Neurogenic tetany. Types, manifestations and therapy of tetany

Tetany is a clinical syndrome in which the central place is occupied by a state of increased excitability of the neuromuscular system, expressed in a tendency to convulsions. According to the clinical course, there are obvious and hidden forms of tetany. With obvious tetany, convulsions occur spontaneously. They are usually preceded by paresthesia. Convulsions are tonic in nature, accompanied by severe pain and occur either in the form of successive mild and short-lived attacks, separated from one another by more or less long periods of time, or in the form of very prolonged severe convulsive states. Mild degrees - the so-called latent (hidden) tetany - can occur without any visible external manifestations, or patients feel only paresthesia in the limbs, a feeling of spasms, coldness, “crawling goosebumps”, not accompanied by convulsions. Hidden forms of tetany under the influence of certain factors, such as: hyperventilation, infections, pregnancy, intoxication, etc., can develop into an overt form of the disease, manifesting itself in attacks of convulsions. With a sufficiently pronounced tendency to convulsions, the latter in a patient can easily be caused by one or another strong irritation: mechanical, painful, thermal, etc.

For convulsions during tetany, a selective nature is typical. They spread to certain muscle groups symmetrically on both sides. Most often, the muscles of the upper extremities are involved, somewhat less frequently - the muscles of the lower extremities. Often, in severe forms of the disease, cramps of the facial muscles are observed, much less often - of the torso, abdominal obstruction, and only in exceptional cases (mainly in children) do they spread to the muscles of the internal organs (larynx, stomach). In the extremities, spasms spread mainly to the flexor muscle groups, which is why during attacks the limbs take on a peculiar position, typical of tetany. With cramps of the upper extremities, the shoulder is slightly brought towards the body, the forearm is bent at the elbow joint, the hand is bent at the radiocarpal and metacarpal joints, the fingers are clenched and slightly inclined towards the palm. The position of the hand and fingers during an attack of convulsions is called the “obstetrician’s hands” due to some similarity with the position of the hand of a doctor ready to begin a gynecological examination.

With cramps of the lower extremities, the foot is curved inward, the toes are in a plantar flexion position, the big toe is covered with the rest and the sole is depressed in the form of a groove. Due to the convulsive contraction of the adductors, the legs are closely pressed against each other in an extended position.

The spasm of the facial muscles gives it a characteristic expression: the mouth takes on the appearance of a so-called fish mouth. The eyelids are half-lowered, the eyebrows are knitted. During convulsions, voluntary movements of the affected muscles become impossible for the patient. Contracted muscles are hard, difficult to stretch, and when the stretching stops, they return to their previous position. An attempt to stretch the cramped limbs sharply increases the pain experienced by the patient. When convulsions spread to the muscles of the body (which is observed quite rarely), due to convulsive contraction of the intercostal muscles, abdominal muscles and diaphragm, severe respiratory distress is noted. Sometimes rigidity of the spine occurs, and when the neck and spinal muscles spasm, the spine bends backward. The spread of spasms to the muscles of the larynx leads to spasm of the glottis (laryngospasm). Laryngospasm is rare in adults; in children, it is a frequent manifestation of tetany, and can occur independently of general widespread convulsions. With laryngospasm, inspiratory shortness of breath of greater or lesser intensity is observed, breathing becomes noisy, the face is cyanotic, and foam appears on the lips. In severe cases, the patient loses consciousness. A prolonged attack with delayed medical care (intubation, tracheotomy) can be fatal.

Attacks of convulsions during tetany occur both spontaneously and in connection with certain physical irritations: bruises, muscle tension, stretching of limbs, overheating of the body (for example, a hot bath) can also contribute to the occurrence of an attack.

A number of symptoms characteristic of tetany are based on the increased excitability of motor nerve trunks, which make it possible to identify the disease outside of attacks and contribute to the diagnosis of a latent form of the disease.

Chvostek's sign

Chvostek's sign (or "facial nerve phenomenon") is caused by tapping with a percussion hammer or finger on the trunk of the facial nerve at its exit near the external auditory canal, after which the patient with tetany experiences contraction of the corresponding side of the facial muscles.

There are three degrees of symptoms:

“Tail I” - when the muscles of the entire area innervated by the facial nerve contract;

“Tail II” - the muscles in the area of the wing of the nose and the corner of the mouth contract;

“Tail III” - only the muscles of the corner of the mouth contract.

Only “Khvostek I” has unconditional diagnostic value. With obvious tetany, it is clearly expressed even with a light touch in the area of the facial nerve trunk. “Khvostek II” and “Khvostek III” are always positive in cases of latent hypoparathyroidism, but their diagnostic value is low, since they can be positive in other diseases not associated with hypoparathyroidism: neurasthenia, hysteria, asthenia, exhaustion, etc.

