RU2290869C1 - Method for treating children at cerebrasthenic syndrome - Google Patents

Abstract

FIELD: medicine, neurology.

SUBSTANCE: the present innovation deals with treating cerebrasthenic syndrome (CS) due to carrying out therapy at taking into account the data of a child's complex inspection. At bioelectric cerebral activity a rest being under 40 mcV and impossibility to reconstruct its background values after functional loadings during 3 min by EEG, deviation of cerebral neuromediator supply by 10% and more, affected fermentative activity along with decreased utilization of glucose and creatine phosphate synthesis according to electromagnetic cerebral scanning (EMS) data it is possible to establish CS as a result of oxygen-dependent cerebral hypoergia to introduce amino acids, enzymes, iron preparations, vitamins, hepatoprotectors during 1-mo-long period; then - nootropes and sedative preparations and then comes transcranial micropolarizations (TCMP) along the intake of antihypoxants and vitamin and microelements complexes. Such therapeutic courses should be repeated twice or thrice at interval being not less than 2 mo at keeping soft daily schedule. In case of analogous EEG alterations, the deficiency of initial pulse circulation in carotid and vertebral-basilary (VB) basin being not less than 10%, and during carrying out functional samples - up to 55-75% against the norm, the signs of venous outflow difficulties at REG and USDG, and decreased activity of neurons by above 20% according EMS data it is possible to state upon CS at VB failure and the risk for syncopic states; also, in therapy one should additionally apply vasoactive, spasmolytic and diuretic preparations for 1 mo, and after TCMP the course of resolution therapy should be conducted. In case of instability of vertebro-motor segments and ligamentous-muscular apparatus of cervical vertebrae and rotation subluxations C₁ or C₂ at wave deviation being above 0.2 mm according to EMS data, and at availability of vascular abnormality of brain or neck it is necessary to fulfill MRT at vascular program. In case of pronounced instability, and/or functional blocks at the level of C₁-C₅, and/or shifts of disks or vertebral bodies it is important to conduct manual therapy of cervical department at "soft techniques", except those at inborn abnormality of cranio-vertebral area. The innovation provides rapid and stable effect due to differentiating complex therapy at taking into account all the links of etiopathogenesis.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, more specifically to neurology, and may find application in the treatment of children with diseases of the nervous system of perinatal origin.

Of all diseases of the nervous system in children, 2/3 have their roots in the perinatal period and are associated with transferred asphyxia. To a greater extent, these diseases are caused by hypoxic-ischemic brain damage. The list of neuropsychiatric disorders associated with hypoxic brain damage is extremely wide: from a delay in psychomotor development to severe forms of cerebral palsy (cerebral palsy), accompanied by mental failure, motor disorders, seizures, etc.

One of the long-term consequences of cerebral dysfunctions is cerebrosthenic syndrome (CS) of hypoxic-ischemic origin. CS is a functional decrease (failure) of the central regulatory systems of the brain.

Clinically, CS is expressed by a decrease in the quality of vital functions of the body due to brain hypoergosis, which is expressed by:

- a decrease in cognitive function (attention, memory, perception, information processing and reproduction), i.e. Learning and human performance are reduced,

- a decrease in visual acuity by the end of the day,

- general weakness, lethargy, difficulty falling asleep and morning awakening, intermittent sleep,

- physical asthenization of the body and a decrease in appetite,

- emotional lability

- a decrease in immunity in the form of frequent colds,

- convulsions of hypoxic origin.

CA is often complicated by the addition of vertebral-basilar (VBB) insufficiency in the form of the following symptoms:

- syncopal conditions,

- vegetative dysfunction (vegetovascular dystonia), psychoemotional instability,

- the occurrence of muscle dystonia syndrome with hypotension of the muscles of the shoulder girdle,

- increased vision deficiency.

It should be noted that hypoergosis, exacerbated by a violation of autonomic regulation and cerebral hemodynamics, is the basis of the clinical manifestations of CS.

Currently, functional disorders of the nervous system are provided to correct nature itself. The passive expectation of recovery, the widespread opinion “will pass with age,” is fraught with adverse consequences for the child [V.A. Aleksandrova. Perinatal lesions of the central nervous system and their consequences in children. Textbook, St. Petersburg: Publishing House of SPbMAPS, 2003].

Practice shows that the treatment of such disorders should begin with the first clinical manifestations, depending on the severity of a violation of a particular function, and it should be aimed, first of all, at restoring and stimulating the activity of central regulatory mechanisms. However, a generally accepted method for treating central nervous system does not currently exist. The treatment is usually symptomatic and is based on the intuition and experience of the pediatrician.

Closest to the proposed one is a method developed at SPbMAPO (Medical Academy of Postgraduate Education) and aimed at restoring cerebral lesions of the respiratory function and cardiac activity, eliminating cerebral edema, restoring normal cerebrospinal fluid and blood circulation, as well as increasing tissue oxygenation in the acute period [ibid. , p. 33-35].

