Hyperkinetic syndrome

Hyperkinetic syndrome is a complex of various involuntary, violent movements.

This syndrome manifests itself mainly as one of the symptoms accompanying a variety of neurological diseases.

[1], [2], [3], [4],

Causes of the hyperkinetic syndrome

The flow of this pathology has not been sufficiently studied. Hyperkinetic syndrome arises from the violation of metabolic processes in neurotransmitters (complex chemical substances and hormones of the body, such as adrenaline, serotonin, dopamine) of neurons of the brain. The syndrome causes an overabundance of catecholamine and dopamine, while glycine, serotonin and acetylcholine are not produced enough.

Hyperkinetic syndrome in adults becomes the cause of high clinical polymorphism and a significant difference in signs of severity, prevalence, localization, rate, rhythm and symmetry. In vascular, infectious, toxic, metabolic and other pathological factors, hyperkinetic syndrome in adults can also have a symptomatic effect on the brain. The following groups of brain lesions are known which have a hyperkinetic syndrome:

• Hyperkinetic stem levels are manifested in the form of tremors, tics, parapasms of the facial muscles and facial hemispasm, myorhythmia, myocolonies, myokimii. They are characterized by rhythm, relative simplicity and stereotyped violent movements.
• Hyperkinesis subcortical level - their symptoms include torsion dystonia, chorea, athetosis, ballism, intentional spasm of Rulff. It is characterized by arrhythmia, the complexity of violent movements and polymorphism, with a dystonic component.
• Subcortical-cortical hyperkinesias are characterized by the presence of kozhevnikovskaya and myoclonus-epilepsy, myoclonic hypantheia of Hunt. It manifests itself in the form of frequent epileptic seizures and generalization.

[5], [6]

Symptoms of the hyperkinetic syndrome

Hyperkinetic syndrome, as a rule, takes one of the four most common forms: tics, tremors, chorea and dystonia. The intensity of such symptoms increases with arbitrary movements, with walking and writing, speech activity and in states of emotional and mental stress. Through volitional efforts they are given to weakening and suppression for a short time. During sleep, hyperkinetic syndrome also does not show itself.

Tremor, the symptom of which is the trembling of the body, is one of the most frequent cases. In tremor, hyperkinetic syndrome manifests itself in the form of involuntary rhythmic vibrational movements of the head and limbs, or the entire body. The state of tremor can take one of two forms: a tremor of action (action) and a tremor of rest. The first type of tremor can be divided into a postural one, which occurs during movement and isometric, as a consequence of isometric muscle contractions. The tremor of rest is more inherent in Parkinson's syndrome and Parkinson's disease. Separate another type of tremor - orostatic, which can accompany the transition of the body vertical position and standing, as well as a kinetic, selective tremor that occurs only with certain movements, such as during writing - writing tremor.

Dystonia is slow, tonic or fast rhythmic, colonicotonic movements that cause spinning, spinning ("torsion dystonia" - from the Latin torsio - rotation, twisting), flexion and extension of the arms and legs and fixation in pathological poses.

Chorea manifests itself as a stream of rapid irregular and chaotic multifocal movements. Hyperkinetic syndrome involves distal parts of the limbs in them, the muscles of the trunk are mimic muscles, sometimes the larynx and pharynx. Muscular contractions cause you to involuntarily grimace and curl, cause deliberate antics and dance movements (choreia in Greek - dance). Often, chorea acts as a symptom of Huntington's disease, which is a hereditary disease that is transmitted by an autosomal dominant type, and occurs against the background of progressive degeneration of the neurons of the subcortical nuclei and the cortex and accompanied by dementia.

Tics are characterized by activation of muscles and separate groups of muscles or part of the body that causes repetitive non-rhythmical movements. The appearance of tics can cause normal motor activity, they resemble fragments of purposeful actions. Ticks are susceptible to weakening until complete suppression for a short time using volitional effort.

