Features of left-sided hemiparesis in children and adults

Description of the disease

Paresis is a medical term for muscle weakness due to the fact that nerve impulses do not reach them.
The state of paresis differs from paralysis in that the body does not completely lose muscle functionality. In this article we will talk about hemiparesis on the left side of the body.

The disease most often occurs either in older people as a result of serious illnesses, or in young children as a result of perinatal pathologies (cerebral palsy).

Hemiparesis is a consequence of damage to neurons in the brain or spinal cord.

Left-sided hemiparesis may vary:

1. By localization:
   Central;
2. Peripheral.
3. According to the speed of flow:
   Spicy;
4. Slowly developing.
5. By severity:
   Easy;
6. Moderate;
7. Deep.

Help: Symptoms of left-sided hemiparesis may differ, it all depends on the degree of damage to the central nervous system, the cause of the pathology, and the age of the patient. When the disease invades the brain and facial nerve, patients begin to experience problems with facial expressions.

In addition, you can identify the following symptoms:

1. Increased muscle tone;
2. Prolonged migraine;
3. Fever;
4. Lack of appetite and fatigue;
5. Aching bones;
6. Weight loss;
7. Muscle resistance when trying to bend a limb;
8. Muscles are affected unevenly;
9. Strengthening tendon reflexes;
10. Rossolimo reflex, Babinski reflex;
11. Emotional swings, personality disorders.

Why does hemiparesis occur?

Circulatory disorders

Strokes are characterized by acute manifestation, rapid progression of symptoms, and persistent nature of the disorders. Hemorrhagic stroke develops rapidly. At the onset, general cerebral manifestations predominate, accompanied by signs of focal lesions. Ischemic stroke is characterized by a slower increase in symptoms and a predominance of focal manifestations over cerebral ones.

When the brain is damaged in the carotid artery basin, central hemiparesis is formed with loss or decrease in muscle strength and increased muscle tone. Smoothing of the nasolabial fold, facial distortion, and lagophthalmos are revealed. Hemianopsia, apraxia, aphasia, and critical impairment are possible. With lacunar strokes, hemiparesis can be observed in isolation.

In patients with transient cerebrovascular accidents, hemiplegia and hemiparesis are rarely diagnosed, and the decrease in muscle strength is insignificant or moderate. Dysarthria and anisoreflexia may be detected. Sometimes epileptic seizures occur. All neurological functions are completely restored within 24 hours.

Tumors

Hemiparesis develops in every second patient with a brain tumor. The disorders progress gradually, appearing against the background of general cerebral symptoms (dizziness, headache, vomiting, which does not bring relief) and focal manifestations. They are detected when the motor cortex is involved, brainstem lesions and craniospinal neoplasia.

Hemiplegia or hemiparesis is determined in patients with pineoblastomas, meningiomas, astrocytomas, medulloblastomas, other primary tumors, cerebral metastases with the spread of malignant neoplasia of other organs. With predominantly unilateral localization of pathological foci, weakness of the muscles of half the body can accompany cerebral gliomatosis, carcinomatosis of the meninges. Sometimes the cause of hemiparesis is neuroleukemia.

Traumatic injuries

The phenomena of hemiparesis are found in victims with traumatic brain injuries. With a mild contusion of the brain, muscle weakness is short-term and is not always detected. For a brain contusion of moderate severity, hemiparesis persists for 1-1.5 months. In case of severe bruises, neurological symptoms partially regress, and persistent residual consequences are observed.

The cause of hemiparesis can be subarachnoid hemorrhage, intracerebral, subdural or epidural hematoma. Unilateral muscle weakness is considered one of the most persistent symptoms of hematoma; it often occurs after a clear interval and is accompanied by headache, psychomotor agitation, disturbances of consciousness, vomiting, aphasia, anisocoria, bradycardia, and increased blood pressure.

Hemiparesis

Purulent processes

Brain abscess becomes a consequence of injuries, postoperative complications, hematogenous spread of infection in inflammatory lung diseases. Otogenic intracranial complications play a significant role in the structure of pathology. The likelihood of developing hemiparesis is determined by the location and extent of the abscess. The clinical picture includes cerebral and focal manifestations. With empyema, meningeal symptoms may appear.

