RU2505293C1 - Method of treating disturbed neuropsychic development of childhood - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: preparation of carnitine is administered in the following doses: in the children aged 1-6 months old - 100 mg/day, 6-12 months old - 150 mg/day, 1-3 years old - 200 mg/day, 3-7 years old - 500 mg/day, 7-10 years old - 1000 mg/day, 10 years old and more - 1500 mg/day for more than 3-6 months, and the therapy of right hemisphere dysfunction requires high doses, namely: in the children aged 1-6 months old 150 mg/day, 6-12 months old - 225 mg/day, 1-3 years old - 300 mg/day, 3-7 years old - 1000 mg/day, 7-10 years old - 1500 mg/day, 10 years old and more - 2000 mg/day for 2-3 weeks; thereafter minimum age doses are prescribed in the therapeutic course of 3 weeks every 3 weeks. The length of the treatment makes from 3 months to 3 years depending on the patient's state.

EFFECT: dose schedule provides the effective therapy of the disturbed neuropsychic development and the absence of side effects accompanying the long administration of the preparation.

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Description

The invention relates to medicine, namely to methods for treating disorders of neuropsychic development in childhood, including developmental delays and borderline neuropsychic disorders of behavior and adaptation, such as hyperactivity (including attention deficit), neurosis-like, autistic and affective disorders , and can be used in neurology, psychiatry and pediatrics.

Known methods for treating L-carnitine preparations, such as elkar, carnitene, carnitine chloride, of borderline neuropsychic states of various genesis in patients with asthenoneurotic reactions, neurosis-like, anxiety-phobic and obsessive-compulsive disorders, hyperdynamic and autistic syndrome (1. Sukhotina NK et al. Experience in the use of nootropics in borderline mental disorders in children, Psychiatry and psychopharmacotherapy 2004; 6 (6): 298-301); 2. Brin I.L., Dunaikin M.L., Sheinkman O.G. Elkar in the complex treatment of disorders of the neuropsychic development of children with the consequences of perinatal brain damage. Questions of modern pediatrics 2005; 4 (1): 32-39.).

The disadvantage of these methods of treatment is the possibility of the effects of "reactivation" in the form of headaches, increased enuresis, psychomotor agitation, which is associated with underestimation of the individual characteristics of the neuropsychic response inherent in various neuropsychological syndromes.

There is a method of treating borderline neuropsychiatric disorders, according to which carbamazepine of prolonged action is used at a dose of 30 to 50 mg in children under the age of 10 years and at a dose of 50 to 100 mg in people over 10 years of age before going to bed at night. In addition, glycine is prescribed, angiotropic drugs selected from the group: vinpocetine, pentoxifylline, ginkgo biloba and L-carnitine preparations in therapeutic doses in the morning. The duration of a continuous course of treatment is from 3 months to 3 years. Additionally, in case of severe mental exhaustion, people over 8 years of age are prescribed L-DOPA + carbidopa drugs in a dose of 30 to 60 mg of L-DOPA once in the morning (RF Patent No. 2321408).

As a prototype, we took a method of dosing L-carnitine depending on the condition of the patients, in which small and medium doses are prescribed for prophylactic and supportive purposes, and high dosages for elevated loads and decompensated conditions (see table 1), and L- carnitine is prescribed in the morning once in the morning or in two divided doses - before breakfast and lunch (Brin I.L., Dunaikin M.L., Sheinkman O.G. Disorders of neuropsychic development. - In the book “Correction of metabolic disorders in various pathologist iCal conditions in children (. Ed AD Tsaregorodtseva, EA Nikolaeva, VS Sukhorukov.) - M .: Publishing House Medpraktika - M 2006 "- s.44-52).

Table 1 Recommended Doses of L-Carnitine Children's age Doses of L-carnitine (mg per day) the minimum medium high 1-6 months 75 one hundred 150 6-12 months 75 150 225 1-3 years one hundred 200 300 3-7 years old 300 500 1000 7-10 years 500 1000 1500 over 10 years old 1000 1500 2000

The disadvantage of this method is the lack of differentiated indications for the dosage and rhythm of taking L-carnitine preparations for children with different structures of impaired neuropsychic development.

The objective of the invention is to develop a method for the treatment of children with impaired neuropsychic development with carnitine preparations differentially depending on the prevalence of left- or right-hemisphere brain dysfunction.

The technical result of the implementation of the task is to develop a differentiated dosage regimen and rhythm of taking L-carnitine preparations, depending on the prevalence of dysfunction of one of the cerebral hemispheres in childhood.