For this, the child is injected intravenously with piracetam 20% - 30 mg / kg, adding a 1% solution of 1 mg / kg and a 0.5% solution of 1 mg / kg of lipoic acid to the dropper of riboflavin-mononucleotide. After 2 hours, as the authors note, a positive effect is noted. In order to stimulate the repair and compensation processes, B vitamins, Cavinton, Sermion, and nootropics are prescribed. Dehydration therapy is indicated. With subarachnoid hemorrhage, a lumbar puncture is performed. Further treatment of perinatal injuries of the nervous system is carried out according to the syndromes:

- in the presence of a convulsive syndrome, phenobarbital, diphenin, depakine, finlepsin in prescribed doses are prescribed.

- for the treatment of hypertension syndrome, diacarb is most often used.

- to improve the metabolism of brain tissue, nootropic drugs are shown, as well as amino acids, adaptogens.

- for the metabolic correction of cerebral disorders, B vitamins are prescribed, with muscle hypotension - proserin, with muscle hypertension syndrome - dibazole, amisil and metamizil, midcalm.

- to improve cerebral circulation - antispasmodics: dibazole, aminophylline, pentoxifylline, cinnarizine.

Such treatment allows stabilizing neuronal activity, increasing brain tissue oxygenation, which leads to an improvement in central regulation mechanisms and a decrease in the clinical manifestations of cerebral asthenia. However, as our long-term experience in treating children with cerebrosthenic syndrome testifies, the relief of one or another syndrome only temporarily improves clinical symptoms, without affecting cerebral hemoliquorrhea regulation, violation of which is one of the main causes of central nervous system. In addition, the appointment of nootropic drugs according to the scheme recommended in the prototype method (30 mg / kg piracetam for 1 month) can lead to depletion of neurons and, thereby, the appearance of paradoxical reactions in them, which is often expressed in the appearance of convulsive headache brain. As in other known methods of treating central nervous system and its manifestations, treatment according to the prototype method is of a general recommendatory nature and is not based on the results of a neurophysiological examination of the child, i.e. the method is pathogenetically unjustified.

The technical result of the present invention is to create a comprehensive method for the treatment of central nervous system, taking into account all the links of the etiopathogenesis of central nervous system, identified as a result of clinical and neurophysiological examination of the child.

This result is achieved by the fact that if the bioelectrical activity of the brain at rest is lower than 40 μV and the inability to restore its background values after functional loads for 3 minutes is according to the EEG, based on the deviation of the neurotransmitter support of brain activity by 10% or more, and / or decrease in the activity of neurons in the secondary associative zones of the cerebral cortex by 20%, and / or impaired enzymatic activity with a decrease in glucose utilization and creatine phosphate synthesis - according to the electromagnetic scan brain cerebrosthenic syndrome due to oxygen-dependent brain hypoergosis is established and oral or intramuscular administration of amino acids, enzymes, iron preparations, vitamins and hepatoprotective drugs for 1 month, then for 1 month, nootropic and sedatives is used as drug therapy carry out transcranial micropolarization (TCMP) with the simultaneous administration of antihypoxants and multivitamins with microelements or metabolic phytoteralia, repeated Taking such courses of treatment 2-3 times with an interval between courses of at least 2 months and observing a sparing regime of the day throughout the course of treatment. In the presence of similar changes in the EEG, the deficiency of the initial pulse blood supply in the carotid and vertebral-basilar pools is at least 10%, and during functional tests - up to 55-75% compared to the norm and with a decrease in the activity of neurons by more than 20%, as well as there are signs of difficulty in venous outflow - according to rheoencephalography (REG) and ultrasound dopplerography (Doppler ultrasound), cerebrosthenic syndrome with vertebral-basilar insufficiency and the risk of syncopal conditions and as a lek are established stvennoj vasoactive therapy additionally used, antispasmodics, diuretics for 1 month, and after the course of TCMP carried resorbable therapy. In the presence of instability of the vertebral-motor segments and ligamentous muscle apparatus of the cervical vertebrae and rotational subluxations of C ₁ or C ₂ with tooth displacement of more than 0.2 mm - according to electromagnetic scanning, an X-ray examination of the cervical spine is carried out, and in the presence of an anomaly of the vessels of the brain or neck - according to Doppler ultrasound, magnetic resonance imaging (MRI) is performed with a vascular program and, when x-ray examination reveals severe instability, and / or functional GOVERNMENTAL blocks vertebrae at C ₁ -C ₅ and / or displacements of the spinal discs or the vertebral bodies further manipulation performed using the cervical "soft technician" except congenital anomaly detection cranio-vertebral area detected during X-ray and MRI.