Neuroinfections

Hemiparesis sometimes develops with encephalitis (post-vaccination, Japanese mosquito, tick-borne, influenza) and meningoencephalitis. A high risk of this disorder is observed in vascular neuroAIDS - vasculitis of cerebral vessels, which is characterized by the transition of ischemic strokes to hemorrhagic ones. In addition, hemiparesis is detected with progressive multifocal encephalopathy, which more often develops in patients with AIDS.

Stroke-like symptoms with hemiparesis are sometimes observed in the later stages of neurosyphilis. As a rare cause of unilateral muscle weakness, one can consider syphilitic gumma, which is located predominantly in one half of the brain stem and, as it grows, compresses the pathways.

Cerebral palsy

Cerebral palsy is characterized by a variety of manifestations and significant variability in the clinical picture. Monotetra or hemiparesis are possible. Increased muscle tone and dysarthria are typical. When the muscles of the larynx and pharynx are affected, dysphagia occurs. Hyperkinesis, epilepsy, and intellectual impairment are often detected. Due to delayed development of the involved limbs, skeletal deformities form as the child grows.

Epilepsy

Todd's palsy occurs after an epileptic seizure and is manifested by central hemiparesis, less often - monoparesis of varying degrees of severity. The symptom persists for 1-2 days, then muscle strength is gradually restored. The pathological condition is more often observed after prolonged epistatus, secondary generalized seizures and paroxysms of Jacksonian epilepsy.

Kozhevnikov epilepsy is secondary in nature, developing against the background of Rasmussen encephalitis, tick-borne encephalitis, and neurosyphilis. Occurs with tumors, strokes, tuberculous meningoencephalitis, and other diseases. Along with simple partial seizures and myoclonus, it manifests itself as hemiparesis, depression, phobias, and sometimes psychopathic disorders.

Parasitoses

Aspergillosis can manifest itself with fever and general cerebral symptoms or manifestations resembling stroke. Neurological deficit is formed already in the first days after the onset of the disease, hemiparesis is complemented by dysarthria, smoothness of the nasolabial fold, and numbness of the face. With rapid progression, disturbances of consciousness are possible.

Other reasons

The symptom can be detected in the following pathologies:

• Sturge-Weber syndrome.
  Congenital angiomatosis is manifested by vascular spots on the skin of the face, the formation of angiomas on the body and meninges. Due to the predominantly homolateral nature of the lesion, hemiparesis predominates among movement disorders.
• Birth injuries.
  The cause of the disorder is intracranial hemorrhage in the conduction pathways or motor parts of the brain due to trauma during childbirth. Muscle weakness is present from birth.
• Hypertensive encephalopathy.
  Mild hemiparesis is observed with pyramidal syndrome. May be accompanied by cephalalgia, dizziness, decreased cognitive abilities, and psycho-emotional disorders.

Hemiparesis is sometimes diagnosed with tetralogy of Fallot and dissecting aortic aneurysm. In the first case, muscle weakness develops after dyspnea-cyanotic attacks, in the second it is the result of cerebral ischemia due to tearing of the aortic wall, hematoma formation and compression of the arterial branches.

Disease in children

It is generally accepted that left-sided hemiparesis in children is a type of cerebral palsy.
Most often in children, hemiparesis is externally manifested in the tone of the arm muscles, which are responsible for flexion, and vice versa, the tone in the legs is in the muscles responsible for extension.

Most often, this pathology is congenital.

Symptoms in children:

1. The child stops recognizing familiar people;
2. Cognitive impairment;
3. Inability to control movements;
4. Deterioration of sensitivity;
5. Epileptic seizures;
6. Headache;
7. Fever;
8. Loss of appetite, fatigue;
9. Pain in bones and joints.

