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Spasmophilia: a mild form of tetany? Causes, Symptoms and Treatment

To this day, we still have to use several definitions to try to understand what spasmophilia is. This term is very controversial because it is not a recognized disease in medical classifications, neither in France nor internationally. The researchers did not agree; it is possible that the vicious circle of symptomsis what makes it difficult to identify.

It most often presents three symptoms: fatigueneurodystonia and anxiety.

The hyperexcitability neuromuscular is marked with two signs present in spasmophily: sign Chvostek (involuntary muscular contraction of the upper lip in response to percussion by the reflex hammer doctor) and the trousseau sign (contracture of the hand the obstetrician).

The electromyogram shows a repetitive electrical hyperactivity of the peripheral nerves , characteristic of neuromuscular excitability, not to be confused with discomforts due to hypoglycemia , with symptoms related to orthostatic hypotension, with nervous breakdown, or with seizures of paroxysmal anxiety . Low levels of intracellular magnesium are often found with normal calcium and phosphorus levels.

The characteristics of this imbalance are hypersensitivityenvironmental dependence, vulnerability to stress and physiological and psychological instability.

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Spasmophilia or tetanus crisis?

The term “spasmophilia” is widely used by the general public to describe anxiety attacks combining breathing difficulties (feeling of oppression, choking, and hyperventilation) and muscle tétanie. Symptoms of spasmophilia, tetany or psychogenic hyperventilation may in some cases be similar to those present in panic attacks .

The concept of spasmophilia still remains rather vague today. There is little scientific literature relating to this,and unfortunately there are very few epidemiological studies on spasmophilia because, like similar syndromes, the reality of this disease is still in doubt. Is considered psychiatric illness). According to the classifications in force (the famous ” DSM4 “, American classification of mental diseases), spasmophilia is a form of pathological anxiety. She is currently in the category of “panic disorder “. Yet, far from being a recent concept, research on spasmophilia already existed at the end.

Note: Breathing difficulties or tetany problems are not always synonymous with an anxiety attack. Many diseases can cause this type of symptoms (eg asthma ), and it is important to consult your doctor in all cases to get the correct diagnosis.

Who is affected?

Anxiety attacks occur most often in young people (between the ages of 15 and 45) and are much more common in women than in men. They would be more common in developed countries.

Causes of Spasmophilia

The mechanisms of spasmophilia are likely to interact with many biologicalpsychologicalgenetic and cardiorespiratory factors.

According to some theories, it would be an inappropriate or excessive reaction to stress, anxiety or anguish triggering hyperventilation (acceleration of the respiratory rate) which itself would amplify the hyperventilation reaction until the crisis of muscular tetany. Thus, different situations of fear and anguish (including that of no longer being able to breathe) can trigger hyperventilation, which can itself cause certain symptoms, and in particular dizziness, limb numbness, tremors and palpitations.

In turn, these symptoms aggravate fear and anxiety. It is therefore a vicious circle that is self-sustaining.

This reaction mode is probably very magnesium consuming and could predispose to chronic deficiency of intracellular magnesium. In addition, our diet increasingly low in magnesium (because of refining and cooking) could aggravate this deficit.

Genetic fragility associated with newly identified tissue groups (HLA-B35) predisposes 18% of the population in industrialized countries to developing spasmophilia.

For specialist doctors working on the site www.sommeil-mg.net (general medicine and sleep), a deficiency of the effectiveness of sleep would be at the origin of Spasmophilia:

  1. Sleep is judged upon awakening, and it seems obvious that spasmophile subjects no longer play its role, since it is from awakening that fatigue is most intense;
  2. The increase in nocturnal diuresis that is often present (one gets up several times in the night to urinate) is the consequence of the collapse of an “antidiuretic” system;
  3. The neurodystonieis another consequence of the ineffectiveness of sleep;
  4. The voluntarism of the patients(this resilient nature allows them to fight for themselves for a long time against their disease): “it’s true, I’m tired, but I’m good” … until the crisis. Evidenced by the unconditional refusal of any sick leave as soon as the crisis is over. These personalities are often altruistic and hyperactive. For us, the crisis is the first sign of decompensation of sleep in a field of functional sleep insufficiency. The aggravation of the fatigue risks leading to more severe and more disabling tables which will express themselves in a hyperalgic mode like in the fibromyalgia or in an asthenic mode as in the chronic fatigue syndromes (SFC). In practice, the crisis stops when a sedative is powerful enough to “turn off the sound of the alarm”, which allows to say that the remarkable effectiveness of benzodiazepines (a family of anxiolytics) in this situation (single dose but sufficient) confirms the neurodystonic character of the discomfort and should guide towards chronobiological care. In our opinion, each crisis has the value of a decompensated “hyposommeil” signal, hence the importance of this care.

