RU2471408C1 - Method of predicting chronic course of migraine in children and teenagers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to neurology, and is intended for predicting chronic course of migraine in children and teenagers. For individual patient with rare migraine headaches prognostic coefficient of each of 20 individual, family and social factors is determined with "+" in case of its presence and "-" in case of its absence: individual factors - intensive headache +7.52 or -6.16; prolonged headache +7.38 or -7.09; medication overuse +8.08 or -5.84; depression +11.74 or -9.55; sleeping disorders +7.96 or -8.37; expressed vegetative disorders +6.61 or -9.82; cognitive disorders +5.2 or -4.59; somatic pathology +5.75 or -3.27; low resistance to infections +5.1 or -1.49; computer, TV addiction +5.29 or -6.08; hypodynamia +3.42 or -4.41; character accentuation +3.07 or -9.71. Family factors - family psychogenies +8.73 or -9.27; painful family - chronic headache in mother, other family members +8.19 or -6.26; high anxiety in mother +7.48 or -9.07; impaired child-parent relationship +6.41 or -8.06; low social-economic status of family +2.5 or -2.22. Social factors are large volume of academic and extracurricular load +5.85 or -5.43; school psychogenies +5.27 or -7.72; psychogenies with peers +4.95 or -3.29. If sum of prognostic coefficients equals or is higher than "+" 13 points, high risk of chronic course of migraine is predicted. If sum is lower than "+" 13 points, but higher than "-" 13 points, conclusion about insufficiency of present signs for making reliable prediction is made. If value equals or is lower than "-" 13 points, favourable course is predicted.

EFFECT: method makes it possible to determine probability of prediction of chronic form of development of chronic form of migraine in children and teenagers.

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Description

The invention relates to medicine, namely to neurology, and is intended to predict the chronic course of migraine in children and adolescents.

It is known that unfavorable individual, family, and social factors predispose to the development of chronic pain (Golubev V.L., Danilov Al.B., Danilov A.B. et al. Psychosocial factors, tenderness and pain // J. Neurology and Psychiatry S.S. Korsakova. - 2004. - No. 11 - p. 70-73 .; Danilov A.B. Biopsychosociocultural model of pain // Doctor. - 2009. - No. 12. - p. 5-8; Scher AI Risk factors for headache chronification / AI Scher, LAMidgette, RBLipton // Headache. - 2008. - V.48. - No. 1. - p.16-25 .; Wang SJ Outcomes and predictors of chronic daily headache in adolescents: a 2-year longitudinal study / SJ Wang, JL Fuh, SR Lu et al. // Neurology. - 2007. -V.68. - No. 8. - p. 591-596 .; Rhee H. Prevalence and predictors of headaches in US adolescents / H. Rhee // Headache. - 2000. - V.40. - No. 7. - p. 528-538).

Depressive, demonstrative, hypochondriacal, excitable, dependent individuals are prone to the development of chronic headache (Izmailova I.G., Belopasov V.V., Kolosova O.A. et al. Clinical and psychophysiological characteristics of headaches in childhood // Zhurn. neuroscience and psychiatry named after S.S. Korsakov. 2002. - No. 4 - p. 4-8 .; Manevich T.M., Sokolova E.D., Yakhno N.N. and others. Features of the personality and mental state of children and adolescents suffering from chronic tension headaches // Journal of Neurology and Psychiatry named after S.S. Korsakov. - 2004. - No. 2 - pp. 11-15).

Passive coping strategies are known to lead to drug abuse due to analgesic abuse, which in turn potentiates the development of chronic cephalgia (Kraaimaat F., Evers A. Pain-coping strategies in chronic pain patients: psychometric characteristics of the pain-coping inventory (PCI) // Int. J. Behav. Med. - 2003. - V. 10. - No. 4. - p. 343-363; Pakalnis A., Butz C., Splaingard D. et al. Emotional problems and prevalence of medication overuse in pediatric chronic daily headache // J Child Neurol. - 2007. - V.22. - No. 12. - p.1356-1359).

