Sympathetic and parasympathetic tone. Loss of tone of the autonomic nervous system. After determining the state of autonomic tone, autonomic reactivity is examined when exposed to pharmacological agents or physical factors. As a pharmaco

This disease is characterized by fatigue, weakness, headache, a tendency to faint, a feeling of lack of air, poor adaptation to heat or stuffy rooms, excessive sweating and other disorders.
This is caused by pathological changes in the functioning of the autonomic nervous system.
Autonomic nervous system (ANS)- a department of the nervous system that controls and regulates the work of all internal organs. This is an autonomous nervous system, since its activity is not subject to the will and control of human consciousness. The ANS is involved in the regulation of many biochemical and physiological processes, for example, it maintains normal body temperature, optimal blood pressure levels, is responsible for the processes of digestion, urination, the activity of the cardiovascular, endocrine, immune systems, etc.

The main divisions of the ANS include: sympathetic and parasympathetic.
Sympathetic division of the ANS responsible for muscle relaxation digestive tract, bladder, bronchi, increased heart rate and increased heart contractions, narrowing of most arteries and veins of the body.
Parasympathetic department is responsible for contracting the muscles of the digestive tract, which leads to increased motility and increased secretion of the digestive glands. Also, the activity of other glands of the body (salivary, lacrimal) is activated, heart contraction slows down and weakens, arteries and veins dilate.
In addition, in a number of organs (intestines, bladder) has its own nervous regulation system (usually represented nerve plexuses), which is attributed to metasympathetic division of the ANS.
Normally, there should be a “relative balance” between the sympathetic and parasympathetic departments, i.e. when the effects of the work of one of the departments predominate, the effects of the work of the other are reduced. Violation of the “equilibrium” between the sympathetic and parasympathetic divisions of the ANS leads to the development autonomic dysfunction.

Manifestations of vegetative-vascular dystonia (vegetative dysfunction)

Manifestations of vegetative-vascular dystonia can be different depending on the disturbances in the activity of one or another organ system.
They are divided into several groups. These symptoms can either separately or together:
- cardiac (heart) manifestations- pain in the heart area, rapid heartbeat (tachycardia), a feeling of sinking heart, interruptions in heart function;
- respiratory (breathing) manifestations- rapid breathing (tachypnea), inability to take a deep breath or, conversely, unexpected deep breaths; feeling of lack of air, feeling of heaviness, congestion in the chest; sudden attacks of shortness of breath, similar to attacks of bronchial asthma, but provoked by other situations: anxiety, fear, awakening, falling asleep;
- dysdynamic manifestations- fluctuations in arterial and venous pressure; disturbances of blood circulation in tissues;
- thermoregulatory manifestations- unpredictable fluctuations in body temperature: it can rise to 37-38 degrees C or drop to 35 degrees C and below. Fluctuations can be constant, long-term or short-term;
- dyspeptic manifestations- disorders of the gastrointestinal tract (abdominal pain, nausea, vomiting, belching, constipation or diarrhea);
- sexual disorders, for example, anorgasmia - absence of orgasm with persistent sexual desire; various dysfunctions of the urinary system - frequent, painful urination in the absence of any real pathology, etc.;
- psycho-neurological manifestations- weakness, lethargy, decreased performance and increased fatigue with light exertion, tearfulness, irritability, headaches, dizziness, increased sensitivity to changes in weather, disruption of the sleep-wake cycle, anxiety, shuddering during sleep, which is most often superficial and short-lived.

Causes of vegetative-vascular dystonia (vegetative dysfunction)

- hereditary predisposition;
- endocrine changes in the body. VD often manifests itself most clearly during periods of active hormonal changes, for example, during puberty; diseases of the endocrine glands (thyroid, adrenal glands, gonads);
- stress, neuroses, psycho-emotional tension;
- organic brain lesions (traumas, tumors, disorders cerebral circulation- strokes);

Classification of vegetative-vascular dystonia (vegetative dysfunction)

Depending on changes in the cardiovascular system and changes in blood pressure, vegetative-vascular dystonia is divided into types:
- normotensive or cardiac (heart) type, manifested by pain in the heart or associated with various heart rhythm disturbances;
- hypertensive type characterized by increased blood pressure in a state of stress or rest;
- hypotensive type, characterized by low blood pressure, accompanied by weakness, fatigue, and a tendency to faint. There are patients with blood pressure of 70 to 40 mmHg. Art. Over the years, the pressure in such people can increase, developing into hypertension, which they can hardly tolerate, when even normal numbers are 120 to 80 mm Hg. are a hypertensive crisis for them.

