposing factors) and identification of objective signs. But taking into account the polymorphism of the causes of seizures, it is not possible to establish the correct diagnosis using clinical data alone. Therefore, the patient is recommended to undergo a comprehensive examination:
- Tomography
. To identify ischemic-hemorrhagic, inflammatory foci, it is preferable to do an MRI of the brain. CT scan of the head clearly visualizes tumors, injuries and abnormalities of the skull bones, and expansion of the ventricular system. Vascular defects - malformations, thrombotic occlusion, aneurysms - are diagnosed using non-invasive CT or MR angiography of the cerebral arteries. - Electroencephalography
. The study of brain biopotentials makes it possible to identify pathological activity in the form of local or generalized discharges (peaks, sharp waves, spike-wave complexes). Violations are assessed when performing provocative tests - photostimulation, hyperventilation. For better documentation of paroxysms, it is recommended to conduct video-EEG recording with myography. - Lab tests
. The causes of some seizures are established on the basis of a blood test with the determination of biochemical parameters (electrolytes, glucose, renal, liver tests), and a toxicological study. Suspicion of an infectious etiology of epileptiform paroxysms requires serological tests (ELISA, RIF), molecular genetic analysis (PCR). Clinical and bacteriological analysis of cerebrospinal fluid is often performed.
To exclude possible cardiac pathology, an ECG is done; in case of toxicosis of pregnancy, a general urinalysis is prescribed; structural pathology of the kidneys and liver is detected by ultrasound results. Diagnosis of convulsive syndrome is carried out by a neurologist, but based on the expected etiological factors, related specialists may be involved. It is necessary to differentiate primary and symptomatic epileptic seizures, to distinguish them from other paroxysmal conditions - syncope, migraine, tremor, etc.
First aid for seizures
Treatment of seizures
Help before diagnosis
Regardless of the cause, seizures are an acute condition that requires qualified medical care. Local painful spasms can be eliminated by self-massage, pinching, or stretching the muscle. When a generalized attack develops, it is important to provide first aid to the victim: place a cushion or pillow under the head, turning it on its side, clear the mouth of foam and mucus, and provide access to fresh air. The ambulance team stops the paroxysm with anticonvulsants; in case of high fever in children, antipyretics are administered.
Conservative therapy
Hospitalization is necessary for everyone who has developed a seizure for the first time, with severe and prolonged paroxysms, or with the presence of aggravating pathology. After verification of the diagnosis, along with symptomatic correction, treatment of seizures involves eliminating the causes and influencing the main pathogenetic moments of their development. Based on the clinical situation, the following groups of medications can be used to relieve attacks and treat the underlying disease:
- Anticonvulsants
. Treatment of partial and generalized epileptic seizures is carried out with lamotrigine, carbamazepine - in monotherapy or in combination with other drugs. Convulsive syndrome in organic pathology of the central nervous system can be treated with valproate, clonazepam; in the neonatal period, the drugs of choice are phenobarbital and diphenine. Refractory epistatus requires the administration of anesthesia (sodium thiopental, propofol). - Electrolytes
. Relief of spasmophilia and hyperkalemia is carried out with calcium preparations. Chloroprivate tetany and hyponatremia are treated with sodium chloride infusions; hypomagnesemia is corrected with magnesium sulfate. To eliminate metabolic alkalosis, saline solution and potassium chloride are used. - Hypotensive
. To correct blood pressure during eclampsia, including renal eclampsia, and hypertensive crises, peripheral vasodilators (sodium nitroprusside), beta blockers (esmolol), and ganglion blockers (pentamine, arfonade) are used. Diuretics - osmotic (mannitol, urea), loop (furosemide) - help eliminate concomitant cerebral edema.
In case of poisoning, antidote, detoxification, and infusion therapy are carried out; withdrawal forms of epistatus are treated with a combination of anticonvulsants and antipsychotics. Detection of neuroinfections requires appropriate antimicrobial (antibacterial, antiviral) correction; hypoglycemia is treated with glucose, pyridoxine-dependent seizures with vitamin B6. In some cases, a high-fat ketogenic diet is recommended to relieve seizure symptoms.
Surgery
Drug-resistant variants of epilepsy are an indication for more radical treatment. Among neurosurgical interventions, resections (temporal and extratemporal, hemispherectomy), disconnection operations (subpial transsections, callosotomy), and transcranial stimulating methods are practiced. As a result, it is possible to achieve a complete cessation of attacks within a year or a significant reduction in their frequency with the achievement of adequate control.
Some symptomatic seizures are also treated surgically. In case of traumatic brain injuries and strokes, early intervention is necessary, aimed at evacuation of intracranial hematoma and decompression of cerebral structures. Abscesses and brain tumors also need to be removed. Intravascular recanalization operations - intraarterial thrombolysis, thrombectomy, angioplasty with stenting - are designed to restore blood flow in ischemic areas of brain tissue.
Local tonic convulsions
Muscle spasm in response to excessive physical activity or prolonged uncomfortable position is a common phenomenon. Professional athletes know this more than others, but even for ordinary fitness enthusiasts, sudden muscle pain causes many unpleasant emotions.
A cramped muscle is tense and hard to the touch, and the spasm is accompanied by severe pain. In addition to the calf muscles, convulsive spasms affect the muscles of the neck, and sometimes the muscles of the thigh and forearm can be affected. Usually, local tonic convulsions go away on their own within 5-10 minutes, but it’s still better not to endure the pain.
There is a simple scheme of actions that will help return the muscle to its normal state.
What to do? The most basic cause of spasm is a lack of microelements (primarily magnesium), excessive stress on an insufficiently warmed muscle, or prolonged stay in an uncomfortable position (this is what causes muscle spasms during sleep).
Therefore, people involved in physical exercise are recommended to take additional vitamin and mineral complexes, eat dried apricots before training, avoid dehydration, and most importantly, devote enough time and effort to warming up to “warm up” the muscles.
If a spasm does occur, there are techniques for local impact on the muscle. For example, if you have a spasm in the calf muscles, you need to stretch your leg forward as much as possible and strongly pull your foot towards you.
