Neurogenic syncope (syncope): treatment

All medical measures in syncopal (syncope) states are divided into two parts: carried out during an attack and carried out outside of attacks of loss of consciousness, the latter option in the practice of neurologists is much more common.

Treatment of syncope (syncope) paroxysm is often limited to giving the patient a horizontal position, especially in conditions when it is difficult - in a crowd, in a telephone booth, etc. (even cases with a fatal outcome from simple fainting are described in connection with the impossibility of falling sick or acceptance of a horizontal position). It is necessary to provide access to fresh air or to take the patient out of the room with sharply expressed contaminated air, maintaining a horizontal position; it is necessary to unfasten the patient's collar, strap or eliminate other obstructing breathing and circulatory obstacles, to conduct a light general body massage. They also use means of reflex action on the centers of respiration and cardiovascular regulation: inhalation of vapors of ammonia, spraying the face with cold water.

The lack of effect from the above activities requires a number of urgent measures. With a sharp drop in blood pressure, sympathicotonic agents are administered: 1% mezatone solution, 5% solution of ephedrine. Indirect cardiac massage, the appointment of a 0.1% solution of atropine sulphate is used with a pronounced hyperparasympathetic component in the fainting structure with a slowing or even stopping of the heart activity. If it is a violation of the heart rhythm with cardiogenic syncope (atrial fibrillation), antiarrhythmics are administered.

Treatment of patients with syncopal (syncope) states in the interictal period is a frequent and habitual situation in neurological practice. The most important for the effectiveness of treatment is the precise diagnosis with clarification of those specific pathogenetic mechanisms that underlie one or another syncope.

As the undifferentiated treatment of virtually all neurogenic syncopal conditions, therapy is aimed at reducing the degree of neurovascular excitability and reactivity, increasing mental and vegetative stability, increasing the overall tone of the body. In this regard, it seems important and necessary to correct obligate for all variants of syncope of psycho-vegetative syndrome of one degree or another. For a simple (vasodepressor) syncope, such a correction is essentially a pathogenetic therapy.

The means used to treat autonomic paroxysms are reflected in the relevant section of the manual. Here we only enumerate them.

Correction of mental disorders is carried out by means of psychotherapy aimed at explaining to the patient the connection of his fainting with the presence of emotional and autonomic dysfunction; measures are also taken to address the psychological problems of the individual, reduce anxiety, etc. Psychotropic therapy includes prescribing drugs depending on the structure of the existing syndromes of mental (most often neurotic) disorders. Correction of anxiety disorders requires the appointment of tranquilizers - seduxen, Relanium, phenazepam, elenium, grandaxin, etc. Antepsinsin (1 mg 3-4 times a day for 1-1.5 months) has particularly proven itself recently. Antidepressants (amitriptyline, pyrazidol, azafen, and inksan) are indicated in patients with distinct, as well as latent depressive disorders, most often combined with anxiety manifestations. When expressed anxiety-hypochondriacal disorders are prescribed antipsychotics (sonapax, frenolone, eglonil). Doses of these psychotropic drugs depend on the severity of affective disorders. Duration of treatment is usually 2-3 months.

Important is the correction of increased neuromuscular excitability (tetanic syndrome), which occurs in 80% of patients with different forms of syncopal conditions.

As fortifying agents prescribe vitamins of group B, vascular preparations and nootropics.

Autonomic correction is achieved in two ways.

The first - carrying out special breathing exercises to increase vegetative stability. Such exercises are shown not only in hyperventilation disorders, but also in all cases when autonomic dysfunction plays an important role in the genesis of syncopal conditions.

The second method of correction of vegetative disorders is the assignment of vegetotrophic agents. Most often, they are preparations of the type of belloid (bellaspon, bellataminal), beta-adrenoblockers (anaprilin, obzidan) in small doses (10 mg 2-3 times a day) in the absence of pronounced vagal disorders, combined alpha and beta adrenoblockers (pyrroxane) and others. With a decrease in the activity of the sympathoadrenal system and the predominance of parasympathetic reactions, such agents as sydnocarb, caffeine, ascorbic acid, and belladonna preparations can be used. An important "regulator" of vegetative functions is a certain, adjusted lifestyle of the patient: a sufficient specific gravity of his physical activity is necessary (gymnastics, swimming and other hydroprocedures, walks, running, skis, etc.).

In addition to psycho-vegetative correction, treatment of a number of background and syncope-associated manifestations is of great importance: vestibular dysfunction, allergic mood, vascular cerebral dysfunction, neuroendocrine (hypothalamic) disorders, residual neurologic manifestations, spinal osteochondrosis, somatic and other diseases.

Therapy of syncopal conditions in patients with hyperventilation manifestations largely depends on the elucidation of the leading pathogenetic link. Correction of hyperventilation disorders is discussed in detail in the corresponding section.

Treatment of syncopal conditions in patients with carotid sinus hypersensitivity consists in the appointment of patients with cholino and sympathicolytics, blockade of the sinus with electrophoresis with novocaine, X-ray therapy, surgical interventions (sinus deprivation, periarterial peeling, etc.). In the practice of cardiac surgery in the cardiac form of the syndrome of the carotid sinus, patients are implanted with pacemakers, rhythm drivers.

In the treatment of cough syncope along with the treatment of the main physical disease, it is very important to eliminate the causes directly causing cough (for example, smoking), the appointment of antitussives, etc. The normalization of the body weight of the patient with its redundancy plays a role.

Treatment of syncopal conditions that occur when swallowing, is to conduct therapeutic measures aimed at eliminating the pathology of the esophagus, and the appointment of drugs atropine action. The use of vegetotrophic agents is also shown.

In the case of nocturnal syncope, it is necessary to isolate the leading pathogenetic mechanism, taking into account their polyfactor pathogenesis. In the case of enhanced vagal tendencies, drugs that increase sympathetic tone are used.

Treatment of glossopharyngeal neuralgia, combined with syncopal conditions, consists in the appointment of anticonvulsants (carbamazepine, picnolepcine, suxylene, trimethine, sodium valproate and their combination). In the case of pharmacological resistance, surgical intervention is indicated - nerve trimming on the neck or in the posterior cranial fossa.

In hypoglycemic syncopal conditions treatment is directed to the underlying disease, which is the cause of hypoglycemia. With the expressed signs of psycho-vegetative syndrome, appropriate correction is made for its reduction.

Syncopal states of a hysterical nature require clarification of the leading link of pathogenesis: is the disturbance of consciousness the expression of a hysterical pseudosyncope or is it the result of a complicated conversion. Clarification of this issue will allow for more focused therapy, in the structure of which, in addition to the necessary massive psychotherapy, it is necessary to include methods of respiratory regulation, the appointment of psychotropic and vegetotrophic drugs.

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