Tetany. convulsive syndrome

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Violation of the functions of organs and systems

Separate these types of seizures:

• Epileptic.
• Psychogenic.
• Febrile.
• Narcoleptic.
• Cataleptic.
• Anoxic.
• Toxic.
• metabolic.
• Tetanic.
• Tonic.
• Atonic.
• Clonic.
• Absences.
• Unclassified.

epileptic

Most of these seizures are part of the structure of epileptoid disorders.

Small generalized epileptic seizures are non-convulsive. They are called absences.

Absence symptoms: consciousness is absent, all actions are interrupted, the look is empty, the pupils are dilated, hyperemia or pallor of the skin of the face. A simple absence may last no more than a few seconds, even the patient himself may not know about it.

Complicated seizures are often characterized by more severe clinical manifestations and in all cases are accompanied by changes in consciousness. Patients are not always aware of what is happening; they may include complex hallucinations of an auditory or visual nature, accompanied by phenomena of derealization or depersonalization.

The phenomenon of depersonalization is characterized by an unusual perception of the sensations of one's body. The patient even finds it difficult to describe them plainly. Derealization is manifested by a feeling of immobility, dullness of the surrounding world. What was well known before the attack seems unfamiliar, and vice versa. It may seem to the patient that everything that happens to him is a dream.

Another characteristic manifestation of complex partial seizures is automatic stereotypical actions that are formally appropriate, but in this situation they are inappropriate - the patient mutters, gesticulates, looks for something with his hands. As a rule, the patient does not remember the automatic actions performed, or remembers them fragmentarily. In more complex cases of automatism, the patient can perform a rather complex behavioral activity: for example, to come by public transport from home to work. Interestingly, he may not remember this event at all.

Complex autonomic and visceral seizures are characterized by unusual and strange sensations in the chest or abdomen that are accompanied by vomiting or nausea, as well as psychic phenomena ( racing thoughts, fear, violent memories). Such an attack may resemble an absence, but there are no changes characteristic of an absence during the EEG. Therefore, in clinical practice, such seizures are sometimes called pseudo-absences.

Mental paroxysmal phenomena that occur in epilepsy are components of partial seizures, or their only manifestation.

Epileptic status

In a coma, pharyngeal respiratory paralysis develops, which consists in the loss of the pharyngeal reflex and, as a result, the accumulation of salivary secretion in the upper respiratory tract, which worsens breathing until the appearance of cyanosis. Changes in hemodynamics: the number of heartbeats reaches 180 per minute, the pressure rises sharply, there is ischemia of the myocardium of the heart. Metabolic acidosis occurs due to a violation of metabolic processes, intracellular respiration is disturbed.

Therapeutic tactics for epilepsy

This disease is a serious stress for the patient's family and for himself. A person begins to live in fear, expecting each new attack, and falls into depression. Some activities cannot be performed by people with epilepsy. The patient's quality of life is limited: he cannot disturb sleep patterns, drink alcohol, drive a car.

The doctor must establish productive contact with the patient, convince him of the need for long-term systematic treatment, explain that even a one-time pass of antiepileptic drugs can lead to a strong decrease in the effectiveness of therapy. After discharge from the hospital, the patient must take the drugs prescribed by the doctor for three years after the last seizure.

At the same time, it is known that long-term use of antiepileptic drugs negatively affects cognitive functions: attention decreases, memory and the pace of thinking deteriorate.

The choice of antiepileptic drugs is influenced by the clinical form of the disease and the type of seizures presented. The mechanism of action of such drugs is the normalization of internal cellular balances and polarization in the cell membranes of epileptic neurons ( Prevention of Na+ inflow into the cell or K+ out of it).

With absences, the appointment is effective sarontine And suxilepa, possibly in combination with valproates.

In cryptogenic or symptomatic epilepsy, in which complex and simple partial seizures occur, effective are phenytoin, phenobarbital, depakine, lamotrigine, carbamazepine.

