From a pathogenetic point of view, spasmophilia and rickets are two stages of disorders of calcium and phosphorus metabolism, which develop as a result of vitamin D deficiency in the body. According to Maslov, by the 60s, spasmophilia was detected in 3,7% of infants.
Spasmophilia has become more common in children due to the recent increase in rickets. The occurrence of seizures and other spastic diseases is associated with high excitability of the nervous system, mainly the nervous system.
The development of spasmophilia is caused by impaired ion balance resulting from hypocalcemia, hyperphosphatemia, and alkalosis. Increased phosphorus levels and increased alkalosis lead to hypocalcemia. A decrease in the amount of calcium in the blood, a decrease in its ions, leads to the development of seizures in children. Excessive entry of alkalis into the cell also leads to convulsions (sodium bicarbonate, nitrates). Spasmophilia occurs in late winter and spring when exposed to ultraviolet radiation, and also occurs during the period of convalescence of rickets, as a result of improved calcium-phosphorus metabolism, increased mobilization of calcium from the blood and its accumulation in the bones. At the same time the pre-thyroid function decreases.
In spasmophilia, convulsions are caused by frequent vomiting, loud crying, and fear. These factors lead to the shift of the acid-base state to alkalosis, the alkaline state in the blood to a decrease in calcium ionization. In such cases, the amount of calcium does not need to be reduced, alkalosis increases neuromuscular excitability.
In contrast, metabolic acidosis leads to the development of tetany because calcium ionization is increased at high pH. Spasmophilia is also associated with magnesium deficiency in the extracellular fluid, where calcium levels are normal. This occurs when breastfeeding or improper absorption of magnesium in the body, as well as excessive excretion of magnesium in the urine. Normally, the amount of magnesium in the blood serum is 0,8-1,5 mmol / l, a decrease in its amount to 0,5 mmol / l causes seizures. Convulsions are also caused by vitamin B1 deficiency, which is observed in rickets and is exacerbated in spasmophilia. This causes a breakdown in the glycolytic chain, pyruvic acid is formed, leading to convulsions.
Spasmophilia is divided into latent and latent types or called “latent tetany” and explicit spasmophilia. In the latent form of spasmophilia, “latent tetany” arises from high levels of neuromuscular excitability. Parents do not complain, the child develops normally, signs of rickets are detected. Hidden
common symptoms in spasmophilia include symptoms of Hvostek (facial phenomenon), Lust, Trusso, Erba, Maslov.
Xvostek symptom - instead of the facial nerve branch with the hammer, the area of the palmar palm, the fossae caninae, the inner corner of the mouth, nose, eyes
causes muscle contraction.
Lust symptoms - (peroneal or fibular) - The small femoral nerve, when struck in the posterior and inferior region of the femur, causes the upper leg to bend, turning outward. A similar phenomenon can be observed manually, when the elbow nerve area is struck by the head of the wrist bone.
Trusso symptoms - When the shoulder is pressed with a tape for a few minutes (on a nerve bundle), there is a tingling sensation in the fingers and the appearance of "obstetric hand".
Erba symptom - Under the influence of galvanic current there is an increase in the electrical excitability of nerves. If the muscles contract when the current is less than 5mA, this is called high excitability. In spasmophilia it is 1-2 mA.
Maslov symptom - Acceleration of children's breathing is observed when the needle is inserted. In latent spasmophilia, breathing stops for a few minutes as you breathe in and out as a result of muscle spasms.
Laryngospasm. One of the obvious symptoms of spasmophilia is laryngospasm and spasm of the swallowing muscles. Sometimes in a calm state, often in tension, excitement, fear or crying, it is difficult to breathe, and a peculiar noisy breath occurs, the breathing may stop for a few seconds. The child turns pale, then coughs, cold sweat appears on his face and body. Sensitivity ends with noisy exhalation and breathing gradually normalizes.Laryngospasm may recur throughout the day. Prolonged spasm may result in loss of consciousness and clonic convulsions.
Carpopedal spasm (obvious tetany). Painful spasm of the muscles of the arms and legs. In this case, the toes are in the position of "obstetric hand", as well as the toes are equin-varus, the feet are bent towards the palm, the skin on the palm forms folds. The spasm lasts from a few seconds to a few minutes
lasts, sometimes longer. Mimic muscle (tetanic face) fatigue, tightening of the masticatory muscles (trismus), neck muscles, respiratory muscles (cessation of breathing, holding) are observed. Smooth muscle spasm can also be observed, with cardiac arrest, and death can also be observed. Sometimes carpopedal
spasms are accompanied by clonic convulsions.
Eclampsia. common seizures accompanied by loss of consciousness. Sometimes the convulsions begin with the flight of the facial muscles at the tip of the mouth and eyes, and spread to the legs. The duration of the attack ranges from a few minutes to several hours (referred to as eclamptic status). Sometimes convulsions are asleep
starts. In children with tetany, no pathological changes are detected on the EEG between attacks. In muscle spasms, pathological waves are recorded on the EEG, changes in cerebral anoxia and ischemia are detected. A clear correlation between calcium levels and EEG data
no. Infantile tetany. hypocalcemia and convulsions (infantile tetany) in the first day of life are more common in premature infants, twins, infections, jaundice syndrome, and others. Low calcium intake after birth, resistance to peripheral receptors, high secretion of calcitonin are of great importance. In the child in the first week of life
hypocalcemia is associated with the nature of nutrition, a violation of its absorption into the body and the transition to early feeding of the child with cow's milk. In rare cases, hypocalcemia in infants occurs as a result of a lack of calcium and vitamin D in the mother's body. Hypocalcemia in infants neuromuscular
diffuse hypersensitivity and occurs as a result of convulsions, respiratory symptoms, tachycardia, recording.
Davosi. In latent and overt spasmophilia, 10% calcium chloride solution is recommended per teaspoon or dessert spoon or 1-2 g of calcium gluconate 3 times a day. Mild attacks of laryngospasm are relieved with fresh air (fresh air is provided), cold water is sprinkled on the face; in protracted attacks
the tongue wall and the back wall of the throat are stimulated, artificial respiration - is carried out until the first breath appears. In tetany and carpopedal spasm 1-2% chloral hydrate solution is recommended in one teaspoon or dessert spoon, 10-15 ml intravenously 10% calcium chloride or gluconate, then calcium 0,1-0,15
g / kg per day.
It is important to determine the eating pattern in children with seizures. During the period of convulsions, the diet is carried out with tea, fruit juices for 8-12 hours. In breast-fed infants, sour mixtures are then added to the milk, and in artificial feeding, cow's milk is replaced by donor (breast milk) and sour mixture; fruit and vegetable juices, vegetable porridge is recommended.
Preventive measures include timely prevention of rickets, proper organization of the schedule, adequate walking in the fresh air, periodic calcium supplements. Calcium bromides are recommended for children with high irritability and rickets in the winter.
Note that the above medications and their dosages have only been reported. It is necessary to consult a pediatrician before use.
