Agra

The ability to express thoughts on paper, and just to correctly write words combines several functions: speech, perception of information and motor. Violation of this ability until its complete loss while retaining the motility of the hand and intellect is called agraphy (literally - the negation of the letter).

Epidemiology

Medical statistics indicate that a variety of forms of disorganization of written speech are often noted in adults as a particular manifestation of broader aphasia or cognitive disorders. The most common risk factor for aggravation is acute cerebrovascular accident. Annually with this diagnosis hospitalized from 460 to 560 people for every 100,000 inhabitants of the planet.

As a special form distinguish congenital disorders of oral and written speech, implying the continued inability to teach the reading and writing of the child, while all other functions of his psyche are within the norm or have minor deviations, including intellect. Although, of course, such defects are much more common among mentally retarded children with hereditarily burdened family history - children of psychopaths, epileptics, alcoholics.

[1],

Causes of the agraphies

To the appearance of a partial or complete loss of the already formed written speech leads to the disintegration of the mental functions involved in its implementation and control. Isolated, this pathology is practically not found. Basically, agraphia is part of the symptom complex for speech disorders, and not even the leading one. The cause of different variations in the inability to write is the localization of damage to the cerebral cortex. When the posterior portion of the II frontal gyrus of the dominant hemisphere is damaged, isolated agraphy can be observed, the pathological process at the border of the angular and second occipital gyrus leads to a combination with alexia (a violation of the ability to read and perceive read). Foci of lesions in the parieto-occipital zone cause agrarians as a symptom of motor aphasia, and at the border of the first temporal gyrus with an edge margin - lead to significant violations of written speech.

The mentioned areas of the brain can be damaged as a result of neoplasm, craniocerebral trauma, inflammatory processes of infectious and non-infectious nature, hemorrhage and cerebral ischemia, intoxication of various genesis, neurosurgical operation.

Risk factors

Risk factors for the development of angiography in childhood: intrauterine brain damage resulting from a pathological mother's pregnancy, asphyxia of a newborn, birth trauma, severe infectious diseases in the postnatal period.

[2],

Pathogenesis

The pathogenesis of agraphia is associated with impairment for any of the above reasons for the interhemispheric organization of mental activity. Speech processes are governed by the dominant hemisphere and are ensured by joint coordinated actions of the hindlimb, temporal, antero-occipital and lower-cel- lular zones of the cerebral cortex, and their ability to use written language is impaired.

Pathogenetic links of this rather complex process can be various brain disorders and, consequently, it can manifest itself in different forms, which should be taken into account when restoring the ability to present speech on paper.

1. The disorder of oral speech, unconditional possession of it, the inability to analyze events and coherently express their thoughts aloud cause speech agrarians, as a symptom of the syndrome of motor or sensory impairment of already formed speech (aphasia). They usually correspond to damage to the cerebral cortex in the region of the upper temporal, dorsal frontal or lower parts of the crown.
2. Violation of sensory and gnostic perception and their interaction causes gnostic (non-verbal) agrarians. They are signs of a syndrome of impaired perception (auditory, optical, spatial, their combinations). They usually correspond to the lesions of the cortical areas in the zone of the crown and occiput.
3. Disorder of the fine motor skills of the hands, various types of their adequately coordinated actions (switching disorders, mobility, etc.), as well as motivation, regulation, control of their activity causes agrarians as a disorder of purposeful behavior. Corresponds to lesions of the frontal cortex of the left hemisphere of the brain.

[3]

Symptoms of the agraphies

The first signs of the disease are manifested when a person needs to write something. He correctly takes a pen or pencil in his hand and can not recall a single letter and reproduce them on paper or unable to connect letters into syllables, and syllables into words. Sometimes the text written by the patient or copied by him is mirror-symmetrical - this form is typical for left-handed people. Agra can be expressed in an infinite repetition of the same letter combination - polygraphy, or in the writing of an alphabetical verbal abracadabra, devoid of any meaning, - a paragraph.

In an easy stage of the disease, the patient writes with errors and omissions, but a readable text. Maybe, even if it's not always right, copy it or write dictation. In severe forms - agrarians can not reproduce any letters, write any circles or dashes, sometimes correctly writing letters, can not combine them into syllables and words.

