Tonic and clonic convulsions. What are cramps: causes of convulsive contractions and treatment Tonic-clonic cramps in the abdomen

The difference lies in the duration of the contraction: with tonic contractions, the spasmed muscle remains in this state for some time, while clonic ones look like twitching of an individual muscle, limb, or like convulsions of the whole body. With the second type of seizures, movements are a consequence of alternate relaxation and contraction of muscle fibers. The combined clonic-tonic variant is often observed during epileptic seizures, when different types of spasms are combined or successively replace each other.

general characteristics

Clonic or tonic convulsions are a consequence of involuntary pathological contractions of muscle fibers. The reasons can be different, in most cases we are talking about neurological diseases. Regardless of the etiology, an attack always develops according to the same pattern:

• Due to a violation of neurohumoral regulation or other reasons, excitation processes in the activity of the central nervous system begin to prevail over inhibition.
• In a certain area of ​​the brain, a focus is formed that captures a group of neurons and puts them in a state of so-called epileptic readiness.
• Some factor (brain injury, illness, hyperthermia) acts as a “trigger” and seizures occur.

Disruption of the skeletal muscles by tonic spasms is accompanied by their rigidity, limitation or complete inability to move. For example, spasm of the muscles of the trunk and neck during an epileptic attack leads to arching of the body. Clonic contractions, depending on the location, look like trembling (of the eyelids, masticatory muscles), chaotic movements of the limbs, and convulsions. Spasm of the speech muscles is expressed in stuttering. If smooth muscles are affected, dysfunction of internal organs is observed.

Regardless of the type of spasm, it is accompanied by pain sensations of varying intensity. Pain in this case is a consequence of pinching of nerve fibers by muscle fibers. The blood supply to the affected area is also disrupted, so after a seizure, paresthesia - numbness or tingling - may be observed for some time. Painful sensations also persist.

Causes

Clonic and tonic seizures, as well as their combined variant, most often occur with neurological disorders. Up to 80% of diseases of the nervous system are accompanied by muscle spasms; somatic, infectious, and endocrine diseases account for no more than 20%. Main reasons:

• organic brain damage, tumors, epilepsy;
• disturbance of calcium metabolism associated with dysfunction of the kidneys, thyroid gland or insufficient absorption of the microelement;
• intoxication due to poisoning, late gestosis (eclampsia);
• arterial hypertension with convulsive crises or renal pathologies;
• some somatic diseases - heart or liver failure, blood diseases, uremia and others;
• infections (tetanus, cholera);
• hysteria;
• magnesium deficiency, water-electrolyte imbalance;
• increased physical activity.

Modern diagnostic methods, including instrumental and laboratory ones, make it possible to accurately determine the cause of the seizure syndrome in order to prescribe appropriate treatment.

Varieties

Tonic and clonic spasms can involve one or more muscle groups. Localized muscle spasm always has its own name: trismus - pathological contraction of the masticatory muscles, blepharospasm - the circular muscles of the eye. Changes in the tone of smooth muscle fibers responsible for the functioning of internal organs are called similarly: cardiospasm, pylorospasm, and others.

Tonic

This type of spasm occurs suddenly, gradually increases, and then goes away on its own within a few minutes. A tense muscle has a characteristic convex appearance and is hard to the touch. Tonic convulsions are always accompanied by intense pain, since at this time nerve fibers are pinched. Any group of muscles or some of them individually can be affected. and the main reasons are micronutrient deficiency, hypothermia, and excessive physical activity. These localized attacks usually occur at night.

Pathological prolonged contractions of individual muscles can also be observed in the body and head. If several groups are covered, we are talking about generalized seizures. For example, during epileptic seizures, the back arches, the arms tense, and the jaw clenches. Spasms of smooth muscle fibers of a tonic nature pose a great danger: attacks of bronchial asthma or angina pectoris can lead to respiratory arrest and heart attack.

First aid for localized contraction is self-massage and taking a relaxing position. For example, a cramp in the calf muscle can be relieved by pulling your toes toward you, and a spasm in your hands can be relieved by clenching your fist or shaking it. You can simply hit or prick the spasmed muscle with a needle. A generalized seizure requires the patient to be restrained in the lateral position until symptoms resolve. Frequent attacks require consultation with a neurologist and other specialized specialists, as they may indicate serious illness.

