Hyperkinesias in children

Hyperkinesis in children manifests itself in unconscious, i.e. unintentional, rapid contractions or twitching of individual muscle groups, which are repeated periodically and under certain circumstances can significantly increase. This neurological pathology occurs in children of various age groups and most often affects the muscles of the face and neck.

It should be borne in mind that there is still confusion in the use of the term "hyperkinesis" as a synonym for the concept of hyperactivity in children. However, hyperactivity is a psychiatric problem and, in accordance with the ICD-10 of the World Health Organization, is classified as a childhood mental and behavioral disorder - ADHD, attention deficit hyperactivity disorder (F90). This psychogenic syndrome has nothing to do with extrapyramidal disorders, which are hyperkinesis in children.

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Causes of hyperkinesis in children

The key causes of hyperkinesis in children are similar to the etiology of hyperkinesis in adults. This pathology is a consequence of:

• dysfunction of the motor neuron centers of the extrapyramidal motor system, located in the reticular formation of the brainstem;
• damage to the deep neural nuclei (basal ganglia) of the cerebral subcortex and disturbances in their coordination with the spinal cord;
• white matter lesions of the brain;
• cerebellar or spinocerebellar atrophy;
• disorders of the lateral motor system of the brainstem, which transmits impulses from motor neurons to muscle nerve receptors;
• imbalance in the synthesis of neurotransmitters responsible for communication between nerve cells of the central nervous system: acetylcholine, gamma-aminobutyric acid (GABA), dopamine, serotonin, norepinephrine, etc.
• damage to the myelin sheath of nerve fibers, leading to disruption of neurosynaptic transmission.

These processes may arise due to damage to the vascular system of the brain or compression effects on its individual structures due to birth injuries, cerebral hypoxia or hemolytic jaundice of newborns; intrauterine pathologies of the brain (cerebral palsy, adrenoleukodystrophy); inflammation in encephalitis or meningitis; systemic autoimmune pathologies (rheumatism, systemic lupus erythematosus, thrombotic vasculopathy); traumatic brain injury; intoxication, as well as the development of brain tumors.

Among the incurable genetic mutations that cause hyperkinesis in children, neurologists pay attention to the Schilder-Addison syndrome, which manifests itself at the age of 4-10 years, childhood cerebral adrenoleukodystrophy. The mechanism of development of this disease is associated with the dysfunction of the cellular organelles of peroxisomes, which stop oxidizing long-chain fatty acids (VLCFA), which are toxic to the white matter of the brain, and also stop synthesizing plasmogen, the main phospholipid of myelin. And this causes profound damage to nerve cells not only in the brain, but also in the spinal cord.

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Symptoms of hyperkinesis in children

The main clinical symptoms of hyperkinesis in children vary depending on the type of muscle motor abnormalities.

Choreic hyperkinesis (chorea) is characterized by irregular spontaneous rapid contractions and relaxations of the muscles of the limbs or facial muscles, forcing rapid movement of the hands and forearms, eyes, mouth and even nose - against the background of general decreased muscle tone.

In rheumatic chorea (Sydenham's chorea), which is a complication of rheumatic damage to the membranes and valves of the heart, negatively affecting the cerebral blood vessels, children (especially often in girls) experience various unintentional movements of the facial muscles (in the form of grimaces) and limbs, swallowing disorders, fine motor skills, as well as episodic difficulties in walking and maintaining a certain posture.

Hyperkinesis of the tongue in children is a type of so-called orofacial dystonia, in which the muscles of the tongue and lower part of the face move episodically, and the child unconsciously bends and sticks out the tongue, as if pushing it out of the oral cavity. In this case, speech and swallowing are temporarily impaired.

Signs of athetoid hyperkinesis (athetosis) are characteristic uncontrolled bending of the phalanges of the fingers, wrists, ankles, as well as convulsive movements of the tongue, neck (spasmodic torticollis) or torso (torsion spasm). Often these arrhythmic twisting movements lead to unnatural body positions. And in the case of myoclonic hyperkinesis, very fast and abrupt movements of the tongue, facial muscles, neck and the entire head are replaced by a phase of complete muscle relaxation with elements of tremor.

Tic hyperkinesis in children

Neurologists note tic hyperkinesis in children among the most frequently diagnosed extrapyramidal disorders. With this type of hyperkinesis, there are repeated identical twitching of the eyelids, blinking, squinting, facial distortions similar to grimacing, turns and tilts of the head in different planes, swallowing movements of the larynx muscles. There may also be phonic tics, when movements are accompanied by various involuntary sounds. If the child is worried, concerned about something or scared, the movements may become more frequent. And when trying to contain the attack, the child tenses up even more, which results in an increase in the hyperkinetic attack.

Specialists separately note the hereditary disease (syndrome) of Tourette; the symptoms of this type of tic hyperkinesis most often appear in children aged 2-12, in boys almost four times more often than in girls. The child's head begins to twitch in both directions, the child shrugs his shoulders, stretches his neck, blinks frequently (with one or both eyes) and opens his mouth; vocalization appears: sounds such as snorting, coughing, buzzing or mooing, and in very rare cases - repetition of what has just been heard (echolalia) or swearing (coprolalia).

A few words should be said about neurotic tics in children with the previously mentioned attention deficit hyperactivity disorder (ADHD). Child psychoneurologists claim that in such children, the tic movement is a conditioned reflex, that is, it does not arise due to pathomorphological changes and dysfunctions of brain structures, but is a psychogenic neurasthenic reaction. A neurotic tic begins only in certain circumstances and, as a rule, is aimed at attracting attention to oneself.

