Convulsive syndrome

Convulsive syndrome is a symptom complex that develops with involuntary contraction of striated or smooth muscles. Spasm may be the case when there is only tonic contraction of muscle fibers, the duration of contraction is long, sometimes up to a day or more, with convulsions there is tonic and clonic (or tetanic) contraction, their duration is usually up to three minutes, but can be longer. It is often impossible to draw a clear parallel between them.

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Causes seizure syndrome

Depending on the cause, the convulsive syndrome can be generalized and local, affecting a separate group of muscle fibers, and can be constant and transient. According to the nature of clinical manifestations, the following are distinguished: spastic reaction, convulsive syndrome, and epileptic disease. The development of convulsions depends on spastic readiness, which depends on the maturity of the nervous system and its genetic characteristics. Convulsions develop 4-5 times more often in children than in adults.

A spastic reaction can develop in any healthy person in extreme situations and conditions: overfatigue, overheating of the body, hypothermia, intoxication, especially alcohol, hypoxic conditions, etc. A spastic reaction is short-term, usually episodic, but can be repeated, which depends on spastic readiness. In this case, it is already necessary to think about the development of such a condition as convulsive syndrome.

Convulsive syndrome develops with active pathological processes in the nervous system, resulting in an acquired decrease in the spastic readiness of the brain with extremely increased excitability of the brain. The excitability center formed in the brain plays a dominant role in the development of such a pathological process as convulsive syndrome, exogenous factors play a significantly smaller role, and convulsions can be repeated, often, even after their action has ceased.

Epilepsy occurs against the background of a hereditary increase in the spastic readiness of the brain. For the development of a minor or major epileptic status, no noticeable provoking factor is usually required; a slight irritation is sufficient.

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Symptoms seizure syndrome

Clonic convulsive syndrome (myoclonus) is characterized by short-term spasms and relaxation of muscles, quickly following one another, which leads to stereotypical movements of varying amplitude. They occur with excessive irritation of the cerebral cortex and are accompanied by somatotopic spread through the muscles according to the position of the motor cortical centers: starting from the face, they successively affect the fingers, hands, forearms, shoulder, then legs.

Localized clonic seizures may occur: choreic with rhythmic contraction of the muscles of the back of the head, shoulders, shoulder blades (Bergeron seizure syndrome), bilateral myoclonus of the face, neck, chest, shoulder girdle and upper limbs (Bergeron-Henoch seizure syndrome), with cortical genesis - in the form of Kozhevnikov epilepsy (arrhythmic seizures of certain body groups) or Jacksonian epilepsy (spastic contractions of the limbs on the side opposite to the brain lesion), with brainstem lesions - seizures of the gaze, soft palate, tongue, facial muscles, neck (nodding spasm), etc. Their distinctive feature (for differentiation from seizures in tetanus) is painlessness or a feeling of fatigue.

Generalized myoclonus in the form of chaotic twitching of the muscles of the body and limbs is called convulsions, which are also characteristic of damage to the cerebral cortex due to trauma, tumors, meningitis, hypoxia, diabetic coma, high temperature, etc.

Tonic convulsive syndrome is accompanied by prolonged (up to 3 minutes or more) muscle contraction. They occur both with irritation of the subcortical structures of the brain and peripheral nerves, as well as with disorders of neurohumoral regulation, in particular / the function of the parathyroid gland, metabolic disorders, especially calcium and phosphorus, hypoxia, etc. General tonic convulsions (opisthotonus) are rare. More often, local convulsions occur, when there is a kind of stiffness, "freezing" of individual muscle fibers, for example, the face, it takes the form of a "fish mouth" - Khvostek's symptom, gastrocnemius or back with osteochondrosis (Korneev's symptom), fingers ("writer's cramp"), hand ("obstetrician's hand" - Trousseau's symptom), thumb and index finger (dactylospasm) - in tailors, musicians and others whose work is associated with irritation of the nerves innervating these muscles. Diagnosis of pronounced myospasm does not cause difficulties; in the interictal period and in the latent form, a number of provocative techniques are carried out to identify increased excitability of the nerve trunks.

