RU2494680C1 - Method of diagnosing congenital dysfunctions of brain hemispheres in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics and can be used in neurology, medical psychology and psychiatry. Clinical examination of children is carried out by complaints, anamnestic information and data of physical examination. Assessed are: symptoms of vegetative manifestations at the moment of examination and peculiarities of sensomotor reactions: weight and length of body at birth, gestation age, response to stimulation in children of first year of life, sleep in children of first year of life, EEG in children of early age, parasomnia, enuresis, meteosensitivity, headaches, vessel lability, vestibulopathy, peculiarities of motor sphere, feeding behaviour, skin manifestations, course of infectious and somatic diseases, menstrual disorders in adolescent girls, brain ultrasound examination. Connection of said disorders with predominant dysfunction of right or left brain hemispheres is determined.

EFFECT: method makes it possible to increase reliability of diagnostics, which is achieved due to taking into account vegetative reactions and disorders in child of first year of life.

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Description

A known method for the diagnosis of minimal brain dysfunctions, including the assessment of clinical signs, is carried out to determine the level of neuron-specific enolase in blood serum by enzyme-linked immunosorbent assay and when the NSE content is from 11.19 μg / l to 18 μg / l, they conclude that there is a diagnosis of minimal brain dysfunctions (RF Patent No. 2282858).

A known method for the diagnosis of minimal brain dysfunctions by immunological analysis of peripheral blood, while the content of cerebral neurotrophic factor in the blood serum is determined by enzyme immunoassay and when the level of BDNF (cerebral neurotrophic factor) is less than 34.54 pg / l, the presence of minimal brain dysfunctions is confirmed (RF Patent No. 2277247).

A known method for the diagnosis of dysfunctions of one of the hemispheres of the brain by the asymmetry of motor reflexes and sensory disorders (A. A. Skoromets. Topical diagnosis of diseases of the nervous system. - Leningrad: Medicine, 1989. - 320 s).

A known method for the diagnosis of dysfunctions of one of the cerebral hemispheres based on the symptoms of disorders of higher mental functions, specifically associated with the left or right hemisphere when using sets of specialized tasks (LS Tsvetkova. Methods of diagnostic neuropsychological examination of children. - M., 1997. - p. 24-74).

The disadvantage of these methods is that the autonomic features and reactions with the predominant dysfunction of the cerebral hemispheres are practically not correlated and, accordingly, it is impossible to get an idea of autonomic syndromes and the dynamics of their development in ontogenesis in children with cerebral residual-organic background of an innate nature.

There is a method of diagnosing developmental disorders in adolescent girls with menstrual disorders, in which their innate features of the neurological status, the complex and dynamics of autonomic dysfunctions, psychological and behavioral problems at different stages of ontogenesis are noted (Brin I.L., Dunaikin M.L., Sheinkman O.G., Dolzhenko I.S. / Neuropsychic development of adolescent girls at risk of reproductive health disorders // Pediatrics. - 2007; 86; 3: 52-57).

However, this particular case of a hemispheric neuropsychological syndrome concerns only girls and does not cover a number of other manifestations of violations of autonomic regulation in childhood.

Closest to the claimed one and taken as a prototype is a method for determining neuropsychological syndromes in children of the first year of life according to the characteristics of the mental development of various areas (motor, sensory, emotional and voice reactions, actions with objects and when interacting with an adult), determined by the response to stimulation (reduced with right-hemispheric and enhanced with left-hemispheric brain dysfunction) (ML Dunaikin. Neuropsychological analysis of mental disorders of children of the first year of life from per atalnym brain damage -. Abstract of diss candidate of psychol Sciences -.... Moscow, 2003. - 27 s). The reaction to stimulation in children of the first year of life is a complex of emotional, motor and behavioral manifestations in response to a change in the environment: the appearance in the field of view of a new object or other sensory stimulus, a person, and so on. With an enhanced reaction, the revitalization complex is over-expressed, which is manifested by psychoemotional and motor excitement up to the impossibility of concentrating the child on age-appropriate activities. The reduced reaction is manifested by the weak response of the child to external stimuli, i.e. an increase in the latent period of response to the stimulus, a short period of concentration, a muffled emotional accompaniment with the continuation of one's own activity. The response to stimulation reflects not only the response to a psychogenic stimulus, but also the adaptive biological reactivity of the body to changing environmental conditions in a broad sense, which is largely regulated by the autonomic nervous system.

The disadvantage of this method is that the diagnosis of lateral neuropsychological syndrome does not include symptoms of autonomic dysfunctions, and is also limited by the age of children under 1 year.

