Vegeto-vascular dystonia

Vegetative-vascular dystonia includes the manifestation of all forms of vegetative regulation disorders.

In recent years, the term "vegetative dystonia syndrome" has been preferred over "vegetative-vascular dystonia syndrome", since this makes it possible to talk about the vegetative-visceral dystonia syndrome, and the latter can be divided into various systemic dystonias (vegetative-cardiac, vegetative-gastric, etc.). Therefore, some authors more often use the term - "vegetative dystonia syndrome". Certain discussions were also caused by the second part of the definition of the syndrome. N. K. Bogolepov proposed to replace "dystonia" with "dysfunction". This is a logical and attractive position, however, for the pathology and physiology of the autonomic nervous system, such terms as vagotonia, sympathicotonia, amphotonia are traditional.

Vegetative-vascular dystonia is a complex of disorders of the vegetative part of the nervous system, presented in the form of subjective complaints from patients. VVD is rightfully considered one of the most difficult syndromes in terms of diagnosis. Clinical manifestations that vegetative-vascular dystonia demonstrates are diverse, there are more than 150 of them. All psychovegetative symptoms are associated with dysfunction of the limbic-reticular structure, which controls the work of the vegetative nervous system. Vegetative-vascular dystonia is not an independent nosological unit, rather it develops as a secondary syndromic reaction in response to persistent, chronic diseases or long-term stressful situations from the outside. VVD is a voluminous concept, more complex than a similar one - "neurocirculatory disorders", accordingly, diagnostic measures should be expanded in the same way as treatment. Three decades ago, vegetative-vascular dystonia was diagnosed relatively rarely, today, according to statistics, more than 75% of the inhabitants of our planet suffer from this disease to one degree or another. Most of them do not seek medical help, since the symptoms of the syndrome are smoothed out, but about a third of patients need complex therapy, and about 10% need hospitalization.

Vegetative-vascular dystonia is called a syndrome because, as a rule, vegetative disorders are secondary manifestations of various forms of pathology. And although the classification distinguishes between primary and secondary vegetative disorders, the common syndromic definition for them is vegetative dystonia syndrome. When analyzing vegetative dystonia syndrome, a number of factors are taken into account:

1. the nature of autonomic disorders;
2. their permanence and paroxysmalness;
3. poly- and monosystemic nature of disorders;
4. generalized systemic and local disorders;
5. Finally, and this seems especially important, three leading vegetative syndromes are distinguished within the vegetative dystonia syndrome:
   • psychovegetative syndrome,
   • progressive autonomic failure syndrome,
   • vegetative-vascular-trophic syndrome.

How does the autonomic nervous system work?

VSD is a dissonance in the work of two subsystems, sympathetic and parasympathetic. The unity of work of these "allies" should ensure homeostasis (internal balance and constancy of work of organs, systems) and an adaptive mechanism that helps to adequately respond to all external factors. The vegetative system is responsible for the unconscious (autonomous) regulation of many important processes, including the following:

• Normalization of blood pressure, tone of the vascular system;
• Heartbeat rhythm, the frequency of its contractions;
• Secretory activity of glands (internal and external) – salivation, sweat, adrenaline, gastric juice, lacrimation;
• Normalization of motor functions of the small and large intestines, gall bladder, and all smooth muscle function.

Under the influence of negative factors, both external and internal, the subsystems stop working harmoniously and begin to function independently of each other. This is how a polymorphic syndrome develops, which is called vegetative-vascular dystonia.

How do disturbances in the operation of subsystems manifest themselves?

• The functions of the sympathetic subsystem are regulated by another system - the sympathoadrenal system, which controls the sympathetic system by producing adrenaline and noradrenaline. An increase in the amount of catecholamine hormones and their concentration provokes crises and attacks, which are very difficult for patients to bear. Tachycardia appears, which has no true cardiac cause, blood pressure rises sharply, shortness of breath and dizziness may begin. All these symptoms develop rapidly and cause inexplicable fear in a person. Attacks can be repeated periodically for many years, exhausting the patient's nervous system. A stressful situation can be a trigger, but sympathoadrenal crises often occur without any apparent objective reasons.
• Vegetative-vascular dystonia can also develop in a different direction. The parasympathetic subsystem functions due to the activity of special nerve fibers, among which the leading ones are the vagus nerves. Nervus vagus secretes specific neurotransmitters responsible for lowering blood pressure - acetylcholines. Not only does the pressure decrease, but the heart rate also decreases, the pulse slows down. As a result, all excretory glands begin to work in an intensive mode: salivation and sweating increase. The complex of these symptoms often ends with a vagus-insular crisis - loss of consciousness, urinary and fecal incontinence, severe pain in the epigastric region. Hypoglycemia is often observed due to increased insulin concentration.