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Evolution and possible complications

Spasmophilic reactions are often associated with a significant decline in the quality of life and can lead to very disabling disorders such as fear of going out , being in the presence of strangers or participating in various social or professional activities (secondary agoraphobia). In some people, the frequency of seizures is very high (several per day), so called panic disorders. The risk of depression to suicidal thoughts, passage to the suicidal act of abuse of drugs or alcohol is increased in case of frequent panic attacks.

However, with proper care, it is possible to control this anxiety and reduce the frequency of seizures.

The symptoms of spasmophilia

They are close to the symptoms of magnesium deficiency. The main symptoms of spasmophilia, as traditionally described, are:

  • an acceleration of the respiratory rhythm associated with a sensation of suffocation, oppression, difficulty in finding air;
  • a feeling of muscular tétanie , mainly in the upper limbs (inability to move, tingling, tingling);
  • physical or mental fatigue without apparent cause with feeling “legs cut” of “empty head” and the occurrence of “strokes”;
  • a feeling of malaise , palpitations , chest or abdominal pain without organic reason, pharyngeal narrowing, “ball up and down” in the throat, impression of “walking in cotton”, various digestive disorders .

All these symptoms can change with disconcerting rapidity, their appearances and disappearances being unpredictable and inexplicable.

Questionnaire: Have you, during your life, suffered from these symptoms?

Answer YES or NO   

1. Contractions and spasms

Cramps and tingling?

Spasms in the throat (balls in the throat)?

Gastric spasms (cramps, aerophagia)?

Intestinal spasms (colitis, bloating)?

Spasms of the uterus (premenstrual pain)?

Clenching of the jaws?

Phosphenes or tinnitus?

Muscle and joint pains?

 2. Various troubles     

Paradoxical asthenia (morning fatigue greater than that of the evening)?

Tachycardia, extrasystoles, cardiac erritisms?

Respiratory oppression?

Problems with sleep and especially with falling asleep?

Great dependence on the environment?

Total

Spasmophilic terrain is determined by a score greater than or equal to 4 out of 8 positive responses in the first part and 3 out of 5 positive responses in the second part.

Somatic disorders

These disorders vary from one person to another and from one crisis to another. They are sometimes spectacular for the person who suffers and for the people who witness the crisis. It is important to distinguish these disorders from a somatic condition (asthma, heart problems, etc …). These disorders can be cardiovascular, muscular, sensory, urinary and respiratory.

  • heart palpitations;
  • increased heart rate (tachycardia)
  • pains in the chest;
  • respiratory problems with need of air and desire to open the windows;
  • tremors, jerks, muscular and digestive spasms;
  • involuntary contractions in the muscles of the eyelids, face or limbs;
  • discomfort, dizziness, vertigo;
  • itches ;
  • blurred vision
  • whistling or buzzing in the ears (tinnitus)
  • pains in the lower abdomen;
  • nausea ;
  • sweats, chills;
  • a frequent urge to urinate;
  • cervical, dorsal, lumbar pain;
  • tingling and impatience in the legs;
  • physical fatigue;
  • tetanus attacks;
  • Migraines.

Psyche disorders

  • an impression of imminent danger accompanied by frightening thoughts (fear of fainting, choking, feeling sick);
  • an irrational fear of losing control, of going mad;
  • a feeling of anxiety
  • character disorders;
  • sleep disorders;
  • intellectual and sexual fatigue

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Psychosensory disorders

When the anxiety is very intense, it is possible to observe:

  • feeling of depersonalization in which the person may have difficulty feeling his or her body limits or having a sensation of bodily splitting;
  • feeling of derealization. The person has a vision of reality that becomes blurred.

Behavioral disorders

Behavioral symptoms can take the following forms:

  • An inhibition or on the contrary a great behavioral agitation. The person may want to flee to a safe place or on the contrary to curl up on himself and become mute;
  • The aggressiveness can be directed to the other or to the person himself up a passage to the suicidal act.

In some cases, the following symptoms occur at the same time:

  • diarrhea;
  • Of intense headaches.

The symptoms then gradually fade, giving way to fatigue.