The objective of the invention is to develop a new method for the diagnosis of congenital dysfunctions of the cerebral hemispheres according to the characteristics of autonomic reactions and disorders in children from birth to 18 years.

The technical result of the implementation of the task is to develop criteria for the diagnosis of congenital dysfunctions mainly of the right and left hemispheres of the brain according to the characteristics of autonomic reactions and disorders.

The essence of the method lies in the fact that for the diagnosis of congenital dysfunctions of the cerebral hemispheres in children, the symptoms of autonomic manifestations are evaluated both anamnestically and by complaints and clinical manifestations at the time of examination: body weight and length at birth, gestational age, response to stimulation in children of the first years of life, sleep and parasomnia, EEG of sleep in young children, enuresis, meteosensitivity, headaches, vascular lability, vestibulopathy, motor features, eating behavior, skin problems manifestations, the course of infectious and somatic diseases, disorders of the menstrual cycle in adolescent girls, brain ultrasound, with: low morphometric indicators at birth, prematurity, increased reaction to stimulation in children of the first year of life, impaired falling asleep with the need for prolonged motion sickness, shuddering during sleep, a superficial shortened dream with frequent awakenings and calm in the hands of parents, a delay in cortical electrogenesis and the formation of a theta rhythm of falling asleep with frequent outbreaks of high casta teta-delta activity without typical epicomplexes, motor anxiety, congestion after emotional arousal, delayed establishment of urination control, nocturnal enuresis in the second half of the night or in the morning, usually with awakening and resumption of its episodes with emotional arousal, increased meteosensitivity with increasing atmospheric pressure , situational and short-term headaches of a spasmodic and pulsating nature, directly related to physical or emotional stress and weather fluctuations, marked vascular lability during physical exertion with a tendency to increase blood pressure, general disinhibition with difficulty in fine motor skills and a tendency to muscle hypertonicity at an early age, anxiety before feeding and during meals with aerophagia, rapid saturation and regurgitation in the first year life, a tendency to hypotrophy, dry pale skin and neurodermatitis, the acute course of infectious and somatic diseases with hyperergic reactions, hyperthermia, a tendency to rorragii with asthenia and underweight adolescent girls, amplification ehopulsatsii extension III and IV diagnosed ventricular dysfunction brain left hemisphere; and with high morphometric indicators at birth, tolerance, a reduced reaction to stimulation in children of the first year of life, sleep and wake inversions, self-stimulation during motion sickness, awakening with a cry and cry after an individually determined time for the child after falling asleep and calming with individually specific rituals and techniques self-cultivation, normal maturation of cortical electrogenesis with rough exaltation of sleep spindles up to epic-like phenomena, parasomnias in the form of phrases, dreams, brooks ism, nightmares, individual rhythm of enuresis with the loss of urine in the first hours of sleep without waking up and associated with the lunar phases, long-lasting weather sensitivity, expressed in cloudy weather and tied to the lunar phases, accompanied by mood changes, persistent, frequent headaches that are delayed after stress situations or with prolonged emotional stress, of a different nature, but with a tendency to migraine episodes, vascular lability in emotiogenic situations with a tendency to arterial hypotension and increased pressure in adolescence, vestibulopathy, muscle hypotension with good fine motor skills, calm during feeding, tendency to spastic constipation, paratrophy, food selectivity, difficulty controlling appetite, wet skin, prone to diaper rash, wet eczema, acne, prone to furunculosis, sluggish course of diseases with paradoxical reactions, a tendency to relapse, chronic process and psychosomatic manifestations, opsomenorrhea, long delays or amenorrhea along with with overweight and symptoms of hypothalamic dysfunction in adolescent girls, the predominance of enlargement of the lateral ventricles of the brain, often the right, diagnose dysfunction of the right hemisphere of the brain.

A significant difference between the proposed solution and the known ones is the development of a table of symptoms of autonomic manifestations characteristic of the predominant dysfunction of one of the cerebral hemispheres in childhood, which allows us to predict the risks and variants of psychosomatic disorders in order to plan preventive, therapeutic and corrective measures.