Vegetative-vascular dystonia is divided into types based on symptoms, which in turn directly depend on which subsystem of the autonomic nervous system has “failed”.

• Failure of the parasympathetic subsystem leads to VSD of the hypotonic type.
• A failure of the sympathetic subsystem leads to VSD of the hypertensive type.
• Dysfunction of two subsystems simultaneously leads to VSD of the normotonic type.

Symptoms vary widely, but the most common are:

Cardiological symptoms.

• Tachycardia and arrhythmia (increased heart rate and activation of the pulse) – tachyarrhythmia;
• Bradycardia and arrhythmia with a decrease in pulse rate - bradyarrhythmia;
• Painful sensations in the heart area, a feeling of heaviness, pressure;
• Activation of vascular tone – hypertension;
• Decreased vascular tone – hypotension;
• Blood pressure surges, fainting;
• Hyperemia of the skin or, conversely, cyanosis (paleness, cyanosis).

Respiratory symptoms.

• Dyspnea;
• Feeling of a lump in the throat, difficulty swallowing food or liquid;
• Feelings of respiratory spasm.

Gastrointestinal symptoms.

• Digestive problems, constipation or diarrhea;
• Spasms in the epigastric region;
• Flatulence.

Neurological symptoms.

• Fatigue, apathy;
• Hypochondriacal symptoms, complaints of the slightest ailment;
• Depressive states;
• Irritability, sometimes aggressiveness;
• Increased sensitivity to weather;
• Subfebrile body temperature;
• Recurrent headaches of unknown etiology;
• Sleep disturbance.

Symptoms of vegetative-vascular dystonia

The clinical teaching on the pathology of the autonomic nervous system is associated with the names of H. Eppinger, L. Hess (1910), who created the concept of such a syndrome as vegetative-vascular dystonia. Taking into account the division of the vegetative dystonia syndrome into sympathetic and parasympathetic sections, a description of the second generalized vegetative syndrome, sympathicotonia, soon appeared. In the classical presentation, they looked as follows.

Vegetative-vascular dystonia, the symptoms of which are pale and dry skin, cold extremities, shiny eyes and slight exophthalmos, unstable temperature, tendency to tachycardia, tachypnea, tendency to increase blood pressure, constipation, is characterized by sympathicotonic tension. Characterized by high performance, initiative, physical endurance and good activity in the evening with reduced ability to remember and concentrate, anxiety. Reduced tolerance to sun, heat, noise, bright light, coffee. Unsettled sleep. Muscle tremors, paresthesia, chilliness, discomfort in the heart area are observed.

Vegetative-vascular dystonia, the symptoms of which are cold, damp, pale skin, hyperhidrosis and hypersalivation, bright red dermographism, bradycardia, a tendency to arterial hypotension, respiratory arrhythmia, a tendency to fainting and weight gain, is characterized by vagotonia. Apathy, asthenia, low endurance, low initiative, indecisiveness, timidity, sensitivity, a tendency to depression, and the best production activity in the morning are observed.

Generalization of individual vegetative disorders into the indicated syndromes contributed to the development of clinical vegetology. Several circumstances should be noted. The described symptoms of vegetative-vascular dystonia, firstly, are not yet formalized pathological syndromes and rather reflect certain, often constitutional, features of the organization and response of the vegetative nervous system; secondly, they quite fully reflect the manifestations that, when expressed more strongly, constitute the generalized syndrome of vegetative dystonia; thirdly, it is extremely important that already in these descriptions of vegetative-vascular dystonia, the symptoms are given in combination with personality traits and emotional response.

