RU2281506C1 - Method for predicting minimal cerebral dysfunctions in children - Google Patents

Abstract

FIELD: medicine, neurology, pediatrics.

SUBSTANCE: in blood serum due to immunoenzymatic assay it is necessary to detect the content of glial neurotrophic factor and at its value being above 17.98 pg/l one should diagnose minimal cerebral dysfunctions. The innovation widens the number of techniques for predicting cerebral dysfunctions in children.

EFFECT: higher efficiency and accuracy of diagnostics.

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Description

The invention relates to medicine, in particular to neurology, pediatrics, immunology, child psychiatry. It can be used in a clinic for the diagnosis of minimal dysfunctions (MDM) in children as a consequence of perinatal lesions of the central nervous system (CNS).

A known method for the diagnosis of MDM according to clinical signs, according to which MDM is differentiated from cerebral palsy (cerebral palsy), childhood mental illness, autonomic-dysregulatory and hypertensive-hydrocephalic syndromes due to somatic pathology or other diseases of the brain. Due to the large number of syndromic clinical manifestations of MDM, the diagnosis requires the use of many special research methods: REG, KIT, CT goal. brain, EEG, ultrasound goal. brain.

These indicators, combined with the data obtained in the study of the clinical picture and medical history, the conclusions of the ophthalmologist, orthopedist, psychiatrist, can more accurately establish the presence of MDM as consequences of perinatal damage to the central nervous system. (Yaremenko B.R., Yaremenko A.B., Goryainova TB.Minimum brain dysfunctions in children. - St. Petersburg: Salit - Dean. 1999. - 27 p.)

The disadvantages of the used methods for diagnosing MDM are the long duration associated with: the use of instrumental and special research methods, the absence of clear criteria for evaluating the results, the involvement of consulting doctors of other specialties, the absence, in most cases, of medical documentation containing a full perinatal history; In addition, these studies are of high cost.

The aim of the invention is to develop a method for the diagnosis of MDM by the level of glial neurotrophic factor (CNTF) in the blood serum, which will provide high efficiency in the diagnosis of MDM, the speed of diagnosis, cost-effectiveness, and also ensure timely and rational implementation of a complex of therapeutic measures.

The essence of the proposed diagnostic method is that the amount of glial neurotrophic factor (CNTF) is determined in the blood serum of children by enzyme-linked immunosorbent assay (ELISA) and if the level of CNTF is above 17.98 pg / l, the presence of MDM is diagnosed.

CNTF currently belongs to a limited family of neuropoietic cytokines and is considered as a key differentiation factor for developing neurons and glial cells, and is also an associated molecule that provides trophism and support for neurons after damage, therefore a change in its content indicates direct involvement of nerve tissue in pathological process. The data obtained showed that an increase in the amount of CNTF clearly indicates the presence of insufficient differentiation of neurons, and possibly the presence of neuronal damage in MDM.

The method is as follows.

All patients were bled from a vein and the CNTF level was determined by enzyme-linked immunosorbent assay (ELISA) using R @ D kits (USA) according to the scheme recommended by the manufacturer.

EXAMPLE.

Patient K, 5 years old, at the time of contacting a pediatric neurologist had complaints of periodic, with a frequency of 1-2 times a week, sharp headaches, accompanied by dizziness, nausea. According to the parents, headaches most often appeared after exertion, and their attacks became more frequent when the weather changed.

When collecting the anamnesis, it turned out that the baby was born on time, with a mass of 3250 g. In the process of childbirth, weakness of labor activity developed, therefore, birth control was carried out. Amniotic fluid was greenish in color. Having been born, the baby cried right away, evaluated on the Apgar scale 8-9b, applied to the chest on the 2nd day. The mother said that the child often and somewhat unusually threw his head back in the first months of life. In addition, he had tremor of hands and chin during crying and the action of violent sudden stimuli (light, sound, etc.). The maternity hospital is at risk for perinatal encephalopathy. The psychomotor and speech development of the child was normal.