It is advisable when conducting drug therapy as

- amino acids use methionine, lecithin, glycine, glutamic and folic acid, and they are administered 1 time per day at night,

- enzymes - hilak-forte, mezim-forte - up to 16-17 hours,

- hepatoprotectors - Essential Forte, carlsil once a day at lunch,

- vitamins - B ₁₂ , magne B ₆ , neuromultivitis, biovital gel with lecithin and calcium 2 times a day,

- iron preparations - ferrum-Lek,

- nootropic - pantogam, kogitum, solcoseryl - in the morning,

- absorbable therapy - aloe, lidase in the morning,

- antispasmodics - aminophylline, papaverine - at night,

- vasoactive - cinnarizine, trental in the afternoon,

- sedatives - deprim, new-passit, persen for the night,

- antihypoxants - solcoseryl, riboxin, actovegin in the morning,

- diuretics - herbal collection, lingonberry leaf with chamomile and St. John's wort, veroshpiron, triampur.

It is also advisable to conduct TCMP according to the program of intellectual and mnestic functions in a gentle mode not more than 1 time per week for 4-8 weeks, manual therapy - at least 3 courses of 5-7 sessions in each of them in combination with orthopedic correction of the cervical spine corset daily for 1.5-2 hours.

A sparing regimen of the day should include a reduction in physical activity, the duration of the school day or an additional day of rest for a week, compulsory day rest, walks of at least 2 hours a day, and dosed visual load.

The detection of cerebral hypoergosis indicates a functional insufficiency of the cerebral cortex and a related decrease in the activity of central regulation mechanisms that determine the main clinical manifestations of central nervous system, and the effectiveness of the drug therapy primarily depends on their relief. In this regard, the appointment of amino acids, enzymes, iron, vitamins and hepatoprotectors during a first month of treatment, as we have shown in the treatment of a large contingent of such children, improves the overall metabolism in the body, the activity of the visceral system and, as a result, improves the general somatic state: sleep is normalized, autonomic disorders are reduced, cognitive functions, vision are improved, and general learning is increased. And only the subsequent administration of nootropic drugs in combination with sedatives provides a significant improvement in neurotransmitter activity and the possibility of stable and continuous function of neurons in the cerebral cortex. In achieving this, an important role is played, as we have shown, by observing a sparing daily regimen throughout the course of treatment.

Identification of vertebral-basilar insufficiency and the risk of syncope, indicating a lack of blood supply to the brain and, as a consequence of it, secondary hypoxia, and taking timely adequate measures to stop them (introducing vasoactive, antispasmodic and diuretics into the treatment regimen, subject to the appropriate daily regimen for sick child) provides improved cerebral blood flow and oxygen supply to brain cells, which reduces cephalgia, vestibular disorders, dizziness I, stabilize visual function.

Subsequent administration of TCMP in a gentle regime with the simultaneous administration of antihypoxants and multivitamins with microelements or metabolic herbal medicine stimulates the regulatory mechanisms of the brain by optimizing the metabolism of neurons and thereby enhances and prolongs the positive therapeutic effect obtained with drug therapy.

Timely detection of instability of the intervertebral discs and ligaments of the cervical vertebrae and rotational subluxations of C ₁ or C ₂ allows you to start manual therapy of the cervical spine using “soft techniques” in time, which eliminates the pathological position of the displaced cervical vertebrae and ensures restoration of the anatomical and physiological state of the cervical spine the spine, which eliminates the extravasal negative effect on the vertebral vessels and improves blood circulation to the brain. An additional x-ray examination of this area reveals a congenital anomaly of the cranio-vertebral region, in the presence of which manual therapy is contraindicated.

Performing an MRI with a vascular program in case of an abnormality of the vessels of the brain or neck, according to the ultrasound scan, clarifies the localization of this anomaly and provides an individual course of vasoactive therapy to prevent the possibility of acute brain ischemia.

Conducting resorption therapy eliminates the residual perinatal commissural-dystrophic changes in the meninges and periventricular tissues and thereby prevents the formation of pathological foci in the brain.

The drugs recommended in the proposed method, their dosages and administration tactics, as well as the regimes of manual therapy and transcranial micropolarizations are based on our many years of experience in treating large groups of children with cerebral pathology and analyzing the clinical results obtained.

Conducting TCMP according to the program of intellectual-mnestic functions with high efficiency was used by us earlier in the treatment of pace delay of neuropsychic development in children [Patent No. 2180245, 2002] and therefore is recommended in this method.

The essence of the method is illustrated by examples.

EXAMPLE 1. Girl A., born in 1996, was admitted to the Institute of the Human Brain of the Russian Academy of Sciences on September 14, 2001 with complaints of weakness attacks with pale skin, headaches, memory loss.

From the anamnesis: the girl was born from the first pregnancy, urgent delivery, birth weight 4 kg. Pregnancy in the mother proceeded with the threat of interruption, preeclampsia, anemia, chronic pyelonephritis. The birth was a long (12 hours 50 minutes) anhydrous period. The girl at birth was rated 8/9 on the Apgar scale. It was applied to the breast from the first day and was up to a year on breastfeeding. It developed with a slight delay in psychomotor development, was observed for a long time for mild to moderate encephalopathy and hypochromic anemia.

At admission: examined by a neurologist, performed a blood test, EEG, REG, ultrasound scan, electromagnetic scanning.

