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Tonic attacks 

Tonic attacks
Chapter:
Tonic attacks
Author(s):

Ivan Donaldson

, C. David Marsden

, Susanne A. Schneider

, and Kailash P. Bhatia

DOI:
10.1093/med/9780192619112.003.1171
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date: 29 May 2020

Tonic attacks are episodic movement disorders characterized by continuous spasm of a muscle or group of muscles resulting in rigidity of the affected part. Movement, if it occurs, is limited to the start of spasm and once the attack is established the affected part remains stationary. To some extent such movements overlap with dystonic posturing, but a sinuous athetotic component, which is the distal counterpart of dystonia, is not present. The distinction between tonic and dystonic attacks is perhaps somewhat artificial. Chapters 49 and 50 should be considered together. Focal epileptic attacks, however, may produce localized or generalized abnormalities of movement, without loss of consciousness. These can be classified according to the brain region involved in the attack. Thus, frontal, temporal, parietal, and occipital lobe seizures have all been recorded as having tonic motor components. About 10 % of patients with multiple sclerosis have tonic spasms, brain stem, spinal cord and peripheral nerve lesions can also cause tonic spasms. The causes and neurological features of hypocalcaemia and hypomagnesaemia are discussed in Chapter 24. Episodic movement disorders include tetany, clonic jerks, and seizures, which are discussed in this chapter. Tonic spasms caused by tetanus can be treated in a variety of ways, with the most severe cases require the use of muscle relaxants, artificial respiration, and full intensive care in addition to sedation. Sympathetic over-activity must be watched for and is usually treated with beta-blockers, and morphine may be helpful for this in certain situations (Buchanan et al. 1974). Tonic attacks caused by Sandifer’s syndrome (torticollis with hiatus hernia) and benign paroxysmal infantile torticollis are also described.

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