The human brain remains a poorly understood organ to this day. Mental processes occurring in the brain, their origin, control and modification are constantly of interest to neurologists who study the functioning of the brain. Since the possibility of recording brain function indicators on an electroencephalogram, paroxysmal activity has been identified and studied as a collective concept for many pathological processes.
Paroxysmal syndrome
In order to understand the essence of this diagnosis, you need to understand some terms. By paroxysm, or attack, we mean a transient dysfunction of any system or organ that occurs suddenly. This condition is divided into two main types: epileptic and non-epileptic.
But speaking generally, we are talking about a situation where a certain painful attack sharply intensifies to the highest degree. In some cases, the term “paroxysmal state” is used to describe recurrent symptoms of a specific disease. We are talking about health problems such as swamp fever, gout, etc.
In fact, paroxysms are a reflection of emerging dysfunction of the autonomic nervous system. The most common causes of such attacks are neuroses, hypothalamic disorders and organic brain damage. Crises may be accompanied by migraines and attacks of temporal lobe epilepsy, as well as severe allergies.
Despite the fact that there are several forms through which the paroxysmal state manifests itself, symptoms with similar characteristics can be found in all cases. We are talking about the following signs: stereotypicality and tendency to regular relapses, reversibility of disorders and short duration. Regardless of the background of what disease the paroxysm made itself felt, these symptoms will be present in any case.
Types of paroxysmal activity
Paroxysmal states in neurology are the process of an increase in the amplitude of brain activity on the electroencephalogram. An interesting fact is that the amplitude of the waves not only increases sharply, but also does not appear chaotically. In addition to the waves themselves, the source of their origin is also recorded. Sometimes some doctors deliberately narrow paroxysmal activity to epileptic seizures, however, this is not true.
An interesting fact is that a child may have paroxysms as a variant of the norm, since paroxysmal activity of the brain will not be supported by pathological changes in the structures of the brain.
For adults, it makes sense to talk about paroxysms as a pathological process occurring in the cerebral cortex. If we talk about paroxysm, as the most general concept, we can summarize the following: paroxysm is an intensified attack, occurring at the maximum of its tension and repeating a certain number of times.
Thus, the paroxysmal state will have the following characteristics:
- in the cerebral cortex there is an area with excitation processes that prevail over inhibition processes;
- excitation of the cortex is characterized by a sudden onset and an equally unexpected decline in activity;
- When studying brain impulses, a characteristic pattern is noticeable on the electroencephalogram, in which one can trace the waves reaching their highest amplitude.
Taking into account all the characteristics, the phenomenon of paroxysmal states is classified into two large categories - epileptic and non-epileptic.
Epileptic type of activity is manifested in a sick person by typical conditions - seizures that appear from time to time. These are convulsive conditions that occur with a certain frequency, and sometimes repeat one after another.
Epilepsy can be a congenital pathology, but it can also be acquired if a person has suffered a severe traumatic brain injury, suffers from a brain tumor, intoxication, or has experienced conditions of severe ischemia. Epilepsy, in turn, is also divided into convulsive and non-convulsive; the picture of such conditions is very diverse.
Provoking factors
So, understanding that the basis of such a problem as a paroxysmal state is actually always cerebral disorders, it is worth paying attention to those diseases that can lead to a sudden deterioration in physical condition, without the appearance of noticeable symptoms before.
It is this fact that allows us to assert that with all the abundance of various pathologies that serve as the background for a crisis, it is almost always possible to trace a single etiological picture.
You need to understand that doctors pay enough attention to this problem, so a study was carried out on the condition of a significant number of patients in order to identify common etiological factors that lead to the occurrence of paroxysms. The examinations were focused primarily on working with diseases such as vegetative-vascular dystonia, migraine, epilepsy, neuralgia and neuroses, etc.
What diseases lead to a crisis?
As a result of the above-mentioned studies, a list of diseases that have characteristic signs of paroxysm was compiled:
— Metabolic disorders and diseases of the endocrine system. These are menopausal syndrome, Cushing's disease, pheochromocytoma, hypercapnia and hypoxia.
— Alcohol and drug poisoning can also provoke paroxysmal conditions. Technical poisoning and certain types of medications can have a similar effect.
— A sharp increase in symptoms is possible with diseases of internal organs such as pneumonia, hepatic coma, etc.
