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https://doi.org/10.29013/ESR-20-7.8-26-29
Lisukha Liubov Mykhailivna, Junior researcher, Ph.D., The department of clinical physiology of connective tissues O. O. Bogomoletz Institute of Physiology, National Academy of Sciences of Ukraine E-mail: lyubovlisukha@gmail.com
EFFICACY OF L-TRYPTOPHANE TREATMENT IN CHILDREN WITH TIC HYPERKINESIS
Abstract. The efficacy of the neuroadaptogen containing L-tryptophan 50 mg in children aged from 6 to 12 years with tic hyperkinesis was investigated. The obtained results indicate that the examined subjects were characterized by a symptom complex of psychoneurotic and somatovegetative disorders. Taking the syrup helped reduce the appearance of tics.
Keywords: tics; children; tic hyperkinesis; central nervous system; autonomic nervous system; L-tryptophan; children's questionnaire of neuroses.
Introduction. It is known that tics significantly peripheral nervous system [1, 12]. Based on clinical
criteria, the following types of tics are distinguished: F95 - transient; F95.1 - chronic motor or vocal; F95.2 - combined vocal and multiple motor (de la Tourette syndrome) [5]. Treatment of tic hyperkinesis remains an urgent problem now [13; 14].
Aim. To determine the effect of neuroadaptogen (containing L-tryptophan 50 mg) in children with tics aged from 6 to 12 years.
Patients and methods. There were examined 30 children (20 boys and 10 girls) aged from 6 to 12 years, which were divided into two groups: main group (I) consisted of 20 children with tics (mean age 7.88 ± 0.55 yrs.); control group (II) - 10 almost healthy children (mean age 8.10 ± 0.67 yrs.). Patients receive medical care at the Children's Clinical Hospital № 4 in Solomyanskyi district of Kyiv. Criteria for inclusion in the study for the control group were: 1) age from 6 to 12 years; 2) the average values of physical and sexual development at the time of the study; 3) absence of acute diseases during the last two months before the examination; 4) children who did not in general use drugs with psychoactive and anticonvulsant and nootropic effects. Criteria for the main group were: 1) age from 6
worsen the children's health [1-4]. The prevalence of the disease in the pediatric population varies from 4 to 25%, according to the data of various authors [1, 4]. Most often this pathology is manifested in children before the age of 12 years. Taking into account that the etiology and pathogenesis of hyperkinesis are insufficiently studied this disease is difficult to treat. Currently, there is no consensus on the causes which lead to this pathology. A genetic predisposition with an autosomal dominant type of inheritance (including tics in families) is considered one of the causes for disease by most scientists [1, 4-6]. Boys get sick 3 times more often than girls, which is possible in cases of incomplete and sex-dependent gene penetration. Some authors [7] point to the infectious and immune mechanisms, others [8-11] consider the kinurein hypothesis.
The effectiveness of the dopaminergic system may be affected by disorders of intrauterine development due to hypoxia, infections, birth trauma. In the pathogenesis, there are not only functional and organic changes of the central nervous system (CNS), but also complex chains of imbalance in the cortex, subcortex with the cerebellum, spinal cord,
to 12 years; 2) the presence of clinical manifestations of tic hyperkinetic disorders; 3) absence of acute diseases during the last 2 weeks; 4) children who did not take drugs with psychoactive, anticonvulsant, and nootropic effects for last 6 months. Exclusion criteria: 1) non-compliance with inclusion criteria; 2) false answers by the scale of the VII children's questionnaire of neuroses (CQN) [15].
Clinical and neurological examinations were carried out including the medical history; complaints; study of neurological status according to the scheme [16]. CQN (Sedneva, Zbarskin, Burtseva) was used to assess the adaptation and clinical profile of the neurotic condition [15]. A following score scale of neurotic disorders was used for testing: I - depression; II - asthenia; III - behavioral disorders; IV - autonomic disorders; V - sleep disorders; VI - anxiety; VII - lies. After converting the primary data using the coefficients, the results were compared with the classifier: 16-20 points - a high level of risk of a certain clinical symptom complex; 12-15 points - average or uptrend; up to 11 points - low livel. Patients were additionally examined by laboratory (clinical analysis with blood formula) and functional methods (electrocardiogram (ECG), electroencephalogram (EEG)). In addition the patients were examined by a cardiorheumatologist, ophthalmologist, otolaryngologist, and if necessary by a psychologist. The medical history of the child's development was analyzed. Neuroadaptogen in syrup containing L-tryptophan 50 mg (Silenta syrup) was used for treatment.
