The syndrome of vegetative dysfunction
(SVD) for children is a dangerous disease, it is not surprising that it is so interesting for parents who ask a lot of questions about this. Suffice it to say that the Internet offers 214 thousand Russian-language documents on this subject, more than 10 million English-speaking.
In the press in the 50 years there were only 68 publications on this issue, and in 2000 there were already more than 10 thousand. However, the abundance of information does not exclude the emergence of a group of myths that are common not only in patients, but also in practicing doctors. Let’s try to understand the essence of the children’s SVD and dispel a group of the most frequent myths on this issue.
SVD is not an independent nosological unit.
In the 10th revision of the International Classification of Diseases, there is a class of “Diseases of the nervous system”, there is a block “Other disorders of the nervous system.” There, there is the number G90.8 is the definition of “Other disorders of the autonomic (autonomic) nervous system”, this is what is the SVD.
SVD appeared only in the twentieth century.
The study of functional pathology, the manifestation of which became disorders of cardiac activity, was started as early as the XIX century. In 1871, an American therapist described the syndrome, later named after him, which was the excitable heart of young soldiers who participated in the Civil War. In Russia, the foundations of studying the physiology and the clinic of the autonomic nervous system were laid by outstanding scientists: Sechenov, Botkin, Pavlov, Speransky and others. Already in 1916, the Russian citizen F. Zelensky in his “Clinical Lectures” composed the symptoms of a cardiac neurosis. Modern ideas about the organization of the vegetative nervous system, about clinical vegetology really formed under the influence of scientists of the 20th century. A doctor practicing in the 21st century, in his work with vegetative dysfunctions, simply can not do without the work of A.M. Wayne and N.A. Belokon, which provide explanations for almost all clinical cases.
The basis of vegetative dysfunction is the suppression of one department due to the activity of the other.
This assumption is a reflection of the “principle of weights”, sympathetic and parasympathetic systems exert opposing influences on the working organ. These can be: rapidity and slowing of the heartbeat, changes in the bronchial lumen, narrowing and widening of the vessels, secretion and peristalsis of the organs of the gastrointestinal tract. However, under physiological conditions, in the control of one of the parts of the autonomic nervous system in the regulatory mechanisms of the other, compensatory stress is observed in others, thereby the system passes to a new level of functioning, and the corresponding homeostatic parameters are restored. In these processes an important place is given to supra-segmental formations and segmental vegetative reflexes. If the body is in a stressed state or the adaptation is broken, then the regulation function is violated, increasing the activity of one of the departments does not cause changes from the other. And this is the clinical manifestation of the symptoms of autonomic dysfunction.
Stress plays a leading role in the etiology of autonomic dysfunction.
In fact, the SVD has multiple causes of occurrence, with features that are both acquired and congenital.Let’s list the main reasons:
– psychoemotional features of the child’s personality, anxiety, depression, hypochondriacal fixation on the state of one’s health;
– hereditary-constitutional features of the autonomic nervous system;
– unfavorable course of pregnancy and childbirth, which led to disruption of maturation of cellular structures of the supragmentary apparatus, traumas of the central nervous system and cervical spine;
– psychoemotional tension, consisting of complex intra-family relations, incorrect education, conflicts in school, participation in informal groups;
– damage to the nervous system through trauma to the skull, infections, tumors;
– physical and mental fatigue, which can arise from occupations in specialized schools, sports sections;
– a sedentary lifestyle, which reduces the ability to dynamic loads;
– hormonal imbalance;
– acute or chronic diseases, present foci of infection – caries, sinusitis, etc.
– negative influence of products of smoking, alcohol, drugs;
– other reasons (osteochondrosis, anesthesia, surgeries, weather, weight, excessive hobby for TV, computer).
In clinical cases, SVD manifests itself as a lesion of the cardiovascular system.