The theory of sympathicotonia and vagotonia has often been criticized, based on the idea that such pure syndromes are rare in real practice. Based on this, A. Guillaume identifies intermediate symptoms of vegetative-vascular dystonia - neurotonia, and A. Danielopolu designates it as "hyperamphotonia" or "hypoamphotonia". Indeed, more often we have to deal with mixed sympathetic or parasympathetic manifestations, but it is often possible to identify the predominant direction of disorders or different directions in individual functional systems (for example, sympathetic activity in the cardiovascular and parasympathetic - in the gastrointestinal systems). With all the reservations and additions, it should be recognized that the principle of identifying vegetative disorders by sympathetic-tonic and vagotonic manifestations has remained fruitful today.

Vegetative-vascular dystonia has permanent (constant) symptoms and is characterized by paroxysmal vegetative disorders (i.e. periods of sharp exacerbations of symptoms). If the latter are time-defined and intense vegetative storms, then the designation of other disorders as "permanent" is to a certain extent conditional. All symptoms of vegetative-vascular dystonia are mobile. This applies to hyperhidrosis, heart rate, and blood pressure. Thus, permanent disorders are not absolutely stable indicators, but their frequent fluctuations that are not detected clinically and do not reach the level of vegetative crises (VC). The latter have been described in specialized literature for quite a long time and are referred to as "Govers' vago-vasal crises", "Barré's sympathetic crises" and "Polzer's mixed sympathetic-vagal attacks", and in modern English-language literature they are referred to as "panic attacks".

Local symptoms

Like any attempt at classification, the allocation of generalized, systemic and local disorders is to a certain extent conditional. It would seem that the question of local syndromes is most clear. It is known that unilateral vegetative disorders can arise in vertebrogenic pathology, tunnel syndromes, mononeuropathies of various genesis. Undoubtedly, these are local symptoms of vegetative-vascular dystonia. However, as they develop and deepen, they begin to acquire generalized psychovegetative disorders that arise as a reaction to chronic pain (if any) or to maladaptation caused by local disorders. And yet this situation seems to be sufficiently outlined from the standpoint of the dominance of local forms of vegetative dystonia syndrome.

Generalized symptoms

The division of generalized and systemic forms is more complicated. If local syndromes usually involve damage to the peripheral segmental vegetative system, then generalized and systemic disorders can result from both dysfunction of suprasegmental vegetative formations (psycho-vegetative syndrome) and damage to peripheral vegetative apparatus (progressive vegetative insufficiency syndrome). We consider it necessary to emphasize that these disorders are fundamentally polysystemic. The reasons for this polysystemic nature are different.

These circumstances have led to a rather active discussion, which is currently being conducted around the terms "vegetative dystonia syndrome" and "neurocirculatory dystonia" (vegetative-vascular dystonia). 60 years ago, the term "neurocirculatory asthenia" was proposed in foreign literature. Several decades later, it was transferred to the soil of Soviet medicine, and its designation also changed somewhat: "asthenia" was replaced by "dystonia". It should be recognized that the concept of "neurocirculatory dystonia" has proven to be tenacious and is widely used in practice (this undoubtedly testifies to its pragmatic potential).

Syndromes of vegetative-vascular dystonia

What has made us fight with varying success against the term "neurocirculatory dystonia" for many years? First of all, it is because therapists and cardiologists want to see vegetative-vascular dystonia not as a syndrome, but as an independent disease. The anxiety about these ideas is understandable. A doctor, having diagnosed vegetative-vascular dystonia, begins to treat this "disease", having completed the necessary search for the causes that caused this syndrome. This is the practical danger of using the term "neurocirculatory dystonia". The second series of objections is based on the erroneous idea that with vegetative-vascular dystonia we have functional disorders exclusively in the cardiovascular system. These views can be explained primarily by the fact that the diagnosis of "vegetative-vascular dystonia" is born mainly in cardiology institutions, while disorders in the respiratory sphere (practically obligatory), gastrointestinal tract, thermoregulatory sphere are not given any significance. The third objection concerns the fact that, having embarked on the path of isolating vegetative-vascular dystonia, we must also give way to such syndromes as hyperventilation, neurogastric dystonia, neurogenic thermoregulation, etc. All of them are an absolute clinical reality, and a number of them (especially hyperventilation disorders) are the subject of our serious analysis.

