Neuralgia in infants: signs, treatment

Neuralgia in newborns is an inflammation of the nerve, which leads to many unpleasant sensations, including a severe pain syndrome. The causes of neuralgia in children can be many, and the treatment directly depends on the etiology. Therefore, it is important to know about the possible manifestations of neuralgia in a child, in order to notice and correctly diagnose pathology in time.

[1], [2], [3], [4], [5]

Epidemiology

Statistics of the spread of neuralgia suggests that this pathology is not so often diagnosed as it really is. About 12% of all neuralgia in newborns are traumatic, about 40% secondary infectious neuralgia. In newborns, this pathology occurs with a frequency of 1 case per 1300 healthy babies, and 1 case of neuralgia for 17 children with neurological problems.

[6], [7], [8], [9],

Causes of the neuralgia in newborns

Each person, and the child in particular, has 12 pairs of cranial nerves. When it comes to neuralgia, it is these nerves that are affected most often, although spinal cord injuries can also be affected. Some of them are responsible only for sensitivity, some are responsible only for the motor function, and some combine these two functions. When there is inflammation of the nerve, it is often involved in the process that nerve, which is the most superficial to the skin. In this case, the facial nerve, which has both motor and sensory fibers, most often becomes inflamed. This is important for understanding the clinical manifestations of this type of neuralgia.

But neuralgia can be any other nerves, including intercostal, trigeminal nerve.

The causes of neuralgia in neonates can be very different. Neuralgia of the trigeminal nerve and facial nerve is most common, and the etiological factors of neuralgia development in each individual case are slightly different.

Under normal conditions, any nerve moves away from the brainstem and passes through the holes in the skull, while innervating the skin, muscles, organs. If there is any obstacle in the path of the nerve, it can cause compression and certain symptoms. Therefore, the causes of the development of different types of neuralgia can be central and peripheral. Central disorders occur in the pathology of the brainstem.

The main reasons for the development of peripheral nerve trigeminal neuralgia include:

1. morphological changes in the spinal path (atheromatous loop and arteriovenous malformation) - this breaks not only the normal passage of the pulse along the nerve, but also such formations lead to a constant compression of the nerve in this region;
2. neurinoma of the trigeminal node and vestibulo-cochlear nerve - in infants it is rare, but it can be;
3. Intracranial tumors in newborns can be of an innate nature, which leads to the compression of several nerves at once;
4. the vascular pathology may lead to ischemia of the nerve or its branches, and also the aneurysms located near the nerve may cause compression syndrome;
5. cyst of the maxillary sinus;
6. congenital anomalies in the structure of the canals in which the nerve branches pass, can lead to nerve compression and clinical manifestations of neuralgia;
7. the pathology of the development of the upper jaw with an unprotected upper sky can lead to secondary neuralgia;
8. fusion of the dura mater in the region of the trigeminal node, as a result of infectious lesions of the meninges.

Recently, there has been an increase in the incidence of herpetic infections, in particular the herpesvirus infection of a child after birth. Therefore, the most common cause of neuralgia in newborns can be considered infectious factors, in particular herpetic lesions. This virus can penetrate into the baby's body after birth and fix in the nerve ganglia. At a certain time, the virus is activated, and the inflammatory process with the involvement of nerves develops. More often the herpetic neuralgia develops with the defeat of the intercostal nerves.

Among other causes of neuralgia in neonates are often traumatic factors. Birth trauma with injuries to the clavicle can cause damage to the integrity of the nerve plexus. This can lead to persistent symptoms of impaired innervation or neuralgia. Subcooling is one of the factors that can also cause neuralgia, as the nerve in a newborn baby can be very superficial to the skin, and the effect of low temperature can lead to inflammation.

In newborns, a frequent cause of neuralgia is secondary inflammatory diseases. Undiagnosed otitis time can lead to a rapid spread of infection along the skull bone structure to nerve fibers, both the trigeminal nerve and the facial nerve. This can cause initially neuralgia, and then a purulent lesion of brain structures.

[10], [11], [12], [13]

Risk factors

Therefore, the risk factors for neuralgia in newborn babies are as follows:

1. inflammatory diseases of the ear, eyes, viral infections;
2. congenital malformations of the structure of bone tissue;
3. infectious diseases in mother;
4. hypothermia;
5. birth trauma.

