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21.09.2005:
   21.09.2005

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INFANTILE CEREBRAL PALSY AND AMAUROSIS (BLINDNESS). POSSIBILITIES OF VISION RECOVERY.

Yu.V. Yudina, Cand. Sc. (Med.), ophthalmologist
(published as a progress report)
1997.

Over a two-year period, an ophthalmologic examination of 723 patients with different forms of infantile cerebral palsy (ICP) has been carried out at the "Primavera Medica" Center.

In 75 (10.4%) out of 723 ICP patients who were treated with amino acids by Prof. A.P. Khokhlov's method, amaurosis (blindness) was recorded.

After an evaluation of the disease syndroms, a characteristic look of the patients was formulated. The head is turned sideways (to the right or to the left), is bent downwards or thrown backwards, the glance is directed to the corresponding side, upwards or downwards, and is indifferent. The eyelids are half-closed, the look of a "sleeping" child. No fixation of the look and no photoperception; occasionally, the child turns the head toward a bright light. No reaction to toys or the parents whom the child recognizes by their voice. Movements of the eyeballs are absent in several directions, more frequently, outwards and upwards; they are largely limited, slowed down, spasmodic or erratic.

Complete or partial ophthalmoplegia, convergent or divergent strabismus, glance paresis (convergent-divergent squint), the "sunrise" or "sunset" syndrome are recorded.

It looks like an imbalance of a synchronous coordination of the oculomotor muscle; nonsynchronous deviation of the eyes upwards, outwards or immobility of one eye the other eye being shifted inwards.

Mydriatic pupils and absent reaction to light were found in 69 (92.0%) patients. No fixation of the look was recorded in all 75 (100%) patients with amaurosis. Inborn look fixation absence was registered in 63 (84.0%) subjects. In 11 (14.7%) patients look fixation disappeared 4-12 months after birth, in 7 (63.6%) patients with hydro- and microcephaly, in 3 patients (27.3%) after meningoencephalitis and in 1 female patient (9.1%) after the apparent death.

In instances where amaurosis developed after infections, oculomotor disturbances were less marked.

In 44 (58.6%) patients amaurosis was attributed to the atrophy of optic nerves, in 8 (10.7%) to congenital anomalities: optical nerve underdevelopment (5), vascular layer coloboma (2), congenital glaucoma (1); in 3 (4.0%) it was due to retrolental fibroplasia and its consequences; in 20 (26.7%) patients no pathology in the ocular refraction media and on the fundus of the eyes was detected. This condition was found to be the amaurosis of the central genesis.

An atrophy of optic nerves in 6 (13.6%) patients was combined with high-degree myopia, in 6 (13.6%) subjects with hydro- and microcephaly; in 4 (9.1%) with uveitis termination and in 1 case (2.3%) a total atrophy of optic nerves was reported in a female patient with the decortical syndrome after the apparent death.

Remote results of ICP and amaurosis treatment were analyzed in 32 patients. First favorable effects were recorded 1-2 weeks following the first course of amino acid treatment. The child opened the eyelids, the "sleeping" child look disappeared; the look became fixed if it was errant earlier. Subsequently, the child's look became more conscious, the child began to follow the parents, got interested in toys and picked them up.

The look paresis decreased or disappeared completely; the nature of nystagmus is altered: rotatory nystagmus turned into large-swinging horizontal nystagmus; the amplitude of oscillating movements and the volume of eyeballs movement increased. The squint angle decreased from 5 to 20 degrees.

A reduction of the squint angle, the disappearance of look paresis and a change of the nature of nystagmus depend on the dosage, duration of the action of amino acids and their combination.

Our studies have shown that amino acid combinations had the best effect on optical muscle disturbances (Glucaprim, Aminovil, Primavit or Primavit with Glucaprim or Aminovil alone).

Whereas "external" amaurosis manifestations ("sleeping" look, look paresis, etc.) begin to disappear 1-2 weeks after amino acids have been prescribed, restoration of optic functions requires more than one course of treatment.

The lids opened and the child's "sleeping look" disappeared in 27 out of 32 patients with amaurosis and ICP as a result of amino acid treatment. 5 - . Six patients began watching light, 5 patient developed unstable and 12 stable look fixation; in 4 subjects vision acuity was found to be from 0.01 to 0.08. Five patients reported no favorable effect. According to our observations, Glucaprim combined with Aminovil and Neurovit influenced the optic nerve condition most beneficially.

We have classified the visual findings into 3 groups:

1st group: "negative effects" - absence of any positive optic functions. The group included 5 (15.6%) patients;

2nd group: "satisfactory effects" - emergence of light perception in conjunction with correct light localization and unstable look fixation. Positive effects were identified in 11 (37.4%) patients;

3rd group: "good effects" - onset of stable look fixation, object vision (the child watches the parents, looks at toys, picks them up) and restoration of vision acuity from 0.01 to 0.08. Good results were recorded in 16 (15.0%) out of 32 patients.

An improvement of the optic disks condition in terms of color, sharpness of borders and restoration of physiological excavation was found in 8 (25.0%) patients. All 8 patients had hydrocephaly and optic nerve atrophy.

Besides, dependence of treatment effects on dosage and time of drug intake was noted. The best effect was produced when Glucaprim was administered at full dosage (4 times daily) in the first course of treatment.

In assessing the "good effects" group it was found that in 16 patients stable look fixation was recorded in 12 subjects following the first course and in 4 after the second course of treatment.

Acuity of vision from 0.01 to 0.04 was reported in 3 patients once the 2nd course of treatment was completed and in 1 patient after completion of the 3rd course. In 1 female patient increased acuity of sight from 0.04-0.05 to 0.07-0.08 following the third treatment period was noted.

Example. Female patient Anya Zh-va, 7. Rotatory nystagmus and convergent (internal) squint at birth, absence of look fixation. Both eyes deviated toward the nose, deviation angle 15 degrees, movement of the eyeballs limited outwards. The optic disks decolorated, a small-size white optic disk on the left eye, its borders blurred. Skiascopically, 5.0 D hypermetropia on both eyes. Diagnosis: ICP, hydrocephaly, amaurosis, atrophy of optic nerves, rotatory nystagmus, convergent strabismus, hypermetropia of moderate degree. Following the 1st course of treatment (Aminovil), the girl did not fix the look; after the 2nd (Aminovil, Glucaprim) the patient fixed the look; vision acuity: 0.04 (right eye), 0.02 (left eye). No rotatory nystagmus was recorded at the moment of the investigation; nystagmus was large-swinging; the squint angle has not changed; deviation of the eyes toward the nose was of convulsive nature and was, as before, confined outwards. After the 3rd course (Ami

The first "good effects" of optic functions obtained in 16 (50.0%) out of 32 amaurosis and ICP patients treated with amino acids by Prof. A.P. Khokhlov' method confirm his hypothesis that amino acids normalize the structure and raise the function of formerly inoperative neurons. Thereby they withdraw the optic and oculomotor nerves from the parabiotic state and raise ICP and amaurosis patients' hopes of vision recovery.


 
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