At the same time, phenobarbital has a pronounced inhibitory effect ( in adults), and in children, on the contrary, very often causes a state of hyperactivity. Phenytoin has a narrow therapeutic latitude and non-linear pharmacokinetics, and is toxic. Therefore, most doctors consider the drugs of choice carbamazepine And valproate. The latter is also effective in idiopathic epilepsy with generalized seizures.

Toxic attacks require intravenous magnesium sulfate to restore intracellular balance. For any seizures as an additional drug is indicated diacarb. This drug has a high antiepileptic activity and exhibits dehydration properties.

In status epilepticus the most severe state of epilepsy) use benzodiazepine derivatives: sibazon, nitrazepam, relanium, clonazepam, seduxen. Drugs such as gabapentin And vigabatrin are not metabolized in the liver, and therefore can be prescribed for liver diseases. Vigabatrin showed excellent efficacy in the treatment of severe forms of the disease: Lennox-Gastaut syndrome .

Some antiepileptic drugs have slow-release properties, which make it possible to ensure a stable concentration of drugs in the blood with a single or double dose. That is, it gives the best effect, and reduces the toxicity of the drug. There funds include depakine-chrono And tegretol.

Relatively new drugs used in antiepileptic therapy are oxcarbazepine (shows better efficacy than carbamazepine); clobazam.

Lamotrigine is the drug of choice for atypical absences and atonic seizures in children. Recently, its effectiveness has been proven in primary generalized convulsive seizures.

It is very difficult to find an effective and least toxic therapy for those patients who suffer from liver diseases.

Non-epileptic seizures

Seizure triggers can be:

• Increase in body temperature.
• Viral infections.
• Polymyopathy.
• Hypoglycemia.
• Rickets in children.
• Inflammatory diseases of the nervous system.
• Polyneuropathy.
• A sharp increase in intracranial pressure.
• Sharp weakness.
• vestibular symptoms.
• Drug poisoning.
• Severe dehydration with vomiting, diarrhea.

Febrile convulsions

Children at this age often have temperature ( febrile) convulsions. The sharp onset of seizures is associated with a rapid increase in temperature. They pass without leaving a trace. Long-term treatment is not required, only symptomatic.

If such convulsions are repeated and occur at subfebrile rather than high temperature, then their cause must be found out. The same applies to those convulsive seizures that recur without an increase in body temperature.

Non-epileptic psychogenic

Accentuations - These are overly pronounced character traits that are amplified during times of stress. Accentuations are on the border between the norm and pathology.

Psychogenic manifestations can be so similar to epileptic ones that it is very difficult to differentiate them from each other. And this, in turn, makes it difficult to choose an effective treatment.

Classic hysterical seizures that develop due to the occurrence of peculiar psycho-emotional reactions ( sick people meow or bark, tear their hair, etc.) is quite rare. When diagnosing a condition, doctors are guided by a combination of clinical signs, which, however, do not have 100% reliability:

• Screams, groans, bite of the lips, shaking the head in different directions.
• Lack of coordination, asynchrony, randomness of limb movements.
• Resistance during examination, when trying to open the eyelids - squinting of the eyes.
• The development of an attack in the eyes of several people ( demonstrativeness).
• Too long seizure more than 15 minutes).

The latest data obtained in the course of psychophysiological studies suggest that the problem of psychogenic seizures is much more complicated, since epileptic seizures that occur due to the appearance of a focus in the pole-mediobasal part of the frontal lobe completely repeat psychogenic seizures.

Narcoleptic

The frequency of occurrence of a narcoleptic seizure is several times a day. In addition to drowsiness, it is accompanied by muscle blockade. The character is chronic. The nature of this condition is encephalitis transferred at a young age, brain tumors, cranial trauma. This disease affects more young people than older people. The syndrome of narcolepsy was described a long time ago - in 1880. Although at that time only the external manifestations of the attack were described, they could only guess about its causes.

