Differential diagnosis between tonic and clonic seizures. Tonic convulsions. Classification of seizures, causes and treatment. Convulsions in a child: causes

The term "clonic" comes from the Greek word "clonus", which means "hustle, bustle". A cramp is an involuntary spasm, or a sharp muscle contraction, accompanied by severe pain. Thus, "clonic seizures" are chaotic, erratic muscle contractions that are uncontrollable and painful.

Clonic and tonic convulsions - differences

With tonic convulsions, the muscles contract and remain in one position for a while. At the moment of spasm, the leg or arm literally freezes in a bent or unbent state.

Tonic and clonic convulsions differ in the duration of muscle contractions - this is the difference between them. In addition, tonic spasms can affect the facial and cervical muscles, and clonic spasms appear predominantly in the extremities.

Seizures are also mixed - in this case they are called tonic-clonic or clonic-tonic. They occur with traumatic brain injuries and organic pathologies of the brain.

Development mechanism

In most cases, the occurrence of seizures is associated with neurological disorders. The algorithm of their development does not depend on the cause and is always the same. Due to a malfunction in the system of neurohumoral regulation, traumatic brain injury or other reasons, the central nervous system begins to work incorrectly.

As a result of the predominance of excitation processes over inhibition, a so-called convulsive focus is formed in a certain area of ​​the brain. Under the influence of provoking factors - intoxication, overheating, infectious disease, etc. - it is activated, and a convulsive attack appears.

At the time of the seizure, the muscles become hard and unyielding, movements in the affected area are sharply limited. Spasticity of the skeletal muscles of the trunk and occiput, observed during epileptic seizures, leads to arching of the entire body.

A striking example of clonic convulsions are twitching of the eyelid and facial muscles. When the muscles involved in speech reproduction are affected, stuttering occurs. Spasm of smooth muscles causes disruption of the internal organs.

A few minutes before the seizure, the person becomes lethargic, nervous; visual, auditory or gustatory hallucinations are possible.

Convulsions of any type are accompanied by pain of varying intensity, due to pinching of nerve endings by muscles. Blood vessels are also pinched, which entails a violation of the blood supply and a transient disorder of skin sensitivity.

The reasons

Muscle spasticity accompanies most neurological pathologies. In 20% of cases, convulsions occur against the background of infectious, endocrine and somatic diseases. The most common causes of muscle spasms are:

• organic lesions and tumors of the brain, epilepsy;
• hypertensive crisis of convulsive type;
• violation of cerebral circulation;
• renal and liver failure;
• infectious diseases - tetanus, cholera, rabies;
• mental disorders - in particular, hysteria, schizophrenia, panic attacks;
• severe toxicosis of pregnant women, eclampsia;
• intoxication of the body with ethyl and methyl alcohol, narcotic substances, drugs (for example, barbiturates, Corazole), carbon monoxide, strychnine;
• excess doses of drugs such as Aminazine, Ceftazidine, Isoniazid;
• hyper- and hypoglycemia;
• violation of calcium metabolism due to dysfunction of the kidneys, thyroid gland;
• deficiency of magnesium and sodium;
• precomatous and coma;
• electrical injury;
• severe dehydration.

Convulsions in children under 6 years of age often appear with an increase in body temperature above 38.5 ° (febrile convulsions). The cause of uncontrolled clonic spasms can also be a nervous shock.

Contractions of individual muscle groups have their own names. So, a spasm of the masticatory muscles is called trismus, blepharospasm is a spasm of the circular muscles of the eyes. With the reduction of the pylorus of the stomach, they speak of pylorospasm. Spasm of the esophagus is called cardiospasm.

Separately, generalized convulsions are distinguished, in which the muscles of the trunk and limbs contract. They can be clonic, tonic or mixed. Clonic-tonic convulsions are observed during epileptic seizures: the body arches and freezes in this position, and the limbs shudder convulsively.

Reference: sometimes the cause of spasms cannot be established and the diagnosis is "idiopathic convulsions".

Symptoms

Clonic convulsions are characterized by a rapid change in periods of contraction and relaxation. They appear most often either due to damage to the motor neurons of the brain, or due to a violation of the transmission of nerve signals to the muscles.

Outwardly, this is manifested by twitches or sharp concussions of the whole body - convulsions. Muscle tension lasts no more than 15 seconds. With a spasm of individual small muscles, a tick appears - a wink, frequent head tilts, hand tremors.

A classic example of clonic seizures is stuttering. It should also be noted that clonic convulsions are rarely accompanied by pain.

