HYPOXIC-ISCHEMIC ENCEPHALOPATHY IN NEONATES BORN TO SEVERE BIRTH ASPHYXIA

This article provides a literature review on the topic of hypoxic-ischemic encephalopathy (HIE). Hypoxic-ischemic brain damage of newborn belongs to one of the most important problems of anesthesiology and resuscitation of newborn babies. Despite progress, perinatal hypoxic-ischemic encephalopathy remains an important cause of child mortality and damage to the central nervous system resulting in a disability of children. HIE clinical signs are nonspecific, so the diagnosis is based on the combination of medical history, physical and neurological examination, laboratory data and neuroimaging techniques. Pathological stage runs when after undergoing asphyxia is the main purpose neuroprotective therapy. The first 6 hours of life of the child, born in asphyxia, is a therapeutic window for the stabilization of the vital functions of the body, during which therapeutic measures are most effective in reducing apoptosis of brain cells. The only method, relatively widely used and effective in infants with severe birth asphyxia, is controlled hypothermia. Published clinical studies show a statistically significant reduction in mortality and severe neuropsychiatric disability at 18 months of life in infants treated with hypothermia. The use of stem cells, the use of hypothermia in combination with xenon or erythropoietin improves neurological outcome: fewer deaths and serious damage to the nervous system. However, these techniques to date are in the experimental stage. Currently, the main task of neonatologists, anesthesiologists and intensive care specialists is not only saving newborn lives, but also creating conditions for proper growth and development of the child

Comprehensive rehabilitation of patients with movement disorders with spastic forms of cerebral palsy

Until now, there is no radical method of treating children with cerebral palsy, which allows us to consider scientific research in this direction reasonable and promising.The aim of the research: to study the effect of exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback on the indicators of motor skills in children with spastic cerebral palsy.Materials and methods. We conducted an open, non-randomized, prospective, comparative, controlled study in pairs (each participant in the main group corresponds to a participant in the control group). The study involved 53 patients aged 4–12 years with cerebral palsy: the intervention group (group 1: n = 27 (13 boys, 14 girls)) and the control group (group 2: n = 26 (11 boys, 15 girls)), comparable in terms of gender, age and severity of movement disorders. Characteristics of the medical intervention: group 1 – botulinum toxin type A (BTA, for exercising against the background of relative muscular normotonus) + exercise therapy + exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback (BFB); group 2 – BTA + exercise therapy. Duration of the study: 2019–2020. The difference between groups in terms of motor skills on the day of hospitalization and after completion of the training program (10 sessions each) was determined. Motor skills were assessed according to the GMFM-66/88 (Gross Motor Function Measure) table using the “Scales for measuring global motor functions”.Results. The inclusion of additional exercises on the mini-simulator “Kinesioplatformswing” with biofeedback in the rehabilitation of patients with movement disorders with spastic cerebral palsy (BTA + exercise therapy) in comparison with the control group. However, the question of the long-term effects of such training remains open and requires further study

Влияние применения L-триптофана на динамику когнитивных функций в комплексной терапии задержек психоречевого развития у детей

