How do seizures manifest in adults? Convulsive syndrome in children

In today's article, we will talk about such a frequent, but rather unpleasant phenomenon as a convulsive syndrome. In most cases, its manifestations look like epilepsy, toxoplasmosis, encephalitis, spasmophilus, meningitis and other diseases. From a scientific point of view, this phenomenon is referred to as a disorder of the functions of the central nervous system, which is manifested by joint symptoms of clonic, tonic or clonic-tonic uncontrolled muscle contraction. In addition, quite often a concomitant manifestation of this condition is a temporary loss of consciousness (from three minutes or more).

Convulsive syndrome: causes

This condition may occur due to the following reasons:

• Intoxication
• Infection.
• Various damage.
• Diseases of the central nervous system.
• A small amount of macronutrients in the blood.

In addition, this condition can be a complication of other diseases, such as the flu or meningitis. Particular attention should be paid to the fact that children, unlike adults, are much more likely to suffer from this phenomenon (at least once every 5). This happens due to the fact that they have not yet fully formed the structure of the brain, and the processes of inhibition are not as strong as in adults. And that is why, at the first signs of such a condition, an urgent need to contact a specialist, as they indicate certain violations in the work of the central nervous system.

In addition, convulsive syndrome in adults can also appear after severe overwork, hypothermia. Also, quite often this condition was diagnosed in a hypoxic state or in alcoholic intoxication. It is especially worth noting that a variety of extreme situations can lead to seizures.

Symptoms

Based on medical practice, we can conclude that convulsive syndrome in children occurs quite suddenly. Appears motor excitement and a wandering look. In addition, there is a tilting of the head and closing of the jaw. A characteristic sign of this condition is flexion upper limb in the wrist and elbow joints, accompanied by straightening of the lower limb. Bradycardia also begins to develop, temporary respiratory arrest is not excluded. Quite often during this condition, changes in the skin were observed.

Classification

According to the type of muscle contractions, convulsions can be clonic, tonic, tonic-clonic, atonic and myoclonic.

By distribution, they can be focal (there is a source of epileptic activity), generalized (diffuse epileptic activity appears). The latter, in turn, are primary generalized, which are caused by bilateral involvement of the brain, and secondary generalized, which are characterized by local involvement of the cortex with further bilateral distribution.

Seizures can be localized in facial muscles, limb muscles, diaphragm and other muscles of the human body.

In addition, there are convulsions simple and complex. The main difference between the second and the first is that they have no disturbances of consciousness.

Clinic

As practice shows, the manifestations of this phenomenon are striking in their diversity and can have a different time interval, form and frequency of occurrence. The very nature of the course of seizures directly depends on the pathological processes, which can be both their cause and play the role of a provoking factor. In addition, the convulsive syndrome is characterized by short-term spasms, muscle relaxation, which quickly follow each other, which later causes a stereotypical movement that has a different amplitude from each other. It appears due to excessive irritation of the cerebral cortex.

Depending on muscle contractions, convulsions are clonic and tonic.

• Clonic refers to rapid muscle contractions that continuously replace each other. There are rhythmic and non-rhythmic.
• Tonic convulsions include muscle contractions, which are of a longer duration. As a rule, their duration is very long. There are primary, those that appear immediately after the end of clonic convulsions, and localized or general.

You also need to remember that a convulsive syndrome, the symptoms of which may look like convulsions, requires immediate medical attention.

Recognition of convulsive syndrome in children

Numerous studies show that convulsions in infants and young children are tonic-clonic in nature. They appear to a greater extent in the toxic form of acute intestinal infections, acute respiratory viral infections, and neuroinfections.

The convulsive syndrome that developed after a rise in temperature is febrile. In this case, we can say with confidence that there are no patients in the family with a predisposition to seizures. This type, as a rule, can manifest itself in children from 6 months. up to 5 years. It is characterized by low frequency (up to a maximum of 2 times during the entire time of fever) and short duration. In addition, during convulsions, body temperature can reach 38, but at the same time everything clinical symptoms, indicating brain damage, are completely absent. When conducting an EEG in the absence of seizures, data on seizure activity will be completely absent.

Max flow time febrile seizures may be 15 minutes, but in most cases it is a maximum of 2 minutes. The basis for the appearance of such convulsions are pathological reactions central nervous system for infectious or toxic effects. The convulsive syndrome itself in children manifests itself during a fever. His characteristic symptoms it is considered a change in the skin (from blanching to cyanosis) and changes in the respiratory rhythm (wheezing is observed).

Atonic and effective respiratory convulsions

In adolescents who suffer from neurasthenia or neurosis, effective respiratory convulsions can be observed, the course of which is caused by anoxia, due to a short-term sudden onset of apnosis. Such convulsions are diagnosed in individuals whose age varies from 1 to 3 years and are characterized by conversion (hysterical) seizures. Most often they appear in families with overprotection. In most cases, convulsions are accompanied by loss of consciousness, but, as a rule, short-term. In addition, an increase in body temperature has never been recorded.

It is very important to understand that the convulsive syndrome, which is accompanied by a syncope, is not life-threatening and does not provide for such treatment. Most often, these convulsions occur in the process of metabolic disorders (salt exchange).

There are also atonic convulsions that occur during a fall or loss of muscle tone. It can appear in children aged 1-8 years. It is characterized by atypical absence seizures, myatonic falls, and tonic and axial seizures. They appear quite high frequency. Also, status epilepticus appears quite often, which is resistant to treatment, which once again confirms the fact that help with convulsive syndrome should be timely.

Diagnostics

As a rule, the diagnosis of a convulsive symptom does not cause any particular difficulties. For example, to determine a pronounced myospasm in the period between attacks, you need to perform a series of actions aimed at identifying the high excitability of the nerve trunks. To do this, tapping with a medical hammer on the trunk of the facial nerve in front of the auricle, in the area of ​​\u200b\u200bthe wings of the nose or the corner of the mouth is used. In addition, quite often a weak galvanic current (less than 0.7 mA) begins to be used as an irritant. Also important is the history of the patient's life and the determination of concomitant chronic diseases. It should also be noted that after a full-time examination by a doctor, additional studies may be prescribed to clarify the cause of this condition. Such diagnostic measures include: taking a spinal puncture, electroencephalography, echoencephalography, examination of the fundus, as well as various examinations of the brain and central nervous system.

Convulsive syndrome: first aid for a person

At the first signs of convulsions, the following is a priority medical measures:

• Laying the patient on a flat and soft surface.
• Ensuring fresh air supply.
• Removing nearby objects that can harm him.
• Unbuttoning tight clothing.
• Putting a spoon into the oral cavity (between the molars), after wrapping it in cotton wool, with a bandage or, if they are absent, then with a napkin.