— Paroxysm can also manifest itself against the background of psychovegetative syndrome diseases (neuroses, migraines, hysteria, depressive states, etc.).
— Hereditary diseases also play an important role in provoking such a problem as a paroxysmal state. This may be the impact of metabolic diseases, systemic degenerations of the central nervous system, etc.
— We should not discount diseases of the nervous system of the organic type. We are talking primarily about post-traumatic cerebrovascular disease, traumatic brain injury and causalgia. But vascular pathologies of the brain, as well as neuralgia and ischemic diseases, can also play a negative role.
Causes of the disease
Scientists have identified a number of negative factors that are common causes of sleep disturbances. The main ones include:
- Prolonged depression;
- Severe or prolonged stress;
- Emotional shock (usually associated with the death of a loved one);
- Problems with hormone balance;
- Detection of thyroid dysfunction;
- Parkinson's disease;
- Poor nutrition;
- Having bad habits;
- A side effect from long-term use of certain categories of medications;
- Chronic pathologies of the respiratory tract;
- Problems in the functioning of the gastrointestinal tract;
- Fever.
A separate group of patients consists of pregnant women and young children. In the first case, the disease manifests itself against the background of general changes in the body and natural sleep disturbances. As a rule, such parasomnia goes away on its own after delivery.
In the case of children, the disease is caused by the formation of the nervous system, accompanied by hyperexcitability, impressionability and a special reaction to various external stimuli. Immediate treatment is required only when sleep disturbances occur very often, preventing the baby from developing normally.
It is obvious that the occurrence of parasomnia is influenced by psychological, physiological and hereditary factors. To treat a disease, it is necessary to establish the cause and act on it.
How paroxysm can manifest itself: features
As mentioned above, in the vast majority of cases, a sharp exacerbation of symptoms occurs due to dysfunction of the brain. In addition, manifestations that are directly related to cerebral disorders are often recorded, and this is one of the key features of this condition.
In addition, you need to understand that there are both primary and secondary paroxysmal genesis. Primary is caused exclusively by congenital factors of manifestation, such as disorders in the brain and genetic disposition, which is formed during the development of the embryo. Secondary paroxysm is a consequence of the influence of internal and external factors. It manifests itself already during life.
The peculiarities of such a problem do not end there. Such paroxysmal states are recorded in neurology, which accompany the disease throughout the entire period of its course. Also, a sharp increase in symptoms may be one-time in nature and result from a state of shock in the central nervous system. One striking example is acute blood loss or a sudden increase in temperature.
There are also cases when paroxysmal attacks, being short-term and regular, affect the condition of the whole organism. Such attacks often occur against the background of migraine.
Such changes in the body can perform a protective function, due to which the compensatory component is stimulated. But this is possible only at an early stage of the disease. But the syndrome of paroxysmal states is very dangerous, since it turns into a significant complicating factor in diseases that initially cannot be called simple.
Migraine-like paroxysms
Headaches are one of the most common signs of cerebral pathologies. Several main etiological causes contributing to the occurrence of headache have been identified: vascular disorders, muscle tension, liquorodynamic causes, neuralgic etiology, mixed and central.
Each etiological factor is characterized by a separate mechanism for the occurrence of pain, but the basis is always a dysfunction of the nerve cells of the brain. In particular, migraine is characterized by vascular disorders, when high or low blood pressure in the network of cerebral capillaries provides regular insufficient trophism of neurons, or pressure from dilated blood vessels occurs on brain tissue.
Paroxysms during migraine belong to the non-epileptic series and are expressed in the form of regular attacks of pain in the area of one side of the head. The pain is excruciating and very long-lasting, sometimes lasting for several days. A feature of migraine-like paroxysms is their sufficient resistance to treatment - it can be extremely difficult to stop the pain.
An extraordinary feature of migraine is the fact that the paroxysmal state in this pathology can be both a clinical sign and also join the complex of symptoms of other cerebral pathologies. This situation makes it much more difficult to make a correct diagnosis - it is extremely difficult to discern third-party diseases behind migraine attacks.
Results of examination of children's condition
In order to understand what non-epileptic paroxysmal states look like in children, it makes sense to pay attention to several current examples.