[14], [15]

Pathogenesis

The pathogenesis of the development of pain syndrome in neuralgia is that the etiological factor leads to a prolonged and constant irritation of the nerve. As a result, local demyelination develops. Myelin is a substance that covers all nerve fibers and promotes a normal nerve impulse. Prolonged compression by a pulsating vessel, tumor, adhesions leads to atrophy of myelin-forming cells, followed by thinning of the membranes around the axons, as a result of which the proximal axon begins to expand and neurinoma arises. In this condition, the nerve is very sensitive to direct mechanical irritation, which causes pain in the innervation area, as well as a tendency to paroxysmal activity. As is known, such unmyelinated fibers are conductors of pain. Due to demyelination, additional "artificial synapses" arise between non-myelinated fibers, which creates the conditions for the formation of a "short circuit", as a result of which for each stimulation the nervous system responds with a chain reaction in the form of high-frequency discharges in the cells of the posterior horns of the spinal cord. Clinically, this is manifested by severe pain paroxysm. A major role in the development of pain syndrome is also assigned to the central nervous system, especially to the painful neurons of trigeminal nuclei of the brain stem. High-frequency discharges activate the substance of the posterior horns of the spinal cord, which in turn causes hyperreactivity of the painful neurons of the subcortical nuclei with the development of a neuralgic attack, which stops in the event of the depletion of brainstem neurons. This phenomenon lies at the heart of paroxysmal neuralgic pain, which sharply arises in the child and is expressed very intensely. And it is he who explains the effectiveness of anticonvulsants acting on the activity of brainstem neurons.

Such features of pathogenesis suggest that, whatever the cause of neuralgia, irritation of the nerve is always very strong and the pain syndrome is expressed quite strongly.

[16], [17], [18], [19], [20], [21]

Symptoms of the neuralgia in newborns

The first signs of neuralgia occur only a few hours after irritation of the affected nerve - there is acute acute pain, short, arises suddenly and just as suddenly disappears. The intensity of pain is very high. But although this is the most important and key symptom of the disease, in newborn babies this complaint can not be determined. The equivalent of such pain in newborns with neuralgia can be considered an attack of severe crying, which arises sharply and also suddenly ceases. Such an attack is characterized by the absence of pain at night. The maximum period of pain paroxysms is in the morning.

For neuralgia is very characteristic of the presence of triggers. These are the zones in the innervation region, with the irritation of which this pain appears. Such zones can be located on the face (nose wing, corner of the mouth) or on the oral mucosa in the area where the affected nerve innervates the mucosa. It is characteristic that in these areas sensitivity is very increased and even a touch causes a pain attack. In newborn babies this symptom is very important and it also is. You can notice that a strong cry of the child appears only in a certain position, for example, during the feeding of the child. If the trigeminal nerve is affected, irritation of the corner of the mouth with a nipple can cause an attack of acute screaming in the newborn. This is one of the symptoms that can tell about neuralgia.

In addition to the severe pain syndrome, vegetative reactions (red face, burning of the skin) are often observed, which is explained by the irrigation of excitation on the autonomic ganglia of a person. Such reddening of one half of the face or part of the face together with attacks of shrill cries also indicates neuralgia.

With the defeat of different nerves, certain symptoms may be expressed more or less, but different types of neuralgia are accompanied by a pronounced pain syndrome, which remains an invariable manifestation. The stages of development of neuralgia involve a consistent development of a symptom. In this case, the child first appears a cry, then a few hours later may appear hyperemia of the skin. If the facial nerve is affected, the motor function of the facial muscles is disturbed already at the last stage.

The facial nerve innervates facial muscles of the face, and also provides sensitivity to the tongue and mucous membranes of the mouth. Therefore, if there is inflammation of the facial nerve, it can be seen in the newborn asymmetry of the face. One corner of the mouth may be slightly lowered, a nasolabial fold may be smoothed. Any violation of the symmetry of the face can be considered a symptom of neuralgia of the trigeminal nerve.

Neuralgia caused by the herpes virus has some features of the clinic. Often the main clinical manifestations of the disease develop a prodromal period. The child becomes sluggish, sleeps all the time, body temperature may slightly increase. During this period, the baby can eat poorly. This condition can last two to three days. After this, there is pain, which manifests itself in episodes of sharp crying in the newborn. Together with this, a rash of vesicular character appears on the skin in the region of the affected nerve. Small vesicles with transparent contents are placed in a chain along the nerve fiber. This causes itching and burning sensation in the child, therefore it is accompanied by intense anxiety and screaming. Such a rash is typical for herpetic neuralgia.