Hypotonic-hyperkinetic syndrome manifests itself in amyostatic symptoms, combined with a rhythmic small-amplitude tremor pikaya. There are oculomotor disturbances of the following two types: transitory ones - which include diplopia and persistent - pareses of sight and convergence, nystagmus, anisocoria, Argyle-Robertson symptom. The degrees of pyramidal disorders in the hypotonic hyperkinetic syndrome are represented by mild hemiparesis, bilateral pathological signs, and a central paresis of 7-9-10-12 nerves, sensitive as painful hemihypersthesis, can also occur.

Hyperkinetic cardiac syndrome is a set of independent clinically conditioned varieties of symptoms of vegetative-vascular dystonia. To date, Western medical specialists reject the very existence of a disease like vegetative-vascular dystonia, yet in countries of the post-Soviet space, vegetative-vascular dystonia is officially recognized. However, it is not considered a specific disease, but is considered a complex of all kinds of symptoms. Hyperkinetic cardiac syndrome is a centrogenic autonomic disorder. Hyperkinetic cardiac syndrome is caused by high activity of myocardial beta-1-adrenergic receptors, the background to which is the sympatadrenal prevalence. Which is characterized by a hyperkinetic type of circulation and is accompanied by three hemodynamic symptoms. Hyperkinetic cardiac syndrome is characterized by three hemodynamic symptoms:

• Increased shock and minute volumes of the heart, which are many times greater than the metabolic needs of heart tissue.
• Increase the speed of pumping blood in the heart cavities.
• The increase in compensatory decline in all peripheral vascular resistance.

Hyperkinetic heart syndrome is an independent clinical variant of the VSD. He belongs to the group of autonomic disorders of a centrogenic nature. With hyperkinetic heart syndrome, the activity of beta-1-adrenoreceptors of the myocardium increases, which is caused and accompanied by sympathoadrenal prevalence. The consequence of this is the formation of blood circulation in a hyperkinetic type, in which the following hemodynamic symptoms occur:

• The minute and shock heart volume rises to a degree much greater than the needs of tissue metabolism;
• The speed of the expulsion of blood from the heart increases;
• The general peripheral vascular resistance of compensatory character decreases.

[7], [8], [9], [10], [11], [12], [13]

Forms

Hyperkinetic syndrome in children

Hyperkinetic syndrome in children is determined by the distracted attention of the child, his heightened anxiety and impulsive actions. This syndrome adversely affects the progress in learning and the social adaptation of children in school, which is why academic performance suffers. Hyperkinetic syndrome in children causes hyperactive behavior and shortens sleep time. Most often, these children are twice as fast as their peers wear clothes and shoes, they are not capable of assiduity and are struggling to cope with class and home affairs that require concentration, are more likely to be distracted by occasional external stimuli.

Hyperkinetic syndrome in children is often accompanied by rash and unexpected actions in a child who can suddenly jump out onto the road, or climb a tree, these children are difficult to communicate with peers, because they show aggression and may rudely or tactlessly speak in communication with peers or adults. Such a child is prone to nervous disorders due to hyperexcitability, it can have a bad, often interrupted sleep, often a lack or a significant decrease in appetite, such children are more impressionable, they are fearful and subject to mood swings. All this is aggravated by musculoskeletal imbalance and unstable perception. Hyperkinetic syndrome in children does not prevent them from easily making acquaintances and socializing, but their sympathies are short-lived, communication with them is complicated by their constant unwillingness to endure, wait, they seek maximum and immediate pleasure.

[14], [15], [16], [17]

Diagnostics of the hyperkinetic syndrome

In many cases, hyperkinetic syndrome in adults is characterized by idiopathic character. For its diagnosis, it is required to exclude all other, secondary forms, especially those associated with curative diseases such as endocrinopathies and tumors. Also, in the diagnosis it is necessary to exclude Wilson-Konovalov's diseases. Precisely because such cases in clinical practice are a rather rare phenomenon, they are subject to priority exclusion. Follow-up diagnostic activities are performed using additional diagnostic tools, for example, EEG CT, MRI of the brain, and in addition - laboratory studies.

It should always be remembered that any hyperkinetic syndrome in adults, first detected before the age of fifty years, indicates that hepatolenticular degeneration is excluded. It can be excluded on the basis of a blood test for ceruloplasmin, and in addition - due to the examination of the cornea of the eye with the help of a slit lamp to detect the Kaiser-Fleischer pigment ring. It is also almost always expedient to diagnose hyperkinetic syndrome, based on its psychogenic origin.

