Method of diagnosing congenital dysfunctions of brain hemispheres in children

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.

1 tbl, 2 ex

 

A known method for the diagnosis of minimal brain dysfunction, including assessment of clinical signs, in doing so, determine the level of neuron-specific enolase in serum enzyme-linked immunosorbent assay and content of NSE from 11,19 µg/l to 18 mg/l conclude the presence of a diagnosis of minimal brain dysfunction (RF Patent No. 2282858).

A known method for the diagnosis of minimal brain dysfunction by immunological analysis of peripheral blood, serum define enzyme-linked immunosorbent assay content of brain-derived neurotrophic factor and the level of BDNF (brain-derived neurotrophic factor) less 34,54 PG/l consider the existence of minimal brain dysfunction confirmed (RF Patent No. 2277247).

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

A known method for the diagnosis of dysfunction of one of the hemispheres of the brain on the basis of symptoms of disorders of higher mental functions, specifically associated with the left or right hemisphere when using sets of specialized tasks (PS Tsvetkov. Methods diagnostic neuropsychological examination of children. - M., 1997. - p.24-74.

The disadvantage of these methods is that vegetative characteristics and reactions with primary dysfunction of the cerebral hemispheres are almost not correlated and, thus, it is impossible to get an idea of vegetative syndromes and the dynamics of their development in ontogenesis in children with cerebral residual organic background congenital character.

A known method for the diagnosis of developmental disorders in adolescent girls with disorders of the menstrual cycle, which marked their innate characteristics of the neurological status, complex and dynamic autonomic dysfunctions, psychological and behavioural problems at different stages of ontogenesis (Brin I., Denikin M., Sheinkman OG, IRINA Dolzhenko / psychological development of adolescent girls at risk of reproductive health // Pediatrics. - 2007; 86; 3: 52-57).

However, this particular case right neuropsychological syndrome affects only girls and does not cover other manifestations of impaired autonomic regulation in children.

Closest to the claimed and taken by us for the prototype is the way to determine neuropsychological syndromes in children the first year of life according to the features of mental development in various areas (motor, sensory, emotional, and voice responses, actions with objects and p and interaction with adults), defined response to stimulation (reduced at right, and enhanced with left hemispheric dysfunction of the brain) (DANILEVSKY Denikin. Neuropsychological analysis of mental development of children in the first year of life with perinatal brain damage. - Abstract of Diss. Kida. the course of studies. Sciences. - Moscow, 2003. - 27). The response to stimulation in children the first year of life is a complex emotional, physical and behavioral manifestations in response to changing environmental conditions: the emergence of the field of view of a new subject or other sensory stimulus, person, etc. When enhanced reaction revitalizing complex is expressed excessively, which is manifested emotional and motor excitation up to the impossibility of the concentration of the child in age-appropriate activities. Reduced reaction is characterized by weak response of the child to external stimuli, i.e. by increasing the latent period of response to a stimulus, a short period of focus, muting emotional support with the continuation classes own activities. Reaction to the stimulation reflects not only the response to psychogenic stimulus, but also adaptive biological reactivity of the organism to changing environmental conditions in a broad sense, which is largely controlled by the autonomic nervous system is emnd.

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

The objective of the invention is to develop a new method for the diagnosis of congenital dysfunction of the cerebral hemispheres by the peculiarities of vegetative reactions and disorders in children from birth to 18 years.

The technical result of the implementation of the tasks is to develop criteria for the diagnosis of congenital dysfunction primarily of the right and left hemispheres of the brain by the peculiarities of vegetative reactions and disorders.

