Specialist of the Salus Vita clinic in the Russian medical publication RMZH

The name of doctor Rafikova Zemfira Barsovna is known throughout Tashkent, if not throughout the Republic. She is a doctor of the highest category, candidate of medical sciences, associate professor, author of more than fifty scientific articles, co-author of 2 monographs on pediatric neuropathology. Under her leadership, specialists currently working in the field of national and foreign healthcare underwent training and practice.

Zemfira Barsovna has repeatedly taken part in international and national conferences and congresses on pediatric issues. Another success in Zemfira Barsovna’s career can be considered her article “Effectiveness of outpatient complex treatment of adolescents with learning difficulties in school adaptation using the drug “Cereton”,” published in the Russian medical journal - RMZh.

Below we present the text of the article with pride that its author is our dear colleague.

Diseases of the nervous system in children and adolescents are leading according to the results of clinical examination of the child population. This can be explained by a number of factors, including the increase in psycho-emotional stress on children at this age, caused by school and extracurricular activities, on the one hand, and a certain infantilism of the psyche of many modern teenagers, caused by hyperprotective, self-centered upbringing characteristic of many families, on the other hand. Such children have difficulty learning when they have normal indicators of intellectual development, and even more so when they have minor impairments in intellectual development (minimal brain dysfunction).

Treatment of children and adolescents with various disorders of school adaptation is one of the most pressing problems of modern neurology, which is associated with their widespread prevalence and the emergence of conflict situations between schoolchildren, teachers and parents. This further leads to limitations in the general education of the adult population.

Materials and research methods

The results of treatment of a group of outpatients with complaints of behavioral disorders, adaptation and academic performance were analyzed.

A total of 46 adolescents aged 16–17 years were examined, since it is at this age that the school load increases, and parents more often turn to a pediatric neurologist. The patients were examined before and after complex treatment using the drug Cereton®.

The study of the capabilities of the drug Cereton® was associated with the peculiarities of its pharmacological action and pharmacokinetics, which met the requirements for the treatment of the examined population.

Cereton® has:

– pronounced neuroprotective effect, improves the conduction of nerve impulses, stabilizes the membranes of brain cells;

– well tolerated by patients, without significant side effects.

There is no addiction to the drug during course use.

Cereton® (choline alfoscerate) is a central anticholinergic stimulant. Contains 40.5% metabolically protected choline. Easily penetrates the blood-brain barrier, accumulates mainly in the brain (concentration in the brain is up to 45% of the level in the blood), splitting into choline and glycerophosphate. Provides synthesis of acetylcholine and phosphatidylcholine of neuronal membranes. Stimulates cholinergic neurotransmission, central nervous system metabolism, improves the plasticity of neuronal membranes and receptor function, activates cerebral blood flow and reticular formation.

The literature contains a description of the experience of using the drug in adolescents; when conducting our treatment, we were based on this experience.

All patients received Cereton® in the first half of the day, 400–800 mg, in combination with measures to normalize the daily routine, physical therapy and sports, additional classes with teachers and work with a psychologist. The course of treatment averaged 3 months.

Research methods

1. Clinical and neurological examination.

2. Electroencephalography (EEG).

3. Magnetic resonance imaging (MRI) of the brain.

4. Consultation with an ophthalmologist, examination of the fundus.

5. Scoring method.

A number of dominant clinical and behavioral symptoms were identified, which were most often indicated by parents. The severity of the symptom was assessed using a 3-point system (subjective assessment by parents): 1 point – the symptom is mild, 2 points – the symptom is pronounced, 3 points – the symptom is very pronounced, prevailing over other symptoms. Parents assessed the child's condition before and after complex treatment. Scores were calculated based on the average prevalence in children and summed before and after treatment.

Discussion of results

In the structure neurological pathology, in addition to school adaptation disorders, which were manifested by reluctance to learn, difficulties in memorizing and logical comprehension of material, uneven learning, conflict, the majority of the examined adolescents had the following symptoms: fatigue, emotional lability, difficulty concentrating and memory loss, anxiety, sleep disturbances, behavior, weather dependence and other neuro-vegetative symptoms. Quite often there were complaints of pain.