Weiss's sign

Diagnostically less reliable and inconsistent is the Weiss symptom, which consists in the fact that when tapping at the outer edge of the orbit (along the superior branch of the facial nerve), a contraction of the round muscles of the eyelids and frontal muscles occurs.

Trousseau's sign

The next symptom, the presence of which always indicates tetany, but the absence does not yet exclude the latent form of the latter, is Trousseau's symptom. It is installed by tightly tightening (until the pulse disappears) the shoulder with a tourniquet or rubber cuff of a device for measuring blood pressure. With a positive Trousseau's symptom, after 2-3 minutes, and sometimes almost immediately, a typical tetanic contraction of the hand occurs in the overstretched hand with its position in the form of an “obstetrician’s hand”; the appearance of cramps is preceded by a feeling of numbness and pain in the fingers.

Schlesinger's symptom

With rapid passive flexion of the patient's leg at the hip joint, straightened at the knee joint, a cramp appears in the extensor muscles of the thigh with simultaneous sharp supination of the foot - Schlesinger's symptom. To identify this symptom, the patient should be placed on his back.

Erb's sign

The state of motor nerves during tetany, in addition to increased mechanical excitability, is also characterized by a sharp increase in their electrical excitability. Erb's symptom is based on this: with a galvanic current of even very low strength (not higher than 0.7 ta), a cathode-closing contraction occurs, which, with a slight increase in the current, turns into cathode-closing tetanus. The study is usually performed on the ulnar or peroneal nerve.

Hoffmann's sign

With tetany, an increase in mechanical and electrical excitability is characteristic not only of motor nerves, but also of sensory nerves. Even light pressure on the nerve causes parasthesia, spreading to the area of branching of this nerve, while normally pressure causes only a local sensation. This symptom is called Hoffmann's symptom.

Autonomic nervous system with tetany

The autonomic nervous system in patients with tetany is in a state of increased excitability, clinically expressed in the patients' tendency to sweating, tachycardia and vasomotor phenomena. Most patients have an increased reaction to the administration of adrenaline and pilocarpine. However, in some cases the response to these pharmacological stimuli may be reduced.

Changes in the respiratory system during tetany

On the part of the respiratory system during tetany, no permanent changes are detected, except for the spasm of the glottis described below in severe forms of tetany, mainly in childhood.

Changes in the cardiovascular system during tetany

The cardiovascular system reflects increased excitability of the autonomic nervous system.

A characteristic electrocardiographic symptom of tetany is an increase in the Q - T interval, mainly due to an increase in the S - T interval, which is caused by hypocalcemia, the elimination of which by intravenous infusion of calcium leads to the normal value of the indicated interval.

Changes in the gastrointestinal tract with tetany

The function of the gastrointestinal tract in patients with tetany is often impaired, and there are both secretory (gastrosucorrhoea, hyperchlorhydria) and motor (pylorospasm, diarrhea) disorders. Sometimes these disorders are concomitant, secondary. In some cases, they are primary, and tetany develops due to these disorders (gastric and intestinal forms of tetany).

Changes in the skeletal system during tetany

On the part of the skeletal system in patients with tetany, no noticeable deviations from the norm can be detected.

Changes in the psyche with tetany

The psyche of patients with tetany is usually not changed. Only in rare cases were combinations with psychoses noted - a manic state and increased mental excitability. Often patients have a tendency to neurasthenic and hysterical reactions, and thus mixed forms of hysteria and tetany arise.

It should be noted that there are frequent cases of combination of tetany with epilepsy. Obviously, the same conditions that create a state of increased excitability of the nerve trunks also contribute to a decrease in the “convulsive tolerance” of the cells of the cerebral cortex. When tetany is combined with epilepsy, a decrease in intelligence can be observed.

Tetany: symptoms and treatment

Tetany - main symptoms:

Convulsions
Speech Impairment
Sweating
Suffocation
Numbness of the limbs
Rapid breathing
Pale skin
Creepy crawling sensation
Muscle spasm of the lower extremities
Arm muscle spasm
Tingling in the limbs
Blurred vision

Tetany is a clinical syndrome during which neuromuscular excitability occurs. It may manifest itself as a result of metabolic disorders and a decrease in ionized calcium in the blood. Most often, this syndrome manifests itself as cramps in the muscles of the limbs and face. In some cases, it may manifest itself as convulsions in the heart muscles, which can lead to cardiac arrest.

Sometimes the syndrome occurs in newborns and disappears after approximately 21 days. During this syndrome, pregnant women may experience uterine tetany, which significantly complicates childbirth.

Clinicians identify many reasons that can cause this syndrome. Often, tetanic muscle contraction occurs due to a decrease in calcium in the blood. The cause of this syndrome is sometimes a dysfunction of the parathyroid glands.

