Neurocirculatory dystonia

Description:

Neurocirculatory dystonia — group of the morbid conditions which are characterized by primary and functional disorders of activity of cardiovascular system which cornerstone the imperfection which is not connected with neurosis or organic pathology of nervous and endocrine systems or disorder of regulation of vegetative functions is.
Is a part of vegeto-vascular dystonia.

Symptoms of Neurocirculatory dystonia:

Classification. Depending on preferential display of neurocirculatory dystonia (a cardiac disturbance or regulation of the ABP with his pathological increase or decrease) V. P. Nikitin (1962) and N. N. Savitsky (1964) suggested to allocate three of its types: cardial, hypertensive and hypotensive. However not all clinical physicians consider this classification capturing a real number and the essence of kliniko-pathogenetic options of neurocirculatory dystonia and the possibility of their reflection in an orientation of changes of the ABP is discussed. At neurocirculatory dystonia of the complaint of patients quite often match the raised and lowered ABP that testifies to a community of the leading circulator frustration which are not connected with the changes of the ABP which are only integrally reflecting deviations in a system hemodynamics prichinno. Practical use of classification showed an essential role of subjective medical interpretations of the types of neurocirculatory dystonia allocated in it at statement and a formulation of the diagnosis. So, the diagnosis neurocirculatory dystonia of cardial type is quite often made to patients with extracardiac displays of vegetative dysfunction (for example, at complaints to a headache, orthostatic frustration) only because of absence at the patient of deviations of the ABP from norm; at best make to such patients the diagnosis neurocirculatory dystonia without indication of type (that contradicts classification). Besides, N.'s diagnosis of of cardial and hypotensive types (or without indication of type) is established, as a rule, only in the presence at sick certain complaints (the ABP low values in itself not necessarily are a disease symptom) while the diagnosis neurocirculatory distoniyagipertenzivny type almost in half of cases is made only on the basis of registration of the increased values of arterial pressure in the absence of any subjective displays of a disease.

Classifications of neurocirculatory dystonia with more detailed division in forms of clinical manifestations have certain advantages. So, for example, Lang (R. Lang, 1989) in the classification of functional cardiovascular frustration, except disturbances of regulation of the ABP (hypotensive and hypertensive types) and cordial activity (in the form of premature ventricular contraction, a Bouveret's disease, a hyperkinetic syndrome), separately considers subjective feelings of serdtsebiyeniye or pains in heart and in addition allocates syndromes of system and regional circulator frustration: acute cardiovascular collapse (simpatiko-vazalny and vagovazalny crises), orthostatic syndrome, vasculomotor headache.

V. P. Nikitin and N. N. Savitsky's classification despite the lack of the uniform principle in designation of types of neurocirculatory dystonia and their obviously insufficient number for reflection of all possible options of clinical manifestations of this morbid condition was widely adopted and is used as the main thanks to the simplicity and also because among patients with neurocirculatory dystonia of each type after all the groups prevailing at it with a certain community of displays of a disease and their pathogeny are found.

Expressiveness of subjective and objective displays of neurocirculatory dystonia fluctuates over a wide range: from monosimptomny, quite often observable at hypertensive type of neurocirculatory dystonia (increase in the ABP in the absence of complaints), to the developed picture of a neurosis-like state with abundance of complaints of nonspecific character and objective symptoms of vegetative dysfunction which patients can have identical with different types of neurocirculatory dystonia. At the developed picture of a neurosis-like state in complaints of patients adynamy signs — increased fatigue, the general weakness, irritability, a superficial ("sensitive") dream prevail, it is frequent with bright dreams, the general or local (axillary, palmar) perspiration, sometimes unstable subfebrile condition. At the same time various unpleasant feelings in heart are, as a rule, noted (cardialgias, feeling of emptiness in a breast, etc.) or other parts of a body, a headache (out of communication with changes of the ABP), sometimes the dissatisfaction with a breath forcing patients to strengthen randomly breath that can lead to development of a syndrome of a hyperventilation  up to faints.

