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Emergency medical care: Convulsive syndrome. Generalized epilepsy in children, acute period ICD 10 convulsive syndrome of unknown etiology

Class VI. Diseases of the nervous system (G00-G47)

This class contains the following blocks:
G00-G09 Inflammatory diseases of the central nervous system
G10-G13 Systemic atrophies affecting primarily the central nervous system
G20-G26 Extrapyramidal and other movement disorders
G30-G32 Other degenerative diseases of the central nervous system
G35-G37 Demyelinating diseases of the central nervous system
G40-G47 Episodic and paroxysmal disorders

INFLAMMATORY DISEASES OF THE CENTRAL NERVOUS SYSTEM (G00-G09)

G00 Bacterial meningitis, not elsewhere classified

Included: arachnoiditis)
leptomeningitis)
meningitis) bacterial
pachymeningitis)
Excluded: bacterial:
meningoencephalitis ( G04.2)
meningomyelitis ( G04.2)

G00.0 Influenza meningitis. Meningitis caused by Haemophilus influenzae
G00.1 Pneumococcal meningitis
G00.2 Streptococcal meningitis
G00.3 Staphylococcal meningitis
G00.8 Meningitis caused by other bacteria
Meningitis caused by:
Friedlander wand
Escherichia coli
Klebsiella
G00.9 Bacterial meningitis, unspecified
Meningitis:
purulent NOS
pyogenic NOS
pyogenic NOS

G01* Meningitis in bacterial diseases classified elsewhere

Meningitis (with):
anthrax ( A22.8+)
gonococcal ( A54.8+)
leptospirosis ( A27. -+)
listeriosis ( A32.1+)
Lyme disease ( A69.2+)
meningococcal ( A39.0+)
neurosyphilis ( A52.1+)
salmonellosis ( A02.2+)
syphilis:
congenital ( A50.4+)
secondary ( A51.4+)
tuberculosis ( A17.0+)
typhoid fever ( A01.0+)
Excluded: meningoencephalitis and meningomyelitis due to bacterial
diseases classified elsewhere ( G05.0*)

G02.0* Meningitis in viral diseases classified elsewhere
Meningitis (caused by a virus):
adenoviral ( A87.1+)
enteroviral ( A87.0+)
herpes simplex ( B00.3+)
infectious mononucleosis ( B27. -+)
measles ( B05.1+)
mumps ( B26.1+)
rubella ( B06.0+)
chickenpox ( B01.0+)
herpes zoster ( B02.1+)
G02.1* Meningitis due to mycoses
Meningitis (with):
candida ( B37.5+)
coccidioidomycosis ( B38.4+)
cryptococcal ( B45.1+)
G02.8* Meningitis in other specified infectious and parasitic diseases classified elsewhere
Meningitis caused by:
African trypanosomiasis ( B56. -+)
Chagas disease ( B57.4+)

G03 Meningitis due to other and unspecified causes

Included: arachnoiditis)
leptomeningitis) due to other and unspecified
meningitis) causes
pachymeningitis)
Excludes: meningoencephalitis ( G04. -)
meningomyelitis ( G04. -)

G03.0 Non-pyogenic meningitis. Nonbacterial meningitis
G03.1 Chronic meningitis
G03.2 Benign recurrent meningitis [Mollaret]
G03.8 Meningitis caused by other specified pathogens
G03.9 Meningitis, unspecified. Arachnoiditis (spinal) NOS

G04 Encephalitis, myelitis and encephalomyelitis

Includes: acute ascending myelitis
meningoencephalitis
meningomyelitis
Excluded: benign myalgic encephalitis ( G93.3)
encephalopathy:
NOS ( G93.4)
alcoholic origin ( G31.2)
toxic ( G92)
multiple sclerosis ( G35)
myelitis:
acute transverse ( G37.3)
subacute necrotizing ( G37.4)

G04.0 Acute disseminated encephalitis
Encephalitis)
Encephalomyelitis) post-immunization
If necessary, identify the vaccine
G04.1 Tropical spastic paraplegia
G04.2 Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified
G04.8 Other encephalitis, myelitis and encephalomyelitis. Postinfectious encephalitis and encephalomyelitis NOS
G04.9 Encephalitis, myelitis or encephalomyelitis, unspecified. Ventriculitis (cerebral) NOS

G05* Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere

Includes: meningoencephalitis and meningomyelitis in diseases
classified elsewhere

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

G06.0 Intracranial abscess and granuloma
Abscess (embolic):
brain [any part]
cerebellar
cerebral
otogenic
Intracranial abscess or granuloma:
epidural
extradural
subdural
G06.1 Intravertebral abscess and granuloma. Abscess (embolic) of the spinal cord [any part]
Intravertebral abscess or granuloma:
epidural
extradural
subdural
G06.2 Extradural and subdural abscess, unspecified

G07* Intracranial and intravertebral abscess and granuloma in diseases classified elsewhere

Brain abscess:
amoebic ( A06.6+)
gonococcal ( A54.8+)
tuberculous ( A17.8+)
Granuloma of the brain in schistosomiasis ( B65. -+)
Tuberculoma:
brain ( A17.8+)
meninges ( A17.1+)