Headaches of various types were noted - tension, migraine, asthenopic and rhinosinusogenic, psychogenic. Headaches were often accompanied by dizziness, nosebleeds, and tinnitus, more often after exercise (physical or psychoemotional) and during additional activities.

In addition, pain was noted in the cervical spine, heart, abdomen, legs, etc. The pain was functional in nature or accompanied by mild gastrointestinal diseases, ENT pathology, poor posture and flat feet.

An objective examination more often revealed minor neurological symptoms: installation nystagmus, slight strabismus, asymmetry of the nasolabial folds, mild deviation of the tongue, uneven revival of reflexes, unstable pathological foot and hand reflexes, changes in muscle tone, uncertainty and intention when performing coordination tests, unsteadiness during the Romberg test, asymmetry of the shoulder girdles, pain in the cervical spine. Autonomic disorders were especially common: decreased or fluctuating blood pressure, local and diffuse hyperhidrosis, thermoregulation disorders, weather sensitivity, tendency to fainting, and panic paroxysms.

All patients underwent an EEG to study the functional state of brain structures. In general, EEG changes were characterized by moderate disturbances in the form of disorganization of cortical activity and flattening and decrease in the α-rhythm index; against this background, the presence of slow-wave activity (4–7 Hz), pointed and acute waves was noted mainly in the parietal-central and parieto-occipital regions. Tests with photostimulation and hyperventilation led to even greater disorganization of the EEG, which more often indicated dysfunction of the suprasegmental regulatory structures of the autonomic system. After the course of treatment, a more organized EEG pattern was recorded in the majority of children (63.04%).

MRI data indicated the presence of chronic ENT pathology; there were MRIs with signs of mild atrophic changes in the cerebral cortex and slight expansion of the ventricular system of the brain. The ratio of normal and mildly abnormal MRIs was 90 and 10%, respectively. An examination by an ophthalmologist revealed decreased vision, asthenopia, spasm of accommodation, and retinal angiopathy.

After a course of treatment with Cereton®, parents noted clear positive changes in their children, which consisted of improved quality of study and school adaptation as a result of increased concentration, perseverance, improved learning of material, memorization and comprehension of tasks. All this led to an increase in adolescents’ self-esteem, self-confidence and, as a result, a decrease in symptoms of school stress and neurotic reactions. The data is presented in Table 1.

Parents' scores for clinical and behavioral symptoms in adolescents before and after treatment are presented in Table 2. As a result of the score analysis, it was revealed that the children who had various behavioral disorders, neuropsychiatric symptoms, and learning difficulties scored the highest number of points. Among them, decreased memory, initiative, irritability and fatigue when performing tasks prevailed. After treatment, all symptoms became less pronounced, and in general, according to parents, the severity of negative behavioral, characterological and psycho-emotional disorders decreased by 2 times (the total number of points before treatment was 49, and after treatment - 25). In general, the results of complex treatment were assessed positively.

Based on the analysis of the effectiveness of complex treatment using the drug Cereton® in the examined group of adolescents, the following conclusions can be drawn:

1. Improvement (from small to significant) was achieved in all subjects.

2. The drug affects the regression of subjective and objective clinical and behavioral symptoms.

3. Neuropsychological examination showed improvement in cognitive functions (improved memory, concentration, productmemory efficiency, attitude to learning, behavior at school) and, as a result, a decrease in the symptoms of school neurosis, an increase in interest in life, and an improvement in mood.

4. Positive dynamics of bioelectrical activity of the brain was noted according to EEG data.

Thus, Cereton® has shown high efficiency and safety in the treatment of adolescents with disorders of school adaptation and deterioration in the quality of study against the background of minimal brain dysfunction and behavioral disorders and can be recommended for the correction of subjective and objective neurological and cognitive disorders in complex therapy on an outpatient basis.

http://rmj.ru/articles_10274.htm

Source: www.salusvita.uz