Convulsive syndrome at children – the nonspecific reaction of an organism of the child to external and internal irritants which is characterized by sudden attacks of involuntary muscular contractions. The convulsive syndrome at children proceeds with development of partial or generalized spasms of clonic and tonic character with loss or without consciousness loss. Consultations of the pediatrician, the neurologist, the traumatologist are necessary for establishment of the reasons of a convulsive syndrome at children; carrying out EEG, NSG, REG, X-ray analysis of a skull, brain KT and so forth. Knocking over of a convulsive syndrome demands introduction of antikonvulsant and performing therapy of the main disease from children.
Convulsive syndrome at children
Convulsive syndrome at children - the frequent urgentny condition of children's age proceeding with development of convulsive paroxysms. The convulsive syndrome meets frequency of 17-20 cases at 1000 children: at the same time 2/3 convulsive attacks at children fall on the first 3 years of life. The convulsive syndrome occurs at children of preschool age by 5 times more often than in general in population. High prevalence of a convulsive syndrome at children's age is explained by immaturity of nervous system of children, tendency to development of all-brain reactions and variety of the reasons causing spasms. The convulsive syndrome at children cannot be considered as the main diagnosis as accompanies a current of a big circle of diseases in pediatrics, children's neurology, traumatology, endocrinology.
The reasons of a convulsive syndrome at children
The convulsive syndrome at children is a polietiologichesky clinical syndrome. The neonatal spasms developing at newborns are usually connected with crushing hypoxemic defeat of TsNS (a fruit hypoxia, asphyxia of newborns), an intra cranial patrimonial trauma, a pre-natal or post-natal infection (a cytomegalic inclusion disease, toxoplasmosis, a rubella, herpes, congenital syphilis, listeriosis, etc.), congenital anomalies of development of a brain (goloprozentsefaliy, gidroanentsefaliy, a lissentsefaliya, hydrocephaly, etc.), an alcoholic syndrome of a fruit. Spasms can be manifestation of a syndrome of abstinency at the children born from mothers having alcoholic and drug addiction. Seldom newborns have tetanic spasms caused by infection of an umbilical wound.
It is necessary to distinguish an electrolytic imbalance from the metabolic violations which are the reason of a convulsive syndrome (a gipokaltsiyemiya, a gipomagniyemiya, hypo - and a gipernatriyemiya) meeting at premature, children with a pre-natal hypotrophy, a galactosemia, a fenilketonuriya. Separately among toksiko-metabolic violations there is a giperbilirubinemiya and the related kernicterus of newborns. The convulsive syndrome can develop at children with endocrine violations - a hypoglycemia at diabetes, a gipokaltsiyemiya at a spazmofiliya and a gipoparatireoza.
At chest and early children's age in genesis of a convulsive syndrome at children the leading role is played by neuroinfections (encephalitis, meningitis), infectious diseases (a SARS, flu, pneumonia, otitis, sepsis), ChMT, vaccine-challenged complications, epilepsy.
As less frequent reasons of a convulsive syndrome at children brain tumors, brain abscess, congenital heart diseases, poisonings and intoxications, hereditary degenerate diseases of TsNS, fakomatoza act.
A certain role in emergence of a convulsive syndrome at children belongs to genetic predisposition, namely – to inheritance of features of metabolism and neurodynamics defining the lowered convulsive threshold. Infections, dehydration, stressful situations, sharp excitement, overheating, etc. can provoke convulsive attacks at the child.
Classification of a convulsive syndrome at children
By origin distinguish epileptic and not epileptic (symptomatic, secondary) a convulsive syndrome at children. Symptomatic are among febrilny (infectious), hypoxemic, metabolic, structural (at organic defeats of TsNS) a spasm. It should be noted that in certain cases not epileptic spasms can pass in epileptic (for example, at long, more than 30 minutes not stopped convulsive attack, repeated spasms).
Depending on clinical manifestations distinguish partial (localized, focal) the spasms covering separate groups of muscles, and generalized spasms (the general convulsive attack). Taking into account the nature of muscular contractions of a spasm can be clonic and tonic: in the first case episodes of reduction and relaxation of skeletal muscles quickly replace each other; in the second the long spasm without the relaxation periods takes place. In most cases the convulsive syndrome at children proceeds with generalized toniko-clonic spasms.
Symptoms of a convulsive syndrome at children
The sudden beginning is peculiar to a typical generalized toniko-clonic attack. Suddenly the child loses contact with the external environment; his look becomes wandering, the movements of eyeballs – floating, then the look is fixed up and aside.
In a tonic phase of a convulsive attack the head of the child is thrown back back, jaws are closed, legs become straight, hands are bent in elbow joints, all body strains. Bradycardia, pallor and a tsianotichnost of integuments is noted short-term . The clonic phase of a generalized convulsive attack is characterized by breath restoration, separate twitchings of mimic and skeletal muscles, consciousness restoration. If convulsive paroxysms follow one by one without consciousness restoration, regard such state as the convulsive status.
