[The use of sirdalud in cerebral palsy in children]. / Primenenie sirdaluda pri tserebral'nom paraliche u detei.

30 diplegic children (mean age 11.3 +/- 2.8 years old) with severe form of cerebral palsy received sirdalud monotherapy during 2-6 weeks (1 mg for children under 10 years old and 2 mg for older children, 3 times daily). Positive effects were determined in motor, autonomic and mental (emotional) spheres. Sirdalud was also very effective in patients after orthopedic-surgical treatment. Electroneuromyographic analysis showed the decrease of the synergic tonic activity, as well as the improvement of the supraspinal influences and the segmental interaction. Thus, the small doses of sirdalud are effective without side effects in children with cerebral palsy.

[The effect of low doses of nakom on the hormonal secretion of the hypothalamo-hypophyseal-adrenal system in patients with infantile cerebral palsy]. / Vliianie malykh doz nakoma na sekretsiiu gormonov gipotalamo-gipofizarno-nadpochechnikovoi sistemy u bol'nykh detskim tserebral'nym paralichom.

The levels of hormones of hypothalamo-hypophyseal-adrenal system were measured in 14 10-14 year old children with infantile cerebral paralysis (ICP) with central catecholaminergic motor insufficiency. Contents of adrenocorticotropic hormone (ACTH), hydrocortisone (HC), somatotropic hormone, prolactin (P) were examined before and during Nacome administration (62.5 mg once daily in the morning). 110 patients of the same age with ICP and 18 children with acquired encephalopathy (EP) formed the control group. The elevations of ACTH, HC and P were revealed in spastic forms of ICP. Meanwhile nearly normal hormonal levels were observed in hyperkinetic forms of ICP and EP. The more pronounced effect was noted in "dopamine-dependent" children in which the drug's administration resulted in normalization of clinical and biochemical indices. Hyperkinetic phenomena revealed the connection between the character of neuromotor dyskinesias and the state of hypothalamo-hypophyseal-adrenal axis which is regulated by dopamine. The data obtained show hypofunction of dopaminergic neurotransmitter cerebral systems in patients with ICP that plays important pathogenetic role in development of disease with systemic manifestations.

[Changes in the indices of standing and walking in patients with infantile cerebral palsy under the influence of low doses of Nakom]. / Ob izmenenii nekotorykh pokazatelei stoianiia i khod'by u bol'nykh detskim tserebral'nym paralichom pod vliianiem malykh doz nakoma.

10 patients were treated with Nacom preparation (62.5 mg/daily in one dose in the morning). Both the feet support area during standing of one leg and the vertical component of support reactions were examined by the using EMED pedographic analyser (Germany-Japan). These indexes were analysed in patients before treatment, in patients treated with Nacom early--in a week after its withdrawal and after 1 months of Nacom administration. It was determined that support area of equinovarus feet was enlarged during the treatment due to the increase of the loading on the heel and the middle part of the feet. Meanwhile the support area of equinovarus feet was decreased as a consequence of loading alterations on foot inner side. The varus component of deformation turned out to be subjected most of all to Nacom action while the equinus one underwent less alterations and the valgus one has changed insignificantly. The improvement of dynamic characteristics of walking, support and pushing legs functions as well as of relations between support step periods phases was observed in all patients. The Nacom effect depended upon the type of initial feet deformation. The results obtained were explained in terms of decrease in influence of both tonic cervical reflexes and synergic tonic reactions on feet. That resulted in alterations in biomechanic and innervation components of static locomotor functions in infantile cerebral paralysis.

[Catecholamines and the dopamine-beta-hydroxylase activity of the blood plasma in motor pathology in children: the role of central and peripheral mechanisms]. / Katekholaminy i aktivnost' dofamin-beta-gidroksilazy plazmy krovi pri dvigatel'noi patologii u detei: rol' tsentral'nykh i perifericheskikh mekhanizmov.

Plasma catecholamine levels and serum dopamine-beta-hydrolase (D beta H) activity were investigated using high-performance chromatography and spectrophotometry, respectively, in 32 patients aged 10-14 with various motor pathology. Group 1 patients (21 children with spastic diplegia and clinical signs of central catecholaminergic neuromediation deficiency) received Nakom in a single daily dose 60 mg in the morning. The treatment produced a good clinical effect. Six children of group 2 with hereditary degenerative cerebral, spinal, nervous diseases and 5 children of group 3 with lower spastic paraplegia consequent to spinal cord trauma inflicted 6-12 months: before received Nakom in a single daily dose 30 mg in the morning for 14 days. The treatment in them resulted in an essential decrease of pelvic dysfunctions. All the children had a high DOPA level in blood plasma irrespective of the group and Nakom administration. Pretreatment dopamine (DA) levels were different: the least in cerebral palsy patients (0.019 +/- 0.01 ng/ml), the highest in group 2 (p < 0.05), in children with spinal cord pathology it was higher than normal and higher than in group 1 (p < 0.001). Nakom treatment promoted DA normalization in all the groups. Norepinephrine (NE) concentrations were very low in all the patients correlating with the degenerative process degree and did not change in response to Nakom administration. D beta H activity was inhibited in all the groups, especially in the spinal patients. Nakom increased both D beta H activity (p < 0.01) and motor activity. Thus, an increased DOPA level is plasma is not specific for nervous diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of small doses of L-dopa on synergic tonic reaction in patients with childhood cerebral palsy]. / Vliianie malykh doz L-dopa na sinergicheskuiu tonicheskuiu reaktsiiu u bol'nykh detskim tserebral'nym paralichom.

As many as 8 patients aged 8-19 years suffering from infantile cerebral paralysis (ICP) with torsion dystonia, akinetic, rigid, spastic and hypotonically atactic syndromes were examined for the maximum amplitude of EMG activity of the musculus tibialis anterior in voluntary rear flexion of the foot and in Strümpell's tibial synkinesia before treatment and after intake of small doses of L-DOPA (nakom, 62 mg/day). It has been established that the amplitude of voluntary EMG activity and the rate of impulse transmission in efferents of the tibial nerve remained practically unchanged during treatment; in all the cases, the synergic EMG activity, discharges of EMG and prolonged activity decreased; the scope of active movements in the talocrural joint increased by 10-20 degrees. The greatest decrease of synergic EMG activity (by 40%) was recorded in patients with rigid muscle tone, the mean in patients with spastic and spastic -dystonic (by 25-33%), the least one (17%) in muscle hypotonia. It is assumed that voluntary and synergic automatic movements have varying neuromediator supply. The effect of L-DOPA is realized via changes in the function of suprasegmental brain structures regulating polysynaptic postural reflexes with primary action on extensors. The effects of the subcortical nuclei, stem and cerebellar systems are made possible by dopamine neuromediation to a different measure.

[Pathological tonic reflexes in adolescents with infantile cerebral palsy]. / Patologicheskie tonicheskie refleksy u podrostkov, bolnykh detskim tserebral'nym paralichom.

A study was made of pathological tonic reflexes (PTR) in adolescents afflicted with infantile cerebral paralysis (ICP) by means of assaying the tone of thigh muscles before and after treatment and in the presence of L-DOPA (nacom, 62.5 mg/day) intake. The drug minimized the manifestations of PTR because of changes in the function of brain structures involved in tonic reactions. It is recommended that during establishment of indications for +orthopedic-surgical treatment of ICP patients with marked PTR determining the formation of reflex contractures and deformities of limb joints, conservative treatment with L-DOPA drugs be preliminarily carried out.