Congenital hemiparesis becomes noticeable in children by three months of life; the following initial symptoms can be identified:

1. Arms and legs move asymmetrically;
2. Often the hand is clenched into a fist;
3. Weak support function.

Important! Basically, the final diagnosis is made by the age of one or even one and a half years, at which time children begin to walk and the symptoms become especially noticeable. Severe cases of hemiparesis also affect the child’s intellectual and psychological development.

Child development with cerebral palsy

Psycho-emotional characteristics manifest themselves in different ways: some children are irritable, excitable, and suffer from sudden changes in mood. Others are shy, fearful, and have difficulty communicating with people.

Restriction of physical activity causes curvature of the spine, contracture and internal pathologies. Due to speech impairments, meaningful communication is limited or absent. Parents should not show excessive pity and impressionability in their upbringing. It is necessary to praise the child more often, encourage him to take active actions, and form normal self-esteem; all this is very important for the normal development of the child. Parents should help the patient adapt socially.

Left-sided spastic hemiparesis

Spastic hemiparesis occurs when the head or cervical region is affected, and causes stiffness of the muscles on the opposite side of the body, in this case, the left.

Spastic hemiparesis manifests itself gradually. First, spasticity appears - tension in the limbs , which is felt as a kind of stiffness. Without treatment, this condition eventually develops into full-fledged hemiparesis.

People with spastic hemiparesis typically have characteristic external symptoms that are noticeable to others, such as the Wernicke-Mann gait.

Causes

By and large, hemiparesis is not an independent disease, but a manifestation of the pathology of the nervous system in which damage to the motor center or pathways has occurred.
The resulting muscle weakness leads to paresis.

Most often, the process occurs in one part of the brain and, interestingly, pathological external processes will be noticeable in the opposite direction.

That is, if the right hemisphere is affected, the left half of the body will be affected, either completely or partially, such as an arm or leg.

This occurs due to the fact that there is an anatomical decussation of nerve fibers that originate from the brain at the level of the transition of the medulla oblongata to the spinal cord.

In children

In childhood, the cause of hemiparesis can be:

• Birth injury;
• Intrauterine infection;
• Hypoxia, that is, oxygen starvation, during pregnancy or childbirth;
• Previous infections: polio, meningitis, tetanus, tuberculosis.

In adults

The cause of left-sided paresis in adults can be:

• Oncology of the central nervous system;
• Head injury;
• Degenerative diseases of the central nervous system, such as Parkinson's disease and Alzheimer's disease;
• Epilepsy;
• Consequence of a serious infectious disease: encephalitis, meningitis, tetanus, rabies, etc.;
• Thrombus;
• Hemorrhages in the head (stroke);
• Lumbosacral plexitis;
• Aneurysm;
• Frequent stress or severe one-time stress.

Factors in the development of cerebral palsy

The causes of the disease include:

• premature or difficult labor
• hypoxia or asphyxia;
• infections during pregnancy;
• having a twin;
• congenital anomalies of the spinal cord or brain;
• impaired cerebral circulation;
• chronic diseases, hypo- and vitamin deficiency in the mother;
• smoking and drinking alcohol by the mother;
• Rhesus conflict.

There are often multiple risk factors present. It is not possible to name a specific reason in all cases.

Diagnostics

Accurate diagnosis is carried out in a clinical setting and includes:

1. Taking anamnesis and visual examination of the patient;
2. CBC and biochemical blood test;
3. Analysis of urine;
4. ECG;
5. CT or MRI of the brain, cervical spine, spinal cord;
6. EEG;
7. Dopplerography of cerebral vessels;
8. Electroencephalography;
9. CSF analysis;
10. Cerebrospinal fluid analysis;
11. The muscle strength of both sides of the body is compared;
12. Muscle resistance test;
13. Barre test - holding hands in weight;
14. For children, in addition to early examination by a neurologist, ultrasound of the brain is used.

Treatment

Since left-sided hemiparesis is a consequence of the underlying disease, then, first of all, it is necessary to treat it. But at the same time, it is equally important to devote time to symptomatic therapy against hemiparesis.