Tonic spasm appears, as a rule, suddenly and gradually intensifies. After a few minutes, the attack goes away on its own. The spasmodic muscle becomes hard and slightly increases in size.

Tonic convulsions are always accompanied by a pronounced pain syndrome, since the nerve endings are literally clamped by muscle fibers. Spasm can occur in any muscle, but the calves and arms are most commonly affected.

The main causes of tonic spasms are micronutrient deficiencies, intense physical activity and hypothermia. In most cases, the attack begins at night.

The clinical picture of tonic-clonic seizures includes several symptoms:

• the body arches up, the eyes roll back;
• facial features are distorted;
• teeth clench, sometimes foam appears at the mouth;
• convulsions spread to the whole body, which is fraught with impaired respiratory function;
• the patient may lose consciousness.

The average duration of an attack is 5-6 minutes. Gradually, the frequency of muscle contractions decreases, the muscles relax. After a seizure, there may be abdominal pain, involuntary urination or defecation.

For a few more minutes, the person remains lethargic, disoriented, and often falls asleep immediately. Some patients do not remember either the attack itself or the events that preceded it.

Depending on the disease that caused the seizures, there may be other signs:

• headaches and dizziness;
• a sharp drop or increase in blood pressure;
• weakness and increasing malaise;
• hand trembling;
• increased sweating;
• pale skin;
• stuttering;
• recurrence of the underlying pathology.

This condition requires a mandatory consultation with a doctor. Self-medication with medications, as well as homemade tinctures and decoctions, is unacceptable.

Simple actions can sometimes save the life of a victim of a seizure.

Help: emergency care for a victim of seizures is to keep him on his side or turn his head to prevent swallowing and inhalation of vomit. A small object should be placed between the teeth. It is forbidden to give the patient liquid and any medicines.

Clonic and tonic convulsions in children

Most often, convulsive syndrome occurs in newborns and children under 3 years of age. The most common cause is an increase in body temperature to febrile values ​​- from 38 ° and above. Respiratory-affective convulsions caused by strong negative emotions are somewhat less common.

Febrile convulsions are more common in the first year of a child's life and are associated with the immaturity of the nervous system and instability of the thermoregulatory centers. An important factor is hereditary predisposition.

Febrile convulsions are manifested by holding the breath, blue or blanching of the skin, straightening or twitching of the limbs. Often children during an attack do not respond to external stimuli and look completely detached.

Respiratory-affective spasms are a kind of expression of resentment, anger and other negative emotions. Therefore, they are accompanied by loud crying and screaming. At the peak of the seizure, there may be a change in the frequency, rhythm, and depth of breathing (dyspnea). In more rare cases, apnea is possible - respiratory arrest.

With respiratory-affective spasm, individual muscles usually contract, but generalized seizures with combined clonic-tonic convulsions are not excluded.

In most cases, after giving first aid to the child, you need to call an ambulance.

Other causes of seizures in children can be metabolic disorders (deficiency of calcium, magnesium, low blood glucose), hemolytic disease (a consequence of nuclear jaundice), CNS damage in the perinatal period, and neuroinfections.

Diagnosis and treatment

To make a diagnosis, a comprehensive examination is prescribed, which may include:

• general blood test and biochemistry;
• general analysis of urine and feces;
• blood test for hormones and tumor markers;
• computed (CT) or magnetic resonance imaging (MRI);
• Ultrasound of the abdominal cavity and small pelvis.

When a brain tumor is detected, a histological examination of the tumor tissue is mandatory. If the cause of seizures is an aneurysm or neoplasm, surgery is performed.

The choice of medication depends on the underlying disease. The therapeutic regimen may include nootropics, sedatives, antiepileptic and anti-inflammatory drugs, antibiotics and immunomodulators.

Instead of a conclusion

Recurrent clonic convulsions are a signal of neurological pathologies of varying severity. This symptom requires a mandatory consultation with a doctor and a comprehensive examination.

If convulsions appear infrequently, then they do not pose a serious threat to health. Periodic spasms of the limbs are most likely associated with active physical work and monotonous movements. Another reason may be a deficiency of vitamins and minerals, which is especially true for pregnant women. In this case, correction of the diet and daily regimen, as well as taking pharmacy vitamin and mineral supplements, will help.

convulsions- these are involuntary muscle contractions that appear suddenly in the form of seizures and continue for a different duration.
There are clonic, tonic and clonic-tonic convulsions.