Tetanic convulsions can also be caused by the following etiological factors:

stomach disease;
endocrine pathologies;
various injuries that caused hemorrhages in the parathyroid glands;
dehydration due to frequent vomiting and loose stools;
hyperparathyroidism of parathyroid adenoma;
nervous tension and stress;
violation of acid-base balance;
congenital pathologies of the parathyroid gland.

Often, tetany may occur after surgery.

In newborns, the syndrome may occur due to the fact that the supply of calcium from the mother stops (hypocalcemic tetany).

Failures in the balance of microelements can lead to the patient developing neurogenic tetany.

In pregnant women, this syndrome can occur if there is a disruption in the functioning of the parathyroid gland. Uterine tetany can be caused by the following reasons:

severe stress;
inflammation and pathological changes in the uterus;
scarring on the uterus;
endocrine and metabolic disorders;
tumor of the pelvic organs or narrow pelvis.

Classification

Clinicians identify the following forms of this pathological process:

neurogenic (manifests itself as a result of a hyperventilation crisis);
enterogenous (caused by impaired absorption of calcium in the intestine);
hyperventilation;
hypocalcemic;
latent tetany;
gastrogenic;
pasture;
tetany of pregnant women.

There is also neonatal tetany, which is divided into early and late neonatal hypocalcemia.

Symptoms

The symptoms of this syndrome depend on its type. Since there are several forms of this syndrome, the clinical picture may vary. However, the following general symptoms of this process can be identified:

tingling;
numbness of the limbs;
crawling sensation;
muscle spasms;
convulsive contractions;
rapid breathing;
speech disorder;
pale skin;
muscle spasm of the arms and legs;
feeling of suffocation;
increased sweating;
blurred vision.

Diagnostics

In order to accurately diagnose tetany syndrome, the following diagnostic procedures are performed:

tapping the nerve endings of the limbs and facial nerve with a hammer;
pass galvanic current through the peroneal nerve and elbow joint;
tighten the limbs of the arms or legs with a rubber band. When carrying out this method, cramping of the hand, numbness of the limb, or painful sensations may occur. Such manifestations are evidence of the presence of this syndrome.

Also, to identify tetany, you need to put the patient on his back and begin to bend his leg at the hip joint. A cramp in the hip flexor muscle will indicate the presence of this disease.

Sometimes an electrocardiogram can help identify the disease. Based on its curve, one can determine a type of syndrome called latent tetany.

As a rule, treatment of tetany is aimed at eliminating seizures and preventing their occurrence.

Drug therapy includes medications that contain vitamin D. These medications include:

Ergocalciferol;
Videohol;
Dihydrotachysterol.

Medicines that contain calcium are also prescribed. Such medications are considered the most effective in treating tetany.

Avoid foods and supplements that contain phosphorus, as they interfere with calcium production.

Often, for treatment, the following solutions are administered intravenously to the patient:

calcium chloride;
magnesium sulfate;
calcium gluconate.

Sedatives are also prescribed, which reduce emotional stress and act as a sedative.

With this syndrome, diet is mandatory. The patient's diet should contain foods rich in calcium. However, you should reduce your intake of dairy products. Although they contain calcium, they also contain a lot of phosphorus.

Often, the patient is prescribed water procedures, which well complement the treatment of tetany syndrome.

With uterine tetany, independent labor is impossible, so a caesarean section is performed.

Possible complications

Tetany syndrome can cause the development of serious pathological processes in the following body systems:

the cardiovascular system;
gastrointestinal tract.

Also affected by this syndrome is the autonomic nervous system, which during illness is in a state of increased excitability, which can lead to complications.

In some cases, tetany can affect the patient's mental state, which is manifested by neurasthenic or hysterical reactions.

Prevention

There are no specific preventive measures against this syndrome. The risk of developing such a pathological process can be reduced if you adhere to the rules of a healthy lifestyle and undergo regular medical examinations.

In most cases, the prognosis for patients with tetany is favorable. The main thing is to start treating this disease on time. Laryngospasms that occur during attacks can pose a threat to the patient. However, the prognosis is unfavorable for those patients who have concomitant diseases of the gastrointestinal tract and cardiovascular system.

If you think that you have Tetany and the symptoms characteristic of this disease, then a general practitioner can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Caisson disease is a pathological condition that progresses due to a person’s transition from an area with elevated atmospheric pressure to an area with normal levels. The disorder gets its name from the process of transition from high blood pressure to normal. Divers and miners who spend a long time at depth are often susceptible to this disorder.

Hypoparathyroidism is a disease caused by insufficient production of parathyroid hormone. As a result of the progression of the pathology, a violation of calcium absorption in the gastrointestinal tract is observed. Hypoparathyroidism without proper treatment can lead to disability.

