Hristov, D.

Minchev, D.

English

Varna Medical University Press: Journals

UPON THE CLINICAL CHARACTERISTICS OF HELMICIDE INTOXICATION IN CHILDISH AGE D. Minchev, D. Hristov Although some new preparations against helmints were recently applied in the practice the piperazin-derivative Helmicide (H) is still quite often used in the treatment of ascaridosis. Its toxic effect due to unproper doses accord-ing to the age and the false opinion that H has a low level of toxicity and slight side-activity for the organism can cause certain disadvantages in the clinical application (B . Krastev, 1966; A. Tzutzomanova, I . Karakostov, 1966; G . At. Genov, 1959). Still unsufficiently analysed is the neurological syndrome of intoxica­tion after Н-application; most often a hyperkinetic subacute encephalitis, chorea minor, "Salaam" spasms, rhombencephalitis, etc. are taken into con­sideration in ambulatory conditions ( (B. Krastev, 1966). The long clinical experience and the profound knowledge of the pipera-zin-derivatives shows that they are substances with expressed toxicity and practically tend to certain side-effects with definite participation of the cen­tral nervous system (CNS). In coordination with the aforementioned data we report our 5 cases of Н-intoxication, creating certain diagnostical difficulties and characteristic changes in brain B E A ; the patients were accepted to the Clinic of Neurology, Higher Institute of Medicine, Varna city. First case: Patient K . A . Y . , age 7, CR N. 16388/1980. Three days defore the clinical examination she was treated with H after her mother's opinion with a dose V 2 spoon-full 3 times a day. Soon after the applied "treatment'' the child began to stagger, was feeble, atonic, with "bended" head, uncomfor­tably feeling, but without any temperature caughing, vomitting or diarrhoea. The physical status shew a total hypotonia, hyporeflexia, drunk-walking; }he child stood in strange positions with a constant attempts to fall down suddenly. The laboratory data: blood, urine, eye-tests, craniographies, liver tests, ionogramme were in the normal range. The EEG-recording demonstra­ted a high-voltage, slow, unregulated B E A with hypersynchronical peak teta— and single delta-waves, forming paroxysmuses without an expressed hemisphere asymetry. The disorders in the electrogenesis show certain disfunctions of the mesodiencephalic brain structures. The suggested dehydratic treatment and application of vitamins cause a considerable improvement of the status of the child, stable walking, straightly lifted head. On the 6-th day the child was discharged healthy with a gradual normalization of the bioelectrical changes in the dynamic EEG-recordings. Second case: Patient I . P . I . , age 6 years, CR N. 20999/1978. Accepted to the clinic with initial diagnosis "Hyperkinetic subacute encephalitis". Fal­ling i l l out of a sudden after a 3-day Н-treatment with the dose of an adult shows the following symptoms: unstable walking, staggering to all directions, Upon the clinical characteristics of. 71 unvoluntary additional movements of the hands. Until then the child had suffered often of pneumonia and cathars of the respiratory tracts. Physical status: spathy, unproper movements of the hands, sudden bend­ing of the body, unstable walking and muscular hypotonia. Laboratory data were in the normal ranges. E E G at the time of first examination shew rough diffusive changes with high-voltage peaks of data-waves, synchronized in of­ten discharges of hyperpnea. 3 days after being accepted to the clinic, with­out any treatment, the neurological symptoms were not repeated and soon later the EEG-recordings also shew a normal picture. Third case: Patient Y . A. I . , age 3 years, CR N. 26125/1979. A week be­fore being accepted to the clinic the child complains of headache and caugh-ing. 2 days later the child was treated by 1 spoon-full twice a day with H and soon after that there was an unstable walking, staggering with sudden bend­ing (suggested to be "Salaam" spasms), hypereflexia and muscular hypoten­sion. Because, of the febrility and auscultatory pulmonary findings the treat­ment was with penicillin, glucose and vitamins; as a result the condition impro­ved considerably and the child was discharged from the clinic healthy. E E G -recordings normalized one week after fading of the neurological symptoms. The rest 2 cases shew analogous clinical characteristics and EEG-record­ings. The analysis of the neurological signs and the dynamics of B E A allow to conclude the following: all patients had an acute beginning of H-intoxi-cation — 2—3 days after the H-treatment; 2 of the children are treated even in the actual for their age dosage. The characteristic clinical symptoms of Н-intoxication were: muscular hypotension, hyporeflexia, staggering walk, unvoluntary movements, sudden bending. 