In children

Mainly, in the treatment of children, emphasis is placed on:

1. Classes with a speech therapist for the treatment of speech dysfunction ;
2. Classes with a defectologist for developmental delays;
3. Treatment of episyndrome;
4. Drug therapy.

In addition to this, it can help a lot:

1. Gymnastics;
2. Therapeutic baths and mud;
3. The use of orthopedic cribs, orthopedic shoes (website of children's orthopedic shoes);
4. Surgical intervention, if necessary;
5. Holidays at resorts.

In adults

To treat hemiparesis, drug treatment is used primarily to improve neuromuscular conduction. Muscle relaxants to relieve tone, medications to improve blood circulation, anticonvulsants.

In addition, adults can also be prescribed:

1. Orthopedic treatment: shoes, splints;
2. Physical therapy and gymnastics;
3. Massage.

Water procedures:

1. cold and hot shower;
2. water gymnastics.

Exercise therapy and a set of exercises

A therapeutic set of exercises shows good results in the treatment of left-sided hemiparesis. You can practice both in specialized centers and at home. The main thing is that the classes are constant, or better yet, daily .

Exercise sets are usually developed individually for each patient . You can give an example of such a system of exercises as:

1. Pulling the chin to the chest;
2. Tilt of head to shoulders;
3. Rotational movements of the hands;
4. Raising your arms to shoulder level;
5. Rotational movements of the feet;
6. Raising on toes;
7. Flexion and extension of the legs in a lying position;
8. Raising your legs while lying down.

We invite you to visually familiarize yourself with an interesting video on the topic:

Cerebral palsy: early diagnosis and rehabilitation treatment

Cerebral palsy (CP) is a disease that occurs as a result of brain damage in the perinatal period or as a result of an abnormality in its development and is characterized by disturbances in motor and statokinetic functions, as well as psycho-speech and sensory disorders, non-progressive, partly amenable to functional compensation and correction [1– 3].

The prevalence of cerebral palsy in Russia is 1.6–6 per 1000 full-term children, 9–40 per 1000 premature infants [3].

Unfavorable factors related to the origin of cerebral palsy: complicated somatic and gynecological history in the mother, pathology of pregnancy, perinatal lesions of the nervous system - hypoxic, infectious, toxic-metabolic, asphyxia during childbirth, birth trauma, brain dysgenesis [2–4].

Classifications of cerebral palsy

According to the International Statistical Classification ICD-10, the following are distinguished:

• G80.0 - Spastic cerebral palsy.
• G80.1 - Spastic diplegia.
• G80.2 - Childhood hemiplegia.
• G80.3 - Dyskinetic cerebral palsy.
• G80.4 - Ataxic cerebral palsy.
• G80.8 - Another type of cerebral palsy.
• G80.9 - Cerebral palsy, unspecified.

The clinical classification of Professor K. A. Semenova (1972) includes the following forms of cerebral palsy: double hemiplegia, spastic diplegia, hemiparetic form, hyperkinetic form, atonic-astatic form, mixed forms [2].

The European clinical classification of cerebral palsy (SCPE, 2000) identifies [3]:

1. Spastic paralysis: unilateral (hemiplegia), bilateral (diplegia, quadriplegia).
2. Dyskinetic: dystonic, choreoathetotic.
3. Ataxic.

The frequency of forms of cerebral palsy: spastic diplegia - 69.3%, hemiparetic form - 16.3%, atonic-astatic form - 9.2%, hyperkinetic form - 3.3%, double hemiplegia - 1.9% [2].

Early manifestations of cerebral palsy are: delayed motor and psycho-speech development, absence or delayed reduction of innate and tonic reflexes, as well as delayed formation of attitudinal reflexes, impaired muscle tone, increased tendon reflexes, the appearance of pathological attitudes and synkinesis [5].