Clonic

The main difference between this type of muscle spasm is the rapid alternation of periods of contraction and relaxation. Clonic seizures occur for two main reasons: direct damage to the motor neurons of the brain or a disorder in the transmission of nerve impulses to muscle fibers. As with tonic contractions, one or more muscles may be involved during an attack. Externally, the pathology is manifested by tremors, chaotic movements or intense tremors of the whole body (convulsions). The severity depends on the size of the muscle and the affected area.

When one small muscle spasms, so-called tics occur - winking, head tilting, hand tremors. Often a nervous tic is of psychogenic origin. Stuttering is another classic example of clonic contractions of the speech muscles. Unlike tonic and tonic-clonic seizures, this type is not accompanied by pain. But the attack is usually longer in duration and can be repeated several times in a row, in series.

Clonic convulsions are a consequence of certain pathological processes, which is expressed by uncontrolled contraction of muscle tissue of a paroxysmal nature. Quite often, attacks are accompanied by partial paralysis, foaming from the mouth, and loss of consciousness.

Most often, clonic convulsions appear after severe attacks of the underlying pathological process or during sleep. The latter is due to the fact that during rest the muscles are relaxed. In some cases, cramps may also be present in healthy people after physical activity.

The nature of the clinical picture will depend on what caused the attack. To determine the root cause factor, a comprehensive diagnosis should be carried out, which will include both laboratory and instrumental methods.

Treatment is determined on an individual basis, based on the underlying cause. There are no gender or age restrictions - seizures occur in children and adults at any age.

Etiology

Convulsions may be caused by the following etiological factors:

• traumatic brain injury;
• genetic disorders;
• severe infectious diseases;
• perinatal disorders - convulsions in newborns;
• poisoning by toxic substances - chemicals, heavy metals, poisons and other compounds;
• uncontrolled use of medications;
• metabolic disorder;
• deterioration of cerebral circulation;
• degenerative brain diseases;
• benign or malignant brain tumors;
• infectious diseases of the central nervous system;
• taking drugs, overdose;
• excessive consumption of alcoholic beverages;
• head injuries.

The causes of clonic seizures may lie in psychosomatics - an attack may be caused by severe stress, nervous shock, and so on. We should not forget that the development of pathology can be caused by a psychiatric illness -,.

The most severe course is characterized by generalized clonic convulsions - the attack affects almost the entire body, and not its individual parts.

In more rare cases (but still not excluded), the nature of clonic seizures cannot be established. In this case, they speak of the idiopathic form of the disease.

Classification

Seizures are divided according to clinical and morphological characteristics into the following types:

• clonic convulsions - in the period between spasms, short-term relaxation is observed;
• tonic convulsions - there is an increase in spasticity, there are no periods of relaxation;
• tonic-clonic convulsions - there is a clinical picture of the two forms described above.

According to the severity of the manifestation of the pathological process, two forms are distinguished:

• localized - affecting only one part of the body;
• generalized - affect the entire body and can cause paralysis.

Tonic and clonic convulsions alternate quite often. As a rule, this nature of the pathological process occurs in serious diseases and cannot manifest itself symptomatically.

Only a doctor can determine the cause of seizures by carrying out the necessary diagnostic measures. Even if there has only been an isolated case of clonic or tonic seizures, you should consult a doctor for advice and not treat at your own discretion or ignore the problem.

Symptoms

The clinical picture of clonic seizures will be supplemented by specific symptoms, the nature of which will depend on the underlying factor.

Directly clonic convulsions are characterized by the following clinical picture:

• muscle tension is short, followed by rapid relaxation;
• the period of muscle tension lasts relatively short - no more than 10–15 seconds;
• attacks change very quickly.

Tonic-clonic seizures are characterized as follows:

• the body arches, the eyes roll back;
• periods of muscle relaxation and tension follow each other within a few minutes;
• after some time, the convulsions spread to the entire body, which can cause breathing problems;
• facial features are distorted;
• teeth are clenched, foam with blood may appear at the mouth;
• loss of consciousness.

The attack ends no earlier than 5–6 minutes. At this stage, the clinical picture will be as follows:

• the rhythm of clonic convulsions gradually decreases;
• muscles relax;
• there may be involuntary urination or defecation, abdominal pain;
• the patient may lose consciousness, and in particularly difficult cases the person falls into a coma.

The duration of the stage is about 10 minutes. Afterwards the patient is lethargic, may be disoriented, and most often falls asleep immediately. It is noted that some patients do not remember the attack itself and the events preceding it.