Inspection results: the girl is asthenized, the skin is pale, the subcutaneous fat layer is reduced, the muscular tone is dystonic, evenly reduced. Tendon reflexes (SR) are reduced, quickly depleted, D≥S. The diffuse focal microsymptomatics of residual genesis is determined. Posture is sluggish. The child is contact, somewhat slow, the concentration of attention is reduced. In the Romberg test, staggering, slight dizziness. Finger-nasal test is fuzzy. Test Stange - 15 sec. Hb - 102 g / l.

To clarify the diagnosis and its genesis, an EEG, REG, ultrasound scan and electromagnetic scanning are prescribed.

EEG - pronounced interhemispheric asymmetry in the form of a decrease in the amplitude of the alpha rhythm in the posterior sections of the cerebral cortex to 30 μV; after functional loads, the restoration of the initial background is incomplete.

REG - the intensity of the pulse blood supply in the basin of the internal carotid artery and the vertebral-basilar basin (WBB) is symmetrical and sufficient. When conducting functional tests - a deficit of 20%.

UZDG - a study of the carotid pool and WBB showed the symmetry and adequacy of blood flow.

The results of electromagnetic scanning (EMC) [Metkin NP, Kamykin Yu.F. et al., Abstracts of the report at the "First International Scientific Congress" Neurobiotelecom - 2004, St. Petersburg, 2004, 34-35]:

The scan in the front and middle sections of the left frontal lobe showed instability of microcirculatory support of brain activity by 13%, in the left frontal lobe revealed a moderate decrease in the density of white matter in the form of degenerative changes in the periventricular tissues of the lateral ventricles of the brain. According to spectral neurometry, a moderate neurotransmitter dissenergy was revealed, which indicates a decrease in the activity of neurons in the secondary associative zones of the cerebral cortex by 10% of the norm.

Based on the studies, the diagnosis was established: CS due to perinatal damage to the central nervous system, oxygen-dependent hypoergosis.

The treatment.

The following drugs were administered for 1 month (from September 20, 2001):

- glutamic acid 0.25 1 time per day in the morning,

- hilak-fort for 20 cap. 2 times a day with meals,

- biovital gel with lecithin and calcium, 1 tsp each 2 times a day,

- vitamin B ₁₂ at 300 mcg / m every other day N 15,

- ferrum-Lek 50 mg 1 time per day during lunch,

- Karsil 1 tab. 1 time a day in the evening.

Day mode: limited physical activity, compulsory day rest, walks of at least 2 hours a day, dosed visual load (TV).

Inspection 10/25/2001: Focal symptoms former. CP are caused, slightly reduced. In coordination tests, the girl is more stable. Sample Stange - 23 sec. Headaches decreased, appetite improved, normal skin color, Hb - 112 g / l.

Over the next month, the girl took:

- pantogam 0.25 1 time per day in the morning,

- deprim 1/2 tab. in a day,

- continued taking biovital gel with lecithin and calcium for 1 tsp. 2 times a day.

Inspection November 28, 2001: According to the mother, bouts of lethargy have passed, perseverance, attention, and sleep have improved. The girl became active, interest in reading books appeared. CP live, D≥S, unstable. The spine is unstable, but posture has improved. Hb - 118 g / l.

From December 05, 2001, once every 2 weeks, TCMP of the left hemisphere of the brain (N 4) was performed using the Potok-1 apparatus with low-intensity currents (from 0.03 to 0.1 mA) in the form of sessions lasting 15 minutes. In this case, during the first 2 sessions, the anode was located on the border of the lower frontal region and the projection of the anterior sections of the superior temporal gyrus of the left hemisphere. In the next two sessions, the anode was placed on the projection zones of the motor cortex, and the cathode was placed on the lower parts of the occipital region.

Throughout the course of TCMP, the girl took

- Riboxin 0.2 1 time per day,

- multivitamins with microelements.

Gentle day routine.

Inspection 03.03.2002 (at the end of the course of treatment):

The girl reads a lot, there was a desire to study, the quality of speech improved. CP live, but quickly depleted. Coordination tests are closer to satisfactory. The spine is more stable. Stange test - 30 sec. Hb - 120 g / l.

EEG - bioelectric activity of 60 μV with the restoration of its background values within 3 minutes.

REG, UZDG - without significant deviations.

Conclusion: according to the results of the examination and neurophysiological examination, according to the mother and according to objective indicators, the course of treatment gave a good therapeutic effect. To consolidate it, it is proposed to repeat such a course after 6 months.

Recommendations for the rest: fresh air, good nutrition, limitation of physical activity, multivitamins with microelements.

Follow-up examination 10.09.2002: the girl is active, cheerful, tanned, recovered, grew up. He goes to the kindergarten preparatory group with interest. SR live, almost symmetrical, muscle tone with mild dystonia in the muscles of the shoulder girdle and back. Hb - 120 g / l.

EEG - bioelectric activity of 45 μV with timely restoration of background values after functional loads.