The essence of the method lies in the fact that for the diagnosis of congenital dysfunction of the cerebral hemispheres in children, assess symptoms of autonomic manifestations as anamnestically and complaints and clinical manifestations at the time of the examination: weight and body length at birth, gestational age, response to stimulation in children the first year of life, sleep, and parasomnias, EEG sleep in children of early age, enuresis, meteosensitivity, headaches, vascular lability, vestibulopathy, especially motor areas, feeding behavior, cutaneous manifestations, for infectious and somatic diseases, disorders of the menstrual cycle in adolescent girls, Ultrasound of the brain, while at low morphometric indices at birth, prematurity, enhanced response to stimulation in children the first year of life, the violation of falling asleep with the necessity of long-term sickness, the shudders in his sleep, superficial shortened sleep with frequent awakenings and comfort in the hands of the parents, the latency of the cortical electrogenesis and the formation of theta rhythm sleep with frequent bursts of high-amplitude theta - Delta activity without the typical apicomplexan, motor restlessness, segoviana after emotional arousal, delays in the establishment of control of urination, night enuresis in the second half of the night or in the morning, usually with the revival and renewal of its episodes when emotional arousal, increased meteochuvstvenosti with increasing atmospheric pressure, situational and intermittent headaches spasmodic and pulsating in nature, directly related to physical or emotional stress and metoclopramid, marked vascular lability during exercise, with a tendency to increase blood pressure, total disinhibition with difficulties, fine motor skills and inclination to hypertonicity of muscles at an early age, anxiety feeding before and during a meal with aerophagia, rapid saturation and spitting on the first year of life, susceptibility to malnutrition, pale dry skin is skin, acute infectious and somatic diseases with unbalanced reactions, pyrexia, propensity for metrorrhagia with fatigue and reduced body weight in adolescent girls, and strengthening ECOPOLICY extension III and IV ventricles of the brain diagnosed dysfunction of the left hemisphere of the brain; and at high morphometric indices at birth, perenoshennosti, reduced response to stimulation in children the first year of life, inversion of sleep and wakefulness, self-stimulation when sickness, revivals, screaming and crying through individually defined for baby time after falling asleep and calm when individually specific rituals and techniques zamorachivatsja, normal maturation of cortical electrogenesis gross exaltation spindles sleep up to EPI-like phenomena, parasomnia as segoviana, sahodari, bruxism, nightmares, individual rhythm of enuresis with opuskanie urine in the first few hours of sleep without waking up and associated with the moon phases, lasting meteochuvstvenosti expressed in cloudy weather and tied to the lunar phases, accompanied by mood swings, persistent, frequent headaches that occur otsrochennoe after stress or prolonged emotional stress, of a different nature, but with a tendency to migraine episodes, the vascular lability in emotional situations with a tendency to arterial hypotension and increased pressure in adolescence, vestibulopathy, muscular hypotonia with good fine motor skills, tranquility during feeding, the trend towards spastic constipation, partiii, food selectivity, challenges, appetite control, wet skin, prone to diaper rash, weeping eczema, acne, prone to abrasions, indolent disease, with paradoxical reactions, the tendency to recurrence, chronicity of the process and psychosomatic manifestations, optimizarea, long delays or amenorrhea along with overweight and symptoms of hypothalamic dysfunction in adolescent girls, the prevalence of expansion of the lateral ventricles of the brain, usually the right, diagnose dysfunction of the right hemisphere of the brain.

Significant difference between the proposed solutions from the known is to develop a table of symptoms of autonomic manifestations characteristic of preferential dysfunction of one of the hemispheres of the brain in childhood, which allows to predict the risks and options psychosomatic disorders with the purpose of planning preventive, curative and corrective measures.