Cataleptic

Such an attack can occur with schizophrenia, narcolepsy, organic brain damage, emotional experiences.

Anoxic

People suffering from vegetative-vascular dystonia often experience neurogenic syncope. They are provoked by various stress factors: stuffiness, the influx of people in a cramped room, the sight of blood. Diagnostic distinction between epileptic seizures of a vegetative-visceral nature with neurogenic syncope is a difficult task.

toxic

Strychnine poisoning is characterized by toxic seizures with a clinical picture in the form of convulsions and trembling of the limbs, stiffness and pain in them.

metabolic

Hypoglycemic states are characterized not only by the fact that blood sugar falls, but also by how quickly this happens. Such conditions occur with pancreatic insulomas, as well as with functional hyperinsulism.

Metabolic cramps, which are a symptom of seizures of the same name, occur as a result of various conditions or diseases ( dehydration, fever, less often cerebral pathologies, etc.). Hypocalcemic and hypoglycemic seizures are more common.

Metabolic disorders are often accompanied by tonic-clonic and multifocal seizures.

Metabolic disorders need immediate correction and the establishment of the root cause of such a condition. Acidosis, kidney failure, or other disorders can influence the occurrence of metabolic seizures. The fact that this is a metabolic convulsive syndrome is indicated by such signs as early onset, ineffectiveness of anticonvulsants, and the constant progress of the disease.

tetanic

The main symptom of an acute disease is a tetanic attack. During a seizure, the nervous system is exposed to strong excitement and because of this, muscle cramps occur. The localization of seizures differs in different forms of tetany. Children are more likely to experience laryngospasms - cramps in the muscles of the larynx. In adults, the most dangerous form of a tetanic attack occurs, in which convulsions of the coronary arteries and the heart muscle occur. Such convulsions can lead to death due to cardiac arrest.

Sometimes there are convulsions of the muscles of the bronchi or stomach. During stomach cramps, indomitable vomiting occurs. With convulsive spasms of the sphincter of the bladder, there is a violation of urination. Cramps are painful. Their duration varies within an hour.

tonic

Three types of tonic seizures:
1. Involving the muscles of the face, torso; causing spasm of the respiratory muscles.
2. Involving muscles of the arms and legs.
3. Involving both the trunk muscles and the muscles of the limbs.

Tonic convulsions can be visually distinguished by the “protective” position of the hands, which, as it were, cover the face with clenched fists from a blow.

Similar types of convulsive manifestations may be accompanied by clouding of consciousness. The pupils stop responding to light, tachycardia appears, blood pressure rises, the eyeballs roll up.

Tonic and tonic-clonic seizures carry the threat of injury to the patient or even death ( due to associated vegetative disorders; due to acute adrenal insufficiency; due to respiratory arrest).

Atonic

Atonic seizures are characteristic of a number of epileptic syndromes.

clonic

If the attack lasts a couple of minutes, then consciousness is quickly restored. But often it lasts longer, and in this case clouding of consciousness is not an exception, and even the onset of a coma.

Absences

Absences are characterized by the fact that such attacks can be repeated dozens of times a day, and a sick person may not even know about it.

With the onset of a complex absence, the clinical picture is supplemented by elementary short-term automatisms ( hand-rolling, eye-rolling, eyelid twitching). In atonic absence, the lack of muscle tone causes the body to fall. Decreased vigor and fatigue, lack of sleep - all this affects the appearance of an absence. Therefore, absences often occur in the evening after a whole day of wakefulness, in the morning immediately after sleep; or after eating, when the blood drains from the brain and rushes to the digestive organs.

Unclassified

Nocturnal paroxysms

In clinical practice, the problem of accurate differential diagnosis of sleep disturbance syndromes of non-epileptic and epileptic genesis has not yet been solved. And without such differentiation, it is extremely difficult to choose an adequate treatment strategy.