G08 Intracranial and intravertebral phlebitis and thrombophlebitis

Septic(s):
embolism)
endoflibit)
phlebitis) intracranial or intravertebral
thrombophlebitis) venous sinuses and veins
thrombosis)
Excluded: intracranial phlebitis and thrombophlebitis:
complicating:
abortion, ectopic or molar pregnancy ( O00 -O07 , O08.7 )
pregnancy, childbirth or the postpartum period ( O22.5, O87.3)
non-purulent origin ( I67.6); non-purulent intravertebral phlebitis and thrombophlebitis ( G95.1)

G09 Consequences of inflammatory diseases of the central nervous system

NoteThis category should be used to indicate
conditions primarily classified under headings

G00-G08(excluding those marked with *) as the cause of consequences that are themselves attributed to
Other headings The concept of “consequences” includes conditions specified as such or as late manifestations or consequences that exist for a year or more after the onset of the condition that caused them. When using this rubric, it is necessary to be guided by the appropriate recommendations and rules for coding morbidity and mortality, given in volume 2.

SYSTEMIC ATROPHY AFFECTING PRIMARILY THE CENTRAL NERVOUS SYSTEM (G10-G13)

G10 Huntington's disease

Huntington's chorea

G11 Hereditary ataxia

Excluded: hereditary and idiopathic neuropathy ( G60. -)
cerebral palsy ( G80. -)
metabolic disorders ( E70-E90)

G11.0 Congenital non-progressive ataxia
G11.1 Early cerebellar ataxia
Note: Usually begins in people under 20 years of age
Early cerebellar ataxia with:
essential tremor
myoclonus [Hunt's ataxia]
with preserved tendon reflexes
Friedreich's ataxia (autosomal recessive)
X-linked recessive spinocerebellar ataxia
G11.2 Tardive cerebellar ataxia
Note: Usually begins in people over 20 years of age
G11.3 Cerebellar ataxia with impaired DNA repair. Telangiectatic ataxia [Louis-Bar syndrome]
Excludes: Cockayne syndrome ( Q87.1)
xeroderma pigmentosa ( Q82.1)
G11.4 Hereditary spastic paraplegia
G11.8 Other hereditary ataxia
G11.9 Hereditary ataxia, unspecified
Hereditary cerebellar:
ataxia NOS
degeneration
disease
syndrome

G12 Spinal muscular atrophy and related syndromes

G12.0 Pediatric spinal muscular atrophy, type I [Werdnig-Hoffmann]
G12.1 Other hereditary spinal muscular atrophies. Progressive bulbar palsy in children [Fazio-Londe]
Spinal muscular atrophy:
adult uniform
child form, type II
distal
juvenile form, type III [Kugelberg-Welander]
scapuloperoneal form
G12.2 Motor neuron disease. Familial motor neuron disease
Lateral sclerosis:
amyotrophic
primary
Progressive:
bulbar palsy
spinal muscular atrophy
G12.8 Other spinal muscular atrophies and related syndromes
G12.9 Spinal muscular atrophy, unspecified

G13* Systemic atrophies affecting primarily the central nervous system in diseases classified elsewhere

G13.0* Paraneoplastic neuromyopathy and neuropathy
Carcinomatous neuromyopathy ( C00-S97+)
Neuropathy of the sensory organs in the tumor process [Denia-Brown] ( C00-D48+)
G13.1* Other systemic atrophies, affecting primarily the central nervous system, in tumor diseases. Paraneoplastic limbic encephalopathy ( C00-D48+)
G13.2* Systemic atrophy due to myxedema, affecting primarily the central nervous system ( E00.1+, E03. -+)
G13.8* Systemic atrophy, affecting primarily the central nervous system, in other diseases classified elsewhere

EXTRAPYRAMIDAL AND OTHER MOTOR DISORDERS (G20-G26)

G20 Parkinson's disease

Hemiparkinsonism
Shaking paralysis
Parkinsonism, or Parkinson's disease:
NOS
idiopathic
primary

G21 Secondary parkinsonism

G21.0 Neuroleptic malignant syndrome. If necessary, identify the drug
use an additional code for external causes (class XX).
G21.1 Other forms of drug-induced secondary parkinsonism.
G21.2 Secondary parkinsonism caused by other external factors
If it is necessary to identify an external factor, use an additional code of external causes (class XX).
G21.3 Postencephalitic parkinsonism
G21.8 Other forms of secondary parkinsonism
G21.9 Secondary parkinsonism, unspecified

G22* Parkinsonism in diseases classified elsewhere

Syphilitic parkinsonism ( A52.1+)

G23 Other degenerative diseases of the basal ganglia

Excludes: multisystem degeneration ( G90.3)

G23.0 Hallervorden-Spatz disease. Pigmented pallidal degeneration
G23.1 Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olszewski]
G23.2 Striatonigral degeneration
G23.8 Other specified degenerative diseases of the basal ganglia. Calcification of the basal ganglia
G23.9 Degenerative basal ganglia disease, unspecified

G24 Dystonia

Included: dyskinesia
Excludes: athetoid cerebral palsy ( G80.3)

G24.0 Drug-induced dystonia. If necessary, identify the drug
use an additional code for external causes (class XX).
G24.1 Idiopathic familial dystonia. Idiopathic dystonia NOS
G24.2 Idiopathic nonfamilial dystonia
G24.3 Spasmodic torticollis
Excludes: torticollis NOS ( M43.6)
G24.4 Idiopathic orofacial dystonia. Orofacial dyskinesia
G24.5 Blepharospasm
G24.8 Other dystonias
G24.9 Dystonia, unspecified. Dyskinesia NOS