There are different types of violation of written language. Isolated agraphy is extremely rare, as a rule it is combined with alexia - a disorder of semantic perception, comprehension and retention in the memory of the information read. Sometimes only the smoothness of reading is broken, in severe cases the patient does not recognize the letters and can not put them into words, confuses visually similar letter symbols. Alexia and agraphy - are part of the symptom complex of various types of violations of speech function (aphasia).

If agraphy is a loss of ability to write, the dysgraphy of children is an inability or great difficulty in the process of mastering a letter, expressed in a letter with constant mistakes, in the absence of hearing defects and mental retardation. Usually, the difficulties with written speech are inextricably linked with the inability to master reading (dyslexia). A great role in the genesis of these pathologies is given to heredity.

Secondary dysgraphy and dyslexia in childhood include writing and reading disorders if the child does not cope with the loads in the primary school, does not fit into the time frame for reading speed, making mistakes in writing tasks or, without a good auditory memory, can not retell the given text. Secondary dysgraphia and dyslexia in children are not considered pathological.

Disgraphy in adults - partial or complete inability to write, considered in the symptom complex of different types of aphasia syndrome.

Agnostic disorders often combine with each other, so agraphy (inability to write) can manifest simultaneously with acalculia - a violation of the perception of numbers, the loss of the ability to count and perform arithmetic operations. The patient can not remember and record not only the alphabetic, but also the digital series, it is not possible to compare numerical values. Sometimes the disease manifests itself as the inability to produce a specific arithmetic effect, for example, the patient can subtract the numbers, but the addition does not cause him difficulty. Either a person does not perceive numbers in which there is any particular figure, for example, "5".

Often the inability to read and write is accompanied by a violation of oral speech, a loss of ability to read. With lesions of the temporal zone, acoustic perception is lost, occipital - visualization, prefrontal - planning and control functions.

Motor acne arises when the functions of the dorsal frontal cortical areas of the brain are disturbed. It is divided into efferent, when the kinetic basis of oral speech is violated, that is, the ability to pronounce syllables and words entirely. At the same time, the patient observes a non-observance of the necessary alphabetic sequence in syllables and words while writing the alphabetic characters themselves does not suffer. And afferent, when the patient does not distinguish between individual sounds that are close in pronunciation - the performance of articulatory movements.

Symptoms of efferent motor agraphy are a lot of mistakes in the written text, up to the total inability to write. A person can write very slowly, in an altered handwriting with angular non-fused letters. There are permutations and omissions of letters, repetitions of syllables and words, in the text there are unfinished words, the structure of the sentence is broken, understanding of its meaning. With severe degree of defeat, patients can not write anything except speech stereotypes (name, surname, address, country of residence, etc.).

In patients with an afferent form, the kinestatic basis of speech motor skills is upset. It is often found in the symptomatic complex of motor aphasia. This type of agraphy is characterized by a loss of the sensation of articulatory boundaries when differentiating sounds that are similar in reproduction. Characteristic symptoms: replacement when writing the words and sentences of some letters by others, meaning sounds with a similar articulatory reproduction technique; miss letters denoting consonant sounds at their confluence or vowels; In the middle of words, syllables can be omitted. This kind of agrarian art is characterized by a violation of all varieties of the letter, except the rewriting of the text. The most violated is the process of writing under the dictation and expressing one's thoughts on paper. Automativeness of the letter is practically absent. Typically, a complete or partial misunderstanding of the meaning of the written, however, more or less preserves the linear unit of speech and the layout of the recorded phrase.

Amnestic or pure agra is revealed when the patient can not compare the sound unit of the language with its image on paper. In the text written by ear or independently there are gross grammatical errors, the missed letters are in words, words are missing in the phrases, punctuation is violated. Sentences can be written from right to left (mirrored). The most readable text is obtained by rewriting.