The essence of the method lies in the fact that, when diagnosing a predominant dysfunction of one of the cerebral hemispheres in case of impaired neuropsychic development in childhood, including developmental delays and borderline neuropsychic disorders of behavior and adaptation, L-carnitine preparations are prescribed in complex or monotherapy, such like elkar, carnitine, carnitine chloride, in the morning, once in the morning or in two doses - before breakfast and lunch, and children with left brain hemisphere dysfunction are treated with carni drugs tina begin with minimal age doses for 2-3 weeks, after which they increase the dose to medium therapeutic and, if necessary, continue treatment continuously for 3-6 months, and children with right hemisphere dysfunction begin therapy with high doses for 2-3 weeks, after which switch to the use of minimum dosages in intermittent courses of 3 weeks with 3-week breaks between them. The duration of treatment is from 3 months to 3 years, depending on the condition of the patients.

The method is as follows. In cases of impaired neuropsychic development in childhood, including developmental delays and borderline neuropsychic disorders of behavior and adaptation, clinical methods are used to diagnose predominant dysfunction of one of the cerebral hemispheres. In complex or monotherapy, L-carnitine preparations are prescribed, such as elkar, carnitene, carnitine chloride, in the morning once in the morning or in two doses - before breakfast and lunch.

In children with dysfunction of the left hemisphere of the brain, carnitine therapy is started with the minimum age doses, namely: in children 1-12 months old, 75 mg / day, 1-3 years old - 100 mg / day, 3-7 years old - 300 mg / day, 7 -10 years - 500 mg / day, over 10 years - 1000 mg / day for 2-3 weeks, after which they increase the dose to the average therapeutic, namely: in children 1-6 months, 100 mg / day, 6-12 months - 150 mg / day, 1-3 years - 200 mg / day, 3-7 years - 500 mg / day, 7-10 years - 1000 mg / day, older than 10 years -1500 mg / day, with possible continuous use up to 3-6 months.

In children with dysfunction of the right hemisphere, therapy is started with high dosages, namely: in children 1-6 months, 150 mg / day, 6-12 months - 225 mg / day, 1-3 years - 300 mg / day, 3-7 years - 1000 mg / day, 7-10 years - 1500 mg / day, over 10 years - 2000 mg / day for 2-3 weeks, after which they switch to using the minimum age dosages in intermittent courses for 3 weeks with 3-week breaks between them . The duration of treatment is from 3 months to 3 years, depending on the condition of the patients.

A significant difference between the proposed solution and the known ones is the development of a method of using carnitine preparations in children with impaired neuropsychic development, differentiated by dosage and mode of administration, depending on the prevalence of dysfunction of one of the cerebral hemispheres.

Examples of the method

Example 1. Twin sisters Ksenia and Anna K. were examined at 9 months of age due to a delay in motor development. Of history: the girls were born a little earlier than the deadline, at 38 weeks, Ksenia was the first in the head presentation with a weight of 2800/51 cm in moderate condition, and Anna the second in the pelvic presentation with a weight of 1800/42 cm in serious condition with bilateral congenital dislocation of the hips. The period of the newborn ™ in both is weighed down by pneumonia, purulent otitis media and omphalitis; before the examination, the children had a sleep disorder - startling and waking up with a cry from Ksenia and difficulty falling asleep with the need for motion sickness in Anna’s parents ’hands, lack of weight in the“ younger ”and a tendency to overweight in the“ older ”. A district pediatrician was prescribed L-carnitine - Elkar at a dose of 300 mg / day to treat Anna's malnutrition, and there was an increase in anxiety, decreased sleep, regurgitation and weight loss over a week of 200 g. On examination: Xenia with excessive subcutaneous fat layer, passive, motor skills with a slight delay: sits with light support, can stand at the support, but does not stand up, can crawl, but performs only the beginning of the action, against the background of muscle hypotension and slight restriction of movements in the left limbs; the girl performs manipulations with objects well, babbling sounds are expressed and there are their combinations. Anna is hypotrophic - a weight deficit of about 10%, excitable, distracted, trying to sit down, crawl, but quickly exhausted. Against the background of arousal, muscle hypertension is distinct, an asymmetric cervical-tonic reflex to the right manifests itself with a pathological installation of the right limbs. Voice activity in the form of a predominance of laryngeal sounds, single babble ones are outlined. Thus, in the picture of perinatal encephalopathy in both girls there was a delay in motor development and autonomic dysfunctions — disturbances in trophism, sleep, but in Ksenia the dysfunction of the right hemisphere prevailed, and that of Anna — the left. Both girls were prescribed Elkar monotherapy, but in different disinfections and regimen: Xenia at a dose of 225 mg / day for two weeks, then 75 mg / day for 3 weeks; Anne - 75 mg / day for 3 weeks, then 150 mg / day for another 3 weeks. After 1.5 months of treatment, the girls were examined again, an improvement was noted in all problem areas. Ksenia has become more active, the planned motor skills are well implemented - she crawls, gets up, steps over with support, her weight returned to normal, her sleep is calm. Anna gained weight well - her weight and height indicator was normal, she became calmer, her muscle tone returned to normal, the asymmetric neck-tonic reflex was reduced, her “speech” repertoire was enriched, long manipulations with objects appeared — her leading hand was left, the girl was sitting steady, crawling, standing and steps over to the support.

