Vegeto-vascular dystonia

Description:

The Vegeto-vascular Dystonia (VVD)  - the symptom complex of diverse clinical manifestations mentioning various bodies and systems and developing owing to deviations in structure and function of the central and/or peripheral departments of the autonomic nervous system.
Vegeto-vascular dystonia - not an independent nosological form, however in combination with other pathogenic factors it can promote development of many diseases and morbid conditions most often having a psychosomatic component (arterial hypertension, coronary heart disease, bronchial asthma, a peptic ulcer, etc.). Vegetative shifts define development and the course of many diseases of children's age. In turn, somatic and any other diseases can aggravate vegetative disturbances.

Symptoms of Vegeto-vascular dystonia:

The bright subjective symptoms of a disease which are not corresponding to considerably less expressed objective displays of this or that organ pathology are characteristic of vegeto-vascular dystonia diverse, often. The clinical picture of vegeto-vascular dystonia in many respects depends on an orientation of vegetative disturbances (dominance vago-or sympathicotonias).
Vagotonia. The set of hypochiondrial complaints, increased fatigue, decrease in working capacity, disturbance of memory, frustration of a dream (difficulty of backfilling, drowsiness), apathy, indecision, fearfulness, tendency to depressions are inherent to children with a vagotonia.
Bad portability of cold, intolerance of stuffy rooms, feeling of a chill, feeling of shortage of air, periodic deep sighs, feeling of "lump" in a throat, and also vestibular frustration, dizzinesses, onychalgias (is more often at night), nausea, unmotivated abdominal pains, a skin mramornost, a Crocq's disease, the expressed red dermographism, raised poto-, sebaceous secretion, tendency to a liquid delay, passing hypostases under eyes, frequent desires to an urination, hypersalivation, spastic locks, allergic reactions are characteristic a loss of appetite in combination with excess body weight.
Cardiovascular frustration are shown by pains in heart, a bradyarrhythmia, a tendency to a lowering of arterial pressure, increase in the sizes of heart due to decrease in a tone of a cardiac muscle, muting of cordial tones. On an ECG reveal a sinus bradycardia (bradyarrhythmia), are possible premature ventricular contraction, lengthening of an interval of R-Q (up to an atrioventricular block of the I-II degree), and also the shift of a segment of ST is higher isolines and increase in amplitude of a tooth of T.
Sympathicotonia

The temperamentnost, irascibility, variability of mood, hypersensitivity to pain, a bystry otvlekayemost, absent-mindedness, various neurotic states are inherent in children with a sympathicotonia. They often complain of feeling of heat, a heart consciousness. At a sympathicotonia often observe an asthenic constitution against the background of the increased appetite, pallor and a xeroderma, the expressed white dermographism, a cold snap of extremities, numbness and paresthesias in them in the mornings, unmotivated fervescence, bad portability of a heat, a polyuria, atonic locks. Respiratory frustration are absent, vestibular are uncharacteristic. Cardiovascular frustration are shown by bent to tachycardia and increase in arterial pressure at the normal sizes of heart and its loud tones. On an ECG often reveal sinus tachycardia, shortening of an interval R-Q, the shift of a segment of ST is lower than the isoline, the flattened T tooth.
Neurocirculatory dystonia. At dominance of cardiovascular frustration in a complex of the available vegetative disturbances it is admissible to use the term "neurocirculatory dystonia". However it is necessary to consider that neurocirculatory dystonia represents a component of wider concept of vegeto-vascular dystonia.
Vegeto-vascular dystonia at children can proceed latentno, being implemented under the influence of adverse factors, or is permanent. Development of vegetative crises is possible (paroxysms, vegetative storms, the panic attacks). Krizovy states arise at emotional overloads, an intellectual and physical overstrain, acute infectious diseases, sharp change of meteoconditions and reflect failure in system of vegetative regulation. They can be short-term, proceeding several minutes or hours, or long (several days) and to proceed in the form of the vagoinsulyarny, sympathoadrenal or mixed crises.

    * Vagoinsulyarny crises are followed by suddenly developing pallor, perspiration, decrease in body temperature and arterial pressure, nausea, vomiting, abdominal pains and sharp swelling of intestines, occasionally - a Quincke's edema. Syncopal conditions, attacks of pains in heart (a pseudo-anginal syndrome), migraine or the suffocation reminding an attack of bronchial asthma are possible.
    * Sympathoadrenal crises are followed by feeling of alarm and fear of death, a fever, a headache, tachycardia (often paroxysmal), increase in arterial pressure, rise in body temperature (to 39-40 °C), dryness in a mouth, a frequent urination, a polyuria.
Vegeto-vascular dystonia has some features at children of different age. So, preschool children have vegetative disturbances, as a rule, moderate, subclinical, with dominance of signs of a vagotonia (increase in a tone of parasympathetic department of the autonomic nervous system). At teenagers vegeto-vascular dystonia proceeds more hard, with the diverse and expressed complaints and frequent development of paroxysms. Increase in vagal influence at them is followed by essential decrease in sympathetic activity.

