Titanic spasms. Clonic and tonic convulsions. Mechanism of occurrence and development

Convulsive syndrome is a clinical syndrome characterized by tonic-clonic muscle contractions and a gross disorder of hemo- and liquor dynamics.

Relevance and significance of the syndrome.

Convulsive syndrome is one of the conditions that is very common in the practice of emergency neurology, and can occur due to a variety of reasons. Convulsive syndrome is one of the body’s universal reactions to various harmful influences. Seizures are a symptom not only of epilepsy, but also of many other diseases of internal organs and the central nervous system that arise as a result of vascular changes, inflammatory processes, tumors, injuries, poisoning, chronic intoxication, etc.

The main nosological forms causing convulsive syndrome.

1. Convulsions caused by brain damage:

genetic epilepsy;

symptomatic and Jacksonian epilepsy;

2. Convulsions associated with calcium metabolism disorders:

hypoparathyroidism;

convulsions due to enterogenous calcium malabsorption;

convulsions in kidney diseases.

3. Convulsions associated with exo- and endogenous intoxications:

convulsions due to poisoning, including alcohol, FOS.

convulsions due to toxicosis of pregnancy (eclampsia).

4. Convulsions associated with arterial hypertension:

eclampsia in acute glomerulonephritis;

epileptiform variant of hypertensive crisis (convulsive variant);

5. Convulsions associated with infectious diseases:

tetanus;

rabies;

6. Hysteria.

7. Convulsions, with somatic diseases:

liver disease (hepatic coma);

hypoglycemic coma;

blood diseases;
heart defects and pathology of the great vessels, etc.

The mechanism of development of convulsive syndrome.

For seizures to develop, a combination of factors must be present.

Under the influence of various reasons, the inhibition of nervous processes occurs, a group of neurons begins to produce pathological impulses - an “epileptic focus” is formed.

This focus acts on adjacent cells and forms in them a state of epileptic readiness.

An epileptic stimulus (i.e. some reason, be it hyperthermia, hypoxia, hypoglycemia, intoxication, mechanical damage to the brain, etc.) affects the epileptic focus, disturbs the balance in the structures of the brain and, against the background of convulsive readiness of the brain, a convulsive reaction occurs.

Clinical manifestations of the syndrome.

Cramps are involuntary muscle contractions that occur intermittently or continuously. Convulsive movements can be widespread and involve many muscle groups. These are generalized seizures. Also, cramps can be localized in a certain muscle group of the body or limb. These are localized seizures.

Generalized convulsive contractions can be slow, lasting a relatively long period of time (tonic convulsions) or rapid, frequently alternating states of contraction and relaxation (clonic convulsions). Mixed tonic-clonic seizures are also possible. Generalized tonic spasms involve the muscles of the arms, legs, torso, neck, face, and sometimes the respiratory tract. The arms are more often in a state of flexion (the predominance of the flexor group), the legs are usually extended, the muscles are tense, the torso is extended, the head is thrown back or turned to the side, the teeth are tightly clenched. Consciousness may be lost or retained.

Local seizures can also be tonic or clonic.

Stages of diagnostic search

The first stage of diagnosis is to establish a convulsive syndrome based on the following sign: the presence of tonic-clonic muscle contractions.

The second stage of the diagnostic search is to establish a possible cause of convulsive syndrome based on anamnesis (onset of the disease, heredity, complicated obstetric history, previous neuroinfections, traumatic brain injuries, etc.) and physical examination, which allows us to detect signs of the disease that caused the picture of convulsive syndrome .

At this stage, differential diagnosis is carried out between diseases occurring with convulsive syndrome. First of all, a classic convulsive seizure, characteristic of genetic epilepsy, is excluded (see diagnostic criteria).

The final stage of the diagnostic search is additional research methods: radiography of the skull, rheoencephalography, electroencephalography, computed tomography, cerebrospinal fluid examination, biochemical blood test (hypoglycemia, hypocalcemia, etc.), general blood test, urine test, etc.

Clinical criteria for the main diseases occurring with convulsive syndrome.