Vegetative-vascular dystonia: symptoms of vegetative dystonia

Of course, the syndrome of vegetative dystonia is a very broad and diverse clinical concept, combining, on the one hand, vivid vegetative crises, prolonged subfebrile conditions, neurogenic fainting and, on the other hand, vascular-trophic local syndromes, orthostatic hypotension, anhidrosis, neurogenic urinary bladder. This led to the fact that we identified three generalized syndromes in the syndrome of vegetative dysfunction. Psychovegetative syndrome is manifested by permanent-paroxysmal disorders caused by dysfunction of non-specific brain systems. All of them were included in Section I of the classification of vegetative disorders.

Vegetative-vascular dystonia: symptoms of progressive vegetative failure

The second syndrome is progressive autonomic failure. Its main manifestations, listed in decreasing frequency, are: fainting spells in the picture of orthostatic hypotension, impotence, weakness, anhidrosis, arterial hypertension in a horizontal position, the symptom of "fixed pulse", weight loss, urinary incontinence, constipation, dysarthria, nasal congestion, angina. It is much less common, is studied by neurologists and occurs in peripheral (segmental), as well as combined cerebral and peripheral autonomic disorders (see the classification of autonomic disorders). The basis of this syndrome is visceral autonomic polyneuropathy - a pathology of the peripheral autonomic system, mainly innervating the visceral systems. At the same time, there are also certain neurological symptoms indicating parallel involvement of a number of cerebral systems, and diffuse autonomic disorders (anhidrosis).

Vegetative-vascular dystonia: symptoms of vegetative-vascular-trophic

The third syndrome is vegetative-vascular-trophic, which in the past was sometimes designated as "angiotrophoneurotic" or, more precisely, "angiotrophopathic". It manifests itself predominantly in the arms and legs, within this framework (for example, tunnel syndromes or vegetative disorders in neural amyotrophies). It is included in Part II of the classification (peripheral vegetative disorders), and is based on the defeat of mixed nerves, plexuses and roots that innervate the arms and legs. Naturally, this syndrome is also the prerogative of neurology; it can also be part of the psychovegetative syndrome (Raynaud's disease).

Vegetative-vascular dystonia: symptoms of vegetative dysfunction

The syndrome of vegetative dysfunction, as a rule, is not a nosological unit. The classification distinguishes between primary and secondary cerebral (suprasegmental), peripheral (segmental) and combined vegetative-vascular dystonia. It is obvious that the overwhelming majority of vegetative disorders are secondary, and in these situations, the analysis of the nosological essence of the pathology that led to the syndrome of vegetative dysfunction is essential for correct diagnosis and, especially, the use of nosological methods of treatment.

1. Vegetative-vascular dystonia, the symptoms of which usually appear in early childhood and are characterized by instability of vegetative parameters: rapid change of skin color, sweating, fluctuations in heart rate and blood pressure, pain and dyskinesia in the gastrointestinal tract, tendency to subfebrile temperature, nausea, poor tolerance of physical and mental stress, meteotropicity, is called constitutional. H. Eppinger, and then A. Guillaume defined them figuratively as "disabled people of the vegetative system", not yet sick, but prone to an increase in all the above manifestations under the adverse effects of the external environment. Often these disorders are familial and hereditary. With age, these patients, with the right hardening education, achieve a certain compensation, although they remain vegetatively stigmatized throughout their lives. The role of genetic factors in the formation of migraine is undeniable. However, sometimes there is also very severe vegetative-vascular dystonia. We are talking about familial dysautonomia, Riley-Day syndrome, in which severe disturbances in the internal environment of the body occur, incompatible with life. It usually manifests itself in early childhood. The syndrome of progressive vegetative failure can be combined with parkinsonism, multiple system atrophy and idiopathic orthostatic hypotension (Bradbury syndrome) - degenerative diseases that manifest themselves in late age. Primary lesions also include hereditary neuropathies (sensory, neural amyotrophy of Charcot-Marie-Tooth, etc.).

Thus, constitutional, degenerative, hereditary diseases can manifest themselves as psycho-vegetative, and progressive vegetative insufficiency syndrome, and vegetative-vascular-trophic syndrome.

