Autonomic dysfunction syndrome

Autonomic dysfunction syndrome

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Autonomic dysfunction syndrome (VDS) for children is a dangerous disease, it is not surprising that parents are so interested in it, who ask a lot of questions about this. Suffice it to say that the Internet offers 214 thousand Russian-language documents on this topic, more than 10 million in English.

In the 50s, there were only 68 publications on this issue in the press, and in the 2000s there were already more than 10 thousand. However, the abundance of information does not exclude the emergence of a group of myths that are common not only among patients, but also among practicing doctors. Let's try to understand the essence of children's SVD and dispel the group of the most common myths on this issue.

SVD is not an independent nosological unit. In the 10th revision of the International Classification of Diseases, there is a class "Diseases of the nervous system", there is a block "Other disorders of the nervous system". There, under the number G90.8, there is a definition "Other disorders of the autonomic (autonomic) nervous system", this is what SVD is.

SVD appeared only in the twentieth century. The study of functional pathology, the manifestation of which was cardiovascular disorders, was begun in the 19th century. In 1871, an American therapist described a syndrome that was later named after him, which consisted of the excitable heart of young soldiers who participated in the Civil War. In Russia, the foundations of the study of the physiology and clinical picture of the autonomic nervous system were laid by outstanding scientists: Sechenov, Botkin, Pavlov, Speransky and others. Already in 1916, the Russian F. Zelensky in his "Clinical Lectures" made up the symptoms of cardiac neurosis. Modern ideas about the organization of the autonomic nervous system, about clinical vegetology really formed under the influence of scientists of the 20th century. A doctor practicing in the 21st century, in his work with autonomic dysfunctions, simply cannot do without the work of A.M. Wein and N.A. Belokon, which provide explanations for almost all clinical cases.

At the heart of autonomic dysfunctions is the suppression of one department due to the activity of another. This assumption is a reflection of the "principle of scales", the sympathetic and parasympathetic systems have opposite effects on the working organ. These can be: increased heart rate and deceleration, changes in the bronchial lumen, vasoconstriction and dilation, secretion and peristalsis of the gastrointestinal tract. However, under physiological conditions, with an increase in the impact in one of the divisions of the autonomic nervous system in the regulatory mechanisms of another, compensatory stress is observed in others, thereby the system moves to a new level of functioning, and the corresponding homeostatic parameters are restored. In these processes, an important place is given to suprasegmental formations and segmental vegetative reflexes. If the body is in a tense state or adaptation breaks down, then the regulation function is disrupted, the increase in the activity of one of the departments does not cause changes on the part of the other. And this is the clinical manifestation of symptoms of autonomic dysfunction.

Stress plays a leading role in the etiology of autonomic dysfunction. In fact, SVD has multiple causes, with both acquired and congenital features. Let's list the main reasons:
- psychoemotional features of a child's personality, anxiety, depression inherent in a child, hypochondriacal fixation on the state of his health;
- hereditary constitutional features of the autonomic nervous system;
- an unfavorable course of pregnancy and childbirth, which led to a violation of the maturation of the cellular structures of the suprasegmental apparatus, injuries of the central nervous system and the cervical spine;
- psychoemotional stress, consisting in difficult intra-family relationships, incorrect upbringing, conflicts at school, participation in informal groups;
- damage to the nervous system through trauma to the skull, infections, tumors;
- physical and mental fatigue that can arise from classes in specialized schools, sports sections;
- a sedentary lifestyle, which reduces the ability to dynamic loads;
- hormonal imbalance;
- acute or chronic diseases, foci of infection present - caries, sinusitis, etc.
- the negative impact of smoking products, alcohol, drugs;
- other reasons (osteochondrosis, anesthesia, operations, weather, weight, excessive interest in TV, computer).