Irrespective of expressiveness or existence of the listed and other neurosis-like displays of a disease at neurocirculatory dystonia symptoms of dysfunction of cardiovascular system, as a rule, come to light. Approximately at a third of patients with any type of neurocirculatory dystonia complaints to feeling of serdtsebiyeniye are noted, is much more rare on interruption in cardiac performance (in these cases supraventricular premature ventricular contraction objectively is defined), paroxysms of supraventricular tachycardia are extremely seldom observed. From subjective manifestations of system circulator frustration complaints to a chill (almost at a half of patients with hypotensive type of neurocirculatory dystonia and approximately in a quarter of cases are most frequent at other types) and orthostatic frustration (weakness, dizziness, sometimes faints at a bystry rising from a bed or at long standing) which are noted approximately at a third of patients with hypotensive type of N. of and are almost twice more rare at other types. Objectively pallor and decrease in temperature of skin of extremities, a tendency to tachycardia at rest and inadequate increase of serdtsebiyeniye usually are found in patients with complaints to a chill and orthostatic frustration at a small exercise stress. Filling of pulse is more often reduced that is usually combined with decrease in the pulse ABP (at any type of neurocirculatory dystonia), and at hypotensive type also with decrease in the systolic ABP. Displays of a disease at patients with hypotensive type  quite often differ in the expressed meteodependence; at a number of patients bad portability of long breaks in food is noted. At hypertensive type  of the complaint either are absent, or nonspecific complaints are noted (on fatigue, a headache, feeling of serdtsebiyeniye); objectively, except tranzitorny increase in the ABP (usually within 150/95 mm of mercury.), at this type  often find strengthening of loudness of cordial tones and a pulsation of carotid arteries, a hyperemia of the person, sometimes strengthening of an apical beat of heart. Similar symptoms are noted at a part of patients with cardial type at which tachycardia is defined more often, quite often also sinus (respiratory) arrhythmia, sometimes premature ventricular contraction and other arrhythmias, increase or reduction of amplitude of a tooth of T by an ECG in certain cases come to light.

Forecast. Children and teenagers have a neurocirculatory dystonia — the state relating to boundary between norm and pathology. Therefore at timely correction of disturbances in development of the child or their spontaneous disappearance with age (for example, at neurocirculatory dystonia owing to a development disproportion) perhaps absolute recovery. For life and working capacity the forecast at all types of neurocirculatory dystonia in general favorable. However the advanced age, the is, as a rule, worse the forecast concerning treatment. Patients with hypertensive type  make risk group on development of an idiopathic hypertensia. Patients with any type of neurocirculatory dystonia and disturbances of lipidic exchange have to be considered as risk group on development of coronary heart disease (especially with hereditary burdeness).

Reasons of Neurocirculatory dystonia:

The reasons of the states combined in group of neurocirculatory dystonias are diverse, but among them there are no organic lesions of nervous and endocrine systems. Children and teenagers have an imperfection of regulation of vegetative functions and inadequacy of reactions of cardiovascular system to a mental and exercise stress are most often caused by a disproportion of development of executive bodies, on the one hand, and the device of regulation of their activity — with another. The most frequent developing of neurocirculatory dystonia at children during the periods of the accelerated growth, in the prepubertatny and pubertal periods is explained by it. At the same time the features of education of the child (teenager) resulting in discrepancy of mental and somatic development (which is insufficiently considered at the choice and performance of various loadings), to the frequent vegetatively painted experiences (for example, at constraining teenagers) can have additional pathogenic value, especially when forming not of absolutely correct, for example idealized, ideas of the teenager of themselves or the social environment surrounding it.

Both children, and at adults the reasons of neurocirculatory dystonia  can have influences of the environment and feature of a way of life leading to a blood circulation regulation device overstrain, exhaustion or a mismatch of its nervous and humoral links: a hypodynamia, an adynamy after the exhausting acute infectious diseases, overfatigue, a sleep debt, mental and physical, including sports, an overstrain, impact on an organism of vibration, production noise, fields of high frequency, long stay in the artificial atmosphere (for example, in the submarine). The close attention as the possible reason of neurocirculatory dystonia at teenagers has to involve smoking. In development of neurocirculatory dystonia heredity has a certain role: frequency of development of neurocirculatory dystonia in children and teenagers whose parents suffer from vascular diseases (an idiopathic hypertensia, coronary heart disease), above, than in the general population and reaches 75% in some groups.

Treatment of Neurocirculatory dystonia:

Treatment of patients with neurocirculatory dystonia is carried out generally by doctors of policlinics — the local pediatrician, the doctor of a teenage office, the district doctor with the advisory help, in need of certain specialists (the cardiologist, the neuropathologist, the endocrinologist, etc.). Hospitalize only patients with for the first time revealed by a Bouveret's disease, frequent premature ventricular contraction, sometimes at the states demanding urgent differential diagnosis (for example, at the pains in heart imitating stenocardia, the orthostatic faint estimated as a symptom of internal bleeding and a t.a.), and indications to hospitalization are more connected with specification of the diagnosis, than with need of hospitalization.

