The term paroxysmal is used in medicine to qualify a period in a disease when symptoms reach a peak in intensity. We can also speak of paroxysmal diseases for pathologies functioning by seizures (for example, epilepsy).

A state is said to be paroxysmal when it manifests itself by access, by relapses.

This medical term is most often heard in association with arterial hypertension, cardiac arrhythmias, or pain, for example. However, it is possible to misinterpret this state.

In paroxysmal (in the medical sense of the term), it is the intermittent aspect that we want to talk about first, then indeed a peak of acuity. We will then evoke a paroxysm of a disease.

For example, the epileptic seizure – a transient clinical manifestation linked to abnormal electrical activity in a specific region or in the whole brain – is the paroxysm of epilepsy, since it manifests itself as a sudden peak of intensity with paroxysmal electric shocks.

Paroxysmal hypertension, for example, is a type of hypertension in which the blood pressure is most often normal but in which there are sometimes hypertensive episodes. This could be the well-known “white coat effect” for example, in which blood pressure is self-measured at home but rises when it is taken by the doctor under the effect of stress.

To better illustrate the absence of “paroxysm” in the non-medical sense, we can cite paroxysmal atrial fibrillation. These are episodes of cardiac arrhythmias interspersed with periods in which there is no arrhythmia, as opposed to permanent atrial fibrillation.

In general, paroxysmal attacks correspond to dysfunctions controlled most of the time by self-regulatory mechanisms of the organism. Sometimes there is an imbalance, a slight imbalance which favors the onset of the crisis.

In epilepsy, the causes are multiple, and are classified according to international criteria; of genetic or symptomatic origin, they are the result of brain damage or inflammation.

In benign paroxysmal positional vertigo (ENT domain), the vertigo attack is triggered by changes in the position of the head. It is a rotatory dizziness (in which one has the impression that everything revolves around one) which persists for less than a minute. It can be associated with nausea or even vomiting.

The cause is the presence in the inner ear of small fragments of calcium called “otoliths” which will increase the impression of movement in a particular direction of space. The crisis can be brief but very intense.

Most often, this dizziness is not linked to a pathology. BPPV is most often idiopathic (with no identified cause).

Certain paroxysmal states will remain paroxysmal, such as the white coat effect for example. Some paroxysmal conditions can become permanent, such as atrial fibrillation for example.

Some paroxysmal states are called upon to disappear, such as benign paroxysmal positional vertigo in which a repeated maneuver of repositioning the head will allow the otoliths to come out of the inner ear and cure the disorder.

In a third of patients, BPPV resolves spontaneously within a week. It is the most common of all dizziness.

Each paroxysmal disease will have different therapeutic methods, in order to reduce the attacks or to make the disease disappear completely.

For example, for benign paroxysmal positional vertigo, two major therapeutic methods exist to treat it:

• therapeutic maneuvers aimed at moving otoliths from the semicircular canals to the utricle so that they are reabsorbed in the utricular macule;

• “vestibular rehabilitation” methods aimed at adaptation, substitution and habituation of the nervous system.

Regarding epilepsy, drug treatments act on the frequency and intensity of seizures. In some cases, the patient may recover from his illness and treatment may be stopped on medical advice. It is nevertheless advisable to respect certain rules of life, such as a good sleep, or not to consume toxic substances.

For other patients, epilepsy may persist despite appropriate treatment.

Some diseases lead to severe paroxysmal states, so much so that it is impossible for the patient to ignore the disease. At the first signs of an attack, you should consult your doctor and see with him how to alleviate the peaks of intensity of the disease.