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Table
Symptoms of autonomic manifestations in children with primary dysfunction of one of the hemispheres of the brain.
Evaluation criteriaThe symptoms of dysfunction of the left hemisphere of the brainThe symptoms of dysfunction of the right hemisphere of the brain
Weight and body length at birthLowest possible delay fetal developmentAbove average
Gestational agePrematurityOften perenoshennosti
The response to stimulation in children the first year of lifeStrengthenedReduced
Sleep in children in the first year of lifeViolation of falling asleep with the necessity of long sickness, tremors during sleep, superficial shortened sleep with frequent awakenings. Children rest in the hands of parents.Inversion of sleep and wakefulness, the originality of the ways motion with self-stimulation, night waking, screaming and crying through individually defined for baby time after falling asleep. Children calm down when individually specific rituals.
EEG sleep in children early in the Rasta Latency cortical electrogenesis (0.5-1 Hz) and the formation of theta rhythm sleep (early stage of slow wave sleep), frequent outbursts of high-amplitude theta - Delta activity without the typical EPI-complexes, coinciding with the movements in the distal limbs of the child, sometimes the flash is accompanied by a K-complex with subsequent exalted "spindle sleep."Normal maturation of cortical electrogenesis, rough exaltation of sleep spindles up to EPI-like phenomena.
ParasomniasMotor anxiety, SNO-speaking after emotional arousal, fear.Techniques zamorachivatsja; red-varenie, siohodennia, bruxism, nightmares.
EnuresisThe delay in the formation of urination control, at an early age often daytime enuresis ("failed"); nocturnal enuresis often in the second half of the night or in the morning, usually with the awakening. Episodes of bedwetting can be renewed when emotional arousal in a new environment, conflict situations (even at school).Characterized by individual rhythm, more typically opuskanie urine in the first few hours after falling asleep without waking up. From escaut relationship with moon phases.
Mediocubital inostIncreased, the brighter is the growth of the atmospheric pressure increased anxiety, vascular lability, diarrhoea and hypertensive disorders (vomiting, symptom Gref, dystonic phenomena). Smoothed with age.More connected with moon phases, clearly in cloudy weather; characterized by mood changes with dysphoric shade, increased negativities reactions, sleep disorders. Saved.
HeadachesSituational, short-term, directly associated with physical or emotional stress and metoclopramid, spasmodic and pulsating character.There otsrochennoe after stress or prolonged emotional stress, persistent, frequent, varied, but with a tendency to migraines th episode.
Vascular labilityExpressed, associated with physical activity, the tendency to raise blood pressure.Associated with emotional situations; often withoptions spots, the tendency to arterial hypotension, puberty age episodes increase arter the social pressure.
VestibulopathyRarelyOften
Features of motive sphereCommon behavior problems, fine motor skills at an early age the tendency to hypertonicity of the muscles.Long-lasting tendency to hypotension, good fine motor skills.
Feeding behaviorAnxiety feeding before and during the meal, aerophagia, quick satiety, vomiting. Under adverse conditions, children are prone to malnutrition. Preferred carbohydrate and easily digestible food.Fairly quiet during feeding, "demanding", crecendo can be colic, the tendency of spastic constipation. Often paratopia. Often the selectivity of food (especially in children with autism, the need for protein and fat products. Difficulties appetite control up to bulimia nervosa (often boys) or anorexia nervosa (mostly girls), especially in adolescence.
Cutaneous manifestationsThe skin is dry, pale, acrocyanosis; phenomena of atopic dermatitis (in the background asthenic conditions after long periods of stress). The skin is moist, at the early age of diaper rash; rash (especially the scalp when falling asleep), weeping eczema. To pubertal age - ASPE, often the infection of elements (furunculosis).
For infectious and somatic diseasesSharp, unbalanced reactions, pyrexia, followed by asthenia.Often paradoxical reactions, sluggish pace, the tendency to reci-deponovanju and chronicity of the process, psychosomatic manifestations.
Menstrual disorders in adolescent girlsThe propensity for metrorrhagia, General asthenia, reduced body weight.Optimizarea (rare, scanty menstruation), long delays or amenorrhea along with excess body weight and other symptoms of hypothalamic dysfunction (clinical and hormonal).
Ultrasound of the brainThe gain-ripple, extension III and IV ventriclesDominated by the enlargement of the lateral ventricles of the brain, D>S

The method is as follows: when the clinical examination of children on complaints, medical history information and records physical examination marked the Ute symptoms on the table of characteristics of vegetative manifestations, determining the Association of these disorders with primary dysfunction of the right or left hemisphere of the brain.