Paroxysmal disorders of various genesis occur in the phase of slow sleep. Sensors attached to the patient to read the activity of nerve impulses show specific patterns that are characteristic of this condition.

Individual paroxysms are similar to each other in terms of polysomnographic characteristics, as well as in clinical manifestations. Consciousness while in these states can be impaired or preserved. It is noted that paroxysms of a non-epileptic nature bring more suffering to patients than epileptic seizures.

Epileptic seizures with convulsive manifestations during sleep are often found in children. They arise in connection with a violation of intrauterine development and with the action of harmful factors that influenced the development of the baby in the first months of life. Children have a functionally immature nervous system and brain, which is why they have a rapid excitability of the central nervous system and a tendency to extensive convulsive reactions.

In children, there is an increased permeability of the vascular walls, and this leads to the fact that toxic or infectious factors quickly cause cerebral edema and a convulsive reaction.

Non-epileptic seizures can turn into epileptic ones. There can be many reasons for this, and not all of them can be studied. Children are diagnosed with epilepsy only at the age of five, subject to uncomplicated heredity, good health of the parents, normal development of pregnancy in the mother, normal uncomplicated childbirth.

Non-epileptic seizures that occur during sleep may have the following etiology: asphyxia of the newborn, congenital developmental defects, hemolytic diseases of the newborn, vascular pathologies, congenital heart defects, brain tumors.

As for adult patients, for the diagnostic differentiation of paroxysmal sleep disorders of various nature, the polysomnography method is used in combination with video monitoring during sleep. Thanks to polysomnography, EEG changes are recorded during and after an attack.
Other methods: mobile long-term EEG ( telemetry), a combination of long-term EEG monitoring and short-term EEG recording.

In some cases, to distinguish between paroxysmal disorders of various origins, a trial anticonvulsant treatment is prescribed. The study of the patient's response ( no change or relief of attack), makes it possible to judge the nature of the paroxysmal disorder in the patient.

Hypocalcemic convulsions (tetanic convulsions, spasmophilia) - due to a decrease in the concentration of ionized calcium in the blood.

They are more common in children aged 6 months to 1.5 years with rickets (usually in spring), as well as with hypofunction of the parathyroid glands, with somatic diseases accompanied by prolonged diarrhea and vomiting, etc.

Clinical diagnostics

Allocate explicit and latent forms of spasmophilia. An attack of a clear form of spasmophilia begins with a tonic tension of the mimic muscles of the face (spasm of the gaze up or to the side, a “fishy” mouth), often with painful carpopedal spasm (the hand is in the form of an “obstetrician’s hand”, the foot and fingers are in the flexion position), laryngospasm ( resounding breath, reminiscent of a cock's cry). Following these local tonic manifestations, in severe cases, generalized tonic convulsions may develop with loss of consciousness up to several minutes. Seizures may recur as status epilepticus. Convulsions stop with the normalization of the ionic composition.

Latent spasmophilia can be detected using special phenomena:

Khvostek's symptom is a lightning-fast contraction of facial muscles on the corresponding side, mainly in the area of ​​​​the mouth, nose, lower and sometimes upper eyelids, when tapping with a hammer on the cheek in the fossa caninae area (between the zygomatic arch and the corner of the mouth).

Trousseau's symptom - a spasm of the hand (in the form of an "obstetrician's hand") that occurs when the neurovascular bundle is squeezed in the shoulder area (when an elastic tourniquet, cuff from a tonometer is applied)

Lust's symptom - involuntary dorsiflexion of the foot with simultaneous abduction and rotation of the leg outward when tapping with a mallet along the peroneal nerve (below the head of the fibula).

Maslov's symptom is a short-term cessation of breathing on inspiration (in healthy children there is an increase and deepening of breathing) with a slight tingling of the child's skin.

Urgent Care:

1. In mild forms of convulsive seizures, appoint orally

5-10% solution of calcium chloride or calcium gluconate at the rate of 0.1-0.15 g/kg per day.

