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Electrostimulation as one of the types of treatment.
Electrostimulation of a spinal cord an ancient method, at the beginning of medicine origin, experienced different and accessible ways, for example electric blackheads, surprisingly but fact. These methods leaving a trace in our DNA pass from generation to generation information. Therefore, many poisons for today cause only that poisoning and some even treat. Speaking of Electrotherapy should be noted, the treatment of epileptic seizures, convulsions, were able to achieve only in the middle of the 20th century.
In today's world, much is decided by pharmaceuticals
Anticonvulsants began to be used for the treatment of pain syndromes in the middle of the last century. In the treatment of trigeminal neuralgia for the first time used anticonvulsants it would (Finlepsin), a drug close in its structure to the Neurontin, which until now remains the drug number № 1 for the treatment of neuropathic pain. The main mechanism of the action of Finlepsin is to block the voltage-dependent sodium channels, which is similar to the neuron, they have a peripheral mechanism of action. The main task in the development of the first generation of drugs is the creation of drugs that have similar efficacy and close to the structure, but with less side effects.
The undoubted effect on peripheral mechanisms of neuropathic pain have anticonvulsants and tricyclic antidepressants.
Сonvulsions and convulsion, conservative treatment
Partial epileptic seizures with or without secondary generalization in adults and children
(Treatment of partial cramps with secondary generalisation and without it)
The concept of convulsive syndrome is defined as a pathological condition characterized by the unreporting contractions of the muscular system. In this case, cramps can occur in one particular place or spread to a whole group of muscles.
- There are several types of seizures:-Tonico-Clone convulsions;
- Miokloonic reductions;
- Partial seizures.
Tonico-Clone cramps are manifested by the loss of consciousness:
first there are tonic spasms - thus dilated pupils, eyes roll up and strain all muscles.
Then comes the phase of the clone convulsions - there is alternating alternation of contractions and relaxation of muscles.
There comes a dream or a state of coma - an attack may be accompanied by the appearance of a blood foam as a result of the occlusion of the tongue and abundant salivation.
These are sudden involuntary contractions of one or more groups of muscles, arising both at movements, and in a state of rest. They may be a variant of the norm, but in some cases they are a sign of very serious diseases of the central nervous system.
Involuntary muscle twitching can occur in children and adults, in one or more groups of muscles, or to be generalized, covering all the muscles of the body. WinCE can be rhythmic or arrhythmia.
If the wince occurs occasionally, are associated with any stimuli, and are not accompanied by a worsening of the overall health of the person, do not worry about them.
If muscle spasms are observed frequently, the physical and psychological condition of the person worsens, the symptoms progress over time, and the connection with possible stimuli is absent, it is probably the manifestation of one of the diseases Central nervous system. The patient should not worry about it silently and to be afraid, and it is necessary as soon as possible to address to the doctor-neurologist for consultation.
Cramps of the clone
Genesis without loss of consciousness are called partial. In the process can be used muscles of the face, foot and other parts of the body.
There are generalized and partial, as well as convulsive and non-convulsive seizures. Generalized convulsive seizures in typical cases flow with loss of consciousness, respiratory disturbance, vegetative symptoms and bilateral tonico-clone sudroms, often with a bite of tongue and urine. Generalized non-convulsive seizures (ABSANSA) are characterized by short-term (up to 20 c) shutdown of consciousness.
In simple Absansah short-term disorder of consciousness can be the only manifestation of a seizure. In complex abscesses at the same time possible motor symptoms, caused by the contraction of the mimic muscles, the muscles of the mouth, oculoviratory muscles. The Atonic attack is manifested by the fall of the patient.
The most common are the partial (focal) seizures, which can be simple or complex (complex). At simple partial seizures consciousness does not change, perhaps the development of motor (local tonic or clone cramps, forced rotation of the head and eyeballs or trunk, flashlight), sensory (sensitivity disorders), Psychic (visual, auditory or olfactory hallucinations, impaired thinking, feeling of fear) or vegetative-visceral (tachycardia, increased hell, abdominal pain, chills-like tremor) manifestations.
At complex partial seizures there is a change of consciousness with psychomotor automoisms. Any of the partial seizures may end in complete loss of consciousness and tonico-clone cramps, in these cases they are called secondary-generalized seizures.