Table Symptoms of autonomic manifestations in children with predominant dysfunction of one of the cerebral hemispheres. Criteria for evaluation Symptoms characteristic of dysfunction of the left hemisphere of the brain Symptoms characteristic of dysfunction of the right hemisphere of the brain Weight and body length at birth Low, intrauterine growth retardation possible Above average Gestational age Often prematurity Often postponement Stimulation response in children of the first year of life Reinforced Lowered Sleep in children of the first year of life Violation of falling asleep with the need for prolonged motion sickness, trembling in a dream, a superficial shortened sleep with frequent awakenings. Children calm down in the arms of their parents. Inversion of sleep and wakefulness, a peculiar way of motion sickness with self-stimulation, night awakenings with a cry and cry after an individually determined time for the child after falling asleep. Children calm down with individually specific rituals. EEG of sleep in young children Delay in cortical electrogenesis (by 0.5-1 Hz) and the formation of theta rhythm of falling asleep (early stage of slow sleep), frequent outbreaks of high-amplitude theta-delta activity without typical epi-complexes, coinciding with movements in the distal parts of the child's limbs, sometimes an outbreak accompanied by a K-complex followed by an exalted "spindle of sleep." Normal maturation of cortical electrogenesis, rough exaltation of spindles of sleep up to epic-like phenomena. Parasomnia Motor anxiety, dreaming after emotional arousal, fears. Self-healing techniques; sleep-stealing, drowsiness, bruxism, nightmares. Enuresis Delay in the establishment of control of urination, at an early age often diurnal enuresis ("did not have time"); nocturnal enuresis more often in the afternoon or in the morning, usually with awakening. Episodes of nocturnal enuresis can resume with emotional arousal, in a new environment, in conflict situations (even at school age). It is characterized by individual rhythm, more typical is the loss of urine in the first hours after falling asleep without waking up. A connection with the lunar phases is noted. Weather sensitivity Increased, more pronounced with increasing atmospheric pressure, increased anxiety, vascular lability, dyspeptic and hypertensive disorders (regurgitation, Graefe symptom, dystonic phenomena). Smoothes with age. It is more associated with the lunar phases, more distinctly in cloudy weather; mood changes with a dysphoric hue, increased negative reactions, sleep disturbances are characteristic. It is stored for a long time. Headache Situational, short-term, directly related to physical or emotional stress and meteorological oscillations, spasmodic and pulsating in nature. They arise delayed after stressful situations or with prolonged emotional stress, persistent, frequent, varied, but with a tendency to migraine episodes. Vascular lability Expressed, associated with physical activity; tendency to increase blood pressure. It is associated with emotional situations; often vasopathic spots, tendency to arterial hypotension, puberty episodes of high blood pressure. Vestibulopathy Seldom Often Features of the motor sphere General disinhibition, difficulties in fine motor skills, at an early age a tendency to hypertonicity of muscles. Long-term tendency to hypotension, good fine motor skills. Eating behavior Anxiety before feeding and during meals, aerophagia, rapid satiety, regurgitation. Under adverse conditions, children are prone to hypotrophy. Preference for carbohydrate and easily digestible foods. Quite calm during feeding, “demanding”, there may be delayed colic, a tendency to spastic constipation. Often paratrophy. Often the selectivity of food (especially in children with autism), the need for protein-fat products. Difficulties in controlling appetite, including bulimia (more often in boys) or anorexia nervosa (more often in girls), especially in adolescence. Skin manifestations The skin is dry, pale, acrocyanosis; phenomena of neurodermatitis (against the background of an asthenic state after long periods of stress). The skin is wet, at an early age diaper rash; hyperhidrosis (especially of the scalp when falling asleep), weeping eczema. By puberty - Aspae, often infection of elements (with furunculosis). The course of infectious and somatic diseases Acute, with hyperergic reactions, hyperthermia, subsequent asthenia. Paradoxical reactions, a sluggish course, a tendency to recycle and chronize the process, and psychosomatic manifestations are frequent. Menstrual disorders in adolescent girls Propensity to metrorrhagia, general asthenia, lack of body weight. Opsenomenorrhea (rare, meager periods), prolonged delays or amenorrhea along with overweight and other symptoms of hypothalamic dysfunction (clinical and hormonal). Ultrasound of the brain Strengthening echo pulsation, expansion of the III and IV ventricles The expansion of the lateral ventricles of the brain is predominant, D> S

The method is as follows: during a clinical examination of children according to complaints, anamnestic information and physical examination data, symptoms are noted on the table of features of vegetative manifestations, determining the relationship of these disorders with predominant dysfunction of the right or left brain.