2. Vegetative-vascular dystonia, the symptoms of which occur in healthy people against the background of acute or chronic stress, is called autonomic dysfunction of psychophysiological nature. Emotional-vegetative-endocrine reactions to acute stress are a normal physiological response of the body and cannot be considered pathological. However, excessive inadequate expression of reactions, their duration and frequency against the background of chronic stress, violation of human adaptive capabilities are already pathological, the basis of clinical manifestations of which is psychovegetative syndrome. Mass manifestation of autonomic dysfunction syndrome of psychophysiological nature is observed during disasters, earthquakes and other stressful extreme situations.
3. Vegetative-vascular dystonia, the symptoms of which appear during hormonal changes. These include the periods of puberty and menopause. In puberty, there are two prerequisites for the appearance of vegetative syndromes: the emergence of new endocrine-vegetative relationships that require the formation of other integrative patterns, and rapid, often accelerated, growth gain, which creates a gap between the new physical parameters and the capabilities of vascular supply. Typical manifestations of this are vegetative-vascular dystonia against the background of mild or severe endocrine disorders, fluctuations in blood pressure, orthostatic syndromes with pre-fainting and fainting states, emotional instability, and thermoregulation disorders.

Vegetative processes are also aggravated during menopause, which is associated with the physiological endocrine and emotional accompaniment of this condition. Vegetative-vascular dystonia is both permanent and paroxysmal in nature, and among the latter, in addition to the characteristic hot flashes, feelings of heat and profuse sweating, vegetative crises may occur. All the described manifestations occur during physiological puberty and menopause, but they are especially pronounced in the pathological course of these conditions. In these situations, we are talking about a psycho-vegetative syndrome, which, as a rule, decreases after the above periods have passed, but in some cases, psycho-vegetative-endocrine disorders are quite persistent.

4. Vegetative-vascular dystonia, the symptoms of which appear in organic somatic diseases. In many psychosomatic diseases (hypertension, ischemic, ulcerative diseases, bronchial asthma), as well as visceral diseases with a pronounced algic component (gallstone, urolithiasis, chronic pancreatitis), psycho-vegetative syndromes are often formed. In psychosomatic diseases, these disorders are a significant factor in the pathogenesis, occur before the final formation of the described diseases and are of a psychophysiological nature in the early stages. Chronic pain syndromes, which are essentially chronic pain stress, also acquire psychovegetative disorders. The latter are clearly represented in allergic disorders.

A large group of somatic diseases, including endocrine (diabetes mellitus, hypothyroidism, etc.), systemic and autoimmune (amyloidosis, scleroderma, etc.), metabolic (porphyria, cryoglobulinemia, etc.) diseases, are accompanied by a syndrome of progressive autonomic failure. Vascular diseases can manifest themselves as a syndrome of autonomic-vascular-trophic disorders. Particular importance should be given to diabetes mellitus (given its high prevalence), in which peripheral autonomic disorders occur in 50-60%, and amyloidosis (up to 80%).

5. Vegetative-vascular dystonia, the symptoms of which are manifested in organic diseases of the nervous system. There are no parts of the brain that would not participate in vegetative and mental regulation. This position does not revive the ideas of equipotentialism at all, since the existing vegetative-endocrine disorders are often subclinical in nature, can be detected during special studies and, as a rule, overlap with sensorimotor, speech and mental disorders. Clinical practice has made it possible to highlight the importance of the structures of the limbic-reticular complex, integrative systems of the brain that ensure holistic behavior and adequate adaptation. The nodal structure is the hypothalamic region, providing primarily neuroendocrine, motivational and thermoregulatory manifestations. Stem structures integrate functional states of the brain in the wakefulness-sleep cycle, regulate cardiovascular and respiratory functions, and supraspinal control of muscle tone. The role of vestibular-vegetative interaction is also undoubted. The possibilities of participation of rhinencephalic structures in the realization of psychovegetative-endocrine symptom complexes are shown; temporal epilepsy can serve as a clinical model. In the experiment, starting with L. A. Orbeli, the role of the cerebellum in vegetative regulation is demonstrated. So far, there are practically no adequate clinical observations of this.

