Spasmophilia - Tetany - Panic disorder

What is spasmophilia ?

The concept of «spasmophilia» is not often taught in the faculties of medicine. The reality of the disease is sometimes even officially refuted.
It is mentioned like an «acute behavior desorder linked to a fear and maintained by a reflex of hyperventilation».
The attacks are perfectly well described (the diagnosis is quite easy) and their caretaking seems to be codified well.
Yet, the sick people do not seem very satisfied by that approach and, according to our experience, like Professor A. Pelissolo wrote so well : "risk to turn away from the health professionals who are likely to provide them an efficient help". (Cf. doc at the bottom of the page).

In our opinion, that failure is linked to the fact that sleep is not mentioned enough during the diagnosis investigation.

For the spectators of the attack and for many doctors (who often face it in the context of emergency visits), it is a form of "depression"...

For the general public, it is a pathology that is often mentioned by the medical profession which often carries out that diagnosis in situations of "felt emergency".
The search engines on the Internet sometimes put forwards a "disorder of the acid-base balance related to a respiratory alkalosis induced by an hyperventilation of psychological cause due to an irrational fear of dying".

Elsewhere, a ground of "neuromuscular hyperexcitability" or "neurovegetative dystonia", meaning a dysfunction of the automatic nervous system (which is more accurate) is mentioned.
Many commercial websites take a stand to praise the virtues of this or that food supplement, diet or other panacea.
A special grade for the "directors of conscience" who make of it a problem of "serenity"...with the purpose of selling something...

A felt emergency

The expression «panic attack» matches an international psychiatric definition in the chapter of the anxiety disorders (of the DSM-IV - Diagnostic and statistical manual of mental disorders, 4th edition) which comprises phobias, GADs (generalized anxiety disorders) and OCDs (obsessive compulsive disorders). (Refer to the doc at the bottom of the page (French).

Feeling a vital emergency

In fact, the attack of spasmophilia can be summarized in the sensation of an imminent danger, it is the onset of an "alarm system". The subject experiences a dysfunction of a presumed vital organ. It is the feeling that something bad is happening at the level of the heart (infarctus), the brain (paralysis), or breathing (choking), the belly (to be surgically operated), and so on...

That sort of crisis is the cause of the majority of the direct calls to the emergency services and causes a lot of hospitalizations in emergency room.
The visible normality of the numerous and repeated checkups contrasts with the apparent seriousness of the attack, to a point that these "true sick persons" end up wondering about the skills of the medical profession which, from its side, often sees them like false sick people. (See the article about the "True False-sick")

As we will see, that misunderstanding is shared by the people who suffer from fibromyalgia, from Chronic Fatigue or simply from chronic functional disorders like migraine or irritable bowel syndrome.

Why?

• During the last 20 years, many doctors (influenced by the publications of some pharmaceutical companies) have mentioned a lack of calcium or magnesium, or, more recently, trace elements...
  
  It was then, for the doctors, sometimes a matter of comforting their patients while building up a theory that was useful at the moment when they had to prescribe a remedy to those nearly "false sick people" who failed almost nothing, eventually.
  The placebo effect, which is a part of every good quality relation between a doctor, a patient and a medication, is often enough in the start.
• For some others, the problem was strictly psychological...stress... nerves....and, if necessary, the efficiency of a "little sedative" written in the end of the prescription would confrirm that point of view.
  That is one of the reasons of the overconsumption of "calming" medications or "antidepressants" in France.
• A third attitude consists in denying the problem : "you fail nothing at all, you think too much", "have some sport and stop the coffee" ...

  But in our opinion, tiredness and its causes are always neglected and another alarm, just as worrying, will not be long to return.
  None of these approaches can be really satisfying for these true sick people which multiply the consultations (or change doctors all the time in their lives).

  The recent knowledges in sleep pathology concerning fibromyalgia offer a more pragmatic alternative based on the rules of sleep hygiene.
  Yet, generally, patients who are interviewed about their sleep often claim to sleep a lot because (as well here as in fibromyalgia and chronic fatigue) it is the quality of sleep that is concerned, not the amount.
  
  

  But I do sleep, "in spite of it all", (too much)

  

  Shadok motto - Sleeping makes me tired

  Do people consider that a food deprived subject eats a lot because he is very hungry?
  The quality of sleep cannot only be measured with the facility to fall asleep (sleepiness) or with duration...

  
  Sleep is evaluated when one gets up and it seems obvious that the sleep of subjects with spasmophilia does not fill its role because it is when the person wakes up that the tiredness is most intense.
  Nb. A good marker of the functional disorganization of sleep is the frequence of the need to urinate during the night. In our experience, that abnormal sign is present in nearly 100 of the cases.
  Beyond the illness, sleep would seem correct if it wasn’t for the need to get up to drink or urinate several times during the night.
  That increase of the nocturnal diuresis. is the consequence of the collapse of an "antidiuretic" system which is normally very active during the phases of deep sleep.
  
  It all looks like if nature had foreseen the need to respect the sleep of the good sleepers by adapting the diuresis to the size of the bladder.
  In case of a bad sleep the kidneys produce more urine than the vesical content cas accept over the duration of sleep.
  That "nocturnal pollakiuria" is also very visible in pathological snorers where it is an "appealing sign" well known by the somnologists.
  IUntil very recently, a prostatic hypertrophy in men or an "unstable" or "too little" bladder in women were made responsible for that disorder...

  

  That’s true, I am tired, but I keep going !