G25 Other extrapyramidal and movement disorders

G25.0 Essential tremor. Familial tremor
Excludes: tremor NOS ( R25.1)
G25.1 Drug-induced tremor
If it is necessary to identify the drug, use an additional code for external causes (class XX).
G25.2 Other specified forms of tremor. Intention tremor
G25.3 Myoclonus. Drug-induced myoclonus. If it is necessary to identify the drug, use an additional code for external causes (class XX).
Excluded: facial myokymia ( G51.4)
myoclonic epilepsy ( G40. -)
G25.4 Drug-induced chorea
If it is necessary to identify the drug, use an additional code for external causes (class XX).
G25.5 Other types of chorea. Chorea NOS
Excludes: chorea NOS with cardiac involvement ( I02.0)
Huntington's chorea ( G10)
rheumatic chorea ( I02. -)
Sydenchen's chorea ( I02. -)
G25.6 Drug-induced and other organic tics
If it is necessary to identify the drug, use an additional code for external causes (class XX).
Excludes: de la Tourette syndrome ( F95.2)
tick NOS ( F95.9)
G25.8 Other specified extrapyramidal and movement disorders
Restless legs syndrome. Shackled person syndrome
G25.9 Extrapyramidal and movement disorder, unspecified

G26* Extrapyramidal and movement disorders in diseases classified elsewhere

OTHER DEGENERATIVE DISEASES OF THE NERVOUS SYSTEM (G30-G32)

G30 Alzheimer's disease

Includes: senile and presenile forms
Excluded: senile:
brain degeneration NEC ( G31.1)
dementia NOS ( F03)
senility NOS ( R54)

G30.0 Early Alzheimer's disease
Note The onset of the disease usually occurs in people under 65 years of age
G30.1 Late Alzheimer's disease
Note The onset of the disease usually occurs in people over 65 years of age
G30.8 Other forms of Alzheimer's disease
G30.9 Alzheimer's disease, unspecified

G31 Other degenerative diseases of the nervous system, not elsewhere classified

Excluded: Reye's syndrome ( G93.7)

G31.0 Limited brain atrophy. Pick's disease. Progressive isolated aphasia
G31.1 Senile degeneration of the brain, not elsewhere classified
Excludes: Alzheimer's disease ( G30. -)
senility NOS ( R54)
G31.2 Nervous system degeneration caused by alcohol
Alcoholic:
cerebellar:
ataxia
degeneration
cerebral degeneration
encephalopathy
Alcohol-induced autonomic nervous system disorder
G31.8 Other specified degenerative diseases of the nervous system. Gray matter degeneration [Alpers disease]
Subacute necrotizing encephalopathy [Leigh's disease]
G31.9 Degenerative disease of the nervous system, unspecified

G32* Other degenerative disorders of the nervous system in diseases classified elsewhere

G32.0* Subacute combined degeneration of the spinal cord in diseases classified elsewhere
Subacute combined degeneration of the spinal cord due to vitamin deficiency AT 12 (E53.8+)
G32.8* Other specified degenerative disorders of the nervous system in diseases classified elsewhere

DEMYELINATING DISEASES OF THE CENTRAL NERVOUS SYSTEM (G35-G37)

G35 Multiple sclerosis

Multiple sclerosis:
NOS
brain stem
spinal cord
disseminated
generalized

G36 Other form of acute disseminated demyelination

Excluded: post-infectious encephalitis and encephalomyelitis NOS ( G04.8)

G36.0 Neuromyelitis optica [Devic's disease]. Demyelination in optic neuritis
Excluded: optic neuritis NOS ( H46)
G36.1 Acute and subacute hemorrhagic leukoencephalitis [Harst disease]
G36.8 Another specified form of acute disseminated demyelination
G36.9 Acute disseminated demyelination, unspecified

G37 Other demyelinating diseases of the central nervous system

G37.0 Diffuse sclerosis. Periaxial encephalitis, Schilder's disease
Excluded: adrenoleukodystrophy [Addison-Schilder] ( E71.3)
G37.1 Central demyelination of the corpus callosum
G37.2 Central pontine myelinolysis
G37.3 Acute transverse myelitis in demyelinating disease of the central nervous system
Acute transverse myelitis NOS
Excluded: multiple sclerosis ( G35)
Neuromyelitis optica [Devic's disease] ( G36.0)
G37.4 Subacute necrotizing myelitis
G37.5 Concentric sclerosis [Balo]
G37.8 Other specified demyelinating diseases of the central nervous system
G37.9 Demyelinating disease of the central nervous system, unspecified

EPISODICA AND PAROXYSMAL DISORDERS (G40-G47)

G40 Epilepsy

Excluded: Landau-Kleffner syndrome ( F80.3)
seizure NOS ( R56.8)
status epilepticus ( G41. -)
Todd's paralysis ( G83.8)