General symptoms may also be present, the occurrence of which will be due to the underlying factor:

• headaches, dizziness;
• high or critically low blood pressure;
• weakness, increasing malaise;
• tremor of fingers;
• increased sweating;
• pale skin;
• general deterioration of health;
• If you have chronic diseases, their relapse is possible.

The presence of such symptoms requires immediate medical attention. Self-medication, especially with traditional medicine, is out of the question.

Diagnostics

The diagnostic program must be comprehensive, since it is impossible to determine the type of pathological process from just one clinical picture. The following laboratory and instrumental tests may be prescribed:

• general clinical and biochemical blood test;
• general analysis of urine and feces;
• CT, MRI of the brain;
• Ultrasound of the abdominal organs, including the abdomen;
• Ultrasound of the genitourinary system;
• hormonal studies;
• test for tumor markers.

If a tumor is detected during diagnosis, a histological examination of the tumor is mandatory.

Based on the results of clinical studies, taking into account the data that was collected during the initial examination, including personal/family history, the doctor can determine the cause of clonic seizures and prescribe effective treatment.

Treatment

The course of basic therapy will depend on the underlying cause. Drug treatment can be based on the following drugs:

• nootropics;
• sedatives;
• antibiotics;
• anti-inflammatory;
• immunomodulators;
• antiepileptic.

If the cause of the seizures is a tumor or an aneurysm, surgery must be performed.

If a patient has an attack outside a medical facility, first aid must be provided urgently:

1. Place the patient on a flat, soft surface.
2. Provide access to fresh air.
3. Unfasten your trouser belt and collar.
4. Lay him on his side so that the sick person does not choke on vomit.

Giving any medications or liquids is prohibited.

There is no definite prognosis, since this is not a separate pathological process, but a symptom. Unfortunately, there are no specific methods of prevention. It is advisable to take measures to prevent those diseases that are included in the etiological list.

Often in life people have to deal with the unpleasant phenomenon of seizures. This refers to uncontrolled muscle contractions (individual muscles or groups), accompanied by pain. Painful manifestations can take you by surprise when walking and sleeping, and do not escape those who play sports. They turn out to be a one-time reaction to an external factor or force a child and an adult to suffer from pain regularly. If convulsive attacks are repeated repeatedly, a convulsive syndrome is diagnosed. Examination and treatment cannot be neglected; regularly recurring seizures indicate a serious illness.

Young children, teenagers, adults, and old people are susceptible to seizures. Children and older people are more often affected. This is due to the immaturity of the nervous system and brain in the former, aging of body systems, and the development of multiple diseases in the latter.

The attacks exhibit a different pattern of muscle contractions and vary in duration, frequency, and mechanism of development.

Prevalence

Depending on the location (a single muscle or group of muscles is seized by a cramp), painful contractions are divided into:

• Local (focal), reduces one muscle group;
• Unilateral, covering the muscles of one side of the body;
• Generalized, muscles of the whole body are involved. Foam appears in the mouth, loss of consciousness occurs, involuntary urination occurs, and breathing stops.

Duration of contraction

Based on the duration and nature of the contractions, the following types of seizures are distinguished:

• Myoclonic. The type is characterized by short-term muscle contractions (small twitches) of the upper half of the body. They are painless and go away on their own after a short period of time.
• Clonic. These contractions, being longer in nature, representing frequent (rhythmic) muscle contractions, can be general and local. Often contribute to the appearance of stuttering.
• Tonic. They show a long-lasting character. Muscle tension, covering any part of the body, sometimes cramps the entire body. Able to invade the airways. As a result, the limb or body takes a forced position. Often a person loses consciousness.
• Tonic-clonic. Mixed type, in which the tonic convulsions that occur first are replaced by clonic ones. If the tonic component predominates, the contractions are called clonic-tonic.

Mechanism of occurrence and development

Spontaneous local seizures

A significant portion of the adult population is familiar with painful contractions of the calf muscles. These, predominantly tonic convulsions, are not permanent and are the result of muscle overstrain during prolonged walking or running. Well known to people professionally involved in sports. Seizures occur in people who are forced to stand for long periods of time. Cramps often occur when swimming, and cramps in the limbs in open water and in the pool.

Leg contractions often occur due to excessive fluid loss in the heat, during sports, or in a sauna. As a result, the blood thickens and sodium levels drop. To prevent bouts of dehydration, you need to drink enough water.

