Treatment of the effects of perinatal damage to the central nervous system

Brain lesions in the perinatal period are the main cause of disability and maladaptation of children.

Treatment of the acute period of perinatal CNS lesions is carried out in a hospital, under the constant supervision of a doctor.

Treatment of the consequences of lesions of the central nervous system of the perinatal period, which pediatricians and neurologists often have to deal with, includes drug therapy, massage, physiotherapy and physiotherapy procedures, acupuncture and elements of pedagogical correction are often used.

The treatment requirements should be quite high and, it must be added, that the main emphasis in the treatment of the consequences of central nervous system damage in the perinatal period is made on physical methods of treatment (physical therapy, massage, FTL, etc.), while drug treatment is used only in a number of cases (convulsions, hydrocephalus, etc.).

Tactics of treatment of the main syndromes encountered in newborns, infants and young children with brain lesions of various origins

Intracranial hypertension syndrome

Essential in the treatment of increased intracranial pressure is the control of the volume of fluid in the cerebrospinal fluid. The drug of choice in this case is diacarb (a carbonic anhydrase inhibitor), which reduces the production of cerebrospinal fluid and increases its outflow. If treatment of increased intracranial pressure with diacarb is ineffective, progressive enlargement of the ventricles according to neuroimaging methods and an increase in atrophy of the brain substance, it is advisable to use neurosurgical methods of treatment (ventriculo-peritoneal or ventriculo-pericardial shunting).

Motor disorder syndrome

The treatment of motor disorders is carried out in accordance with the nature of motor disorders.

In case of muscle hypotension syndrome (decreased muscle tone), dibazole or, sometimes, galantamine is used. The advantage of these drugs is their direct effect on the central nervous system, while other drugs act on the peripheral nervous system. However, the appointment of these drugs should be very careful in order to avoid a change in muscle hypotension with spastic conditions.

With the syndrome of muscle hypertension (increased muscle tone), midocal or baclofen is used.

However, the leading role in the treatment of motor disorder syndrome in children with the consequences of perinatal CNS damage is played by the physical methods of exposure listed above.

Syndrome of increased neuro-reflex excitability

There is still no clear-cut generally accepted tactics for the management of children with the syndrome of increased neuro-reflex irritability, many experts regard this condition as a borderline condition and advise only to observe such children, refraining from treatment.

In domestic practice, some doctors continue to use quite serious drugs (phenobarbital, diazepam, sonapax, etc.) for children with the syndrome of increased neuro-reflex excitability, the purpose of which in most cases is little justified. The use of nootropic drugs with inhibitory effects, such as pathogam, phenibut, is widespread. Herbal medicine is quite effective (sedative teas, fees and decoctions).

If there is a delay in speech, mental or motor development, the basic drugs of domestic medicine in the treatment of these conditions are nootropic drugs (nootropil, aminalon, encephabol). Along with nootropics, all kinds of exercises are used aimed at developing impaired function (classes with a speech therapist, psychologist, etc.).

Epilepsy

Epilepsy, or, as this disease is often called in Russia, epileptic syndrome is often one of the consequences of perinatal brain damage. Treatment of this disease should be carried out by a neurologist with sufficient qualifications in this area or an epileptologist, which is preferable.

For the treatment of epilepsy, anticonvulsants (anticonvulsants) are used, the appointment and monitoring of which is carried out directly by the attending physician. Abrupt drug withdrawal, replacement of one drug with another, or any unauthorized changes in the anticonvulsant regimen often provoke the development of epileptic seizures. Since anticonvulsants are not harmless drugs, they should be taken strictly according to indications (an accurately established diagnosis of epilepsy, epileptic syndrome).

Minimum cerebral dysfunction (MMD, hyperactivity disorder, hypermotor baby)

The development of this syndrome is associated with immaturity and a decrease in the activity of inhibitory mechanisms of the brain. Therefore, in some foreign countries, amphetamines that are banned for use in Russia are used to treat this syndrome (drugs fall into the category of narcotic substances that cause rapid addiction).

Various elements of pedagogical correction, classes with a psychologist and speech therapist, exercises for concentration are also used.