Partial convulsively seizures
Partial convulsive seizures are provoked by pathological activity of an isolated group of neurons and localized in a separate group of muscles or parts of the body. In this case, the influence has the location of the areas that control the muscles in the brain, not the closeness of the body parts involved in convulsions.
For example, the cramps of the fingers or hands may be accompanied by contractions of the facial muscles. Sometimes convulsions that started locally in part of a limb, such as a foot, spread to the whole limb. This phenomenon is called the "Jackson March". Partial convulsive seizures are divided into simple (without disturbing the consciousness, the person adequately perceives and reacts to what is happening) and complex (with impaired consciousness and unconscious behavior).
If a person on the background of a seizure cannot fulfill a simple request (reach out, sit down), the condition is described as a complex seizure. In a complex type is characterized by the phenomenon of automatism: repetition of the same words, movements, walking circles. The duration of the condition is a couple of minutes. At the end of the attack, a person can lose consciousness and almost never remembers what happened. Simple partial seizures can move into complex and secondary-generalized.
Generalized convulsive seizures – when "the whole body is convulsed".
To generalized convulsive seizures include Tonico-clone and Myokloonic. These seizures are characterized by the inclusion of many muscles in the process, the sensation of "cramping the whole body". Occasionally Tonico-clone attack is accompanied only by tononic or only clone cramps. At the end of the attack comes drowsiness or coma, consciousness is not restored immediately.
Often the attack, which was held without witnesses, can be guessed only by the sensation of a break-in, abrasions, wounds in the tongue, muscle pain from cramps and bumps. The seizure is a very short-term attack of rhythmic or chaotic contractions of muscles, sometimes accompanied by clouding of consciousness, but the time of seizure is so small that the change of consciousness is practically not noticed either by the person or Surrounding.
Common types of seizures
Some convulsive manifestations occur quite often and have the character of a symptom of a temporary painful condition. In other cases, cramps can accompany a person throughout life. Depending on the cause of cramps, type of attack, age and status of the person specialists choose the type of therapy. However, treatment and therapy are always aimed not at the symptom, but in the underlying disease.
What to do with cramps
Treatment of cramps occurs in two stages. First, the attack is bought, and then the treatment is done over the main cause.
Medical treatment should be carried out only on prescription. Medications are often prescribed in the presence of generalized or partial epileptic attack.
Medicinal remedies for the seizure of epileptic convulsions
- drugs-gamma amino acid and its derivatives.
- Anticonvulsants trace elements.
rehabilitation after brain injuries and strokes, severe forms of psychosis, convulsions generalized and partial convulsions arrhythmia, seizures in pregnant and poisoning.
Sodium oxybutyrate in the form of injections of magnesium sulfate in the form of injections.
Treatment means to eliminate the causes of cramps
- Derivatives of valproproi acid.
- Cardiac glycozides.
- Iron preparations.
- Partial and generalized convulsions.
- Seizures of different strength.
- Complex forms of psychosis.
- In ischemic stroke.
- In heart failure.
- Convulsive syndrome caused by anemia.
- Sodium phenobarbital.
- Sodium valproat in the form of syrup.
- Phenazepama tablets.
- Injections of Aminazina.
- Urokinase in the form of injections.
- Digoxin pills.
- Sorbifera pills.
In preventive measures to avoid repetition of cramps, it is necessary to observe the correct mode of work and rest, to fully eat and avoid excessive physical exertion.
Magnesium and potassium
The deficit of magnesium and potassium can occur muscular contractions. Tingling and crawling of goosebumps can also be felt.
The lack of these microelements can occur in the following cases:
- If for a long time to take laxatives or diuretic drugs;
- As a result of poisoning or alcohol abuse;
In order to fill the magnesium deficiency, the product of magnesium B6 is appointed. It is also necessary to eat foods rich in useful trace elements. For example, watermelons, milk, oranges, bananas, buckwheat groats and Bran.
Phenobarbital-a derivative of acid, is one of the most "old" anticonvulsants, the history of the application of about 100 years. Daily standard dose of 1 to 5 mg/kg, optimal therapeutic concentration of 12 to 40 μ g/ml. The drug has a pronounced sleeping effect, so it is not recommended for reception during the daytime. Phenobarbital is a part of various combined drugs.