Neuropathy is a disease characterized by degenerative-dystrophic damage to nerve fibers. With this disease, not only peripheral nerves are affected, but also cranial nerves. Often there is inflammation of a single nerve; in such cases, this disorder is called mononeuropathy, and when several nerves are affected simultaneously, it is called polyneuropathy. The frequency of manifestation depends on the causes of occurrence.

Diabetic neuropathy is a consequence of ignoring symptoms or lack of treatment to control diabetes. There are several predisposing factors for the appearance of such a disorder against the background of the underlying disease. The main ones are addiction to bad habits and high blood pressure.

Diabetic polyneuropathy manifests itself as a complication of diabetes mellitus. The disease is based on damage to the patient’s nervous system. Often, the disease develops in people 15–20 years after diabetes developed. The incidence of progression of the disease to a complicated stage is 40–60%. The disease can occur in people with both type 1 and type 2 disease.

With the help of exercise and abstinence, most people can do without medicine.

Tetany- convulsive syndrome and increased neuromuscular excitability caused by impaired calcium metabolism in the body.

Causes of tetany

Tetany occurs due to insufficient function of the parathyroid glands.

The disease can occur as a result of injury, inflammatory and infectious processes in the area of the parathyroid glands, as well as during surgical removal of the glands.

Types of tetany

Main types of tetany- gastrogenic tetany and neurogenic tetany syndrome.

Neurogenic tetany is characterized by a negative effect on the autonomic nervous system, and gastrogenic tetany is characterized by disturbances in the digestive system.

The disease often occurs in conjunction with epilepsy, neurasthenic and hysterical reactions, manic psychoses and increased mental excitability.

Symptoms of tetany

Tetany is characterized by symptoms such as:
Attacks of tonic muscle spasms, accompanied by painful sensations;v Facial muscle spasms;
Convulsive contractions of the respiratory muscles;
Loss of consciousness;
Arching of the body backwards when spasms spread to the back muscles.

With prolonged tetany, the patient develops cataracts, and tooth enamel defects become chronic. Chronic excessive hair loss on the scalp also occurs.

For neurogenic tetany characterized by laryngospasm, during a severe attack of which life-threatening asphyxia may occur.

Treatment of tetany

Treatment of tetany comes down to eliminating hypocalcemia (lack of calcium in the body). Drug therapy with calcium preparations is carried out.

During an attack The patient is injected intravenously with a 10% calcium chloride solution in a dose of 10 ml. At the same time, 1-3 ml of parathyroidism is injected intramuscularly. The attack is eliminated.

Outside of an attack, the patient needs to take calcium supplements. A diet rich in calcium is prescribed, while phosphorus-containing foods should be limited.

The quantity of animal products is limited. Also appointed taking vitamin D.

When treating tetany, it is necessary to control the level of calcium in the blood.

Tetany: types, causes and treatment methods

The term “tetany” refers to convulsions that occur due to a disturbance in calcium metabolism in the human body (see figure). They can be explicit and latent (hidden). In the first case, during prolonged muscle contractions that occur voluntarily, a person experiences pain, and before this he notes a sensitivity disorder. In the case of a latent form of tetany, a person feels spasms in the arms or legs, his limbs become cold, and goosebumps begin to run throughout his body.

A feature of the pathology is that cramps occur only in one muscle group, but without fail on both sides, that is, symmetrically.

The presence of tetany can be determined by several signs. For example, according to Chvostek's symptom, when tapping with a finger or a special hammer along the facial nerve leads to contraction of this entire area.

To identify the Weiss symptom, tapping is done on the outer edge of the eye, which leads to muscle contraction of the eyelids and forehead.

If, while inflating the cuff to determine blood pressure, the fingers begin to cramp, this is also a sign of tetany (Trousseau's sign).

Schlesinger's symptom: if you bend your leg while lying down, a cramp begins in the extensor muscles.

Hoffmann's sign is detected by light pressure on the area of the nerve, which causes tingling, goosebumps, and numbness.

Doctors also perform an electromyographic test for latent tetany.

Treatment of tetany

The essence of treatment is to stop the convulsive state and prevent its further occurrence with the help of calcium-containing drugs.

Neurogenic tetany

One type of tetany is neurogenic tetany. It is characterized by problems with sensitivity (numbness, tingling, burning), muscle spasms, tonic contraction of the arm muscles, carpopedal spasms (tonic contraction of the muscles of the feet and hands). In addition, neurogenic tetany syndrome is expressed in rapid heartbeat, increased excitability and a tendency to sweat.

To eliminate this syndrome, the doctor introduces a certain dose of parathyroid hormone into the human body. But long-term use of this drug causes addiction in the patient, as a result of which the treatment becomes ineffective.

Tetany in children

Children also suffer from tetany. Infantile tetany (or spasmophilia) is characterized by laryngospasm. In the event of a severe attack, life-threatening asphyxia can occur. Seizures in children are the most common occurrence compared to adults. Before the age of two, tetany complications are common. This is associated with pathological disorders that occur during pregnancy and childbirth.