Examples of the clinical implementation of the method

Example 1. Girl Tanya W., 13.5 years, was examined by a gynecologist due to uterine bleeding twice a month for 9 months. Along with this complaint on episodic headaches after training overload (10 years), coordinatory awkwardness. History: the threat of termination of pregnancy in mothers of preterm birth at 37 weeks the fetus, weighing 2500, length 45 cm, in the state of moderate severity (pneumopathy, the conjugation jaundice, edema syndrome). In the first year of life was excitable, development of motor skills with a little delay, went on their own in 1 year, 2 months; up to 8 years differed motor clumsiness, often fell. Noted restless sleep (the need for long-term sickness, frequent awakenings), extended the period of formation control urination (up to 4 years), emotional irritability and lability, sensitivity to metoclopram with increasing concern. Ill not often, but respiratory disease was leaking badly, with hyperthermia. On examination, paying attention to the deficit of body weight (56 kg with height 176 cm), dry skin, lability of blood pressure (marked by episodes of his increasing physical n the burden to 140/90 mm Hg at ordinary level 110/75 m Hg).

In accordance with the table of symptoms peculiarities of vegetative manifestations diagnosed prevalence of dysfunction of the left hemisphere of the brain that correlated with the features of easy asymmetry of motor reactions (recovery of tendon reflexes in the right limbs, difficulty performing dynamic praxis right hand) and the restriction of the number of oral-aural memory with delayed reproduction of groups of words. The treatment program based on identified lateralization of violations allowed to quickly arrest the problem, to normalize the menstrual cycle (stopped metrorrhagia, and use of hormonal regulators of the cycle). The girl was followed for 3.5 years, the family complied with the recommendations for the prevention of possible decompensate state, was conducted courses of treatment, is dedicated to increasing training loads. To end childhood marked harmonization of physical and psychological development, she successfully studied at the University, noted high activity and performance, in a good mood.

This case demonstrates the peculiarities of vegetative manifestations in the prevalence of dysfunction of the left hemisphere of the brain, which may be diagnosed from an early age, and aimed at prevention and treatment to prevent pronounced the s disorder to pubertal age.

Example 2. Girl Dasha F., 16 years, 9 months, was examined by a gynecologist due to ovarian dysfunction (long cycle, painful periods). The girl was complaining of daily headaches spasmodic nature of the temporal-frontal and sometimes occipital localization (in the latter case with high blood pressure to 135/90 mm Hg at normal pressure 100/75 mm Hg)that was associated with fatigue on the educational background of stress and psycho-emotional stress with anxiety, if necessary, public speaking (answers in the class at the blackboard), and contacts with strangers; noted violations falling asleep, restless sleep with frequent nightmares, recent panic sensations indoors, frequent urination during periods of unrest. History: pregnancy in mothers with threat of termination on the background of anemia and hypertension, birth to 2 weeks later by caesarean section large fruit (3900 g, 52 cm) in a serious condition (conducted resuscitation). The girl was systematically treated, motor development delay the development of motor skills on the background of muscular hypotonia, but with a good manual ableness. Noted sleep disturbance: in the first year of life sudden Wake up with a wince, cry, calmed down when a particular sequence is eljnosti actions of parents (walking on a particular route in the apartment), sucking favourite toy; at an older age to sleep at night series, timed to coincide with the full moon, often with mnogodenek and segoviana, episodes of enuresis. At preschool age, spasmodic abdominal pain (diagnosed dysfunction of the gall bladder), with 7 years of headaches with increasing frequency and severity with age. Often suffers from respiratory diseases (long-term, with allergic manifestations). At survey: redundant power supply (70 kg, height 165 cm), the skin of the face and back with ASPE (individual items with boils, there are traces of former suppurations), on the border of the scalp and forehead areas of eczema with skin peeling, increased pilosis limbs. Expressed withoptions spots, facial flushing, persistent red dermographism, purple stretch marks on the chest and inner thighs, hyperhidrosis (zianoticnae of the palms and soles). In accordance with the table of symptoms peculiarities of vegetative manifestations diagnosed prevalence of dysfunction of the right hemisphere of the brain, which was incorporated into the treatment program. The girl was followed for 4 years with a gradual improvement and relief problems. This observation demonstrates the possibility and necessity of early diagnosis of primary cerebral lateralization dysfunction symptoms vegetative person who values and violations that would prevent the development of a sufficiently serious physical and psychological problems at all stages of childhood.