No one denies the fact that cardiovascular manifestations are present in different manifestations of autonomic dysfunction. However, it is impossible to forget about the following other manifestations of this pathology during diagnosis: violation of thermoregulation, skin condition, changes in the respiratory system, up to pseudo-asthmatic attacks, disruption of the gastrointestinal tract, impaired urination. Vegetative paroxysms are generally difficult for a practicing physician in the aspect of their diagnosis. In the structure of the attack in childhood, vegetative-somatic manifestations predominate over the emotional experiences of the child. It should be noted that in childhood vegetology there are a number of unexplored problems, although it is quite common.
The manifestation of autonomic dysfunction is typical only for adolescents.
This disease is indeed one of the most common in the adolescent environment, so in boys its frequency ranges from 54% to 72%, and in girls from 62% to 78%. Indirect indicator of the disease is the number of publications on this topic – the number of such for adolescents is more than 7 times the number of articles for newborns. It is likely that this is due to the difficulties in diagnosing vegetative dysfunctions in neontology, although an attentive physician can already notice vegetative symptoms at such a period: the “marbling” of the skin, the violation of thermoregulation, regurgitation, vomiting, disturbance of the heart rhythm, etc. By 4-7 years, vegetative shifts are aggravated, the parasympathetic orientation begins to predominate, which is characterized by the child’s indecisiveness, fearfulness, and weight gain. The third peak in the manifestation of dysfunction occurs in pubertal age, at this time there is a manifestation of violent emotions, personal breakdowns and disorders. Accordingly, there is a more frequent access to medical care, and consequently, registration of diseases.
Practical physician does not have any opportunities for objective assessments of the state of the autonomic nervous system.
Indeed, the diagnosis of SVD is subjective and largely depends on the experience of the doctor and his worldview, based on clinical symptoms. That is, the vegetative status is assessed by special questionnaires, which are modified for children. The characteristics of the vegetative tonus in pediatrics are calculated using mathematical models, and according to the standards developed in 1996, the following 4 numerical indicators are used: SDNN, SDANN, HRV-index and RMSSD. Recently, due to the applied spectral analysis, the possibility of a mathematical evaluation of the variability of the heart rate has increased.The possibilities for assessing dysfunction are constantly expanding, the application of stress tests, pressure monitoring systems, assessment of its rhythms, etc. is being introduced. The complex clinical-experimental approach together with the functional-dynamic study of the vegetative status allows the treating physician to identify abnormalities in the functioning of the organism, to assess the state of its adaptive mechanisms.
There is no effective therapy for children and adolescents with SVD.
In order for the treatment of children to be successful, therapy should be applied in a timely manner and be adequate, in addition, its duration and complexity, age of the patient, manifestations of the disease are needed. Treatment should be carried out with the active participation of the patient and the people around him. Preference is given to non-pharmacological methods, but drug treatment should be carried out with a minimum number of drugs specially selected for this. Among the non-drug methods can be identified normalization of rest and labor regimes, therapeutic massages, physiotherapy, hydro-, reflexo- and psychotherapy. To medicamental means should include sedatives, plant adaptogens, vitamins and trace elements, antidepressants and a group of specialized drugs like Cavinton, Trental or Phenibut.
ADD is easier to prevent than to conduct a long course of treatment.
Prevention of ADD should begin before the birth of the child by the most up-to-date mother, for this it is necessary to put in order the daily routine, the psycho-emotional environment and control the weight, and also the role of the doctors patronizing the pregnant woman is of no small importance. For the prevention of SVD in adolescents and children, it is necessary to give them correct and adequate upbringing, ensuring harmonious physical and mental development. Overloading the child is unacceptable, and sedentary pursuits are also unacceptable. For people of any age, it is necessary to engage in physical education, as this is the most important way to prevent SVD. However, sports activities should be provided even if informal, but quality control of the doctor. Today, more than ever, it is important to promote healthy lifestyles, fight against smoking and bad habits. It is necessary to understand that the problem of SVD prevention should not lie solely on medical measures, social and ecological transformations are needed, and the overall welfare of the population is increased.