Vertebral Fractures as a Complication of Convulsions

Abstract

In a previous communication we presented the frequent complication of vertebral fractures in the course of metrazol therapy in psychiatric disorders.1 At that time, in a roentgenographic study of fifty-one psychiatric patients who had received treatment with metrazol, twenty-two (43.1 per cent) manifested compression fractures of the vertebrae, most commonly in the midthoracic region, and in most instances the fractures of the vertebral bodies were multiple. Fragmentation and compression of the anterior portion of the upper surface of the body occurred frequently, while in about half the cases the fractures manifested themselves only by a slight forward displacement of a disklike fragment of the upper portion of the body. There was a higher incidence of fractures in female (sixteen) than in male (six) patients.At the time of the first report it was indicated that a study was being made of the effect of keeping the patient on his side in an acutely flexed position, since it was felt that the force of sudden flexions of the spine, which may be the cause of the vertebral fractures, would thereby be reduced.The present report is an extension of our previous studies and includes a roentgenographic survey of the following groups : ( 1 ) patients who manifested con¬ vulsions during the course of hypoglycémie shock ther¬ apy; (2) patients who had received both hypoglycémie shock and metrazol therapy, with convulsions occurring during the insulin shock; (3) patients who were placed in the position of acute flexion during the treatment with metrazol ; (4) a control series of patients who received hypoglycémie shock therapy but who had no convulsions, and also an untreated group of patients whose spines were examined roentgenographically.Sakel2 describes two types of hypoglycémie shock : the "wet shock," during which the patient sweats pro¬ fusely, grows somnolent and goes into deep coma, and the "dry shock," during which an epileptic attack occurs in the second or third hour of hypoglycemia. He states that the type of response cannot be predicted in advance and is independent of the size of the dose. Early in the work on hypoglycémie shock therapy there was a differ¬ ence of opinion as to the therapeutic value of these convulsions. At first, when they occurred, the shock was immediately interrupted by intravenous dextrose. Later, Sakel3 clarified this point by stating that in the "dry shock" the epileptic seizure is not dangerous and one may wait a few minutes before terminating the hypo-glycemia by nasal tube. However, if the epileptic seizure occurs in the fourth or fifth hour of hypoglycemia there is presented a very dangerous situation, and hypo¬ glycemia must be terminated at once by intravenous dextrose. Recently Sakeli has specified that metrazol may be used to produce convulsions during the hypo¬ glycemia in certain types of resistant cases and empha¬ sizes that the therapeutic value of epileptic seizures was recognized in certain cases from the beginning of the insulin shock treatment.Plattner and Frölicher, as qu...