Epileptiform spasms

Description:

At diagnosis of the convulsive attacks observed at children of early age it is necessary to subdivide them into 2 groups of attacks: not epileptic and epileptic. Attacks, not epileptic first, can accept epileptic character further.

Symptoms of Epileptiform spasms:

Spasms at asphyxia of newborns

One of the most frequent reasons of spasms at newborns is asphyxia which is a consequence of a lack of oxygen of blood and fabrics with carbonic acid accumulation. As a result blood circulation is broken, vascular permeability increases, there are wet brain phenomena which are followed by dot hemorrhages. Long asphyxia promotes growth of gliozny (cicatricial) fabric and an atrophy of a brain.

Similar changes have sources in the period of pre-natal fetation (at pregnancy toxicoses, at premature placental detachment, at umbilical cord encirclement around a neck or a trunk of a fruit, at long childbirth and a prezhdevremnny bursting of waters and etc.

Depending on expressiveness and duration of asphyxia the arising spasms can have various character.

Attacks usually stop at removal of the newborn from asphyxia and disappearance of the phenomena of wet brain. Spasms can repeat in 2-3 months and at more advanced age again, accepting not epileptic (epileptiform) character.

Spasms at an intracranial (patrimonial) injury

Spasms at an intracranial injury are caused by the arising intracraneal hemorrhages. At hemorrhage in substance of a brain motive disturbances, changes in a muscle tone, decrease in a physical activity of extremities can be observed.

The local nature of spasms in the form of rhythmical stereotypic reductions of certain groups of muscles, in a face or extremities is important. However more often spasms have generalized character in the form of tonic tension, with breath regulation disturbance, cyanosis (a posineniye of the person, trunk).

At the same time along with disorders of breath, detection of cyanosis, high temperature can be observed. The big fontanel becomes intense, bulked up, vomiting, vomiting are noted.

Quite often spasms at the newborn who had asphyxia or cherepnomozgovy injury at the birth for the first time arise for 3-5 days. Their emergence is caused by intracraneal hemorrhages, gradually accruing hematoma. Spasms are promoted at the same time by the physical tension of the child during the feeding, concern and the ave.

The spasms at the children who had a craniocereberal injury developing in later terms, 2-3 months later are often caused by sites of a gliosis (cicatricial) tissues of a brain, the formed cysts, liquorodynamic disturbances as a result of formation of commissures, hems, hydrocephaly (a brain edema) and other. Such spasms differ in a steady form of a current. Sometimes for the first time they come to light at any infection, a home accident, after an inoculation, at increase in intracranial pressure.

In the remote period of a craniocereberal injury convulsive attacks can accept the expressed epileptiform (not epileptic) character.

Spasms at a hemolitic disease of the newborn

At a hemolitic disease against the background of flavovirent coloring of skin, sharp slackness, concern, disturbance of the act of suction the newborn can have spasms. Attacks of tonic spasms (tension of all body) are very characteristic, are followed by a loud shriek.

Diagnostic value special tests of Koombs, a blood analysis of mother and child on a Rhesus factor, definition of specific antibodies at mother in blood and in milk, and also have determination of level of an indirect bilirubin in blood at the child.

Spasms at inborn defects of development of a nervous system

Among inborn defects of development of the central nervous system the convulsive phenomena are often observed at children with a nanocephalia, with a brain underdevelopment, with a craniostenosis (premature ossification of intracranial seams) owing to the increased intracranial pressure (intracranial hypertensia); with hydrocephaly and etc.

Spasms at infectious diseases

Spasms at the infectious diseases proceeding with temperature increase at children of early age are observed more often than at children of advanced age, and are result of infectious and toxic influence with development of intracranial hypertensia and wet brain.

Big tendency to febrile spasms is noted at the pastose children sick with the exudative diathesis having the known convulsive readiness.

Spasms at flu, a SARS, pneumonia are observed usually at the beginning of a disease, and stop at recession of sharpness of a basic disease; at children's infections (measles, chicken pox, a rubella) of a spasm arise at the height of rashes pointing out sharpness of toxic impact of a virus on a nervous system.

