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Urinov Muso Boltayevich, Ph D., associate professor, Chair of the Nervous Deceases of the Bukhara State Medical Institute, Bukhara, Uzbekistan E-mail: ss-1961@mail.ru
SOME PSYCHOVEGETATIVE FEATURES OF PATIENTS WITH FACIAL NEURALGIA IN ASPECT OF SEXUAL DIMORPHISM
Abstract: This work shows presence and expressiveness of the syndrome of vegetative dystonia (VDS) and anxiety in the emotional sphere in 372 patients suffering from idiopathic form of neuralgia of the trigeminal nerve (TNN). It was found that intensity of the accompanying psychovegetative disorders in TNN prevailed in the group of women and in the age over 45 years irrespectively of the gender of patients. In the group of men the degree of the VDS and anxiety in the emotional sphere prevailed in the right form of damage, and in the group of women was type of the left lateral damage. The authors suggest that the data obtained should be taking into account during choice of vegetotropic and psychotropic drugs in the range of complex therapy of TNN.
Keywords: psychovegetative, features, patient, facial neuralgia, sexual dimorphism, trigeminal nerve, vegetative dystonia, epileptiform neuralgia.
Until recently in diagnostics and treatment of many diseases including neurologic, the sex factor was not given special meaning. Researches on action of new medicinal preparations were often carried out only on volunteers-men and features of their influence on female organism were lost sight [3]. In many publications there were no indications on a sex of examined persons, in others to conserve "cleanliness of experiment» the women [9] were intentionally excluded. At the same time experience shows that one diseases is more characteristic for men, whereas others for women [4]. Severities of disease course, its outcome, response to treatment are also in many cases depended on the patient sex [1; 8; 10; 11].
The real boom in studying of a problem of sexual differences has begun hardly more 10 years ago after wide introduction in practice of magneto-resonant tomography when morphological differences of men and women brain have been found out. Doctors, scientists, psychologists and sociologists have presented an overall picture specifying accurate sexual differentiation [5-7, 15].
It is considered to be that the main differences of men from women are features of genesial system. However the brain [12] is an organ defining development of organism by male or female type. In a blastogenesis there is a brain differentiation on male or female type that is shown in certain anatomic, morphological features, in various distribution of receptors, establishment of different communications in a brain. It finally, defines differences in functioning of a brain of men and women. According to the maj ority of the given epidemiological studies, women more often than men show complaints to various by character pains. Thus
they have pains more frequent and long [13]. Not always it is possible to explain these differences by biological factors. It is known, that migraine, facial pain (neuralgia of V nerve), dorsodynias and breasts of the woman suffer more often. Chronic paroxysmal hemicrany is exclusive prerogative of women. Differences in metabolism of a brain and biological mechanisms of transfer of a pain may be the reasons. Researches on animals have revealed differences in the analgetic response having shown possibility for involving of estrogenic dependent mechanisms. However the most powerful contribution to character of implication of a painful syndrome often brings the mental factor. The stress and painful stimulus cause more expressed emotional response in women at enough similar changes in somatic, nervous and suprarenal adrenal systems. Men and women have differences in perception of a pain. Men use more opioids (Morphinum) after operations than the woman. Thus according to experimental data at females painful threshold is lower and strain of muscles is higher [2].
These signs often associate with painful syndromes which is often met at women (migraine, strain headache, miofascial painful syndrome, myalgia including fibromialgiya). However, even if to admit that men and women variously react to a pain, it is impossible to explain it only by differences in painful thresholds. The issue on the importance of psychovegetative characteristics of painful syndromes in aspect of a sexual dimorphism demands studying [14].
The aim of the research was to analyze the clinical and psychovegetative (PV) characteristics of epileptic neuralgia (EN) in men and women.