As practice shows, the relief of a convulsive syndrome consists in taking drugs that cause the least oppression. respiratory tract. As an example, active active substance Midazolam or diazepam tablets. Also, the introduction of the drug "Hexobarbital" ("Geksenel") or tipental sodium has proven itself quite well. If there are no positive changes, then you can use ferrous-oxygen anesthesia with the addition of Ftorotan (Halothane) to it.

In addition, emergency care for convulsive syndrome is the introduction of anticonvulsants. For example, intramuscular or intravenous administration of a 20% solution of sodium hydroxybutyrate (50-70-100 mg / kg) or in a ratio of 1 ml to 1 year of life is allowed. You can also use a 5% glucose solution, which will significantly delay or completely avoid the recurrence of seizures. If they continue long enough long time, then you need to apply hormonal therapy, which consists in taking the drug "Prednisolone" 2-5 M7KG or "Hydrocortisone" 10 m7kg during the day. Maximum amount injections intravenously or intramuscularly is 2 or 3 times. If observed serious complications, such as failures in breathing, blood circulation, or a threat to the life of a child, then the provision of assistance for a convulsive syndrome consists in intensive therapy with the appointment of potent anticonvulsant drugs. In addition, for people who have experienced severe manifestations this condition, mandatory hospitalization is indicated.

Treatment

As shown by numerous studies that confirm the widespread opinion of most neurologists, the appointment of long-term therapy after 1 seizure is not entirely correct. Since single outbreaks that occur against the background of fevers, changes in metabolism, infectious lesions or poisoning is quite easily stopped during therapeutic measures aimed at eliminating the cause of the underlying disease. Monotherapy has proven itself best in this regard.

If people are diagnosed with recurrent convulsive syndrome, treatment consists in taking certain medications. For example, for the treatment of febrile seizures the best option will be taking Diazepam. It can be used both intravenously (0.2-0.5) or rectally (daily dose is 0.1-0.3). It should be continued even after the seizures have disappeared. For longer treatment, as a rule, the drug "Phenobarbital" is prescribed. Orally, you can take the drug "Difenin" (2-4 mg / kg), "Suksilep" (10-35 mg / kg) or "Antelepsin" (0.1-0.3 mg / kg during the day).

It should also be noted that the use antihistamines and neuroleptics will significantly enhance the effect of the use of anticonvulsants. If during convulsions there is a high probability of cardiac arrest, then anesthetics and muscle relaxants can be used. But it should be borne in mind that in this case the person should be immediately transferred to a ventilator.

When it's bright severe symptoms neonatal seizures, it is recommended to use the drugs "Feniton" and "Phenobarbital". The minimum dose of the latter should be 5-15 mg / kg, then it should be taken at 5-10 mg / kg. In addition, half of the first dose may be administered intravenously and the second dose orally. But it should be noted that this drug should be taken under the supervision of doctors, since there is a high probability of cardiac arrest.

Seizures in newborns are caused not only by hypocalcemia, but also by hypomagnesemia, vitamin B6 deficiency, which implies an operational laboratory screening, this is especially true when there is no time left for a full diagnosis. That is why emergency care for convulsive syndrome is so important.

Forecast

As a rule, with timely first aid and subsequently correctly diagnosed with the appointment of a treatment regimen, the prognosis is quite favorable. The only thing to remember is that with the periodic manifestation of this condition, it is necessary to urgently contact a specialized medical institution. It should be especially noted that persons whose professional activities are associated with constant mental stress should undergo periodic checks with specialists.

The reasons

The most common causes of seizures in various age groups:

The most common causes of status epilepticus are:

• discontinuation or irregular use of anticonvulsants;
• alcohol withdrawal syndrome;
• stroke;
• anoxia or metabolic disorders;
• CNS infections;
• a brain tumor;
• overdose of drugs that stimulate the central nervous system (in particular, cocaine).

Seizures occur paroxysmal, and in the interictal period in many patients for months and even years, no violations are detected. Seizures in patients with epilepsy develop under the influence of provoking factors. These same provoking factors can cause a seizure in healthy people. These factors include stress, sleep deprivation, hormonal changes during menstrual cycle. Some external factors(for example, toxic and medicinal substances) can also trigger seizures. In a cancer patient, epileptic seizures can be caused by tumor lesion brain tissue, metabolic disorders, radiation therapy, cerebral infarction, drug intoxication and CNS infections.

Epileptic seizures are the first symptom of brain metastases in 6-29% of patients; in about 10% they are observed in the outcome of the disease. When the frontal lobe is affected, early seizures are more common. With damage to the cerebral hemispheres, the risk of late seizures is higher, and seizures are not typical for lesions of the posterior cranial fossa. Epileptic seizures are often observed with intracranial melanoma metastases. Rarely, epileptic seizures are caused by antitumor agents, in particular etoposide, busulfan and chlorambucil.

Thus, any epileptic seizure, regardless of etiology, develops as a result of the interaction of endogenous, epileptogenic and provoking factors. Before starting treatment, it is necessary to clearly establish the role of each of these factors in the development of seizures.

Mechanisms of emergence and development (pathogenesis)

The pathogenesis is not well understood. Unmanaged electrical activity groups of neurons of the brain ("epileptic focus") involves significant areas of the brain in the process of pathological excitation. With the rapid spread of pathological hypersynchronous activity to large areas of the brain, consciousness is lost. If pathological activity is limited to a certain area, partial (focal) convulsive seizures develop, which are not accompanied by loss of consciousness. With status epilepticus, incessant generalized epileptic discharges of neurons in the brain occur, leading to depletion of vital resources and irreversible damage to nerve cells, which is the direct cause of severe neurological consequences of status and death.

A seizure is the result of an imbalance between the processes of excitation and inhibition in the central nervous system. Symptoms depend on the function of the area of ​​the brain where the epileptic focus is formed, and the pathway of the spread of epileptic excitation.

We still know little about the mechanisms of the development of seizures, therefore, a generalized scheme of the pathogenesis of seizures various etiologies does not exist. However, the following three points help to understand what factors and why can cause a seizure in this patient:

An epileptic discharge may occur even in a healthy brain mo zge; threshold convulsive readiness brain is individual. For example, a seizure may develop in a child on the background of high temperature. At the same time, in the future, no neurological diseases, including epilepsy, do not occur. At the same time, febrile seizures develop only in 3-5% of children. This suggests that under the influence of endogenous factors, the threshold of convulsive readiness is lowered in them. One such factor may be heredity - seizures are more likely to develop in individuals with a family history of epilepsy.

In addition, the threshold for convulsive readiness depends on the degree of maturity of the nervous system. Some diseases significantly increase the likelihood of epileptic seizures. One of these diseases is severe penetrating traumatic brain injury. Epileptic seizures after such injuries develop in 50% of cases. This suggests that trauma leads to such a change in interneuronal interactions, which increases the excitability of neurons. This process is called epileptogenesis, and the factors that lower the threshold for convulsive readiness are called epileptogenic.

