SPASMOPHILIA

From Big Medical Encyclopedia

SPASMOPHILIA (spasmophilia; Greek spasmos spasm, spasm + philia tendency; synonym rachitic tetany) — the morbid condition arising at children of preferential early age, which is characterized by tendency to tonic and toniko-clonic spasms and other manifestations of the increased neuromuscular excitability owing to decrease in content of the ionized calcium in extracellular liquid and also at development of an alkalosis.

Pathogenetic communication of S. with rickets is noticed long ago, but Klottsem (N. of P. Klotz) with sotr is proved in 1979., found low level 25 oxycholecalciferols (see. Calciferols ) in blood at children from S. Tonicheskiye spasms (see) and other manifestations of S. can be a symptom of a hypomagnesiemia, not rachitogenic hypocalcemia which is found at a hypoparathyrosis, a renal or liver failure, persistent vomitings, excess introduction to an organism of hydrosodium carbonate and also at chronic idiopathic, or constitutional, tetanies (see) and the tetany of newborns caused by a hypocalcemia and a hypomagnesiemia.

Fig. 2. Foot of the child with a spasmophilia at the time of convulsive reduction of muscles.

Explicit S. is characterized by symptoms laryngospasm (see), bronchospasm (see), attacks of tonic spasms (fig. 2).

S.'s attacks are more often observed in the spring at the children who are on artificial feeding. Repeated vomitings, napr can provoke S.'s attack, at a pylorostenosis, a hyperventilation at strong crying, elevated temperature at various diseases.

Fig. 1. A brush of the child with a spasmophilia at the time of convulsive reduction of muscles (a so-called obstetrical hand).

Distinguish the hidden (latent) and explicit (manifest) S. Skrytaya S. the century on the inspected party of the sick person at effleurage is shown by fulminant reductions of muscles of a mouth, nose, a finger in the field of fossa canina — on the middle between a corner of a mouth and a trestle of an ear (Hvostek's symptom); convulsive reduction of muscles of the brush reminding at the same time an obstetrical hand (fig. 1) as a result of a prelum a cuff or fingers of a shoulder of the patient in his average third (Trusso's symptom); bystry assignment and an easy dorsiflexion of foot at blow nevrol. a hammer heads of a fibular bone (Lyust's phenomenon) are lower; reduction of muscles at irritation their current with a force below 5 ma (a symptom of Erba); a short-term apnoea at pain stimulation — a prick a needle (the phenomenon described by M. S. Maslov).

Diagnosis put on the basis of a clinical picture (at an explicit spasmophilia), the yielded neurologic inspection and results of a laboratory research. At sick S. decrease in concentration of the ionized calcium in blood serum (less than 0,9 mmol/l is noted at norm 1,1 — 1,35 mmol/l) in combination with respiratory, is more rare metabolic alkalosis (see). Decrease in concentration of the general calcium in blood serum (less than 1,75 mmol/l at norm of 2,5 — 2,87 mmol/l) meets less than decrease in concentration of the ionized calcium. Differentiate with other forms of the tetany caused by disturbance of exchange of calcium and magnesium.

Treatment at explicit S. begin with removal of spasms. For this purpose intravenously pour in Calcii chloridum (10% solution of 0,3 — 0,5 ml on 1 kg of body weight) or magnesium sulfate (0,5 ml of 25% of solution for 1 kg of body weight), intramusculary enter Seduxenum (0,1 ml of 0,5% of solution for 1 kg of body weight). At the hidden S. drugs of calcium (a gluconate or glycerophosphate) appoint inside (0,5 — 2 g 3 — 4 times a day) in combination with ammonium chloride (0,1 g 3 — 4 times a day inside). Specific treatment is shown to all patients rickets (see). Breastfeeding is recommended. At artificial feeding as much as possible limit amount of cow's milk in a diet, replacing it with the acid or acidified mixes (see. Feeding of children ).

Forecast Page at timely diagnosis and rational treatment favorable. In case of the untimely help at a bronchospasm and a heavy laryngospasm the lethal outcome is possible.

Prevention consists in early identification and in correction of a hypocalcemia, alkalosis and other disturbances of exchange, and also the increased neuromuscular excitability.


Bibliography: The multivolume guide to pediatrics, under the editorship of Yu. F. Dombrovskaya, t. 2, page 491, M., 1961; The Christmas-tide on K. A., X in at l A. M. and P and with with about l about in and M. A. Rakhit, M., 1964, bibliogr.; Round A. F. Rakhit, L., 1966, bibliogr.; D about r L. J. and. Miller E. V. Biochemical alterations during tetany, Anesthesiology, v. 52, p. 82, 1980; Dubois B. e. a. La spasmophy-lie chez l’enfant, Considerations diagnosti-ques, Arch, frang. Pediat., t. 32, p. 492, 1975; To 1 about t z H. P. e. a. Le 25 hydroxy-cholecalciferol (25 OHCC) dans la spasmo-philie, Ann. Endocr. (Paris), t. 40, p. 443, 1979; Lovinger R. D. Rickets, Pediatrics, v. 66, p. 359, 1980; M u n e r a Y. e. a. Symptomatologie observee chez 162 mala-des classes comme spasmophilies (tetanie chronique idiopathique ou constitutionnelle), Ann. Med. intern., t. 130, p. 9, 1979; Neonatal-perinatal medicine, ed. by R. E. Behr-man, St Louis, 1977.


H. P. Shabalov.

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