The study meets all modern requirements of moral and ethical norms. Programs of Microsoft Ex-sel and Origin Pro 7.5 were used to analyze the results. The significance of disagreements for samples with normal distribution was evaluated by Student's t test. Differences in the results were considered statistically significant if P < 0.05.
Results. There were 3 of the 20 children in the main group (I) who had false answers by the VII CQN scale and they were excluded from the examination. The average age of patients (group I) was
7.88 ± 0.55 years: boys - 1.9 ± 0.18; girls -1.7 ± 0.17. In the control group (II) the average age was 8.10 ± ± 0.67: boys - 1.6 ± 0.17; girls - 1.4 ± 0.15. Analysis of the anamnestic data of the examined patients (group I) revealed the factors which contributed to the change in CNS reactivity, and could affect the monoaminegic system of the brain: 7 out of 17(41%) were premature infants with gestational age from 35 to 38 weeks; 2 of 17(12%) had perinatal lesions of the CNS. At the time of examination, 10 of 17(59%) patients in group I had frequent blinking of the eyelids, 5 of 17(2 9%) - twitching of facial muscles, 2 of 17(12%) - obsessive neck movements, 1 out of 17 - upper shoulder girdle, 3 out of 17(18%) - "sniffing", 4 out of 17(23%) - "snoring". Based on clinical data, and neurological status tic hyperkinesis of facial mimic muscles was registered in 11 of 17(65%) children and combined tic (hyperkinesis of the muscles of the face, head, neck, shoulder girdle) - in 6 of 17(35%). Chronic motor tic hyperkinesias were noted in 4 out of 17 patients.
Complaints from the CNS and ANS were as follows: emotional lability in 7 out of 17(41%); sleep disorders in 2 of 17(12%); hyperactivity in 2 (17%); fatigue in 5 out of 17(32%) patients. Studying the neurological status in patients according to the scheme [16], microsymptoms such as installation nystagmus in the removal of the eyeballs were registered in 3 of 17(18%), eyelid tremor - in 7 of 17(41%), local hyperhidrosis of the palms and soles - in 4 of 17(23%), increased tendon reflexes in the lower extremities - in 3 of 17(18%). White dermographism of the skin (anterior outer abdominal wall) was revealed in 8 out of 17(47%), pink ones -in 9 out of 17(53%) patients.
CQN allows to detect subclinical prenosological phenomena which form borderline neuropsychiatry, psychosomatic and somatoform autonomic disorders. The manifestation of neurotic disorders in the CNS, the presence of various symptom complexes and the possibility of simulation and aggravation by the patient (by the VII scale of neuropsychiatric
disorders) were revealed in this study. A high risk of sleep disturbance (> 16 points by the V scale) was found in 1 of 17 patients (group I) of our studies. The average level of symptom complexes (group I) (> 12 points) was registered by the following scales: III - behavioral disorders in 4 of 17 (23%); IV - auto-nomic disorders in 3 out of 17 (18%); V - sleep disorders in 6 of 17(35%); VI - anxiety in 2 of 17(12%) patients. In the examined subjects (group II) the average level of risk was demonstrated in 1 out of 10 patients by the IIIrd scale and in 1 out of 10 by the IVth scale. That is, according to the CQN analysis, borderline psychoneurotic syndromes and somato-phomic autonomic dysfunctions were formed in the vast majority of patients. The course of tics was manifested by emotional lability, excitability, and by tension in some children when trying to control the situation. All this reduces the quality of life.
The functional state of the cardiovascular system, which was assessed by ECG recording, showed that 2 out of 17 persons had repolarization disorders, 5 out of 17(29%) - sinus tachycardia (1 out of 10 in controls), which may be the result of extracardiac influences (strengthening of cardiac sympathetic innervation or weakening of vagal innervations against psychoemotional excitement). The study of brain bioelectrical activity according the EEG record showed that the presence of non-epileptic activity, lowering the threshold of convulsive readiness, which indirectly indicates instability of the cerebral cortex (rhythm disorganization, dominant theta-delta activity) was a characteristic feature in 7 of 17(41%) examined persons. Convulsive readiness was detected in 2 of17 patients, during a hyperventilation test.