First of all, these are short-term breath holdings. This problem can be caused by severe fear, frustration, pain, or any surprise. During this condition, the child may scream, while the scream itself is delayed while exhaling, which is often followed by loss of consciousness. Sometimes clonic twitching appears. Such an attack usually lasts a minute. Severe bradycardia and voluntary urination are possible.
Attacks of this kind are most often recorded in the age period from 6 months to 3 years. The good news is that their presence does not increase the risk of cognitive decline or epilepsy.
Paroxysmal state in a child - what is it? It is worth paying attention to one more example that clearly demonstrates a similar problem. We are talking about loss of consciousness. Fainting in this case is the result of acute circulatory failure in the brain area. In fact, this is nothing more than a manifestation of vascular lability.
Fainting occurs mainly in adolescents; among children who are at an early age, such conditions are rare. As for the causes of this problem, they include a sharp transition from a horizontal to a vertical position, as well as a state of strong emotional arousal.
Fainting begins with a feeling of darkening in the eyes and dizziness. In this case, both loss of consciousness and loss of muscle tone occur at the same time. There is always a possibility that short-term clonic convulsions may occur during depression of the child’s consciousness. As a rule, children do not remain unconscious due to fainting for more than 1 minute.
Reflex epilepsy is another problem that can be caused by a paroxysmal state in a child. It is unnecessary to say that this is a rather dangerous condition. Stressful situations and flashes of light can provoke such manifestations. But complex activities and auditory stimuli are unlikely to cause reflex epilepsy.
Features of the clinical picture
Features of the clinical course of different types of syncope are as follows:
- Vasovagal or vasodepressor syncope occurs due to stress, a person being in stuffy rooms, when exposed to a pain factor, etc. Also predisposing factors for the development of this condition are blood loss and hyperthermia. Before the attack itself, nausea, abdominal pain, etc. may occur.
- Orostatic syncope is manifested by a feeling of dizziness and nausea. When the body returns to a horizontal position, such symptoms usually disappear. During the first three minutes after the body moves to a vertical position, there may be dizziness and even loss of consciousness.
- With cardiogenic syncope, before loss of consciousness, the patient often feels weakness and chest pain. Loss of consciousness often occurs when a person sits or stands for a long time.
- As already noted, cerebrovascular syncope accompanies conditions such as hypoglycemia, oxygen starvation, etc. In some cases, a person experiences symptoms such as double vision, dizziness, and impaired visual acuity.
Non-epileptic form
When considering the syndrome of paroxysmal states, it is worth paying attention to those diseases that most often accompany such crises.
We can distinguish four main types of diseases within this group, which are recorded in the clinic more often than others and, in turn, have other, more specific forms. We are talking about the following problems:
- headache;
— myoclonic syndromes and other hyperkinetic states;
- autonomic disorders;
- muscular dystonic syndromes and dystonia.
In most cases, these problems are recorded in patients who have not reached the age of majority. But recently, more and more often, the paroxysmal state makes itself felt for the first time already in adulthood. It is also possible for the symptoms of the above diseases to dynamically progress, which become more severe against the background of chronic and acute cerebrovascular accidents or age-related cerebral disorders.
It is also important to take into account the fact that in some cases, non-epileptic paroxysmal conditions may be a consequence of the effects of certain medications prescribed to neutralize circulatory failure, as well as diseases such as parkinsonism and some mental disorders caused by old age.
Epilepsy and paroxysmal conditions
This is a rather difficult diagnosis in terms of the level of its negative impact on a person. But first, it’s worth remembering what epilepsy is. We are talking about a chronic pathological disease of the brain, which is characterized by seizures that have a different clinical structure and are constantly recurring. This condition is also characterized by psychopathic paroxysmal and non-convulsive manifestations.
It is possible to develop two forms of epilepsy: genuine and symptomatic. The latter is a consequence of traumatic brain injury, intoxication, brain tumors, acute circulatory disorders in the head, etc.
It is worth understanding that the special relationship between the epileptic focus and different parts of the nervous system determines the occurrence of repeated seizures of various clinical structures. Some features of the pathological process can lead to this result.
In addition, other paroxysmal conditions may occur
What are nightmares in children?
Nightmares in children cannot be called the imagination of a child or the speculation of overly caring parents. This is a physiological phenomenon of a hallucinatory nature, when the child’s overexcited brain cannot go into the inhibition stage. As a result, increased mental excitability occurs in the first stage of deep sleep.