Early clinical and neurological diagnosis of cerebral palsy is largely based on the doctor’s knowledge of the sequence of formation of the stages of neuropsychic development of a child of the first year [1]: 1 month - the child tries to hold his head, fix his gaze, innate reflexes are expressed; 2 months - briefly holds the head on the stomach and in an upright position, fixes the gaze, hums, physiological astasia-abasia; 3 months - holds his head, follows the object, the grasping reflex weakens, and tries to voluntarily hold the inserted toy, rests on his forearms on his stomach; 4 months - turns his head in the direction of the sound, reaches out and takes a toy, turns on his side, sits down and sits with the support of his hands, pronounces vowel sounds; 5 and 6 months - sits with support from one hand or briefly independently, turns from back to side and stomach, distinguishes familiar faces, first syllables appear; 7 and 8 months - sits independently, gets on all fours, tries to stand briefly against a support; 9 and 10 months - kneels with support, stands and tries to move with support, stands independently for a short time, speaks the first words; 11 and 12 months - walks with one arm supported and tries to walk independently, follows simple instructions, speaks a few words, tries to feed himself with a spoon. Assessment of the degree of delay in motor and psycho-speech development: up to 3 months - mild, 3-6 months - moderate, more than 6 months - severe. Correction factors for prematurity: up to 1 year - the period of prematurity in months is added, from 1 year to 2 years - half the period of prematurity in months [5].

The motor development of a healthy child is characterized by a certain sequence, which is manifested by the extinction of unconditioned reflexes, the formation of righting (righting) reflexes, and the improvement of balance reactions [5, 6].

One of the early signs of cerebral palsy is a violation of the timely reduction (at 2 months in full-term infants, at 3–4 months in premature infants) of unconditioned reflexes - palmar-oral, proboscis, Moro, support reflex and automatic gait, postural reactions (labyrinthine, as well as cervical tonic - asymmetric and symmetrical - reflexes). As unconditioned reflexes fade, from the first month of life, adjustment reflexes are formed (labyrinth adjustment, chain cervical adjustment, etc.), which provide turns and straightening of the body, and are improved up to 10–15 months [1, 2, 6]. In patients with cerebral palsy, tonic reflexes can persist for life, which inhibits the formation of attitudinal reflexes, voluntary motor activity, and balance reactions and leads to the development of a pathological postural stereotype [5, 6].

Impaired muscle tone is one of the early signs of developing cerebral palsy [1, 2, 6]. Muscle hypertonicity and asymmetrical posture that persist after 4 months are observed in the consequences of perinatal lesions of the central nervous system (CNS), the threat of cerebral palsy (its spastic forms). The “spread out frog” position is observed with diffuse muscle hypotonia in premature infants, with hereditary diseases, perinatal lesions of the central nervous system, and the threat of atonic-astatic form of cerebral palsy [1, 2, 5].

Thus, early diagnosis of cerebral palsy can and should be carried out already in the first year of a child’s life, which can significantly reduce the risk of developing complications of cerebral palsy and the degree of disability of the patient.

Clinical forms of cerebral palsy

With spastic diplegia, a history of prematurity is common (67%), the clinical picture shows tetraparesis (the lower limbs are affected to a greater extent than the upper ones), sharply increased muscle tone of the limbs, body, tongue, high tendon reflexes, increased tonic reflexes, and pathological installation and deformation of the limbs, a spastic gait with a cross is formed, while only half of the patients walk independently, 30% with support, the rest move in a wheelchair. Speech disturbances in the form of spastic dysarthria and vision pathology in 70% of patients (refractive errors, optic nerve atrophy, strabismus) are characteristic [1, 2, 5]. The hemiparetic form is often caused by birth trauma; spastic hemiparesis is noted in the clinic, with the upper limb suffering more than the lower, shortening and hypotrophy of the affected limbs, hemiparetic gait, Wernicke-Mann posture with flexion of the arm and extension of the leg (“the hand asks, the leg squints”) is observed "), foot deformities and contractures on one side, the incidence of symptomatic epilepsy is high (about 35% of cases) [1, 2]. The hyperkinetic form is often the outcome of bilirubin encephalopathy, due to kernicterus, which develops in full-term newborns with a bilirubin level in the blood of 428-496 µmol/l, in premature infants - at 171-205 µmol/l. Characterized by violent involuntary movements (hyperkinesis) of the limbs and torso, which intensify with excitement and disappear during sleep. Hyperkinesis appears first in the tongue (at the age of 3–6 months), then spreads to the face, and then by 2–6 years to the trunk and limbs. There are disturbances in muscle tone such as dystonia, frequent autonomic disorders, hyperkinetic dysarthria, and sensorineural hearing loss (in 30–50%) [1, 2, 5]. The atonic-astatic form is characterized by low muscle tone, impaired coordination of movements and balance, as well as an excessive range of motion in the joints of the limbs. Double hemiplegia is the most severe form of cerebral palsy, manifested by gross motor impairment, increased muscle tone, tendon reflexes, severe speech impairment, and the mental development of children at the level of mental retardation [1, 2, 7].