At present, the hyperkinetic syndrome has practically no place in the number of recorded cases. But this does not detract from the need to diagnose it and timely actualization, which will provide an opportunity to begin in the shortest possible time a targeted treatment that will allow the patient to avoid unnecessary and sometimes life-threatening therapy.

Treatment of the hyperkinetic syndrome

Hyperkinetic syndrome is amenable to drug treatment by applying a certain sequence of drugs. Preparations for levodopa are prescribed for children and adolescents; high doses of anticholinergics (up to 100 mg of cyclodol per day); baclofen; clonazepam and other benzodiazepines; carbamazepine (finlepsin); drugs depleting effects on dopamine reserves in presynaptic depots (reserpine); Neuroleptics blocking dopamine receptors (haloperidol, pimozide, sulpiride, fluorophenazine); a combination of the above remedies (eg, cholinolytics plus reserpine or in combination with a neuroleptic).

Treatment of chorea occurs with the use of neuroleptics carrying out blockade of dopamine receptors on striatal neurons. Basically, haloperidol, pimozide, and fluorophenazine are recommended. Slightly less effective and have sulpiride and tiaprid, but due to the fact that they cause fewer side effects, are recommended as topical medications. Nowadays, treatment with atypical antipsychotics, such as risperidone, clozapine and olanzapine, is becoming increasingly popular. It is also possible to use a wide combinatorial treatment, so in addition to antipsychotics, antiglutamatergics, anticonvulsants and sympatholytics can be used.

In the treatment of tics, in many cases it is possible to achieve a positive effect without the use of medication. All that is necessary is to inspire calmness in the patient and his loved ones, by convincing that the decline of intellect and severe mental or neurological disorder is excluded and such patients usually achieve a good social adaptation.

Treatment of hyperkinetic syndrome in children

The regime and diet in the treatment of hyperkinetic syndrome in children primarily begins with nutrition, since nutrition is an important aspect in the treatment of a child. But, perhaps it is not entirely reasonable to hope for a complete solution of the problem in a child with a lack of attention, changing his diet. In cases where the problem is caused by malnutrition in children, for example, the presence of preservatives or colorants in the baby's diet, the exclusion of non-useful foods and menus can dramatically help your child in the treatment of hyperkinetic syndrome in children.

The most careful attention to the diet should be given to a child whose hyperkinetic syndrome appeared as a consequence of an allergy. Naturally, food for such a child should be based solely on the advice of his attending physician. It also does not hurt the child's test for allergens. Menu in the treatment of hyperkinetic syndrome in children should be based mainly on fresh vegetables, salads, which must be filled with vegetable oils (necessarily cold pressing), with sunflower oil should occupy only 5-10% in the diet due to its inadequate utility. Also, butter of at least 82% fat content, which must be consumed, without subjecting it to heat treatment, is suitable. Instead of white wheat flour, wholemeal flour is introduced into the diet, preferably with bran. There are thousands of recipes for delicious dishes for children from these products and ways to decorate them in an original way. It is important to distract your child from eating harmful foods, all kinds of crackers, cookies, chips and sweet fizzy drinks.

Recommended products in the treatment of hyperkinetic syndrome in children:

• Vegetables: white cabbage, green peas, carrots, soybeans, cauliflower, kohlrabi cabbage, red cabbage, broccoli, spinach, beans, cucumbers.
• Greenery: leaf lettuce, dill, parsley, basil.
• Fruits: bananas, pears, apples.
• Garnish: unpolished rice, potatoes, wholemeal noodles.
• Kashi: wheat, rye, barley, flaxseed, millet.
• Bakery: wheat and rye bread, cooked without milk.
• Fats: sour milk oil, vegetable oils (sunflower should not exceed 5-10% in a weekly diet).
• Meat: poultry, veal, fish, lamb, beef (no more than 2 times a week, not fried).
• Drinks: not sweet tea, water without gas with a sodium content of about 50 mg / kg.
• Condiments and spices: iodized salt, sea salt, sea salt with the addition of algae.