Approximately 1/3 of children suffering from nightmares exhibit increased motor activity. They may kick their legs and wave their arms in a panic, try to get up and run, without leaving the deep stage of sleep. Subsequently, they may develop sleepwalking or parasomnia.
This condition is characterized by the baby’s desire to move around and are in a state of sleep. At the same time, his eyes may be wide open. But the pupils are usually dilated and do not respond to movements in front of them. It is not easy to wake up a child; he does not recognize the people around him, does not orient himself in space, and does not understand where he is.
Primary night terrors in children usually last 15-20 minutes. At this time, the pulse quickens, blood pressure rises, and sweating increases. The child breathes quickly and abruptly. Rapid eye movements occur. Then the stage of arousal passes into deep sleep. Uncomplicated childhood nightmares do not repeat twice during the night. After waking up, the baby may not remember what happened to him at night.
Children's nightmares are not hereditary diseases and are not caused by genetic factors. They can be triggered by a mismatch of physical and mental development, the presence of severe functional diseases of some organs and systems. Sometimes nightmares precede the development of mental illness.
Manifestations of nightmares occur in children of all ages. However, the largest number of cases is recorded in the age group from 3 to 5 years. Boys suffer more often. Complete relief from night terrors occurs at the age of 12 years.
Different forms of seizures
Epilepsy is not the only form of manifestation of disorders of the central nervous system. There are other paroxysmal conditions in neurology that can be classified as epileptic.
One striking example is sensory (sensitive) Jacksonian seizures. Their manifestation occurs when a person is conscious. Symptoms include tingling and numbness in the face, limbs and half of the torso. In some cases, sensory seizures can turn into motor ones, which will significantly complicate the patient’s condition.
Attention should also be paid to Jacksonian epilepsy. In this case, both sensory and motor seizures are possible. The latter are especially problematic because they involve muscle spasms in the part of the face and limbs that are located on the side opposite the epileptic focus. In this case, disturbances in consciousness, as a rule, are not observed. In some cases, motor seizures can become generalized.
Complex absence seizures can be atonic, myoclonic, or akinetic. The first make themselves known through a sudden fall, the cause of which is a sharp decrease in the postural tone of the legs. As for the myoclonic form, it is characterized by rhythmic short-term muscle twitching, accompanied by a loss of consciousness. Akinetic absence seizure is a seizure with immobility, which can also result in falls.
Small absence seizures are also possible, in which a person also plunges into an unconscious state. There are no feelings of discomfort after its completion. The patient often cannot remember the moment of the attack.
Kozhevnikov epilepsy is characterized by limited short seizures that are clonic in nature. They most often capture the muscles of the arms, but the tongue, face and even legs can be affected by this process. Loss of consciousness during such convulsions is rare.
Classification subtypes of syndromes
The classification of syncope is very complex. They are distinguished according to pathophysiological principles. It should be noted that in a significant number of cases the cause of syncope cannot be determined. In this case, they speak of idiopathic syncope syndrome.
The following types of syncope also differ:
- Reflex . These include vasovagal and situational fainting.
- Orthostatic . They arise due to insufficient autonomic regulation, taking certain medications, drinking alcoholic beverages, and hypovolemia.
- Cardiogenic . The cause of syncope in this case is cardiovascular pathology.
- Cerebrovascular . Occurs due to blockage of the subclavian vein by a thrombus.
There are also non-syncope pathologies, but they are diagnosed as syncope. Complete or partial loss of consciousness during a fall occurs due to hypoglycemia, epilepsy, poisoning, and ischemic attacks.
There are non-syncope states without loss of consciousness. These include short-term muscle relaxation due to emotional overload, panic attack, pseudosyncope of a psychogenic nature, as well as hysterical syndromes.
Generalized status epilepticus
This form of seizures is serious enough to warrant special attention. In fact, we are talking about the development of tonic-clonic seizures in all parts of the body. This paroxysmal state appears suddenly, with mild muscle tension and moderate dilation of the pupils. The symptoms do not end there and go into the tonic phase, lasting from 15 minutes to half an hour.
The tonic phase is characterized by tension in the torso, limbs, as well as masticatory and facial muscles. In this case, the body tone becomes so high that it is virtually impossible to change the position of the body.