Clonic convulsions- fast muscle contractions that follow each other after a short period of time. They can be rhythmic and non-rhythmic and are characterized by excitation of the cerebral cortex.
tonic convulsions- prolonged muscle contractions. They come on slowly and last for a long time. Their appearance indicates the excitation of the subcortical structures of the brain.
Seizures in epilepsy, traumas of the skull, organic diseases of the brain are clonic-tonic, and with tetanus - tonic.

Recognition convulsive attack usually presents no difficulty.
epileptic seizure. The patient suddenly loses consciousness. The look is wandering, the eyeballs first "float", and then are fixed upward or to the side. The head is thrown back, the arms are bent at the hands and elbows, the legs are extended, the jaws are convulsively closed. Breathing and pulse slow down, biting of the tongue, apnea is possible. The patient's face first turns pale, then becomes purplish blue. The tonic phase of convulsions lasts no more than a minute. The second phase of the seizure is characterized by clonic convulsions, in which flexion and extension of the muscles of the arms and legs, twitching of the muscles of the face, neck, and torso quickly alternate (the patient "beats"). Often there is involuntary urination. Foamy saliva comes out of the mouth. The total duration of the seizure is 2-3 minutes, then the muscles of the limbs and torso relax. Consciousness remains confused for a while, then sleep usually follows. Waking up, the patient does not remember what happened, complains of weakness, muscle pain, weakness, headache.

convulsive seizure in epilepsy, the so-called aura (harbinger) is often preceded, which is manifested by palpitations, dizziness, a feeling of heat, unpleasant odors, perception of various sounds, a feeling of fear, etc.
Finding out causes of seizures, their differentiated diagnosis is carried out in stationary conditions - usually in a neurological clinic (or is decided together with a neuropathologist). Sometimes epileptic seizures have to be differentiated from hysterical.

Tactics of conducting patient with convulsive syndrome consists of emergency life-saving care and transportation to a neurological (psycho-neurological) department or to an infectious disease clinic (tetanus, rabies, acute infections).
Treatment of a convulsive syndrome. Experimental data show that after 60 min. convulsive status in a number of areas of the cortex and subcortex, irreversible cell damage occurs. In addition, according to clinical studies, the longer the attack lasts, the more difficult it is to stop it and the higher the frequency of neurological complications. Therefore, it is important to recognize and treat aggressively in the early stages, i.e. before such consequences develop.

First Aid for Seizures

Treatment should be comprehensive and directed:
to maintain vital functions;
elimination of seizures;
reduction of intracranial hypertension.

I. Maintaining the functions of vital organs: ensuring free airway patency; protection of the patient from possible trauma during convulsions.

II. Anticonvulsant therapy:
magnesium sulfate - 25% solution 10-25 ml in/in or/m; chlorpromazine 2.5% solution 2 ml / m;
seduxen (diazepam) - 10-20 mg per 20 ml of 40% glucose solution IV; barbiturates (hexenal, thiopental up to 1 g per day - 300-500 mg intravenously, the rest of the dose - intramuscularly); phenobarbital loading dose (15-20 mg/kg) is administered at a rate not exceeding 50-100 mg/min until the highest dose is reached or convulsions stop. The loading dose is followed by a maintenance dose of 1-4 mg/kg/day.
Sometimes anesthesia is used with nitrous oxide and oxygen in a ratio of 3:1.

III. Reducing intracranial pressure and reducing the hydrophilicity of the brain tissue:
osmotic diuretics (mannitol), lasix;
magnesium sulfate repeatedly;
spinal puncture;
glucocorticoids - preferably dexamethasone.

When convulsions docked, it is important to establish their etiology.
Convulsive syndrome is a consequence of damage to the central nervous system.
Depending on the alleged reasons, in the absence of the need for resuscitation at this stage of the patient's management, the issues of transporting the patient to specialized clinics are determined.

Many have experienced seizures. Often they suddenly appear and also suddenly disappear. For some people, muscle cramps happen quite rarely, while for others they recur frequently and can last from three to fifteen minutes. If the convulsive syndrome is repeated several times a week, then a doctor's consultation in this case is required. Perhaps this is just a lack of vitamins, or maybe spasms indicate the development of some serious illness. A doctor can help you sort out this problem.

Muscle spasms are divided into several varieties. But most often, tonic, clonic and complicated clonic-tonic convulsions are diagnosed. Despite the fact that these varieties characterize involuntary muscle contractions and algia, they still have a number of significant differences.

They can occur under the influence of various adverse factors, which mainly indicate any disturbances in the body. Despite the fact that muscle contractions are quite common, they most often affect only a few muscle groups.

Tonic convulsions are characterized by short-term contractions of muscle areas with the onset of slow spasms that provoke a strong overstrain of muscle fibers.

