General convulsions. Convulsive syndrome in children and the causes of its development

Cramps are involuntary, uncontrolled muscle contractions, manifested as a series of contractions and relaxations, as well as in the form of a period of tension. Depending on the number of muscles involved, localized and generalized types are distinguished.

Convulsions appear suddenly, are paroxysmal or permanent. Almost any type of seizure indicates pathological excitation of neurons in the cortex or subcortical structures brain.

In case of prolonged, severe or frequent convulsions that affect your well-being, you should immediately consult a doctor. Seizures are a symptom of many diseases, some of them can lead to loss of health, disability and lethal outcome. Therefore, when complaining of convulsions, treatment should begin immediately.

Types of seizures

Depending on the type and duration of seizures, they are divided into several types.

tonic convulsions

Tonic convulsions are a consequence of neuronal excitation in the subcortical structures of the brain. Prolonged muscle contractions hold part or all of the body in a certain position. Tonic convulsions begin gradually and can last quite a long time.

The attack may be accompanied by loss of consciousness, apnea (stop breathing), be replaced by clonic type.

The tonic type often indicates the presence of diseases caused by infections, craniocerebral injuries, epilepsy, poisoning and intoxication of the body. It can develop as a result of dehydration of the body and be a symptom of a hysterical seizure.

The classic picture of a severe tonic attack is tetanus opisthotonus. The lying body is arched, leaning on the heels and the back of the head.

The cause of tonic seizures must be established by a doctor. The specialist of first choice in this type is most often a neurologist.

Clonic convulsions

Clonic convulsions familiar to almost everyone. Rhythmic tensions and contractions, limited to one muscle or affecting several groups (for example, limbs and face), these convulsions are provoked by excitation of the cerebral cortex.

Localized clonic seizures are divided into focal and multifocal (several separate muscles at the same time). Generalized clonic convulsions are accompanied by a loss or disturbance of consciousness, a change in the rhythm of breathing, hypoxia (and, as a result, cyanosis).

The cause can be both vitamin and mineral deficiency, fatigue, dehydration, hypertension, stress, as well as serious diseases associated with high intracranial pressure and circulatory disorders in the brain. Among the diseases accompanied by clonic convulsive seizures are epilepsy, abscesses, brain tumors, consequences of TBI, eclampsia.

A classic illustration of an attack of two types, replacing each other in a convulsive attack, is an epileptic seizure.

A tonic-clonic seizure starts from the tonic stage against the background of a sudden loss of consciousness. The tension of the skeletal muscles of the body lasts up to several tens of seconds. The tonic is followed by a phase of generalized clonic seizures, about 40 seconds. The muscles of the body tense and relax alternately, convulsions are replaced by relaxation. At the clonic stage, breathing resumes, cyanosis decreases.

Tonic-clonic seizure accompanied by rolling eyeballs with white stripes of sclera, profuse salivation, when biting the tongue - with blood. The final stage is a coma, followed by sleep or brief episodes of confusion. maybe severe course coma leading to death or new series seizures.

Most often, tonic-clonic convulsions indicate epilepsy, traumatic brain injury, cerebral edema in encephalopathies and eclampsia. May also occur when high temperature(febrile convulsions), chronic poisoning carbon monoxide, lead, alcohol (without loss of consciousness). With eclampsia, a tonic-clonic seizure is accompanied by a frequent, filled pulse, high blood pressure, enhanced tendon reflexes.

Myoclonic convulsions

A variety of clonic convulsions, rhythmic or arrhythmic twitches of one or more muscles of the body, myoclonic convulsions are divided into benign (physiological) and pathological.

Physiological myoclonus includes hiccups (the reaction of the muscle fibers of the diaphragm and larynx to irritation of the vagus nerve), flinching with fright, accompanied by vegetative manifestations, and twitching during falling asleep and in sleep. In children of the first year of life, myoclonus can also accompany periods of wakefulness and are necessarily differentiated from pathological convulsions, tremors, and tremors.

If myoclonus manifests itself as a response to a stimulus, does not cause much discomfort, does not cause a deterioration in the physiological and psychological state, then there is nothing to worry about.

When myoclonic convulsions progress, affect well-being, the connection with the irritant is not traced, it is urgent to seek the advice of a doctor. Most likely, such phenomena are caused by a malfunction of the central nervous system and indicate the presence of a disease.

Pathological myoclonus is manifested by rhythmic twitches of the whole body (with a generalized form), convulsive flexion of the limbs, trembling of individual parts of the body. If myoclonus affects the muscles of the tongue and palate, the functioning of the speech apparatus, the processes of chewing and swallowing are disturbed, speech becomes illegible, food in the mouth is not processed properly.

Another difference between physiological and pathological myoclonus is the presence of seizures during sleep. Myoclonus, which is a symptom of diseases, usually manifests itself as convulsions during wakefulness, aggravated by physical exertion or stress.

Predisposition to myoclonus is genetically determined, reaching a peak of manifestations in adolescence.

A seizure is a reaction of the muscles of the body to a sudden increase in neurogenic activity in the brain. Depending on the part of the brain involved, there are partial (localized in specific muscles, limbs) and generalized, involving the whole body, seizures.