Cramps - uncontrolled contraction of muscle tissue due to overexertion; the nature of the seizures is paroxysmal.
Typically, cramps are not constant. Their appearance and disappearance are sudden, but last no more than a minute.

Depending on the cause, seizures can be frequent or infrequent, short or long. Pain is usually not typical, but children and older people can quite clearly feel muscle contractions, which manifest as pain syndromes.

The most common time for seizures to occur is at night. This is due to the fact that during sleep all muscles are in a relaxed state. Also, cramps are not uncommon in healthy people after active muscle activity.

Convulsions are not clearly localized. Muscle contraction can affect one muscle or an entire group. The most common muscle groups are: calves, thighs, abdomen, back and neck.

Convulsive attack

Seizures in other diseases and conditions

Diseases that provoke the development of seizures:

calcium or magnesium deficiency;
insufficient brain maturity (in children);
psychophysiological disorders;
varicose veins;
thyroid diseases;
poisoning by nitrogenous decomposition products;
cirrhosis;
diabetes;
kidney disease;
atherosclerotic vascular damage;
malignant neoplasms;
pathology of the musculoskeletal system.

Provoking conditions:

insufficient blood supply to the muscles (during physical activity);
overwork (insufficient blood supply or stress factors);
pregnancy;
increased sweating, diarrhea and salt loss;
monotonous, frequently repeated movements of the hand (typing text on a computer);
pregnancy;
alcohol intoxication;
insufficient supply of micro and macroelements during fasting and improper diets.

First aid for convulsions and seizures

In case of seizures, you must:

place the patient on a flat but soft surface, if necessary, use outer clothing, pillows, blankets;
free a person from restraining clothing and accessories;
if a person loses consciousness, place him on his side so that the tongue does not roll back and inhale saliva and vomit;
limbs should be carefully held, as excessive force can cause a fracture or dislocation;
It is prohibited to give medications or water to the patient during an attack.

What to do if your legs have cramps:

use self-massage or ask another person to stretch the spasmed muscle;
stretch muscles;
raise the limb for a rush of blood;
use warming ointments and compresses;
take a warm bath.

Help concept

Any treatment should begin with a diagnosis, only after this a diagnosis is made and a plan for further treatment actions is selected.
If seizures are caused by diseases of organs and systems not related to neurology, then treatment will be aimed specifically at this organ.

If the cause is a specific neurological condition, then it is important to implement measures aimed at eliminating or compensating for this condition.

Thus, convulsions in infectious diseases or febrile conditions go away on their own, but only after treatment of the underlying disease and without the development of complications.

General concepts for the treatment of seizures:

Purpose sedatives and, which will help relax muscles and reduce the activity of the nervous system. Examples of such drugs are Andaxin.
Intravenous administration of Droperidol or sodium oxybutyrate with severe convulsions or seizures.
to inhibit the transmission of nerve impulses.
Proper nutrition. It is prescribed by a doctor individually, taking into account the patient’s characteristics and concomitant diseases. It is important to replenish the deficiency of missing substances (lack of calcium, magnesium, salts, macroelements).
Surgery(for tumors and epilepsy with an identified focus of epileptic excitation).

A cramp is an involuntary contraction of muscles accompanied by pain. There are tonic, clonic and tonic-clonic. In each case, it is important to correctly and timely diagnose disorders. For diagnosis, a comprehensive examination of the body is usually prescribed.

Tonic convulsions, similarly to clonic ones, develop when there is a gross disruption of the central nervous system. Reasons given:

Neurological pathologies: epilepsy, acute cerebrovascular accident, pathological volumetric phenomena in the brain, hypertensive crisis, traumatic brain injury, neuroinfections (acute and chronic).
The most dangerous infectious diseases are tetanus, rabies, childhood diseases, especially those accompanied by high body temperature.
Toxic processes developing against the background of acute and chronic renal failure, adrenal insufficiency, hypoglycemic coma.
Violation of water-salt metabolism during heat stroke.
Hysterical fits.

Factors that contribute to the occurrence of seizures:

With tonic convulsions, only a spasm develops. – rhythmic twitching of a muscle group with high frequency. The combination of two types of seizures is a tonic-clonic spasm.