Section 2. Medical science
Material and methods. Under our observation there were 372 patients, suffering idiopathic EN form including 234 women and 138 men. We carried out continuous retrospective and prospective study on materials of the Bukhara regional Multidisciplinary Medical Center and municipal hospital of a city of Bukhara. Taking it into account already from the very beginning it is possible to notice EN women suffer in 1,7 times more. The age analysis carried out by us has shown that as a whole EN as in group of women and men meets at those older 45 years with authentic prevalence in female group. At the same time in group of men the tendency to greater presentation in age groups is noted at younger 45 years, and on presentation the patients are older 35 years the men almost twice pass ahed women. The analysis of the party of a lesion has revealed also characteristic differences. As a whole irrespective of a sex authentically were more often right-hand EN in comparison with left hand. And the analysis in the general groups ofwomen and men has shown about identical presentation of the right and left hand forms of a lesion. However the age analysis has revealed that among patients to 45 years, right-hand EN occurs more often than in similar age group of women, at the same time of senior 45 years some prevalence of right-hand forms of disease in group of women becomes perceptible.
Table 1. - Features of PV disturbances at
For studying of PV disturbances we used screening questionnaire and the scheme for revealing and mark estimation of a syndrome of a vegetative dystonia (VD). developed in MMA of I. M. Sechenov under the guidance of academician A. M. Vein and Spilberger test for estimation of presence and expression of reactive and personal uneasiness. The statistical analysis of figures was carried out by nonparametric methods with use of Vilcocson-Mann-Witni criterion.
Results and discussion. The received results are presented in (tables 1 and 2). From (table 1) it can see that as by results of Spilberger test and by data of screening researches about presence and expression VD between groups of men and women there are essential differences. It is noticed the fact that as a whole in group ofwomen there is tendency to prevalence of uneasiness in emotional sphere. Thus it was revealed the authentic difference on reactive uneasiness especially in age group older 45 years. On personal uneasiness authentic differences on age group younger 35 years was revealed. Comparison of presence and expression of VD in the studied groups reveals authentically more expressed prevalence of point characteristic of VD in group of women as a whole in all age groups. These differences are especially visible in the age from 35 to 45 years.
EN patients Depending on sex and age
Age Spilberger test (points) VD (points)
RТ LТ Questionnaire Scheme
Group as a whole 42.8* 39.6* 46.5 45.5 46.8** 35.2** 59.5** 36.3**
to 35 years 42.5 42.8 50.5* 47.0* 49.3*** 35.0*** 64.8* 52.0*
36-45 45.0 49.0 45.8*** 60.6***
43.0 49.0 18.0*** 22.5***
46-60 41.0* 40.0 45.3* 53.1**
32.9* 40.6 40.5* 34.5**
Note: in numerator - data for group of women, in denominator-for group of men
Sign * - reliability of differences between groups of men and women. One - P < 0.05; two - P < 0.01; three P < 0.005 Table 2.- The side of a lesion and PV EN features at men and women
Research methods Men Women
Right hand EN Left hand EN Right hand EN Left hand EN
VD (points) questionnaire 37.2** A 25.2** A 48.0** 45.6**
Scheme 40.0** AA 32.6** AA 60.4** 58.6**
Spilberger (points) RT 42.1 A 37.1** A 42.0 43.6**
LT 49.4 A 41.6* A 47.2 45.8**
Note: sign A - reliability of differences between the sides of a lesion in groups of men and women. One - P < 0.05; two - P < 0.01. Sign * - reliability of differences between groups of men and women with the identical side of a lesion
Interesting data are received by comparison ofVD expression and uneasiness in emotional sphere depending on the lesion side. As seen from (table 2), in group of men the tendency to larger expression both uneasiness and VD is distinct at right-hand lateralization process. In group of women at larger VD expression and uneasiness between subgroups with right-hand and left hand lateralization process statistically significant difference was not revealed. At the same time the accurate tendency to prevalence ofVD expression and uneasiness becomes perceptible at left hand lateralization process in a subgroup of women after comparison with similar group of men.
Conclusions:
1. Expression of accompanying PV disorders at EN prevails in group of women.
2. As a whole degree of expression of accompanying PVe disturbances at EN prevails in the age older 45 years.
3. In group of men degree of expression of VD and uneasiness in emotional sphere prevails at the right-hand form of a lesion, and in group of women at left hand lateralization.
4. The obtained data is required to consider at appointment vegetotropic and psychotropic drugs within the limits of complex EN therapy.
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