In addition to traumatic brain injury, epileptogenic factors include stroke, infectious diseases of the central nervous system, and malformations of the central nervous system. Some epileptic syndromes (eg, benign familial neonatal seizures and juvenile myoclonic epilepsy) have been shown to have genetic abnormalities; apparently, these disorders are realized through the formation of certain epileptogenic factors.

Clinical picture (symptoms and syndromes)

Classification

Forms of seizures

1. Partial (focal, local) - individual muscle groups are involved in convulsions, consciousness, as a rule, is preserved.

2. Generalized - consciousness is impaired, convulsions cover the whole body:

• primary generalized - bilateral involvement of the cerebral cortex;
• secondary generalized - local involvement of the cortex with subsequent bilateral spread.

The nature of seizures

• tonic - prolonged muscle contraction;
• clonic - short muscle contractions following immediately after each other;
• tonic-clonic.

Partial seizures

• Contraction of individual muscle groups, in some cases only on one side.
• Seizure activity may gradually involve new areas of the body (Jacksonian epilepsy).
• Violation of the sensitivity of certain areas of the body.
• Automatisms (small movements of the hands, champing, inarticulate sounds, etc.).
• Consciousness is often preserved (disturbed in complex partial seizures).
• The patient loses contact with others for 1-2 minutes (does not understand speech and sometimes actively resists the assistance provided).
• Confusion usually lasts 1-2 minutes after the seizure ends.
• May precede generalized seizures (Kozhevnikov epilepsy).
• In case of impaired consciousness, the patient does not remember the seizure.

Generalized seizures

• Typically occurs in a sitting or lying position.
• Characterized by the occurrence in a dream
• May begin with the aura (discomfort in the epigastric region, involuntary head movements, visual, auditory and olfactory hallucinations and etc.).
• Initial scream.
• Loss of consciousness.
• Fall to the floor. Fall injuries are common.
• As a rule, pupils are dilated, not sensitive to light.
• tonic convulsions within 10-30 seconds, accompanied by respiratory arrest, then clonic convulsions (1-5 minutes) with rhythmic twitching of the arms and legs.
• Focal neurological symptoms are possible (implying focal brain damage).
• Skin color of the face: hyperemia or cyanosis at the beginning of the attack.
• Characteristic biting of the tongue on the sides.
• In some cases, involuntary urination.
• In some cases, foam around the mouth.
• After the seizure - confusion, final deep dream often headache and muscle pain. The patient does not remember the seizure.
• Amnesia throughout the seizure.

Epileptic status

• Occurs spontaneously or as a result of rapid withdrawal of anticonvulsants.
• Convulsive seizures follow each other, consciousness is not fully restored.
• Patients in a coma objective symptoms seizures can be erased, attention should be paid to twitching of the limbs, mouth and eyes.
• It often ends in death, the prognosis worsens with the lengthening of the seizure for more than 1 hour and in elderly patients.

Convulsive seizures must be differentiated from:

psychogenic seizure

• May occur while sitting or lying down.
• Does not occur in a dream.
• The precursors are variable.
• Tonic-clonic movements are asynchronous, movements of the pelvis and head from side to side, eyes tightly closed, resistance to passive movements.
• Facial skin color does not change or facial redness.
• No biting of the tongue or biting in the middle.
• There is no involuntary urination.
• No fall damage.
• Confusion of consciousness after an attack is absent or is demonstrative.
• Pain in the extremities: various complaints.
• Amnesia is absent.

Fainting

• Occurrence in a sitting or lying position is rare.
• Does not occur in a dream.
• Harbingers: typical dizziness, darkening before the eyes, sweating, salivation, tinnitus, yawning.
• Focal neurological symptoms are absent.
• Skin color of the face: pallor at the beginning or after convulsions.
• Involuntary urination is not typical.
• Fall damage is not common.
• partial amnesia.

Cardiogenic syncope (Morgagni-Adams-Stokes seizures)

• Occurrence in a sitting or lying position is possible.
• The occurrence in a dream is possible.
• Harbingers: often absent (with tachyarrhythmias, fainting may be preceded by a rapid heartbeat).
• Focal neurological symptoms are absent.
• Tonic-clonic movements may occur after 30 seconds of syncope (secondary anoxic convulsions).
• Skin color of the face: pallor at the beginning, hyperemia after recovery.
• Biting the tongue is rare.
• Involuntary urination is possible.
• Fall damage is possible.
• Confusion of consciousness after an attack is not typical.
• Pain in the limbs is absent.
• partial amnesia.

hysterical fit occurs in a certain emotionally tense situation for the patient in the presence of people. This is a spectacle that unfolds with the viewer in mind; When falling, patients never break. Convulsions are most often manifested as a hysterical arc, patients take elaborate poses, tear their clothes, bite. The pupillary response to light and the corneal reflex are preserved.

Transient ischemic attacks(TIA) and migraine attacks giving transient disorders CNS functions (usually without loss of consciousness) may be mistaken for focal epileptic seizures. Neurological dysfunction due to ischemia (TIA or migraine) often produces negative symptoms, i.e., prolapse symptoms (eg, loss of sensation, numbness, visual field limitation, paralysis), while defects associated with focal epileptic activity are usually positive. character (convulsive twitches, paresthesias, distortions of visual sensations and hallucinations), although this distinction is not absolute. Short-term stereotypical episodes indicating dysfunction in a specific area of ​​the brain's blood supply in a patient with vascular disease, heart disease, or risk factors vascular lesion(diabetes, arterial hypertension), are more characteristic of TIA. But, since in older patients a common cause of epileptic seizures are cerebral infarctions in remote period diseases, it is necessary to search for the focus of paroxysmal activity on the EEG.

Classic migraine headaches with visual aura, unilateral localization and gastrointestinal disturbances are usually easy to differentiate from epileptic seizures. However, some patients with migraine have only migraine equivalents, such as hemiparesis, numbness, or aphasia, and there may not be a headache after them. These episodes, especially in older patients, are difficult to distinguish from TIA but may also represent focal epilepsy. Loss of consciousness after some forms of vertebrobasilar migraine and a high frequency of headaches after epileptic seizures further complicate the differential diagnosis. The slower development of neurological dysfunction in migraine (often within minutes) serves as an effective differential diagnostic criterion. Be that as it may, in some cases, patients who are suspected of having any of the three conditions under consideration, for the diagnosis, it is necessary to conduct an examination, including CT, cerebral angiography and specialized EEG. Sometimes trial courses of antiepileptic drugs should be prescribed to confirm the diagnosis (interestingly, in some patients, such a course of treatment prevents both epileptic and migraine attacks).