Depending on the predominance of activity of the sympathetic or parasympathetic parts of the autonomic nervous system, there are sympathicotonic, parasympathicotonic and mixed types of vegetative-vascular dystonia.

According to the nature of the flow Vegetative-vascular dystonia can be permanent (with constantly present signs of the disease; develops more often with the hereditary nature of the disease), paroxysmal (occur in the form of so-called vegetative attacks) or latent (occur hidden).

Autonomic attacks (vegetative-vascular crises, panic attacks) usually begin at the age of 20-40 years - this characteristic course of autonomic dysfunction for adults is more common in women.

If activity predominates in the work of the autonomic system sympathetic department of the autonomic nervous system, then a so-called sympathoadrenal attack (crisis) occurs. It usually begins with a headache or pain in the heart area, palpitations, and a flushed or pale face. Blood pressure rises, pulse quickens, body temperature rises, and chills appear. Sometimes there is unreasonable fear.

If the activity of the autonomic nervous system predominates parasympathetic department, then the so-called vagoinsular attack (crisis) develops, characterized by general weakness, darkening of the eyes. Sweating, nausea, dizziness appear, blood pressure and body temperature decrease, and the pulse slows down.

Overwork, anxiety, and psycho-emotional stress cause more frequent attacks. After a crisis, a feeling of weakness, general malaise, and weakness may remain for several days.
Most often, the manifestations of attacks are mixed, so the indicated division into different types (sympathoadrenal, vagoinsular) is arbitrary, but the approach to treatment is the same.

Development of the pathological process

Most often the disease begins in childhood. According to various sources, from 12 to 29% of children and adolescents suffer from autonomic dysfunction. This is facilitated by hypoxia ( oxygen starvation) fetus during pregnancy and childbirth, birth injuries, other pathologies of the central nervous system, diseases of infancy. As a result, inferiority in the functioning of the ANS occurs, disorders appear on the part of various organs and systems, for example, the gastrointestinal tract (frequent regurgitation, bloating, unstable stool, decreased appetite) and the central nervous system (shallow, intermittent and nap With frequent awakenings). Such children are prone to frequent colds with “temperature tails” - maintaining an elevated temperature after recovery. They do not tolerate stuffiness, heat, changes in weather, complain of headaches, difficulty breathing (most often, the so-called “unsatisfied breath”), and feel a “lump in the throat.”

During puberty Autonomic dysfunction is aggravated by a mismatch between the rapid development of internal organs, the growth of the entire organism and the lag in the formation and maturation of nervous and endocrine regulation. At this time, complaints usually arise of pain in the heart area, interruptions in heart function, palpitations, and an increase or decrease in blood pressure is recorded. Psychoneurological disorders often occur: increased fatigue, memory loss, emotional instability (tearfulness, irritability, short temper), high anxiety.

In adults the appearance of signs of vegetative-vascular dystonia is provoked and aggravated by the presence of various chronic diseases, stress, personal characteristics, hormonal changes associated, for example, with pregnancy.

Treatment of vegetative-vascular dystonia

Prevention and treatment of autonomic dysfunction should begin in childhood and adolescence. It is a mistaken belief that autonomic dysfunction is a condition that reflects the characteristics of a growing organism, which goes away on its own over time. It has already been proven that autonomic dysfunction that occurs in childhood or adolescence is an unfavorable background and a harbinger of many diseases.

In adults, the presence of symptoms of vegetative-vascular dystonia requires, first of all, exclusion various diseases, the course of which is accompanied by dysfunction of the ANS. Among them various diseases endocrine glands (thyroid, adrenal glands, reproductive system disorders); many mental disorders (from neurosis, neurasthenia to diseases caused by significant changes in brain structures). Moreover, almost everything chronic diseases accompanied by symptoms of vegetative-vascular dystonia. That is why timely contact with a specialist is so necessary.

In the treatment of vegetative-vascular dystonia, non-drug methods are widely used: normalization of lifestyle, physical therapy, country walks, tourism, spa treatment, hardening procedures, psychophysical training, outdoor recreation. Complex application medications, physiotherapeutic procedures are carried out as prescribed by a doctor.

Daily regime. You definitely need to get enough sleep. The average sleep duration should be at least 8-9 hours a day. The bedroom should not be hot or stuffy. Do not rest on too soft or hard mattresses and pillows. It is better to sleep on orthopedic mattresses and pillows that promote the most physiological position of the body and head.

Optimization of work and rest. You should alternate mental and physical activity, use various methods psychological relief, auto-training. If possible, reduce the time spent watching TV shows and working on the computer. If this is not possible, preventive breaks when working with a computer, eye exercises, etc. are required. Quitting smoking is mandatory.