Spontaneous convulsions are observed if you are in an uncomfortable position for a long time or when stretching (for example, during sleep). To eliminate it, it is recommended to change position. Wearing high heels leads to periodic cramping of the legs. It is better to give up high-heeled shoes or wear them for a short time. Hypothermia is an indispensable cause of such muscle spasms.

Attacks from overexertion also occur in the hands. Spasms are called professional and are observed in typists, seamstresses, and musicians.

The listed harmless options do not require special treatment. If your leg cramps (as they say about cramps), it is recommended to stand, leaning on your full foot, stretch the cramped muscle with one hand, while simultaneously extending the foot with the other. To prevent cramps, massage the arms and legs to prevent the body from losing a large amount of fluid. If attacks occur regularly when walking, at night while sleeping, and there is no direct connection with the listed reasons, you should consult a doctor, the phenomenon may be a sign of a serious illness.

It is possible to identify diseases that are characterized by febrile conditions - influenza, ARVI. At extremely high temperatures, febrile seizures may occur. Dangerous due to cerebral edema. It is necessary to quickly stop convulsive attacks that occur at fever. This situation is more typical for children due to age-related immaturity of the body. You can get ARVI more than once every year; it is important not to allow the temperature to rise to high levels in order to avoid recurrence of painful contractions. Even the first convulsions in a child (including those caused by ARVI) become an indication to see a doctor. This will allow you to identify the disease and begin treatment immediately.

Convulsive seizures as a result of a lack of microelements and vitamins

Often, convulsive attacks appear due to a lack of microelements in the body: calcium, magnesium, sodium, potassium, which are important for proper muscle function.

Magnesium is easily lost by the body: through sweat, in stressful situations. Magnesium and calcium deficiency are expected with excessive consumption of alcohol, coffee and sweets. Often the reason for the lack of an element lies in diseases of the thyroid gland. A lack of calcium in pregnant women is often observed, causing leg cramps. Hypocalcemia causes spasmophilia, the main symptom of the malaise is painful contractions. Potassium and magnesium are actively washed out when taking diuretics and hormonal drugs, with diarrhea and vomiting (leading to dehydration).

It is possible to experience cramps during prolonged fasting. Painful spasms (first of the fingers, then of the calf muscles, masticatory muscles) become a complication during therapeutic fasting, appearing by the end of the third week without food. The likelihood of occurrence increases with problems with the kidneys and liver, if repeated vomiting has occurred or an aversion to water develops. Spasms are caused by the loss of calcium salts, phosphorus, sodium chloride, which occurs during dehydration (due to vomiting, rapid weight loss). If a solution of table salt does not help relieve painful contractions, you will have to forget about fasting.

A lack of vitamin D increases the risk of seizures; the element is necessary for the absorption of calcium and magnesium. Vitamins A, B, C, E affect the ability of muscles to contract. With repeated attacks, the presence of substances in the body is monitored. Sometimes, to eliminate it, it is enough to compensate for the lack of vitamins.

Magnesium supplements are often prescribed. Magnesia (magnesium sulfate or magnesium sulfate) has proven itself well. Indications for the use of the drug are considered to be a lack of magnesium, convulsions (magnesium is used against such manifestations during pregnancy), and epilepsy. For an anticonvulsant effect, magnesium is administered intramuscularly (effective within an hour and up to 4 hours) or intravenously (effective instantly, but not for long).

Seizures as symptoms of diseases

Seizures of various types are recognized as symptoms of a number of diseases. Observed in diabetes mellitus, spasmophilia, varicose veins, tetanus and other diseases.