Chronicification of headaches in childhood is promoted by stress (Cuvellier JC, Cuisset JM, Vallée L. Chronic daily headache in children and adolescents // Arch Pediatr. - 2008. - V. 15. - No. 12. - p.1805-1814), especially family psychogeny (parental divorce, conflict, antisocial family), “pain families” (Rachin AP Regularities of the formation of chronic headache (clinical, psychophysiological and social factors), optimization of therapy, prognosis and prevention: abstract ... Dr. med. Science / A.P. Rachin - Moscow, 2007 .-- 48 p.).

It is important to increase the information load on schoolchildren and the intensity of the educational process that contribute to the growth of psychosomatic pathology (Isaev D.N. Psychosomatic disorders in children: a guide for doctors. - St. Petersburg: Piter Publishing House, 2000. - 512 p .; Santinello M., Vieno A., Battistella PA Primary headache in Italian early adolescents: correlation with stress and school social support // Epidemiol Psichiatr Soc. - 2006. - V. 15. - No. 1. - p. 52-58).

In specialized periodicals of recent years, the influence of adverse socio-economic factors on the development of chronic headache in children is discussed. The significant role of low social status and cultural level of the family, unsatisfactory living conditions, poverty, unemployment of parents (Unalp A., Dirik E., Kurul S. Prevalence and clinical findings of migraine and tension-type headache in adolescents // Pediatr Int. - 2007. - V.49. - No. 6. - p.943-949).

The main significant drawback of the known publications is that when discussing many risk factors for an unfavorable headache course, including migraine, in childhood only their statement is given, methods for the scientifically based prediction of the migraine course are not developed, and the predictor significance of clinical and medical history is not established. neuropsychological data, their quantitative values are absent.

Risk factors often act not in isolation, but in a complex manner. In this regard, it is necessary not only to determine the independent significance of each of them, but also the degree of their combined impact on the likelihood of developing the disease.

Prediction allows you to determine the prospective scenario for the development of a particular pathology, identify predictor factors, show their significance, develop a set of preventive measures to maintain the health and harmonious development of the child, and, ultimately, prevent the onset of severe forms of the disease (Dzhumagaziev A.A. Possibilities and prospects of forecasting in pediatrics // IPMZH Astrakhan Medical Journal. - 2006. - No. 1. - p. 46-56).

The most valuable forecast form is considered to be a prognostic scenario that allows one to determine the probability of occurrence and severity of the pathological process, evaluate long-term prospects (V. Lisichkin On the reliability of forecasts / V. A. Lisichkin - M .: Knowledge, 1979. - 64 p .; Lakin G .F. Biometrics: Textbook for Biological Specialized Universities - 4th ed. Revised and revised / G.F. Lakin. - M .: Higher School, 1990. - 352 p .; Dzhumagaziev A.A. Prediction of diseases and abnormalities in the development of children in the first two years of life: Methodological recommendations. - Astrakhan, 1992. - 44 p.).

To select the most significant signs that are informative for forecasting, we use original computer programs that allow us to process parameters (clinical, psychological, social and others), calculate their prognostic significance in the form of a prognostic coefficient (PC), select the most informative risk factors for pathology, and group them in prognostic tables (Dzhumagaziev A.A. Prediction of diseases and abnormalities in the development of children of the first two years of life: Methodological recommendations. - Astrakhan, 1992. - 44 p.).

The main task solved by the proposed method is to determine the likelihood of predicting the development of a chronic form of migraine in children and adolescents.