The most significant complications of cerebral palsy: orthopedic and surgical disorders (hip dysplasia, foot deformities - equinus, valgus, varus, contractures of the joints of the extremities), speech and cognitive disorders in the form of delayed psycho-speech development or mental retardation (more than 60%), episyndrome ( in 35%), behavioral disorders, neurotic disorders (in 65% of patients), autonomic dysfunction syndrome (in more than 70%), asthenic syndrome (in more than 85%) [1, 2, 7, 8].

Rehabilitation of cerebral palsy

The leading principles of cerebral palsy rehabilitation are: early onset, comprehensive multidisciplinary approach, differentiated nature, continuity, duration, phasing, succession. Rehabilitation treatment of a patient with cerebral palsy should be carried out in accordance with an individual rehabilitation program and include the following areas [2, 4–8]:

1. Medical rehabilitation: drug therapy, physical therapy and massage (classical, segmental, periosteal, connective tissue, circular trophic, acupressure), Vojta therapy, neurodevelopmental system B. and K. Bobath; the use of therapeutic and loading suits ("Adele", "Gravistat", "Regent", "Spiral"), pneumatic suits ("Atlant"), mechanotherapy (exercises using simulators and special devices, including robotic complexes (Lokomat, etc. ), physiotherapy (electrotherapy, electrophoresis and electromyostimulation, magnetic therapy, paraffin-socerite applications, mud therapy, hydrokinesitherapy, acupuncture), orthopedic-surgical and sanatorium-resort treatment [2, 6–8].
2. Psychological, pedagogical and speech therapy correction (psychocorrection, sensory education, classes with a speech therapist-defectologist, conductive pedagogy by A. Peto, the Montessori method, work with families, etc.) [3, 7].
3. Social and environmental adaptation.

Drug therapy for cerebral palsy includes [4, 5, 7]:

• drugs that have neurotrophic and nootropic effects (Cortexin, Cerebrolysin, Nootropil, Phenibut, Pantogam, Encephabol);
• drugs that improve general cerebral hemodynamics and microcirculation (Cortexin, Cinnarizine, Actovegin, Trental, Instenon, etc.);
• drugs that improve metabolism in the nervous system, reparative and absorbable effects (ATP, Elcar, Lidaza, Vitreous, Derinat);
• anticonvulsants for the combination of cerebral palsy with convulsive syndrome (valproates - Konvulex, Depakin, etc.);
• drugs that normalize muscle tone (for hypertonicity - Mydocalm, Baclofen, botulinum toxin preparations; for hypotension - Proserin, Galantamine);
• drugs that reduce hyperkinesis (Pantogam, Phenibut, Nacom, Tiapridal);
• vitamins (B1, B6, B12, C, Neuromultivit, Milgamma, Aevit, etc.).