• For diabetes mellitus. Diabetes is a complex phenomenon that affects all systems of the body. Increased glucose levels in diabetes mellitus affect diuresis, resulting in the loss of a lot of fluid, including essential microelements. Due to impaired nerve conduction, an imbalance appears in the signals going to the leg muscles, unpleasant and painful sensations interfere with walking. In diabetes mellitus, the production of adenosine triphosphoric acid (ATP) decreases, disrupting metabolic processes in the muscles, reducing the muscle's ability to relax, leading to seizures. With increased physical activity, overwork, poor nutrition, and stressful situations, these factors are aggravated. Cramps in diabetes are a sign of disease progression (especially in combination with pain when walking, damage to the skin of the feet), which should immediately alert you. Treatment for diabetes mellitus is prescribed comprehensively. Magnesia is also prescribed, with caution. The main treatment for seizures in diabetes mellitus will be physical exercise (therapeutic), the effect will be provided by orthopedic shoes, selected individually.
• For tetanus. Acute infectious bacterial disease is extremely dangerous. Tonic convulsions are an early sign. Moreover, tetanus first affects the facial muscles (a “sardonic smile” appears), then it spreads to the torso and limbs (except for the feet and hands). At the height of the disease, tension is almost constant, accompanied by severe pain. Previously, magnesia was considered the best treatment for tetanus (it is no longer used). Treatment is with antitetanus serum and anticonvulsants.
• For osteochondrosis. More often, leg cramps are observed with osteochondrosis of the lumbar spine. Destruction of the intervertebral discs, leading to compression of the blood vessels and roots of the spinal cord, leads to the occurrence of seizures. Nighttime contractions in one leg are usually observed (depending on the location of the damage to the brain root), similar to muscle contractions due to a deficiency of microelements. Magnesia is often prescribed to relieve pain and spasms. Bath massage is useful for cramps caused by osteochondrosis; the procedure helps improve blood circulation in the tissues. You should first consult with your doctor to see if a bath is contraindicated for osteochondrosis due to other diseases.
• For spasmophilia. Infantile tetany (another name for spasmophilia) is characterized by convulsions and spastic states. The disease is most likely a childhood one, affecting children aged 6-12 months. Can be observed in an adult. The cause of spasmophilia is a lack of calcium and vitamin D (sometimes it begins to progress with an excess). It appears in one of three options, or in several at the same time. In the first type of spasmophilia, a spasm of the glottis occurs, causing breathing problems. With spasmophilia of the second type, spasms of the hands and feet occur, lasting from several minutes to several hours. With the third variant of spasmophilia, breathing first becomes rare and the child becomes numb. Later, other signs appear: body cramps, uncontrolled urination, tongue biting. Immediate treatment is required to prevent complications of the disease, the most severe being cardiac arrest.
• For hypoparathyroidism. The disease develops as a result of a disturbance in calcium-phosphorus metabolism, which occurs due to a lack of parathyroid hormone produced by the damaged thyroid gland. The main signs are convulsive syndrome and high excitability of nerves and muscles. The disease is characterized by tonic and clonic convulsions of heterogeneous muscle groups (flexor, mainly). The hand is characterized by the appearance of an “obstetrician’s hand”, the foot is characterized by a strong bend inward (“horse foot”), and a “fish mouth” is formed on the face. Unexpected irritants can provoke spasms in any part of the body.
• With hysterical neurosis. Known since ancient times, the disease shows convulsive attacks among the main symptoms. In hysteria (hysterical neurosis), convulsions (usually tonic) are accompanied by groans and sobs, the patient arches. The face is red or pale, the body is arched. After the attack there is no sleep and memory loss.

Convulsions accompany other diseases and conditions of the human body. High blood pressure causes a convulsive hypertensive crisis, leading to cerebral hemorrhage. Hypertension must be controlled with properly selected medications. To relieve pressure and crisis, magnesia is used, as in diabetes mellitus, only as prescribed by a doctor. Oncological diseases often manifest themselves as convulsive phenomena.

"Female" cramps

Often women throughout their lives (from the moment of puberty) experience painful tonic cramps in the legs and abdomen. First, painful menstrual contractions occur. They appear 1-2 days before the start of menstruation and can persist for several days. Pain in the lower abdomen (dull and aching or sharp and severe) is associated with contractions of the uterus, which gets rid of the lining if fertilization does not occur. A common type of seizures during menstruation is described.

Often, pain during menstruation spreads to the legs. A woman experiences cramps, aching pain and other unpleasant symptoms before the onset of menstruation. The manifestations are associated with hormonal changes and are considered a variant of the norm if they do not last long. Moreover, severe stress, early puberty, and age less than twenty years increase the risk of painful contractions during menstruation. As a rule, after pregnancy and childbirth, cramps and pain experienced during menstruation stop or noticeably weaken. Keep in mind that your stomach and legs may hurt during your period due to diseases of the reproductive system and lack of blood supply, which are aggravated at this time. If convulsive attacks during menstruation are too frequent, the pain is intense, it is better to consult a doctor to rule out inflammatory processes.