The objective of the invention is achieved due to the fact that in a particular patient with rare migraine headaches, the prognostic factor of each of the 20 individual, family and social factors is determined according to the prognostic table if it has “+” or no “-” individual factors - intense headache +7.52 or -6.16; prolonged headache +7.38 or -7.09; drug abusus + 8.08 or -5.84; depression + 11.74 or -9.55; sleep disturbance +7.96 or -8.37; pronounced autonomic disturbances +6.61 or -9.82; cognitive impairment +5.2 or -4.59; somatic pathology +5.75 or -3.27; low resistance to infections +5.1 or -1.49; abuse of the TV, computer +5.29 or -6.08; physical inactivity +3.42 or -4.41; accentuation of character +3.07 or -9.71; family factors - family psychogeny +8.73 or -9.27; pain family (chronic headache in the mother, other family members) +8.19 or -6.26; high mother anxiety +7.48 or -9.07; violation of parent-child relationship +6.41 or -8.06; low socio-economic status of the family +2.5 or -2.22; social factors - a large amount of academic and extracurricular workload +5.85 or -5.43; school psychogeny + 5.27 or -7.72; psychogeny with peers + 4.95 or -3.29; at the same time, the prognostic factors factors, taking into account the “+” or “-” sign, summarize, with the sum of the prognostic factors equal to or more than “+” 13 points, a high risk of chronic migraine is predicted, with the amount less than “+” 13 points, but more than “-” 13 points judge the insufficiency of the available signs for making a reliable forecast, with a value equal to and less than “-” 13 points, they predict a favorable course.

The prognostic coefficients (PC) were calculated according to the Wald formula (see Gubler E.V. Computer science in pathology, clinical medicine and pediatrics. - Leningrad, - 1990. - 176 p.) PC = 101gP1 [xi / A] / P2 [xi / B], where PC is the prognostic factor;

P1-2 - the probability of getting patients with state A and B in the group of patients with the opposite state; xi / A, xi / B - designation of the probability of states.

Neither from the patent literature, nor from the medical literature, as well as from medical practice, was aware of the proposed method for predicting the chronicity of migraine in children and adolescents. The set of essential features of the proposed solution is new, which means that this solution meets the criterion of novelty, necessary for recognition of his invention. Moreover, the totality of the claimed object of new essential features is connected by a causal relationship with the solution of the problem, where each of the new essential features is necessary, and all together are sufficient to solve the problem. In this solution, the totality of new significant features is the cause, and the result of solving the problem is the consequence.

Thus, the claimed solution meets the criterion of "inventive step".

The set of essential features characterizing the new solution can be repeatedly realized with the solution of the same problem, which meets the criterion of "industrial applicability" for recognition of its invention.

The proposed method was tested on the basis of the Department of Nervous Diseases of the State educational institution "Astrakhan State Medical Academy" of the Ministry of Health and Social Development of the Russian Federation in 2009-2010. Based on the prognostic tables, prognostic scenarios were compiled for 29 children with infrequent migraines. In 8 of them, the total prognostic coefficient exceeded 13 points. The verification percentage for the confirmed diagnosis of chronic migraine was 75%. The remaining children (25%) showed an increase in migraine attacks up to 3-4 times a month. Below are the results of testing.

Example 1: Girl 12 years old, diagnosed with migraine without aura. Rare, not prolonged attacks of intense headache (9 points) 1 time in 1-2 months were stopped by taking analgesics (without abusus). At the time of making the forecast, sleep disturbance, pronounced autonomic disorders with a predominance of parasympathetic tone (38 points), and concomitant pathology (chronic gastroduodenitis) were revealed. SARS rarely gets sick. Cognitive indicators are normal, no depression. Psychasthenic accentuation of character.

A girl from a prosperous family with good material wealth and living conditions. Father is a programmer, mother is a teacher, suffers from a chronic tension headache; the level of personal anxiety of the mother was 54 points - high. Symbiotic authoritarian style of parent-child relationship. Studying at the gymnasium, learning two foreign languages, doing lessons for a long time, sitting at the computer. She studies well, there are no conflicts with teachers, and relations with peers are friendly.

Assessment of survey results:

1. The absence of signs in the amount amounted to (-51.06) points.

2. The presence of risk factors totaled 67.55 points.

3. The total amount: 16.49 points, that is, a high risk of a chronic course of migraine is predicted.

It is necessary to carry out preventive measures:

1. Therapeutic:

a) treatment of autonomic and insomnia disorders in a girl;

b) treatment of chronic maternal tension headache with the use of anxiolytics and antidepressants.