2 days after the Н-application was stopped the symptoms were almost absent, whereas on the third day the sta­tus was already normal. The dynamics of EEG-recordings in the acute stage of intoxication wit­nesses the participation of middle brain structures which is a result of the neuroleptical action of H on the CNS (F . Moeschlin, 1964; E . Perrottet, 1965). The high-voltage teta-, peaks and single delta-deviations with an expressed tendence of clonal synchronizing were not so manifested on the second and third day; the voltage of bioelectrical waves and the level of electrogenesis had a constant tendence of normalizing. The latter came after the neurologi­cal symptoms faded and the subjective complaints of the patients were ab­sent. A l l that proved the prolonged toxical effect of H on the reticular for­mation, which clinically, in the phase of recreation, could not be registered. The c l in ic -EEG correlations provided additional information about the pa-thogenetical mechanism of the toxic action of H on the mesodiencephalic brain structures. Latash L . P . (1956) and Grashtenkov N . I . (1966) tried to find a possible relation between the decreased initial influence of the reticular formation through the reticulo-spinal connection, common clinical features of hypotonia, hyporeflexia and bioelectrical changes. For the diagnosis of Н-intoxication an important role is contributed to the precise anaemnesis and absence of local neurological symptoms against the background of an expressed muscular hypotonia. The BEA-disorders shew a coincidence with the clinical signs; a result of the toxically affected functions of mesodiencephalic structures in the acute stage. During the period of re­creation the neurological symptoms precede the normalization of the pathologi­cal disorders of the cerebral electrogenesis, which requires a longer EEG-control. 72 D. Minchev, V . Hristov R E F E R E N C E S 1. Г е н о в , Г. M. Върху антихелминтното действие на пиперазинхексахидрата. Съвр. медицина. С , 1959, 5, 81—84. — 2. Г р а щ е н к о в, Н. И. Ф и з и о л о г и я и па­тофизиология гипоталамуса. М., Наука , 1966, 143. — 3. К р ъ с т е в , Б . Към клинич­ната характеристика на пиперазиновата интоксикация с препарата хелмицид. Педиат­рия . С , 1966, 3, 292. — 4. Л а т а ш, Л . П. Гипоталамус, приспособительная актив­ность и ЭЭГ. М., Наука , 85. — 5. Ц у ц у м а н о в а, А., И. К а р а к о с т о в. От-равяние с хелмицид в детската възраст. Педиатрия. С , 1966, 3, 296—299. — 6. М б • s с h l i n, F . K l i n i k und Therapie der Vergiftungen. Stuttgart, 1964. — 7. P e r r o t -t e t , E . Med. et Hyg. , 47, 1965, 670. К К Л И Н И Ч Е С К О Й Х А Р А К Т Е Р И С Т И К Е И Н Т О К С И К А Ц И И Г Е Л Ь М И Ц И Д О М В Д Е Т С К О М В О З Р А С Т Е Д. Минчев, В. Христов Р Е З Ю М Е Авторами анализируется клиническая картина 5 детей в возрасте от 3 до 7 лет, интоксикированных пиперазиновым препаратом гельмицидом при лечнии аскаридоз . У двух детей интоксикация развивалась при обычной для их возраста дозировке, а при остальных — в результате ее превышения. Во всех случаях были отмечены следующие неврологические проявления: недомогание, мышечная гипотония, гипорефлексия» по­нурость головы, самопроизвольные сверхдвижения рук, поклоны телом и ЭЭГ изменения. Все эти особенности свидетельствуют о дисфункции мезодиэнцефальных мозговых струк­тур . Своевременный диагноз и клинико-ЭЭГ корреляции в связи с использованием гель-мицидов в практике способствуют быстрой клинической ориентации и правильному терапевтическому подходу. 

UPON THE CLINICAL CHARACTERISTICS OF HELMICIDE INTOXICATION IN CHILDISH AGE

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UPON THE CLINICAL CHARACTERISTICS OF HELMICIDE INTOXICATION IN CHILDISH AGE

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