Psychomotor variants and hysterical attacks. As noted above, behavioral disturbances are often noted in patients during a complex partial seizure. This is manifested by sudden changes in the structure of the personality, the appearance of a sense of impending death or unmotivated fear, pathological sensations of a somatic nature, episodic forgetfulness, short-term stereotyped motor activity such as ripping off clothes or tapping with a foot. Many patients have personality disorders, in connection with which such patients need the help of a psychiatrist. Often, especially if patients do not experience tonic-clonic seizures and loss of consciousness, but note emotional disturbances, episodes of psychomotor seizures are referred to as psychopathic fugues (flight reactions) or hysterical seizures. In such cases misdiagnosis often based on a normal EEG in the interictal period and even during one of the episodes. It must be emphasized that seizures can be generated from a focus that has a deep location in temporal lobe and not manifesting itself in surface EEG recording. This was repeatedly confirmed by EEG recording using deep electrodes. Moreover, deep temporal seizures can manifest only in the form of the above phenomena and are not accompanied by the usual convulsive phenomenon, muscle twitching, and loss of consciousness.

It is extremely rare for patients who are observed for epileptiform episodes to actually have hysterical pseudo-seizures or frank simulation. Often these individuals have indeed had epileptic seizures in the past or have been in contact with people with epilepsy. Such pseudo-seizures can sometimes be difficult to distinguish from true seizures. Hysterical seizures are characterized by a non-physiological course of events: for example, muscle twitches spread from one arm to another without moving to the muscles of the face and legs on the same side, convulsive contractions of the muscles of all limbs are not accompanied by loss of consciousness (or the patient feigns loss of consciousness), the patient tries to avoid trauma , for which, at the time of convulsive contractions, it moves away from the wall or moves away from the edge of the bed. In addition, hysterical seizures, especially in adolescent girls, can be overtly sexual in nature, accompanied by pelvic movements and manipulation of the genitals. If in many forms of seizures in the case of temporal lobe epilepsy the surface EEG is unchanged, then generalized tonic-clonic seizures are always accompanied by EEG disturbances both during and after the seizure. Generalized tonic-clonic seizures (usually) and complex partial seizures of moderate duration (in many cases) are accompanied by an increase in serum prolactin levels (during the first 30 minutes after the attack), while this is not noted in hysterical seizures. Although the results of such analyzes do not have an absolute differential diagnostic value, obtaining positive data can play an important role in characterizing the genesis of seizures.

Diagnostics

Patients with epileptic seizures are admitted to medical institutions as an emergency during an attack, and in a planned manner a few days after an attack.

If there is a history of recent febrile illness accompanied by headaches, mental status changes, and confusion, an acute CNS infection (meningitis or encephalitis) may be suspected; In this case, it is necessary to immediately investigate cerebrospinal fluid. AT similar situation A complex partial seizure may be the first symptom of encephalitis caused by the herpes simplex virus.

The presence of a history of headaches and/or mental changes preceding the attack, in combination with signs of increased intracranial pressure or focal neurological symptoms, rules out a mass lesion (tumor, abscess, arteriovenous malformation) or chronic subdural hematoma. In this case, seizures with a clear focal onset or aura are of particular concern. To clarify the diagnosis, CT is indicated.

General examination can provide important etiological information. Gingival hyperplasia is a common consequence of long-term treatment with phenytoin. Exacerbation of chronic convulsive disease associated with intercurrent infection, alcohol intake, or discontinuation of treatment is a common reason for admission of patients to the emergency department.

When examining the skin on the face, capillary hemangioma is sometimes found - a symptom of Sturge-Weber disease (radiography can reveal cerebral calcifications), stigmas of tuberous sclerosis (adenomas of the sebaceous glands and spots of pebbled skin) and neurofibromatosis (subcutaneous nodules, spots the color of coffee with milk). Asymmetry of the trunk or limbs usually indicates hemihypotrophy of the type of somatic developmental delay, contralateral to congenital or acquired in early childhood focal lesion brain.

Data from the anamnesis or general examination also allow you to establish signs chronic alcoholism. In severely alcoholic individuals, seizures are usually caused by withdrawal symptoms (rum seizures), old brain bruises (from falls or fights), chronic subdural hematoma, and metabolic disorders due to malnutrition and liver damage. Epileptic seizures against the background of withdrawal symptoms usually occur 12-36 hours after the cessation of alcohol intake and are short-term tonic-clonic, both single and serial in the form of 2-3 seizures. In such cases, after a period of epileptic activity, there is no need to prescribe treatment to the patient, since seizures usually do not occur in the future. As for patients with alcoholism, in whom epileptic seizures develop at a different time (and not after 12-36 hours), they must be treated, but this group of patients requires Special attention due to their lack of complaints and the presence metabolic disorders that complicate drug therapy.

Routine blood tests can determine whether seizures are related to hypoglycemia, hypo- or hypernatremia, hypo- or hypercalcemia. It is necessary to determine the causes of these biochemical disorders and correct them. In addition, other less common causes of epileptic seizures are identified with appropriate tests for thyrotoxicosis, acute intermittent porphyria, lead or arsenic intoxication.

In older patients, epileptic seizures may indicate acute disorder cerebral circulation or be a distant consequence an old cerebral infarction (even a silent one). The plan for further examination will be determined by the patient's age, functional state of cardio-vascular system and associated symptoms.

Generalized tonic-clonic seizures can develop in individuals without abnormalities of the nervous system after moderate sleep deprivation. Such seizures are sometimes noted in persons working double shifts, in students of higher educational institutions during the examination session, and in soldiers returning from short holidays. If the results of all studies conducted after a single seizure are normal, such patients do not need further treatment.

If a patient who has had an epileptic seizure, according to the anamnesis, examination, biochemical blood tests, fails to detect abnormalities, then one gets the impression of an idiopathic nature of the seizure and the absence of a serious CNS lesion underlying it. Meanwhile, tumors and other volumetric formations for a long time can proceed and manifest asymptomatically in the form of epileptic seizures, and therefore further examination of patients is indicated.

EEG is important for the differential diagnosis of seizures, determining their cause, as well as the correct classification. When the diagnosis of an epileptic seizure is in doubt, such as in cases where epileptic seizures are differentiated from syncope, the presence of paroxysmal EEG changes confirms the diagnosis of epilepsy. For this purpose, special activation methods are used (recording during sleep, photostimulation and hyperventilation) and special EEG leads (nasopharyngeal, nasoethmoidal, sphenoidal) for recording from deep structures brain and long-term monitoring even in outpatient settings. EEG can also detect focal abnormalities (spikes, sharp waves, or focal slow waves) that indicate the likelihood of focal neurological damage, even if the symptomatology of the attack is initially similar to that of generalized seizures. The EEG also helps classify seizures. It makes it possible to distinguish focal secondary generalized seizures from primary generalized seizures and is especially effective in the differential diagnosis of short-term lapses of consciousness. Small seizures are always accompanied by bilateral spike-wave discharges, while complex partial seizures can be accompanied by both focal paroxysmal spikes and slow waves or a normal surface EEG pattern. In cases of small epileptic seizures, the EEG can demonstrate that the patient has many more small seizures than is clinically apparent; thus EEG helps in monitoring antiepileptic drug therapy.