In addition to the role of the limbic-reticular complex, the role of interhemispheric asymmetry is also revealed. A closer connection of the right hemisphere of the brain with psychovegetative regulation is shown. The above considerations are based on the topical principle, which is quite reasonable, since the nature of the disease is of lesser importance. At the same time, one should not forget the type of disorders (destruction and irritation, the extent and depth of brain destruction).

The clinical manifestation of the cerebral disorders described above will be the psychovegetative syndrome in patients.

Vegetative-vascular dystonia, the symptoms of which occur with peripheral syndromes (radiculopathy, plexopathy, neuropathy) is called vegetative-vascular-trophic. Let us emphasize the role of tunnel (trap) symptom complexes. The main clinical manifestations are found on the arms and legs, they are often unilateral. In recent years, the doctrine of myofascial syndromes (vertebrogenic reflex disorders) has been rapidly developing, manifested by sharply painful muscle compactions, accompanied by both segmental vegetative disorders and psycho-vegetative reactions to pain. It is necessary to remember about irritation of the vegetative plexuses of the vertebral arteries (Frank's nerve), often manifested with posterior sympathetic syndrome (cervical migraine, Barre syndrome). Facial sympathalgias are also described as a result of damage (involvement) of the pterygopalatine ganglion (Slader syndrome) and nasociliary ganglion (Charlin syndrome). They are extremely rare, and in such cases cluster headache should be ruled out first of all.

Vegetative-vascular dystonia, the symptoms of which occur with myasthenia, Guillain-Barré syndrome, multiple sclerosis, is called progressive vegetative insufficiency.

Peripheral (segmental) vegetative syndromes that manifest themselves in vegetative-vascular dystonia were until recently reduced to the diagnosis of ganglionitis (truncitis) of the sympathetic chain and damage to the solar plexus (solarite). It should be emphasized with all certainty that such diagnostics are poorly justified, have no analogues in world neurology and arose in the "pre-osteochondrosis era" of neurology and before the description and detailed study of the syndrome of progressive vegetative insufficiency.

6. Vegetative-vascular dystonia, the symptoms of which arise in occupational diseases. The leading manifestations are psycho-vegetative (mainly astheno-vegetative) and syndrome of vegetative-vascular-trophic disorders in the arms and - especially - legs.
7. Vegetative-vascular dystonia, the symptoms of which occur with neuroses, is one of the most common forms that cause vegetative disorders. The latter are considered an obligatory manifestation of neuroses, and disorders of the neurotic circle are quite widespread. The syndrome of vegetative dysfunction in this situation is a classic manifestation of psychovegetative syndrome.
8. Vegetative-vascular dystonia, the symptoms of which occur in mental disorders. This primarily concerns affective-emotional-personality disorders. Intellectual-mnestic syndromes are less associated with vegetative manifestations. The role of various forms of endogenous depression should be emphasized - both as a distinct syndrome and as masked (larval) forms. As with organic cerebral disorders, when vegetative-vascular dystonia is overlapped by sensorimotor ones, psychopathological syndromes clearly dominate in the picture of mental illnesses. At the same time, psychiatrists often ignore the accompanying vegetative dysfunction. The rationale for this rather pragmatic position is the disappearance of vegetative disorders with successful treatment of psychopathological disorders. It is one of the forms of psychovegetative syndrome.

How is vegetative-vascular dystonia treated?

Vegetative-vascular dystonia is treated depending on the type of syndrome, and the therapeutic strategy should also take into account other existing somatic diseases. The treatment complex includes drug-based methods of VSD management and non-drug methods, which can sometimes be very effective and even replace basic drug therapy.

Non-drug methods and techniques include the following recommendations:

Making a rational daily routine. A healthy lifestyle is not a familiar concept that has already become a household word, it is a truly effective way to neutralize symptoms. An elementary rule - waking up no later than 7 am and going to bed no later than 10 pm, can remove several symptoms of VSD in just one month. Such a regimen resumes the normal production of "day" and "night" hormones. Moreover, observing the conditions of normal sleep, you can improve not only your well-being, but also your appearance, since a special hormone that controls the slowing down of the aging process is released from 12 pm to 3 am during deep sleep. This miracle regulator is called intermedin, it is it that stops being produced in those who work at night, or simply do not sleep due to watching a movie or participating in an online game.

