Spastic syndrome

Spastic syndrome. Etiology, pathogenesis. Spastic syndrome originally divided into non-epileptic (secondary, symptomatic seizures) and epileptic. Non-epileptic seizures can later become epileptic. Secondary apnea (epileptiform) attacks are more common in infants and young children. Seizures may be associated with neonatal asphyxia, intracranial birth trauma or domestic, hypoglycemia, hypocalcemia, hemolytic disease of the newborn (giperbilirubinemicheskaya encephalopathy), intrauterine infections. Seizures occur in early acute infectious diseases, endogenous and exogenous intoxication and poisoning (uremia, hepatic coma, toxic syndrome, household poisoning) with hereditary metabolic diseases (phenylketonuria and other amino acid metabolism abnormality, galactosemia, disease Tay - Sachs).

The cause of seizures may be birth defects of the central nervous system, hereditary metabolic diseases and focal brain lesions (tumor, abscess). They are also observed in the pathology of the cardiovascular system and heart (congenital heart disease, collapse), in some diseases of the blood (hemophilia, kapillyarotoksikoz, thrombocytopenic purpura, leukemia). Seizures may occur when anoxic conditions, which include fainting, respiratory affective convulsions (the result of strong emotions). In infants seizures may be associated with a high fever.

Risk factors for febrile seizures in transition are epileptic cranial trauma history, seizures, duration of more than 30 minutes, their re-emergence. In these cases, long-term therapy with anticonvulsants may be indicated. When convulsions in children during the first weeks of life, it is advisable to conduct research on hereditary diseases obmena- express giperaminoatsiduriyu test, Fehling's test with ferric chloride to phenylpyruvic acid in the urine test for galactose in the urine.

When seizures are detected characteristic changes in the EEG. When X-rays of the skull may reveal small size or premature closure of the fontanelles and sutures (craniostenosis, microcephaly), the availability of digital impressions, the divergence of seams and increased cranium size of hydrocephalus, intracranial hypertension, foci of calcification, change sella circuits, indicating the organic nature of a convulsive syndrome. Rheoencephalography detects changes in blood flow and blood supply to the brain, the asymmetry of blood supply. In a number of cases to determine the causes of seizures Pneumoencephalography used, angiography, ehozntsefalografiyu and other studies.

In the study of cerebrospinal fluid can detect an increase in pressure over 130-140 mm of water. Art. Blood admixture ksantohromnost or cerebrospinal fluid, increasing the number of cells and protein (normally in children from 5 to 20 cells in 1 mm, 0.2-0.3% protein, 0.5-0.6 g / L sugar). Lymphocytic pleocytosis indicates serous meningitis. Turbidity, neutrophilia or mixed neutrophil-lymphocyte pleocytosis suggests purulent meningitis. Loss fibrinous mesh, reducing sugar content in the cerebrospinal fluid with mixed pleocytosis can be suspected tuberculous meningitis. Increased protein content with normal or slightly increased cell count (protein-cell dissociation) suggests volume process (tumor, cyst, abscess). Biochemical blood analysis in some cases detects hypocalcaemia (rickets, spazmofiliya), hypoglycemia, alkalosis as a cause of seizures.

The clinical picture. Convulsions clinically expressed clonic-tonic brief involuntary contractions of skeletal muscles. These may be local or generalized. Characterized by acute onset, agitation, changes in consciousness. When repeated attacks, between which consciousness does not return, say convulsive status.

Diagnosis is based on history and clinical manifestations.

Differential diagnosis is to determine the cause of convulsions.

Treatment. It eliminates the cause of seizures - febrile convulsions when administered antipyretics, while hypocalcemia -10% calcium gluconate solution, according to testimony eliminate hypoxia, respiratory and cardiac failure, detoxification is carried out. Anticonvulsants: seduksen (0.05-1 ml / kg of 0.5% solution) GHB (100 to 150 mg / kg) / w or w / o; 0.5% solution of 0,5-hexenal ml / kg / m.

According to the testimony perform spinal tap to the breeding of 5-15 ml of fluid, reducing intracranial pressure. If the child swallows the luminal administered orally at a dose of from 0.005 to 0.03 g reception depending on age can be combined with other anticonvulsants (dilantin, Benzonalum). If necessary luminal administered every 3 hours.

About the treatment of epilepsy, see chap. "Nervous Diseases" and "mental illness."

Forecast determined the cause of seizures, with convulsive status Seriously.

Prevention: the treatment of the underlying disease.