Examples of clinical implementation of the method

Example 1. Girl Tanya Sh., 13.5 years old, was consulted by a gynecologist in connection with uterine bleeding twice a month for 9 months. Along with this, complaints of episodic headaches after training overload (from 10 years), coordinating awkwardness. History: threatened miscarriage of mother, premature birth at 37 weeks with a fetus weighing 2500, 45 cm long, in a state of moderate severity (pneumopathy, conjugation jaundice, edematous syndrome). In the first year of life was excitable, the development of motor skills with a slight delay, went independently at 1 year 2 months; up to 8 years old was distinguished by motor awkwardness, often fell. They noted restless sleep (the need for prolonged motion sickness, frequent awakenings), an extended period of formation of urination control (up to 4 years), emotional excitability and lability, sensitivity to weather fluctuations with increasing anxiety. She was ill often, but respiratory diseases were acute, with hyperthermia. During the examination, attention was drawn to a lack of body weight (56 kg with an increase of 176 cm), dry skin, and lability of blood pressure (episodes of its increase during physical activity up to 140/90 mm Hg were noted at the usual level of 110/75 m Hg )

In accordance with the table of symptoms of vegetative manifestations, the prevalence of dysfunction of the left hemisphere of the brain was diagnosed, which was correlated with the features of mild asymmetry of motor reactions (revitalization of tendon reflexes in the right extremities, difficulty in performing dynamic praxis with the right hand) and narrowing of the volume of auditory speech memory with delayed reproduction of groups of words. The treatment program, taking into account the revealed lateralization of violations, allowed to quickly stop problems, normalize the menstrual cycle (metrorrhagia and the need to use hormonal regulators of the cycle stopped). The girl was observed for 3.5 years, the family followed the recommendations for the prevention of possible decompensations of the condition, treatment courses were held, timed to coincide with increased training loads. Towards the end of childhood, harmonization of physical and psychological development was noted, the girl successfully studied at the university, noted high activity and performance, good mood.

This case demonstrates the features of vegetative manifestations with a predominance of dysfunction of the left hemisphere of the brain, which can be diagnosed from an early age, and with targeted prevention and treatment to prevent severe disorders to puberty.

Example 2. A girl Dasha F., 16 years old, 9 months old, was consulted by a gynecologist in connection with ovarian dysfunction (extended cycle, painful periods). The girl complained of daily headaches of a spasmodic nature of the temporal-frontal and sometimes occipital localization (in the latter case, with an increase in blood pressure to 135/90 mmHg at normal pressure of 100/75 mmHg), which was associated with fatigue against the background of training loads and psycho-emotional stress with anxiety if necessary, public speaking (answers in the classroom at the blackboard) and contacts with strangers; noted violations of falling asleep, a restless night's sleep with frequent nightmares, recent panic sensations in enclosed spaces, frequent urges to urinate during periods of excitement. In the anamnesis: pregnancy in mother with the threat of interruption against the background of anemia and hypertension, childbirth 2 weeks later by cesarean section with a large fetus (3900 g, 52 cm) in serious condition (resuscitation was performed). The girl was systematically treated, motor development with some delay in the formation of motor skills against the background of muscle hypotension, but with good manual skill. Sleep disturbances were noted: in the first year of life, sudden awakenings with trembling, screaming, calmed down with a certain sequence of parents' actions (walking along a certain route in the apartment), sucking on a favorite toy; at an older age, disturbances of night sleep in series confined to the full moon, often with dreaming and sleepiness, episodes of enuresis. In preschool age, spasmodic abdominal pain (diagnosed with gallbladder dysfunction), headaches from 7 years old with an increase in their frequency and severity with age. Often sick with respiratory diseases (long-term, with allergic manifestations). On examination: excess nutrition (70 kg, height 165 cm), face and back skin with aspae (individual elements with boils, there are traces of former suppuration), eczema with peeling of the skin on the border of the scalp and forehead, increased limb hair growth. Vasopathic spots, facial flushing, persistent red dermographism, crimson striae on the chest and inner thighs, and hyperhidrosis (with cyanotic palms and feet) are expressed. In accordance with the table of symptoms of the features of vegetative manifestations, the predominance of dysfunction of the right hemisphere of the brain was diagnosed, which was taken into account in the treatment program. The girl was observed for 4 years with a gradual improvement in condition and relief of problems. This observation demonstrates the possibility and necessity of early diagnosis of the predominant lateralization of cerebral dysfunction according to the symptoms of autonomic features and disorders, which would prevent the development of quite severe somatic and psychological problems at all stages of childhood.

The proposed method has shown its effectiveness in the diagnosis of lateralization of congenital cerebral dysfunctions, which allowed us to offer differentiated methods of correction and treatment of developmental disorders of children of different ages.

The method can be used for early determination of risk groups for various psychosomatic pathologies at different stages of childhood, which is necessary for preventive purposes. The proposed diagnostic method is available for use by doctors of various specialties, which allows for the effective interaction of specialists and screening of patients during mass examinations for the purpose of their further in-depth examination.

Claims (1)

A method for diagnosing cerebral hemisphere dysfunction in children, including a study of sensorimotor reactions, characterized in that it is further examined in accordance with the table described in the description, the features of the anamnesis and autonomic reactions of the child and the prevalence of dysfunction of the right or left hemisphere is revealed.