Some seizures are so weak that they go unnoticed both by others and by the person himself. According to studies, 2% of people experience at least one seizure during their lifetime.

Partial seizures

Partial seizures are provoked by the pathological activity of an isolated group of neurons and are localized in separate group muscles or body parts. In this case, the location of the zones that control the muscles in the brain has an influence, and not the proximity of the parts of the body involved in convulsions. For example, cramps in the fingers or hands may be accompanied by contractions of the facial muscles.

Sometimes cramps that begin locally in a part of a limb, such as a foot, spread to the entire limb. This phenomenon is called the "Jacksonian march".

Partial convulsive seizures are divided into simple (without impaired consciousness, a person adequately perceives and reacts to what is happening) and complex (with impaired consciousness and unconscious behavior). If a person on the background of a seizure cannot fulfill a simple request (stretch out a hand, sit down), the condition is described as a complex seizure.

At complex type the phenomenon of automatism is characteristic: the repetition of the same words, movements, walking in circles. The duration of the state is a couple of minutes. At the end of the attack, the person may lose consciousness and almost never remember what happened.

Simple partial seizures can turn into complex and secondary generalized (with Kozhevnikov epilepsy)

Generalized seizures - when "cramps the whole body."

Generalized seizures include tonic-clonic and myoclonic. Such seizures are characterized by the inclusion of many muscles in the process, the sensation of "convulsing the whole body."

Occasionally, a tonic-clonic seizure is accompanied by only tonic or only clonic convulsions. At the end of the attack, drowsiness or coma occurs, consciousness is not restored immediately. Often, an attack that has passed without witnesses can only be guessed by the feeling of weakness, abrasions, wounds on the tongue, muscle pain from cramps and strokes.

A myoclonic seizure is a very short attack of rhythmic or chaotic muscle contractions, sometimes accompanied by clouding of consciousness, but the seizure time is so short that the change in consciousness is practically not noticed by either the person or others.

Common Types of Seizures

Some convulsive manifestations are quite common and are in the nature of a symptom of a temporary painful condition. In other cases, convulsions can accompany a person throughout life. Depending on the cause of seizures, type of seizure, age and status of the person, specialists choose the type of therapy. However, always with complaints of convulsions, treatment and therapy are not aimed at the symptom, but at the underlying disease.

Febrile convulsions

Two and a half millennia ago, in the treatise On the Sacred Disease, Hippocrates described febrile convulsions as a symptom most common in children under 7 years of age. Modern studies confirm that convulsions against the background of hyperthermia develop mainly in children aged six months to five years. Febrile seizures in adults are quite rare and are caused not only by an increase in body temperature.

Peak febrile seizures falls between the ages of 18 and 22 months. Boys are prone to convulsive attacks on the background of high fever more often than girls. In different regions of the world, the prevalence of the phenomenon is statistically heterogeneous. On average, seizures at a temperature occur in 2-5% of children of the corresponding age group. In closed populations and on islands, this figure reaches 14%, which confirms the presence of a genetic predisposition.

It is important to distinguish true febrile seizures in children from a combination of high fever and an illness that causes convulsive conditions. Convulsions at a temperature can be both caused by hyperthermia, and be febrile-provoked seizures, symptoms of some forms of epilepsy.

Convulsions at a temperature in children are usually divided into simple and atypical.

The simple form accounts for ¾ of all febrile seizures, typical for children from 6 months to 5 years old from families burdened by a hereditary tendency to febrile convulsions or cases of epilepsy. Simple (typical) convulsions at temperature last less than 15 minutes (usually 1-3 minutes), with single episodes against the background of fever, partial components are not observed. Attacks stop on their own, and with antipyretics they do not appear against the background of a decrease in body temperature.

When examining a child, neurological symptoms and EEG abnormalities are not detected, with rare minor exceptions.

Complicated febrile seizures (atypical) are characterized by several series of seizures that follow one after another. They develop at the age of up to a year, as well as after five years. Subsequent spontaneous remission may be replaced by afebrile (not dependent on temperature) psychomotor seizures and temporal lobe epilepsy in children older than 9 years.

Only 3% of all febrile seizures are subsequently manifested by epilepsy. However, if there is even a single attack, an examination by a doctor is necessary to diagnose and prevent subsequent diseases.

Convulsions at a temperature in adults

As a rule, adults do not suffer from febrile convulsions. If a high body temperature is accompanied by a seizure, an urgent consultation with a specialist is necessary to determine true reason. Convulsions at a temperature in adults may indicate neuroinfections, poisoning, and other diseases. Differentiation of febrile seizures from a convulsive state caused by other reasons helps to make a correct diagnosis, maintain health and prevent serious complications from developing.

Convulsions during pregnancy can develop due to physiological stress on the body, be a consequence pathological course and be a symptom concomitant diseases not related to childbearing.

One of the frequent phenomena during pregnancy is calf muscle cramps caused by vitamin and mineral deficiencies. Often the second and third trimesters are accompanied by painful spasms of the calf muscles in pregnant women.