Until recently, important additional methods for examining patients with epileptic seizures were lumbar puncture, X-ray of the skull, arteriography and pneumoencephalography.

Lumbar Puncture still performed for suspected acute or chronic infections CNS or subarachnoid hemorrhage. Computed tomography and MRI provide more definite information about anatomical disorders than previously used invasive methods research. All adults with a first epileptic seizure should have a diagnostic CT scan with or without contrast enhancement. If the first studies give normal results, a second examination is carried out after 6-12 months. MRI imaging is especially effective in the early stages of examination in focal epileptic seizures, when it can detect changes of a minor degree better than CT.

Arteriography performed with serious suspicion and for arteriovenous malformation, even if no changes were detected according to CT, or in order to visualize the vascular pattern in the lesion detected using non-invasive methods.

Treatment

Urgent care

To protect the patient from possible injuries that may occur during a fall and during convulsive twitches of the body, to ensure his safety.

Calm those around you. Put something soft (jacket, hat) under the patient's head to avoid head injury during convulsive movements. Loosen clothing that may make breathing difficult. Between the teeth of the lower and upper jaws, you can put a handkerchief twisted into a knot in the event that if the attack is just beginning. This is to prevent biting the tongue and damage to the teeth. Turn the patient's head on its side so that saliva can freely drain to the floor. If the patient stops breathing, start CPR.

After the seizure has stopped, if the seizure occurs outside, arrange for the patient to be transported home or to the hospital. Contact the relatives of the patient to report the incident. As a rule, relatives know what to do.

If the patient does not report that he is suffering from epilepsy, it is better to call an ambulance, since convulsive syndrome can be a sign of a significant amount of even more serious pathology (cerebral edema, intoxication, etc.). Do not leave the patient unattended.

What not to do with an epileptic seizure

• Leave the patient alone during an attack.
• Try to hold the patient (by the arms, shoulders or head) or transfer to another, even more convenient place for him, during a convulsive seizure.
• Try to open the patient's jaws and insert any objects between them in order to avoid a fracture of the lower jaw and injury to the teeth.

Conservative treatment

Treatment of a patient with epilepsy is aimed at eliminating the cause of the disease, suppressing the mechanisms of seizure development and correcting the psychosocial consequences that may occur as a result of the neurological dysfunction underlying the diseases or in connection with a persistent decrease in working capacity.

If the epileptic syndrome is the result of metabolic disorders, such as hypoglycemia or hypocalcemia, then after the restoration of metabolic processes to a normal level, the seizures usually stop. If epileptic seizures are caused by an anatomical lesion of the brain, such as a tumor, an arteriovenous malformation, or a brain cyst, then removal of the pathological focus also leads to the disappearance of seizures. However, long-term even non-progressive lesions can cause the development of gliosis and other denervation changes. These changes can lead to the formation of chronic epileptic foci that cannot be eliminated by removing the primary lesion. In such cases, to control the course of epilepsy, surgical extirpation of epileptic areas of the brain is sometimes necessary (see below Neurosurgical treatment for epilepsy).

There are complex relationships between the limbic system and neuroendocrine function that can have a significant impact on epileptic patients. Normal fluctuations in hormonal status affect the frequency of seizures, epilepsy, in turn, also causes neuroendocrine disorders. For example, in some women, significant changes in the pattern of epileptic seizures coincide with certain phases of the menstrual cycle (menstrual epilepsy), in others, changes in the frequency of seizures are due to oral contraceptives and pregnancy. In general, estrogens have the property of provoking seizures, while progestins have an inhibitory effect on them. On the other hand, some patients with epilepsy, especially those with complex partial seizures, may show signs of concomitant reproductive disorders. endocrine dysfunction. Disorders of sexual desire, especially hyposexuality, are often observed. In addition, women often develop polycystic ovaries, men - potency disorders. In some patients with data endocrine disorders clinically there are no epileptic seizures, but there are changes in the EEG (often with temporal discharges). It remains unclear whether epilepsy causes endocrine and/or behavioral disorders, or whether these two types of disorders are separate manifestations of the same neuropathological process underlying them. However, therapeutic effects on the endocrine system are in some cases effective in controlling certain forms of seizures, and antiepileptic therapy is good method treatment for some forms of endocrine dysfunction.

Pharmacotherapy underlies the treatment of patients with epilepsy. Its purpose is to prevent seizures without affecting the normal course of thought processes (or normal development intelligence in a child) and without negative systemic side effects. The patient, as far as possible, should be prescribed the lowest possible dose of any one anticonvulsant drug. If the doctor knows exactly the type of seizures in a patient with epilepsy, the spectrum of action of the anticonvulsants available to him and the basic pharmacokinetic principles, he can completely control seizures in 60-75% of patients with epilepsy. However, many patients are resistant to treatment because the drugs chosen are not appropriate for the type(s) of seizures or are not prescribed optimal doses; they develop unwanted side effects. Determination of the content of anticonvulsants in the blood serum allows the doctor to dose the drug individually to each patient and monitor the administration of the drug. At the same time, in a patient who is prescribed drug treatment, after an appropriate period of reaching an equilibrium state (usually taking several weeks, but not less than a time interval of 5 half-lives), the content of the drug in the blood serum is determined and compared with the standard therapeutic concentrations established for each drug. By adjusting the prescribed dose, bringing it into line with the required therapeutic level of the drug in the blood, the doctor can compensate for the effect of the factor of individual fluctuations in the absorption and metabolism of the drug.

Long-term intensive EEG studies and video monitoring, careful elucidation of the nature of seizures and the selection of anticonvulsants can significantly increase the effectiveness of seizure control in many patients who were previously considered resistant to conventional antiepileptic therapy. Indeed, often such patients have to cancel several drugs until they can find the most suitable one.

Hospitalizations in the neurological department subject to the following categories of patients.

• With a first epileptic seizure.
• With stopped status epilepticus.
• With a series of seizures or status epilepticus, emergency hospitalization in the neurocritical care unit is indicated.
• Patients with TBI are preferably hospitalized in the neurosurgical department.
• Pregnant women with convulsive seizures are subject to immediate hospitalization in an obstetric and gynecological hospital.
• Patients after a single epileptic seizure with established cause hospitalization is not required.

With symptomatic status epilepticus (acute TBI, brain tumor, stroke, brain abscess, severe infections and intoxication) is carried out simultaneously pathogenetic therapy of these conditions with a special emphasis on dehydration therapy due to the severity of cerebral edema (furosemide, uregit).

If epileptic seizures are due to brain metastases, phenytoin is prescribed. Prophylactic anticonvulsant therapy is carried out only when high risk late seizures. In this case, the serum concentration of phenytoin is often determined and the dose of the drug is adjusted in a timely manner.

