Cramps are sudden involuntary contractions that involve individual muscle groups or the entire body. Tonic-clonic paroxysms are accompanied by loss of consciousness, urination, respiratory failure. Causes of seizures include organic pathology of the central nervous system, toxic and metabolic damage to neurons, hyperthermia, and other disorders. Diagnosis is carried out using CT and MRI of the brain, EEG, laboratory tests. In complex treatment, anticonvulsants, pathogenetic and etiotropic therapy, and surgical correction are used.
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 often occur in childhood (up to 15 years) and old age. Convulsions are felt as involuntary spastic contractions of the skeletal muscles - individual muscle groups or the whole body - of varying intensity, short-term or long-term. They arise spontaneously or are provoked by acute pathology, the action of external factors.
Pronounced convulsive twitching of the muscles of the limbs and torso disrupts the musculoskeletal function, entailing falls and injuries. Spasmodic 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 impaired consciousness and breathing, urinary incontinence, some are preceded by focal neurological symptoms. Single episodes have a favorable prognosis, but frequent convulsions disrupt habitual activity and reduce the patient's quality of life.
According to the mechanism of formation, convulsions are classified as fast hyperkinesias, in the structure of which the phase component predominates. They are divided into epileptic and non-epileptic, primary (idiopathic) and symptomatic (secondary). According to the nature of the predominant involvement of skeletal muscles, there are several types of convulsive contractions:
Tonic spasms underlie athetosis, a type of clonic spasms are myoclonus - sudden and sharp (lasting up to a second) contractions of the flexor muscles. Based on the group of affected muscles, cramps are flexor (flexor), extensor (extensor), mixed. An important criterion that has found a place in the clinical classification is the prevalence of seizures, which makes it possible to distinguish two types of paroxysms:
Separate conditions combine signs of focal and generalized paroxysms or have an unspecified character. In pediatric practice, afebrile and febrile convulsions, neonatal, infantile paroxysms are distinguished. The international classification for some convulsive seizures takes into account the prognosis (benign, severe).
Prolonged muscle tension occurs against the background of excessive excitability of cerebral structures, in conditions of violation of the cortical regulation of segmental functions. Very often, neurons are negatively affected by toxic, metabolic factors, endocrine and metabolic disorders. The causes of tonic seizures are the following conditions:
Sometimes painful spasms are professional in nature, occurring with prolonged muscle tension in stenographers, musicians, milkmaids. Leg cramps are typical for athletes and people whose work is associated with prolonged standing. They are often observed during pregnancy, with vascular pathology of the lower extremities - varicose veins, obliterating atherosclerosis, endarteritis.
Pathological impulses that provoke short-term spasms of skeletal muscles are formed in the higher cortical centers, the extrapyramidal system, or peripheral motor neurons. Some clonic seizures develop due to focal lesions of the stem region or spinal cord with tumors, strokes. Other causes of such cramps are:
Often in the clinical picture there is a change of tonic convulsive contractions to clonic ones. Generalized mixed seizures are a typical symptom of epilepsy and its severe complication, epistatus. The occurrence of paroxysmal electrical activity of brain neurons is due to a wide range of damaging factors:
The initial examination of the patient involves the analysis of anamnestic information (the time of onset of the disease, the presence of predisposing factors), the identification of objective signs. But taking into account the polymorphism of the causes of seizures, it is not possible to establish the correct diagnosis only by clinical data. Therefore, the patient is recommended to undergo a comprehensive examination:
To exclude probable cardiac pathology, an ECG is done, with toxicosis of pregnancy, a general urinalysis is prescribed, structural pathology of the kidneys and liver is detected by the results of ultrasound. Diagnosis of convulsive syndrome is carried out by a neurologist, but based on the alleged etiological factors, specialists of a related profile 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
Regardless of the cause, seizures are an acute condition that requires qualified medical attention. Local painful spasms can be eliminated by self-massage, pinching, muscle stretching. With the development of a generalized attack, it is important to provide first aid to the victim: put a roller or pillow under the head, turning it on its side, clean the oral cavity from foam and mucus, and provide fresh air. The ambulance crew stops the paroxysm with anticonvulsants, and with high fever in children, antipyretics are administered.
Hospitalization is necessary for everyone who has developed a seizure for the first time, with severe and prolonged paroxysms, the presence of an aggravating pathology. After verification of the diagnosis, along with symptomatic correction, the treatment of seizures involves the elimination of causes, the impact on the main pathogenetic moments of their development. Based on the clinical situation, for the relief of seizures and the treatment of the underlying disease, the following groups of medicines can be used:
In case of poisoning, antidote, detoxification, infusion therapy is carried out, withdrawal forms of epistatus are treated with a combination of anticonvulsants and neuroleptics. Detection of neuroinfections requires an appropriate antimicrobial (antibacterial, antiviral) correction, hypoglycemia is stopped by the administration of glucose, pyridoxine-dependent convulsions - by vitamin B6. In some cases, a high-fat ketogenic diet is recommended to relieve seizure symptoms.
Pharmacoresistant variants of epilepsy are an indication for more radical treatment. Among neurosurgical interventions, resections (temporal and extratemporal, hemispherectomy), dissociation operations (subpial transection, callosotomy), and transcranial stimulating methods are practiced. As a result, it is possible to achieve a complete cessation of seizures within a year or a significant reduction in their frequency with the achievement of adequate control.
Some symptomatic seizures are also treated surgically. In craniocerebral injuries and strokes, early intervention is necessary to evacuate the intracranial hematoma and decompress cerebral structures. Abscesses and brain tumors are also subject to removal. Operations of intravascular recanalization - intra-arterial thrombolysis, thrombectomy, angioplasty with stenting - are designed to restore blood flow in ischemic areas of the brain tissue.