This example demonstrates the possibilities of carnitine monotherapy with developmental delays in children of the first year of life and the need for a differentiated regimen and rhythm of its dosage, taking into account the predominant damage to the hemisphere of the brain.

Example 2

Andrei R., 4 years 2 months, consulted about complaints of developmental delay (speech, skills, coordination and agility of movements, communication skills and neatness), a short period of productive activity and quick exhaustion with increasing excitement and the appearance of aggressive and destructive tendencies and satiety, falling asleep with the appearance of myoclonus in the muscles of the neck, trunk and arms. Of anamnesis: the mother’s pregnancy was physiological, the delivery on time was arbitrary in the head presentation by the fetus, weighing 2720 g, length 49.5 cm, in satisfactory condition. At the age of 6 months, the child underwent surgery on the stomach for pyloric stenosis, after which development with a pronounced delay (crawling and sitting from 12 months, walking from 2 years), malnutrition (protein deficiency of animal origin). At 2 years 7 months, a total developmental delay was diagnosed: motor functions by 32-48% (statics by 32%, dynamics by 48%, manipulation of objects by 35%), cognitive skills by 23% (with distortion of the sequence of their formation), speech on 24-35% (also with a distortion of the sequence of its formation with better development of impressive speech than expressive with a violation of its intelligibility and severe salivation), emotional and communicative skills by 54% (with the avoidance of a group of peers and a tendency to stereotypical activities, short eye contact m and negativistic reactions to requests from unfamiliar adults). Violations of chewing and swallowing (solid and liquid foods) with hypersalivation, avoidance of noisy places and fear of unfamiliar sounds with a simultaneous desire to produce sounds, a negative attitude to severe tactile irritations (shampooing and a number of hygiene procedures), and inedible licking were noted. On examination: the child actively avoids contact with an unfamiliar adult (hides, turns away, shouts), does not allow himself to be examined. At a distance he continues the game he has begun (he collects a construction from large colored blocks according to the instruction plan together with the teacher, in most cases choosing the right elements correctly), there are elements of a symbolic game with dolls and cars, the boy expresses his needs in separate words; elementary stereotypes for the purpose of self-stimulation were not noted. The presence of stigma of dysembryogenesis (a peculiar shape of the head, protruding ears, extra nipples), hypomimia, hypersalivation, moderate ataxia when walking, standing and delicate hand manipulations, muscle hypotension with good strength, hallux valgus feet (rougher left), and walking and dystonic installation of the left leg with rotation of the foot inward, lack of body weight. A short phrase, blurred, agramatic, expresses the actual needs of the child, spontaneous echolalia occurs occasionally. Eye contact short, appears at a distance. The productive period of activity is about 10 minutes, gradually excitation with aggressive destructive actions appears, however, with timely attention switching and rest, the child’s behavior is more correct. Night EEG video monitoring: in wakefulness - against the background of age-related cortical electrogenesis, irritation of the caudal parts of the brain is expressed with moderate interest in diencephalic and gross irritation of basal limbic structures, a decrease in the functional activity of the frontal parts; when falling asleep and in sleep, the gross severity of K-complexes reflects the interest in the deep brain structures, and hypersynchronous sleep spindles indicate an irritation of the thalamo-cortical level and a decrease in the functional activity of the sensorimotor cortex, there is a migratory lateralization of sleep spindles and a disturbance in sleep structure with a deficiency of its deep phases.