Complications and consequences

The consequences of untreated neuralgia can be distant, because a violation of myelination of the nerve can lead to a violation of its structure, which can no longer be restored. This can cause hearing loss in the child or cause language impairment. Complications can occur if neuralgia is not diagnosed for a long time or is diagnosed incorrectly. The child constantly screams and does not refuse to eat, as this is a trigger factor that intensifies the pain. This leads to rapid weight loss and worsening of the condition.

[22], [23], [24], [25]

Diagnostics of the neuralgia in newborns

Diagnosis of neuralgia in newborns is carried out only by a children's neurologist. Therefore, if neuralgia is suspected, the child must be examined by a neurologist.

To establish the diagnosis, carry out differential diagnosis of facial pain syndromes, determine the etiopathogenesis of the disease, it is necessary to study the somato-neurological status of the child with the use of clinical, paraclinical, laboratory methods of investigation.

Great importance is given to a thorough questioning of the mother: finding out complaints, studying the history of development and the course of the disease, as well as the conditions for the birth of the child. When clarifying complaints, pay attention to the nature of pain, localization, cyclicity, duration, the cause that caused facial pain. Determine, according to the mother of the child, a violation of functions such as salivation, tearing. During the collection of anamnesis, it is necessary to find out the details of the birth of the child, whether there were traumas at birth or any infectious diseases in the mother. It is important to clarify when a child has a cry and is provoked by something.

Then the child should be examined, paying special attention to facial expression, symmetry, skin color. You need to pay attention to the corners of the mouth, nasolabial folds, eyes. Any violation of symmetry may indicate a violation of innervation. After that, palpation of the muscles is performed, paying attention to muscle tightness, tension, spasms. Palpation should be done carefully, because this can provoke a painful attack in the child and identify a trigger zone in the affected nerve. The study of sensitive functions in newborns is difficult, so a simple examination and palpation makes it possible to establish a preliminary diagnosis.

Instrumental diagnosis of neuralgia is of great importance for clarifying the diagnosis.

The method of classical electrodiagnosis of muscles is used to determine the reaction to stimulation by current. The data of this study allow to establish the degree of defeat of peripheral motor neuron. This diagnostic method can be used even in the long-term process, when the restoration of the affected nerve remains in question.

Muscles produce biopotentials, from which one can judge their condition. To diagnose this function, the electromyography method is used. The recording of biopotentials is carried out at different states of the muscle (active contraction, complete voluntary relaxation). The amplitude, frequency, general structure of the myogram is estimated. Electromyogram makes it possible to judge the condition of motoneurons.

In more severe cases or with suspected damage to the muscle of the central genesis, there is a need for brain research using encephalography. On the electroencephalogram both outside the attack of pain, and directly during and after the attack, there are significant changes in the electrical activity of the brain. As a rule, these changes are of an irrational nature, stable changes in the type of synchronization and desynchronization in pain syndromes as a result of the defeat of the cranial nerves, especially the trigeminal nerves.

For the diagnosis of neuralgia, especially in newborns with suspected congenital anomalies in the structure of the vessels, it is advisable to carry out rheographic examination. With neuralgia, signs of a high tonus of the face vessels, a decrease in blood filling, a difficulty in venous outflow are recorded. These changes, as a rule, are reversible.

Analyzes can be conducted only for the purpose of differential diagnosis. If there is a suspicion of postherpetic neuralgia, then it is possible to conduct a blood test with a study on the herpes virus.

[26], [27],

Differential diagnosis

Differential diagnosis of neuralgia in newborns should be carried out especially carefully, since screaming during attacks of neuralgia is often confused with attacks of intestinal colic. Differential signs of pain in neuralgia are the appearance of screaming episodes, which are amplified during the feeding of the child, opening the mouth, facial movements or any other provocative movements. When it comes to colic, the cry of the child is monotonous, lasts for several hours and almost does not calm down. It is also important to differentiate neuralgia with symptoms of hypoxic damage to the central nervous system. With such ischemic lesions, there are violations of muscle tone, hyperexcitability or oppression syndromes.

Treatment of the neuralgia in newborns

Treatment of neuralgia in newborns can be slightly limited by the age of the child, because many drugs in the period of newborns do not use. Therefore, some medicines may not be used in an acute period, but already during the recovery period.

The main method of treatment is pathogenetic, after careful examination of the patient and revealing the cause of the development of pain.