Most common cause- low content of potassium, calcium and magnesium in the blood, provoking pain and cramps in the muscles both day and night. A growing fetus requires an increase in the amount nutrients. Often, magnesium deficiency does not occur due to a lack of this element in food or in vitamin preparations, but as a result of poor absorption against the background of low calcium in the blood. It must be remembered that the absorption of magnesium and calcium by the body is a balanced process, with a low content of one element, the second is poorly absorbed.

Such conditions are normalized when foods rich in essential minerals, medicines or complexes of supplements for pregnant women.

Eclampsia (other Greek - outbreak) of pregnant women - dangerous state for both baby and future mother. The condition is characterized by edema and high blood pressure and refers to late toxicosis of pregnancy, manifested in the third trimester.

Developing during pregnancy, eclampsia can occur during gestation, during childbirth or in the postpartum period.

Eclamptic seizures are tonic-clonic, starting with loss of consciousness. Seizure precursors may include headaches, edema, and nephropathic manifestations. In the process, fibrillar contractions of the muscles of the face (10-30 seconds) are replaced by tonic convulsions with cyanosis, respiratory disorders, eyes roll back. The duration of tonic convulsions is up to 20 seconds.

The tonic stage is replaced by the clonic one, with contractions and relaxation of the muscles of the body and limbs (1-1.5 minutes). Often salivation, the allocation of foam with blood from the mouth, bruises, fractures.

The eclamptic seizure usually ends in a coma. During or after an eclamptic attack, death is possible due to cerebral hemorrhage, asphyxia, and pulmonary edema. The child in the process experiences acute hypoxia, which also has an extremely negative effect on his condition.

After a successful exit from a coma, the development of aspiration pneumonia, hepatic and renal insufficiency.

Eclampsia is a serious disease of pregnant women. Its occurrence cannot be predicted, although among the factors contributing to the development of eclampsia, there are genetic predisposition, heredity, the presence of preeclamptic episodes in previous pregnancies, multiple pregnancies, obesity, diabetes, kidney disease and of cardio-vascular system. Also at risk are expectant mothers over 40 years old, especially with the first pregnancy, as well as a break between bearing children for more than 10 years.

Timely diagnosis eclampsia will help reduce the chances of having an attack. With the threatening development of eclampsia, early delivery with mandatory monitoring in the postpartum period is strongly recommended.

Differentiation of the phenomenon of convulsions during pregnancy, caused by pathologies of gestation, from other convulsive seizures, has importance when choosing therapy. Pre-pregnancy examination, family history taking, genetic counseling are the key to successful preventive measures to prevent conditions life threatening mom and baby.

Convulsions after physical exertion occur as a result of an overstrain of the body with a disease that manifests itself in convulsive seizures, or manifest itself as a reaction to a decrease in the level of electrolytes (magnesium, calcium) in the blood.

In some diseases, poisonings, infections, areas of the brain can function unstably, causing convulsive phenomena. In such cases, the prevention and treatment of seizures will be the treatment of the underlying disease.

Cramps of the calf muscles

If a person is healthy, cramps after exercise may be manifested by muscle spasms. Starting in the calf muscle, the spasm can spread to the foot and thigh area. Neither beginners nor professional athletes are immune from such manifestations.

Cramps of the calf muscles most often accompany sports such as running, walking, jumping, swimming. The cause of spasms, often referred to as cramps (sometimes they use the word crumpy, tracing paper with English word cramp - spasm), there can be both a hereditary predisposition, and the consequences of diseases and temporary conditions of the body.

Factors that cause cramps in the calf muscles include:

• dehydration. The most common cause in sports caused by profuse sweating, loss of moisture when breathing through the mouth, non-compliance water balance organism;
• mismatch between consumption and assimilation minerals(potassium, magnesium);
• iron deficiency or vitamin E surplus.

Myoclonus that occurs during physical exertion is also distinguished. Sudden single or serial contractions, cramps during exercise, or physical work, not causing strong pain are called benign myoclonic seizures. Such attacks go away on their own and do not require medical intervention.

Convulsions during movement

Doing healthy lifestyle life, observance, correct mode training, work and rest will help to avoid such a phenomenon as cramps during movement caused by violations water-salt balance stress, micronutrient deficiencies. It is also necessary to remember the importance of warming up before training, replenishing the cost of water and minerals.

With complaints of convulsions, treatment is carried out by restoring the water-salt balance, massage, and maintaining a healthy lifestyle. It helps to introduce foods rich in potassium, magnesium, calcium into the diet: cottage cheese, cheeses, bananas, sauerkraut, legumes.

With a painful spasm, self-massage, pinching the lower leg, pulling on the foot or big toe helps. In cases of severe spasms, physiotherapy and acupuncture are also prescribed. With prolonged, painful, unusual sensations of muscle cramps after training, a doctor's consultation is necessary.

If it is known about the presence of a disease that is manifested by convulsions, then convulsions during movement can only be avoided by treating the main cause of seizures.

Seizures as a symptom of diseases of the body

True convulsions are caused by excitation of the neurons of the cortex or subcortical structures of the brain. Therefore, any convulsive phenomenon should cause close attention to human health and a visit to the doctor.