G40.0 Localized (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures with focal onset. Benign childhood epilepsy with EEG peaks in the central temporal region
Childhood epilepsy with paroxysmal activity and EEG in the occipital region
G40.1 Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures. Seizures without changes in consciousness. Simple partial seizures, developing into secondary
generalized seizures
G40.2 Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures. Seizures with changes in consciousness, often with epileptic automatism
Complex partial seizures progressing to secondary generalized seizures
G40.3 Generalized idiopathic epilepsy and epileptic syndromes
Benign(s):
myoclonic epilepsy of early childhood
neonatal seizures (familial)
Childhood epileptic absence seizures [pycnolepsy]. Epilepsy with grand mal seizures on awakening
Juvenile:
absence epilepsy
myoclonic epilepsy [impulsive petit mal]
Nonspecific epileptic seizures:
atonic
clonic
myoclonic
tonic
tonic-clonic
G40.4 Other types of generalized epilepsy and epileptic syndromes
Epilepsy with:
myoclonic absence seizures
myoclonic-astatic seizures

Baby spasms. Lennox-Gastaut syndrome. Salaam's tick. Symptomatic early myoclonic encephalopathy
West syndrome
G40.5 Special epileptic syndromes. Epilepsy partial continuous [Kozhevnikova]
Epileptic seizures associated with:
drinking alcohol
use of medicines
hormonal changes
sleep deprivation
exposure to stress factors
If it is necessary to identify the drug, use an additional code for external causes (class XX).
G40.6 Grand mal seizures, unspecified (with or without minor seizures)
G40.7 Minor seizures, unspecified, without grand mal seizures
G40.8 Other specified forms of epilepsy. Epilepsy and epileptic syndromes not defined as focal or generalized
G40.9 Epilepsy, unspecified
Epileptic:
convulsions NOS
seizures NOS
seizures NOS

G41 Status epilepticus

G41.0 Status epilepticus grand mal (convulsive seizures). Tonic-clonic status epilepticus
Excluded: partial continuous epilepsy [Kozhevnikova] ( G40.5)
G41.1 Zpileptic status petit mal (minor seizures). Status epilepticus absence seizures
G41.2 Complex partial status epilepticus
G41.8 Other specified status epilepticus
G41.9 Status epilepticus, unspecified

G43 Migraine

Excludes: headache NOS ( R51)

G43.0 Migraine without aura [simple migraine]
G43.1 Migraine with aura [classical migraine]
Migraine:
headache-free aura
basilar
equivalents
familial hemiplegic
hemiplegic
With:
aura in acute onset
long lasting aura
typical aura
G43.2 Migrainous status
G43.3 Complicated migraine
G43.8 Another migraine. Ophthalmoplegic migraine. Retinal migraine
G43.9 Migraine, unspecified

G44 Other headache syndromes

Excluded: atypical facial pain ( G50.1)
headache NOS ( R51)
trigeminal neuralgia ( G50.0)

G44.0 Histamine headache syndrome. Chronic paroxysmal hemicrania.

Histamine headache:
chronic
episodic
G44.1 Vascular headache, not elsewhere classified. Vascular headache NOS
G44.2 Tension type headache. Chronic tension headache
Episodic tension headache. Tension headache NOS
G44.3 Chronic post-traumatic headache
G44.4 Drug-induced headache, not elsewhere classified
If it is necessary to identify the drug, use an additional code for external causes (class XX).
G44.8 Other specified headache syndrome

G45 Transient transient cerebral ischemic attacks [attacks] and related syndromes

Excludes: neonatal cerebral ischemia ( P91.0)

G45.0 Vertebrobasilar arterial system syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral cerebral artery syndromes
G45.3 Transient blindness
G45.4 Transient global amnesia
Excludes: amnesia NOS ( R41.3)
G45.8 Other transient cerebral ischemic attacks and associated syndromes
G45.9 Transient cerebral ischemic attack, unspecified. Cerebral artery spasm
Transient cerebral ischemia NOS

G46* Vascular brain syndromes in cerebrovascular diseases ( I60-I67+)

G46.0* Middle cerebral artery syndrome ( I66.0+)
G46.1* Anterior cerebral artery syndrome ( I66.1+)
G46.2* Posterior cerebral artery syndrome ( I66.2+)
G46.3* Brainstem stroke syndrome ( I60-I67+)
Syndrome:
Benedicta
Claude
Fauville
Millard-Jublay
Wallenberg
Weber
G46.4* Cerebellar stroke syndrome ( I60-I67+)
G46.5* Pure motor lacunar syndrome ( I60-I67+)
G46.6* Pure sensory lacunar syndrome ( I60-I67+)
G46.7* Other lacunar syndromes ( I60-I67+)
G46.8* Other vascular syndromes of the brain in cerebrovascular diseases ( I60-I67+)

G47 Sleep disorders

Excluded: nightmares ( F51.5)
sleep disorders of non-organic etiology ( F51. -)
night terrors ( F51.4)
sleepwalking ( F51.3)

G47.0 Disturbances in falling asleep and maintaining sleep [insomnia]
G47.1 Disturbances in the form of increased sleepiness [hypersomnia]
G47.2 Disturbances in sleep-wake cycles. Delayed sleep phase syndrome. Disturbance of the sleep-wake cycle
G47.3 Sleep apnea
Sleep apnea:
central
obstructive
Excludes: Pickwickian syndrome ( E66.2)
sleep apnea in newborns ( P28.3)
G47.4 Narcolepsy and cataplexy
G47.8 Other sleep disorders. Kleine-Levin syndrome
G47.9 Sleep disorder, unspecified

Convulsive syndrome in children is a typical manifestation of epilepsy, spasmophilia, toxoplasmosis, encephalitis, meningitis and other diseases. Convulsions occur with metabolic disorders (hypocalcemia, hypoglycemia, acidosis), endocrinopathy, hypovolemia (vomiting, diarrhea), overheating.