Silenta syrup (containing L-tryptophan 50 mg) was used by us. The drug was administered in a dose of 10 ml 2 times a day for 21 days. The clinical and neurological status and manifestations of neurotic disorders were assessed after the course of treatment. Positive changes were registered in the vast majority of patients: tic hyperkinesias were almost invisible
in 8 of 17(47%); an improvement was noted in 5 out of 17(29%). The condition remained unchanged in 4 out of 17(23%) persons. The best response to treatment was observed in patients with tics which were manifested by twitching of facial mimic muscles (one muscle group), and a mild course was registered in them. Children have reduced complaints of emotional lability, sleep disturbances, fatigue, and improved well-being. According to the results of CQN, the total number of points by the scales was significantly decreased by 21.35 conventional units (from 43.29 ± 2.45 to 21.94 ± 2.79). Individual analysis of the scales showed that the risk of developing autonomic disorders, sleep, anxiety decreased to a low level after treatment. The functional state of the cardiovascular (according to the EEG) system also was within the physiological norm after treatment. According to the EEG, the instability of the cerebral cortex remained in 2 of17 patients.
Thus, the obtained results indicate that the condition of children aged from 6 to 12 years with tic hyperkinesias, was characterized by a symptom complex of psychoneurotic and somatovegetative disorders according to the used tests. The use of syrup containing L-tryptophan, magnesium and herbs has a positive effect on the CNS and improves well-being of patients.
Conclusions
1. The clinical manifestation of tics may be accompanied by an imbalance ofANS, which indicates a decrease in the adaptive capacity of the body in children aged from 6 to 12 years.
2. The use of a neuroadaptogen which contains L-tryptophan helps to restore the activity of the CNS in the form of reducing the symptoms of tics and improving general well-being of children.
3. Silenta syrup can be recommended for the comprehensive treatment of children with tic hy-perkinesias.
References:
1. Chutko L. G. Tics in children. - Moscow: Media sphere, 2008.- 10 p.
2. Zalyalova Z. A., Bogdanov E. I., Munasipova S. E. Tic hyperkinesis: current views. Neurological Bulletin. 2010.- 4LII (3).- P. 77-84.
3. Delyagin V. M. Tics in children. Breast cancer "Mother and Child". 2013. 14.- P. 784-790.
4. Jankovic J. Klinic of tics. Adv. Neurol. 2001.- 85.- P. 15-29.
5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 4lh ed. Washington (DS): American Psychiatric Association, 1994.
6. Kurlan R. Handbook of Tourette's Syndrome and Related Tic and Behavioral Disorders (Neurological Disease and Therapy). 2005.- P. 325-329.
7. Murphy T., Storch E., Turner A. et al. Material history of autoimmune disease in children presenting with tics and / or obsessive-compulsive disorder. J Neuroimmunol. 2010.- 229(1-2).- P. 5-13.
8. Uzbekov M. G. The hyperkinetic syndrome as a manifestation of disturbances in the brain monoaminer-gic systems development. Social Psychiatry. 2006.- P. 31-43.
9. Oades R. D. Differential measures of "sustained attention" in children with attention-deficit / hyperactivity or tie disordes: relations to monoamine metabolism. Psychiatry Res. 2000.- 93.- P. 165-178.
10. Gainetdinov R. R., Wetsel W. S., Jones S. R. et al. Role of serotonin in the paradoxical calming effect of psychostimulants on hyperactivity. Scienses 1999.- 283.- P. 397-401.
11. Askenazy F., Caci H., Myquel M. et al. Relationship between impulsivity and platelet serotonin content in adolescents. Psychiatry Res. 2000.- 94.- P. 19-28.
12. Fedoseyev I. F., Poponnikova T. V., Veremeev A. B. The metabolic state ofneurotransmitters in tic hyperkinesis in children. Mother and child in Kuzbass. 2012.- 2.- P. 53-56.
13. Asimova N. M., Achilova K. T. Tic hyperkinesia in children and their comorbidity. Vestnik Kazan NMU. 2016.-2.- P. 178-182.
14. Fedoseeva I. F., Poponnikova T. V., Veremeeva A. V. The condition of metabolism of neurotransmitters in chidren with tic disorders. Mother and child in Kuzbass. 2012.- 2(49).- P. 53-56.
15. Sednev B. P. Diagnosis of neurotic disorders in children of primary and secondary school age. Children's Neurosis Questionnaire (DON). Application for rationalization.- Donetsk: DOLKO. 1994.- No. 48.
16. Petrukhin A. S. Pediatric neurology: in 2 vol.- Moskow: GEO-TAR-Media; 2012.- 815 p.