An additional type of “female” cramps is during menopause. Cramps are associated with calcium deficiency caused by decreased production of the hormone estrogen. During menopause, hypothermia sets in faster, contributing to the occurrence of attacks. During this period, sensitivity to factors that irritate the body increases. You should pay special attention to your health.

Cramps during menopause indicate the onset of osteoporosis. In complex treatment prescribed for menopause, calcium and vitamin D preparations are necessarily present. Magnesia is sometimes used as a sedative. Pay attention to feasible sports (it is useful to swim in the pool or try Nordic walking).

Highlights

Cramps are common and can affect any part of the body. There are many reasons for this, and sometimes it’s not easy to understand the sources. Let's consider the important points:

• There are different types of seizures. The division into types is carried out according to several criteria: duration, nature, prevalence. Certain types of painful contractions are usually characteristic of certain diseases and conditions of the body.
• The immediate cause of involuntary muscle contraction is metabolic disorders in the muscles, an imbalance of excitatory and relaxing signals in the muscles. The disorders are caused by a lack of microelements and vitamins (primarily magnesium, calcium and vitamin D) that play an important role in the proper functioning of muscles, a recognized consequence of systemic diseases, poor nutrition and lifestyle. On the other hand, deficiency of substances leads to diseases with symptoms of seizures.

• If there is no obvious reason for contractions (too much or too long a load on the muscles that cramp, prolonged exposure to a static position, hypothermia), seek advice from a professional. In other cases, seizures are a sign of a disease that requires mandatory treatment. Spasms occur with diabetes mellitus, tetanus, spasmophilia, which does not spare children, and hysterical neurosis, which is not always recognized by loved ones as a real disease. They become manifestations of terrible diseases: cancer, severe damage to the central nervous system. Even acute respiratory viral infections can cause the appearance of symptoms; they should be removed faster. Muscle spasms during therapeutic fasting that cannot be overcome are a reason to interrupt the procedure.
• Cramps are considered a consequence of natural conditions of the body. For example, it is not uncommon during menstruation and menopause.
• No universal medicine has been created that can be used for convulsive attacks of any origin. Treatment of a symptom depends on the cause and the presence of other diseases. In frequent cases, magnesium helps, but with low blood pressure the medicine cannot be used. Avoid self-medicating with medications and traditional methods without consulting a doctor.
• The main thing is that cramps are a symptom. It is necessary, first of all, to treat the disease. With successful treatment, the symptoms will go away.

Almost every person has experienced a cramp - a phenomenon of spontaneous muscle contraction, accompanied by quite noticeable pain. Spasms of this kind are usually classified into two equivalent classes - tonic and clonic spasms.

Causes of clonic convulsions

The development of seizures, as a rule, begins in the presence of dysfunction of the central nervous system. The occurrence of clonic seizures can be expected in the following patient conditions:

• worsened or experienced hysteria;
• ailments of a neurological nature in the form of acute cerebral circulatory disorders, acute/chronic neuroinfections, epilepsy, traumatic brain injuries, the presence of space-occupying processes in the brain, hypertensive crisis;
• diseases of an infectious nature in the form of tetanus, childhood infections accompanied by high fever, rabies;
• in case of impaired water-salt metabolism as a result of eclampsia, heat stroke;
• in processes of toxic etiology in the form of renal failure, hypoglycemic coma, adrenal insufficiency, uremia, intoxication.

What is the difference between clonic and tonic?

Involuntary muscle contraction occurs when the body reacts to any influence that harms it. However, such spasms do not always occur in the same way. When muscle contraction is slow and does not bother you for long, this phenomenon is called a tonic spasm, but a clonic spasm will change quite quickly during its development, either relaxing the muscle or straining it.

The development of clonic convulsions is smooth and rhythmic in the nature of muscle spasmodic contractions in many cases, localized in the extremities. Also, clonic contractions can be of a general nature. When the contracted muscles of the respiratory tract are involved in the process, there is a high probability of stuttering.

Symptoms of the phenomenon

When the seizure is over and the patient comes to his senses, he should be shown to a specialist for diagnostic clarification and selection of an individual treatment program.

Cramps or involuntary contractions of muscle fibers are familiar to all people. Single convulsions do not pose a threat to life and health. Another thing is convulsive syndrome, especially when it occurs with impaired consciousness.

Tonic-clonic seizures occur during the so-called grand mal or generalized seizure in epilepsy. In this case, loss of consciousness occurs.