Sensory agraphy is associated with impaired perception of sounds associated with a disorder of sound (defects in the sensorimotor mechanism of acoustic perception of speech sounds), therefore, the main symptom of this form of the disease is the inability to write at all and, mainly, dictation. The independent letter also disintegrates, the ability to rewrite the texts may be partially preserved, but the automatism of this action disappears and only the ability to copy by one letter remains. In patients, either a complete inability to write, or gross disorders of this ability is revealed. An idiogram letter can be preserved, with light degrees of damage, the text is filled with alphabetic paragraphs in abundance, while the replacement of letters occurs according to the kinesthetic sign (meaning sounds similar to reproduction). This type of agraphy is usually part of the symptom complex of sensory aphasia syndrome - disorder of active speech and self-writing, as well as its perception and understanding.

Some specialists single out another form of agrarian - acoustic-mnestic, arising from certain morphological features of the structure of the II temporal gyrus of the left hemisphere. This is an insufficiently studied pathology and not all specialists agree with its isolation in a separate type of agraphia.

Acoustical-mnemonic agraphy is characterized by a disorder of the higher processes of writing organization. Symptoms of this kind are subjective sensation of the patient that he can not write. Violated is not the habit of writing, but its level, the automatism of the process disappears, the patient is completely unable to write independently, although his skills are not affected and the perception of the sound series is not violated. In patients, one-stage perception of information (simultaneous) is replaced by step-by-step (successive) information, stretched over time. When step-by-step actions are violated, the integrity picture of the text read or heard does not add up. The patient is disturbed by the volume of sound perception, he confuses the names of actions and objects, repeats himself, there is confusion in the letter symbols, while he retains other forms of perception, attention, general motivation, purposefulness and verbal behavior are not broken.

With this form of writing, the writing of texts is conscious, arbitrary and very slow. Typical mistakes in writing are not complete words, replacement of parts of a word.

Aprakticheskaya agrai occurs usually in the ideator form of speech disorder. In this case, the patient loses his skills to the usual systematic and pursuing a certain goal actions. He is not able to remember how to pick up a pen and the sequence of further actions is also unknown to him. Since the very motor organization of the writing process is violated, all kinds of written speech are violated, even simple copying is not possible. The text is obtained with gross distortions, the spatial ratio of its elements is violated, in the heavy patients instead of letters only chaotically arranged dashes are obtained. The border between the marginal gyrus and the angular border is struck in this case, much less often this form of agraphia accompanies the foci in the rear of the II frontal gyrus.

Optical-spatial agra is a variant of the optical that affects the visual image of a letter corresponding to a particular sound and its spatial form. In addition to this species, optical, optocompositional, apraktognostic forms of pathology are also isolated. The latter is extremely rare. All four kinds are connected by the fact that the graphic image of sound is not perceived as a visual object, with the audio-perception preserved.

Such forms of agraphia correspond to foci in the lower parts of the parietal region of the cerebral cortex. This disrupts the visualization of the image and its comparison with the graphic form. The patient hears and distinguishes sounds, but can not reproduce on paper a letter, especially it is difficult to give him an image of spatially oriented alphabetic characters, which in the alphabet are most. In the symptomatology there are spatial distortions of letters, their elements and combinations, difficulties in selecting the desired letter.

Optical agraphy differs from the previous form of the disease in that the patient does not remember at all the visual image of the letter, which designates a specific sound, the recognition of the visual image of the letter symbol is violated. Characteristic symptoms are the replacement of letters, similar in appearance, a long search for the desired letter, a very slow and arbitrary written speech. For the optical form of the disease, it is often possible to write, for example, only in block letters or, conversely, handwritten, if it is impossible to switch from one type of letter to another.

Optical-mnogical agraphy - violations are expressed in the fact that the patient remembers how letters look like letters, can write them, but does not remember their meanings, and designates sounds with existing, but not corresponding, letters. This form of agraphy is usually a symptom of amnestic aphasia, in which the patient can not recall the names of the objects.

The aprakto-agnostic agra is characterized by a distortion in the writing of letters, while the grapheme is preserved.

In the case of violations of psychological activity, such types of agraphy as dynamic can develop, when the order of structuring a sentence, the coordination of words within it and sentences in the text, and the semantic one, are broken, when difficulties arise when using complex logical grammatical constructions conveying shades of meanings, comparisons, and others. With such disorders, written speech is violated at the higher levels of its organization as a means of expressing thought. Violations of sensorics and motor skills of written speech do not occur.