REG, UZDG - the norm.

Diagnosis: CS, hypoergosis in the stage of subcompensation.

The course of treatment was repeated without TCMP, since the dynamics are positive, the effect is quite stable. Recommended once every six months, a visit by a neurologist and a gentle regime of the day.

The girl’s parents applied for a checkup in October 2003 due to some deterioration in her condition.

Inspection on 10/20/2003: the girl is somewhat pale, emotionally labile, tearful, tired at the end of the day, slowly performs school tasks, falls asleep badly. CP reduced, rapidly depleted, muscle tone dystonic, evenly reduced. Posture is sluggish (round back), there is a tendency to scoliosis of the chest. The background in coordination samples is unstable. Test Stange - 17 sec.

EEG - bioelectric activity - 35 μV at the basic rhythm, recovery from functional tests is incomplete. Hb - 115 g / l.

Diagnosis: mild central nervous system on the background of adaptive stress - the girl went to school.

It is recommended to repeat the course of treatment - the treatment was repeated similarly to the above for 4 months, including the course of TCMP and in compliance with a sparing regime of the day.

Inspection February 25, 2004. The girl began to do better at school, she copes with the curriculum on her own. Sleep is not disturbed. Focal symptoms of residual genesis did not increase. CP of medium vivacity, D≥S. Coordination tests are satisfactory. Stange test - 25 sec.

EEG - bioelectric activity of 55 μV at the basic rhythm, sufficient compensation.

EMC - on the scan, residual dystrophy of the periventricular tissues of the lateral ventricles of the brain, the neurotransmitter support of the brain activity is balanced.

Diagnosis: CS in the stage of subcompensation. Clinical supervision by a neurologist once every 6 months during the school season with the monitoring of EEG and REG, the observance of a sparing regimen of the day is recommended.

Follow-up examination in November 2004: there are practically no complaints, she copes well with her studies on her own, normal sleep. CP live, D≥S, muscle tone closer to physiological. Posture is somewhat sluggish. Coordination tests are satisfactory. Stange test - 30 sec. Hb - 120 g / l.

Diagnosis: period of convalescence of CS as a consequence of perinatal brain damage. For the three treatment courses, a satisfactory therapeutic effect was achieved.

To date, the girl’s parents have not sought medical help.

EXAMPLE 2. Girl Sh., Born in 1997, was admitted on 2.10.2004 for examination at the Institute of the Human Brain of the Russian Academy of Sciences (St. Petersburg) with suspicion of central nervous system.

From the anamnesis: a girl from the 2nd pregnancy, the first urgent birth. The mother during pregnancy had hypochromic anemia - Hb 105 g / l. The birth was a long (12 hours) anhydrous period, the fetus entwined with an umbilical cord around the neck, intrauterine pneumonia. The girl at birth is rated on the Apgar scale of 7/8 points. Attached to the breast on the 5th day, went to 1 year 3 months. In the first year of life was observed due to perinatal encephalopathy (treated for 1.5 years), there were no seizures. It developed with a slight delay in psychomotor development, was observed for a long time due to hypochromic anemia, intestinal dysbiosis, and fermentopathy. At 7, she went to school and from the first days of study, complications began.

At admission: complaints of bouts of weakness, lethargy, inattention, poor memory. According to her mother, the girl is emotionally unstable, it is difficult to fall asleep, upon awakening, negative reactions to others, complaints of a headache, dizziness, blurred vision in the evenings, unwillingness to go to school.

The institute performed: examination by a neurologist, blood test, ultrasound scan, EEG, REG, EMC.

The result of a neurologist examination: a contact girl, emotionally negative, quickly exhausted. The skin is pale, periorbital shadows. In the area of the temples, a light venous network is determined. There are no focal symptoms, but with prolonged visual tracking, an unstable, partial paresis of the adductors and abducers of the rectus muscles of the eyes is determined. Symptom Gref +, mild. Muscle tone is diffusely reduced, D≥S. CP low, rapidly depleted, reflexogenic zones are narrow. The Romberg pose is unstable, with tremors of the fingers. Finger-nasal test fuzzy on the left. During coordination tests complaints of dizziness. Heart sounds are clear, respiratory arrhythmia, functional systolic murmur at the point of Botkin. Test Stange - 15 sec. Hb - 108 g / l.

According to the EEG: a pronounced interhemispheric asymmetry was detected in the form of a decrease in the amplitude of the alpha rhythm in the posterior parts of the cerebral cortex to 35 μV, after functional loads, the initial background was not completely restored in 3 minutes.

According to REG: the initial deficiency of pulse blood supply, in the WBB is 25% lower than normal, while functional tests - a deficit of 60%.

USDG: signs of stagnation of venous outflow along the main vessels of the brain and in the WB.

EMC: Dystrophic changes in periventricular tissues, mild ventriculodilation. Instability of microcirculatory support of brain activity is determined (91-78% of the proper level) along the periphery of the left frontal lobe. On the scan of the cervical spine signs of instability C ₂ -C ₆ .