Many endogenous and exogenous factors can lead to the development of seizures: intoxication, infection, trauma, central nervous system diseases. In newborns, the cause of seizures can be asphyxia, hemolytic disease, and congenital defects of the central nervous system.

ICD-10 code

R56 Convulsions, not elsewhere classified

Symptoms of seizure syndrome

Convulsive syndrome in children develops suddenly. Motor excitement occurs. The gaze becomes wandering, the head is thrown back, the jaws close. Characteristic is flexion of the upper limbs at the wrist and elbow joints, accompanied by straightening of the lower limbs. Bradycardia develops. Possible respiratory arrest. The color of the skin changes, up to cyanosis. Then, after a deep breath, breathing becomes noisy, and cyanosis gives way to pallor. Seizures can be clonic, tonic, or clonic-tonic in nature, depending on the involvement of brain structures. The younger the child is, the more often generalized seizures occur.

How to recognize convulsive syndrome in children?

Convulsive syndrome in infants and young children is, as a rule, tonic-clonic in nature and occurs mainly with neuroinfection, toxic forms of acute respiratory viral infections and acute respiratory infections, and less often with epilepsy and spasmophilia.

Seizures in children with fever are probably febrile. In this case, there are no patients with convulsive attacks in the child’s family, there is no indication of a history of convulsions at normal body temperature.

Febrile seizures usually develop between 6 months and 5 years of age. At the same time, they are characterized by their short duration and low frequency (1-2 times during the period of fever). The body temperature during an attack of convulsions is more than 38 °C, there are no clinical symptoms of infectious damage to the brain and its membranes. On the EEG, focal and convulsive activity is not detected outside of seizures, although there is evidence of perinatal encephalopathy in the child.

The basis of febrile seizures is the pathological reaction of the central nervous system to an infectious-toxic effect with increased convulsive readiness of the brain. The latter is associated with a genetic predisposition to paroxysmal conditions, mild brain damage in the perinatal period, or due to a combination of these factors.

The duration of an attack of febrile seizures, as a rule, does not exceed 15 minutes (usually 1-2 minutes). Typically, an attack of convulsions occurs at the height of fever and is generalized, which is characterized by changes in skin color (pallor in combination with various shades of diffuse cyanosis) and breathing rhythm (it becomes hoarse, less often - superficial).

In children with neurasthenia and neurosis, affective-respiratory convulsions occur, the genesis of which is caused by anoxia, due to short-term, spontaneously resolving apnea. These seizures develop mainly in children aged 1 to 3 years and are conversion (hysterical) seizures. They usually occur in overprotective families. Seizures may be accompanied by loss of consciousness, but children quickly recover from this state. Body temperature during affective-respiratory convulsions is normal, no signs of intoxication are noted.

Convulsions accompanying syncope are not life-threatening and do not require treatment. Muscle contractions (cramps) occur as a result of metabolic disorders, usually salt metabolism. For example, the development of repeated, short-term seizures for 2-3 minutes between the 3rd and 7th days of life (“fifth day seizures”) is explained by a decrease in zinc concentration in newborns.

In neonatal epileptic encephalopathy (Otahara syndrome), tonic spasms develop, occurring in series both during wakefulness and during sleep.

Atonic seizures manifest as falls due to a sudden loss of muscle tone. With Lennox-Gastaut syndrome, the tone of the muscles supporting the head is suddenly lost, and the child's head falls. Lennox-Gastaut syndrome debuts between the ages of 1 and 8 years. Clinically, it is characterized by a triad of attacks: tonic axial, atypical absences and myatonic falls. Seizures occur with high frequency, and status epilepticus often develops, resistant to treatment.

West syndrome debuts in the first year of life (on average 5-7 months). Seizures occur in the form of epileptic spasms (flexor, extensor, mixed), affecting both axial muscles and limbs. Typical are short duration and high frequency of attacks per day, their grouping in series. Delayed mental and motor development has been noted since birth.

Emergency care for convulsive syndrome in children

If convulsions are accompanied by severe disturbances in breathing, blood circulation and water-electrolyte metabolism, i.e. manifestations that directly threaten the child’s life, treatment should begin with their correction.

To relieve seizures, preference is given to drugs that cause the least respiratory depression - midazolam or diazepam (Seduxen, Relanium, Relium), as well as sodium oxybate. A quick and reliable effect is achieved by the administration of hexobarbital (hexenal) or sodium thiopental. If there is no effect, you can use nitrous-oxygen anesthesia with the addition of halothane (fluorothane).

In cases of severe respiratory failure, the use of long-term mechanical ventilation is indicated along with the use of muscle relaxants (preferably atracurium besylate (Tracrium)). In newborns and infants, if hypocalcemia or hypoglycemia is suspected, glucose and calcium gluconate should be administered, respectively.

Treatment of seizures in children

According to the majority of neurologists, it is not recommended to prescribe long-term anticonvulsant therapy after the 1st convulsive paroxysm. Single convulsive attacks that occur against the background of fever, metabolic disorders, acute infections, or poisoning can be effectively stopped when treating the underlying disease. Preference is given to monotherapy.