At whooping cough the convulsive phenomena can arise in various phases of a disease, on 3-4 week and are connected with disturbance of cerebral circulation and ischemia of a brain.

Spasms at acute neuroinfections (meningitis, encephalitis) arise at disease height, have tonic (trunk tension) and toniko-clonic (twitching of various groups of muscles of extremities) character. At the same time they reflect the syndrome of the general brain disturbances proceeding with intracranial hypertensia, the wet brain phenomena more often. As a rule, neuroinfections spasms arising at height disappear together with recession of temperature.

At preventive inoculations (AKDS, ADS) convulsive attacks usually happen short-term, proceeding as encephalitic reaction, usually arise for 1-2 days in connection with a fabric anoxia (the termination of access of oxygen to brain tissues) and disturbance of vascular circulation.

Especially often convulsive reactions to preventive vaccination are observed at the children with display of exudative diathesis who had asphyxia, a birth trauma at the birth. These children usually have a peculiar convulsive readiness. Therefore at early age, children with the increased convulsive readiness have to receive branch from preventive inoculations.

Convulsive states can arise at some disturbances of exchange (calcium-phosphorus, amino-acid, lipoid)

At disturbance of calcium-phosphorus exchange (hypocalcemia) of a spasm can be caused by the phenomena of rickets and make the diagnosis "spasmophilia". In blood the lowered content of calcium is found (norm =6, 0 – 6, 7 mg of %).

Convulsive manifestations of a rachitogenic hypocalcemia it is more often observed at the end of winter and at the beginning of spring, at children aged from 6 up to 12 months. Spasms can be followed by a long spasm of peripheral muscles and transition to the general tonic spasms. At the same time the distorted face as expression of a spasm of muscles, an oculogyric crisis, a laryngospasm is noted tetanically.

The spasms which are followed by the lowered content of calcium in blood can have also other origin in addition to rickets. In the period of a neonatality it is possible to observe spasms at premature children, in connection with considerable lability of calcium-phosphorus exchange.

Later, the spasms caused by a hypocalcemia can develop at babies upon sharp and bystry transition to artificial feeding by cow's milk in which phosphorus contains in a significant amount and is not removed sufficiently with urine.

Respiratory and affective paroxysms

Respiratory and affective spasms usually result from strong emotions. The child begins to shout more and more loudly, becomes excited. Suddenly at it there comes the breath holding which is followed by the cyanosis of integuments which was more expressed around a mouth, tension of all body. This attack is always preceded by spasmodic crying. This type of an attack can be carried to hysterical reactions. It is noticed that it never arises at children in children's collectives but only in the presence of mother or grandmothers are more often.

Reasons of Epileptiform spasms:

Insufficient degree of a maturity of a brain at children of early age causes a low excitation threshold of the central nervous system and their tendency to diffusion convulsive reactions. As children of early age have a hyperpermeability of walls of vessels, under the influence of infections, toxic and other harmful factors the phenomena of the wet brain which is followed by convulsive reaction quickly develop. If there is no burdened heredity, there are no organic lesions of the central nervous system, there are no characteristic changes on EEG, there is no distinction in displays of convulsive attacks, there are no characteristics of the personality, the diagnosis of epilepsy to children up to 5 years is usually not made.

Not epileptic convulsive epileptic seizures divide by the etiological (causal) principle:

Spasms at asphyxia of newborns;
Spasms at intracranial (patrimonial) and other types of injuries;
Spasms at a hemolitic disease of the newborn;
Spasms at inborn defects of development of the central nervous system; inborn uglinesses, nanocephalia, hydrocephaly and others;
Spasms at brain tumors;
Spasms at pathology of vascular system and heart (aneurism, an angiomatosis, acute disorders of cerebral circulation, inborn heart diseases);
Spasms in the acute period of infectious diseases at children (a SARS, Flu, neuroinfections: meningitis, encephalitis, etc.); at high temperature – febrile spasms;
Spasms at preventive inoculations;
Spasms at various intoxications;
Spasms at some disbolism;
Spasms at some diseases of blood;
Anoxic spasms.

Treatment of Epileptiform spasms:

Treatment of the main pathology against the background of which there were epileptiform spasms is carried out.