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21.09.2005:
   21.09.2005

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EXPERIENCE OF TREATMENT WITH AMINO ACID COMPOUNDS IN THE PREVENTION OF INFANTILE CEREBRAL DISABILITY.

S.S. Zhilina, Cand. Sc. (Med.), neuropathologist
1997

INTRODUCTION

Hypoxic-ischemic lesion of the central nervous system (CNS) in the antenatal, perinatal and postnatal period is one of the main causes of infantile disability (1). At the same time, the plasticity of the child's brain, provided an early and adequate therapeutic intervention has occurred, allows to largely compensate for the damage sustained. Up to now, the physical method has been the most efficient therapy. The effectiveness of the medications (nootropic drugs, vitamins, tranquilizers, myorelaxants, etc.) traditionally used in the first months of the child's life in domestic pediatric practice remains disputable (2). Nevertheless, positive results obtained in the use of amino acid compounds in infantile cerebral palsy, residual phenomena after sustained neuroinfection and multiple sclerosis in adult neurological practice led us to assume that amino acid compounds prescribed in early childhood in children with consequences of hypoxic-ischemic impairment of the CNS can enhance the

In accordance with the Program of Infantile Cerebral Disability Prevention, the purpose of the present investigation was to study the therapeutic effect of amino acid compounds on children of the first months of life with consequences of hypoxic-ischemic CNS injury; preliminary findings of this study will be presented below.

CLINICAL MATERIAL AND RESULTS

On the basis of the children's polyclinic No. 100 of the Central District of Moscow, a group of 28 children of the first 3 months of life with after-effects of hypoxic-ischemic CNS involvement was selected; they had to satisfy at least two of the following criteria:

Lowered threshold of Moro's reflex or reduction delay;

Disturbance of the diurnal (uninterrupted duration less than 30 min.) or nocturnal (uninterrupted duration less than 1.5 hours) sleep;

Intensified (obligate) asymmetric tonic neck reflex or reduction delay;

Positive supporting response;

Spastic hypertonicity or muscular hypotonicity or muscular tension asymmetry;

Instability of temperature control or regulation of the peripheral blood flow (acrocyanosis, mottling of the skin teguments, lowered temperature of the limbs).

One case of the Beckwitt-Wiedemann syndrome and one of suspected chromosomal pathology found in clinical neurological examination were excluded from the investigation. All of 28 children who met the above criteria had in the obstetric history at least one risk factor of infantile cerebral palsy development. Distribution by sex and age is illustrated in the following Table.

Table: Distribution by age and sex of patients with consequences of CNS hypoxic-ischemic lesion.

Sex/age

Under 1 month

1-2 months

2-3 months

3-4 months

Over 4 months

Girls

---

2

7

---

---

Boys

2

5

7

4

1

TOTAL

2

7

14

4

1

Based on the objective of the investigation, the group of children was broken down into 2 subgroups, Group A included 20 children who were prescribed 10-day treatment with amino acid compounds (Provit preparation) and received either 1 capsule 3 times daily per os. Eight subjects of this subgroup were twice treated with Provit. The course was repeated after a 10-day interval. The severity of the child's condition was an indication for a repeated course of treatment. In two cases, the parents of the child refused to continue the course after the first day of Provit treatment because of exacerbation of exudative diathesis of which both children suffered before the therapy course. These two cases were precluded from further investigations. Subgroup B comprised 8 children who underwent a 30-day treatment with Cavintone (Richter Gedeon, Hungary) per os at a daily dosage of 3.75 mg split in 3 intakes. All the children of both subgroups received 15-day therapeutical massage treatment; all

A follow-up clinical neurological examination of children the findings of which were included in statistic surveys was conducted 1, 2 and 3 months after the treatment began. An improved condition of children was recorded in the first follow-up study in both subgroups. In subgroup A 14 out of 18 children (77.7%) did not meet the criteria by which they were included in the study group at the moment of the follow-up examination. Out of these 14 children, 5 in 8 patients completed two periods of Provit therapy. In group B similar positive results obtained during the first examination were found in 5 out of 8 children (62.5%). During the second follow-up examination in subgroup A all of 18 patients and in subgroup B 7 out of 8 children (87.5%) did not satisfy the described criteria. The condition of the 8th patient from subgroup B normalized by the third follow-up study (3 months after the therapy had begun). The statistic assessment of the study findings did not reveal statistically relev

CONCLUSION

The small number of patients examined may not have made it possible to arrive at statistically meaningful findings on the efficacy of Provit versus Cavintone in the infants of the first months of life with a CNS hypoxic-ischemic lesion. Nevertheless, there is a trend towards a more rapid normalization of neurologic functions of the greater part of patients under the action of Provit. This provides grounds for conducting at some later stage a larger-scale study on the efficacy of amino acid compounds in infants with neurological disorders.

REFERENCES

Delong, G.A., Adams, R.D. Developmental and congenital abnormalities of the nervous system. Principles of Internal Medicine. 11th Ed. - McGraw Hill, 1987, pp. 2032-2034 (in English).

Badalyan, L.O., Zhurba, L.T, Vsevolzhskaya, N.M. Guide on neurology in early child age. M., Zdorovye - 1980, pp. 483-507 (in Russian).


 
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