[4], [5]

Complications and consequences

Since the loss of ability to write, partial or complete, is provoked by pathological processes developing in the cerebral cortex, the consequences of even minor signs of agraphy can be very serious. Therefore, the appearance of the first signs of a disorder of written language should be a reason for a serious brain examination, as it can signal the presence of an evolving tumor, ischemic process, micro-stroke, timely treatment of which can lead to complete restoration of functions, and the launched process is fraught with aggravation, disability and even mortality. A person who has lost the opportunity to write texts, greatly reduces the level of self-esteem, the quality of life, the likelihood of finding a job and lead an independent independent existence.

[6], [7]

Diagnostics of the agraphies

To establish that the patient has lost in any capacity the ability to use written language does not present any special difficulties. After studying the patient's complaints, he is asked to perform tests for the letter under dictation, rewriting, independent and idiogram. The patient's capabilities and the types of errors made during the test are analyzed.

Not only the patient's speech processes are being examined. The state of his motor and cognitive functions is necessarily comprehensively evaluated.

It is much more difficult to establish the cause of the pathology that has arisen. Sometimes it lies on the surface, if the advent of agraphia was preceded by trauma, severe infection, in other cases more hidden causes should be discovered. In establishing the causes and depth of the emerged pathology, laboratory and instrumental diagnostic methods are used.

The patient is assigned clinical tests. They can not specify the direct cause of agraphy, but they are necessary for assessing the general condition of the patient and identifying inflammatory, intoxication processes, concomitant diseases.

Modern instrumental studies - electro- and ECHO-encephalography, radiography of the skull, study of blood circulation in the vessels of the brain (rheovasography), magnetic resonance imaging or computed tomography, if necessary with the use of contrast, will help to pinpoint the site of the lesion of the cerebral cortex.

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Differential diagnosis

Differential diagnosis is carried out at the final stage of the survey. Combining the data of the anamnesis, they are considered from the point of view of determining the cerebral pathology that caused the violation of written speech.

Treatment of the agraphies

The process of restoring the ability to write is multistage and multicomponent. First of all, the main disease is treated, sometimes surgical intervention is required. The patient is registered with a specialist in psychiatry or neurology, he undergoes a course of drug treatment. At the same time, classes with a speech therapist are assigned, which, with the help of special exercises, restores the work of the sites of the cerebral cortex. Especially beneficial are musical studies - singing, playing musical instruments. They develop (repair) the fine motor skills of the hands and fingers. Logopedic rhythmics, dictation, presentation, reading - such regular classes, both individual and collective, are very effective, especially when the problem is treated in a timely manner by specialists.

Medical therapy is designed primarily to provide nutrition to brain cells, stop the growth of the focus of ischemia and restore blood circulation in this area.

To restore the functions of the brain, Cereton can be appointed  . The active ingredient of the drug is choline alphoscerate. Getting into the body, it is converted into the necessary for the normal functioning of the nervous system acetylcholine (a conductor of interneuronal impulses) and a building material for damaged neuronal membranes - phosphatidylcholine. Restored impaired cerebral circulation and the function of nerve endings. The effect of the drug is manifested in the acceleration of pulses between neurons and the regeneration of damaged cell membranes, which becomes noticeable in eliminating the reactive inhibition of the patient, improving his memory, concentration, and learning. Neurological symptoms go away and behavioral stereotypes improve.

The drug is eliminated mainly through the lungs with exhaled carbon dioxide (about 85%), the rest is excreted with the kidneys and intestines. As a recovery drug, capsules are taken for half a year, while in the morning it is recommended to swallow two capsules, during lunch - one more. The drug is recommended for adult patients. It does not need to be taken by pregnant and lactating women and with allergies to ingredients. The most common adverse reaction after taking is nausea, dyspeptic and neurological disorders can sometimes occur.