Only the attending physician will be able to tell about everything else, who will establish a diagnosis and prescribe a course of treatment, subject to which convulsive seizures can remain in the past. And do not forget that your life and health depend on the timely visit to the doctor.

But the most commonly diagnosed are clonic and tonic. Both those and others are characterized by involuntary contraction of muscle tissue and pain. But still there is a difference between them.

Clonic convulsions are periodic contractions and relaxation of muscle tissue. Quite a long period of time passes between these periods.

Tonic convulsions are short-term and provoke muscle tension. It is not so difficult to distinguish one species from another on your own.

What it is

The clonic form appears when the pyramidal tracts are affected. Most often, clonus of the foot is diagnosed. It appears when a person lies on his back. In order to check whether the patient has such convulsions or not, it is necessary to conduct a small test.

To do this, the leg must be bent at the hip and knee joint. The doctor at this time flexes the foot as much as possible, after which he quickly extends it. In response to these movements, sharp clonic foot movements appear.

You can also determine the clonus of the patella. To do this, the patient must lie on his back and straighten his legs. The doctor grasps the patella with his fingers, raises it and then lowers it. If any pathological changes in the body are present, then such a test leads to a contraction of the quadriceps femoris muscle and to a twitching of the knee.

Clonic contractions are based on the absence of an inhibitory effect of the cerebral cortex on the motor neurons of the spinal cord. At the same time, during the stretching of some tendons, the excitation of the antagonist muscles begins. After that, the muscles begin to contract, and the antagonist muscles, which should relax, contract with them. And this process can take an indefinite period of time.

Clonic muscle contractions also occur in epilepsy, as well as during other generalized convulsive seizures.

The reasons

Many people ask what is the difference between clonic and tonic seizures? Here it is necessary to understand what is the cause of this condition. And most often these are disorders in the work of the central nervous system that occur due to chronic diseases. And it can manifest itself in both adults and children.

The main causes of clonic and tonic seizures can be considered:

1. Neuroinfections.
2. Acute disorders of cerebral circulation.
3. hypertensive crisis.
4. Tetanus.
5. Rabies.
6. High body temperature.
7. Adrenal insufficiency.
8. liver failure.
9. Elevated levels of insulin in the blood.
10. Hypoglycemic coma.
11. Stress.
12. Nervous experiences.

Why are such conditions dangerous? Any convulsions can lead to many unpleasant consequences. So, for example, it can be a fracture of the spine during contractions of the back muscles, when a person arches sharply, and pulmonary edema in case of respiratory failure, and cardiac arrest, if there is a spasm of the muscle tissue of the heart.

Often, after an attack, patients are diagnosed with ruptures of muscle tissue, arrhythmias, hemorrhages of varying severity, and, of course, all kinds of injuries. And pain, which can be quite strong, appears due to excess lactate in the blood, which is formed when glucose is not completely oxidized.

First aid

The differences between tonic and clonic seizures must be known to provide first aid to a person. The first thing to do is to lay the person on a soft surface so that during an attack he cannot injure himself. Even if it is the floor, a blanket should be laid on it.

Next, you need to unbutton or remove those clothes that restrict breathing. You can put a small piece of cloth, such as a handkerchief, in your mouth. This is necessary so that the victim does not crush his teeth and bite his tongue. The head during the attack must be turned to the side.

Clonic muscle contractions are not an independent disease, but just one of the symptoms of many other diseases. Therefore, before starting treatment, you should understand what caused the seizure.

As for the therapy itself, it is strictly individual and depends on what caused the attack. Drugs such as trioxazine, seduxen, or andaxin may be given intravenously to help the seizures go away as quickly as possible. Only a doctor should do this, as it is necessary to carefully calculate the dosage.

It is worth noting that if a person is healthy, then his muscle contraction occurs with the participation of various factors: nerve fibers, brain, muscle tissue, minerals and hormones.

If there is a failure somewhere, then a person will have tonic convulsions. As a rule, their total duration from 20-30 seconds to several minutes. At the same time, in severe cases, a negative phenomenon can be observed for several days, while short pauses occur.

In most cases tonic cramps affect the calves, foot, and hands. A little less often, the phenomenon extends to the muscles of the face, neck, thighs, and also the trunk. In this case, the specific location of localization directly depends on the reason for which a negative symptom appeared.

Tonic convulsions in a person can occur for various reasons. That is why it will be important to find out what in a particular case provoked an unpleasant symptom. There are several main provoking factors, and a person can even independently assume what exactly he has to deal with.