The major (though quite often difficult feasible) the principle of treatment of patients — whenever possible to avoid use of medicines. The gradual statement of this principle in modern medical practice is combined, however, with even widespread idea of neurocirculatory dystonia  as about neurosis and therefore about need of psychotherapy as main alternative to drug treatment. Meanwhile it — not neurosis (that is emphasized with its allocation in independent, though conditional, to a nozoform), and psychotherapy at it has only symptomatic value, just as at any somatopathy. For tactics of treatment of patients with neurocirculatory dystonia the understanding that this disease belongs to those few diseases at which not an auxiliary condition, but the main (strategic) direction of therapy and prevention is the healthy lifestyle is key. It makes a basis of the medical recommendations developed taking into account the defects of physical and social adaptation revealed at the specific patient to the environment.

Irrespective of the nature and type of neurocirculatory dystonia it is necessary first of all to try to eliminate the stressful influences and factors reducing resistance to a stress from the patient's life: excess mental and exercise stresses, insufficient rest, the unbalanced and grown poor by vitamins food, a hypodynamia. Influence on the patient of adverse ecological deviations (the choice of a source of drinking water, refusal of the use of products with the high content of nitrates, etc.), production vrednost, including impact of vibration, high-frequency fields, long and strong noise has to be reduced to a minimum. Departures are shown to the sick children and teenagers living in the cities during vacation to the village (not in all cases pioneer and recreational nurseries of the camp have advantage). Are shown the dosed physical work on air, pedestrian tourism (or long walks), the tempering procedures, sea bathings, are obligatory a balanced diet  and correction of disorders of appetite.

In many cases social conditions do not allow the patient (or to parents of the sick child) to provide implementation of medical recommendations about normalization of a way of life, in this regard it is necessary to resort to special methods of treatment from which preference should be given to a gidrobalneoterapiya and hardware physical therapy.

Gidrobalneoterapiya along with physical culture most closer costs to methods of pathogenetic treatment, promoting a training of systems of regulation of a number of vegetative functions, especially thermal controls (including sweating function) and managements of cardiovascular reactions to nonspecific loadings. Depending on age of the patient and features of displays of a disease apply rain and circular medical smother, douches by fresh and mineral water, pine, carbonic and mineral needle baths, an underwater shower massage, bathing in pools which is desirable for combining with performance in water of the program of medical physical exercises which is individually picked up by the doctor.

The physical therapy, as well as purpose of medicines, has preferential symptomatic value, and the choice of its separate methods is defined generally by the nature of any steady displays of a disease (for example, irritability, pains in heart, a headache, a chill of extremities, etc.). The type of neurocirculatory dystonia for the choice of methods of physical therapy has smaller value though such methods as an electrosleep, darsonvalization, an electrophoresis of bromine, magnesium, novocaine apply at hypertensive and cardial types of neurocirculatory dystonia more often. One of the most effective methods of a symptomatic treatment is acupuncture.

Drug treatment is shown at a Bouveret's disease (for stopping of attacks), frequent premature ventricular contraction (as a temporary measure) and displays of a disease, burdensome for the patient (sleep disorders, the expressed headache) if they are not eliminated with non-drug methods of treatment. Whenever possible it is necessary to be limited to use of the least dangerous (concerning side effects and polysystem influence on an organism) medicines, as much as possible using psychotherapeutic aspect of use of medicine in certain hours, according to a certain scheme, etc. So, at the disturbing patient of tachycardia or premature ventricular contraction, sometimes at burdensome pain (cardialgias, a headache) use according to antiarrhytmic means and analgetics is not always required. Quite often these displays of dystonia, as well as frustration of a dream, irritability, are removed use of such absolutely safe, but often effective  sedatives as drugs of a valerian, a motherwort; valocordin or Corvalol, Nozepamum or other tranquilizers of group of benzdiazepine are even more effective.

Medicamentous correction of circulator frustration is defined by their pathogenetic diagnosis and to some extent an orientation of change of the ABP. For elimination of hyperkinetic type of a hemodynamics use of b-adrenoblockers (for example, an anaprilina) which in most cases remove at patients  and supraventricular arrhythmias of heart is the most effective. At increase in the ABP at patients with normal and reduced cordial emission use of b-adrenoblockers with so-called internal adrenomimetichesky action, for example Pindololum (Viskenum) is possible or (at the expressed tachycardia) Nadololum (Corgardum), in some cases Rauwolfia drugs are preferable. The patient with arterial hypotension and signs of an adynamy (increased fatigue, drowsiness, etc.) appoint magnolia vine tincture (a ginseng, an aralia, a sekuriya) or Pantocrinum. At meteodependent orthostatic frustration recommend (in the absence of premature ventricular contraction) to apply in adverse days strong tea, coffee, and before estimated long orthostatic loading — caffeine. At steady displays of system hypotonia of veins, and also at an angiogenic hemicrany the drugs containing ergot alkaloids are shown (Belloidum, белласпон).