Physical education. Optimal for VD are swimming, water aerobics, walking, skiing, country walks, and hiking. With these types of loads, the heart muscle and blood vessels are trained, and blood pressure is stabilized. Game sports are good if they are carried out in the fresh air, not for the result, but for the sake of pleasure. They promote psycho-emotional relaxation and have a general strengthening effect on the body. Among the exercise machines, it is best to use a bicycle ergometer, a treadmill, a stepper, and a rowing machine. Exercises on simulators where the head is below chest level and exercises are performed upside down are contraindicated due to the risk of fainting and deterioration of well-being. Martial arts, strength gymnastics, bodybuilding, aerobics with high jumps, and somersaults put a significant strain on the cardiovascular system. Exercises with a large amplitude of movement of the head and torso, sharp and quickly performed movements, and exercises with prolonged static effort should be avoided. During exercise, you should not experience discomfort, excessive fatigue, or irritability.

Nutrition correction. The intake of potassium and magnesium salts into the body should be increased. These substances participate in the conduction of nerve impulses, improve the functioning of blood vessels and the heart, and help restore the disturbed balance between the parts of the ANS. Potassium and magnesium are found in buckwheat, oatmeal, soybeans, beans, peas, apricots, rose hips, dried apricots, raisins, carrots, eggplants, onions, lettuce, parsley, and nuts.
For the hypotonic type of VD, products that increase vascular tone are recommended: milk, kefir, tea, coffee.
For the hypertensive type of VD, it is recommended to limit the consumption of table salt, tea, coffee, marinades and pickles and include in your diet foods that reduce vascular tone: barley porridge, beans, carrots, lettuce, spinach, cottage cheese.
For the normotonic type of VD, the diet should include foods that improve blood flow and reduce vascular spasm: vegetable oils, citrus fruits, a moderate amount of spices.

Herbal medicine. For disorders of the parasympathicotonic type, herbal stimulants are used: eleutherococcus, ginseng, zamanikha, aralia, leuzea, various diuretic herbs and herbs (bearberry, juniper, lingonberry).
For disorders of the sympathicotonic and mixed types - sedative (calming) herbs and herbs: valerian, motherwort, sage, mint, lemon balm, hops, peony root. Herbal medicine treatment regimens are prescribed by the attending physician.

Drug treatment should only be carried out under the supervision of a physician. It includes: potassium and calcium supplements, vitamin and mineral complexes, vascular drugs, nootropics (drugs that improve nutrition, metabolism and the functioning of brain cells), antidepressants, etc.

In order not to find yourself helpless in a difficult situation, it is best to learn how to cope with vegetative-vascular attacks (crises) on your own.
Take 20 drops of Valocordin or CORVALOL.
For palpitations and increased blood pressure, take one tablet (40 mg) of PROPRANOLOL (another name for the drug ANAPRILIN, OBZIDAN).
To remove nervous excitement you need to take 1-2 tablets of DIAZEPAM (RELANIUM) under the tongue (for quick and complete absorption).

First aid for fainting
One of the forms of vegetative attacks is fainting - a sudden short-term loss of consciousness, accompanied by severe pallor, a significant weakening of breathing and blood circulation. It is caused by a temporary disturbance of vascular tone, blood outflow from the brain and a drop in blood pressure. Usually, fainting occurs during severe emotional disturbance, in a stuffy room, etc. Precursors of fainting are pale skin, difficulty breathing, a feeling of lack of air, dizziness, darkening of the eyes, ringing and noise in the ears, nausea. Then a loss of consciousness and a fall occurs (some women can anticipate the onset of fainting and manage to prevent the fall, i.e., sit up in time with support on their back, unfasten constricting clothing, etc.). Cold sweat appears on the forehead, breathing becomes shallow and slow, the pulse is rapid and weak, the hands and feet are cold. Most often, fainting does not last long. After a few minutes consciousness is restored.

First of all, you need to unfasten the collar, belt and loosen everything that restricts breathing, lay the patient down so that the head is lower than the body, or you can raise the legs (this way the blood flows better to the head). There is no need to fiddle with the victim or try to lift her. You need to open a window, a window, and, if necessary, take it out into the air. You should spray your face with cold water and warm your feet, for example, if possible, apply a heating pad to your feet. You cannot get up quickly after fainting, as you may lose consciousness again. After the return of consciousness, it is useful to give the person strong sweet tea or coffee, valerian drops.

Forecast of vegetative-vascular dystonia

The prognosis of vegetative-vascular dystonia is favorable; often its manifestations remain forever in childhood. However, without prevention and treatment, vegetative-vascular dystonia can lead to a persistent increase in blood pressure, which changes the structure and functions of various internal organs; to disturbances of the digestive processes, etc.. In case of vegetative-vascular dystonia, it is necessary to conduct regular (usually seasonal) courses of prevention of exacerbations, for which herbal medicine, vitamin therapy, massage, physical therapy, physiotherapeutic procedures, and sanatorium treatment are prescribed.