  

  Shadok motto - one is never beaten better than by himself

  One of the first official definitions of "spasmophilia" goes back to 1992, when the French public welfare system decided to consider that there was not enough reasons to keep monitoring magnesium, in order to lower the useless expenses, while France was the only country to do it, amongst others in the case of a "complete checkup for tiredness".

  The first row of Opposable Medical References (RMO) asserted «spasmophilia» justified the measurement of magnesium
  The text thus defined that illness, still not in the medical dictionaries, as a clinical chart combining three symptoms : "tiredness", "neurodystonia" and "anxiety".
  In our analysis, the chart could be completed with a fourth sign : the volunteer personnality of the sick people (that tough character allows them to fight very long alone against their illness). A recurrent sign witnesses for it : the flat refusal of being stopped from work as soon as the attack is over.
  (That often altruist and hyperactive personnality is sometimes called "Sister Theresa"...)

  • Fear is the cause of the call.
    
    It is fear that provoques the emergency of the situation, when the reluctance to consult collapses in front of a symptom clearly identified like being potentially dangerous.
    The doctor only meets the sick person at the occasion of an attack (generally during the night or when aid is difficult to access to).
    
    In that context of imminent death sensation, it is legitimate to cabut as soon as the attack is over and in the absence of objective sequellae, the sick person convinces him/herself that he/she panicked for no reason (or that he/she is too anxious).
    
    The relatives (who begin to think about the story of Peter and the Wolf...) and the doctor besides encourages them to accuse the nerves and the stress in order to give a meaning to the attacks.
    
    That way, some patients, though persuaded that their last hour has arrived, dare no longer to call for help and sometimes experience very scary moments without allowing themselves to "disturb" again.
    Outside of these attacks, finally comforted, the avoid to discuss the problem with their doctor (which thereby ensures the continuation of the disorder) because they know he/she will talk about "stress".
  • Tiredness is always present under the condition of being able to detect it. There is not one subject with spasmophilia who is not especially tired since at least three weeks.
    Often, the strength of character of the sick person covers the sensation of tiredness. Their exists a true «deafness» in those sick people who consider that complaining is a form of weakness !
    
    Often, the sick person event claims to be in a perfect shape (and the relatives will counter him/her). He/she says that he/she could not have consulted as soon as the attack starts fading (or that he/she would not have consulted if he/she had not been "really" scared).
    
    Just like in fibromyalgia (or CFS), that tiredness has no organic cause (the sick people have often had numerous checkups).

    
    For us, the attack is the first sign of decompensation of sleep on a ground of functional insufficiency of sleep.
    If the unefficiency of sleep is not pointed at, the sick person will return at the occasion of another attack which may take a very different clinical form .
    
    The patient who goes to emergency room in a situation of panic tries to express his/her feeling through quite characteristic words :
    - "I know that I have spasmophilia (because I lack magnesium, or I don’t "fix" it) ", - " But this time, it is different, it isn’t that, it’s something else, it’s serious, it’s urgent...!"

    

    The reasons to call for help

  • Neurodystonia is the other consequence of that sleep unefficiency.
    All the automatic systems of the organism can be touched as the variety of the symptoms witnesses reported by the patients witnesses for it (see table.
    That ground of neurodystonia very often precedes the attacks but the patient who is used to it very often refuses to consult until the appearance of a new symptom which will make him/her change his/her mind because of its intensity or its location.
    In our opinion, "spasmophilia" (or tetany) is a sign of emergency stop when the "somnobar" is in the red zone (cf).

  
  

  So, it is not bad?

  

  Shadok motto - the worst illness of the brain is thinking

  For an emergency practician «spasmophilia (or tetany)» is not a true emergency and it is relatively easy to review it on the phone : no vital danger, level of gravity zero

  Three consequences of the absence of caretaking can be faced yet :

  • the repeated attacks induce huge public health expenses;
  • the frequent explorations and diagnosis roaming (see the problem of the false sick person) lead to a major iatrogenic risk (illnesses induced by the medical intervention) from which result a loss of trust in official medicine and a (legitimate) turn towards the market of "parallel" medicines;
  • the aggravation of tiredness risks to result in more serious and disabling charts which express in an hyperalgic mode like in fibromyalgia or in an asthenic mode like in the chronic fatigue syndrome (CFS).

A risk factor for fibromyalgia and chronic fatigue ?

The attack of spasmophilia represents, in our opinion, an appealing point for the hyposleep syndrome.
The sick person is at risk to see the steps of the "train of the hyposleep syndrome" follow each other.
Unfortunately there are only very few epidemiological studies about spasmophilia because (like in other equivalent syndromes) the reality of that illness is still called into question by those who consider it a psychiatric illness.
According to the current classifications (the famous "DSM4", american classification of mental diseases), spasmophilia is a form of pathological anxiety.

We think that it would rather be pathological not to panic when danger seems imminent (The alarm systems are there for that purpose).
When the alarms indicate a "danger", the solution is not to get away from it (in running to emergency room for example) because it is the alarm system in itself that is the problem.

In practice, the attack stops as soon as a sedative is powerful enough to "cut the sound off" (the best use, in emergency, of BZs.)
The remarkable efficiency of benzodiazepines in that situation (in a sole and sufficient dosis) confirms the "neurodystonia" characteristic of the faintness.
In our opinion, every attack stands for a sign of decompensated "hyposleep", and if the cause (the efficiency of sleep) is not taken care of, the attack can return "without warning" with every occasion.

The preventive treatment of spasmophilia essentially relies on sleep hygiene and the understanding of the notions of chronobiology.

Smg° offers you here an interactive questionnaire of sleep disorder screening : "clic on the items for which you feel concerned" ... ... "your answers match with the following problem(s) ... you should discuss these questions with your doctor".

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