As for the clonic phase, its duration is 10-40 s, during which rhythmic closure of the oral fissure is recorded. In this condition, there is a high risk that the person will bite the tongue, which may result in reddish foam (stained with blood) coming out of the mouth.
The next phase of the generalized status is relaxation, which is expressed in spontaneous defecation and urination. The troubles do not end there: each attack ends with post-paroxysmal exhaustion. In other words, depression of reflexes, muscle hypotonia and deepening of coma occurs. This state lasts on average 30 minutes. Next comes the final phase of epileptic prostration.
Stages of development - from fright to hitting the floor
Syncope develops in three stages:
- prodromal (precursor stage);
- immediate loss of consciousness;
- post-fainting state.
The severity of each stage and its duration depend on the cause and mechanism of development of syncopal syndrome.
The prodromal stage develops as a result of the action of a provoking factor. It can last from a few seconds to tens of hours. Arises from pain, fear, tension, stuffiness, etc.
It manifests itself as weakness, paleness of the face (this may be replaced by redness), sweating, ringing in the ears and head, darkening in the eyes. If a person in such a state manages to lie down or at least bow his head, then fainting does not occur.
Under unfavorable conditions (inability to change body position, continued exposure to provoking factors), general weakness increases, consciousness is impaired. Duration - from seconds to ten minutes. The patient falls, but significant physical damage does not occur, foam at the mouth or involuntary movements are not observed. The pupils dilate and blood pressure drops.
The post-syncope state is characterized by the preservation of the ability to navigate in time and space. However, lethargy and weakness persist.
How to help with seizures
Treatment of paroxysmal conditions is the domain of highly qualified specialists. Therefore, if signs of a single seizure become noticeable, especially when it is the first, the patient must be urgently hospitalized in a neurosurgical or neurological department. There they will be able to examine him and determine the current treatment plan.
It is important to ensure that the patient does not suffer any injuries before being taken to the hospital. It is also worth putting a spoon wrapped in a bandage into the mouth or using a mouth dilator.
In most cases, the treatment process for patients with status epilepticus begins in the ambulance. If doctors are not yet around, and the person is still having a seizure, then the first thing to do is to rule out the possibility of aspiration of vomit or mechanical asphyxia due to tongue prolapse. To do this, you need to insert the air duct into your mouth, first releasing it. It also makes sense to try to block seizures and maintain cardiac function.
As for non-epileptic forms, the causes of paroxysmal states can be completely different. It all depends on the key disease, the symptoms of which are aggravated. Therefore, the best thing that can be done is to take the person to the hospital as quickly as possible, where he can be examined and an accurate diagnosis made.
Diagnostic criteria
First of all, collecting an anamnesis is of great importance for diagnosing syncope. It is extremely important for the doctor to find out in detail the following circumstances: whether there were precursors, what kind of character they had, what kind of consciousness the person had before the attack, how quickly the clinical signs of syncope grew, the nature of the patient’s fall directly during the attack, the color of his face, the presence of a pulse, character changes in pupils.
It is also important to indicate to the doctor the length of time the patient has been in a state of loss of consciousness, the presence of convulsions, involuntary urination and/or defecation, and foam discharged from the mouth.
When examining patients, the following diagnostic procedures are performed:
- measure blood pressure while standing, sitting and lying down;
- carry out diagnostic tests with physical activity;
- do blood and urine tests (required!), determining the amount of blood sugar, as well as hematocrit;
- They also do electrocardiography, electroencephalography, ultrasound;
- if cardiac causes of syncope are suspected, an X-ray of the lungs, an ultrasound of the lungs and heart are performed;
- Computer and magnetic resonance diagnostics are also indicated.
It is important to distinguish between syncope and an epileptic seizure. Characteristic differential signs of syncope:
- dependence on the vertical position of the body;
- recurrence of attacks during the day;
- occurs more often from a painful attack or emotional overload;
- the warning signs are usually noticeable and long-lasting, unlike, say, an epileptic seizure;
- pale skin;
- muscle tone is reduced;
- very rarely there are body injuries, urinary incontinence and confusion after the end of the attack;
- no symptoms of focal lesions are observed;
- no amnesia, no changes in the electroencephalogram;
- When the person returns to a horizontal position, the signs of syncope disappear.