2. For severe attacks, enter parenterally:

10% solution of calcium gluconate at a dose of 0.2 ml / kg (20 mg / kg) IV slowly after preliminary dilution with a solution of 5% glucose 2 times;

With ongoing convulsions, 25% solution of magnesium sulfate 0.2 ml / kg / m or 0.5% solution of seduxen 0.05 ml / kg (0.3 mg / kg) / m.

Hospitalization after relief of seizures, if necessary, in the somatic department. In the post-attack period, it is necessary to continue taking calcium preparations orally in combination with a citrate mixture (citric acid and sodium citrate in a ratio of 2: 1 in the form of a 10% solution of 5 ml 3 times a day).

Today we will talk about tonic convulsions. We will find out what it is, get acquainted with the causes and treatment, and also try to figure out how to provide first aid.

It should be understood that most often tonic convulsions occur when a person becomes ill with something. Seizures can be caused by many factors. However, their appearance is accompanied by a number of other symptoms that require immediate treatment.

What it is?

It is believed that a spasm is a reaction of the human body to an irritant. It can be an external or internal stimulus. The aggressive effect of certain factors on the body provokes pathology in a group of nerve tissues. They, in turn, transmit nerve impulses to muscle sections throughout the body. It is generally accepted to consider tonic convulsions as a type of convulsive seizures.

What is the feature? With such convulsions, almost all human muscle tissues are involved, that is, the spasm is very extensive. This implies that during a spasm, a spasm of muscles that, for example, provide breathing, may occur. In this case, the outcome can be fatal if timely medical care is not provided.

Clonic convulsions

The main difference between tonic and clonic convulsions is that during the latter, muscle spasms alternate with their relaxation. Clonic convulsions are those involuntary muscle contractions that a person may not even notice at an early stage of the disease. Tonic spasms are long. Clonic are smoother, they are only local. In this case, there are often convulsions of the respiratory system, which can lead to the development of stuttering.

Symptoms

Tonic convulsions, the symptoms of which can be varied, can still be identified. The main manifestations: pain in the body, shortness of breath, flexion of the arm in the elbow joint, which occurs spontaneously, spasms of the jaw muscles, muscle contraction for a long time, disorders of the musculoskeletal system, body tension.

These are the main symptoms that appear in almost all patients. In this case, often a person throws his head back involuntarily. This causes muscle spasms in the cervical and back regions. One of the most unpleasant symptoms is involuntary urination or defecation. If you find this symptom, you should immediately go to the hospital, and not treat the gastrointestinal tract at home. The reason for this symptom is the spasm of the muscles of the body, which are responsible for retaining fluids.

It should be noted that the symptoms listed above are very similar to those that patients experience during a seizure. A distinctive feature of tonic convulsions is their duration. Unfortunately, spasms can last for hours. It will take even longer to restore the body to a normal state.

It is important to remember that the convulsions described are a type of convulsive seizure, but the symptoms have their own characteristics.

Causes

We have already figured out what tonic convulsions are. What are their reasons? The main cause of convulsions and seizures is a violation of the activity of the human nervous system. However, to date, it is not exactly known which one causes convulsions. But scientists have an assumption that the cause is the increased excitability of the subcortical region of the brain. There is also a generally accepted list of the most likely causes of seizures:

1. Violation of metabolic processes. There is a huge variety of pathologies associated with metabolic processes in the body that can adversely affect the functioning of the brain. There are frequent cases of seizures due to insufficient amounts of calcium. A provoking factor can be oxygen deficiency in the brain, high sugar, the presence of toxic substances in the body.
2. Epilepsy. This disease is very similar to tonic convulsions, which do not last long. The frequency of seizures depends largely on the severity of the disease itself. The seizure usually lasts up to 5 minutes, during which the person loses consciousness.
3. Infectious diseases. Even then, a seizure may occur. It usually begins with the mimic muscles of the face, and then falls below. In this case, everything is accompanied by profuse sweat and rapid heartbeat. Most often, convulsions occur with tetanus and polio.
4. Pregnancy. The special condition of the woman's body can contribute to the occurrence of seizures (clonic and tonic). The reason is the swelling of the brain, which is observed in late pregnancy. The seizure may be accompanied by weakness, worsening of the general condition and an increase in blood pressure.
5. Disorders in the work of the thyroid gland. Hormonal imbalances are another possible cause. Typically, seizures are characteristic of people whose thyroid gland is completely or partially removed.