Based on the studies, the diagnosis was established: CS as a result of the consequences of perinatal damage to the central nervous system, chronic VBB, the threat of syncope, hypertension syndrome, oxygen-dependent hypoergosis.

Recommended treatment:

Within 1 month (from 01.10.2004) introduction

- glycine 0.1 orally at night,

- Essential Forte 1 capsule. 1 time per day at lunch,

- neuromultivitis, 1 tab. 2 times a day,

- Actiferrin 20 cap. 1 time per day.

Day mode: limited physical activity, physiotherapy exercises (with exemption from classes in the main group), preferably an additional day of rest, compulsory day rest, walks of at least 2 hours a day, recreational swimming, homework only in the daytime, the exception of television broadcasts - during the entire course of treatment.

Inspection 05.11.2004 g: the girl, according to her mother, became calmer, more assiduous, falls asleep better, headaches eased, dizziness stopped. There are no significant changes in the neurological status.

The second month of treatment:

- trental 100 on 1 tab. in the afternoon in the afternoon,

- electrophoresis with aminophylline on the collar zone 2 times a week N 10,

- Veroshpiron 1/2 tab. 1 time in 3 days in the morning,

After the completion of drug therapy, the implementation of TCMP is similar to EXAMPLE 1 with the simultaneous administration of the entire TCMP Magnene ₆ daily once a day, riboxin 0.2 1 time per day in the second half of the day, and 100 ml of herbal tea in the morning once every 3 days.

At the end of TCMP, resorption therapy was performed: aloe, 1 ml i / m N 15 every other day with a simultaneous intake of 1 tab. Once a day blueberries forte with zinc and herbal tea. Gentle day routine.

The full course of treatment took 5 months.

Inspection 05/10/2005: the girl is emotionally stable, contact, satisfactorily copes with studies. Virtually no dizziness, no complaints of visual impairment. The sleep returned to normal. Normal skin color, Hb - 116 g / l. The venous network in the temple area decreased. Gref's symptom ± of inconstant character. Focal symptoms are not detected. Muscle tone with mild dystonia in the muscles of the shoulder girdle. CP live, D≥S. Coordination tests are closer to satisfactory. The intensity of functional noise in the heart and respiratory arrhythmia decreased. Stange test - 30 sec.

EEG - bioelectric activity of 55 μV; after functional loads, the initial background is completely restored.

REG - the initial deficiency of pulse blood supply in the WBB 15%, while conducting functional tests - a deficit of 25%.

USDG - signs of stagnation of the venous outflow persist, but to a lesser extent.

Diagnosis: CS in the stage of subcompensation. This positive therapeutic effect was achieved as a result of one course of the treatment method developed by the authors. It should be noted that the child has a rather serious history of pathology as a result of the consequences of perinatal damage to the central nervous system. In the future, treatment according to this scheme will be continued - the girl is at the dispensary.

EXAMPLE 3. Boy K., born in 1994, was admitted to the PMI RAS on 14.05.2003 with complaints of headaches, dizziness, lethargy, severe weakness to a faint.

From the anamnesis: a boy from his first pregnancy, in childbirth there was a long, anhydrous period (6 hours), the fetus was entwined with an umbilical cord around the neck. Birth weight 3300 g. Observed at the place of residence regarding perinatal encephalopathy, hypertension syndrome, there were no seizures. Until school age, it developed without serious deviations. In the first grade, headaches with dizziness, fatigue, disturbance of night sleep, and visual impairment first appeared. However, parents did not seek medical help for a long time. A month before admission to the IMI, the boy first suffered a syncope, a month later this condition recurred, which served as a reason for contacting a neurologist. In the clinic, the boy was examined by specialists and sent for examination at the PMI RAS with suspicion of a central nervous system.

Upon admission to the clinic, PMI: the boy is lethargic, pale, asthenic, with diffuse focal symptoms of residual genesis. Tendon reflexes are reduced (D> S), muscle dystonia, right-sided neurogenic installation torticollis is determined, palpation - instability of the cervical spine. Symptom Gref +. Hb - 105 g / l.

EEG - a decrease in the amplitude of the alpha rhythm in the posterior sections of the cerebral cortex to 20 μV; with functional loads, the initial background was not restored.

REG - the initial deficiency of pulse blood supply in the carotid pool and WBB 15%, while conducting functional tests - a deficit of 60%. Obstruction of venous outflow.

UZDG - asymmetry of blood flow in the internal carotid artery and in the WB. The right vertebral artery is smaller than the left and has a bend at the level of C ₃ , and the outflow to the right is difficult intracranially along the basal veins.

EMC - on the scan, pronounced dystrophic changes in periventricular tissues around the anterior and posterior horns of the lateral ventricles, in the frontal and temporal-occipital regions (more to the right), the activity of neurons is reduced by 20%. According to spectral neurometry, the input of glucose into the brain cells is reduced to 84%, the synthesis of creatine phosphate - to 82% of the norm. EMC of the cervical region: rotation of the C ₂ body in a horizontal plane with a tooth offset of 0.4 mm and instability at the C ₂ -C ₅ level. This necessitated an X-ray examination of the cervical spine and craniovertebral region. The study revealed a shift in the tooth-like process of C _{2 to the} left and a rotational subluxation of C ₁ .