Types of tonic seizures

Tonic convulsions can be local or generalized. With local cramps, individual muscle groups are affected. With generalized convulsions, on the contrary, the entire body is affected. Let us consider the characteristic manifestations of tonic and clonic-tonic seizures. Local and generalized convulsions show different forms - tonic or clonic, and are mixed.

Facial hemispasm. Tonic, less often clonic spasms (convulsions) of the muscles of half the face occur. Often the duration of the phenomenon is no more than three minutes. During the specified time, the patient experiences a number of unpleasant characteristic symptoms: squinting of one eye, tonic tension of half the face. The mouth is pulled to the side. In fact, a frozen mask appears on the face. What is happening is complemented by pain. If the cause of the spasm is not found, they speak of idiopathic hepispasm of the face.
Symptomatic hemispasm occurs as a result of compression of the facial nerve by blood vessels. There are many reasons - vascular malformation, tumor, multiple sclerosis, infections. Such an attack is uncontrollable and can persist while the person is sleeping. Sometimes surgery is indicated for cure. It is possible to use strong anticonvulsants.
Blepharospasm is a tonic or clonic-tonic contraction of the orbicularis oculi muscle. It often becomes a sign of torsion muscular dystonia, brain tumor, stroke, degenerative changes in the nervous system, myotonia and other serious diseases. Sometimes blepharospasm becomes a complication of treatment with antidepressants, drugs including lithium, unsuccessful prosthetics or tooth extraction, facial trauma, or simply overstrain of the facial muscle. A person’s condition improves only after sleep, for several hours. Sometimes blepharospasm becomes a sign of a dangerous eye disease - glaucoma. The pathology reveals severe pain symptoms and threatens a person with complete loss of vision.
Facial paraspasm – bilateral tonic spasm – hyperkinesis. Occurs more often from inflammation of the subcortical nodes.
Torticollis is an involuntary turn of the head, neck, tonic convulsions on one side of the neck. It can occur as a result of congenital anomalies or torsion dystonia.
Writer's cramp is a manifestation of hand cramp. It becomes the result of prolonged tension in the hand during writing or typing on a computer, due to nervous tension. When trying to write or type on the keyboard, muscle tension occurs, often accompanied by pain. A similar contraction of the hand muscles occurs in pianists and milkmaids. Before treating the disease, it is necessary to conduct a differential diagnosis to exclude serious pathologies: chorea, torsion dystonia. Such local seizures require a detailed examination by a doctor.
Myoclonus is a small spasm in individual muscle fibers. It is often clonic, less often – tonic.
Cramps are very painful, although short-term, cramps or twitching in the calf muscles, foot, and toes. Often the condition occurs at night. A person wakes up from a sharp and sudden pain. Cramps appear as a result of diseases of the peripheral nervous system, diseases of internal organs, blood vessels, especially the lower extremities, and diabetes. Predisposing factors for the appearance of cramps are alcohol consumption, smoking, overwork, water and electrolyte imbalance, low blood sugar (hypoglycemia), low potassium and calcium in the blood.
With hysteria, convulsive syndromes are observed - from small tonic feet to a hysterical arc.
Generalized convulsive syndrome occurs with epilepsy and traumatic brain injury. A similar tonic convulsion can initiate a stroke or insulin-dependent diabetes mellitus. The appearance of such a cramp is noted with a brain tumor.

General principles of treatment of tonic seizures

Treatment of tonic type seizures is possible only after a carefully carried out differential diagnosis. Methods used:

Magnetic resonance imaging;
CT scan;
Electroencephalography;
Angiography;
Serological reactions;
Blood chemistry.

If compression of the facial nerve is detected, surgery is often indicated. Its feasibility is discussed individually with each patient.

Anticonvulsants are prescribed for myopathies, neuropathy of the facial nerve, and tumors of the parotid gland. Muscle relaxants help effectively relax the facial muscles and eliminate tonic spasms. Acupuncture and reflexology effectively relieves tonic spasms. Such procedures are prescribed exclusively by a doctor.

