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21.09.2005:
   21.09.2005

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TWO-YEAR EXPERIENCE OF USE OF AMINO ACID PREPARATIONS DEVELOPED AT THE "PRIMAVERA MEDICA" CENTER IN INFANTILE CEREBRAL PALSY TREATMENT: CHANGES IN THERAPY TACTICS.

A.A. Savin, M.D., Asst. Prof., neuropathologist;
Yu.K. Khokhlov, Cand. Sc. (Med.), Asst. Prof., neuropathologist
1997

INTRODUCTION

Infantile cerebral palsy (ICP) is known to be one of the commonest diseases of the nervous system in children. Incidence of infantile cerebral paralyses accounts for 2.5-5.9 cases in 1,000 newborns (L.O. Badalyan, 1984), but, taking into account the so-called perinatal and early postnatal encephalopathies, the number of such patients increases still further.

The now available ICP treatment methods are mainly concerned with the action on the child's locomotor system (massage, exercise therapy, different types of physiotherapy, etc.) and they cannot any longer satisfy either health care professionals or parents. Methods affecting some biochemical processes in the nervous system that have appeared in the recent years, such as Shoshina-Vasilyev's and Prof. Skvortsov's methods are equally far from ideal since the first procedure (Shoshina-Vasilyev) basically influences the pyramidal system structures while in ICP the cerebral cortex and the pyramidal system are mostly impaired; the use of the second method (Prof. Skvortsov) is painful and may be hazardous to the child's mentality. In this connection, a new method originated by Prof. A.P. Khokhlov that consists in the use of specially selected amino acid combinations designed to control the exchange processes in the impaired brain cells has aroused interest among neurologists.

MATERIAL AND STUDY METHODS

The present study analyzes the treatment effects in 84 infantile cerebral palsy patients who underwent therapy by Prof. A.P. Khokhlov's method at the Center from February 1994 to February 1996. During this time, all patients completed repeated courses of treatment that lasted from 4 to 6-8 weeks (an average of 5 weeks). 39 subjects (46.43%) received two courses of treatment; 20 subjects (23.81%) had 3; 9 subjects (10.7%) took 4 courses; another 9 subjects (10.7%) received 5 courses; 6 patients (7.1%) got 6 courses; and 1 female patient (1.19%) underwent 7 courses of treatment. Accordingly, 53.56% of patients received 3 and more therapy courses. Catamnesis times (follow-up histories) ranged from 0.5 year to 2 years.

In the patients' clinical history, spastic forms of the disease were predominant: 58 patients (69.04%), including 19 patients with spastic diplegia (Little's disease), a typical form of ICP; spastic tetrapareses were identified in 24 patients, hemipareses in 15, atonic-static syndrome in 6 patients, hyperkinetic form was recorded in 13 subjects, among whom hyperkineses in 6 cases combined with central paralyses; pronounced intellectual disorders were found in 7 patients who had a non-severe motor defect background. In 17 subjects (20.23%) motor disturbances were concomitant with epileptic, more frequently, convulsive seizures. Among the examined patients males significantly prevailed: 50 male patients (59.52%) versus 34 female patients (40.47%).

STUDY RESULTS

In the first 6-8 months following the start of the Center's activity, the following standard pattern was used to influence motor disturbances: depending on their age, patients were administered 4-16 capsules of either 500 mg of Glucaprim every day. Aminovil was recommended at similar doses in the presence of a hyperkinetic syndrome or epileptic attacks in the neurologic status. With Glucaprim producing no effect, the intake of Aminovil alone was recommended.

At the same time, the first months of the Center's work have revealed a very distinctive feature of patient's therapy, namely, the possibility and high efficiency of prescribing a combination of the above-mentioned drugs: for instance, Glucaprim was administered for the morning and evening, whereas Aminovil was prescribed for daytime and nighttime. This combination was especially indicated in motor disturbances with speech and mind impairment.

As new amino acid preparations appeared, new combinations acting on motor disorders emerged, for example, Glucaprim+Primavit, 6 Steroids Shop Glucaprim+Aminovil+Primavit or Glucaprim+Primavit+Vitamixt, the latter combination having proved its merit in the presence of increased muscular tone of mixed type with spastic and plastic component manifestations.

The subsequent observation of patients allowed a new important conclusion: as courses of treatment were repeated, particularly, beginning with the third course in 42 patients (50% ! ), the clinical effect was manifested at significantly smaller dosages of amino acid preparations compared with the initial periods of treatment. This is an indirect clinical corroboration of Prof. A.P. Khokhlov's hypothesis that an increased activity of formerly inoperant nerve cells forms the basis for the recovery of motor funcions in ICP patients. This is also evidenced by the fact that if the course of treatment was discontinued, the obtained effect did non disappear but, on the contrary, persisted during 3-4 months and, to achieve a repeated clinical result, minor amino acid dosages sufficed to stimulate the functioning nerve cells. As a result, only 21 patients (25%) were to take the former dosages when they repeated courses of treatment.

In another group of patients (21 subjects = 25%), repeated periods of treatment had to be conducted with the use of diverse drug combinations. In this case, one half of the patients of this group had to take drug combinations for the purpose of further enhancing therapy effectiveness while the other half received them because of the lacking effect. This group was primarily made up of patients with severe hyperkinetic and mixed forms of ICP. In treating these patients, we occasionally restricted ourselves to the effect on isolated disease symptoms, for instance, on a reduction of spasticity while hyperkineses were retained.

A dynamic supervision of the patients enabled us to detect some side effects of amino acid therapy. Thus, the use of maximum amounts of Primavit often produced increased somnolence and in 5 cases repeated prescription of maximum Aminovil doses was accompanied by hightened agitation.

A clinical effect manifested in a distinct positive dynamics of the neurologic status was recorded in 73 patients (86.9% ! ). The treatment was in most cases well tolerated by patients; children took with preasure the greater part of medicines.

An objective positive dynamics was in many cases reported by the end of the first week of treatment and typically included a decreased muscular tonicity with an ensuing increase in the strength and volume of movements in the limbs over 3-4 weeks.

From this point on, the treatment tactics increasingly acquired individual traits. At the same time, we should strive to obtain a clear-cut positive effect already in the first course of treatment; this is why, the duration of the first course should be extended (with the clinical effect increasing) without confining ourselves to 4-6 weeks.

CONCLUSION

The analysis of the results obtained allows the conclusion to the effect that a new highly effective method of treating infantile cerebral paralysis has been found. Undoubtedly, the appearance of new amino acid compounds will help further increase treatment efficiency. In its turn, the working through of various drug combinations will hold out hope of improving results of the treatment of patients with hyperkinetic forms of disease.


 
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