Emergency care for a pain attack consists of local or central anesthesia. With a view to local anesthesia, novocaine and its analogs are used. In small children are often confined to taking Paracetamol or Ibuprofen, which relieves pain and irritation.

1. Paracetamol is a drug that has moderate analgesics and marked antipyretic properties. The drug can be used to treat pain in neuralgia in newborn babies: in the form of a solution for injection during an acute attack, or in the form of a syrup for further treatment. Dosage of the drug for injection - 0.1 milliliter, if used in syrup - it is calculated 10-15 milligrams per kilogram of mass. Side effects can be in the pathology of the liver in the child in the form of toxic effects.
2. Ibuprofen is a drug from a group of non-steroid agents. Can be used from the newborn period to relieve pain during neuralgia. Dosage - 8-10 milligrams per kilogram of body weight. Side effects can be in the form of intestinal bleeding, effects on blood cells.

For central anesthesia use anticonvulsant drugs, reception of which in newborns is limited.

Due to the fact that swallowing is a strong trigger factor, a suppository with carbamazepine (0.1 g) is proposed, which are quickly absorbed and therefore anesthesia is more likely. Use drugs acting on the opiate mechanism of antinociception: sodium oxybutyrate, which can be used in children, counting on body weight.

Apply the effect on trigger areas: lubricate the skin with a 5% anesthetic or 5% lidocaine ointment, alcohol tincture of water pepper.

3. Anesthetic ointment is an anesthetic for topical application. If the child has an accurate source of the affected nerve, you can use the drug for external use. The way of application - it is necessary to put on the skin of the child one drop of ointment and rub it with a cotton swab. Dosage - apply no more than twice a day. Precautions - Use only after the sensitivity test on the skin of the legs, as there may be a marked allergic reaction. For this test, you need to dilute the ointment in half with water and apply a small drop to the skin, rubbing it. If after two hours there are no redness or other changes, then the ointment can be used.

In the case of irrigation of vegetative formations, people use belloid, bellataminal, pyroxane, spasmolitin.

Treatment of neuralgia of herpetic etiology has some peculiarities, since there are drugs that act specifically on this virus. They use two directions in treatment: elimination of acute attack and antiviral specific therapy.

In the neuritic (acute) stage of the disease, antiviral agents are prescribed:

4. Zovirax is an antiviral drug that is active against herpes viruses. Dosage of the drug - 5 10 mg per 1 kg of body weight intravenously drip per 100 ml of isotonic sodium chloride solution, or 0.4 g in tablets 2 times a day for 5-7 days, or as an ointment for external use. Side effects can be in the form of oppression of the nervous system, drowsiness, impaired consciousness.
   • Valtrex (1000 mg 3 times daily for 7 days)
   • Bonafton and Floreal in tablets or ointments for external use,
   • Deoxyribonuclease (0.2% solution for instillation of eyes or in the form of inhalation for 10-12 minutes 2 3 times a day)
   • Interferon (for instillation of the eyes and nose 2 drops 3-4 times a day).

For anesthesia, dimexide with novocaine is used in the ratio 1: 3 for compresses, analgesics (2 ml of a 50% solution of analgin intramuscularly up to 2 times a day, baralgin). In case of severe pain, injection of lytic mixtures (2 ml of 50% solution of analgin, 1 ml of 1% solution of dimedrol, 2 ml of 0.5% solution of novocaine, 1 ml of a 2.5% solution of aminazine) is shown.

It is not recommended to use in the acute stage of the disease drugs that improve the conduct on the nerves (vitamins, proserin), because they can cause the development of postherpetic neuralgia. It also makes no sense to use antibiotics, which further depress immunity and do not produce any effect on viruses. Explain the use of antibiotics can only be used as a prophylaxis of secondary infections in the presence of inflammatory diseases (pneumonia, tonsillitis).

In the case of postherpetic neuralgia, it is inappropriate to use anticonvulsants, because they are practically ineffective; dyes that do not have antiviral activity (methylene blue).

Vitamins can be used after the child's recovery to better accelerate the regeneration of the nerves. B vitamins are especially recommended.

Physiotherapeutic treatment can be widely used for the purpose of restoring the muscles of the child before the onset of complications and violations of muscle movements. To this end, microcurrents are used on the affected areas of the skin, as well as massage.