As the most frequent clinical form of a convulsive syndrome at children serve febrilny spasms. They are typical for children aged from 6 months up to 3-5 years and develop against the background of rise in body temperature above 38 °C. Signs of toksiko-infectious damage of a brain and its covers at the same time are absent. Duration of febrilny spasms at children usually makes 1-2 minutes (sometimes up to 5 minutes). A current of this option of a convulsive syndrome at children favorable; permanent neurologic violations, as a rule, do not develop.
The convulsive syndrome at children with an intra cranial trauma proceeds with a vybukhaniye of fontanels, vomiting, vomiting, disorders of breath, cyanosis. Spasms at the same time can have character of rhythmical reductions of certain groups of face muscles or extremities or generalized tonic character. At neuroinfections in structure of a convulsive syndrome at children toniko-clonic spasms usually dominate, it is noted rigidnost of occipital muscles. Tetaniya caused by a gipokaltsiyemiya is characterized by spasms in muscles-sgibatelyakh ("the obstetrician's hand"), facial muscles ("a sardonic smile"), pilorospazmy with nausea and vomiting, a laryngospasm. At a hypoglycemia development of spasms is preceded by weakness, perspiration, a shiver in extremities, a headache.
The "aura" preceding an attack is typical for a convulsive syndrome at epilepsy at children (feeling of a fever, heat, dizziness, smells, sounds and so forth). Actually epileptic attack begins with shout of the child, the loss of consciousness following it and spasms. Upon termination of an attack there comes the dream; after awakening the child is slowed down, does not remember the event.
In most cases establishment of an etiology of a convulsive syndrome at children only on the basis of clinical signs is impossible.
Diagnostics of a convulsive syndrome at children
Owing to a mnogofaktornost of an origin of a convulsive syndrome at children, children's experts of various profile can be engaged in its diagnostics and treatment: neonatology, pediatricians, children's neurologists, children's traumatologists, children's ophthalmologists, children's endocrinologists, resuscitators, toxicologists, etc.
Point in the correct assessment of the reasons of a convulsive syndrome at children careful collecting the anamnesis is decisive: clarification of a hereditary otyagoshchennost and the perinatal anamnesis preceding an attack of diseases, injuries, preventive inoculations and so forth. At the same time it is important to specify the nature of a convulsive attack, a circumstance of its emergence, duration, repeatability, an exit from spasms.
In diagnostics of a convulsive syndrome at children tool and laboratory researches are important. Carrying out EEG helps to estimate changes of bioelectric activity and to reveal convulsive readiness of a brain. The rheoencephalography allows to judge character of a blood-groove and blood supply of a brain. At a skull X-ray analysis at the child premature closing of seams and fontanels, a divergence of cranial seams, existence of manual vdavleniye, increase in the sizes of a skull, change of contours of the Turkish saddle, the centers of calcification and other signs which are indirectly testifying to the reason of a convulsive syndrome can come to light.
The neyrosonografiya, diafanoskopiya, brain KT, angiography, oftalmoskopiya, carrying out a lyumbalny puncture help to specify an etiology of a convulsive syndrome at children in some cases. At development of a convulsive syndrome in children it is necessary to execute biochemical blood test and urine on the content of calcium, sodium, phosphorus, potassium, glucose, a pyridoxine, amino acids.
Treatment of a convulsive syndrome at children
At emergence of a convulsive attack of the child it is necessary to lay on a firm surface, to turn the head on one side, to undo a collar, to provide inflow of fresh air. If the convulsive syndrome at the child developed for the first time and his reasons are not clear, it is necessary to call the ambulance.
For free breath it is necessary to remove from an oral cavity slime, the remains of food or emetic masses by means of an electrosuction or a mechanical way, to adjust oxygen inhalations. If the reason of spasms is established, then for the purpose of their knocking over pathogenetic therapy (introduction gluconate calcium solution is carried out at a gipokaltsiyemiya, sulfate magnesium solution – at a gipomagniyemiya, glucose solution – at a hypoglycemia, antipiretik – at febrilny spasms etc.).
However, as in an urgentny clinical situation it is not always possible to carry out diagnostic search, for knocking over of a convulsive paroxysm symptomatic therapy is carried out. As means of first aid use intramuscular or intravenous administration of sulfate of magnesium, diazepam, GOMK, hexabarbital. Some anticonvulsive medicines (diazepam, hexabarbital, etc.) can be entered to children rektalno. Except anticonvulsive medicines, for prevention of hypostasis of a brain to children dehydrational therapy is appointed (, furosemide).
Children with the convulsive syndrome of not clear genesis, spasms which arose against the background of infectious and metabolic diseases, brain injuries are subject to obligatory hospitalization.
The forecast and prevention of a convulsive syndrome at children
Febrilny spasms usually stop with age. For the prevention of their repeated emergence should not allow the expressed hyperthermia at emergence at the child of an infectious disease. The risk of transformation of febrilny spasms in epileptic makes 2-10%.
In other cases prevention of a convulsive syndrome at children includes the prevention of perinatal pathology of a fruit, therapy of the main disease, observation at children's experts. If the convulsive syndrome at children does not disappear after the termination of the main disease, it is possible to assume that at the child epilepsy developed.