One of the complex drugs that has found active use in neurorehabilitation is Cortexin (INN - polypeptides of the cerebral cortex of livestock) [7–9]. Cortexin belongs to pharmacological group 9.7 (“Nootropics (neurometabolic stimulants)”). According to the ATC system (anatomical-therapeutic-chemical) classification, the drug belongs to heading N06 BX (“Other psychostimulants and nootropic drugs”). Cortexin is an innovative drug, its substance and dosage forms are protected by patents of the Russian Federation (RF No. 2104702b 2275924b 2195297) and other countries [7–9]. Cortexin contains not only neuropeptide substances, but also 20 amino acids, a number of vitamins and minerals, which explains its high neurochemical activity in regulating the processes of neurocellular dynamics and apoptosis, providing mechanisms of neuroprotection. Cortexin is available as a lyophilisate in bottles of 10 mg and 5 mg (Cortexin for children). Before injection, the contents of the bottle are dissolved in 1.0–2.0 ml of a 0.5% solution of novocaine, water for injection or isotonic sodium chloride solution. The drug is prescribed intramuscularly, for children weighing up to 20 kg - at a dose of 0.5 mg/kg, and for children weighing more than 20 kg - at a dose of 10 mg. The duration of the course is 10–20 days.

The results of numerous studies indicate the high effectiveness of Cortexin in the complex rehabilitation of children with diseases of the nervous system, including perinatal lesions of the nervous system and cerebral palsy, which is due to its direct effect on the metabolism of nerve cells, normalization of cerebral and systemic circulation, and a decrease in the manifestations of convulsive syndrome [7 -10]. Cortexin is included in clinical recommendations [4] and standards of medical care for cerebral palsy (Order of the Ministry of Health of the Russian Federation dated June 16, 2015 No. 349n “On approval of the standard of specialized medical care for cerebral palsy”).

Significant positive experience has been accumulated in the use of Cortexin in the acute period of perinatal cerebral pathology, and it has been revealed that its use in the complex treatment of critical conditions in children reduces the duration of intensive care and the length of stay of patients in the intensive care unit, the average length of hospital treatment and the stage of primary neurological rehabilitation, which significantly improves the prognosis for the recovery of motor and cognitive functions, as well as the neurological status of the patient as a whole [9–11]. Analysis of the results of the use of Cortexin in the rehabilitation of children in the first years of life with consequences of perinatal central nervous system damage indicates a significant improvement in motor and cognitive functions, as well as pre-speech and speech development [11–13].

When studying the effectiveness of rehabilitation treatment using Cortexin in 67 children aged 3 months to 3 years with developmental disorders of psychoneurological functions of perinatal origin, a significantly more intensive formation of the functions of visual and auditory perception, impressive speech, and communicative functions was noted than in treatment without Cortexin [11 ].

Clinical and psychological examination of 96 patients aged 1–15 years with cerebral pathology of various origins (including perinatal damage to the central nervous system), when Cortexin was used in complex treatment, revealed in 70.2% of patients a good clinical effect in the form of improved well-being, increased academic performance at school, improvements in integrative brain functions, a satisfactory result was achieved in 22.4%, and in the control group, satisfactory and “no changes” results were noted 2 times more often [12]. There was a significant improvement in the function of attention according to the correction test, and positive changes in electroencephalography (in patients receiving Cortexin, indicators improved in 76% of cases, and in the control group - only in 50%) [12]. The researchers also revealed a clear decrease in the content of CPK-BB, the degree of accumulation of which serves as an indicator of the pathological state of the central nervous system, under the influence of treatment with Cortexin, in 62.2% of those examined, which was significantly lower than with traditional treatment, and allowed us to make an assumption about the neuroprotective effect of the drug , which promotes metabolic support of the affected neuron and restoration of impaired brain functions [12].

When examining 135 children (aged from 1 month to 5 years) with consequences of perinatal damage to the central nervous system, pronounced positive neurophysiological dynamics were observed during the use of Cortexin, while as a result of 5 years of treatment with its use, complete compensation of motor and cognitive disorders was observed in 74% , and without it - in only 9.6% of patients [13].

Conducting a comparative study of the effect of Cortexin in combination with kinesiotherapy on impaired motor and cognitive functions in 118 patients with cerebral palsy aged 1 to 18 years (in this case, 73 patients in the main group underwent rehabilitation using kinesitherapy in combination with treatment with Cortexin, 45 patients in the control group - kinesiotherapy only) revealed a significant positive effect of Cortexin at the end of a two-month course of treatment, manifested both in improvement of motor abilities and indicators of cognitive activity (auditory-verbal memory, attention, object-related activity) [14].