Indications for prescribing specific drugs

Three drugs are most effective for generalized tonic-clonic seizures - phenytoin(or diphenylhydantoin), phenobarbital (and other long-acting barbiturates), and carbamazepine. The condition of most patients can be controlled with adequate doses of any of these drugs, although a certain drug may work better for each patient individually, phenytoin is quite effective in terms of preventing seizures, its sedative effect is very weak, and it does not intellectual disabilities. However, in some patients, phenytoin causes gingival hyperplasia and mild hirsutism, which is especially unpleasant for young women. With prolonged use, coarsening of facial features may be observed. The use of phenytoin sometimes leads to the development of lymphadenopathy, and very high doses of it have toxic effect to the cerebellum.

Carbamazepine no less effective and does not cause many adverse reactions inherent in phenytoin. Intellectual functions not only do not suffer, but remain intact to a greater extent than against the background of taking phenytoin. Meanwhile, carbamazepine is able to provoke gastrointestinal disorders, depression bone marrow with a slight or moderate decrease in the number of leukocytes in the peripheral blood (up to 3.5-4.10 9 / l), which in some cases becomes pronounced, and therefore these changes require careful monitoring. In addition, carbamazepine is hepatotoxic. For these reasons, a complete blood count and liver function tests should be performed prior to initiation of carbamazepine therapy and then at 2-week intervals throughout the treatment period.

Phenobarbital also effective in tonic-clonic seizures and does not have any of the above side effects. However, at the beginning of the application, patients experience depression and lethargy, which is due to poor tolerance drug. Sedation is dose-dependent, which may limit the amount of drug given to achieve full control seizures. In the same case, if therapeutic effect can be achieved with doses of phenobarbital that do not give a sedative effect, then the mildest regimen of long-term use of the drug is prescribed. primidon is a barbiturate that is metabolized to phenobarbital and phenylethylmalonamide (FEMA) and may be more effective than phenobarbital alone due to its active metabolite. In children, barbiturates can provoke states of hyperactivity and irritability, which reduces the effectiveness of treatment.

In addition to systemic side effects, all three classes of drugs have toxic effects on the nervous system at higher doses. Nystagmus is often observed already at therapeutic drug concentrations, while ataxia, dizziness, tremor, mental retardation, memory loss, confusion, and even stupor can develop with increasing blood levels of drugs. These phenomena are reversible with a decrease in the concentration of the drug in the blood to therapeutic.

Partial seizures, including complex partial seizures (with temporal lobe epilepsy). The drugs widely prescribed for patients with tonic-clonic seizures are also effective in partial seizures. It is possible that carbamazepine and phenytoin are somewhat more effective than barbiturates in these seizures, although this has not been definitively established. In general, complex partial seizures are difficult to correct, requiring more than one drug (eg, carbamazepine and primidone or phenytoin, or any of the first-line drugs in combination with high doses of metsuximide) and, in some cases, neurosurgical intervention. In these forms of seizures, many epilepsy centers are testing new antiepileptic drugs.

Primarily generalized small seizures (absences and atypical). These seizures are amenable to treatment with drugs of various classes, in contrast to tonic-clonic and focal seizures. In simple absences, the remedy of choice is ethosuximide. Side effects include gastrointestinal disturbances, behavioral changes, dizziness and drowsiness, but related complaints are rare. For more difficult to control atypical minor and myoclonic seizures, the drug of choice is valproic acid(it is also effective in primary generalized tonic-clonic seizures). Valproic acid can lead to gastrointestinal irritation, bone marrow depression (especially thrombocytopenia), hyperammonemia, and liver dysfunction (including rare cases of progressive liver failure with a fatal outcome, which is rather a consequence hypersensitivity to the drug than a dose-dependent effect). A complete blood count with platelet count and liver function tests should be performed before starting therapy and during treatment at two-week intervals for a period sufficient to confirm good tolerability of the drug in a particular patient.

Clonazepam(benzodiazepine drug) can also be used for atypical small and myoclonic seizures. Sometimes it provokes dizziness and irritability, but, as a rule, does not give other systemic side effects. One of the first anti-absence drugs was trimethadione, but it is now rarely used due to potential toxicity.

Surgery

See neurosurgical treatment of epilepsy.

- a non-specific reaction of the child's body to external and internal stimuli, characterized by sudden attacks of involuntary muscle contractions. Convulsive syndrome in children occurs with the development of partial or generalized convulsions of a clonic and tonic nature with or without loss of consciousness. To establish the causes of convulsive syndrome in children, consultations of a pediatrician, neurologist, traumatologist are necessary; EEG, NSG, REG, X-ray of the skull, CT of the brain, etc. Relief of convulsive syndrome in children requires the introduction of anticonvulsants and the treatment of the underlying disease.

Causes of convulsive syndrome in children

Convulsive syndrome in children is a polyetiological clinical syndrome. Neonatal convulsions that develop in newborns are usually associated with severe hypoxic CNS damage (fetal hypoxia, neonatal asphyxia), intracranial birth trauma, intrauterine or postnatal infection (cytomegaly, toxoplasmosis, rubella, herpes, congenital syphilis, listeriosis, etc.), congenital anomalies brain development (holoprosencephaly, hydroanencephaly, lissencephaly, hydrocephalus, etc.), fetal alcohol syndrome. Seizures may be a manifestation of withdrawal syndrome in children born to mothers suffering from alcohol and drug addiction. Rarely, newborns experience tetanus cramps due to infection of the umbilical wound.

Among the metabolic disorders that cause convulsive syndrome, electrolyte imbalance (hypocalcemia, hypomagnesemia, hypo- and hypernatremia) occurring in preterm infants, children with intrauterine malnutrition, galactosemia, phenylketonuria should be distinguished. Separately, among the toxic-metabolic disorders is hyperbilirubinemia and the associated nuclear jaundice of newborns. Convulsive syndrome can develop in children with endocrine disorders - hypoglycemia in diabetes mellitus, hypocalcemia in spasmophilia and hypoparathyroidism.

In infancy and early childhood in the genesis of convulsive syndrome in children, the leading role is played by neuroinfections (encephalitis, meningitis), infectious diseases (ARVI, influenza, pneumonia, otitis media, sepsis), TBI, post-vaccination complications, epilepsy.

Less common causes of convulsive syndrome in children are brain abscess, congenital heart defects, poisoning and intoxication, hereditary degenerative diseases of the central nervous system, phakomatosis.

A certain role in the occurrence of convulsive syndrome in children belongs to a genetic predisposition, namely, the inheritance of metabolic and neurodynamic features that determine a lower convulsive threshold. Infections, dehydration, stressful situations, sudden excitement, overheating, etc. can provoke seizures in a child.