Blepharospasm is treated with muscle relaxants and anticonvulsants. These drugs are prescribed by a doctor. For epilepsy, it is necessary to administer anticonvulsants:

Magnesium sulfate (25%) 10 – 25 ml;
Aminazine 2.5% – 2 ml;
Seduxen;
Barbituric acid preparations;
Phenobarbital in a dose of up to 20 mg per kilogram of weight. Treatment lasts until complete recovery.

To reduce intracranial pressure, use:

Diuretics – Lasix or mannitol;
Magnesium sulphate multiple times;
Dexamethasone and other glucocorticosteroid drugs.

Sometimes a spinal tap is prescribed.

Tetanus seizures are always treated in the intensive care unit. The fight against seizures is carried out by introducing sedatives, anticonvulsants, antipsychotic drugs, and muscle relaxants into the body. Diazepam is widely used (sometimes administered intravenously in large doses). Prescribed drugs include barbituric acid, seduxen, curare-like substances, alpha and beta blockers.

Cancellation of antipsychotics and other anticonvulsants is carried out only according to a doctor’s indications. Remember, treatment can be lengthy and last at least a year.

Features of tonic seizures in epilepsy

In epilepsy, seizures are tonic-clonic in nature. Before an epileptic seizure, a so-called aura appears: the patient feels palpitations, dizziness, a feeling of heat, unpleasant odors, and sometimes fear. Immediately after the phenomena, the unfortunate person instantly loses consciousness. The gaze is directed in one direction. Breathing and heart rate slow down. The face is initially pale, later becoming purple or blue.

The tonic phase of the attack lasts no more than a minute. Then the tonic muscle tension is followed by the clonic phase: the muscles of the arms and legs flex and extend, the muscles of the face, neck, and torso twitch. The duration of the attack phase is no more than two minutes.

After the end of the attack, the muscles relax and the tonic spasm stops. The patient does not remember what happened, complains of headache and severe fatigue, muscle pain.

Tonic convulsions in tetanus

Tetanus convulsions are tonic, generalized. The main specific symptoms of seizures in the initial period of the disease:

Trismus is tension in the masticatory muscles. Leads to difficulty in opening the mouth.
A sardonic smile is of the tonic type. Externally it manifests itself in a wrinkling of the forehead, narrowing of the slits of the eyes, stretched lips and drooping corners of the mouth.
Painful swallowing.
Rigidity of the neck muscles.

As the disease progresses, the clinical picture changes. The spasm spreads further to the muscles of the trunk and limbs. Muscle tension does not go away even when a person sleeps. From such convulsions, the contours of the skeletal muscles are clearly visible. Due to spasms of the intercostal muscles and muscles of the diaphragm, breathing, defecation and urination are difficult. When positioned on the back, the patient's head is tilted back. The lumbar part rises.

Against the background of constant tonic spasms, tetanic convulsions occur. At first, their duration is a few seconds, as the disease progresses, they occur more often and become long-lasting. Tetanic seizures occur suddenly:

The face takes on a pained expression and a bluish coloration;
The contours of the muscles are clearly outlined;
Patients scream because of pain, hold on to the headboard to relieve the condition;
The skin becomes covered with sweat;
The temperature rises;
Heart sounds change, shortness of breath appears.

The symptoms are alarming. At the same time, consciousness remains clear. Tetanus has an indescribably severe course and is extremely dangerous for the patient’s life. The risk of death increases due to the threat of asphyxia, heart failure, cardiac paralysis, and intense tetanic convulsions.

Tonic convulsions become a source of difficulties in the body. To get rid of them, long-term treatment is necessary. It is undesirable to self-medicate: it will not bring results and will be harmful. Always consult an experienced physician for the treatment and prevention of seizures.

Cramps are involuntary muscle contractions that can be accompanied by attacks and pain. There are tonic and clonic convulsions, which differ from each other. There are also tonic-clonic seizures, but in any case, in order to accurately determine the cause of their occurrence, it is necessary to undergo a full examination and consultation with a doctor.