The main treatment for febrile seizures is diazepam. It can be used intravenously (sibazon, seduxen, relanium) in a single dose of 0.2-0.5 mg/kg (in young children 1 mg/kg), rectally and orally (clonazepam) in a dose of 0.1-0.3 mg/(kg day) for several days after attacks or periodically for their prevention. For long-term therapy, phenobarbital (single dose 1-3 mg/kg) and sodium valproate are usually prescribed. The most common oral anticonvulsants include finlepsin (10-25 mg/kg per day), antelepsin (0.1-0.3 mg/kg per day), suxilep (10-35 mg/kg per day), diphenin (2- 4 mg/kg).

Antihistamines and antipsychotics enhance the effect of anticonvulsants. In case of convulsive status, accompanied by respiratory failure and the threat of cardiac arrest, the use of anesthetics and muscle relaxants is possible. In this case, children are immediately transferred to mechanical ventilation.

For anticonvulsant purposes in ICU conditions, GHB is used at a dose of 75-150 mg/kg, fast-acting barbiturates (sodium thiopental, hexenal) at a dose of 5-10 mg/kg, etc.

For neonatal and infantile (afebrile) seizures, the drugs of choice are phenobarbital and diphenin (phenytoin). The initial dose of phenobarbital is 5-15 mg/kg-day), maintenance dose is 5-10 mg/kg-day). If phenobarbital is ineffective, diphenine is prescribed; initial dose 5-15 mg/(kg/day), maintenance dose - 2.5-4.0 mg/(kg/day). Part of the 1st dose of both drugs can be administered intravenously, the rest - orally. When using the indicated doses, treatment should be carried out in intensive care units, since respiratory arrest in children is possible.

Pediatric single doses of anticonvulsants

The occurrence of hypocalcemic seizures is possible when the level of total calcium in the blood decreases below 1.75 mmol/l or ionized calcium below 0.75 mmol/l. During the neonatal period of a child’s life, seizures can be early (2-3 days) and late (5-14 days). During the 1st year of life, the most common cause of hypocalcemic seizures in children is spasmophilia, which occurs against the background of rickets. The likelihood of a convulsive syndrome increases in the presence of metabolic (with rickets) or respiratory (typical of hysterical attacks) alkalosis. Clinical signs of hypocalcemia: tetanic convulsions, apnea attacks due to laryngospasm, carpopedal spasm, “obstetrician’s hand”, positive symptoms of Khvostek, Trousseau, Lyust.

Intravenous slow (over 5-10 minutes) administration of a 10% solution of calcium chloride (0.5 ml/kg) or calcium gluconate (1 ml/kg) is effective. Administration at the same dose can be repeated after 0.5-1 hour if clinical and (or) laboratory signs of hypocalcemia persist.

In newborns, seizures can be caused not only by hypocalcemia (

ICD-10 code – G40.3

Idiopathicgeneralized epilepsy (IGE) is a disease in which repeated convulsive seizures occur, caused by excessive bioelectrical activity (discharges) of neurons and accompanied by various clinical and paraclinical manifestations.

A mandatory difference between it and acute symptomatic attacks is the absence of specific causes that cause them (encephalitis, etc.).

Types and classification

Idiopathic generalized epilepsy. Image source: en.ppt-online.org

1.Idiopathic with age-dependent onset

· Benign familial convulsions of newborns (occur on the second or third day of life, the presence of similar convulsions in the family is also known).
· Benign convulsions of newborns (manifest around the fifth day of a baby’s life).
· Benign myoclonic epilepsy of early infancy (occurs in the first or second year of a child’s life; manifests itself as generalized myoclonus, good prognosis).
· Childhood absence epilepsy, or pycnolepsy (in small children 2-8 years old, simple absence seizures are typical, the prognosis is favorable).
· Juvenile absence epilepsy (appears during puberty, combined with GTCS and myoclonus).
· Juvenile myoclonic epilepsy (synchronous bilateral myoclonus occurs after sleep).
· Epilepsy with generalized convulsive seizures of awakening (bilateral myoclonus occurs several hours after sleep).
· Other forms of idiopathic generalized epilepsy.
· Epilepsy with seizures caused by specific methods (usually photosensitive epilepsy).

2. Cryptogenic

· West syndrome, or infantile spasms(appears at four to seven months, seizures occur in series, with pauses, the head and torso are bent, and the arms are abducted, the prognosis is serious).
· Lennox-Gastaut syndrome(onset at three to six years, mental development slows down, absence seizures of an atypical nature, atonic seizures and tonic seizures that occur at night are characteristic; this form is insensitive to therapy).
· Epilepsy with myoclonic-astatic seizures(occurs from the first years in the form of febrile GTCS, and can spontaneously go into remission).
· Epilepsy with myoclonic absence seizures(debuts at six to eight years with the addition of mental retardation, insensitive to therapy).

3.Symptomatic

This is a specialized clinical specialist who diagnoses and treats sleep disorders. For these disorders, as well as for epileptic seizures, video EEG is of great diagnostic importance - when electroencephalography is performed under the control of cameras, with the transmission of convulsive seizures on the monitor screen. This helps to observe and differentiate convulsive syndrome from other pathological conditions not only based on EEG results, but also visually.