As we have already understood, the causes of seizures can be different, but the root of the problem lies in the work of the nervous system.

Diagnostics

Tonic seizures can occur in both adults and children. In this case, it is very important to immediately consult a doctor. Very often, people attribute convulsions during defecation, shortness of breath, etc. to diseases of certain organs. However, it is not the case. If any symptoms of a convulsive syndrome are found, it is necessary to be examined by a surgeon, therapist, neurosurgeon, neuropathologist and psychologist. Based on the information collected, specialists will draw up a general picture of the state of human health and determine the possible causes of seizures.

At the same time, it is very important not to delay going to the hospital, since tonic convulsions can happen at any time and at the most inopportune moment. The most dangerous situation is when such problems occur in the respiratory system.

Children

Convulsions in children begin with a wandering look. The child quickly loses contact with the outside world. The symptom continues with the throwing of the head back, already known to us. Also, the child can involuntarily straighten-bend his legs and arms, close his jaws. Outwardly, the baby may turn pale dramatically.

Children are more prone to seizures, since their brain is still immature, the excitability of the nervous system is low. Under the influence of infections and toxins that enter weak vessels, convulsions can occur. Children's seizures are divided into epileptic and non-epileptic. Sometimes the latter can transform into the former. Seizures can also be a consequence of the vaccine.

newborns

In newborns, the febrile form of the syndrome is most common. It is accompanied by high body temperature, observed not only in infants, but also in children under 5 years of age. Febrile convulsions most often go away with age and do not bring much inconvenience.

Premature babies are most susceptible to tonic convulsions. The syndrome may be accompanied by vomiting, regurgitation, cyanosis, and impaired breathing. Duration about 20 minutes. Very often, tonic convulsions in newborns are associated with asphyxia and birth injuries. Asphyxia causes swelling of the brain, resulting in petechial hemorrhages. In this case, immediate help from doctors is needed, as brain atrophy may begin. Seizures in children can occur as a result of traumatic brain injuries during childbirth. There are also local tonic convulsions (on the face, hands, etc.), which disappear after the baby is taken out of the womb.

Seizures with stuttering

Tonic convulsions during stuttering bring great discomfort to the child. They are a spasm that lasts for a long time and prevents the child from talking. May occur during speech. Tonic and clonic convulsions during stuttering differ in that the latter cause a short contraction of the muscles of the speech apparatus. The speech of the child in this case resembles a conversation in the cold, resembling a shiver.

There are three degrees of severity of seizures in stuttering. In the first stage, stuttering and convulsions appear when a person speaks quickly or excitedly. Moderate severity means that the spasms are present even when the person is speaking calmly. The severe stage occurs when the convulsions are prolonged and the stuttering is continuous.

Treatment

Treating tonic seizures is not an easy task even for an experienced specialist. Professional medical help for convulsions is a must. The doctor must determine the cause of their occurrence and prescribe treatment. While the patient is taking tests to find the cause, he is prescribed drugs to normalize pressure and sedatives. In emergency cases, use drugs aimed at stopping seizures.

Treatment has three goals: maintaining vital functions for the body, getting rid of seizures and reducing

At the same time, one should not ignore such traditional medicine as tinctures and ointments. Radical measures should not be taken, but it will be useful to support the body and calm the nervous system with decoctions of herbs. Herbs such as clover, mistletoe, rhubarb leaves, sweet clover, and chamomile are excellent for relieving symptoms.