Headaches first appeared at 3.5 years old when the child went to kindergarten. At the same time, parents drew attention to inexplicable periods of lethargy, drowsiness, during which headaches intensified, nausea appeared.

Objectively at the time of inspection: the skin is pale, blood pressure 100/60 mm Hg, NPV 18 per min.

Neurological status: palpebral fissures symmetrical, D = S; pupils of normal shape and size, D = S; photoreaction saved. The movements of the eyeballs in full. Trigeminal exit points are painless. The mandibular reflex is lively. The face is symmetrical, nasolabial folds D = S. Tongue in the midline. Muscle tone S = D, not changed. Muscle strength in the limbs 4-5 points. Tendon reflexes are high, D = S; skin abdominal reflexes are inhibited. There are no pathological reflexes. No sensitive disorders have been identified. He performs dynamic coordinating tests confidently, is stable in the Romberg position, tremor of fingers of outstretched hands is noted. Dermographism is white, unstable; Hildebrant coefficient 3.5. Vegetative index Creed 17. Distal hyperhidrosis is expressed.

General blood tests, urine tests, biochemical blood tests without pathology.

Optometrist's conclusion: optic discs are pale pink, the borders are clear, the retinal arteries are narrowed.

ECG - sinus rhythm, exchange-recovery changes in the myocardium. REG - Vein tone is reduced, pulse blood supply is increased. KIT - The initial vegetative tone is hypersympathicotonic, IN 2 = 105 (with heart rate = 90), autonomic reactivity = asympatheticotonic. EEG - Moderate cerebral changes (closer to the lungs), of a regular nature. No interhemispheric asymmetry was detected. Epiactivity was not detected.

Conclusion on screening - vegetative tone assessment table - sympathicotonia.

CT of the brain was not performed.

The amount of CNTF determined by ELISA was 21.05 pg / ml.

Diagnosis. Minimal brain dysfunction in the form of autonomic dysregulation syndrome.

In healthy children, the amount of CNTF does not exceed 18.82 pg / L. Data show that CNTF may serve as a marker of MDM as a consequence of central nervous system PP.

A method for diagnosing minimal brain dysfunctions in children by the amount of CNTF in serum was tested on 31 children with a diagnosis of MDM (main group). In 9 (29%) - vegetative-dysregulatory (SVD), in 12 (39%) - cerebrospinal fluid (SAD), emotional-volitional and behavioral disorders of the type of hyperdynamia - in 10 (32%) (GDS).

All subjects underwent blood sampling and determination of the amount of CNTF in the above manner.

The results of the study are presented in the table. To process the obtained material and conduct statistical analysis in the studied groups, the statistical information processing program "Statgraph" was used. The mean and mean error (M ± m) were calculated. Comparison in the studied groups was carried out in pairs using parametric methods, since the studied samples can be approximated by the normal distribution law. The comparison was carried out using Student's t test (t) (comparison of means) and Fisher (comparison of mean square deviations). The confidence level was evaluated by the value of "p". Differences in the comparison were considered significant with a probability of more than 95% at P <0.05.

Using the proposed diagnostic method has the following advantages:

1) high specificity in the diagnosis of the consequences of perinatal damage to the central nervous system, in particular MDM, associated with a delay in the development of neurons and glial cells or their damage;

2) quick diagnosis;

3) provides timely and rational implementation of a complex of therapeutic measures.

DIAGNOSTIC METHOD FOR MINIMUM BRAIN DYSFUNCTIONS IN CHILDREN Minimal brain dysfunctions healthy M ± m n M ± m n 20.35 ± 0.79 * 31 16.67 ± 2.15 * 10 Note: * - p <0.01 - significance of differences in groups when compared.

Claims (1)

A method for diagnosing minimal brain dysfunctions in children, characterized in that the content of glial neurotrophic factor in the blood serum is determined by an enzyme-linked immunosorbent assay and, with its content of more than 17.98 pg / l, minimal cerebral dysfunctions are diagnosed.