Classification of convulsive syndrome in children

By origin, epileptic and non-epileptic (symptomatic, secondary) convulsive syndrome in children are distinguished. Symptomatic include febrile (infectious), hypoxic, metabolic, structural (with organic lesions CNS) convulsions. It should be noted that in some cases, non-epileptic convulsions can turn into epileptic ones (for example, with prolonged, more than 30 minutes, an intractable convulsive seizure, repeated convulsions).

Depending on the clinical manifestations, partial (localized, focal) seizures are distinguished, covering individual groups muscles, and generalized convulsions (general convulsive seizure). Given the nature of muscle contractions, convulsions can be clonic and tonic: in the first case, episodes of contraction and relaxation of skeletal muscles quickly follow each other; in the second, there is a prolonged spasm without periods of relaxation. In most cases, convulsive syndrome in children occurs with generalized tonic-clonic convulsions.

Symptoms of convulsive syndrome in children

A typical generalized tonic-clonic seizure has a sudden onset. Suddenly the child loses contact with the external environment; his gaze becomes wandering, the movements of the eyeballs become floating, then the gaze is fixed up and to the side.

In the tonic phase of a convulsive attack, the child's head is thrown back, the jaws are closed, the legs are straightened, the arms are bent at the elbow joints, the whole body is tense. Short-term apnea, bradycardia, pallor and cyanosis of the skin are noted. The clonic phase of a generalized convulsive seizure is characterized by the restoration of breathing, individual twitches of mimic and skeletal muscles restoration of consciousness. If convulsive paroxysms follow one after another without recovery of consciousness, such a condition is regarded as a convulsive status.

Most frequent clinical form convulsive syndrome in children are febrile convulsions. They are typical for children aged 6 months to 3-5 years and develop against the background of a rise in body temperature above 38 ° C. There are no signs of toxic-infectious damage to the brain and its membranes. The duration of febrile seizures in children is usually 1-2 minutes (sometimes up to 5 minutes). The course of this variant of the convulsive syndrome in children is favorable; persistent neurological disorders, as a rule, do not develop.

Convulsive syndrome in children with intracranial injury proceeds with bulging fontanelles, regurgitation, vomiting, respiratory disorders, cyanosis. Convulsions in this case can be in the nature of rhythmic contractions of certain muscle groups of the face or limbs, or a generalized tonic character. With neuroinfections, the structure of the convulsive syndrome in children is usually dominated by tonic-clonic convulsions, there is stiffness of the occipital muscles. Tetany due to hypocalcemia is characterized by convulsions in the flexor muscles ("obstetrician's hand"), facial muscles ("sardonic smile"), pylorospasm with nausea and vomiting, laryngospasm. With hypoglycemia, the development of seizures is preceded by weakness, sweating, trembling in the limbs, and headache.

For the convulsive syndrome in epilepsy in children, the “aura” preceding the attack is typical (feeling of chills, heat, dizziness, smells, sounds, etc.). Actually epileptic seizure begins with the cry of a child, followed by loss of consciousness and convulsions. At the end of the attack comes sleep; after awakening, the child is inhibited, does not remember what happened.

In most cases, the establishment of the etiology of convulsive syndrome in children only on the basis of clinical signs is impossible.

Diagnosis of convulsive syndrome in children

Due to the multifactorial nature of the origin of convulsive syndrome in children, pediatric specialists of various profiles can deal with its diagnosis and treatment: neonatologists, pediatricians, pediatric neurologists, pediatric traumatologists, pediatric ophthalmologists, pediatric endocrinologists, resuscitators, toxicologists, etc.

The decisive moment in the correct assessment of the causes of convulsive syndrome in children is a thorough history taking: clarification of hereditary burden and perinatal history, diseases preceding the attack, injuries, preventive vaccinations, etc. It is important to clarify the nature of the convulsive seizure, the circumstances of its occurrence, duration, frequency, output from convulsions.

Important in the diagnosis of convulsive syndrome in children are instrumental and laboratory research. Holding lumbar puncture. With the development of convulsive syndrome in children, it is necessary to perform a biochemical study of blood and urine for the content of calcium, sodium, phosphorus, potassium, glucose, pyridoxine, amino acids.

Treatment of convulsive syndrome in children

If a convulsive attack occurs, the child must be laid on a hard surface, turn his head to one side, unbutton the collar, and provide fresh air. If the convulsive syndrome in a child has developed for the first time and its causes are unclear, it is necessary to call ambulance.

For free breathing, mucus, food debris or vomit should be removed from the oral cavity using an electric suction or mechanically, oxygen inhalation should be established. If the cause of seizures is established, then in order to stop them, pathogenetic therapy is carried out (the introduction of calcium gluconate solution for hypocalcemia, magnesium sulfate solution for hypomagnesemia, glucose solution for hypoglycemia, antipyretics for febrile convulsions, etc.).

However, since in an urgent clinical situation it is not always possible to carry out diagnostic search, to stop the convulsive paroxysm is carried out symptomatic therapy. As a means of first aid, intramuscular or intravenous administration of magnesium sulfate, diazepam, GHB, hexobarbital is used. Some anticonvulsants (diazepam, hexobarbital, etc.) can be administered rectally to children. In addition to anticonvulsants, dehydration therapy (mannitol, furosemide) is prescribed for the prevention of cerebral edema in children.

Children with a convulsive syndrome of unknown origin, convulsions that have arisen on the background of infectious and metabolic diseases, brain injuries are subject to mandatory hospitalization.

Prediction and prevention of convulsive syndrome in children

Febrile seizures usually stop with age. To prevent their recurrence, severe hyperthermia should not be allowed if an infectious disease occurs in a child. The risk of transformation of febrile seizures into epileptic seizures is 2-10%.

In other cases, the prevention of convulsive syndrome in children includes the prevention perinatal pathology fetus, therapy of the underlying disease, observation by pediatric specialists. If the convulsive syndrome in children does not disappear after the cessation of the underlying disease, it can be assumed that the child has developed epilepsy.

Cramps (spasms) are involuntary muscle contractions, often accompanied by sharp pains. They can occur in individual muscles or cover all groups. Every person at least once in his life had such unpleasant phenomenon. It is not alarming until it becomes frequent and painful. We will understand the specifics of the convulsive syndrome in more detail.

What types of pathology are there?

Seizures may be a sign serious illness central nervous system. They are divided into:

1. Localized seizures. Individual muscle groups are affected.
2. Generalized convulsions. Covers all muscles. They are a typical manifestation of epilepsy.
3. Clonic convulsions. Alternating spasms, during which there is an alternating contraction and relaxation of the muscles.
4. Tonic convulsions. Muscle contraction is long, relaxation does not follow it.
5. Tonic-clonic convulsions. Combination of tonic and clonic.