Vegetative-vascular dystonia (syndrome vegetative dystonia)
Autonomic-vascular dystonia (autonomic dystonia) is a disease of the autonomic nervous system that occurs as a result of dysfunction of the suprasegmental centers of autonomic regulation, which leads to an imbalance between the sympathetic and parasympathetic parts of the autonomic nervous system and inadequate reactivity of effector organs. Important Features vegetative dystonia are:
– functional nature of the disease;
– as a rule, congenital inferiority of suprasegmental vegetative centers;
– actualization of the disease against the background of exposure to adverse factors on the body (stress, traumatic brain injury, infections);
– absence of any organic defect in effector organs (heart, blood vessels, gastrointestinal tract, etc.).
Pathogenesis. The main role in the pathogenesis of autonomic dystonia is played by disruption of autonomic regulation and the development of autonomic imbalance. The relationship between the sympathetic and parasympathetic autonomic nervous systems corresponds to the principle of “swinging equilibrium”: an increase in the tone of one system entails an increase in the tone of the other. This form of vegetative support allows you to maintain homeostasis and create conditions for increased lability physiological functions. Clinical and experimental studies have discovered this lability in almost all systems - variations in heart rate, blood pressure, body temperature and other indicators. When these fluctuations go beyond the homeostatic range, the autonomic regulation system is more vulnerable to damaging factors. Under such conditions, exogenous or endogenous stimuli can lead to extreme tension in regulatory systems, and then to their “breakdown” with clinical manifestation in the form of vegetative dystonia.
Clinical picture. Clinical manifestations of the disease are varied and often not constant. This disease is characterized by rapid changes in skin color, increased sweating, fluctuations in pulse, blood pressure, pain and disruption of the gastrointestinal tract (constipation, diarrhea), frequent attacks of nausea, a tendency to low-grade fever, weather sensitivity, poor tolerance of elevated temperatures, physical and mental stress. Patients suffering from vegetative dystonia syndrome do not tolerate physical and intellectual stress well. In extreme severity, the disease can manifest itself as vegetative crises, neuroreflex syncope, and permanent autonomic disorders.
Autonomic crises can be sympathetic, parasympathetic and mixed. Sympathetic crises occur due to a sudden increase in the activity of the sympathetic nervous system, which leads to excessive release of norepinephrine and epinephrine from the efferent sympathetic fibers and adrenal glands. This is manifested by corresponding effects: a sudden increase in blood pressure, tachycardia, fear of death, low-grade fever (up to 37.5 ° C), chills, trembling, hyperhidrosis, pale skin, dilated pupils, and the release of copious light-colored urine at the end of the attack. At the time of the attack, there is an increase in the content of catecholamines in the urine. An increase in blood pressure, heart rate and body temperature in such patients at the time of an attack can be verified by daily monitoring of these indicators. With parasympathetic paroxysms, there is a sudden increase in the activity of the parasympathetic system, which is manifested by an attack of bradycardia, hypotension, dizziness, nausea, vomiting, a feeling of lack of air (less often suffocation), an increase in the depth and frequency of breathing, diarrhea, redness of the skin, a feeling of a rush of heat to the face, a decrease in temperature body, profuse sweating, headache. After an attack, in the vast majority of cases, there is a feeling of lethargy, weakness, drowsiness, and copious urination is often noted. With a long history of the disease, the type of autonomic crisis may change (as a rule, sympathetic crises are replaced by parasympathetic or mixed ones, and parasympathetic ones become mixed). The clinical picture of neuroreflex syncope is described in the corresponding section.
Treatment. Based on the pathogenesis, clinical picture and neurofunctional diagnostic data, the basic principles of treatment of autonomic dystonia include:
- correction of the psycho-emotional state of the patient;
- elimination of foci of pathological afferent impulses;
– elimination of foci of stagnant excitation and circulation of impulses in suprasegmental vegetative centers;
- restoration of disturbed vegetative balance;
– a differentiated approach to prescribing medications depending on the type and severity of vegetative crises;
- elimination of excess stress in the functioning of internal organs;
– creating favorable metabolic conditions for the brain during therapy;
– complexity of therapy.
To correct the psycho-emotional state of the patient, drugs of different groups are used - benzodiazepine tranquilizers, antidepressants, some neuroleptics and anticonvulsants. They also have a beneficial effect on areas of increased excitability and “stagnant” circulation of nerve impulses.
Benzodiazepine tranquilizers potentiate the effect of GABA, reduce the excitability of the limbic system, thalamus, hypothalamus, limit the irradiation of impulses from the focus of “stagnant” excitation and reduce their “stagnant” circulation. Among them, phenazepam is especially effective, and alprazolam is especially effective for sympathetic crises.
Antidepressants, to varying degrees, block the reuptake of norepinephrine and serotonin and have anxiolytic, thymoanaleptic and sedative effects. Amitriptyline, escitalopram, trazodone, maprotiline, mianserin, and fluvoxamine are widely used for the treatment of vegetative paroxysms.
In case of ineffectiveness of drugs from other groups, some antipsychotics, which include thioridazine, periciazine, azaleptin, can be used to treat vegetative crises in their severe course.
From the group of anticonvulsants, the drugs carbamazepine and pregabalin, which have normotimic and vegetostabilizing effects, have found their use.
In mild cases, it is possible to use herbal preparations that have antidepressant, anxiolytic and sedative effects. This group includes preparations of the herb extract St. John's wort perforatum. To correct the psycho-emotional state, it is also necessary to use psychotherapy, including one aimed at changing the patient’s attitude towards traumatic factors.
Stress protectors are an effective means of preventing vegetative crises. For this purpose, the daytime tranquilizers tofisopam and aminophenylbutyric acid can be widely used. Tofisopam has tranquilizing activity without causing drowsiness. It reduces psycho-emotional stress, anxiety, and has a vegetative-stabilizing effect. Aminophenylbutyric acid has a nootropic and anti-anxiety (anxiolytic) effect.
Restoration of disturbed vegetative balance. For this purpose, the drugs proroxan (reduces overall sympathetic tone) and etimizol (increases the activity of the hypothalamic-pituitary-adrenal system) are used. The drug hydroxyzine, which has moderate anxiolytic activity, showed a good effect.
Elimination of functional visceral tension. The latter is especially often detected in the cardiovascular system and is manifested by the syndromes of resting tachycardia and postural tachycardia. To correct these disorders, β-blockers are prescribed - anaprilin, bisoprolol, pindolol. The administration of these drugs is a symptomatic measure and they should be used as an adjunct to primary therapeutic agents.
Metabolic correction. Patients with organic diseases of the nervous system, in the structure of which there are vegetative paroxysms (consequences of closed brain injuries, chronic cerebral circulatory failure), must be prescribed drugs that create favorable metabolic conditions for the brain. These include various vitamin complexes - dekamevit, aerovit, glutamevit, unicap, spectrum; amino acids – glutamic acid; nootropics with a mild sedative component - pyriditol, deanol.
After regression of the main symptoms (after 2–4 weeks), adaptogens are prescribed to reduce the phenomena of asthenia and apathy.
To relieve any vegetative crisis, it is possible to use diazepam, clozapine, and hydroxyzine. When sympathetic manifestations predominate, obsidan and pyrroxan are used; when parasympathetic manifestations predominate, atropine is used.