Tetany of pregnant women

This is a form of toxicosis that is quite rare. Most often it manifests itself in the spring and occurs due to a malfunction of the parathyroid glands. Typically, cramps occur in the arms, less often in the legs. Sometimes the face cramps, which can cause speech problems.

The greatest danger is posed by heart muscle convulsions, as this can lead to death. If the muscles of the intestines and stomach cramp, there is non-stop vomiting, and sometimes diarrhea and constipation. In addition, convulsive seizures are possible in pregnant women. In exceptional cases, convulsions cover the entire body, with women losing consciousness and biting their tongues.

Diagnostic data indicate low blood levels of calcium and high concentrations of inorganic phosphorus. The calcium content in urine is also reduced.

If tetany occurs in women during pregnancy, it is necessary to interrupt it both in the early and late stages. To eliminate tetany, parathyroidin, calcium preparations, and vitamin D are prescribed. Calcium-containing preparations not only eliminate attacks of tetany, but also prevent their occurrence in the future. But you need to know that the use of calcium hyperphosphate and other phosphorus-based compounds is prohibited in this case, since an increase in the level of phosphorus in the blood slows down the release of calcium into the blood. A special diet and water procedures are recommended in this case as additional measures.

Tetany uterus

Uterine tetany is a deviation of labor, accompanied by constant tonic tension of this organ. As a result, the parts of the uterus do not contract simultaneously, which causes labor to slow down and stop.

The causes of this anomaly may be endocrine system disorders; nervous stress; overdistension of the uterus due to multiple pregnancy, polyhydramnios or a large fetus; pathological changes in this organ caused by inflammatory processes, uterine malformations, uterine fibroids; obstacles that interfere with the dilation of the cervix and the movement of the fetus (narrow pelvis, neoplasms of the pelvic organs, cicatricial changes in the cervix); incorrect use of drugs that affect the tone of the uterus. In addition, the reasons for the development of tetany include a certain age of pregnant women: before 17 and after 30 years.

During diagnosis, the doctor focuses on the patient’s complaints, medical history, performs palpation, examination of the vagina, cardiotocography, and listens to the fetal heartbeat.

To treat uterine tetany, doctors use anesthesia to help restore labor. If the birth of a child naturally is not possible, a caesarean section is performed. If the cervix is completely dilated, the fetus is removed using obstetric forceps or by the stem.

Parathyroid tetany

Parathyroid tetany is a fairly rare but very serious complication that occurs after strumectomy (removal of the thyroid gland in full or in part). It is associated with a sharp decrease in the concentration of calcium in the blood and an increase in the concentration of potassium ions and inorganic phosphorus.

During an acute attack, convulsions of the upper and lower extremities are most often observed, and less often - of the muscles of the face and torso. One of the first symptoms of parathyroid tetany is hypocalcemia.

With the development of parathyroid tetany after strumectomy, it is recommended to administer 10–20 ml of a 10% calcium chloride solution intravenously, 2–3 times a day in the case of an acute course of the disease; in a subacute course, the number of injections is reduced. In addition, 5–10% solutions of calcium chloride (in the form of a mixture) are prescribed 3 times a day, one tablespoon.

Hypocalcemic tetany

A decrease in the production of parathyroid hormone leads to a decrease in the production of phosphorus by the kidneys, which is why its concentration in the blood increases. Less and less phosphorus is used from bones, which means less calcium is also released, and the body no longer has enough of it.

Gastrogenic tetany

This type of tetany is a serious complication of peptic ulcer disease. Since practicing doctors do not often encounter this disease, it is often diagnosed very late, and therefore the outcome of treatment is not always positive.

Natekal D3 in the treatment of latent tetany associated with psychovegetative syndrome.

MMA im. THEM. Sechenov, Department of Nervous Diseases, Faculty of Physical Education, Central Clinical Military Hospital of the Federal Security Service of the Russian Federation
prof. Vorobyova O.V., Popova E.V., Ph.D. Kuzmenko V.A.

Hyperventilation disorders are extremely common in the clinical structure of autonomic dysfunction that accompanies various neurotic or stress-dependent disorders. The importance of diagnosis and treatment of hyperventilation syndrome (HVS) is primarily determined by its direct participation in the pathogenesis and symptom formation of many clinical manifestations of psychovegetative syndrome. The symptom-forming factor of HVS is realized through the mechanisms of hypocapnia and related processes, including those leading to tetany. In classical descriptions of hyperventilation syndrome (1), a triad of signs has always been distinguished:

increased breathing,

paresthesia,

tetany.