To restore disturbed as a result of strokes, intoxications, injuries and operations, mental functions, other drugs with nootropic properties are used. For example,  Nootropil  (the active ingredient is piracetam). This drug is represented by a variety of synonyms (Cerebropan, Cyclocetam, Encephalus, Eumental, Nocephalus, Pirates, Piroxilum, Euvifor, Neutrophin, Nocecebril, Norotrop and others). It has a positive effect on metabolic processes, in particular, glucose uptake, and cerebral circulation, activates enzymes of oxidation-reduction reactions, helps to reduce the area of ischemic areas of the cerebral cortex, increases the resistance of nerve cells to oxygen starvation and the action of toxic substances. Nootropic action is based on increased production in brain cells of dopamine and norepinephrine, as well as in intercellular synapses of acetylcholine. Eliminated by the kidneys, the spinal fluid persists longer than in other organs and tissues, that is, it has the greatest affinity for the brain tissues. It can be used to treat children with a one-year-old age, pregnant and lactating women to apply, by measuring the risk / benefit ratio. Use with caution allergy sufferers with fructose intolerance. Side effects are neurological and dyspeptic. Treatment is long, used in a daily dose of 2.4 g, divided into three meals before meals. Over time, the dosage is reduced to a minimum effective, canceled gradually. Maximum can be prescribed at the beginning of treatment daily dose of 4.8 g. The pediatric neurologist counts the dose for children (not more than 0,03-0,05 g per day).

Drugs of neuroamic acids may be prescribed. For example,  Fenibut, which improves blood circulation in the vessels of the brain and restores metabolic processes in its cells. Increases intellectual performance, reduces negative psycho-emotional symptoms. As a result of taking the drug, attention, memory, speed of perception and accuracy of response reactions are quickly enough improved. Well absorbed, the tropen to the brain tissue. Eliminated mainly by the kidneys. It is not prescribed for children under the age of eight, pregnant and lactating women, with its intolerance. Side effects are similar to previous drugs, low toxicity, but the dosage prescribed by a doctor should not be exceeded. The standard dose is 0.75-1.5 g per day, divided into three doses. Take the drug before meals. Elderly people are not recommended to prescribe the highest dosage, for adults, if necessary, the daily dose may be 2.25 g. Children aged 8-14 years old usually take 0.75 g per day.

Glycine, a combination of the same-name active ingredient with vitamins B1, B6, B12, regulates metabolism, mental activity and other areas of neuro-psychic activity. It overcomes the blood-brain barrier, it is not cumulated in organs and tissues, it is excreted in the form of metabolites: water and carbon dioxide. Contraindicated only in cases of allergy to components. The drug should appoint a doctor, the standard dosage assumes taking one tablet two to four times a day.

Metabolic processes in the cerebral cortex, nutrition of its cells and blood circulation can be normalized with the help of preparations containing only vitamins. For example, Ascorutin, containing vitamin C and P (rutin), strengthens blood vessels, favorably affects erythropoiesis, prevents thrombogenesis. It is used in conjunction with drugs that dilute blood.

In cases of cerebral circulation disorders, depending on the patient's condition, the doctor can prescribe different complexes containing B vitamins.

Angiovitis (vitamins B6, B9, B12) is prescribed with increasing serum homocysteine concentration for its normalization in cases of cerebral circulation disorders. Apply one tablet per day for three to four weeks.

Pentovit in  addition to the already listed contains vitamins B1 and B3, compensates for the deficiency of its constituent vitamins, which is often observed with neuropsychic disorders, improves tissue nutrition and metabolism of proteins, fats and carbohydrates. It is prescribed from six to 12 tablets in three divided doses after meals for about a month.

It should be remembered that vitamins are taken only as part of complex treatment and only on the prescription of a doctor.

All the above drugs, including vitamins, do not combine with alcohol.

Physiotherapy treatment increases the sensitivity of the body to drug therapy, allowing you to shorten the timing of taking drugs and their dosage. At the initial stages of the disease can be used independently, usually - it is included in the treatment complex.

In neurological practice is applied: laser therapy, magnetotherapy, darsonvalization, drug electrophoresis, oxygen and iodine-bromine, and dry carbonic baths.

Alternative treatment

At home, you can also organize classes with the patient - to write with him dictations and exposition or just letters. For the purpose of feeding brain cells and activating the cerebral circulation, prescriptions for alternative medicine can be used in complex treatment. However, before restoring brain functions in this way, it is necessary to consult with the attending physician regarding the safety of the methods chosen by you and their combination with the prescribed medications.