Migraine
Migraine is a common form of primary headache. The high prevalence of migraine and the significant socioeconomic losses associated with it contributed to the fact that the World Health Organization included migraine in the list of diseases that most disrupt the social adaptation of patients.
Etiology and pathogenesis. One of the main etiological factors of migraine is hereditary predisposition. It manifests itself in the form of dysfunction of vascular regulation. This dysfunction can be caused by changes in the segmental sympathetic apparatus, disturbances in the metabolism of neurotransmitters (serotonin, norepinephrine, histamine, glutamate and a number of others). The disease is inherited in an autosomal dominant manner. Provoking factors for the development of headache attacks can be overwork, insomnia, hunger, emotionally stressful situations, sexual excesses, menstruation (decreased estrogen levels in the blood), eye strain, infections, and head injuries. Often, headaches can occur for no apparent reason. During an attack, generalized disturbances of vasomotor regulation occur, mainly in the vessels of the head, while the headache is caused by dilation of the vessels of the dura mater. A phase course of vascular tone disorders was revealed. First, vasospasm occurs (first phase), and then their dilation (second phase), followed by edema vascular wall(third phase). The first phase is most pronounced in the intracranial vessels, the second - in the extracranial and meningeal.

Classification of migraine (International Classification of Headache Disorders, 2nd edition (ICHD-2, 2004))
1.1. Migraine without aura.
1.2. Migraine with aura.
1.2.1. Typical aura with migraine headache.
1.2.2. Typical aura with non-migraine headache.
1.2.3. Typical aura without headache.
1.2.4. Familial hemiplegic migraine.
1.2.5. Sporadic hemiplegic migraine.
1.2.6. Basilar type migraine.
1.3. Periodic syndromes of childhood, usually preceding migraine.
1.3.1. Cyclic vomiting.
1.3.2. Abdominal migraine.
1.3.3. Benign paroxysmal vertigo of childhood.
1.4. Retinal migraine.
1.5. Complications of migraine.
1.5.1. Chronic migraine.
1.5.2. Migrainous status.
1.5.3. Persistent aura without infarction.
1.5.4. Migraine infarction.
1.5.5. An attack caused by a migraine.
1.6. Possible migraine.
1.6.1. Possible migraine without aura.
1.6.2. Possible migraine with aura.
1.6.3. Possible chronic migraine.
Clinical picture. Migraine is a disease that manifests itself in the form of periodically recurring attacks of headache, usually in one half of the head, and is caused by hereditarily determined dysfunction of vasomotor regulation.
Typically starting around puberty, migraines primarily affect people aged 35–45 years, although they can also affect people much younger, including children. According to WHO studies conducted in Europe and America, 6-8% of men and 15-18% of women suffer from migraines every year. The same prevalence of this disease is observed in Central and South America. Higher incidence rates among women, regardless of place of residence, are due to hormonal factors. In 60-70% of cases, the disease is hereditary.
Migraine manifests itself in attacks, which occur more or less uniformly in each patient. The attack is usually preceded by prodromal phenomena in the form of poor health, drowsiness, decreased performance, and irritability. Migraine with aura is preceded by various sensory or motor disturbances. The headache in the vast majority of cases is unilateral (hemicrania), less often the whole head hurts or alternating sides are observed. The intensity of pain is moderate to severe. The pain is felt in the temple area, eyes, has a pulsating nature, intensifies under the influence of normal mental and physical activity, is accompanied by nausea and (or) vomiting, redness or paleness of the face. During an attack, general hyperesthesia occurs (photophobia, intolerance to loud sounds, light, etc.).
In 10-15% of cases, the attack is preceded by a migraine aura - a complex neurological symptoms occurring immediately before or at the onset of a migraine headache. The aura develops within 5-20 minutes, persists for no more than 60 minutes and completely disappears with the onset of the pain phase. The most common is visual (the so-called “classical”) aura, manifested by various visual phenomena: photopsia, “flickering of floaters,” unilateral loss of visual fields, zigzag luminous lines, flickering scotoma. Less common are unilateral weakness and paresthesia in the extremities, transient speech disorders, and distorted perception of the size and shape of objects.