Alternative treatment

1. Flowers of lilac and chamomile perfectly relieve pain syndrome and reduce edema, which can be formed as a result of nerve compression. To prepare the infusion, you need to take thirty grams of chamomile flowers and thirty grams of lilac flowers in fresh form. It is necessary to pour a mixture of flowers with hot water, but not with boiling water, and insist for two hours. After the infusion slightly cool, you need to make bandage compresses on the affected area.
2. Black radish can be used to relieve a painful attack in an acute period. To do this, you need to make juice from the radish, and apply a painful syndrome to the place of irritation for a few minutes.
3. Burdock relieves pain and swelling, especially with birth trauma, which leads to neuralgia. To prepare a compress you need to take one sheet of young burdock, dry it and add to it water pepper, which you can already ready to buy at the pharmacy. Mix the herbs in a one to one ratio and pour warm water overnight. In the morning, the infusion is ready for use as compresses.
4. Wormwood is a natural antioxidant and an anesthetic. To make a brew, you need to make a weak infusion. To do this, 10 grams of dry grass you need to fill with a liter of hot water and insist for ten minutes. Such a solution can be applied to the projection of the affected nerve. Grass can cause allergic reactions in children, so you need to first make sure that there is no allergy.

Herbs are also widely used for the treatment of neuralgia, since many of them have an anti-inflammatory effect and improve nerve regeneration after its compression or damage. Use herbs for infants inside very carefully, so the priority is given to herbal compresses.

1. Motherwort and mint leaves can be used to treat neuralgia as a tincture for ingestion. For cooking, you need to take 50 grams of both herbs and insist two hours in hot water. You can give the child two drops of this infusion overnight.
2. Sage leaves have a relaxing effect and relieve skin irritation with neuralgia and pain. Very useful in this case for newborn baths with sage. For such a bath you need to take two sachets of sage leaves and pour hot water to make it infuse for ten minutes. After this, you can pour the infusion into the bath and bathe the baby, lubricating the skin after swimming with fir oil, especially in the area of nerve damage.
3. Melissa infusion helps to improve the baby's sleep and relieves increased irritability against neuralgia. For cooking, you need to take dry leaves of lemon balm and make tea. Give the child you need a teaspoon at night before going to bed.

Homeopathy in the treatment of neuralgia is especially effective in cases of residual phenomena of muscle function disorders after neuralgia.

1. Magnesium phosphoricum is an inorganic homeopathic remedy, which is a magnesium derivative. This drug is used to treat neuralgia, which is accompanied by muscle twitching, muscle tone disorders. Dosage of the drug for newborns - two pellets three times a day. Side effects can be in the form of allergic manifestations and pronounced itching.
2. Agaricus is a herbal homeopathic remedy, which is widely used in children's practice. It is effective in treating neuralgia especially the trigeminal nerve in newborns, which is accompanied by reddening of the facial skin and changes in facial muscles. The preparation is used in granules and the dosage is four granules once a week, then two granules per day for three more months. Side effects can be only when the dose is exceeded, then the twitching of the muscles of the child's face may appear.
3. Spiegelia is a monocomponent organic drug that is used in the treatment of neuralgia, especially with the expressed anxiety of the child with concomitant stool disorders and abdominal pain. Often apply the drug in the treatment of severe forms of postherpetic neuralgia. The dosage of the drug depends on the degree of disturbances and, with minimal disturbances, it is one granule per day. Side effects can be in the form of lethargy, lowering reflexes.
4. Calcium is a homeopathic drug that is used to treat complications after neuralgia - with reduced sensitivity or in the case of prolonged recovery of the function of facial muscles. The drug improves the peripheral conductivity of nerve fibers. The agent is applied in granules two granules five times a day for five days, and then three granules twice a week. The course of treatment is 40 days. Side effects are very rare, can cause a short-term weakening of the stool.

[28], [29], [30], [31], [32]

Prevention

Prevention of neuralgia in newborn babies is to avoid sharp trauma, avoid contact with patients for herpetic infection, as well as treatment of acute inflammatory diseases in time until the appearance of signs of nerve damage. It is very important that the mother adheres to the correct temperature regime when caring for a child.

[33], [34], [35]

Forecast

The prognosis for recovery is favorable with active and timely treatment. Less than 5% of children have complications after a neuralgia, but the nerve function can quickly recover with proper care and massage.

Neuralgia in newborns, although infrequent, but serious enough. Since there are very few specific symptoms of the disease, but the child can not say a lot about the pain, the pathology is often diagnosed quite late. Therefore, parents should pay attention to any changes in the state of their child and at the first sign of contacting the doctor.