Another type of electroencephalography is daily EEG monitoring. This study is carried out in a somnology laboratory, which is a room where indicators of bioelectrical activity are taken at night. It is at this time that nocturnal epilepsy may manifest itself. A person comes for a study in the evening and goes to bed, and during sleep the indicators of interest to the doctor are taken.

In addition to the appearance of characteristic changes that can be seen on the encephalograph film, one can also observe how these changes look from the outside: how the person behaves at this time, how long the convulsive seizure lasts and what its nature is.

Convulsive syndrome in adults is an emergency condition that can develop for a variety of reasons, although this condition is more typical for children.

Muscle contractions during an attack can be localized or generalized. Localized ones appear in certain muscles, and generalized ones cover the entire body. In addition, they can be divided into:

Clonic.
Tonic.
Clonic-tonic.

The exact type of seizure a person has can be determined by a doctor based on the symptoms that appear during the attack.

Why does this happen

The causes of convulsive syndrome can be a variety of pathological conditions and diseases. For example, under the age of 25, it occurs against the background of brain tumors, head injuries, toxoplasmosis, and angioma.

In older people, this phenomenon often occurs due to the consumption of alcoholic beverages, metastases of various tumors in the brain, and inflammatory processes in its membranes.

If such attacks occur in people over 60 years of age, then there will be slightly different causes and predisposing factors. These are Alzheimer's disease, drug overdose, kidney failure, cerebrovascular disease.

Therefore, after providing emergency care, a person who suffers from seizures should definitely visit a doctor in order to find out what is causing this condition and begin treatment, because this is one of the symptoms of many diseases.

Symptoms

One of the most common types is alcoholic convulsive syndrome. Moreover, it develops not while drinking alcoholic beverages, but some time after binge drinking. Seizures can be of varying severity and duration - from short-term to long-term clonic-tonic, which later develop into status epilepticus.

The second most common cause is brain tumors. Most often these are myoclonic spasms of the facial muscles or other parts of the body. But tonic-clonic ones can also develop, with loss of consciousness and interruptions in breathing for 30 seconds or more.

After an attack, a person notes weakness, drowsiness, headache, confusion, pain and numbness in the muscles.

Almost all such syndromes occur in the same way, be it alcoholic, epileptic, developed against the background of a head injury or tumors, as well as those that occur due to brain pathologies associated with disruption of its blood supply.

How to help

First aid for the syndrome is provided on the spot. The patient lies on a hard surface, put a pillow or blanket under his head, and be sure to turn it on his side. During an attack, you cannot restrain a person, since this way he can get fractures - you just need to monitor your breathing and pulse. It is also necessary to call an ambulance and be sure to hospitalize this person.

In the hospital, if the attack recurs, it is stopped with the help of medications. This is basically a 0.5% solution of seduxen or relanium, which is administered intravenously in an amount of 2 ml. If everything happens again, then these drugs are reintroduced. If the status persists after the third administration, then a 1% sodium thiopental solution is administered.

Treatment of convulsive syndrome in adults is carried out after the seizure has been eliminated. It is important to understand what caused the seizures and to treat the cause itself.

So, for example, if it is a tumor, then surgery is performed to remove it. If it is epilepsy, then you should regularly take appropriate medications that help prevent the development of seizures. If this is alcohol intake, then treatment in specialized clinics is necessary. If these are head injuries, then you should be under constant supervision of a neurologist.

To find out exactly why this condition occurs, it is necessary to undergo a thorough investigation, which will include blood and urine tests, brain examination, MRI or CT scan. Special diagnostic measures may also be recommended, which are carried out if a particular disease is suspected.

It also happens that such a condition occurs only once in a lifetime, for example, against the background of high fever, infectious disease, poisoning, or metabolic disorder. In this case, no special treatment is required and after eliminating the main cause, this no longer happens.

But with epilepsy, seizures are very common. This means that a person must constantly be under medical supervision and be sure to follow all the doctor’s orders, since intractable status epilepticus may develop, which can be very, very difficult to cope with.

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The cause of back pain can be myalgia, the symptoms of which can be varied. Back pain occurs quite often in every adult. They are often intense and painful. The pain may occur suddenly or gradually increase over hours or even days. Any gardener is familiar with the situation when, a few hours after working on the plot, muscle pain appears in the arm, back or neck area.

This pain is well known to athletes. In addition to physical activity, inflammation or emotional stress can cause muscle pain. But pain syndromes do not always arise due to myalgia. There are many reasons for back pain. How does myalgia manifest and how to get rid of it?

Myalgia is muscle pain. ICD-10 code (International Classification of Diseases, 10th revision) M79.1. The pain can vary in intensity and nature: sharp, shooting and tearing or dull and aching.

Muscle pain can be localized in the neck, chest, lumbar region or limbs, but can affect the entire body. The most common ailment is neck myalgia.

If muscle pain occurs as a result of hypothermia, painful compactions may be found in the muscle tissue - gelotic plaques (geloses). They usually appear in the back of the head, chest and legs. Geloses can reflect pain syndromes occurring in the internal organs. For this reason, an erroneous diagnosis of myalgia is possible. Geloses can spread to the tissues of joints, ligaments and tendons. These changes cause a person severe pain.

If the disease is not treated, it will provoke serious pathologies. Over time, osteoarthritis, osteochondrosis or intervertebral hernia may develop.