During the observation of 25 children with cerebral palsy aged 6–15 years, it was shown that the use of Cortexin (5 courses of 10 injections at intervals of 3 months) significantly increased the volume of motor activity, the range of motor skills, improved hand-eye coordination, and normalized the sleep-wake cycle, the emotional background improved, and disorders of the articulatory apparatus decreased. The cumulative effect of the drug was revealed: with repeated courses of therapy, its positive effect persisted for 6 to 18 months [15].

When examining 22 patients with cerebral palsy aged 11–18 years in the process of complex rehabilitation with 20-day use of Cortexin (course dose 200 mg), a significant improvement in well-being, behavior, communication and integrative functions was noted in 62.1% of patients, a moderate improvement in the form reduction in the severity of subjective manifestations - in 33.3% of those examined [16].

A high result has been shown in the treatment of speech disorders in cerebral palsy with Cortexin in combination with reflexology [17]. 78 children with cerebral palsy aged 2 to 7 years with atonic-astatic and spastic forms of the disease received treatment on an outpatient basis. For treatment, courses of microcurrent reflexology (MCRT) were used according to the author’s method in combination with a course of Cortexin. Analysis of the results of complex treatment with a combination of MPRT and Cortexin showed its high effectiveness in restoring speech functions in children with cerebral palsy in relation to patients in the comparison group [17].

One of the pressing problems in the treatment of cerebral palsy, especially the hemiparetic form, is the presence of concomitant epilepsy, which often occurs against the background of impaired cognitive functions, when, along with basic anticonvulsant therapy, there is a need to prescribe a drug that has a cerebroprotective and neurotropic effect, and also does not cause an increase in seizure activity [ 18–20]. A study of the effectiveness of using Cortexin in children with epilepsy showed that after a course of treatment with the drug, not a single patient had a recurrence of epileptic seizures, 40–50% of children had improved memory and attention, and positive dynamics of psychomotor and speech development were noted [18].

When studying the effectiveness of Cortexin in children suffering from generalized epilepsy (21 children aged 10–11 years were examined), it was found that not a single patient had a relapse of epileptic seizures, while improved memory and positive dynamics in psycho-speech development were noted in 70% of patients [19]. Special conditions for prescribing Cortexin as a nootropic therapy in patients with epilepsy have been noted: stable remission, as well as in patients with persistent attacks, but in the period after the second month since the last change of antiepileptic therapy [20].

Thus, the complex effect and wide range of clinical use of Cortexin for perinatal lesions of the nervous system and cerebral palsy is due to a combination of nootropic, neurotrophic, neuroprotective, reparative and anticonvulsant effects, as well as its antioxidant, metabolic and anti-stress effects. The presented results confirm the high therapeutic effectiveness of the drug Cortexin in complex rehabilitation for various diseases of the central nervous system in children.

Early diagnosis and comprehensive rehabilitation treatment help to increase the effectiveness of rehabilitation measures, reduce disability and increase social adaptation of children with cerebral palsy.

Literature

1. Badalyan L. O., Zhurba L. T., Timonina O. V. Cerebral palsy. Kyiv, Health, 1988. 327 p.
2. Semenova K. A. Restorative treatment of children with perinatal damage to the nervous system and cerebral palsy. M.: Codex, 2007.
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S. A. Nemkova, Doctor of Medical Sciences, Professor

GBOU VPO RNIMU im. N. I. Pirogova Ministry of Health of the Russian Federation, Moscow

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Prognosis for adults and children

The prognosis for left-sided hemiparesis depends on many factors: the patient’s age, his medical history, how quickly treatment and recovery began. But, most often, with acquired hemiparesis, the prognosis is favorable, and most patients can restore all muscle functions .

Information: In cases of congenital hemiparesis in a child, doctors usually give cautious prognoses. Because mild forms of left-sided hemiparesis respond well to treatment, while severe forms can only be partially corrected.