Hyperkinesis in children

Hyperkinesis in children is manifested in the unconscious, that is, unintentional frequent contractions or twitches of individual muscle groups that periodically recur and under certain circumstances can greatly increase. This neurological pathology occurs in children of different age groups and most often affects the muscles of the face and neck.

It should be borne in mind that until now there is 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, according to the ICD-10 of the World Health Organization, is attributed to child psychiatric and behavioral disorders - ADHD, Attention Deficit Hyperactivity Disorder (F90). To extrapyramidal disorders, such as hyperkinesis in children, this psychogenic syndrome is irrelevant.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

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:

• violations of the functions of the motor neuron centers of the extrapyramidal motor system located in the reticular formation of the brainstem;
• lesions of deep neuronal nuclei (basal ganglia) subcortex of the brain and violations of their coordination with the spinal cord;
• lesions of white matter in the brain;
• cerebellar or spinal cord atrophy;
• disorders of the lateral motor system of the brainstem transmitting impulses from motoneurons to the muscular nerve receptors;
• an imbalance in the synthesis of the neurotransmitters responsible for communication between the neural cells of the CNS: acetylcholine, gamma-aminobutyric acid (GABA), dopamine, serotonin, noradrenaline, etc.
• damage to the myelin sheath of nerve fibers, leading to a violation of neurosynaptic transmission.

These processes can arise because of lesions of the cerebral vascular system or compression effects on its individual structures during birth trauma, 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); craniocerebral injuries; intoxication, as well as the development of brain tumors.

Among the incurable genetic mutations that cause hyperkinesis in children, neurologists pay attention to the childish cerebral adrenoleukodystrophy that occurs at the age of 4-10 years of Schilder-Addison syndrome. The mechanism of the development of this disease is associated with a violation of the functions of cellular organelles peroxisomes, which cease to oxidize long-chain toxic fatty acids (VLCFA), toxic to white matter of the brain, and cease to synthesize the plasmogen of the basic phospholipid myelin. And this causes deep disturbances of the nerve cells not only of the brain but also of the spinal cord.

[10], [11], [12], [13], [14], [15], [16], [17], [18]

Symptoms of hyperkinesis in children

The main clinical symptoms of hyperkinesia in children differ depending on the type of abnormality of muscle motor function.

Choreic hyperkinesis (chorea) is characterized by irregular spontaneous rapid contractions, relaxation of the musculature of the limbs or facial muscles of the face, which make it quick to move the hands and forearms of the hands, eyes, mouth and even nose - against the background of a general lowered muscle tone.

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

Hyperkinesis of the tongue in children is a kind of so-called orofacial dystonia, in which the muscles of the tongue and lower part of the face move episodically, and the child unconsciously arches and protrudes the tongue, as if pushing it out of the mouth. At the same time, speech and swallowing are temporarily broken.

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

Chronic hyperkinesis in children

Typhoid hyperkinesis in children is noted among neurologists among the most frequently diagnosed extrapyramidal disorders. With this kind of hyperkinesia, there are repeated same eyelid twitches, blinking, eye blinking, distortion-like facial distortions, turns and inclinations of the head in various 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 or frightened, the movements can become more frequent. And when trying to restrain an attack, the child becomes even more tense, which results in an increase in hyperkinetic attack.

Separately, experts note hereditary disease (syndrome) Tourette; the symptoms of this type of ticative hyperkinesia are most often manifested in children 2-12 years of age, in boys almost four times more often than in girls. The child's head starts to twitch in both directions, the child shrugs, stretches out his neck, often blinks (one or both eyes) and opens his mouth; thus there is vocalization: sounds like snorting, coughing, buzzing or mooing, and in very rare cases - repetition of just 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). Children's psychoneurologists state that in such children the movement is conditionally reflexive, that is, it does not arise because of pathomorphological changes and impairments in the functions of brain structures, but is a psychogenic neurasthenic reaction. Neurotic tic begins only in certain circumstances and, as a rule, is aimed at drawing attention to oneself.

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

[19], [20], [21], [22], [23], [24]

Hyperkinesis in children with cerebral palsy

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

In addition to problems with coordination of movements, holding the body in an upright position and stability in a sitting position, various involuntary movements of the extremities, neck and head of athetoid, horeathetoid, dystonic or athetoid-dystonic hyperkinesis constantly occur in children with this diagnosis. These more or less repetitive movements can be slow and arrhythmic or fast and rhythmic enough, can take the form of strong jerks, jerks and twists.

Athetoses manifest themselves in slowed rhythmic and often recurring cramps, including convulsive crooks of hands and feet. With choreic motor neuropathies, the movements of the arms and legs are regular and rapid. Dystonic hyperkinesises in cerebral palsy affect mainly the muscles of the neck and trunk, which is expressed in various crooked poses.

According to experts in the field of pediatric neurology, in children's cerebral palsy, hyperkinesia of mimic muscles and limb muscles begin to appear in 1.5-2 years.

Diagnosis of hyperkinesia in children

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

The examination of children with hyperkinesis is carried out with the help of:

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

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

[25], [26], [27], [28], [29], [30], [31], [32], [33], [34]

Treatment of hyperkinesia in children

Treatment of hyperkinesia in children is a long and complex process, as today the causes of their occurrence can not be eliminated.

In the arsenal of neurology there are only pharmacological agents and physiotherapy methods to alleviate the manifestations of the symptoms of these diseases, which make it possible to significantly improve the condition of sick children.

To improve the blood circulation of the brain and complete oxygen supply to cells of its tissues are used vitamins B1, B6 and B12, as well as drugs such as Piracetam, Pantokaltsin, Glycine.

Piracetam (Nootropilum, Pyatropil, Cerebril, Cyclocetam, etc.) in tablets, in the form of granules for the preparation of syrup and solution for oral administration. This nootropic drug contributes to the normal functioning of the cerebral vascular system, and also increases the level of neurotransmitter substances acetylcholine, dopamine and norepinephrine. Standard dosage for children 15-25 mg twice a day (before morning and evening meals), allowed to dilute with water or juice. The dose adjustment and determination of the duration of application is carried out by the attending physician on an individual basis.

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

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

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

Relaxation of muscles is facilitated by Acediprol (Apilepsin, Diplexil, Convulex, Orphyril) in tablets of 0.3 g and as a syrup. It is prescribed at a rate of 20-30 mg per kilogram of body weight per day. Side effects can be in the form of nausea, vomiting, diarrhea, abdominal pain, and skin rashes.

The appointment of muscle relaxant Baclofen (Baklosan) in hyperkinetic forms of cerebral palsy in children over 12 years is aimed at stimulating GABA receptors and reducing the excitability of nerve fibers. The drug is taken internally according to a certain scheme, causes a lot of side effects: from enuresis and aversion to food to suppress respiration and hallucinations.

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

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

Parents need to know that prophylaxis of hyperkinesis in children has not been developed to date, except for genetic counseling before the planned pregnancy. A prognosis of hyperkinesis in children is reduced to the chronic course of diseases that cause this syndrome. Nevertheless, in many children, with the passage of time closer in 17-20 years the condition can improve, but these pathologies are lifelong.