Treatment of hyperkinetic syndrome in children with drugs

Treatment of hyperkinetic syndrome in children is medically effective in the case of 75-80% of treatment. Due to the fact that medical treatment is symptomatic, it is carried out in children for several years, and if there is such a need, then drug treatment continues in young and in adulthood.

Medical treatment of hyperkinetic syndrome in children is based on several important factors. One of the most important principles is the dosage of drugs, which is based on the objective effects and sensations of the patient. Disputes arising from the interruption or non-termination of the treatment of a child are medicamentous, during a vacation are easily resolved by factors such as complications in communication with the child not only during classes, but also his daily relationships in society, with parents and friends. If, on the background of medical treatment, the child is weakened by mental stress while communicating with others, then treatment should not be interrupted during the holidays.

Psychostimulants have a beneficial effect on the general nervous state of the child, help him become calmer, and also affect other symptoms during the treatment of hyperkinetic syndrome in children. Children taking stimulants increase concentration, it becomes much easier to bear failures, children acquire greater emotional stability, easily build their relationships with parents and friends. To date, it is customary to prescribe amphetamines such as dexamphetamine, methamphetamine, and methylphenidate and pemoline. In the treatment scheme, preference is initially given to methylphenidate or amphetamine, due to the fact that pemoline is often less effective.

Methylphenidate is prescribed two or three times a day: in the morning, in the afternoon and preferably after the lessons. Unfortunately, to date, a specific treatment regimen, which could ensure the uniform effect of methylphenidate on the body throughout the day, has not yet been created. Often the complexity of taking this drug is a late-day use of methylphenidate, which can interfere with a child, normally fall asleep in the evening. The intervals between doses of the drug are from two and a half to six hours. Negative in the overdose of methylphenidate, are the complaints of the parents about the child's slightly sluggish behavior, which, as some parents put it: "behaves like a hypnotized"

Methylphenidate 10-60 mg per day, dexamphetamine and methamphetamine 5-40 mg per day, pemoline 56.25-75 mg per day. If there is a need for higher doses, it is necessary to consult a specialist. Often, treatment begins with a small dose, which is gradually increased until there is a result in the form of a positive therapeutic effect. Side effects with increasing the dose of the drug: loss of appetite, irritability, pain in the stomach, headache, insomnia. Children do not have physical dependence on psychostimulants.

Manufacturers do not recommend the appointment of methylphenidate for children under 6 years, and dexamphthamine for children under 3 years.

Pemolin is usually prescribed if treatment with other drugs is not effective. A negative factor in the administration of pemoline, is the high activity of hepatic enzymes in the study, this side effect was detected in 1-2% of children, which can cause jaundice.

When treating a child with pemoline, it is necessary to examine liver function. If a child has kidney failure or a suspicion of it, then at the time of taking pemoline, children should be under the supervision of a specialist, because 50% of pemoline is released unchanged through almost.

Pemoline is not recommended to be prescribed as a full therapeutic dose. It is necessary to start with 18,75-37,5 mg in the morning, and then from the new week to increase the daily dose by 18.75 mg, until there is a result in the form of a positive therapeutic effect, or side effects with an increase in the dose: loss of appetite, irritability, pain in the stomach, headache. Side effects have been decreasing for some time. The maximum infant dose is 112.5 mg per day.

In the event that psychostimulants do not produce the necessary therapeutic effect, neuroleptics and antidepressants are prescribed by a specialist. Neuroleptics, in particular chlorpromazine and thioridazine are prescribed if the child is too hyperactive and behaves too aggressively. The side effect of these drugs is their ability to reduce attention, which makes it difficult and even exacerbates the child's mental development and interferes with his social adaptation. However, this does not give an excuse, to treat hyperkinetic syndrome in children without the use of antipsychotics, just appointing them must be strictly limited.

In the treatment of hyperkinetic syndrome, such atidipressants as imipramine, desipramine, amfetbutamone, phenelzine, tranylcypromine have shown themselves in children with the maximum positive effect. The dose of an antidepressant in each case is prescribed by a specialist.

Taking antidepressants by children is associated with very high risks. In the case of admission, the child needs a fairly frequent study with the help of ECG, as there were three deaths among children suffering from hyperkinetic syndrome.

