Spasmophilia in adults

The tendency, that is, predisposition to the occurrence of tonic muscle spasms - their involuntary convulsive contractions - is defined in medicine as spasmophilia or latent tetania (tetanus in Greek - tension, convulsion).

According to ICD-10, tetany (spasmophilia) is a symptom related to the nervous and musculoskeletal systems (code R29.0). It is believed that most often observed spasmophilia in children, but the manifestation of peripheral dysfunction at the neuromuscular level is quite common in adults, as it can occur at any age. [1]

Epidemiology

According to statistics, spasmophilia in adults with hypoparathyroidism is noted in almost 90% of cases, and the presence of recurrent seizures is observed in half of patients.

The incidence of spasmophilia in patients presenting for cardiac pain is estimated to be 20% and 100% in patients with normal ECG values.

Causes of the spasmophilia in adults

The main causes of spasmophilia in adults - increased excitability of the neuromuscular system, resulting from a violation of mineral and water-salt metabolism in the body.

And neuromuscular excitability can increase with intra- or extracellular imbalances of calcium and magnesium, as well as phosphorus.

First of all, in adults, spasmophilia is etiologically associated with low blood calcium levels - hypocalcemia, [2] which may be a consequence of functional insufficiency of the parathyroid glands and a history of hypoparathyroidism, [3] cholecalciferol (vitamin D) deficiency and functional kidney failure.

Thus, during gestation due to nephropathy of pregnancy there is increased excretion of calcium by the kidneys (leading to calcium deficiency), which in late terms leads to eclampsia - with frequent seizures. Read also - Causes of decreased calcium in the blood.

Provokes muscle cramps magnesium deficiency - hypomagnesemia, [4] which can be caused by its insufficient intake, increased excretion, diabetes mellitus, chronic alcoholism, pre-eclampsia and eclampsia in pregnancy. By the way, in case of hypomagnesemia there is a decrease in the synthesis of paratgormone (hormone of parathyroid glands).

But the link between the tendency to involuntary muscle contraction and phosphorus levels is an increased level of phosphorus - hyperphosphatemia, [5] among the causes of which the same hypoparathyroidism and chronic renal failure are noted. For more information see. - How does phosphorus affect human health?

In addition, tetany in adults is one of the symptoms:

• Metabolic alkalosis and Gitelman syndrome with magnesium and potassium deficiency - hypokalemia;
• caused by pulmonary hyperventilation (increased respiratory rate) respiratory alkalosis;
• Hypokalemic alkalosis in Conn's syndrome - primary hyperaldosteronism;
• of malignant renovascular (renal) hypertension syndrome;
• the bleeding-induced decrease in circulating blood volume - hypovolemia;
• Long-term use of diuretics (diuretics) or systemic glucocorticoids.

Risk factors

In addition to the already mentioned conditions and pathologies, experts associate risk factors for neuromuscular hyperexcitability with acute inflammation of the pancreas (pancreatitis); renal failure in chronic nephrological diseases and decay of malignant neoplasms (of any localization); removal or extensive alteration of parathyroid glands (with subsequent deficiency of parathyroid hormone, which directly affects the level of calcium in the blood); hyperventilation syndrome; genetic predisposition to metabolic disorders; poor diet, alcohol dependence.

Pathogenesis

In hypocalcemia, the pathogenesis of increased excitability of the neuromuscular system and spasmophilia is due to the fact that at low levels of ionized calcium in the extracellular fluid, the permeability of the plasma membrane of nerve cells of the peripheral nervous system for sodium ions increases.

When plasma calcium levels are significantly below normal (9.4 mg/dL), there is a progressive depolarization of the cell membrane of axons, which provokes the occurrence of spontaneous action potentials and transmission of nerve impulses to muscle cells (myofibrils), which lead to contraction of peripheral skeletal muscles.

In cases of reduced levels of magnesium, which regulates the transmission of nerve signals of the autonomic nervous system, the mechanism of tetany lies in the violation of relaxation of spasmed muscles, because magnesium is responsible for the reduction of muscle tone: it provides normal interaction of sympathetic and parasympathetic sections of the ANS and the return of muscle fibers in the initial state.

Symptoms of the spasmophilia in adults

According to clinical manifestations, such forms or types of spasmophilia as latent (latent or asymptomatic) and manifest (manifest) are distinguished.

Since hyperexcitability of the neuromuscular system is of a functional nature, the first signs of this condition manifest themselves in the form of convulsive attacks.

There are also clinical symptoms of the manifest form of spasmophilia such as:

• painful muscle spasms and tonic spasms;
• spasm and hypertonus of the muscles of the hands and feet - carpopedal spasm;
• numbness (paresthesia) of the extremities;
• fasciculations (twitching) of facial mimic muscles innervated by the facial (seventh cranial) nerve, when tapping in front of the ear - Chvostek's symptom;
• spasms of the laryngeal muscles and stenosis of the vocal cleft - laryngospasm - making speech and breathing difficult;
• increased sweat production;
• tightness in the chest, tachycardia and chest pains reminiscent of coronary heart disease.

Complications and consequences

Spasm of the laryngeal muscles causes not only spasmodic dysphonia but also breathing difficulties, with patients becoming unconscious, requiring emergency medical attention to avoid asphyxia.

Respiratory distress - due to spasms of the thoracic respiratory muscles and bronchial smooth muscle - also occurs in cases of parathyroid tetany in acute hypoparathyroidism (hypocalcemic crisis).

With overt spasmophilia, generalized muscle cramps, abdominal spasms, and deadly myocardial convulsions may occur.

Diagnostics of the spasmophilia in adults

Diagnosis of this condition is aimed at finding out the etiology of hyperexcitability of the neuromuscular system.

Laboratory tests are necessary: blood tests for the level of ionized calcium, serum levels of magnesium, phosphorus and potassium; alkaline phosphatase; blood levels of parathormone, calcitonin and adrenal cortex hormone aldosterone; determination of the acid-base state of the blood; urinalysis for pH and calcium and phosphate levels.

Instrumental diagnosis is performed using electromyography (EMG), electrocardiography (ECG), electroencephalography (EEG).

Differential diagnosis

Differential diagnosis should exclude epilepsy, seizure syndrome, hyperkinesias of cortical and trunk origin, extrapyramidal movement disorders and myoclonias, myotonia with peripheral nerve damage, and amyotrophic lateral sclerosis.

Treatment of the spasmophilia in adults

Drug therapy of hypocalcemia-induced manifest tetany in adults consists of calcium preparations: Calcium gluconate, Calcium chloride, Calcium citrate.

They are taken along with vitamin D (for better calcium absorption).

Continuous treatment with calcium preparations may be required in renal failure.

In cases of hypomagnesemia take Magne B6, Magvit B6, Magnefar B6 containing magnesium asparaginate and potassium Panangin and others.

Anticonvulsant medications containing diazepam, such as Relanium; anticonvulsant Carbamazepine, and myorelaxants of other pharmacologic groups are prescribed.

Read more:

• Treatment of hypoparathyroidism
• Treatment of laryngospasm

Prevention

Prevention of spasmophilia in adults depends on accurately identifying the cause of neuro-reflex hyperexcitability, so in most cases this condition is difficult to prevent.

Read - How to increase calcium in the blood?

Forecast

In general, spasmophilia in adults - if treated in a timely manner - has a favorable prognosis.