The purpose of this study is to evaluate the ability of L-tryptophan used in complex therapy of delayed psycho-speech development in children to influence the dynamics of cognitive performance.Materials and methods. The study included 80 children aged 3–7 years with delayed psycho-speech development (DPSD). The main group consisted of 37 children (25 male and 12 female), a control group – 43 patients (30 male and 13 female). Both groups of children were comparable in age, sex, degree of speech and cognitive impairment, and IQ level. Patients in the main group have taken standard therapy with L-tryptophan (25–50 mg per day depending on the age) supplement for 14 days. Control patients have taken standard therapy only. Psychodiagnostic tests at the entrance and exit of patients from this study was carried out for evaluation the dynamics of cognitive functions. All differences were considered significant at p < 0.05.Results. The study suggests that oral L-tryptophan intake selectively affects the dynamics of cognitive performance in children with DPSD. So, we studied pre- and post-treatment cognitive performance in both group patients and noted a significant improvement in the visual memory (p < 0.001) and an increase in thinking productivity (p < 0.001) in the tryptophan group versus similar indicators in the control group. Intergroup differences (p < 0.001 and p = 0.026, respectively, for the main and control groups) also found.Conclusion. Two-week L-tryptophan intake in complex therapy of DPSD in children can significantly improve the cognitive activity, and greatly increase both the effectiveness and sustainability of treatment outcomes, which will significantly reduce the time and frequency of hospitalization and financial costs for the rehabilitation of this patients. Цель исследования – оценка способности L-триптофана, применяемого в комплексной терапии задержек психоречевого развития у детей, влиять на динамику показателей когнитивной деятельности.Материалы и методы. В исследование включены 80 детей в возрасте 3–7 лет с задержкой психоречевого развития (ЗПРР). Основную группу составили 37 детей (25 мальчиков и 12 девочек), контрольную группу – 43 пациента (30 мальчиков и 13 девочек). Обе группы детей были сопоставимы по полу, возрасту, степени речевой и когнитивной недостаточности, уровню интеллекта. Пациентами основной группы на фоне стандартной терапии дополнительно осуществлялся прием L-триптофана в суточной дозе 25–50 мг/кг в зависимости от возраста в течение 14 дней. Пациенты контрольной группы были пролечены только по стандартной схеме терапии ЗПРР. Оценка динамики когнитивных функций проводилась с помощью психодиагностических тестов на входе и выходе пациентов из данного исследования. Значимость различий рассчитывали с учетом критического значения p < 0,05.Результаты. В результате проведения исследования были получены данные о том, что триптофан избирательно влияет на динамику показателей когнитивной деятельности при задержках психоречевого развития у детей. Так, при исследовании состояния когнитивных функций у детей с ЗПРР до и после курса терапии, включающей прием L-триптофана, отмечены значительное улучшение зрительной памяти (p < 0,001) и повышение продуктивности мышления (p < 0,001) относительно аналогичных показателей пациентов, пролеченных без дополнительной фармакологической нагрузки данным препаратом. При этом достоверные отличия выявлены и при межгрупповом сравнении результатов лечения (p < 0,001 и p = 0,026 соответственно для основной и контрольной групп).Заключение. Следовательно, введение L-триптофана в комплексную терапию ЗПРР у детей способно заметно улучшить состояние когнитивной деятельности и значительно повысить как эффективность, так и устойчивость результатов лечения, что позволит существенно сократить сроки и кратность госпитализации и финансовые издержки на реабилитацию данной категории пациентов.

Многоуровневые инъекции ботулинического токсина типа А (Абоботулотоксина) при лечении спастических форм детского церебрального паралича: ретроспективное исследование опыта 8 российских центров

Background: The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.Современная концепция ботулинотерапии при детском церебральном параличе (ДЦП) предлагает использование многоуровневых инъекций в расширенное число мышц. Однако по-прежнему отсутствует консенсус относительно выбора оптимальных доз, мышц и интервалов между инъекциями.Цель исследования: изучить российский опыт применения однократных и повторных многоуровневых инъекций абоботулотоксина при лечении спастичности у пациентов с ДЦП.Методы: в ретроспективном исследовании проанализирован опыт ботулинотерапии при ДЦПв 8 специализированных центрах России. Изучали протоколы клинически эффективных инъекций. Оценивали общие дозы препарата БТА, дозы на единицу массы тела пациентов, на всю инъекционную сессию и отдельные мышцы, а также интервалы между инъекциями.Результаты: изучено 1872 протокола клинически эффективных инъекций, всего от 1 до 14 повторных инъекций, сделанных 724 пациентам в возрасте от 8 мес до 17 лет 4 мес (медиана возраста на момент первой инъекции БТА — 3 года 10 мес) на момент начала ботулинотерапии. Большинство пациентов (n = 634; 87,6% инъекций) получили многоуровневую ботулинотерапию. Во всех центрах при первичных инъекциях БТА медиана доз находилась в пределах 30–31 Ед/кг массы тела (общая — 500 Ед). При повторных инъекциях в большинстве учреждений максимальные дозы превышали 45 Ед/кг (1000 Ед). Средние интервалы между повторными инъекциями колебались в пределах 140–180 сут для 157 (24,7%) и 180–200 сут для 484 (66,9%) пациентов. В 2 из 8 центров пациенты с наиболее выраженными двигательными нарушениями (GMFCS IV–V) требовали более частых повторных инъекций БТА.Заключение: в специализированных центрах большинству пациентов с ДЦП ботулинотерапию проводили по многоуровневой схеме. Общая доза абоботулотоксина при первичных инъекциях составляла 30–31 Ед/кг; при повторных инъекциях она могла быть увеличена до 40 Ед/кг и более. Вопрос о повторном проведении инъекции БТА рассматривался в интервале 140–200 сут после предшествующей инъекции

Multilevel Botulinum Toxin A (Abobotulinum Toxin A) Injections in Spastic Forms of Cerebral Palsy: Retrospective Analysis of 8 Russian Centers Experience

Background: The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection