Paroxysmal attack  

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Kunstformen der Natur (1904) by Ernst Haeckel
Kunstformen der Natur (1904) by Ernst Haeckel

Paroxysmal attacks are short, frequent and stereotyped symptoms that can be observed in various clinical conditions. They are usually associated with multiple sclerosis, pertussis, but they may also be observed in other disorders such as encephalitis, head trauma, stroke, asthma, trigeminal neuralgia, breath-holding spells, epilepsy, malaria, tabes dorsalis, and Behçet's disease. It has also been noted as a symptom of Gratification disorder in children.

Paroxysmal attacks in various disorders have been reported extensively and ephaptic coupling of myelin nerve has been presumed as one of the underlying mechanisms of this phenomenon. This is supported by the presence of these attacks in multiple sclerosis and tabes dorsalis, which both involve demyelination of spinal cord neurons. Exercise, tactile stimuli, hot water, anxiety and neck flexion may provoke paroxysmal attacks. Mostly reported paroxysmal attacks are painful tonic spasms, dysarthria and ataxia, numbness and hemiparesis. They are typically different from other transient symptoms by their brevity (lasting no more than 2 minutes), frequency (from 1-2 times/day up to a few hundred times/day), stereotyped fashion and excellent response to drugs (usually carbamazepine). Withdrawal of symptoms without any residual neurological finding is another key feature in their recognition.

The word paroxysm means sudden attack, outburst, fit and comes from the Greek παροξυσμός (paroxusmos), "irritation, exasperation".


From French paroxysme, from Medieval Latin paroxysmus, from Ancient Greek παροξυσμός (paroksusmós, “irritation, the severe fit of a disease”), from παροξύνειν (paroksúnein, “to sharpen, irritate”), from παρά (pará) + ὀξύνειν (oksúnein, “sharpen”), from ὀξύς (oksús, “sharp”).

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