Vegeto-vascular dystonia (neurocirculatory dystonia) in children

Until now, in our country there is no common opinion among doctors of various specialties (pediatricians, cardiologists, neurologists) on the interpretation of the concept of vegetative-vascular dystonia in children and adolescents. The term "neurocirculatory asthenia", introduced for the first time in clinical practice by the American physician B. Oppenheimer in 1918, is used worldwide and is included in the ICD-10 revision in the rubric "Somatic diseases of allegedly psychogenic etiology".

In the expanded formulation of neurocirculatory asthenia is a "painful condition, characterized by a large number of signs, which according to statistical significance can be built in the following order: palpitation, anxiety, fatigue, pain in the heart, shortness of breath, symptoms of obsession. They are observed in the absence of any kind of heart disease of an organic type that could justify their appearance. " In our country, the term neurocirculatory dystonia is most often used, although it continues to be a topic of discussion. For the first time this term was proposed by G.F. Lang (1953), considering it as a syndrome predisposing to the development of hypertensive disease. In the late 50's, N.N. Savitsky united in vegetative-vascular dystonia pathological conditions, denoted in the medical literature as "neurosis of the heart," " Da Costa syndrome , " "neurocirculatory asthenia," "stress syndrome," "excitable heart," etc., which differ from others clinical forms of autonomic dysfunction of a number of features. Among them - the prevalence of cardiovascular disorders in clinical manifestations, the primary functional nature of vegetative function regulation disorders and the absence of their connection with any outlined form of pathology, including neurosis. From this point of view, vegetative-vascular dystonia is a variant of primary functional autonomic dysfunction not associated with neurosis, which is an independent disease (nosological form).

There is also a diametrically opposite point of view - vegetative-vascular dystonia can not be an independent disease, and its development should be preceded by organic lesions of the ENT organs, gastrointestinal tract, nervous or other systems. According to this, vegetative-vascular dystonia is a consequence of secondary disorders of neurohumoral and vegetative regulation of vascular tone in the pathology of various organs and systems. Other authors believe that vegetative-vascular dystonia should be considered primarily as neurosis, taking into account that according to ICD-10, vegetative-vascular dystonia refers to mental disorders. Sat. Shvarkov, considering vegeto-vascular dystonia as one of the variants of autonomic dysfunction, believes that the time has come for pediatricians to abandon the term vegetative-vascular dystonia altogether.

Most often in the medical literature and clinical practice use the definition of vegetative-vascular dystonia, given by V.I. Mokolkin and S.A. Abakumov: "Vegeto-vascular dystonia is an independent, poly-therapeutic disease that is a particular manifestation of vegetative dystonia, in which there are dysregulatory changes predominantly in the cardiovascular system, and arising as a result of primary or secondary abnormalities in the superegmental and segmental centers of the autonomic nervous system."

Neurocirculatory dystonia is the most common form of vegetoneurosis, observed mainly in older children, adolescents and young people (50-75%). Accurate statistics of vegetative-vascular dystonia is difficult, first of all, because of insufficiently homogeneous approaches of practical doctors to the criteria of diagnosis and its terminology (very often the concepts of "neurocirculatory dystonia" and "vegetative-vascular dystonia" are used in practice as synonyms). At the same time, most pediatricians believe that generalization and systemic nature of vegetative disorders are typical for children and adolescents, which leads to multiple and diverse clinical manifestations, which testify to the involvement of virtually all organs and systems in the pathological process - cardiovascular, respiratory, digestive, endocrine and immune. In such cases, the diagnosis is the syndrome of autonomic dysfunction.

Causes of vegetative-vascular dystonia

The most significant causes of vegetative-vascular dystonia are disorders of a healthy lifestyle and, first of all, low physical activity, prolonged (more than 3-6 hours) work on the computer and watching TV, alcohol abuse, toxic and drug addiction, leading to destabilization of the autonomic nervous system with the formation of vegetative-vascular dystonia. Development of vegetative-vascular dystonia is promoted by chronic foci of infection, hypertensive-hydrocephalic syndrome, osteochondrosis, syncopal conditions. A major role in the development of vegetative-vascular dystonia belongs to a hereditary heredity of arterial hypertension, other cardiovascular diseases, diabetes mellitus, especially the presence of these diseases in parents under the age of 55 years. The negative influence is exerted both by excessive and insufficient body weight, as well as by excessive consumption of salt.

Causes of vegetative-vascular dystonia

Symptoms of vegetative-vascular dystonia

The severity of subjective and objective manifestations of vegetative-vascular dystonia varies widely: from monosymptomatic, often observed in the hypertensive type of vegetative-vascular dystonia (increased arterial pressure in the absence of complaints), to the unfolded picture with an abundance of complaints evidencing the dysfunction of the cardiovascular system.

In the clinical picture of vegetative-vascular dystonia, hypotensive and hypertensive variants are distinguished, the main manifestation of which are changes in arterial pressure, as well as a cardiological variant with predominance of pain in the region of the heart.

The severity of the course of vegetative-vascular dystonia is determined by a complex of various parameters: severity of tachycardia, frequency of vegetative-vascular crises, pain syndrome, tolerance to physical exertion.

Symptoms of vegetative-vascular dystonia

Diagnosis of vegetative-vascular dystonia

Despite the high prevalence of the disease, it is quite difficult to diagnose vegetative-vascular dystonia because of the absence of specific symptoms and in each specific case it is necessary to exclude diseases with similar symptoms, ie. Differential diagnostics is always necessary. The range of diseases that have to be excluded is very wide: organic pathology of the central nervous system (neuroinfections, tumors, consequences of craniocerebral trauma): various endocrinopathies (thyrotoxicosis, hypothyroidism), symptomatic forms of arterial hypertension and arterial hypotension, coronary heart disease, myocarditis and myocardial dystrophy , vices and other heart diseases. The occurrence of symptoms of vegetative-vascular dystonia during transitional (critical) age periods (pubertal) can not be a weighty argument for justifying the diagnosis of vegetative-vascular dystonia without differential diagnosis, since during these periods, many other diseases often appear or worsen.

Diagnosis of vegetative-vascular dystonia

Treatment of vegetative-vascular dystonia

An important place in the treatment of children with vegetative-vascular dystonia should be assigned to individual rational psychotherapy. The results of treatment of children with vegetative-vascular dystonia are largely determined by the depth of contact with the doctor.

Treatment should begin with the normalization of the regimen of the day, while ordering the physical and mental loads of the child. Mental and emotional stress is well eliminated by physical exercises (swimming, skiing, skating, cycling, dosed walking, table tennis, badminton). Not only children, but also their parents should understand that the main thing in the treatment of vegetative-vascular dystonia belongs to the normalization of the daily routine and the optimization of physical activity, the main components of a healthy lifestyle. It is necessary that the child was in the fresh air every day for at least 2-3 hours. It is very important that night sleep last 8-10 hours. At the same time, you should limit the viewing of television broadcasts to 1 hour per day. Classes with a computer should be dosed taking into account the state and age of the child.

Treatment of vegetative-vascular dystonia

Prevention of vegetative-vascular dystonia

Preventive maintenance should begin with non-medicinal measures - normalization of the regime of the day, nutrition, walking outdoors, water procedures. Prevention of vegetative-vascular dystonia is possible only with its early diagnosis, determined long before the appearance of complaints of the child. Prevention is based on a healthy lifestyle. Optimization of physical activity and balanced rational nutrition with low calorie and antisclerotic orientation are the main components of prophylaxis of vegetative-vascular dystonia and other diseases, especially cardiovascular diseases.