Tonic-clonic seizures are a nonspecific reaction of the brain to the action of stimuli.

The development of an attack occurs in several stages or stages.

Stages

Aura

A few hours (minutes) before the onset of a seizure, the patient begins to experience “bells” that foreshadow its onset. The patient becomes lethargic, irritable, withdrawn. Unfounded anxiety appears. In some patients, the aura is very specific. For example, some of them describe the appearance of rainbow circles a few minutes before the onset of an attack.

Based on the nature of the complaints, the following types of aura are distinguished:

• visual (as in the example described above);
• auditory (before an attack there may be auditory hallucinations);
• motor (obsessive movements appear);
• gustatory (various taste sensations);
• mental (depression, worsening mood, anger, irritability);
• vegetative (redness or pallor of the face, increased sweating, hyperhidrosis of the feet and palms);
• abdominal (pain, abdominal discomfort, stool upset);
• the state of what has already been seen (de jà vu);
• the feeling of never having been seen;
• nonspecific (general discomfort is noted, the warning signs are not specific).

This diversity is associated with irritation of certain areas of the cerebral cortex. Changes are recorded on the EEG.

Epilepsy is characterized by the presence of foci of pathological activity in the brain

In any case, most patients or their relatives feel an attack coming. During this phase, you need to try to take measures to prevent it (take the necessary medications, avoid stressful situations, overwork) or at least to prevent possible injury (put the patient on the bed or at least on the floor, having previously laid a blanket on him, turn his head to one side, remove the sharp objects nearby). Unfortunately, this is not always possible, since it is difficult to predict the exact time of the next attack. Some patients have no aura.

Complex partial seizure

This phase develops after the aura (secondary generalized seizure) or immediately without warning (primarily generalized seizure).

An attack occurs with obligatory loss of consciousness. The patient falls (during this, the patient may receive a head injury, broken limbs, since he does not control what is happening), often during this he involuntarily makes various sounds (“vocalization” occurs due to a tonic spasm of the glottis and chest muscles). During an attack, the face is distorted with a grimace, the expression on the face is absent. The gaze is directed “to nowhere.”

There are 2 phases: tonic and clonic.

Characteristic position of the body during different phases of an epileptic attack

Tonic phase

It usually lasts a few seconds. The patient's body tenses and arches due to increased tone of the extensor muscles. Due to the contraction of smooth muscles, involuntary urination occurs, sometimes defecation, and breathing becomes difficult.

Clonic phase

Involuntary convulsive contractions of the flexor muscles occur. The patient may hit his head on the floor. Foam comes out of the mouth. There may be a bite of the tongue, lips, or oral mucosa, then the foam becomes scarlet. During an attack, the patient may break teeth or choke on his tongue. To prevent tongue retraction and biting, try to turn the patient’s head to one side, insert a spatula or spoon wrapped in cloth between the teeth, and prevent retraction. The duration of this phase is 1.5 – 2 minutes.

The phase ends with the onset of sleep lasting from several minutes to 1-2 hours.

In some patients, post-attack sleep is absent, and the next phase begins.

It is very common to bite the tongue during an attack.

Postictal twilight disorder

Occurs soon after an attack. The patient makes motor stereotypes, unconscious movements (trying to get dressed, go somewhere, take something). The patient does not remember either the seizure itself or the time immediately after it.

Generalized seizures can also occur with hysteria. They are initiated in order to attract attention. At the same time, they are constantly demonstrated by the patient in public, with large crowds of people. There are no precursors unless the patient first learned about their existence, but if he read about it from books or the Internet, then a colorful, fanciful description of the imaginary aura appears. Convulsions occur without loss of consciousness, which is confirmed by the absence of pathological reflexes, a normal reaction to painful stimuli, and a preserved reaction of the pupils to light. The patient can describe what happened during the so-called “attack.”

When falling during a hysterical attack, severe injuries never occur, there is no involuntary urination, and there are no specific changes on the EEG.

Such an attack is characterized by theatricality, artistry, and ostentation. The patient demonstrates how, in his opinion, a real attack should proceed. The duration of such an attack is longer than with epilepsy. Pathological sleep does not occur after hysterical convulsions.