Possible reasons:

• Neurological diseases that manifest themselves in the form of acute. For example, it can be epilepsy, traumatic brain injury, neuroinfections, acute blood flow disorders.
• Infectious diseases such as tetanus. Often, such diseases can be accompanied by fever and rabies.
• that has aggravated or been previously transferred by a person.
• Violation of the water-salt balance, which arose due to heat stroke and eclampsia.
• Processes of toxic etiology. For example, renal failure, uremia, intoxication.
• Serious pathologies of the vascular system, as well as circulatory disorders.
• Excessive physical activity or muscle strain.

As you can understand, tonic convulsions occur for various reasons. At the same time, it is important to find out the specific one in order to roughly understand what exactly you have to deal with.

You should also know the symptoms of the pathology, because in this case it will be possible to immediately understand what you have to deal with. If the phenomenon is regularly repeated, then a person can be advised to consult a doctor. There you can go through diagnostics and understand what exactly you have to deal with.

Classification

A convulsive attack can be of different types, and it will definitely be necessary to understand what specific type you have to deal with. It is necessary to accurately determine the disease for the reason that in this case a person will be able to find out what exactly is happening to him.

Kinds:

• Tonic convulsions. With them, a person has a strong and painful muscle spasm. It lasts for a short time. At the same time, it can be caused by both external and internal factors. Therefore, it is impossible to say unequivocally whether everything is in order with a person’s health.
• Clonic convulsions. They are rhythmic muscle twitches. It causes relaxation and muscle tension. Most often, this happens when the nervous system is affected. Of course, external factors can also affect, but this happens extremely rarely.
• Tonic-clonic convulsions. This combined type is most often seen in epilepsy and other serious illnesses.

Of course, both tonic and clonic seizures should alert a person. They cannot be considered normal, so you should definitely go through diagnostic measures. It is important to make sure that everything is in order with health, and there are no deviations

Symptoms

The main symptom of seizures is that a person quickly contracts and then relaxes the muscles. In this case, such an attack most often occurs due to diseases of the central nervous system. Less commonly, the problem lies in the muscle tissue itself.

When a person has a cramp, it comes from the center, while involving muscles throughout the body in the process. If there is epilepsy or other similar disorders, then the seizures are generalized. During a seizure, a person will stretch, may take an arcuate position.

At the same time, he can clasp his face with his hands, as if trying to protect himself from external influences. Breathing will become more frequent, blood pressure may rise.

In some cases, the person loses consciousness. As soon as relaxation occurs after tonic spasms, the person may experience involuntary defecation or urination.

If we talk directly about clonic convulsions, then the contraction will alternate with interruptions, while the spine also bends, and the limbs bend.

There are a number of characteristic symptoms:

• Involuntary and at the same time a deep breath that a person will take during an attack.
• Convulsions.
• Trembling in the arms and legs, which will increase.
• Lack of reaction to external stimuli, also a person will not have protective reflexes.
• Profuse sweat.
• Falling of the tongue, while the respiratory function is disturbed.
• Muscle relaxation at the end of an attack, which may be accompanied by urination.

With the appearance of tonic convulsions, a person will often need the help of people around him. At the same time, they should not remain indifferent, because it is important to try to improve the human condition. If the seizure lasts for a long period, then it will be important to contact an ambulance.

What to do during an attack

With tonic convulsions, it is often necessary to help a person in order to improve his well-being. To do this, you need to perform a number of actions, thanks to which it will be possible to normalize the patient's condition.

It is important to lay the person on a soft surface so that there is no injury due to involuntary movements. If the patient is unconscious, then he should be placed on his side to prevent suffocation. After all, during a seizure, the appearance of vomiting is not ruled out.

It is important to open the windows, as well as free the person's chest from tight clothing. In this situation, the air will flow better to the body.

It is necessary to observe a person with tonic convulsions. In this condition, it may be necessary to provide additional assistance, for example, empty the mouth of vomit and watch that the tongue does not sunk. If convulsions occur, then it is worth holding the limbs so that the person does not injure them. From a person with tonic spasm, you should not go far before the arrival of doctors.

The main treatment will largely depend on what kind of problem the person has. To stop the attack of tonic seizures, it may be necessary to use sedatives, anticonvulsants, and barbiturates. All this will improve the human condition and eliminate tonic and clonic convulsions.

To avoid complications, you should immediately consult a doctor. Then it will be possible to find out why tonic convulsions appeared. It is possible that treatment will have to be started in order to improve the person's condition. You should definitely go to the hospital if your child suffers from muscle spasms. Health is not worth risking if you do not want to face negative consequences.