The presence of tetanic symptoms in the structure of the HVS is considered a highly pathognomonic diagnostic sign (2). Symptoms of neurogenic tetany tend to persist and are difficult to treat with psychotropic drugs. Even after successful treatment of psychovegetative syndrome, many patients retain symptoms of tetany, which makes remission incomplete. Probably, tetanic symptoms of unknown origin for the patient and hypochondriacal fixation on them, forming a “vicious circle”, aggravate anxiety, chronicizing the neurotic disease. Therefore, the treatment of latent tetany is as urgent a task as the actual therapeutic effect on the HVS.

Vivid tetanic manifestations within the framework of HVS, such as carpopedal spasms, occur infrequently, in approximately 1-5% of cases. But this is just the tip of the iceberg, which far from exhausts all manifestations of tetany within the framework of hot water supply. Hidden or latent tetany is the main underwater part of the iceberg.

Clinical manifestations latent tetany are presented in Table 1.

Table 1. Clinical and paraclinical manifestations of neurogenic tetany.

Paresthesia
Painful muscle tension
Convulsive muscle-tonic phenomena
Clinical correlates of neuromuscular excitability (positive Chvostek’s sign, Trousseau-Bonsdorff test)
EMG correlates of neuromuscular excitability

There are many symptoms and clinical signs of latent tetany, but no specific symptoms, so the diagnosis is often difficult (3). Diagnosis should be based on a combination of symptoms. The most common manifestations of hidden tetany are paresthesia. Sensory disturbances (numbness, tingling, a feeling of “crawling”, buzzing, burning) and pain are characterized by spontaneity of occurrence and short duration, predominant involvement of the hands, and a centropetal type of distribution. Most often, sensory disorders are symmetrical. As a rule, paresthesia precedes the appearance of muscle spasms.

Muscle cramps that follow paresthesia involve the muscles of the hands (“obstetrician’s hand”) and feet (carpopedal spasms), starting in most cases from the upper extremities. But more often, patients complain of painful sensations in individual muscles (for example, cramps), which are provoked by physical activity, thermal effects (cold water) or occur during voluntary extension of a limb.

Neuromuscular excitability (NME) is tested clinically and electromyographically. The most informative clinical tests are Chvostek's symptom (percussion with a neurological hammer of the buccal muscle in the area of passage of the facial nerve) and Trousseau's test (ischemic cuff test). Trousseau's test is less sensitive than Chvostek's sign, but its sensitivity increases when a hyperventilation load is performed at 10 minutes of ischemia (Bonsdorff test). The electromyogram (EMG) demonstrates spontaneous autorhythmic activity containing doublets, triplets, and multiplets that occur within short time intervals during provocative tests (Trousseau test, hyperventilation load).

Hyperventilation tetany is considered normocalcemic, although approximately one third of patients have hypocalcemia (4). Voluntary hyperventilation can lead to significant changes in ionized calcium levels in healthy individuals. At the same time, studies using radioisotope methods made it possible to establish the existence of deep anomalies in calcium metabolism, mainly associated with a decrease in the “total calcium pool” in patients with tetany.

Pathogenetically calcium imbalance and hyperventilatory tetany proper are associated with respiratory alkalosis. Hypocapnia and associated respiratory alkalosis are an obligate biochemical phenomenon in HVS. Both alkalosis itself and the large range of biochemical changes associated with it, including calcium metabolism disorders, naturally increase neuromuscular excitability. Theoretically, it is quite tempting to assume that long-term changes in biochemical processes caused by chronic HVS can ultimately lead to an increase in the level of NMV. However, NMV is not an obligate symptom of HVS and is absent in 15-20% of patients with chronic HVS. Probably, for the development of NMV, a constellation of factors is required: “constitutional predisposition” (possibly in the form of features of calcium metabolism) and alkalosis itself caused by HVS. Long-term successful use of calcium supplements for hyperventilation tetany indirectly confirms the pathogenetic participation of calcium metabolism in the genesis of normocalcemic tetany. However, the use of drugs that regulate calcium metabolism in latent tetany is based largely on the clinical experience of doctors. Research studies on the effectiveness of calcium supplements in the treatment of hyperventilation tetany are relatively few.

We conducted an open “pilot” study of the effectiveness of high doses of vitamin-calcium therapy in the treatment of hyperventilation tetany.

Purpose This open comparative study assessed the effectiveness of Natekal D3 in the treatment of latent tetany associated with hyperventilation syndrome. The choice of Natekal D3 was due to the high content of ionized calcium in this drug. One tablet of Natekal D3 contains 400 IU of colecalciferol and 1.5 g of calcium carbonate, which corresponds to the content of 600 mg of ionized calcium. In this study, the following tasks were solved: assessment of the therapeutic effect of the therapy in relation to tetany itself and accompanying syndromes; study of adverse reactions and complications.