Convulsions in a child must be distinguished from tremors or tremors - frequent physiological manifestations of the immaturity of the nervous system of children. Alarming manifestations include both myoclonus and convulsions at a temperature in newborns. These manifestations may indicate serious illnesses, developmental disorders, infections.

Sometimes a child's seizures may go unnoticed due to the short duration of the seizure and the children's inability to describe how they feel. Any deviation from normal behavior and response should be noted for consultation with a pediatrician.

Seizures in adults

Convulsions in adults are manifested both in chronic diseases and in temporary pathological, painful or physiological conditions. Depending on the etiology of the phenomenon, various specialists deal with the symptom.

It is often believed that convulsive seizures are the lot of patients with epilepsy. However, the causes of seizures in adults are many, including infections transmitted by ticks, carbon monoxide poisoning, or an excess of alcohol (including a single one). Some convulsive conditions are signs serious illnesses leading to health problems or death. In the presence of frequent, painful convulsions, convulsive seizures, it is urgent to contact the clinic.

Seizures during stress, as a rule, a manifestation of unstable work brain structures. Such a symptom may indicate the presence of a disease or infection, exacerbated by stressful experiences, and require immediate medical attention.

Conditionally harmless cramps during stress can be considered cramps - cramps of the calf muscles. Most often they occur due to the high consumption of magnesium by the body during nervous stress, as well as non-compliance with the diet when stressful conditions. A large amount of black coffee, a companion of tense situations, also contributes to the “washing out” of beneficial minerals from the body and can lead to neuroticism and muscle spasms.

Seizures: causes and treatment

The causes of true convulsions are rooted in the excitation of the neurons of the cortex and subcortical structures of the brain. Most often, speaking of convulsions, they mean muscle spasms, and not convulsive seizures. The treatment of true convulsive seizures depends on the etiology of the disease that caused the seizures.

Most often, muscles cramp when dehydrated or lack of magnesium in the body. Such spasms do not belong to true convulsions, and appear as individual symptom against the background of physical exertion, stress, during pregnancy and other conditions that cause a violation of the water-salt balance. These may also include frequent visits to the bath, frequent use of alcohol, coffee, diuretics.

If the muscles cramp repeatedly, the attack is prolonged, accompanied by neurological symptoms, temperature, respiratory disorders, consciousness - it is urgent to contact a specialist. A similar picture accompanies both violations of body functions and diseases that can lead to death without immediate medical intervention.

Spasms at night or myoclonus?

Spasms at night are often a manifestation of myoclonus. Repetitive or single muscle twitches in the limbs occur at the border of wakefulness and sleep and are called benign myoclonus. Unlike pathological myoclonus, such attacks do not require treatment and are provoked by physical or mental stress during the day.

In children, such convulsions at night appear as a response to a large number of impressions or high physical activity.

Sometimes nocturnal tonic convulsions are the result awkward position limbs, accompanied by stretching of the muscle. Most often, such cramps at night disrupt the sleep of older people, but they can interfere with sleep at any age.

Painful spasms at rest are usually provoked by metabolic disorders, lack of minerals and salts, and dehydration of the body. That is why cramps at night often indicate non-compliance with the rules of nutrition.

Swimming is a load for the whole organism. Most often, convulsions occur when swimming as a response to physical activity or due to a violation of the water-salt balance (which is especially typical for scuba diving, when breathing through the mouth causes moisture loss through the mucous membrane).

The second reason why cramps often occur during swimming is the stretching of the leg muscles during unusual movements.

The most characteristic cramps in the legs during swimming are localized tonic.

Leg cramps while swimming

Leg cramps during swimming are provoked by physical activity, a change in temperature. Most often reduces calf muscles. The spasm itself does not pose a threat, but fear and pain leg cramps can cause a person to panic and drown.

To relieve spasm, you need to calm down, pull on yourself thumb feet, if necessary, conduct a series of pinches of the reduced muscle.

Finger cramps can develop in professional musicians and dancers, and also manifest themselves with a slight load on the limbs. The main causes of finger cramps:

• circulatory disorders in the limbs due to the structure, injuries, hypothermia, occupational hazards;
• physical activity of the fingers, especially accompanied by sprain;
• hypocalcemia, lack of calcium in the daily diet or impaired absorption;
• food, alcohol, chemical poisoning, neuroinfections.

As therapeutic and preventive measures, physiotherapy is used to restore blood supply, including self-massage, a sparing exercise regimen and calcium preparations are prescribed. Such therapy can reduce the frequency and have a preventive effect.

Seizures: drug treatment

The drugs used in drug therapy convulsive conditions depend on the etiology of the underlying disease. Anticonvulsants are often used to relieve a seizure and subsequent prevention. However, for convulsive events, drug treatment is generally aimed at treating the disease or condition causing the symptom.

All severe convulsions, regardless of the frequency of manifestation, are due to a factor requiring medical intervention.

When complaining of convulsions, the cause and treatment are carried out by various specialists. In order to correctly compose a picture of the phenomenon and help in determining the diagnosis, when contacting a specialist, you must have answers to the following questions:

• seizure duration, start and end time;
• what preceded severe convulsions: stress, pain, strange sounds, sensations, smells;
• the presence of comorbidities and physiological states: pregnancy, SARS, physical training;
• whether there was a loss of consciousness during the attack, whether there were strong convulsions or mild ones, what movements were made, what else accompanied the attack;
• how the seizure ended, whether there are clear memories of what happened.