Urgent Care

An attack of tonic convulsions can happen at the most inopportune time. That is why it is very important to know how to help a person in such a situation, because a respiratory spasm may occur, which is deadly. The first thing to do is call the doctors. Only then should you start providing first aid. It is very important to provide a person with an influx of oxygen, so it is advisable to open windows, place a person closer to a source of fresh air. This will avoid oxygen starvation, as well as a number of negative consequences that arise because of this. If the person is dressed too warmly and the clothes are too tight, you may need to undress them a bit to ease the spasm. It is important to take care that a person does not damage his tongue during a seizure. To do this, place a folded towel or handkerchief in your mouth.

The person should lie on their side, as there is a possibility of vomiting. The position on the side will avoid possible suffocation by vomit. Put something soft under your head.

help yourself

Sometimes a person has to provide first aid to himself even through pain, if no one is around. If a generalized cramp has occurred, that is, one that has spread to the whole body, you will have to wait for outside help. If the cramp is local, then self-massage should be performed. It should be short-lived, but the impact must be firm. If a person is prone to seizures, you should always have a needle with you to prick a certain part of the body and relieve tension.

Preventive measures

Sometimes seizures are the result of a serious illness or injury. However, involuntary contraction of the muscles of the arm, for example, may be the result of an indifferent attitude towards one's health. To prevent the occurrence of seizures, it is very important to give the whole body feasible and regular exercise. Sport is the best prevention. Especially experts recommend jogging. Equally important is the diet, which should not contain too much junk or fatty foods. You should also exclude coffee, alcohol and tobacco from your diet.

Summing up the results of the article, I would like to say that the health of each person is in his own hands. Lead a healthy lifestyle, eat the right foods, and get out in the fresh air. Equally important is the advice to be less nervous and not worry about trifling reasons.

Tetany is a prolonged tonic convulsions in violation of calcium-phosphorus metabolism (see Hypoparathyroidism).

Tetany is a symptom complex that occurs in the form of convulsive seizures and is accompanied by severe disorders of the central and peripheral nervous system.

Etiology and pathogenesis. Tetany can occur with gastrointestinal diseases (pylorus, colitis, dysentery); with acute infectious diseases (for example,) and intoxications; with some endocrine disorders (hypoparathyroidism, Addison's disease, etc.); from sharp hyperventilation (for example, with hysteria or); after heavy operations; in women during pregnancy and lactation; in children suffering from, etc. There are cases of idiopathic tetany.

The pathogenesis of tetany is based on an increase in neuromuscular excitability resulting from a violation of acid-base balance and a decrease in the content of ionized calcium in the blood. In gastrointestinal diseases, these disorders are associated with the loss of a large amount of chlorides and hydrogen ions (as a result of loss of fluid with vomiting and diarrhea), which causes increased CO 2 binding, and increased protein breakdown, resulting in the accumulation of nitrogenous wastes and excessive intake into the blood. the increased content of which contributes to the excretion of ionized calcium from the body. Tetany during hyperventilation occurs against the background of alkalosis and hypocapnia, leading to a drop in the content of ionized calcium. Pregnant tetany occurs due to increased calcium intake by the fetus; with endocrine disorders - as a result of disorders and acid-base balance, Parathyroid tetany often occurs with complete or partial removal of the parathyroid glands, as well as due to various injuries and chronic infections (,) as a result of a decrease in the content of the parathyroid hormone. The lack of parathyroid hormone leads to hypocalcemia in two ways: primarily due to difficulty in mobilizing calcium from the depot and secondarily due to the accumulation of inorganic phosphorus in the blood.

Clinical picture(signs and symptoms). Tetany proceeds according to the type of latent and pronounced convulsive seizures. The latent (latent) form of tetany manifests itself only in the form of spasms and coldness of the extremities; sometimes it is not detected for a long time, or under the influence of any provoking factors (narcosis, infections, pregnancy, etc.), more or less obvious seizures occur.