Treatment of hyperkinetic syndrome in children with the help of physiotherapy can have a good prognosis. As shown by numerous studies systematic exercise by a child with attention deficit disorder, make it much calmer and more balanced. And the most important is the fact that gymnastics has a positive impact on the body of the child as a whole.

In children with hyperkinetic syndrome, due to exercise, proper coordination of movements appears, sleep is normalized, and most importantly, the child's bones are strengthened and muscles develop. Physical education will benefit the child if they are compulsorily carried out under the supervision of the attending physician, neurologist and physician of physiotherapy. This does not mean that you can not go in for sports with your child at home or in nature.

It should be remembered that the positive effect of physiotherapy depends on its duration and regularity. It is important that all the exercises that you will do with the child at home have been shown to you by a specialist. Just as important is the understanding of parents that a child suffering from hyperkinetic syndrome can not play sports and participate in games in which emotions are strongly expressed. It can be all sorts of competitions, team games, such as: football, hockey, basketball, etc., every possible show that will make the child nervous. And the last thing to remember is that when starting your studies your child will have to undergo mandatory medical examination so that you can be sure that the additional physical load will not negatively affect other organs and systems of the child's organism.

Treatment of hyperkinetic syndrome by alternative methods

Warm baths with water sprinkled with sea salt and a bath on herbs (mint or lavender). It will be more useful for a child to take a bath shortly before sleep and lasts about 14 minutes.

Infusion of grains of oats. Preparation: 500 g of oat grains, rinse, add 1 liter of water, cook on low heat until half-ready to grains. After that, drain, add to the broth 1 teaspoon of honey, take in 1 glass each.

Decoction of three herbs. Preparation: Take 1 tablespoon of each herb (three-colored violet, melissa leaves, motherwort) and pour 1 liter of hot water, bring to a boil over a small fire. Insist for 2 hours, add 1 teaspoon of honey, take in 1 glass each.

A simple, and very effective method of treatment is walking bare feet on the ground. In the summer, it will be useful for a child to walk barefoot on grass, earth, sand or pebbles on the beach. Walking barefoot on the ground will give the child a pleasant sensation and will have a beneficial effect on his psyche.

Treatment of hyperkinetic syndrome in children at home

Treatment of hyperkinetic syndrome in children at home implies the treatment of not only the child alone. Probably, it is not difficult to guess that, no matter how much your child is not engaged in a specialist, it is still difficult to achieve a positive therapeutic effect in treatment if the atmosphere in the family and in the house does not change. After all, the health of the baby, first, and in the most important depends on you parents!

Your child will be much quicker to cope with his problems if he feels your kind, calm and consistent attitude. The most important thing is that the parents of a child with attention deficit disorder should do this, categorically exclude the two extremes that interfere with the treatment of the child. The first is a manifestation of hypertrophied pity, which in turn generates permissiveness. The second is that the statement does not justly inflate the demands on the child, which it will be difficult for him to carry out. Also, excessive punctuality of parents and their cruelty in punishment are very harmful. It should be remembered that any frequent change in the mood of adults, has a much greater negative impact on the child suffering from attention deficit disorder than other children. Parents need to learn how to cope with their emotions.

Individual approach in the treatment of hyperkinetic syndrome in children in particular for each case implies an individual scheme. And therefore, you do not need to bet on any one method in treatment, be sure to try to find a whole range of measures and methods that will help your child cope with this disease with the help of an experienced specialist. The most important thing remains timely access to a specialist. And do not despair, because hyperkinetic syndrome in children is very well treated and receives the most optimistic predictions, if diagnosed in a timely manner in children from 5 to 10 years. Try not to miss such a valuable time.

Forecast

Hyperkinetic syndrome is a disease that has a tendency to progress with time. Unfortunately, there are currently no effective medicines or appropriate technologies for surgical intervention to treat it. As a rule, due to physical and mental disorders the patient is in a position in which he is unable to self-service and independent movement. There may also be problems with the swallowing process, and progressing dementia. Proceeding from this, at the deep stages of the disease, patients, as a rule, need hospitalization and treatment in a psychiatric hospital.

[18], [19]