According to the X-ray analysis of the craniovertebral region, no bone abnormalities were revealed, which made it possible to prescribe manual therapy during treatment. To clarify the vascular anomaly, an MRI was performed, according to the results of which a convoluted course of both vertebral arteries was found at the level of C ₁ -C ₄ , i.e. there is an anomaly of blood vessels.

Based on the obtained data, the diagnosis was established: CS, hypoergosis, WB, syncope, hypertensive and hydrocephalic syndrome.

The treatment.

During the first month:

- folic acid at 0.005 1 time per day,

- glycine 0.1 at night,

- ferrum-Lek 100 mg per day,

- mezim-fort for 1 tab. 1 time per day (for dinner),

- MagneV ₆ to 1 tab. per day and vitamin B ₁₂ 400 mg / m every other day,

- Essential Fort for 1 caps. at lunch.

Examination on June 16, 2003: there were no syncopal conditions for a month, neurological symptoms remained practically unchanged.

During the second month:

- cinnarizine at 0.025 1 time per day in the afternoon,

- triampur 1/2 tab. 1 time in three days in the morning,

- deprim 1/2 tab. for the night

- Pantogam 0.25 after breakfast.

- electrophoresis with aminophylline on the collar zone 2 times a week N10.

At the same time, manual therapy using “soft techniques” was performed during this month: PIR (postisometric relaxation) plus traction - all this 2 times a week for the first two weeks, then once a week with obligatory orthopedic correction with a neck corset daily for 1.5-2 hours. A total of 7 sessions.

Inspection 02.08.2003: syncope was still not repeated, there are practically no complaints. Improved memory, attention, perseverance. The improvement in the condition of a child with an initially severe degree of central nervous system is due, in our opinion, to the effectiveness of therapy aimed at correcting cerebral hemodynamic deficiency, in which vasoactive drugs occupied the main place.

From 05.08.2003, they began to conduct TCMP in the same way as EXAMPLE 1 - with sessions once every 10 days. At the end of TCMP, a course of resorption therapy was conducted: lidase 64 units. by electrophoresis on the collar zone N 10 every other day with the intake of riboxin 0.2 g 1 time per day in the afternoon, multivitamins and blueberries forte.

Inspection on 10/12/2003: no complaints, attention, working capacity, school performance improved. There was a desire to learn. On examination, the position of the head is correct, the muscular tone of the shoulder girdle of the back is symmetrical, palpation - instability of the cervical spine remains. The diffuse focal symptoms are the same. Symptom Gref +. CP are invoked, lively, quickly depleted. Coordination tests are fuzzy. Stange test - 25 sec.

Diagnosis: CS and hypertension syndrome in the stage of subcompensation. It is recommended in March to repeat the course of treatment.

On March 11, 2004, when examined before treatment: the child’s condition worsened slightly, her working capacity decreased, attention: the intense school load and the catarrhal diseases suffered by the boy affected. CP is low, coordination tests are fuzzy, Graefe symptom +, a tendency to the formation of right-sided kyphoscoliosis. Test Stange - 18 sec.

EEG - bioelectric activity of 35 μV, decreased compensation after functional loads.

REG - deficiency of pulse blood supply in the WBB, with samples on the right vertebral artery, the deficit is up to 50%. Signs of mild venous stasis.

UZDG - without significant changes.

The course of treatment was repeated - against the background of drug therapy, manual therapy, TCMP and resorption therapy were performed. During the entire course of treatment, a gentle regimen of the day. The course of treatment lasted a little over 4 months.

Inspection in August 2004, before school. There were no syncope, lethargy, fatigue, no dizziness, sleep is not disturbed, active throughout the day. Focal symptoms of residual genesis are dim, scattered. Symptom Gref -. Muscle tone with mild dystonia. CP live, S≥D. Romberg test and finger-nasal - satisfactory. Test Stange - 33 sec. Hb - 134 g / l.

Diagnosis: CS in the stage of subcompensation. Recommended observation by a neurologist and follow-up examination after 3-4 months to decide on the nature of further treatment.

In December 2004, the boy suffered a high fever flu and during school hours he began to feel tired by the end of the day, his previous complaints resumed. This caused the parents of the child to go to the clinic at the place of treatment.

On examination 12.01.2005: in neurological status, focal residual symptoms, a decrease in CP, and lethargy of posture were noted as before. Coordination tests are closer to satisfactory. Stange test - 25 sec. Hb - 112 g / l.

EEG - a decrease in the bioelectric activity of the brain to 40 μV with incomplete restoration of its background values after functional tests.

REG - deficiency of pulse blood supply during functional tests on the right along the right vertebral artery up to 40%. Signs of mild venous stasis.