The beginning of the crisis is often preceded by a period when the degree of anxiety increases gradually. The frequency of panic attacks varies from one or two only in all life to several per day.

People at risk for Spasmophilia

The most affected people are:

  • the women (they are 1.5 to 2 times more affected than men);
  • the young (between 15 and 20 years);
  • people with a family history of panic disorder ;
  • People with a history of sexual abuse or abuse.

Risk factors

Several factors can trigger panic attacks or spasmophilia. These vary enormously from person to person, and in many cases there is no clearly identified trigger, although several studies have shown the influence of traumatic events experienced in childhood, especially in connection with separation anxiety (fear of separating from parents).

Among the factors frequently found:

  • a context of relationship difficulties (divorce, conflict, abuse …);
  • bereavement or illness
  • the consumption of alcohol, cannabis or drugs;
  • Certain anxiety-provoking situations, such as public transportation, the airplane, the crowd, etc.;
  • Taking or stopping certain drugs, especially certain antidepressants.

All symptoms are greatly amplified by additional problems: dental, parasitic diseases, viral infections, etc…. The crisis and the “fear of the crisis” correspond to the threshold that, once crossed, makes life impossible. Listening to the patient and the ability to reassure him are important.

Prevention of spasmophilia

Can we prevent?
There is no really effective way to prevent anxiety attacks, especially as they usually happen in an unpredictable way.

However, appropriate management, both pharmacological and non-pharmacological, can help to learn how to manage stress and prevent seizures from becoming too frequent or too disabling. It is therefore important to consult a doctor quickly to stop the vicious circle as soon as possible. 

Basic preventive measures
To reduce the risk of anxiety attacks, the following measures, which are mainly common sense, are very useful:

– To follow his treatment well, and not to interrupt the drugs without medical advice;

– Avoid consuming exciting substances, alcohol or drugs that can trigger seizures;

– Learn how to manage stress to limit triggers or interrupt the crisis when it starts (relaxation, yoga, sports, meditation techniques …);

– Adopt a healthy lifestyle: good nutrition, regular physical activity, restful sleep …;

– Find support from therapists (psychiatrist, psychologist), and associations of people with the same anxiety disorders, to feel less alone and to benefit from relevant advice.

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Medical treatments for spasmophilia

It can be difficult to overcome anxiety attacks, but there are effective treatments and therapies. Sometimes you have to try several or combine them, but the vast majority of people are able to reduce or eliminate their seizures in a few weeks or months thanks to these measures.

Therapies

The effectiveness of psychotherapy for treating anxiety disorders is well established. It is even the preferred treatment in many cases, before having to resort to drugs.

To treat anxiety attacks, the therapy of choice is Cognitive and Behavioral Therapy, or CBT. In practice, CBT is usually performed on 10 to 25 sessions spaced a week, individually or in groups.

The therapy sessions are intended to inform the state of panic and gradually change the “false beliefs”, misinterpretations and negative behaviors associated with them, to replace them with more knowledge. Rational and realistic.

Several techniques can teach you how to stop seizures, and calm down when you feel anxiety rising. Simple exercises must be done from one week to the next in order to progress. It should be noted that CBT is useful for reducing symptoms but its purpose is not to define the origin or cause of the emergence of these panic attacks. It may be interesting to associate another type of psychotherapeutic treatment (analytic therapy, systemic therapy, etc.) to prevent the symptoms from moving to reappear in other forms.

Pharmaceuticals

Among the pharmacological treatments, several classes of drugs have been proven to reduce the frequency of acute anxiety attacks.

Antidepressants are the first choice, followed by benzodiazepines (Xanax), which, however, have a higher risk of dependence and side effects. The latter are therefore reserved for the treatment of the crisis, when it is prolonged and a treatment is necessary.

In France, the two types of antidepressants recommended to treat panic disorders in the long term are:

  • selective serotonin reuptake inhibitors (SSRIs) whose principle is to increase the amount of serotonin in the synapses (junction between two neurons) by preventing the recapture of the latter. Paroxetine (Deroxat / Paxil), escitalopram (Seroplex / Lexapro) and citalopram (Seropram / Celexa) are particularly recommended;
  • Tricyclic antidepressants such as clomipramine (Anafranil).

In some cases, venlafaxine (Effexor) may also be prescribed.

Antidepressant treatment is first prescribed for 12 weeks, and then an assessment is made to decide whether to continue treatment or change it.

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