To the study turned on patients meeting the following criteria:

The leading complaint is dyspnea, paresthesia and/or muscle spasms of the limbs
positive Chvostek's sign (grades I-III) and Trousseau-Bonsdorff test
presence of an anxiety disorder meeting the ICD-10 criteria for panic disorder or generalized anxiety disorder
patient age over 20 years
absence of current somatic diseases
absence of comorbidity of anxiety disorder with psychotic disorders
patient consent to participate in the study.

Treatment was prescribed after discontinuation of previous therapy for at least 2 weeks. Natecal D3 was prescribed 1 chewable tablet twice a day. The duration of treatment was 4 weeks.

Before prescribing the drug, each patient was subjected to a standard clinical and neurological examination with clinical tests for latent tetany, the degree of autonomic dysfunction and hyperventilation was assessed using questionnaires developed in the Department of Pathology of the Autonomic Nervous System of the MMA (5), mental status was assessed using the Spielberger and Beck Anxiety Questionnaire for depression. The impact of tetanic symptoms on quality of life was also assessed.

After 4 weeks of therapy with Natecal D3, the therapeutic effect was assessed primarily on the severity of tetany, as well as in relation to concomitant syndromes. Tolerability of treatment was determined based on clinical examination, and patient self-reports were also used (the number of serious adverse events, non-serious adverse events was assessed).

The study group consisted of 12 patients (3 men; 9 women) aged 38±4.5 years; all women included in the study were of reproductive age. The majority of patients (70%) were diagnosed with panic disorder; a feature of the panic attacks of these patients were respiratory and tetanic manifestations, which made it possible to discuss hyperventilatory crises. 30% of patients had generalized anxiety disorder or anxiety-depressive disorder.

First of all, we assessed the effect of Natekal D3 on the so-called “tetanic” symptoms: the severity of paresthesia, pain, painful muscle spasms (subscales of the autonomic dystonia questionnaire) (Fig. 1).

Rice. 1 Dynamics of “tetanic symptoms”

After a month of treatment, a significant (p) Clinical correlates of latent tetany (LMT) also underwent a certain regression (Fig. 2). The number of patients with a positive Trousseau-Bonsdorff test (χ2 = 2.9) decreased significantly.

Rice. 2 Trousseau-Bonsdorff test

Some positive trend (p Fig. 3 Dynamics of the intensity of hyperventilation and the total score of vegetative dystonia.

Indicators of the current mental state also improved: the level of anxiety decreased from 37.6±1.3 to 32.2±1.1 (pTolerability of Natekal D3 in the study sample was very good. We did not observe any side effects of the therapy. All patients completed the course of treatment.

The results obtained convincingly demonstrate that the symptoms of latent tetany are partially regressed under the influence of vitamin-calcium therapy. This to a certain extent confirms the complexity of the formation of latent tetany, where calcium metabolism disorders are an important, but not the only mechanism. The insignificant dynamics of the severity of HVS in treated patients indicates the relative independence of HVS and latent tetany and the need for additional influence on HVS. On the other hand, it becomes clear that only influencing hyperventilation without therapeutic consideration of the symptoms of tetany cannot provide complete remission.

The observed improvement in the current mental state in the studied category of patients may be associated with regression of tetanic symptoms, with a placebo effect, or with the actual effect of calcium on the central nervous system. The role of calcium in the central nervous system is multifaceted; for a long time this element was considered as an important component of vegetative-humoral regulation, as “liquid sympatheticus”.

The study showed the usefulness of using drugs that affect calcium metabolism in latent tetany. Of course, vitamin-calcium therapy cannot be considered as the main method of treating HVS. But even partial regression of tetanic symptoms allows one to break the vicious circle of HVS-tetany-HVS.

Natecal D3 can be recommended as an important element in the complex treatment of HVS with latent tetany along with psychotropic therapy and correction of respiratory disorders. Diagnosis and treatment of latent tetany will improve the prognosis of a neurotic disease.

LITERATURE
1. Vein A.M., Moldovanu I.V. Neurogenic hyperventilation. Chisinau "Shtiinta" 1988
2. Moldovanu I.V., Yakhno N.N. Neurogenic tetany. Chisinau “Shtiinta” 1985
3. Torunska K. Tetany as a difficult diagnostic problem in the neurological outpatient department. // Neurol Neurochir Pol. 2003;37(3):653-64
4. Durlach J, Bac P, Durlach V et al. Neurotic, neuromuscular and autonomic nervous form of magnesium imbalance. // Magnes Res 1997;10(2):169-95
5. Autonomic disorders (clinic, diagnosis, treatment) Edited by A.M. Vein MIA Moscow 1998

Etiology and pathogenesis. Tetany can occur with gastrointestinal diseases (pyloric stenosis, pancreatitis, colitis, dysentery); for acute infectious diseases (for example, tetanus) and intoxication; for some endocrine disorders (hypoparathyroidism, Addison's disease, etc.); from sudden hyperventilation (for example, during hysteria or encephalitis); after major operations; in women during pregnancy and lactation; in children suffering from rickets, etc. There are cases of idiopathic tetany.