Tonic and clonic convulsions can develop in case of disruption of the central nervous system:

diseases of a neurological nature: stroke, epilepsy, hypertensive crisis, acute and chronic neuroinfections, head injury;
infectious diseases: childhood infections accompanied by fever, rabies, tetanus;
toxic processes: uremia, renal failure, adrenal insufficiency, poisoning, hypoglycemic coma, overdose of hypoglycemic drugs;
violation of water-salt metabolism: eclampsia, heat stroke;
hysteria.

Clonic and tonic seizures - general characteristics

Cramps are the body's reaction to various harmful influences; they are characterized by involuntary muscle contraction. Convulsive movements can be widespread, and they can affect several muscle groups - these are generalized spasms that can be localized in any limb or part of the body.

Such generalized spasms are caused by slow muscle contraction for a short period of time. These are tonic spasms. If the convulsions change frequently: sometimes they contract, sometimes they relax, then they are clonic. In simple terms, tonic and clonic spasms differ in that clonic spasms are involuntary muscle twitching - changes in muscle tone, and tonic spasms are spasms - muscle tension.

Tonic convulsions can affect the muscles of the arms, legs, torso, neck, face, and less commonly, the respiratory tract. The arms are bent, the legs are extended, the head is thrown back, the muscles are tense, the teeth are clenched, the torso is extended, and consciousness may be lost or retained.

Clonic seizures are relatively smooth and rhythmic contractions of the muscles, trunk and limbs. They can be local rather than general and take part in the work of the respiratory muscles, which can result in stuttering.

Tonic cramps are unconscious muscle contractions that appear due to severe and sharp pain. There are three types of seizures: clonic, tonic, and tonic-clonic. To accurately determine the type of seizure in a person, timely diagnosis is necessary. Seizures are not always dangerous, but prompt treatment is necessary. An incorrectly functioning body signals that disturbances are occurring within it. In acute forms of the disease, convulsions are considered a factor in blocking the airways and stopping the heart.

Seizures

When the body undergoes a tonic spasm, an increase in the frequency of spasmodic contractions is noticed.

Difference between tonic seizures from other types is that parts of the body change their position, blood pressure increases, the reaction to light stimuli decreases, and breathing quickens. Severe forms of the disease can occur with loss of consciousness.

A characteristic feature of a tonic attack is rigidity of the limbs and torso. This process occurs in a short time, so it does not enter the clonic phase. The duration of convulsions is no more than 3 minutes.

The reason for the appearance of tension in the muscles is the improper functioning of the nervous system. It is influenced by improper development of the fetus during pregnancy and the formation of the body in early childhood, genetics and heredity.

Convulsions can occur with a large loss of fluid from the body, an increase in temperature, a lack of oxygen supplied to the brain, or caffeine poisoning.

Most often, newborn children experience seizures due to the fact that their nervous system is poorly developed. The brain of a newborn baby easily becomes excited. Convulsions in children indicate impaired function of the nervous and endocrine systems. When there is a deficiency of microelements, in particular calcium, the muscles become excited. Newborns experiencing seizures stretch and arch their arms and legs unnaturally.

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.

Localized and generalized tonic seizures

Generalized seizures: 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 differ in their 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.

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.

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.

Symptoms of seizures

Common signs of all types of convulsions are hardening of the muscles of various parts of the body, muscle pain, and unnatural, distorted facial expressions.

Treatment of tonic seizures

The first aid that can be provided to a person paralyzed by a spasm is to perform massaging movements on the stiff part of the body.

The choice of medications is dictated by the cause of the seizures.

It is better to exclude treatment with traditional medicine immediately - it is necessary to take high-quality medications.

To eliminate tonic convulsions, it is necessary to take tranquilizers that have a sedative and vegetotropic effect.

In cases where the cause of seizures is hysteria, sedatives should be used as treatment. Local convulsions in a specific area of the body must be eliminated with blockade agents, such as novocaine.

For epileptic seizures, drugs that inhibit reactions are used. Common tablets that can be found in pharmacies: Asparkam, Panangin.

It is important to remember that any disease is easier to prevent than to cure! Therefore, do not forget to visit our clinic!