2. Psychotherapeutic correction of the accentuation of the girl’s character, disturbed parent-child relationships, emotional disorders of the mother, the formation of adaptive strategies for overcoming headaches in mother and child.

3. Mode hygiene:

a) compliance with the diet and diet to prevent exacerbation of gastritis in a child;

b) the organization of a rational regime with alternating mental loads with physical activity, walks; limitation of computer load, introduction to the daily conduct of the evening "sedative ritual".

Example 2. Girl 11 years old, diagnosed with migraine without aura.

GB - intensive (8 points), lasting up to 4 hours, with a frequency of up to 1 time in 1-3 months, are stopped by sleep or taking analgesics (without abusus). During the examination, vegetative dysfunction of a moderate degree (30 points), sleep disturbance, decreased voluntary attention, and prolonged serial counting time were determined. Somatically healthy, respiratory infections are rare. There are no depressive manifestations, hysterical accentuation of character.

A friendly family with an average income, parents successfully do business; they do not suffer from chronic cephalalgia, my mother has a rare migraine (1 time in 3-4 months). Relations with a child are built on the type of condoning hyperprotection. The level of personal anxiety of the mother 49 points - high. The girl is studying in a general education program. There is no school maladaptation. In the evenings, in her free time she likes to sit by the TV, computer (more than 2 hours), chat with her friends on the Internet.

Assessment of survey results:

1. The absence of signs in the amount amounted to (-71.25) points.

2. The presence of risk factors totaled 46.35 points.

3. The total amount: (-24.9) points, that is, a favorable course is predicted, the girl with a high degree of probability is protected from the transformation of migraine into a chronic form.

Despite the absence of a direct threat of chronic migraine, recommendations can be made to optimize the regime of the day: reducing the television load in the evening will improve falling asleep and the quality of sleep, and increasing the time of walking will solve the problem of physical inactivity. Psychotherapeutic correction of parent-child relationships, anxiety in the mother and accentuation of character in the girl is desirable.

Thus, the use of this forecasting method allows to determine the probability of predicting the development of a chronic form of migraine in children and adolescents, and to significantly simplify the identification of children with a high risk of chronic migraine. In addition, this forecasting method provides the key to conducting informed individual comprehensive preventive measures aimed at minimizing predictor factors identified in each particular case, relying on the available protective medical and social conditions. The forecasting method and the prognostic table can be recommended for practical use in children's medical institutions, for school doctors (together with school psychologists).

Claims (1)

A method for predicting the chronic course of migraine in children and adolescents, which consists in the fact that in a particular patient with rare migraine headaches, the prognostic coefficient of each of the 20 individual, family and social factors is determined with the presence of “+” or absence of “-”: individual factors - intense headache +7.52 or -6.16; prolonged headache +7.38 or -7.09; drug abusus + 8.08 or -5.84; depression + 11.74 or -9.55; sleep disturbance +7.96 or -8.37; pronounced autonomic disturbances +6.61 or -9.82; cognitive impairment +5.2 or -4.59; somatic pathology + 5.75 or -3.27; low resistance to infections +5.1 or -1.49; abuse of the TV, computer +5.29 or -6.08; physical inactivity +3.42 or -4.41; accentuation of character +3.07 or -9.71; family factors - family psychogeny +8.73 or -9.27; pain family - chronic headache in the mother, other family members +8.19 or -6.26; high mother anxiety +7.48 or -9.07; violation of parent-child relationship +6.41 or -8.06; low socio-economic status of the family +2.5 or -2.22; social factors - a large amount of academic and extracurricular workload +5.85 or -5.43; school psychogeny + 5.27 or -7.72; psychogeny with peers + 4.95 or -3.29; the prognostic factors factors, taking into account the “+” or “-” sign, summarize, with the sum of the prognostic factors equal to or more than “+” 13 points, a high risk of chronic migraine is predicted, with the sum less than “+” 13 points, but more than “-” 13 points, they judge the insufficiency of the available signs for making a reliable forecast, with a value equal to or less than “-” 13 points, they predict a favorable course.