The proposed method has shown its effectiveness in the diagnosis of lateralization congenital brain dysfunction that allowed us to offer differentiated methods of correction and treatment of disorders of the development of children of different ages.

The method can be used for the early identification of risk groups for various psychosomatic pathology at different stages of childhood, which is necessary as a preventive measure. The proposed diagnostic method is available to use by physicians of different specialties, which allows for effective interaction and screening patients for mass screening for their further in-depth survey.

Method for the diagnosis of dysfunction of the cerebral hemispheres in children, including the study of sensorimotor reactions, characterized in that it further examined in accordance with the table set forth in the description, especially the history and vegetative reactions of the child and identify the prevalence of dysfunction of the right or left hemisphere.



 

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FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to neuroinfections. Assessment of anamnesis data, virological indices, fever reaction and spotty-papular rash appearance is carried out. EEG is additionally registered in the first three days from the moment of admission, leukocyte index of intoxication, presence of mixed hypervirus infection are determined. If hypoxy-ischemic affection of central nervous system, spotty-papular rash on the body from the first day of disease with its "additional appearance" during 5-7 days, fever to 39-40°C during first 3-5 days are present in child's anamnesis, reduction of index of main physiological rhythm less than 30%, increased paroxysmal activity in form of diffuse sharp waves and flashes of slow activity with amplitude more than 100 mcV during 3 days or at least on one of these days are detected on EEG, value of leukocyte index is 0.2-3 conv.units, mixed hyperviruses together with varicella zoster virus, virus of type 6 herpes and/or type I herpes simplex virus are detected, risk of neurological complications is predicted.

EFFECT: method makes it possible to increase reliability of predicting risk of neurological complications in case of chicken pox in children.

3 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine and medical equipment, particularly to methods and apparatuses for scalp electric potential measurement. The apparatus comprises a number of sensors obtaining the initial measurement of a scalp electric potential through a hair-covering and an air contact area; a number of preamplifiers connected to one of the appropriate mentioned sensors. The contact area produces a high and variable coupling impedance of the source and the scalp. Each preamplifier contains a broadband high-impedance input and an active bias circuit generating input impedance more than 10 petaOhm over the range from 0.01 Hz to 400 Hz; a high-gain low-noise operating amplifier with the input impedance of 10 teraOhm; and a shielded feedback and bias circuit. The preamplifier is configured to have the input impedance substantially higher than the impedance produced by the source-sensor contact area. One version of the implementation of the method for scalp electric potential measurement, the preamplifier obtains the initial measurement of the scalp electric potential and forms a pre-intensified measurement of the scalp electric potential. The measurement is taken through the hair-covering and air. In the other version of the implementation of the method, an input signal of the initial scalp electric potential is obtained from the number of sensors to generate an appropriate number of channels. It is followed by the signal pre-amplification by the preamplifier with the high input impedance to form the pre-intensified measurement of the scalp electric potential. Then, a measurement mode is configured in a group containing a channel mode relative to a reference channel, a channel mode relative to a middle channel and a differential interchannel mode. Then, the pre-intensified measurement of the scalp electric potential is biased with maintaining the mentioned high input impedance; a channel gain is adjusted to differential obtaining of the channel signal. An additional stage providing the processed channel signal is suppressing radiofrequency interferences of the channel signal with maintaining adjustment of the gain and the phase; a common-mode of the channel signal is suppressed, and the band-pass channel filtration is provided. The processed channel signal is digitised to present a digital signal of the measurement of the scalp electric potential, characterising the mentioned input signal measured according to the mentioned chosen measurement mode.