The nature of the origin of myalgia varies. Depending on the causes of the disease, its symptoms vary.

The causes of muscle pain can be different. Myalgia can occur after a sudden or awkward movement, after a long stay in an uncomfortable position, as a result of hypothermia or injury, due to intoxication, for example, due to excessive alcohol consumption.

Myalgia is often caused by systemic inflammatory diseases of connective tissue and metabolic diseases. For example, gout or diabetes.

The disease can be caused by medications. Myalgia may occur as a result of taking medications that normalize blood cholesterol levels.

Often the cause of myalgia is a sedentary lifestyle.

There are several types of myalgia.

There are different types of myalgia depending on whether damage to muscle tissue has occurred or not.

When muscle tissue is damaged, the enzyme creatine phosphokinase (CPK) leaves the cells and its level in the blood increases. Damage to muscle tissue occurs, as a rule, with inflammatory myositis, due to injury or due to intoxication.

It is important to correctly diagnose the disease.

Manifestations of the disease are similar to the symptoms of neuritis, neuralgia or radiculitis. After all, pain when pressing on muscle tissue can occur not only due to damage to the muscles, but also to peripheral nerves.

If symptoms of myalgia occur, you should visit a doctor. If the diagnosis of myalgia is confirmed, only a doctor should prescribe treatment. He will recommend the patient complete rest and bed rest. Warmth in any form is useful. The affected areas can be covered with warm bandages - a woolen scarf or belt. They will provide “dry heat”.

To alleviate the condition of severe and unbearable pain, it is recommended to take painkillers. Your doctor will help you choose them. He will also determine the medication regimen and course duration. In cases of particularly severe pain, the doctor may prescribe intravenous injections. Treatment with medications should be carried out under the supervision of a physician.

With the development of purulent myositis, the help of a surgeon is necessary. Treatment with medications of such myositis is carried out with the obligatory opening of the source of infection, removal of pus and application of a drainage bandage. Any delay in treating purulent myositis is dangerous to human health.

Physiotherapy is effective in treating myalgia. The doctor may recommend ultraviolet irradiation of the affected areas, electrophoresis with histamine or novocaine.

Massage will help get rid of gelotic plaques. When diagnosing purulent myositis, massage is strictly contraindicated. Any massages for myalgia should be entrusted to a professional. Improper rubbing of the affected areas can provoke an increase in the disease and cause damage to other tissues.

At home, you can use warming ointments and gels. Such drugs are Fastum gel, Finalgon or Menovazin. Before using them, you must carefully read the instructions and perform all actions strictly according to the manufacturer’s recommendations.

Folk remedies will help alleviate the patient's condition. For example, lard. Unsalted lard must be ground and crushed dried horsetail added to it. For 3 parts lard take 1 part horsetail. The mixture is thoroughly ground until smooth and gently rubbed into the affected area.

White cabbage has long been famous for its analgesic and anti-inflammatory properties. A leaf of white cabbage should be generously soaped with laundry soap and sprinkled with baking soda. After this, the sheet is applied to the affected area. A woolen scarf or bandage is tied over the warming compress.

Bay oil has an analgesic and relaxing effect on tense muscles. To prepare the solution, add 10 drops of oil to 1 liter of warm water. A cotton towel is immersed in the solution, wrung out, rolled into a tourniquet and applied to the sore spot.

At night you can make a compress of potatoes. Several potatoes are boiled in their skins, mashed and applied to the body. If the puree is too hot, you need to place a cloth between the potatoes and the body. The compress should not be scalding. A warm bandage is tied on top.

In summer, burdock leaves will help. Large fleshy leaves should be doused with boiling water and applied in layers to the sore spot. A flannel or wool bandage is applied on top.

Prevention of pain syndrome

Some people suffer from myalgia regularly. It can be enough to walk in windy weather without a scarf or sit in a draft, and literally the next day neck myalgia appears. Such people need to pay more attention to the prevention of this disease.

To do this, you need to dress according to the weather. Since temperature changes can provoke muscle pain, you should not run outside in cold weather or into a cold room after physical activity.

Also at risk are people who, due to their professional activities, remain in one position for a long time and repeat monotonous movements.

These are drivers, office workers, musicians. Such people need to take regular breaks from work, during which it is recommended to walk around and stretch their muscles. While sitting, you need to monitor your posture, since if the body is positioned incorrectly, the muscles are subjected to unnatural static loads.

People with diseases of the musculoskeletal system need to further treat their ailments. This will reduce the likelihood of myalgia.

You should exercise regularly. Moderate physical activity will strengthen muscles and reduce the influence of various negative factors on them. Swimming in open water in the summer or in a pool during the cold season is very useful. Swimming also has a hardening effect and helps strengthen the immune system of the whole body.

Additional sources

Myalgia in therapeutic practice - approaches to differential diagnosis, treatment N.A. Shostak, N.G. Pravdyuk, I.V. Novikov, E.S. Trofimov GBOU VPO RNIMU im. N.I. Pirogova Ministry of Health and Social Development of Russia, Moscow, journal Attending Physician issue No. 4 2012

Pain syndrome in patients with fibromyalgia G.R. Tabeev, MMA named after. I.M. Sechenova, Moscow, RMJ magazine Independent publication for practicing physicians, issue No. 10 2003