CURVES - paroxysmal involuntary muscle contractions, one of the forms of hyperkinesis. They can occur in various diseases of the nervous system - epilepsy, meningitis and encephalitis, traumatic brain injury, cerebral edema, intracranial neoplasms, brain abscesses, subarachnoid hemorrhages, as well as secondary changes in the central nervous system caused by common infections and intoxications, with hypoglycemic and uremia and others
Depending on the nature of muscle contractions, tonic and clonic convulsions are distinguished. Tonic cramps are more or less prolonged muscle contractions, as a result of which the limbs “freeze” in the position of flexion or extension, the patient’s body stretches, the head throws back or is brought to the chest. With clonic convulsions, successive contractions of the flexor and extensor muscles are observed, which is manifested by the rapid involuntary movements of the limbs and trunk. Often there are tonic-clonic convulsions, in which the attack consists of two phases: first, tonic convulsions develop, and then clonic ones follow. Depending on the completeness of involvement of skeletal muscles, local, or local (partial), and general, or generalized, convulsions are distinguished. Local cramps more often occur with focal irritation of the motor centers of the cerebral cortex, related to the innervation of a particular muscle group of the limbs, face, trunk; this causes a convulsive contraction of the muscles of the hand, foot, and facial muscles on the side opposite to the localization of the focus (for example, a tumor , hematoma, aneurysm of the brain vessels) in the hemisphere of the brain. Local cramps can also be associated with systematic overfatigue of the muscles involved in stereotyped professional movements - professional cramps (for example, cramping spasm, leg muscle cramps in runners and football players, hand muscles in violinists, typists, etc.). Cramps of the calf muscles, which are often observed in practically healthy individuals when bathing in cold water or during night sleep, are not only a local spasm and occur with the participation of the central nervous system in response to impulses from the periphery. With local seizures, consciousness in patients, as a rule, does not turn off. Generalized convulsions are observed, in particular, with a large convulsive seizure, which proceeds quite stereotypically (see Epilepsy).
Convulsive attacks in children are observed much more often than in adults, and mainly in the early period of life. An increased predisposition of children to convulsive reactions is associated with immaturity of the brain, incomplete myelination of nerve fibers, high permeability of the blood-brain barrier, increased hydrophilicity of the brain tissue, lability of metabolic processes, weak inhibitory mechanisms, pronounced tendency to generalization of excitation.
High convulsive readiness in children is formed under the influence of harmful factors acting on the central nervous system during pregnancy, during childbirth and after childbirth. In the prenatal period, such factors as toxicosis of pregnant women , intrauterine infections, acute and chronic diseases of the mother, drug intoxication are of great importance; in childbirth - hypoxia and (or) mechanical damage to the fetal brain; after childbirth - general infectious diseases, neuroinfections, post-vaccination complications, traumatic brain injury , brain tumors . An important role in the development of convulsive readiness is played by hereditary metabolic disorders, degenerative diseases of the brain.
In newborns, convulsions occur with asphyxia and intracranial birth injury, hyperbilirubinemia, neuroinfectious diseases (meningitis, encephalitis), hypoglycemia, hypocalcemia, hypomagnesemia, vitamin B6 deficiency, and abnormalities in the development of the nervous system. In young children, febrile, spasmophilic (tetanic), respiratory-affective and post-vaccination convulsions, as well as convulsions with neuroinfection and metabolic disorders, are most often observed. At an older age, convulsions mainly occur with traumatic brain injury, neuroinfections, and epilepsy.
Treatment is carried out taking into account the underlying disease. Anticonvulsants are used - phenobarbital , diphenin , benzonal, hexamidine, etc. With professional convulsions, local massage, thermal procedures, a clear regime of work and rest have a positive effect. With serial seizures or convulsive status, emergency care is necessary, since they threaten the development of cerebral edema, respiratory depression and other vital functions. When assisting, the genesis of convulsive syndrome should be considered. Along with the introduction of anticonvulsants, antipyretics (with hyperthermia), dehydrating agents, drugs that correct metabolic disorders (calcium, magnesium, glucose, pyridoxine) are prescribed. Of the anticonvulsants, seduxen, droperidol , GHB, aminazine, etc. are used.