The clinical forms of migraine with aura depend on the area in which vascular system the pathological process unfolds. Ophthalmic (classical) migraine is manifested by homonymous visual phenomena (photopsia, loss or reduction of visual fields, blurred vision).
Paresthetic migraine is characterized by an aura in the form of sensations of numbness, tingling in the hand (starting with the fingers), face, and tongue. Sensory disorders are in second place in terms of frequency of occurrence after ophthalmic migraine. In hemiplegic migraine, part of the aura is hemiparesis. There are also speech (motor, sensory aphasia, dysarthria), vestibular (dizziness) and cerebellar disorders. If the aura lasts more than 1 hour, then they talk about migraine with prolonged aura. Sometimes an aura without headache may be observed.
Basilar migraine is relatively rare. It usually occurs in girls aged 10–15 years. Manifested by visual disturbances (sensation of bright light in the eyes, bilateral blindness for several minutes), dizziness, ataxia, dysarthria, tinnitus, followed by a sharp throbbing headache. Sometimes loss of consciousness occurs (in 30%).
Ophthalmoplegic migraine is diagnosed when various oculomotor disorders (one-sided ptosis, diplopia, etc.) occur at the height of the headache or simultaneously with it. Ophthalmoplegic migraine may be symptomatic and associated with organic brain damage ( serous meningitis, brain tumor, aneurysm of the vessels of the base of the brain).
Retinal migraine presents with a central or paracentral scotoma and transient blindness in one or both eyes. In this case, it is necessary to exclude ophthalmological diseases and retinal artery embolism.
Autonomic (panic) migraine is characterized by the presence of vegetative symptoms: tachycardia, facial swelling, chills, hyperventilation symptoms (lack of air, feeling of suffocation), lacrimation, hyperhidrosis, and the development of a pre-fainting state. In 3–5% of patients, vegetative manifestations reach extreme severity and look like a panic attack, accompanied by severe anxiety and fear.
In the majority of patients (60%), attacks occur primarily during wakefulness; in 25%, pain occurs both during sleep and while awake; in 15%, pain occurs primarily during sleep or immediately after waking up.
In 15–20% of patients with a typical picture of the disease, the pain subsequently becomes less severe, but becomes permanent. If these attacks occur more than 15 days a month for 3 months. and more such migraine is called chronic.
The group of childhood periodic syndromes that precede or accompany migraine is the least clinically defined. Some authors doubt its existence. It includes various disorders: transient hemiplegia of the limbs, abdominal pain, bouts of vomiting, dizziness, which occur before the age of one and a half years.
In some patients, migraine is combined with epilepsy - after an attack of severe headache, convulsive seizures sometimes occur, while paroxysmal activity is noted on the electroencephalogram. The occurrence of epilepsy is explained by the fact that under the influence of repeated migraine attacks, ischemic foci with epileptogenic properties are formed.
Diagnosis is based on the data of the clinical picture and additional research methods. The diagnosis of migraine is supported by the absence of symptoms of organic brain damage, the onset of the disease in adolescence or childhood, localization of pain in one half of the head, hereditary history, significant relief (or disappearance) of pain after sleep or vomiting, absence of signs of organic damage to the nervous system outside the attack. During an attack, palpation can determine the tense and pulsating temporal artery.
Of the additional research methods, ultrasound dopplerography is by far the main method for verifying the disease. With the help of this method, in the interictal period, the hyperreactivity of the cerebral vessels to carbon dioxide is revealed, which is more pronounced on the side of headaches. During the period of painful paroxysms, the following are recorded in typical cases of migraine during the aura period - diffuse angiospasm, more pronounced in the corresponding clinic pool, and during the period of extended painful paroxysm - vasodilation and a significant decrease in the range of vascular reactions in the hypercapnia test. Sometimes it is possible to register simultaneous narrowing of intracranial vessels and expansion of extracranial ones; in some cases the opposite picture is observed. Signs of autonomic dysfunction are widespread in patients: palmar hyperhidrosis, Raynaud's syndrome, Chvostek's symptom, and others. Among diseases of internal organs, migraine is often accompanied by chronic cholecystitis, gastritis, peptic ulcer, colitis
