To begin with, let's divide all seizures into generalized, when the whole body is subject to a convulsive attack, and local, when only one area is affected - for example, the calf muscle.
There are also tonic and clonic seizures. The first ones are more like not a cramp, but a spasm, in which the body seems to be frozen in one position. A classic example of a tonic seizure is opisthotonus in tetanus. Such seizures are rare and are always caused by a serious illness: tetanus, neuroinfection, brain tumors.
The second option is clonic convulsions, in which the body makes frequent chaotic movements, that is, it beats in a typical convulsive seizure, as most of us imagine it.
This option can be encountered much more often in life - these include febrile convulsions when the temperature rises in young children, and epileptic seizures in people of any age. If your leg is cramped or your biceps is constantly twitching, this is unpleasant, but not dangerous.
If we are talking about generalized seizures, a person needs quick medical attention. Although neurologists like to repeat that a seizure is not as terrible as it looks from the outside.
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.
Treatment of seizures at the Yusupov Hospital
At the Yusupov Hospital, patients are seen 24 hours a day, 7 days a week. Doctors will quickly and efficiently diagnose, determine the cause of seizures and prescribe a course of effective treatment. The clinic accepts patients aged 18 years and older.
After a seizure, patients require hospitalization. The wards of the Yusupov Hospital are equipped with modern medical equipment, appliances, and comfortable furniture, which makes the patient’s stay in the hospital comfortable. The professionalism of the doctors at the Yusupov Hospital allows them to “get patients back on their feet” in a short time and avoid complications and repeated convulsive seizures.
Under no circumstances should seizures be ignored; they do not go away on their own, seizures will recur more often, and the disease will begin to progress. Timely medical intervention for seizures is very important to avoid the development of severe pathologies.
You can make an appointment at the Yusupov Hospital by phone.
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).
Differences between clonic and tonic seizures
A specific feature of tonic spasms is the sudden tension of all muscles. The body is held in a tense state for a long time. The cause of tonic seizures lies in the cerebral cortex. Convulsions can overtake the patient in his sleep if he was very active the day before. Spasms usually do not affect the facial muscles, respiratory system and arms.
Clonic seizures vary in frequency. Severe spasms are replaced by temporary relaxation. Irregular spasms occur on the face and hands. The torso is involved in a convulsion if the patient has developed attacks of epilepsy. Tonic and clinical convulsions occur alternately in acute epilepsy.
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.
Localized and generalized tonic seizures
Generalized convulsions : convulsions of the torso, limbs and lungs are added to muscle arrhythmia. The arms twist unnaturally, but the lower limbs remain in a relaxed state. The entire body is under extreme tension. The jaw closes tightly due to the tension on the face, and the head tilts towards the back. A person under such tension is rarely conscious. Generalized tonic convulsions are combined with epileptic seizures. A similar effect can occur due to the penetration of a toxic substance into the body.
Localized seizures are characterized by a paralytic effect on only one part of the body. Contractions do not occur constantly, but in portions, with short intervals. During localized convulsions, the person remains conscious. It is necessary to eliminate the source of irritation and provide rest for the body. No special medical skills are required to eliminate such seizures.
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
Signs
Medical experts call epilepsy the main disease leading to convulsive syndrome. The approach of a tonic attack can be predicted in advance by several signs: hearing and smell become more acute, and an unpleasant taste appears in the mouth. Epileptics fall into unconsciousness and scream or howl loudly. The muscles experience extreme tension: the jaws tighten, breathing becomes difficult, the face turns blue. The duration of the attack does not exceed 3-5 minutes. After the muscles relax, a sleepy state sets in, and the person is unable to remember what happened.
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.
Causes of tonic seizures
Causes of seizures include:
- Disturbed neurology
- Diseases of the cardiovascular system, swelling.
- Infectious diseases
- Poisoning of the body
- Hysterics
- Sprains and microtraumas
- Overheating and lack of water in the body
- Depletion of the body in vitamins and minerals
- Diabetes, kidney disorders, impaired thyroid function.