Thus, the anamnesis and clinical picture made it possible to diagnose organic damage to the nervous system, atactic syndrome of cerebral palsy with deficiency of the fronto-subcortical functions and predominant dysfunction of the right hemisphere of the brain, mental and speech development retardation, spastic-atactic dysarthria, emotional characteristics of the excitable and autistic spectrum. In complex therapy, the drug L-carnitine-elkar was included in a dose of 500 mg 2 times (at breakfast and lunch) for 2 weeks, then after 3 weeks 300 mg once in the morning for 3 weeks. For 2 months of the first stage of therapy, the diet expanded, the boy gained 1 kg in weight, became calmer, sleep and behavior improved, the productivity of corrective exercises increased, and the severity of coordinating disorders, including speech, decreased. Subsequently, he took Elkar in 3-week courses with 3-week intervals between them at the minimum age dosages (300 mg / day) for 3 years. By the beginning of schooling, a significant improvement in development was noted: ordered behavior, the boy is socialized, communicates with peers, participates in common games; motor dexterity is not enough, however, subtle manipulations are available; speech is simple, somewhat blurry, but legible, with agramatisms; account within two dozen; an understanding of logical connections in everyday life is available; it has difficulties in abstract representations. Started training in the correction class (then the boy dropped out of the observation due to a change of residence).

This example of successful treatment of a child with severe organic damage to the nervous system and a total delay in the development of mental functions demonstrates the importance of the individual dosage regimen of the carnitine preparation, taking into account the predominant dysfunction of the right hemisphere of the brain.

Example 3

Roma T., 15 years old, was first monitored in serious condition after orthopedic and surgical treatment for contractures in the joints of the right leg, complicated by traumatic neuritis of the sciatic nerve on the right with relapse of knee flexion contracture, postoperative hypothalamic syndrome (dystrophy, hyperthermia, sleep disturbance ) A boy from an early age was observed in the clinic for cerebral palsy, right-sided hemiparesis (cyst of the left frontotemporal region), developmental delay, emotional features, motor alalia, symptomatic epilepsy. The previously proposed treatment, which included activating drugs, including elkar in high doses in order to increase body weight, led to a worsening of the condition until the resumption of epileptic seizures that had been absent for 10 years.

Given the structure of developmental disorders, which is correlated with the left hemisphere neuropsychological syndrome, complex therapy was prescribed, including the drug L-carnitine - elkar in minimum age doses of 1000 mg / day in two doses in the morning for 3 weeks, followed by an increase in the daily dose to 1,500 therapeutic mg / day with improvement. The treatment was carried out almost continuously for 3 years with a marked improvement in overall development and motor functions: there was a speech, the boy began to study at the school according to an individual program, gradually began to walk independently without additional support (with persisting phenomena of right-sided hemiparesis and post-traumatic sciatic nerve neuritis), vegetative dysfunctions were significantly stopped; there are no convulsive episodes. Observation continues to the present time (about 9 years), the patient's condition is good, the young man graduated from school, socialized. He takes carnitine preparations in medium therapeutic doses, confining the course to periods of increased training and physical activity.

In this observation, the importance of the differentiated prescription of carnitine preparations is graphically shown: ignoring the structure of disorders of cerebral dysfunctions complications and deterioration of patients are inevitable, and, on the contrary, taking this factor into account allows achieving significant results even in initially very severe cases.

The proposed method has shown its effectiveness in the treatment of developmental disorders in childhood, the absence of undesirable effects and the safety of prolonged use of carnitine preparations in the recommended dosage regimen taking into account the predominant dysfunction of the cerebral hemispheres.

Claims (1)

A method of treating disorders of neuropsychic development in childhood with carnitine preparations, characterized in that in children with left brain hemisphere dysfunction, carnitine drugs selected from the series: elkar, carnitene, carnitine chloride are started with minimal age doses, namely, in children 1 -12 months 75 mg / day, 1-3 years - 100 mg / day, 3-7 years - 300 mg / day, 7-10 years - 500 mg / day, over 10 years - 1000 mg / day for 2- 3 weeks, after which they increase the dose to medium therapeutic, namely: in children 1-6 months, 100 mg / day, 6-12 months - 150 mg / day and, 1-3 years - 200 mg / day, 3-7 years -500 mg / day, 7-10 years - 1000 mg / day, older than 10 years - 1500 mg / day, with their use up to 3-6 months, and in children with dysfunction of the right hemisphere, therapy is started with high dosages, namely: in children 1-6 months, 150 mg / day, 6-12 months - 225 mg / day, 1-3 years - 300 mg / day, 3-7 years -1000 mg / day, 7-10 years - 1500 mg / day, older than 10 years - 2000 mg / day for 2-3 weeks, after which they switch to using the minimum age-related dosages in 3-week courses with 3-week intervals between them, and the duration of treatment is from 3 months s to 3 years, depending on the patient's condition.