With timely psychological assistance to the child and the correct behavior of his parents, a neurotic tic can pass after a certain time, but tic hyperkinesis in children in most cases remains into adulthood.

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Hyperkinesis in children with cerebral palsy

Hyperkinesis in children with cerebral palsy due to dysfunction of the brain stem and subcortical regions of the brain that regulate various muscle contractions is characteristic of the extrapyramidal form of this disease, which accounts for up to 25% of all clinical cases.

In addition to problems with coordination of movements, maintaining the body in an upright position and stability in a sitting position, children with this diagnosis constantly experience various involuntary movements of the limbs, neck and head - athetoid, choreiathetoid, dystonic or athetoid-dystonic hyperkinesis. These more or less frequently repeated movements can be slow and arrhythmic or fast and quite rhythmic, can have the form of strong pushes, jerks and twists.

Athetoses manifest themselves as slow, rhythmic and frequently repeated writhing, including convulsive twisting of the hands and feet. In choreic motor neuropathies, the movements of the arms and legs are regular, fast and jerky. Dystonic hyperkinesias in cerebral palsy mainly affect the muscles of the neck and trunk, which is expressed in various twisted postures.

According to specialists in the field of pediatric neurology, in cerebral palsy, hyperkinesis of the facial muscles and muscles of the limbs begins to appear at 1.5-2 years.

Diagnosis of hyperkinesis in children

Differential diagnosis of hyperkinesis in children should exclude the presence of epilepsy (with its characteristic seizures) and congenital childhood cerebral adrenoleukodystrophy (Schilder-Addison syndrome) in the child.

Examination of children with hyperkinesis is carried out using:

• biochemical blood test for the content of amino acids, immunoglobulins, alpha-fetoprotein, long-chain fatty acids (VLCFA);
• electroencephalography (EEG) of the brain;
• ultrasound examination (ultrasound) of the brain;
• electromyography (study of the electrical potential of muscles and the speed of nerve impulses passing to them);
• computed tomography (CT) and magnetic resonance imaging (MRI) of the brain.

Since in most cases hyperkinesis in children is genetically determined, an analysis of the genes of both parents helps to clarify the etiology of a specific disease.

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Treatment of hyperkinesis in children

Treatment of hyperkinesis in children is a long and complex process, since today it is impossible to eliminate the causes of their occurrence.

In the arsenal of neurology there are only pharmacological means and physiotherapeutic methods to alleviate the symptoms of these diseases, which can significantly improve the condition of sick children.

To improve blood circulation in the brain and fully supply the cells of its tissues with oxygen, vitamins B1, B6 and B12 are used, as well as drugs such as Piracetam, Pantocalcin, and Glycine.

Piracetam (Nootropil, Piratropil, Cerebril, Cyclocetam, etc.) in tablets, in the form of granules for the preparation of syrup and solution for oral administration. This nootropic drug promotes the normal functioning of the vascular system of the brain, and also increases the level of neurotransmitters acetylcholine, dopamine and norepinephrine. The standard dosage for children is 15-25 mg twice a day (before morning and evening meals), it is allowed to dilute with water or juice. The dosage and duration of use are determined by the attending physician on an individual basis.

The drug Pantocalcin (calcium salt of hopantenic acid) reduces motor excitability and is prescribed to children over three years old at 0.25-0.5 g 3-4 times a day (half an hour after meals), the course of treatment lasts 1-4 months. Possible side effects: rhinitis, conjunctivitis, skin rashes.

Improves the metabolism of brain cells and has a calming effect on the central nervous system drug Glycine (Aminoacetic acid, Amiton, Glycosil) in tablets of 0.1 for resorption under the tongue. Children 2-3 years old are recommended to give half a tablet (0.05 g) twice a day for 1-2 weeks, children over three years old - a whole tablet. Then a single dose is taken once. The maximum duration of admission is a month, a repeat course of treatment can be prescribed after 4 weeks.

In drug therapy of hyperkinesis in cerebral palsy, neurologists use analogs of gamma-aminobutyric acid with an anticonvulsant effect. These are drugs such as Gabapentin and Acediprol. Gabapentin (Gabantin, Gabalept, Neurontin) is recommended for children over 12 years old, one capsule (300 mg) three times a day. However, the drug can have side effects: dizziness and headache, increased blood pressure, tachycardia, sleep disorders.

Muscle relaxation is also promoted by Acediprol (Apilepsin, Diplexil, Convulex, Orfiril) in 0.3 g tablets and syrup. It is prescribed at a rate of 20-30 mg per kilogram of body weight per day. Side effects may include nausea, vomiting, diarrhea, abdominal pain, and skin rashes.

The prescription of the muscle relaxant Baclofen (Baclosan) for hyperkinetic forms of cerebral palsy in children over 12 years of age is aimed at stimulating GABA receptors and reducing the excitability of nerve fibers. The drug is taken orally according to a specific scheme, causes many side effects: from enuresis and aversion to food to respiratory depression and hallucinations.

Galantamine (Galantamine hydrobromide, Nivalin) can also be prescribed, which activates the transmission of nerve impulses by stimulating acetylcholine receptors. This drug is intended for subcutaneous injections and is available as a 0.25-1% solution.

In case of hyperkinesis, physiotherapy and exercise therapy, water procedures and massages are useful for children. In particularly severe cases, surgical intervention can be performed: destructive or neuromodulatory surgery on the brain.

Parents need to know that prevention of hyperkinesis in children has not been developed to date, except for genetic counseling before a planned pregnancy. And the prognosis for hyperkinesis in children is reduced to the chronic course of diseases that cause this syndrome. However, in many children, over time, closer to 17-20 years, the condition may improve, but these pathologies are lifelong.