Spasm

Uncontrolled tonic or clonic muscle convulsions are referred to as convulsions , which, unlike fibrillation (muscle contraction without locomotion effect) or fasciculation (contraction of one muscle fiber), make any voluntary activity almost impossible. Although they can represent a completely benign phenomenon (typically a convulsion on the dorsal side of the thigh during sports or while kneeling), they are often an accompanying phenomenon of serious diseases (encephalitis, epilepsy, intoxication, hypoglycemia). Whole-body convulsions are usually associated with a profound disturbance of consciousness.

Division according to the clinical picture

For clinical purposes, convulsions are most often divided into:

• Clonic (Short-lived, repetitive twitches)
• Tonic (muscle contractions lasting longer)
• Tonic-clonic (combination of the two previous ones, typical of epileptic seizures of the grand mal type)

Division by cause

A simple aid for use over the patient - A dozen causes of unconsciousness

• Metabolic (hypoglycemia)
• Neurological (typically epilepsy)
• Expansive intracranial processes
• Febrile (febrile spasms occur mainly in children under 2-3 years old)
• Affective respiratory seizures (in young children as a result of intense emotions - crying, laughing, when convulsions are provoked by temporary apnea)
• Syncope (in this case it is rather rare - so-called convulsive syncope with short lasting spasms)
• Deficiency of vitamins or minerals (sodium, potassium, magnesium)or their excess

• Tetanic spasms
• Endocrinopathy (hyperthyroidism)
• Eclampsia
• Intoxication – typically central psychostimulants (exciting amine derivates)
• Withdrawal syndrome (Delirium tremens, withdrawal state after benzodiazepines or barbiturates)
• Psychiatric
  • as a result of psychiatric diseases without primary neurological causes
  • in neurodegenerative diseases
  • somatoform (psychosomatic) disorders - pseudospasms
  • iatrogenically induced prolonged grand mal seizures (GTCS) during electroconvulsive therapy (case studies)

Treatment

It is always necessary to remember that convulsions are a symptom, and it is therefore necessary to treat their cause, not the convulsions themselves. However, the truth is that mainly clonic convulsions can cause complications during treatment (during additional examinations, cannula insertion, etc.). In justified cases, it is therefore appropriate to suppress muscle contractions. IV benzodiazepines (e.g. diazepam) are typically used for this purpose, especially in the case of status epilepticus. Maybe there are other spasmolytics and myorelaxants. It is necessary to proceed with caution in case of intoxication with CNS depressants (alcohol, benzodiazepines, opiates), or in withdrawal states after benzodiazepines - in this case, e.g. Clomethiazole (Heminevrin) may be indicated.

Adult patients

In most adult patients, the cause of the convulsive condition is a grand mal epileptic seizure , which is usually not life-threatening in itself. In such a case, diazepam or phenytoin can be administered, and we also administer diazepam for convulsions of unclear origin.

If hypoglycemia is suspected, we administer 0.2–0.5 g of glucose /kg IV

If it is tetanic convulsions , we administer 10 ml of a 10% solution of calcium chloratum iv, possibly. and 10 mg of a 10% solution of magnesium sulfate.

Children

In children, these are usually febrile convulsions, which can be alleviated with diazepam administered rectally (even the application can make an already traumatized child even more agitated). Antipyretics are a matter of course .

If tetanic convulsions are suspected, administer 5 ml of a 10% solution of calcium chloratum IV + 5 ml of a 10% solution of magnesium sulfate.

It is important to keep in mind that the convulsions themselves can sometimes directly endanger the patient's life (aspiration of regurgitated stomach contents, convulsion-induced falls associated with head injuries).

Topical convulsions and convulsions of a hemi -character in children under six months and over 6 years of age are urgent conditions, especially in patients with a positive family history

Links

Related articles

• Epilepsy
• Intoxication
• Encephalitis
• Hypoglycemia
• Antispasmodics
• Muscle relaxant
• Parasympatholytics

References

• AMBLER, Zdenek. Basics of neurology : [textbook for medical schools]. 7th edition. Prague: Galén, 2011.  ISBN 978-80-7262-707-3

• HUMBLE, Jiří. Medical first aid. 1st edition. Prague: Galén, 2005. pp. 58-59, 205-209. ISBN 80-7262-214-5