Severe convulsions are the reason for the immediate consultation of a doctor.

epileptic convulsions

Epileptic convulsions are of varying strength and duration of manifestation. To differentiate convulsive conditions caused by epilepsy from other causes, an examination of the patient is required.

Contrary to popular belief, epileptic convulsions are characterized not only by the picture of a tonic-clonic convulsive seizure, but can also pass almost imperceptibly to outsiders. The epiactivity of the brain in such cases is recorded during special studies in clinics. If epileptic seizures are suspected, the search for the cause and treatment should be carried out as early as possible.

Psychogenic convulsions caused by hysterical conditions differ from generalized convulsive seizures. Despite the outward resemblance, convulsions in hysteria do not manifest themselves in sleep, they occur more often in a sitting or lying position. There is no change in the skin of the face (or there is redness), movements are asynchronous, no involuntary urination, rolled eyes, severe injuries to the limbs.

At the end of the attack are not observed (or are demonstrative) phenomena of confusion.

Convulsions in neuroinfections and TBI

Seizures in neuroinfections and craniocerebral injuries are a symptom of impaired brain activity. Seizures can be severe, move into the next series of seizures and cause severe complications in addition to the underlying disease.

Any convulsive seizure is a reason to immediately call specialists.

Degenerative changes in the spinal region can also cause seizures, known as pathological cramps. Painful spasms occur in the presence of osteochondrosis lumbar, ischalgia.

Therapy of seizures in this case is directly related to the treatment of a degenerative disease that caused changes in the body.

Seizures - a reason to see a doctor

Physiological convulsions, benign myoclonus, single spasms, as a rule, do not require medical intervention and pass on their own. However, repeated convulsions that cause discomfort, convulsive seizures that affect well-being, both physical and mental, should be the reason for an early visit to the doctor. Timely diagnosis of the causes of seizures, treatment and prevention painful conditions- a pledge to maintain and preserve human life.

This is one of the most formidable complications of neurotoxicosis, increased intracranial pressure and cerebral edema.

Cramps are involuntary muscle contractions. Most often, seizures are a response of the body to external annoying factors. They appear in the form of seizures that continue different times. Seizures are observed in epilepsy, toxoplasmosis, brain tumors, mental factors due to injuries, burns, poisoning. Seizures can also be caused by acute viral infections, metabolic disorders, water-electrolyte (hypoglycemia, acidosis, hyponatremia, dehydration), dysfunction endocrine organs(adrenal insufficiency, pituitary dysfunction), meningitis, encephalitis, impaired cerebral circulation, coma, arterial hypertension.

convulsive syndrome by origin, they are divided into non-epileptic (secondary, symptomatic, convulsive seizures) and epileptic. Non-epileptic seizures may later become epileptic.

The term "epilepsy" refers to repeated, often stereotyped seizures that continue periodically for several months or years. At the heart of epileptic, or convulsive seizures, is a sharp violation electrical activity cerebral cortex.

Clinic

The attack usually lasts for 1-2 minutes, and then the patient falls asleep. A short sleep is replaced by apathy, fatigue and confusion.

Status epilepticus is a series of generalized convulsions that occur at short intervals (several minutes), during which consciousness does not have time to recover. Status epilepticus may occur as a result of a past brain injury (for example, after a cerebral infarction). Long periods of apnea are possible. At the end of the seizure, the patient is in a deep coma, the pupils are maximally dilated, without reaction to light, the skin is cyanotic, often moist. In these cases, it is required immediate treatment, because cumulative action Generalized and cerebral anoxia caused by repeated generalized seizures can lead to permanent brain damage or death. The diagnosis of status epilepticus is easily made when repeated convulsions are interspersed with a coma.

Urgent care

Prevent tongue retraction;
. If necessary - restoration of cardiac activity ( indirect massage hearts);
. Ensure adequate oxygenation or access fresh air;
. Prevent injury to the head and torso;
. dotted peripheral vein, install a catheter, set up an infusion of crystalloid solutions;
. Provide physical methods of cooling for hyperthermia (use wet sheets, ice packs on large vessels neck groin areas);
. To stop the convulsive syndrome - intravenous administration of diazepam (sibazon) 10-20 mg (2-4 ml), previously diluted in 10 ml of 0.9% sodium chloride solution. In the absence of effect - intravenous administration of sodium oxybutyrate at the rate of 70-100 mg / kg of body weight, previously diluted in 100-200 ml of 5% glucose solution. Enter intravenously drip, slowly;
. If convulsions are associated with cerebral edema, intravenous administration of 8-12 mg of dexamethasone or 60-90 mg of prednisolone is justified;
. Decongestant therapy includes intravenous administration of 20-40 mg of furosemide (lasix), previously diluted in 10-20 ml of 0.9% sodium chloride solution;
. For relief of headache, intramuscular injection of analgin 2 ml of a 50% solution or baralgin 5.0 ml is used.