The simplest and safest way to cleanse the body, remove toxic substances and renew all organs is to suck a tablespoon of vegetable oil in the morning on an empty stomach. The apologists of this method claim that it works without fail, only the time spent on treatment depends on the degree of neglect of the disease: from acute conditions one can get rid of in just two days, and to get rid of chronic ones it can take years. For this method any vegetable oil, in particular, sunflower oil, in which there is no shortage on our territory, will do. The oil is taken unrefined. After waking up in the morning, take about a tablespoon of butter in your mouth and suck it like a sweet in your mouth, trying to get it under your tongue. Do this for at least a quarter of an hour, swallowing the contents can not be, because it is put toxic. At the end of the process, it should be spilled into the sewer system or even buried in the ground. In the process of sucking, the oil first thickens, then it becomes liquid and turns white - you can spit it out. After the procedure - rinse your mouth with clean water.

More laborious, but also much more pleasant is the cleansing of the body with the help of beet kvass. Prepare it as follows: wash three medium root vegetables with a vegetable brush (do not clean!), Cut into salad (small cubes) and put in an enameled pot with a capacity of three liters (can be put in a glass jar), pour two tablespoons of sugar. Close the lid. Infuse for two days at a temperature of about 20 ℃, stirring the contents twice a day. Then pour two glasses of clean raisins (without pits) into the dishes. Leave for another week, stirring the contents still twice a day. The cleansing process begins on the eighth day: take a tablespoon of kvass before four meals. It is recommended to hold a three-month course, then take a break. Hypotonics such cleansing is not suitable, because beet reduces blood pressure.

The leaves of the relic Ginkgo Biloba have long been recognized as official medicine as a universal remedy for improving cerebral circulation and metabolism. The plant increases the resistance of brain cells to hypoxia, has antioxidant qualities, has an antispasmodic effect and prevents the development of cerebral edema. With his help, rehabilitation after brain surgery, stroke and craniocerebral trauma occurs much faster. Pharmacies present different forms of phytopreparations prepared from the leaves of Ginkgo Biloba. These are non-prescription drugs: tinctures, capsules, extracts and oils. Each form of the release is accompanied by an instruction for use.

These drugs can not be used for ulcerative and erosive lesions of the gastrointestinal tract, acute disorders of cerebral and coronary circulation, as well as for hypotension, pregnant and lactating women, people taking drugs that dilute blood.

Alternative healers do not object to the external use of the leaves of Ginkgo Biloba and to treat children, but the official pediatrics do not approve of it.

To stimulate metabolic processes in alternative medicine, herbal therapy is used. For example, it is recommended to prepare the following multicomponent product for herbal infusion: take three liters of cold water for 100 g of yarrow and wormwood, and the same number of pine buds. Boil in an enamel saucepan and leave overnight, drain in the morning. Pour into a saucepan with infusion of kilograms of sugar, pour one glass of aloe juice, all boil and leave until the next morning. Again drain and boil again, then press for seven hours. In this infusion, add a kilogram of light flower honey, 500ml of quality cognac, 100g of befungin. Mix well, spread on glass jars and insist in a warm, sheltered from the light spot for a week. Drink one tablespoon three times a day for half an hour before meals. It is recommended to have a three-month course of treatment.

With the same purpose, fresh birch sap is used, and not in season - leaves or kidneys. Birch products remove all unnecessary from the body, stimulates metabolic processes and promotes the rejuvenation of all organs and tissues - the patient feels energized, becomes energetic and smart. For the infusion, both young leaves and kidneys are used, and dried (sold at the pharmacy). Brew them at a rate of 10 g for 200ml of boiling water.

To restore cerebral circulation during the rehabilitation period after his acute violation, it is recommended to take three or four times a day for three to four times a day a third of a glass of herbal infusion. First it is necessary to mix the dried and crushed parts of plants: a handful of thyme and oregano; two handfuls of leaves of mint, roots of valerian and cones of hops; four - the leaves of geranium, flowers of the labaznik, grass motherwort and St. John's wort. Add five handfuls of willow-tea, mix well. To fill in a thermos two tablespoons of a dry mix and to fill in ½ liter of boiling water. Leave for the night, drain in the morning and take during the day.