In clinical cases, SVD is manifested by damage to the cardiovascular system. No one denies the fact that cardiovascular manifestations are present with various manifestations of autonomic dysfunctions. However, when diagnosing, one should not forget about the following other manifestations of this pathology: violation of thermoregulation, skin condition, changes in the respiratory system up to pseudo-asthmatic attacks, disturbances in the work of the gastrointestinal tract, urinary disorders. Vegetative paroxysms are generally difficult for the practicing physician in terms of their diagnosis. In the structure of an attack in childhood, vegetative-somatic manifestations prevail over the emotional experiences of the child. It should be noted that there are a number of unexplored problems in pediatric vegetation, although it is itself quite common.

The manifestation of autonomic dysfunction is typical only for adolescents. This disease is indeed one of the most common among adolescents, as in boys its frequency ranges from 54% to 72%, and in girls from 62% to 78%. An indirect indicator of the state of the disease is the number of publications on this topic - the number of such publications for adolescents exceeds 7 times the number of articles for newborns. It is likely that this is due to the difficulties in diagnosing autonomic dysfunctions in neontology, although an attentive doctor already in such a period may notice vegetative symptoms: "marbling" of the skin, disturbed thermoregulation, regurgitation, vomiting, heart rhythm disturbances, etc. By the age of 4-7 years, vegetative shifts are aggravated, a parasympathetic orientation begins to prevail, which is characterized in a child by indecision, fearfulness, and an increase in body weight. The third peak in the manifestation of dysfunction occurs at puberty, at this time there is a manifestation of violent emotions, personality breakdowns and disorders. Accordingly, there is a more frequent appeal to medical care, hence the registration of diseases.

The practical doctor does not have any opportunities for objective assessments of the state of the autonomic nervous system. Indeed, the diagnosis of SVD is subjective and largely depends on the experience of the doctor and his worldview, based on clinical symptoms. That is, the vegetative status is assessed using special questionnaires that have been modified for children. The characteristics of autonomic tone in pediatrics are calculated using mathematical models, and according to standards developed in 1996, the following 4 numerical indicators are used: SDNN, SDANN, HRV-index and RMSSD. Recently, due to the applied spectral analysis, the possibility of mathematical assessment of heart rate variability has increased. The possibilities for assessing dysfunction are constantly expanding, the use of stress tests, pressure monitoring systems, assessing its rhythms, etc. is being introduced. A complex clinical and experimental approach, together with a functional-dynamic study of the vegetative status, allows the attending physician to identify violations in the body, assess the state of its adaptive mechanisms.

There is no effective therapy for children and adolescents with SVD. In order for the treatment of children to be successful, therapy must be applied in a timely manner and be adequate, in addition, its duration and complexity, taking into account the age of the patient, and manifestations of the disease are necessary. Treatment must be carried out with the active participation of the patient himself and the people around him. Preference is given to non-drug methods, but drug treatment should be carried out with a minimum number of drugs specially selected for this. Among non-drug methods, one can single out the normalization of rest and work regimes, therapeutic massages, physiotherapy, hydro, reflex and psychotherapy. Medications include sedatives, herbal adaptogens, vitamins and minerals, antidepressants and a group of specialized drugs like Cavinton, Trental or Phenibut.

ADD is easier to prevent than long-term treatment. Prevention of ADD should begin even before the birth of a child by the expectant mother herself, for this, the daily routine, psycho-emotional environment and weight control should be put in order, and the role of doctors who patronize a pregnant woman is also important. To carry out the prevention of SVD in adolescents and children, it is necessary to give them correct and adequate education, ensuring harmonious physical and mental development. Overloading a child is unacceptable, and sedentary activities are also unacceptable. For people of all ages, it is necessary to engage in physical education, as this is the most important way to prevent SVD. However, sports activities should be provided, albeit informal, but with high-quality medical supervision. Today, more than ever, the promotion of a healthy lifestyle, the fight against smoking and bad habits is important. It is necessary to understand that the problem of HIC prevention should not fall solely on medical measures, social and environmental transformations are needed, as well as a general increase in the well-being of the population.

Watch the video: Autonomic Dysfunction in Ehlers-Danlos and Related Syndromes - Alan Pocinki, MD (August 2022).