Close to the chemical structure Phenobarbitalum is a pyramid, the optimal therapeutic concentration of which is similar to phenobarbital. Daily standard dose of 10 to 25 mg/kg. The constant level of the drug in the blood plasma achieved through 1-3 weeks of admission.
The use of barbiturates is possible at the beginning of the treatment of convulsive seizures, prolonged monotherapy with these drugs is not advisable.
Fenitin, a derivative of hydantoin, became the first anticonvulsants of non-edative action. does not cause oppression of the nervous system, but on the contrary, can intensify it. Stable concentration is achieved in 1 – 2 weeks. Therapeutic effect is shown at the level of drug concentration in the blood of 10 to 20 μg/ml, which approximately corresponds to a dose of 5 mg/kg.
When the level of 20 μ g/ml in most patients appear the first signs of acute intoxication: nistammus, ataxia, dysarthria, nausea. Fenitin has a relatively long half-life-about 22 hours so usually enough reception twice a day. The suction speed is variable, and the peak of plasma concentration is reached in 3 – 15 hours.
Fenitine is equally effective in generalized and partial seizures, but acts mainly on convulsive forms of seizures. The drug should not appoint patients with arousal.
Lammotrijin has a wide range of therapeutic action and can be used as both monotherapy and politotherapy for different types of seizures. It blocks the sodium channels of the presinavian membrane, reduces the ejection in the synaptic slit of the glutamate and the aspartate. Therapeutic concentration in the plasma is 1-3 mg/L. Indications for the appointment of Lamotrigine are generalized Tonico-clone and partial seizures, absansa.
The recommended daily dose depends on the method of use (mono or political therapy) and is 1 to 15 mg/kg, therapy provides a slow increase in the daily dose. In monotherapy dosing begins with 25 mg/day, 2 weeks from the start of the daily intake increases to 50 mg. Supporting dose, divided into 2 admission, should be 100 to 200 mg/day.
At appointment with inductors of hepatic enzymes initial dose lammotrigin for 2 weeks is 50 mg/day, the following 2 weeks-100 mg per day, supporting dose of 300-500 mg per day for 2 admission.
The structure of Lamotrigine is not similar to the known Anticonvulsants. According to many authors, Lamotrigine, along with anticonvulsive effect, is a distinct psychotropic effect. In therapy Lamotrigine marked improvement of cortical functions.
Toppiramate has a complex mechanism of action. It has neuroprotective and normotic action. The daily therapeutic dose is in patients under 2 years of age-3 to 6 mg/kg, over 12 years-5 to 9 mg/kg (200 to 400 mg), and therapeutic concentration in plasma-2-12 mg/L. pharmacokinetics of Topiramate has a linear character, so there is no need for mandatory Control the content of the drug in the blood.
Start treatment of children with a dose of 0.5 to 1 mg/kg, adults with 25 mg per day, adding each week to 25 mg. The multiplicity of reception is not less than 2 times a day.
The highest efficacy of topiramate showed in adults in the treatment of primary and secondary-generalized seizures, in children-in all types of seizures.
Side effects of topiramate are in the emergence of cognitive disorders, tremor, ataxia, headache. These undesirable properties are marked by the rapid titration of the dose of topiramate and are easily eliminated when it is corrected.
The criteria for positive evaluation
Treatment are cessation and reduction of seizures, reduction of their duration, relief of after condition, improvement of mood, increase of working capacity, as well as decrease or disappearance activity
Modern pharmacotherapy of convulsive syndromes allows in 70 – 80% of cases to achieve a complete absence of seizures or a significant reduction in the frequency of attacks. It should be noted that true pharmacological resistance occurs in 10-15% of cases, and the lack of effectiveness of treatment in other cases is caused by irrational selection of drugs.
The duration of treatment is determined by the form of epilepsy, age of patients and their individual characteristics. Relapses after the abolition of pharmacotherapy occur in 20 – 25% of cases in children and in 30-40% of cases in adults. The most likely practical recovery in idiopathic forms of epilepsy.
The relatively low risk of relapse is noted in generalized idiopathic epilepsy with the Absansami children and youth age. In the form of epilepsy with a low risk of recurrence, the question of the abolition of treatment can be put after 2 years of remission. In the forms of epilepsy with a known high risk of relapse, the discussion of treatment cancellation is possible only after 5 years of remission. Cessation of treatment is provided in the absence of expressed pathological activity.