Differential diagnosis is carried out with space-occupying formations of the brain (tumor, abscess), vascular anomalies (aneurysms of the vessels of the base of the brain), temporal arteritis(Horton's disease), Tolosa-Hunt syndrome (based on limited granulomatous arteritis of the internal carotid artery in the cavernous sinus), glaucoma, diseases paranasal sinuses nose, Slyuder's syndrome and trigeminal neuralgia. In diagnostic terms, it is necessary to differentiate migraine from episodic tension-type headache.
Treatment. To relieve an already developed attack lasting no more than 1 day, simple or combined analgesics are used: acetylsalicylic acid, including soluble forms, acetaminophen (paracetamol), ibuprofen, naproxen, as well as their combinations with other drugs, especially caffeine and phenobarbital (ascophen , sedalgin, pentalgin, spasmoveralgin), codeine (codeine + paracetamol + propyphenazone + caffeine) and others.
In more severe cases drugs with a specific mechanism of action are used: selective 5-HT1 receptor agonists, or triptans: sumatriptan, zolmitriptan, naratriptan, eletriptan, etc. Drugs in this group, acting on 5-HT1 receptors located in the central and peripheral nervous system, block the release pain neuropeptides and selectively narrow the vessels dilated during an attack. In addition to tablets, other dosage forms triptans - nasal spray, solution for subcutaneous injections, suppositories.
Non-selective 5-HT1 receptor agonists with a pronounced vasoconstrictor effect: ergotamine. Despite the fact that the use of ergotamine drugs is quite effective, especially in combination with caffeine (caffetamine), phenobarbital (cofegort) or analgesics, caution should be exercised, since it is a strong vasoconstrictor and, if used incorrectly, can cause an attack of angina, peripheral neuropathy and limb ischemia ( signs of ergotamine intoxication - ergotism). To avoid this, you should not take more than 4 mg of ergotamine in one attack or more than 12 mg per week, which is why drugs in this group are prescribed less and less.
Due to the fact that during a migraine attack many patients develop atony of the stomach and intestines, which not only impairs the absorption of drugs, but also provokes the development of nausea and vomiting, antiemetics: metoclopramide, domperidone, atropine, belloid. The drugs are taken 30 minutes before taking analgesics. There is evidence of the use of drugs that suppress the formation of prostaglandins (flufenamic and tolfenamic (clotam) acids).
Preventative treatment for migraine is aimed at reducing the frequency, duration and severity of migraine attacks.
The following set of measures is advisable:
1) exclude products that trigger migraines, of which the most significant are dairy products (including whole cow's milk, goat's milk, cheese, yogurt, etc.); chocolate; eggs; citrus; meat (including beef, pork, chicken, turkey, fish, etc.); wheat (bread, pasta, etc.); nuts and peanuts; tomatoes; onion; corn; apples; bananas;
2) achieve correct mode work and rest, sleep;
3) conduct courses preventive treatment sufficient duration (from 2 to 12 months, depending on the severity of the disease).
Most widely used the following drugs: beta blockers – metoprolol, propranolol; calcium channel blockers – nifedipine, verapamil; antidepressants – amitriptyline, citalopram, fluoxetine; metoclopramide and other drugs.
If this therapy is insufficiently effective, it is possible to use drugs from the group of anticonvulsants (carbamazepine, topiramate). Topiramate (Topamax) has been shown to be effective in the prevention of classic migraine with aura.
In patients of the older age group, it is possible to use vasoactive, antioxidant, nootropic drugs (vinpocetine, dihydroergocryptine + caffeine (vasobral), piracetam, ethylmethylhydroxypyridine succinate). Non-drug medications are also widely used reflex action: mustard plasters on back surface necks, lubricating the temples with a menthol pencil, hot foot baths. Complex therapy uses psychotherapy, biofeedback, acupuncture and other techniques.
Migrainous status. When a migraine attack is severe and protracted, does not respond to conventional therapy, and recurs several hours after some improvement, we speak of status migraine. In such cases, the patient must be hospitalized. To relieve migraine status, intravenous drip administration of dihydroergotamine is used ( long-term use history of ergotamine is a contraindication). Intravenous slow administration of diazepam, melipramine, Lasix, injections of pipolfen, suprastin, and diphenhydramine are also used. Sometimes neuroleptics (haloperidol) are used. If these measures are ineffective, the patient is put into medicated sleep for several hours or days.