Status epilepticus care is carried out according to the algorithm given for helping with convulsive seizures. Add to therapy:
. Inhalation anesthesia nitrous oxide with oxygen in a ratio of 2:1
. With an increase blood pressure above the usual figures, intramuscular administration of dibazol 1% solution of 5 ml and papaverine 2% solution of 2 ml, clonidine 0.5-1 ml of a 0.01% solution intramuscularly or intravenously slowly pre-diluted in 20 ml of 0.9% sodium chloride solution.

Patients with the first seizures in their lives should be hospitalized to find out their cause. In the case of relief of both a convulsive syndrome of known etiology and post-seizure changes in consciousness, the patient can be left at home with subsequent observation by a polyclinic neurologist. If consciousness is restored slowly, there are cerebral and / or focal symptoms, then hospitalization is indicated. Patients with stopped status epilepticus or a series of convulsive seizures are hospitalized in multidisciplinary hospital with neurological and intensive care unit(department intensive care), and in case of convulsive syndrome, presumably caused by traumatic brain injury, to the neurosurgical department.

The main dangers and complications are asphyxia during a seizure and the development of acute heart failure.

Note:
1. Aminazine (chlorpromazine) is not an anticonvulsant.
2. Magnesium sulfate and chloral hydrate are not currently used for the relief of convulsive syndrome due to low efficiency.
3. The use of hexenal or sodium thiopental to relieve status epilepticus is possible only in a specialized team, if there are conditions and the possibility of transferring the patient to a ventilator if necessary (laryngoscope, a set of endotracheal tubes, a ventilator).
4. In case of hypocalcemic convulsions, calcium gluconate (10-20 ml of a 10% solution intravenously), calcium chloride (10-20 ml of a 10% solution strictly intravenously) are administered.
5. With hypokalemic convulsions, Panangin (potassium and magnesium asparaginate) 10 ml is administered intravenously.

Sakrut V.N., Kazakov V.N.

Convulsive syndrome is a non-specific reaction of the body to external and internal stimuli, which is characterized by sudden and involuntary attacks of muscle contractions. Seizures appear against the background of pathological synchronized activity of a group of neurons and can occur both in an adult and in a newborn baby. To determine the cause of this phenomenon, as well as to further treatment medical advice is needed.

According to statistical studies, convulsive syndrome in children occurs in 17-25 cases out of a thousand. In preschool children, this phenomenon is observed five times more often than in the general population. Wherein most of seizures occur in the first three years of a child's life.

Varieties of seizures: a brief description

Muscle contractions in convulsive syndrome can be localized and generalized. Local (partial) cramps spread to a specific muscle group. In contrast, generalized convulsive seizures cover the entire body of the patient and are accompanied by foam at the mouth, loss of consciousness, involuntary defecation or urination, biting of the tongue and periodic respiratory arrest.

According to the symptoms, partial seizures are divided into:

1. Clonic convulsions. They are characterized by rhythmic and frequent muscle contractions. In some cases, they even contribute to the development of stuttering.
2. Tonic convulsions. They cover almost all the muscles of the body and can spread to the respiratory tract. Their symptoms include slow muscle contractions over a long period of time. At the same time, the patient's body is elongated, the arms are bent, the teeth are clenched, the head is thrown back, the muscles are tense.
3. Clonic-tonic convulsions. it mixed type convulsive syndrome. AT medical practice it is most often observed in coma and shock states.

Causes of the syndrome

The reasons for the development of this syndrome include congenital defects and pathologies of the central nervous system, hereditary diseases, tumors, impaired functioning of the cardiovascular system, and much more. Convulsive syndrome in children often occurs against the background of severe emotional overstrain or sharp increase body temperature.

The most common causes of convulsive syndrome, depending on the age of a person, are presented in the table:

It can be concluded that the manifestation of convulsive syndrome in both adults and children can be associated with a number of reasons. Therefore, his treatment will be based primarily on the search for the factor that provoked the manifestation of this syndrome.

Seizures in a child: features

Symptoms of convulsive syndrome in children appear at the beginning of the attack. The child's gaze suddenly becomes wandering, and he gradually loses contact with the outside world. In the tonic phase, this syndrome in children may be accompanied by tilting the head back, closing the jaws, straightening the legs, bending the arms in elbow joints and blanching of the skin.

The most common form of seizures in children is called febrile. As a rule, it develops against the background of a sharp increase in body temperature, observed in infants and children under the age of 5 years. At the same time, there are no signs of an infectious lesion of the meninges of the brain. The outcome of the course of febrile convulsions in most cases is favorable. It is necessary to distinguish a single case of febrile seizures from epilepsy.

Convulsive syndrome in newborns is manifested in 1.4% of full-term and 20% of premature babies. This condition occurs with regurgitation, respiratory distress, vomiting, cyanosis, and most often does not exceed 20 minutes. The occurrence of this syndrome in newborns requires immediate examination, as it may be associated with birth trauma, heredity and other factors.

Urgent care

Emergency care for a convulsive syndrome can be provided by anyone. The most important thing is that he be able to recognize the type of seizures and understand which one first aid should be given to the victim. In order to prevent serious damage to the patient's body, the actions of the person providing first aid must be accurate and consistent.