Tapping with a hammer on the trunk of the facial nerve in front of the auricle can cause a spasm of all muscles innervated by the facial nerve (Chvostek's symptom I), the area of the wings of the nose and the corner of the mouth (Chvostek's symptom II), and only the corner of the mouth (Chvostek's symptom III). Tapping at the outer edge of the orbit along the zygomatic branch of the facial nerve causes contraction of the orbicularis oculi and frontalis muscles (Weiss's symptom). Squeezing the shoulder with a cuff of a blood pressure measuring device after 2-3 minutes causes a spastic contraction of the hand like an "obstetrician's hand" (Trousseau's symptom).

Passive flexion of the hip joint with the knee straightened and the patient lying on his back causes myospasm of the hip extensors and supination of the foot (Stelzinger-Poole symptom). Tapping on the middle part of the anterior surface of the shin causes spastic plantar flexion of the foot (Petin symptom). Stimulation of the median, ulnar or peroneal nerves with a weak galvanic current of less than 0.7 mA causes spastic contraction of the nerves innervated by these nerves (Erb symptom).

Convulsive syndrome is typical for tetanus - a wound infection caused by the toxin of the absolute anaerobic spore-bearing bacillus Clostridium tetani, characterized by damage to the nervous system with attacks of tonic and clonic convulsions. With a long incubation period (sometimes up to a month), convulsive syndrome can develop already with healed wounds. Convulsive syndrome and its severity depend on the amount of toxin.

With a very small amount of toxin, its spread occurs through local tissues (muscles) with damage to the nerve endings of these muscles and regional nerve trunks. The process develops locally, most often causing non-spastic contraction, but fibrillation.

With a small amount of toxin, its spread occurs along muscle fibers and perineurally, including nerve endings, nerves to synapses and spinal cord roots. The process has the character of a mild ascending form with the development of tonic and clonic seizures in the limb segment.

With moderate and significant amounts of toxin, the spread occurs peri- and endoneurally, as well as intraxonally, affecting the anterior and posterior horns of the spinal cord, synapses and neurons, as well as the motor nuclei of the spinal cord and cranial nerves with the development of a severe ascending form of tetanus. It is accompanied by the development of general tonic seizures, against the background of which clonic ones also appear.

When the toxin enters the blood and lymph, a descending form of tetanus develops, in which it spreads throughout the body, affecting all groups of muscle fibers and nerve trunks and intra-axially from neuron to neuron, reaching various motor centers. The speed of spread depends on the length of each neural pathway.

The shortest neural pathway is in the facial nerves, therefore the convulsive syndrome develops in them, first of all, affecting the muscles of the face and masticatory muscles with the formation of three pathognomonic symptoms: trismus, caused by tonic contraction of the masticatory muscles, as a result of which the patient cannot open his mouth, sardonic (mocking, malicious) smile, caused by spasms of the facial muscles (the forehead is wrinkled, the eye slits are narrowed, the lips are stretched and the corners of the mouth are lowered down); dysphagia, caused by a spasm involved in the act of swallowing. Then the centers of the muscles of the neck and back are affected, later the limbs. In this case, a typical picture of opisthatonus develops, the patient, due to a sharp contraction of the muscles, bends in an arc, leaning on the back of the head, heels and elbows"

Unlike hysteria and catalepsy, the convulsive syndrome is aggravated by sound (it is enough to clap your hands) or light (turn on the light) stimulation. In addition, with tetanus, only large muscle fibers are involved in the process; the hands and feet remain mobile, which never happens with hysteria and catalepsy - on the contrary, the hands are clenched into a fist, the feet are extended. With tetanic contraction of the face and neck, the tongue moves forward and the patient usually bites it, which does not happen with epilepsy, meningitis and craniocerebral trauma, which are characterized by the tongue sinking. The respiratory muscles of the chest and diaphragm are the last to be involved in the process. The brain is not affected by tetanus toxin, so patients remain conscious even in the most severe cases.

Currently, all patients who have a convulsive syndrome, including tetanus, are sent to specialized hospitals with neurological and intensive care units.

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