EFFECT: use of the group of inventions allows more effective measurements of the scalp electric potential due to the preamplifiers, and allows reducing the need of exfoliating of the necrotic epithelial cells or application of abrasive or conducting gels.

27 cl, 11 dwg

FIELD: medicine.

SUBSTANCE: invention concerns medicine and medical technology. A patient is exposed to electrical stimulation generated by the 'simpaticor-01' apparatus. A one-element electrode is placed in a projection of cervical ganglia, while a multiple-element electrode - on a patient's neck. The exposure to the field is paused. A convulsive readiness threshold is assessed. Neurometabolic preparation dosage is specified in accordance with age, while anticolvulsants are dosed as per manufacturer's recommendations. Amplitude, frequency and length of the current pulse field, length of exposure and pauses are specified individually for each patient so that in the process of treatment and later on, the convulsive readiness threshold tends to decrease in the form of reducing a number of paroxysmal sharp and slow waves, as well as elimination of epileptoid activity.

EFFECT: method provides higher clinical effectiveness ensured by combining drug-induced therapy with electrical stimulation of the vegetative nervous system.

7 dwg, 1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to oncologic neurosurgery, neurology and functional diagnostics. Electroencephalographic (EEG) examination is carried out. Power of delta-range waves in parietal regions is estimated on EEG. In case of simultaneous increase of power in left parietal region above 80 mcV2 and in right region above 85 mcV2, malignant form of growth of neuroepithelial tumour of III ventricle is diagnosed.

EFFECT: method extends arsenal of means for diagnosing type of growth of neuroepithelial tumours of III brain ventricle.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: claimed invention relates to medicine, namely to cardiology. Day monitoring of arterial pressure (DMAP) is performed to patients with stable arterial hypertension of I-II degree. 5 time intervals (TI) are estimated: from 6 to 8 o'clock; spent at the doctor's, from 9 to 11 o'clock; spent at workplace from 11 to 19 o/clock; evening, from 21 to 23 o'clock; night, from 0 to 6 a.m. For each TI average absolute indices of systolic arterial pressure (SAP) and diastolic AP (DAP) are calculated. Relative AP indices are calculated as difference between average AP for one of TI and average day AP. Relative indices are compared with average population ones for patients with the same degree of AH. TIs, in which deviation of relative AP indices from the average population values for said patient is maximal, are identified and type of day AP dynamics is determined. After that patient is tested by means of questionnaire, questions of which are grouped into 5 scales, where each scale characterised behavioural type of patient from the point of view of probability of AP increase in one of five TIs. Each question is assessed in points. Indices for each scale are calculated as the mean arithmetic of the sum of points of scale-forming questions. Depending on the quantity of points, obtained for each scale as a result of testing, patient is referred to the behavioural type, predisposed to increase of AP in morning, spent at the doctor's, spent at the workplace, evening or night TI. Results of circadian AP fluctuations, obtained by DMAP, and supposed character of AP behaviour, based on the results of testing, are compared, and if AP behaviour in all tested TIs coincides, conclusion that circadian indices of arterial pressure, obtained during DMAP, are typical of patient, are obtained in habitual for them psychosocial conditions, is made, and it is not required to repeat DMAP.

EFFECT: method makes it possible to specify character of circadian AP fluctuations taking into account predictors of AP increase in different TIs and determine optimal scheme for treatment of patient, as well as to correct its behaviour in the most vulnerable TI.

5 tbl, 1 ex

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