Maintaining the air regime in the room. Basic ventilation should become a habit. In addition, you should exclude bulky feather beds or uncomfortable mattresses and pillows. The bed should be optimally comfortable and ergonomic. Even if a person thinks that he is sleeping, but when he wakes up, he feels exhausted, the sleep can be considered a failure. Often the reason for this is excessively soft beds, uncomfortable pillows, and general external discomfort.

It is necessary to introduce variety into the daily routine. Switching activities every one and a half to two hours makes the brain activate its unused functions. In addition, changing the type of activity makes you involuntarily change your posture, activate stagnation in muscles and tissues. Such regular warm-ups should become a habit, there should be at least five of them per day.

A positive result is achieved by studying the methods of autogenic training. You can study them yourself, fortunately today there is quite a lot of such literature. The method is absolutely safe and does not harm the subconscious, unlike other esoteric "delights".

Ideally, alcohol and nicotine should be eliminated from life forever. If this radical withdrawal is difficult, their use should be minimized. Nicotine contributes to the development of chronic oxygen starvation of the brain, and there is no need to talk about the harm of alcohol. These habits are not useful, as they deplete the already exhausted nervous system and the body's resources.

Moderate physical activity can also help reduce the severity of VSD symptoms. Vegetative-vascular dystonia often disappears after three to four months of training under the guidance of a professional fitness trainer.

It is necessary to review the diet and include in it a sufficient amount of products containing vitamins and microelements. Everything that contains magnesium, calcium, potassium and B vitamins should become a daily "participant" in the menu.

Physiotherapeutic procedures can help reduce the frequency of VSD manifestations. Electrophoresis courses on the collar area of the spine, mud baths, SPA procedures, and acupuncture have proven themselves well.

Vegetative-vascular dystonia is treated with medications; people suffering from attacks and crises especially need these methods.

Adrenoblockers are prescribed to patients with VSD with sympathoadrenal crises. The choice of drugs is made by the doctor, as a rule, atenolol and its derivatives, metoprolol and nadolol are prescribed.

Tranquilizers are prescribed for anxiety states to relieve crisis symptoms. The entire group of benzodiazepines (phenazepam, oxazepam, diazepam) have proven themselves to be effective anti-anxiety agents. In particularly severe states, anxiolytics may also be prescribed.

Vagoinsular crises are stopped with the help of drugs of the atropine group. As a cholinergic blocker, atropine neutralizes the main symptom of the crisis, as a rule, the drug is administered by injection, subcutaneously. Also effective is the introduction of pacemakers to activate the heart (cordiamine intramuscularly). The use of caffeine-containing drugs has not been practiced recently due to various side effects.

Bronchospasm of vegetative etiology is treated with bronchodilator drugs. Salbutamol and berodual inhalations are also effective. In cases of severe exacerbation and suffocation, intramuscular administration of ephedrine is indicated.

Hypoglycemia is controlled by intravenous glucose administration.

Vegetative-vascular dystonia with vestibular symptoms is treated with nootropic drugs - fezam, cinnarizine, pyrocetam.

Vegetative-vascular dystonia is treatable, the duration of which depends on the severity of the syndrome and the patient's desire to get rid of the painful symptoms. The main principles of therapy used in the treatment of VSD are as follows:

• Timely referral to a neurologist or neurologist.
• A comprehensive, thorough examination, which is carried out either on an outpatient basis or in a hospital. The most effective examinations are those carried out in a hospital under the supervision of the attending physician, since this method allows one to see the symptomatic dynamics more objectively.
• Elimination of concomitant somatic diseases, which are often primary and trigger for the manifestation of VSD.
• A mandatory condition is to follow and implement all the doctor's recommendations, no matter how extensive they are. Vegetative-vascular dystonia is treated for a long time, at least one year, so the patient needs to gain strength, patience and confidence in the successful outcome of therapeutic actions.
• A mandatory condition is psycho-emotional correction of the patient's personality traits. Long courses of psychotherapeutic sessions are effective.

Vegetative-vascular dystonia is not a life-threatening disease; as a rule, this syndrome can be successfully managed with accurate diagnosis and properly selected treatment.