UZDG - without significant changes.

Conclusion: a slight deterioration in the condition of the child is associated with a viral disease and general asthenization of the body, and it was decided to conduct the third course of treatment in the same modes.

Inspection on May 23, 2005: after the course of treatment, the child’s condition has improved significantly, there are no weaknesses, no fatigue, she is doing well with school. The severity of focal residual symptoms decreased. Posture is close to normal. Symptom Gref -. In coordination samples it is steady.

REG - positive dynamics in the form of reducing the deficiency of pulse blood supply in the WBB with rotation of the head to the right to 25%.

Conclusion: stabilization of the child’s state is achieved, which is expressed in a stable positive clinical and neurological status, despite the fact that the child initially had CS, aggravated by syncope.

Recommendations for the summer: good rest, air and water procedures, swimming, good nutrition, limitation of physical activity. In the fall, come for a checkup.

The proposed method for the treatment of central nervous system compares favorably with the known ones in that it is built on the basis of a comprehensive clinical and neurophysiological examination of the child, is pathogenetically substantiated, and therefore allows achieving a stable positive clinical effect in a fairly short time.

The method was developed at the Department of Emergency Medicine of MAPO together with the Research Institute of Human Evolution and the Center for Rehabilitation of Children of the Kirov District (St. Petersburg) and has been clinically tested in more than 100 children with central nervous system, including those with severe consequences of perinatal injuries - all of them received positive therapeutic effect.

Claims (5)

1. A method for the treatment of children with cerebrosthenic syndrome (CS), including drug therapy, characterized in that when the bioelectrical activity of the brain at rest is below 40 μV and the inability to restore its background values after functional loads for 3 minutes - according to the EEG, deviations neurotransmitter support of brain activity by 10% or more, and / or impaired enzymatic activity with a decrease in glucose utilization and creatine phosphate synthesis - according to the electromagnetic scan (EMC) goal of the brain, establish a central nervous system due to oxygen-dependent brain hypoergosis, and oral or intramuscular administration of amino acids, enzymes, iron preparations, vitamins and hepatoprotective drugs for 1 month, then for 1 month - nootropic and sedatives, as a drug therapy carry out transcranial micropolarization (TCMP) with the simultaneous administration of antihypoxants and multivitamins with trace elements, and such courses of treatment are repeated 2-3 times with an interval between them not her 2 months in compliance with a sparing regime of the day during the entire course of treatment; in the presence of similar changes in EEG, deficiency of the initial pulse blood supply in the carotid and vertebral-basilar pools of at least 10%, and during functional tests - up to 55-75% compared to the norm, as well as signs of obstruction of the venous outflow - according to REG and ultrasound , and a decrease in neuron activity of more than 20% according to EMC, CSs with vertebral-basilar insufficiency and the risk of syncope are established, and vasoactive, antispasmodic and chegon funds for 1 month, and after TCMP, a course of absorbable therapy is carried out; in the presence of instability of the vertebral-motor segments and ligamentous muscle apparatus of the cervical vertebrae and rotational subluxations of C ₁ or C ₂ with tooth displacement of more than 0.2 mm - according to electromagnetic scanning and in the presence of anomalies of the vessels of the brain or neck - according to USG perform an MRI with a vascular program, and when detecting severe instability and / or functional blocks of the vertebrae at the level of C ₁ -C ₅ , and / or displacements of the vertebral discs or vertebral bodies, they also perform manual therapy of the cervical region with using “soft techniques” with the exception of cases of detection of congenital bone abnormality of the cranio-vertebral region detected during MRI. 2. The method according to claim 1, characterized in that when conducting drug therapy as: amino acids use methionine, lecithin, glycine, glutamic and folic acid 1 time per day, enzymes - hilak-forte, mesim-forte, hepatoprotectors - essentia forte, carlsil once a day at lunch, vitamins - At ₁₂ , MagneB ₆ , neuromultivitis, biovital gel with lecithin and calcium 2 times a day, iron preparations - ferrum-Lek, nootropic drugs - pantogam, cogitum, solcoseryl - in the first half a day, absorbable therapy - aloe, lidase, antispasmodics - aminophylline, papaverine, vasoactive drugs - cinnarizine, trental, sedatives - deprim, novopassit, persen for the night, antihypoxants - solcoseryl, riboxin, actovegin, diuretics - herbal collection, lingonberry leaf with chamomile and hypericum, veroshpiron, triampur. 3. The method according to claim 1, characterized in that the TCMP is carried out according to the program of intellectual-mnestic functions in a sparing mode not more than 1 time per week for 4-8 weeks. 4. The method according to claim 1, characterized in that the manual therapy includes at least 3 courses of 5-7 sessions in each of them in combination with orthopedic correction of the cervical spine with a corset daily for 1.5-2 hours. 5. The method according to claim 1, characterized in that the gentle regime of the day includes reducing physical activity, the duration of the school day or an additional day of rest for a week, compulsory day rest, walks of at least 2 hours per day and dosed visual load.