First aid is of great importance in this syndrome! It can be conditionally considered the first stage in the treatment of this pathology, because in its absence there is a possibility of a fatal outcome.

Imagine the situation. Your acquaintance with whom you are talking suddenly falls to the ground. His eyes are open, his arms are bent, and his torso is extended. Wherein skin covering the victim turns pale, and breathing practically stops. Moreover, it takes additional damage when it hits the ground. Therefore, it is very important, if you can react, to try to prevent a person from falling.

Immediately call an ambulance, specifying that the person has started having seizures and needs emergency help!

Then you should ensure the flow of fresh air to the patient. To do this, remove tight clothing, unbutton the shirt collar, etc. It is also necessary for him to put a folded handkerchief or a small towel in his mouth so that he does not bite his tongue and break his teeth. Turn the victim's head or entire body to the side. These actions are a preventive measure against suffocation, because in this way possible vomit will come out without any harm.

Note! It is very important to remove from the victim all objects that during an attack can injure him. You can put something soft under your head, such as a pillow.

If a seizure the child was preceded by strong crying and hysteria, and during the attack there is a change in complexion, fainting, violation of cardiac activity, it is necessary to prevent respiratory failure of the victim. Namely, splash water on your face, let it breathe ammonia, wrap a spoon with a clean cloth and press it with a handle on the root of the tongue. Try to calm and distract the child.

Treatment of a convulsive syndrome

Treatment of convulsive syndrome in children and adults begins with determining the factor that provoked its appearance. Examination and personal examination of the patient is carried out. If a this syndrome arose, for example, due to a fever or an infectious disease, then its symptoms will disappear on their own after the treatment of the underlying disease.

After providing first aid, doctors usually prescribe the following treatment:

1. Reception sedatives(Seduxen, Trioxazine, Andaxin).
2. Relief of convulsive syndrome with severe seizures is possible only with intravenous administration drugs (Droperidol, sodium hydroxybutyrate and others).
3. Not less than milestone in the treatment of this syndrome is good nutrition recovery normal functioning organism.

The diagnosis of "convulsive syndrome" indicates the presence of seizures that can occur against the background of many diseases, injuries and other phenomena. When they appear, depending on their scale, it is important to provide the patient with correct, emergency care and call a doctor for examination and treatment.

Convulsive syndrome is a universal reaction of the body to various influences. All involuntary muscle contractions are called convulsions. Such involuntary movements may be local in nature, covering a separate part of the body. There may be generalized cramps that cover many muscle groups.

Convulsive syndrome is caused by spontaneous discharges that the brain sends. It is they who cause involuntary contractions - convulsions.

Types of seizures

Types of seizures are distinguished into tonic, clonic and clonic-tonic types of seizures.

• Tonic convulsions cover the muscles of the trunk, face, neck, arms. May spread to the respiratory tract. When they manifest, the arms are bent, the torso is elongated, the muscles are tense. The patient's head is thrown back, the teeth are clenched, there may be a tilting of the head to the side. The patient often loses consciousness. This type of seizure is characterized by slow muscle contractions.
• Clonic seizures - this convulsive syndrome is characterized by frequent rhythmic muscle contractions. They can be either general or local. So, local clonic convulsions cause hiccups. Clonic seizures extend to respiratory system. They cause stuttering.
• The mixed type of seizures is called clonic-tonic. This convulsive syndrome most often occurs in shock and coma.

Convulsive syndrome - causes

Causes of convulsive syndrome may be various diseases nervous system.

Convulsive syndrome is caused by such diseases as epilepsy, hypertensive crisis, neuroinfections. Traumatic brain injuries of varying severity, as well as their consequences.

Seizures can also be caused infectious diseases such as tetanus and rabies.

In children, convulsions are caused by high body temperature.

Convulsive syndrome causes toxic processes in the body. So, kidney failure can cause seizures. Also, convulsive syndrome can be caused by various alcohol poisoning, household chemicals, carbon monoxide, other poisonous drugs. With a hypoglycemic coma, the body reacts with a convulsive syndrome. This syndrome is also manifested in acute thyroid insufficiency.

Convulsions cause violations of the water-salt balance of the body, as well as eclampsia and heat stroke. Moreover, hysteria can also cause seizures.

Urgent care

Emergency care for a convulsive syndrome primarily requires that the person who provides care knows what type of seizures accompanies the patient in order to correctly determine what first aid he requires.

During an epileptic seizure, the patient suddenly loses consciousness. Falls. May cause serious injury or damage. With epilepsy, the patient's torso is extended, arms are bent. His face turns pale, his breathing stops. His jaws are tightly clenched, his eyes are open. The pupils of the patient with an epileptic seizure do not react to light.

It is important to prevent a traumatic fall of the patient at the onset of a seizure. It is necessary to prevent biting of the tongue during convulsions. But at the same time, it is impossible to forcefully open the patient's mouth, insert any objects into the mouth. During the attack, the patient's jaws close strongly, he can bite the object put into his mouth, choke on its fragments. If the object is metal, then the patient runs the risk of being left without teeth, breaking them against the metal. An epileptic seizure can be caused by refusal to take drugs, an attached infection. To prevent seizures, diazepam tablets can be recommended to the patient.