Situational seizures

In addition to epilepsy and hysteria, there are a number of conditions that occur with tonic-clonic seizures:

• poisoning with alcohol, methyl alcohol, drugs, barbiturates, psychotropic drugs, carbon monoxide, “convulsive” poisons (strychnine, corazole);
• overdose of certain drugs (isoniazid, aminazine, ceftazidine);
• severe traumatic brain injury;
• tumor diseases of the brain;
• renal, liver failure;
• tetanus;
• rabies;
• hyper-, hypoglycemia;
• hyper-, hypocalcemia (with spasmophilia), hyperkalemia, hyponatremia;
• precoma, coma;
• severe cases of hyperthermia (especially in children - “febrile” convulsions when the body temperature rises above 38.5 degrees) and hypothermia;
• influence of ionizing radiation;
• severe form of toxicosis during pregnancy;
• psychotrauma;
• severe dehydration;
• electrical injuries.

The same reasons can trigger an attack in a patient with epilepsy. With prolonged attacks of epilepsy, the presence of provoking factors, or unauthorized withdrawal of medications, status epilepticus may occur, when the next seizure occurs against the background of an unfinished previous one. This is a very dangerous complication of epilepsy that poses a threat to the patient’s life.

Febrile seizures usually go away by age 5, but in 4-5% of children they can develop into epilepsy. To determine the prognosis, the frequency and duration of convulsive attacks are taken into account. There are simple and complex febrile seizures.

Simple ones are characterized by single episodes, lasting no more than 15 minutes.

Complex ones are characterized by repetition throughout the day, lasting more than 15 minutes.

It is complex febrile seizures that can eventually develop into epilepsy.

The risk group includes children with frequently recurring, prolonged attacks, their early (up to a year) appearance, and changes in the EEG.

This category of children requires observation and clinical examination by a neurologist. In case of colds and other diseases, body temperature should be monitored and measures should be taken in a timely manner to normalize it.

Children may experience seizures after prolonged computer games, bright flashes of light, unlimited television viewing, loud music, overwork, or a nervous breakdown.

Diagnostics

A correctly collected anamnesis will help to determine the cause of seizures. It will make it possible to clarify the presence or absence of hereditary diseases manifested by convulsive seizures. From the patient’s relatives, you can find out the picture of the attack: what precedes it, duration, condition after the end.

The most significant of the instrumental methods are:

• EEG (can record pathological activity in parts of the brain);
• radiography of the skull bones (determines the integrity of bone tissue, the presence or absence of fractures);
• computed tomography (makes it possible to determine the presence, size and location of a tumor, cerebral hemorrhage).

Treatment

In case of convulsive syndrome, it is necessary to take measures to prevent trauma to the patient, relieve an attack of convulsions, then begin to search for and treat the main cause of the disease.

Schematic representation of emergency care

The patient is placed on a flat horizontal surface, having previously laid a soft blanket. Turning on one side will help prevent aspiration of gastric contents. Place a soft cushion under your head; it can be made from available materials (towels, blankets).

You should not forcefully unclench the patient’s jaws, as this can damage the teeth.

You need to wait until the attack ends, when the patient regains consciousness.

If attacks recur, hospitalization is necessary.

The following medications are used to relieve a seizure:

• GABA (sodium osibutyrate injections);
• magnesia (injections);
• benzodiazepines (diazepam).

If there is a deficiency of magnesium and potassium in the body (with prolonged dehydration, diarrhea, vomiting, pregnancy, diabetes, taking glucocorticosteroids), it is necessary to replenish them. For this purpose, medications are used (panangin, Magnelis).

Points of influence for relieving cramps

For the treatment and prevention of seizures in patients with epilepsy, carbamazepine and phenobarbital are prescribed; during an attack, Relanium and magnesium are administered.

For convulsions caused by heavy drinking, water and electrolyte imbalance in the body is eliminated.

During pregnancy, the range of medications is limited due to the possible effect on the unborn child; it is necessary to find out the root cause of seizures and treat accordingly.

For febrile seizures, in addition to anticonvulsant therapy, it is necessary to normalize the child’s body temperature.

For convulsions, in addition to medications, massage (classical and acupressure), physiotherapy (magnet), herbal medicine (decoctions of motherwort, valerian) are used.

Do not forget about the proper organization of your daily routine. It is very important to create a favorable atmosphere in the home for your child. No screams, scandals. Daytime and full night sleep is required for the child. TV viewing should be limited to a minimum. Walks in the fresh air in a quiet, calm environment are required. A properly organized daily routine will help prevent the occurrence of adverse events.