Reasons of Vegeto-vascular dystonia:

The reasons of formation of vegetative frustration are numerous. Primary, hereditarily caused deviations in structure and function of various departments of the autonomic nervous system more often traced on the maternal line have major importance. Other factors, as a rule, play a role of the releasers causing manifestation of already available latent vegetative dysfunction.

    * Formation of vegeto-vascular dystonia is promoted in many respects by the perinatal defeats of TsNS leading to cerebral vascular frustration, disturbance of a likvorodinamika, hydrocephaly, damage of a hypothalamus and other departments of a limbiko-reticular complex. Damage of the central departments of the autonomic nervous system leads to an emotional imbalance, neurotic and psychotic disturbances at children, to inadequate reactions to stressful situations that also influences formation and the course of vegeto-vascular dystonia.
    * In development of vegeto-vascular dystonia the role of various psychoinjuring influences (conflict situations in a family, school, family alcoholism, incomplete families, isolation of the child or excessive guardianship by his parents) leading to the mental disadaptation of children promoting implementation and strengthening of vegetative frustration is very big. Often repeating acute emotional overloads, chronic stresses, an intellectual overstrain have not smaller value.
    * Carry to provocative factors various somatic, endocrine and neurologic diseases, anomalies of the constitution, allergic states, the adverse or sharply changing weather conditions, features of climate, ecological trouble, disturbances of balance of microelements, a hypodynamia or an excessive exercise stress, hormonal reorganization of the pubertal period, non-compliance with a diet, etc.
    * Age features of rates of maturing of sympathetic and parasympathetic departments of the autonomic nervous system, instability of metabolism of a brain, and also developmental potency of generalized reactions inherent in a children's organism in response to local irritation have undoubted value that defines bigger polymorphism and expressiveness of a syndrome at children in comparison with adults. The disturbances which arose in the autonomic nervous system lead to various changes of functions of sympathetic and parasympathetic systems with disturbance of allocation of mediators (noradrenaline, acetylcholine), adrenal hormones and other hemadens, a number of biologically active agents (polypeptides, prostaglandins), and also to disturbances of sensitivity vascular and - and ß adrenoceptors.

Treatment of Vegeto-vascular dystonia:

Treatment at vegeto-vascular dystonia has to be complex, long, individual, considering features of vegetative disturbances and their etiology. Preference is given to non-drug methods. Refer normalization of a day regimen, elimination of a hypodynamia, the dosed exercise stress, restriction of emotional influences to them (telecasts, computer games), individual and family psychological correction, and also a regular and balanced diet.
The positive effect is rendered by medical massage, acupuncture, hydrotherapeutic procedures. Features of physiotherapeutic influence depend on a form of vegetative frustration (for example, at a vagotonia appoint an electrophoresis with calcium, caffeine, a phenylephine hydrochloride, and at a sympathicotonia - with an Euphyllinum, a papaverine, magnesium, bromine).
At insufficient efficiency of non-drug treatment appoint individually picked up medicamentous therapy limited amount of drugs in the minimum doses with their gradual increase to effective. The great value in complex therapy of vegeto-vascular dystonia is attached to treatment of persistent focal infection, and also the accompanying somatic, endocrine and other pathology.

    * Widely apply sedatives (drugs of a valerian, motherwort, St. John's Wort, hawthorn, etc.), and also tranquilizers, antidepressants, nootropa (for example, Phenibutum, carbamazepine, diazepam, amitriptyline, piracetam, Pyritinolum).
    * Use of glycine, Pantogamum, glutaminic acid, complex vitamin and microelement drugs has quite often favorable effect.
    * Apply a Vinpocetine to improvement of cerebral and peripheric circulation, recovery of microcirculation (for example, Cavintonum), cinnarizine, niacin, пентоксифиллин (for example, trental).
    * At a sympathicotonia use of ß adrenoblockers [propranolol (for example, an anaprilina, Obsidanum)], in the presence of vagotonic reactions - psychostimulants of a plant origin is possible (drugs of an eleuterokokk, a magnolia vine, a wolfberry, etc.).
    * At children with intracranial hypertensia carry out dehydrational therapy [acetazoleamide (Diacarbum) with potassium drugs, глицерол]. The great value in complex therapy of vegeto-vascular dystonia is attached to treatment of persistent focal infection, and also the accompanying somatic, endocrine or other pathology.
At development of vegetative paroxysms in hard cases along with use of non-drug methods and medicinal peroral therapy parenteral administration of tranquilizers, neuroleptics, ß adrenoblockers, atropine depending on the nature of crisis is necessary. Dispensary observation for children with vegeto-vascular dystonia has to be regular (1 time in 3-6 months or a thicket depending on a form, weight and type of a current of a syndrome), especially during transitional seasons (spring, fall) when it is necessary to repeat inspection and according to indications to appoint a complex of medical actions.