[9], [10], [11]

Homeopathy

Improve nutrition of brain cells and microcirculation of blood in its vessels can included in treatment regimens or designated as a monotherapy complex homeopathic remedies.

Ubiquinone compositum  provides purification of the body of toxins and toxins, stimulates metabolic processes and tissue respiration, binds free radicals, reduces inflammatory and allergic manifestations.

Coenzyme compositum possesses the same properties due to a somewhat different composition of homeopathic components. These complex medicines can be used with any medications. They are used both for acute disorders of cerebral circulation, for any inflammatory and infectious processes, for neoplasm and for rehabilitation, to increase resistance to hypoxia and restore disturbed processes of nutrition, respiration and blood circulation. The manufacturer recommends alternating these two products to achieve a rapid therapeutic effect and does not even rule out the possibility of their simultaneous application. The standard course includes at least ten injections, however, the frequency of administration and duration of treatment should be prescribed by a physician. Drugs can be prescribed to children, Ubiquinone compositum is not recommended for the treatment of pregnant and lactating women, and the use of coenzyme compositum in such cases is permissible by the doctor's decision.

Cerebrum compositum  has a multifaceted effect on the work of the brain, including improves the interaction between the left and right hemispheres. Strengthens the walls of blood vessels, prevents embrittlement, has a moderate vasodilator and spasmolytic effect, activates cellular nutrition. It is applied in the rehabilitation period after the suffered brain injuries, acute disorders of cerebral circulation, neurosurgical operations, inflammatory and infectious diseases.

All of the above injection preparations are administered by any means. Agra becomes noticeable in children, usually from the age of six, they are already prescribed adult dosages. Drugs are administered at a frequency of one to three times per week for one ampoule.

Orally you can take Ubihinon and Cerebrum compositum, diluting one ampoule in 50ml of clean water and drinking the contents during the day in equal portions.

For a more effective and quick rehabilitation after a disturbance of the nervous system, especially in patients with increased nervous excitability, drops or Nerve Vegetable tablets may be used  . This drug has a beneficial effect on memory, improves psycho-emotional status. Possible application at any age.

Undoubtedly, the most stable and effective drug will be one that will be appointed by a specialist homeopath individually. Homeopathic arsenal is used in different periods of illness, both acute and chronic. First aid for injuries of various locations, including craniocerebral, is Arnica.

The consequences of injuries and / or surgical interventions on the brain are well controlled by drugs: Natrium sulfuricum and Helleborus niger. For hemorrhagic and ischemic strokes, homeopathic granules of Veratrum viride, Baryta carbonica and Baryta iodata can be prescribed. To restore the vessels of the brain in the ischemic zone, Ambra grisea, Lachesis and Phosphorus are used.

Surgery

Patients with violations of written speech due to acute disorders of cerebral circulation, craniocerebral trauma, with brain tumors may be indicated surgical treatment. These can be open-type operations and minimally invasive interventions, for example, selective thrombolysis-the dissolution of thrombi that clogs the vessel, removes the hematomas that result from a stroke or trauma, and neoplasms. The scope of the operation is determined by the type of pathology and the patient's condition. Sometimes surgical intervention gives tangible and rapid results.

However, sometimes the neurosurgical operation itself becomes the cause of agraphia.

Prevention

Measures to prevent the development of agrarians in a person with written speech skills is rational behavior, which allows to avoid craniocerebral traumas and intoxications as much as possible, and a healthy lifestyle that prevents the development of tumors, inflammations, acute circulatory disorders in the vessels of the brain.

The prevention of congenital agrarians can be a conscious and pragmatic attitude to the birth of children, which will prevent the pathology of pregnancy and childbirth.

If the parents discovered the symptoms of agraphia in the child, the immediate application for medical help, the timely diagnosis and treatment will guarantee the successful elimination of the pathology. At home, you need to more often engage with the child speech exercises, write it in developing circles, focusing on music and dance classes.

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Forecast

Treatment of this pathology can be prolonged, however, in isolated agraphy the probability of recovering the lost function is quite high (much higher than in the symptomatic complex of aphasia). A great role is played by the timeliness of the treatment started and its complexity.