Tonic-clonic convulsions are mixed paroxysms in which prolonged tonic spasms are replaced by rapid clonic contractions of the skeletal muscles. The causes of generalized seizures are quite extensive: epilepsy, organic pathology of the central nervous system, neuroinfections and other conditions. To verify the diagnosis, a comprehensive examination is required, including laboratory tests, tomography, and neurophysiological techniques. For the relief and therapy of convulsive syndrome, medications are used, in some cases, surgical treatment is indicated.
Epilepsy is the most common cause of generalized tonic-clonic seizures. The basis of classic mixed seizures is pathological activity, covering both hemispheres of the brain. Many impulses originate in the cortex of the frontal lobes as focal, but soon acquire a bilateral character. They first lead to symmetrical muscle tension, then they are converted into clonic contractions.
Separate paroxysms may begin with myoclonic jerks, but then acquire a typical three-phase course. The attack is accompanied by biting the tongue, involuntary urination. The greatest danger to patients is a sudden fall with loss of consciousness, which entails injuries with a potential threat to life. After the paroxysm, confusion, drowsiness, and transient amnesia are noted.
Among the causes of convulsive syndrome, an important place is given to structural damage to the substance of the brain. Pathological impulses are generated in response to mechanical stimulation of motor neurons, supplemented by ischemic and metabolic shifts. Clonic and tonic convulsions are accompanied by the following conditions:
Tonic-clonic paroxysms are caused by cerebral (intracranial hypertension, edema) or focal disorders. As the pathology progresses, signs of irritation are replaced by loss of functions. In acute situations, a neurological deficit rapidly increases, damage to vital centers is associated with high mortality.
Seizures are a frequent manifestation of neuroinfections. They are based on the direct cytopathogenic effect of a microbial agent or damage involving vascular, autoimmune mechanisms. Spasms can occur against the background of fever, cerebrospinal fluid hypertension and cerebral edema, provoking ischemic changes. The most typical reasons are:
Acute infections in children manifest convulsive syndrome 2 times more often than in adults. Paroxysms are single or repeated, may indicate the development of a number of complications - subdural effusion or hematoma, heart attacks and intracerebral hemorrhages, abscesses. In the remote period after the disease, the risk of epileptic seizures is high.
Convulsions in acute hypertensive encephalopathy are associated with cerebral edema, generalized spasm of arterioles. They occur in patients suffering from malignant arterial hypertension and acute kidney disease - diffuse glomerulonephritis, late toxicosis of pregnancy (severe nephropathy). In the latter case, the clinical picture is supplemented by edema, urinary syndrome with proteinuria.
The convulsive form of a hypertensive crisis and eclampsia during pregnancy debut with a severe headache, arousal. Characterized by visual disturbances, tinnitus, vomiting. Consciousness is quickly disturbed, tonic and clonic convulsions develop. The seizure begins with fibrillar twitching of the muscles of the face, then spasms of the whole body join with trismus, cyanosis. The attack ends in a coma with a gradual recovery of consciousness.
With hereditary pathology, tonic-clonic convulsions in children debut at an early age. They are often resistant to anticonvulsants and transform into various forms of epilepsy. Convulsions occur in diseases of accumulation and metabolic defects, which are characterized by a violation of metabolic processes in the structures of the central nervous system:
Brain damage in case of poisoning is usually due to the direct action of poisons on nerve structures with neurotransmitter, metabolic, and electrolyte disorders. Another mechanism is explained by endotoxicosis due to impaired function of internal organs (liver, kidneys). Convulsive syndrome is a clinical picture of a wide range of intoxications:
Mixed attacks manifest an overdose of drugs from the group of alkaloids - atropine, lobelin, theophylline. Convulsions are observed with the irrational use of psychotropic (antidepressants, neuroleptics, psychostimulants), antimicrobial (β-lactam antibiotics, isoniazid, antiretroviral), painkillers.
Early diagnosis is essential to determine the cause of tonic and clonic seizures. The risk of recurrence of attacks, the nature and extent of therapeutic measures, and the outcome of the disease will depend on the results obtained. The examination begins with an anamnesis and a medical examination, after which the neurologist prescribes additional procedures:
Changes in the vessels are detected by neurosonography, which helps to verify ischemic damage. The displacement of the median structures of the brain can be seen on the Echo-EG, the state of the parenchymal organs (kidneys, liver) is examined by ultrasound. Mixed convulsions have to be differentiated from other paroxysmal conditions encountered in neurology and the clinic of internal diseases.
Convulsions of the tonic and clonic type are an acute situation requiring emergency care. With the onset of an attack, the victim should be protected from injury by laying on a flat surface with a pillow under his head, to ensure free access of air. With eclampsia, it is important to minimize the effect of external stimuli. A team of specialists who arrived at the call stops the ongoing attack with anticonvulsants, and conducts oxygen therapy.
A single convulsive episode is not an indication for specific therapy, but requires an active impact on the cause and mechanisms of its occurrence. In severe and life-threatening conditions, the patient is hospitalized in the resuscitation and intensive care unit, where medical correction is carried out. Among its priority areas are:
Children with hereditary fermentopathy are prescribed a special diet that reduces the formation of toxic substances. In case of poisoning, infusion and antidote therapy is carried out, in severe situations - extracorporeal detoxification. Vascular and degenerative diseases are treated with neuroprotectors, vasoactive, metabolic agents.
Neurosurgical intervention helps to eliminate the cause of seizures in brain tumors, hematomas and abscesses - removal of pathological tissues, blood extraction, opening of abscesses. For the treatment of resistant epilepsy, resections (temporal, hemispherectomy), uncoupling operations, and transcranial stimulation are performed. In patients with leukodystrophies, improvement can be achieved with bone marrow transplantation.