Emergency care for convulsive syndrome from epilepsy is such that, first of all, the patient must be put on something soft and flat. To do this, you can put a blanket, clothes or something soft under it so that the patient does not damage the beating parts of the body. It is also necessary as soon as possible to rid the patient of all kinds of belts, belts, ties, as well as unbutton the buttons on the clothes. The patient's head must be turned on its side so that it does not choke on its saliva.

Until the seizure is over, you need to hold the legs and arms of the patient a little, but do not hold by force. So that the patient does not bite his tongue and does not break his teeth, put a folded handkerchief or towel in his mouth between his teeth. But if the patient's jaws are strongly compressed, then there is no need to try to unclench them by force.

With convulsions that are caused by tetanus, the patient makes chewing movements. He has a convulsive grimace on his face. Breath holding develops. Convulsions in a patient can be caused by bright light, noise. The best prevention for tetanus is a timely vaccination. Emergency care for this type of convulsive syndrome should only be carried out by a doctor. You can only prevent the patient from falling, make sure that he is not injured during a seizure.

convulsive syndrome caused by various tumors brain, appear locally. Often the tumor does not manifest itself. The patient should be suspicious of convulsions that occur without visible reasons. When convulsions appear, help the patient to take a comfortable position. Have him sit down. Prevent him from falling. Mandatory hospitalization of the patient with subsequent diagnosis is necessary.

In rabies, convulsions are tonic in nature. There is a spasm of the pharynx. The patient is active, on the face all the signs of arousal. He jumps up and screams. Convulsions appear at the sight of water or the sound of flowing water. Rabies is a very dangerous disease. A patient with such a diagnosis should be treated only in a hospital. The best prevention is mandatory vaccinations pets. In case of a bite by a pet, and even more so by rabid or wild animals, it is necessary to undergo a diagnosis and be vaccinated against rabies.

With a decrease in calcium in the blood, the patient experiences local convulsions. Yes, such a sharp decline calcium is observed in diseases thyroid gland, its damage. Such convulsions rarely lead to loss of consciousness. Most often, such a convulsive syndrome is manifested by a tremor of the hands. Emergency care for a local type of convulsive syndrome is not provided, since the patient does not require outside intervention. To alleviate the patient's condition, it is necessary to take adequate treatment.

Convulsions often accompany a hysterical state. In hysteria, the patient rarely loses consciousness. If the loss of consciousness has occurred, then the pupils of the patient react sharply to light. His movements are often theatrical. With hysteria, the patient can bite his lips, tongue, wring his hands, beat on the floor, walls. To alleviate the state of hysteria, it is necessary to give the patient sedatives, remove the audience. Outside help is needed for such a patient. He should help the patient stop the seizure. In case of loss of consciousness, injuries that may be caused by a fall must be prevented.

Convulsive syndrome in children

Convulsive syndrome in children can be caused by the immaturity of brain structures. Most often, seizures in children occur with an increase in body temperature. At high body temperature, the child develops clonic or tonic-clonic convulsions. They are dangerous, since the basis of such convulsions is cerebral edema. To relieve such convulsions, the child is given antipyretic drugs.

Emergency care for convulsive syndrome in children is physical methods body cooling, cool baths rubbing with cool water. It is important not to wrap up the child, so as not to cause an even higher temperature increase. let's plentiful drink. Can be given and anticonvulsants: diazepam, put an enema with hydrochloride, make an injection of magnesium sulfate.

In children, convulsive syndrome develops when birth defect heart, cerebrovascular disease, due to previous diseases. Most often, such convulsions begin in the first year of a child's life. They are difficult to treat. It is impossible to treat seizures separately from the underlying disease. Treatment should only be carried out by a doctor. With the manifestation of convulsions, the child rarely loses consciousness. It is important to observe the position of the child's body so that during an attack he receives enough oxygen.

Often convulsions in children develop against the background of neuroses. They are subject to children with unstable mentality, older than 3 years. They are characterized by tonic-clonic convulsions, blue nasolabial triangle, short-term respiratory arrest. If during an attack the child is given increased attention, then the attack intensifies. During such an attack, it is important to allow the child to calm down, not to provoke a new attack. With frequent manifestations, it is necessary to see a neurologist.

The dangers of seizures

The dangers of convulsive syndrome lies in the fact that convulsions can cause swelling of the brain, respiratory arrest, damage the vascular and cardiac systems. They are the harbingers of many dangerous diseases. Never self-medicate in an attempt to relieve or alleviate a seizure.

Convulsive syndrome is caused by many diseases. The doctor should remove the consequences of the convulsive syndrome itself. An outside observer can only provide emergency care for a convulsive syndrome, which is associated with controlling the position of the body, releasing the patient's airways during a seizure. Do not give any medicines that are not prescribed by a doctor.

Only in some cases the patient can be helped independently. Such cases include an increase in body temperature in a child, hysteria and childhood neuroses. With convulsions that are associated with them, you must act on your own. And only then get a doctor's advice.