Severe tetanic seizures occur spontaneously and are manifested by tonic muscle cramps, predominantly affecting the flexor muscles of the limbs, as well as the muscles of the face, trunk, less often the larynx and stomach. more often symmetrically capture both upper limbs, although sometimes they attack only on one side. The hand usually takes the so-called position of the obstetrician's hand, sometimes clenched into a fist with the thumb extended. The legs are also much less likely to be involved, while the leg is usually extended, bent inward, with cramps of the adductors, the legs are closely pressed against one another. Cramps of the muscles of the face are accompanied, the lips take on a typical proboscis shape. Sometimes, due to muscle spasms of the tongue, it is difficult. Cramps of the neck and back muscles are accompanied by arching of the spine. Involvement in the convulsive state of the bronchial and intercostal muscles, as well as the diaphragm, can lead to respiratory distress. Convulsions of the heart muscle lead to angina pectoris, which can result in death from cardiac arrest in systole. Cramps in the muscles of the stomach and intestines cause vomiting, and constipation, with convulsions of the bladder, urination is difficult. As a result of a violation of convergence or temporary strabismus, double vision occurs in the eyes. Muscle cramps are sharply painful. Their duration is extremely diverse: from several minutes to several hours. Seizures are sometimes rare, sometimes repeated at short intervals. After the end of the attacks, weakness and even paresis are observed.

Trousseau phenomenon- the appearance of a tonic cramp of the fingers during tetany (the so-called "obstetrician's hand") under the influence of compression of the shoulder with a tourniquet for several minutes until the blood circulation is completely stopped. Appears due to a decrease in neuromuscular tone.

convulsions- These are sudden attacks of clonic or clonic-tonic involuntary muscle contractions with or without loss of consciousness. Seizures occur as a result of an organic or functional lesion of the nervous system.

Clinical picture: Regardless of the etiology, seizures are characterized by a sudden onset, motor excitement, impaired consciousness and loss of contact with the outside world. The head is thrown back, the arms are bent at the elbow joints, the legs are extended, biting of the tongue, slowing of the pulse, slowing down or short-term cessation of breathing are often noted. Such a tonic spasm lasts no more than 1 minute. And is replaced by a deep breath and the restoration of consciousness.

Clonic convulsions begin with twitching of the muscles of the face with a transition to the limbs. Then there are noisy breathing, foam on the lips, tongue bite, increased heart rate. Convulsions can be of varying duration and follow one after another; sometimes end in death. After an attack, the patient falls asleep, and upon awakening, he may not remember anything and feel healthy.

Tetanic convulsions- these are muscle contractions that follow one after another without relaxation and are accompanied by pain.

Grand mal seizures of epilepsy: possible at any age. In 10% of cases, an aura precedes (a period of precursors). Then the patient falls screaming, he has a tonic convulsion lasting up to 30 seconds with opisthotonus, apnea, cyanosis and transition to clonic convulsions lasting up to 2 minutes, with salivation, sometimes vomiting, involuntary urination, defecation and subsequent falling asleep.

First aid:

Ensure an open airway

Relanium 2-4 ml intravenously

Anesthesiologist's consultation

General anesthesia if needed
2% solution of hexenal, or
1% solution of sodium thiopental i.v.

Hospitalization

Other articles

Emergency conditions in dentistry. Anaphylactic shock.

Anaphylactic shock is a general allergic reaction of the immediate type. 5 clinical forms of anaphylactic shock: - Cardiogenic - chest pain, angina attacks; - Intestinal - various pains in the abdomen, enhanced by peristalsis;

Emergency conditions in pediatric dentistry. myocardial ischemia. Part 6

An angina attack is myocardial ischemia due to a mismatch between myocardial oxygen demand and its actual delivery. Myocardial infarction - ischemic necrosis of the heart muscle, resulting from an acute discrepancy between myocardial oxygen demand and its blood supply through the coronary arteries of the heart.