The syndrome is manifested by sudden and involuntary muscle contractions

In addition, convulsions can be observed with:

• traumatic encephalopathy;
• vascular pathology;
• oncology of the brain;
• liver failure;
• uremia (intoxication of the body as a result of impaired kidney function);
• hypoglycemic coma;
• neuroinfections (meningitis, encephalitis, poliomyelitis, leptospirosis, herpes, neurosyphilis)

It is necessary to distinguish between epilepsy and convulsive syndrome (code according to ICD-10 - R56.0). Unlike epilepsy, this pathology is only a symptom and not a separate disease. Its characteristic feature is that after the elimination of the underlying disease, the convulsive syndrome itself, which was only a sign of this disease, is also eliminated.

This syndrome can occur in the form of several seizures or even convulsive status (a series of convulsive seizures, following one after another with a short interval, the patient does not regain consciousness during breaks).

The reasons

Seizures or symptomatic epilepsy are caused by:

Seizures occur due to spontaneous discharges sent by the brain

Febrile convulsions, which often affect children, are generalized. They are almost always provoked by a prolonged increase in body temperature (above 38°C).

Convulsions of this nature predominate:

• clonic;
• tonic;
• clonic-tonic.

The main reason for this condition is sharp rise body temperature. It can be with acute respiratory viral infections, tonsillitis, influenza, otitis media, teething, acute intestinal infections, as a reaction to vaccination. Hyperthermia irritates the immature nervous system of the child, excitation of neurons and muscle contraction occurs, severe tremors or convulsions are observed.

Convulsive syndrome in children under 10 years old can occur for the following reasons:

The attack begins acutely with loss of consciousness, breathing becomes heavy. The muscles tense up, and then the limbs begin to shudder rhythmically. There is cyanosis, which is especially pronounced on the face. Cyanosis is a bluish discoloration due to insufficient oxygen in the blood. Possible acts involuntary urination and defecation.

The child usually recovers within a few minutes. He can be scared, whiny, disoriented. In a fairly short period of time, consciousness gradually returns, but there is general weakness and sleepiness. Such single episodes do not mean at all that the child has epilepsy and will suffer from similar attacks in the future.

After an attack, it is imperative to get specialist advice by visiting with a child medical institution or calling a doctor at home. In children, seizures can develop up to 6 years of age; if seizures occur in older children, the diagnosis usually tends to be epilepsy.

Emergency care for convulsive syndrome

Convulsive, or convulsive syndrome is a pathological condition characterized by the periodic appearance of seizures. In this case, the causes of seizures can be different. Convulsive syndrome develops against the background of many diseases of the central nervous system.

Seizures are short, temporary brain dysfunctions accompanied by involuntary muscle contractions. A temporary one also occurs, in which the perception of reality is disturbed. The manifestation of seizures disrupts the normal functioning of not only the nervous, but also the digestive, excretory muscular, and other body systems.

What diseases can cause convulsive syndrome, first aid, symptoms, treatment, causes of this condition, what are they? Let's talk about it:

Why does convulsive syndrome occur? Causes of the condition

There can be many reasons for seizures. First of all, this serious illnesses central nervous system, in particular: meningitis, encephalitis, epilepsy or the presence of a tumor. The causes of the syndrome are often head injuries, strokes, abscesses and hemorrhages in the brain area.

convulsive attack in an adult or a child, it can occur with heavy metal poisoning, with acute infections with severe flow. The cause may be severe intoxication of the body, severe hypothermia.

Convulsive syndrome in newborns usually occurs due to insufficient development, immaturity of some brain structures. For example, an incompletely formed regulatory center can provoke the appearance of convulsions even due to a slight hypothermia of the body.
It should be noted that convulsive syndrome in children is much more common than in adults.

In addition, the spastic reaction of the body can appear in healthy people under various conditions. It is often observed in an extreme situation, severe alcohol intoxication, etc. In these cases, the spastic reaction is episodic, short-lived, but may be repeated.

There are local, generalized, tonic, as well as clonic and tonic-clonic types of seizures.

How does convulsive syndrome manifest itself? Symptoms and first aid

In order to provide first aid to a person, not to harm him, first of all, you need to know what exactly caused the spastic reaction. Consider the symptoms of some common diseases accompanied by convulsions, and find out how to help the patient before the doctor arrives:

epileptic seizure

This condition is manifested by a sudden fall of the patient. His body is stretched, and his arms are bent at the joints. The skin turns pale, breathing is intermittent, the eyes are open (the pupils do not react to light), the jaws are tightly compressed, foamy salivation may be observed. If a person falls, it can cause injury, injury, or other damage.

To help, put something soft under the patient's body. Unfasten buttons, belts, all kinds of fasteners. Turn the patient's head to one side so that he does not choke on his own saliva.

To prevent biting your tongue, place a folded handkerchief, napkin, or towel between your jaws. If his teeth are tightly clenched, do not try to unclench them. Do not insert any hard objects between them. On them, the patient can break his teeth. Until the convulsive seizure ends, hold his arms and legs. Taking diazepam will help prevent a seizure.

Spasms with tetanus

This condition is characterized by involuntary chewing movements. The patient's face twists into a convulsive grimace. There is a delay in breathing, the person falls to the floor. First aid in this condition is provided only by an ambulance doctor, which must be called immediately. Your actions are to prevent a person from falling, preventing injury. To avoid this pathological condition, timely vaccinate against tetanus.

Convulsive syndrome in brain tumors

This state manifests itself locally. Often, a brain tumor develops without severe symptoms. One of the manifestations that indicate it may be a convulsive syndrome. When giving first aid, prevent the person from falling, seat or lay him down comfortably. Call an ambulance right away.

With a lack of calcium in the blood

This condition can occur with pathologies of the thyroid gland. Convulsive syndrome begins with trembling of the hands, accompanied by a short-term loss of consciousness. Emergency assistance in this case is not provided, outside intervention is not required for a person. To prevent such conditions, it is necessary to take measures for adequate treatment, elimination of calcium deficiency.

hysterical state

Very often with hysteria, a convulsive syndrome is manifested. The man bites his lips and tongue. Usually theatrically wringing his hands. It can beat in a fit, hit the floor or walls. However, consciousness usually does not lose. For first aid, you need to give him a sedative. And most importantly, remove the audience. Alone, a person quickly calms down, convulsions stop. If hysterical fit does not last long, call an ambulance.

How is convulsive syndrome corrected? Treatment of the condition

As you understand, it is possible to save a person from a convulsive syndrome only after establishing the main cause that causes it. For example, a syndrome caused by fever, intoxication, infectious diseases, etc. disappears after the underlying disease is cured.

Treatment for seizures is the use of anticonvulsants. They are prescribed taking into account the etiology convulsive state. Then they carry out medical measures to normalize, maintain the basic functions - respiration, blood circulation.

In any case, with a condition such as a convulsive syndrome, it is required to find out its cause. Diagnose, establish the underlying disease, prescribe the right treatment maybe a doctor. Your task is to provide the patient with medical care as soon as possible. Be healthy!