The pathogenesis of tetany is based on an increase in neuromuscular excitability, resulting from a violation of the acid-base balance and a decrease in the content of ionized calcium in the blood. In gastrointestinal diseases, these disorders are associated with the loss of large amounts of chlorides and hydrogen ions (as a result of loss of fluid through vomiting and diarrhea), causing increased binding of CO 2, and increased breakdown of proteins, leading to the accumulation of nitrogenous wastes and excessive entry of phosphorus into the blood , the increased content of which promotes the removal of ionized calcium from the body. Tetany during hyperventilation occurs against the background of alkalosis and hypocapnia, leading to a drop in the content of ionized calcium. Tetany in pregnancy occurs due to increased calcium intake by the fetus; for endocrine disorders - as a result of disorders of salt metabolism and acid-base balance, Parathyroid tetany often occurs during operations on the thyroid gland with complete or partial removal of the parathyroid glands, as well as due to various injuries and chronic infections (tuberculosis, syphilis) as a result of decreased hormone levels parathyroid glands. A lack of parathyroid hormone leads to hypocalcemia in two ways: primarily due to difficulty mobilizing calcium from the depot and secondarily due to the accumulation of inorganic phosphorus in the blood.

Clinical picture (signs and symptoms). Tetany occurs as latent and pronounced convulsive seizures. The hidden (latent) form of tetany manifests itself only in the form of paresthesia, spasms and coldness of the extremities; sometimes it is not detected for a long time, or under the influence of any provoking factors (anesthesia, infections, pregnancy, etc.) more or less obvious seizures occur.

Severe tetanic seizures occur spontaneously and are manifested by tonic muscle spasms, involving mainly the flexor muscles of the limbs, as well as the muscles of the face, trunk, spine, and less often - the larynx and stomach. Cramps often symmetrically affect both upper limbs, although sometimes they occur only on one side. The hand usually assumes the so-called obstetrician's hand position, sometimes clenched into a fist with the thumb extended. Much less often, cramps also affect the legs, while the leg is usually extended, the foot is bent inward, and with cramps of the adductors, the legs are closely pressed to one another. Facial muscle spasms are accompanied by trismus, the lips take on a typical trunk-like shape. Sometimes speech becomes difficult due to spasms of the tongue muscles. Cramps of the neck and back muscles are accompanied by arching of the spine. Involvement of the bronchial and intercostal muscles, as well as the diaphragm, in a convulsive state can lead to respiratory distress. Convulsions of the heart muscle lead to an angina attack, which can result in death from cardiac arrest in systole. Spasms of the muscles of the stomach and intestines cause vomiting, diarrhea and constipation; with bladder spasms, urination becomes difficult. As a result of a violation of convergence or temporary strabismus, double vision occurs. Muscle spasms are sharply painful. Their duration is extremely varied: from several minutes to several hours. Seizure attacks are sometimes rare, sometimes repeated at short intervals. After the attacks end, weakness and even paresis are observed.

Trousseau phenomenon - the appearance during tetany of a tonic spasm of the fingers (the so-called “obstetrician’s hand”) under the influence of compression of the shoulder with a tourniquet for several minutes until the blood circulation completely stops. Appears due to a decrease in neuromuscular tone.

The autonomic nervous system is overexcited during tetany. Often there is the appearance of a “dead finger” and a sharp pallor of the limb when causing Trousseau’s symptom (typical tonic convulsions in the hand when pressing on the nerve in the sulcus bicipitalis area). Patients react sharply to the introduction of vegetotropic substances. For example, the administration of adrenaline promotes the resumption of a subsided convulsive attack, the administration of pilocarpine in the acute stage of tetany causes sudden sweating and salivation, lacrimation, redness of the skin, cardiac disorders, vomiting, diarrhea, and a significant increase in urination.

Disorders of cardiac activity during an attack of tetany are expressed in increased tones, and sometimes noise appears. Very common phenomena with tetany are pallor caused by spasm of peripheral vessels and angiospastic edema.

Violations of thermoregulation during tetany are expressed both in increased excitability when the external temperature changes, and in fluctuations in body temperature during convulsive seizures. Trophic disorders are observed: hair becomes thin, falls out, splits; nails are brittle, streaked; teeth break, crumble, and enamel defects appear. Cataracts often develop in young patients.

During attacks of tetany, leukocytosis appears, the fraction of calcium associated with protein in the blood decreases or is completely absent, while the amount of total calcium is preserved, the amount of potassium and phosphorus is increased. With tetany, alkalosis is observed, and the nitrogen content in the blood and urine increases.