Erythromelalgia
Clinical picture. The main clinical symptom is attacks of burning pain, which are provoked by overheating, muscle strain, strong emotions, and staying in a warm bed. The pain is localized in the distal parts of the extremities (most often in the big toe, heel, then moves to the sole, dorsum of the foot, and sometimes to the lower leg). During attacks, redness of the skin, local increase in temperature, swelling, hyperhidrosis, severe emotional disorders. Excruciating pain can drive the patient to despair. Pain is reduced by applying a cold, wet cloth or by moving the limb to a horizontal position.
Etiology and pathogenesis. Participate in pathogenesis different levels autonomic nervous system. This is confirmed by observations of the erythromelalgic phenomenon in patients with various lesions of the spinal cord (lateral and posterior horns), diencephalic region. Erythromelalgia can occur as a syndrome in multiple sclerosis, syringomyelia, consequences of nerve injuries (mainly median and tibial), neuroma of one of the nerves of the leg, thrombophlebitis, endarteritis, diabetes, etc. (see Fig. 123 on color incl.).
Treatment. A number of general measures are used (wearing light shoes, avoiding overheating, stressful situations) and pharmacological therapy. They use vasoconstrictors, vitamin B12, novocaine blockade of Th2-Th4 sympathetic nodes when the arms are affected and L2-L4 when the legs are affected, histamine therapy, benzodiazepines, antidepressants that comprehensively change the metabolism of serotonin and norepinephrine (Veloxin). Physiotherapy is widely used (contrast baths, ultraviolet irradiation of the area of ​​the thoracic sympathetic nodes, galvanic collar according to Shcherbak, mud applications to segmental zones). In severe cases of the disease, surgical treatment (preganglionic sympathectomy) is resorted to.

Raynaud's disease
The disease was described in 1862 by M. Raynaud, who considered it a neurosis caused by increased excitability of the spinal vasomotor centers. The disease is based on a dynamic disorder of vasomotor regulation. Raynaud's complex may manifest as independent disease or as a syndrome in a number of diseases (digital arteritis, accessory cervical ribs, scalenus syndrome, systemic diseases, syringomyelia, multiple sclerosis, scleroderma, thyrotoxicosis, etc.). The disease usually begins after the age of 25, although cases have been described in children 10–14 years of age and in people over 50 years of age.
The disease occurs in the form of attacks consisting of three phases:
1) paleness and coldness of the fingers and toes, accompanied by pain;
2) the addition of cyanosis and increased pain;
3) redness of the extremities and subsidence of pain. Attacks are triggered by cold and emotional stress.
Treatment. Compliance with the regimen (avoiding hypothermia, exposure to vibration, stress), prescribing calcium channel blockers (nifedipine), drugs that improve microcirculation (pentoxifylline), tranquilizers (oxazepam, tazepam, phenazepam), antidepressants (amitriptyline).

Panic attacks
Panic attacks are attacks of severe anxiety (panic) that have no direct connection with a specific situation or circumstances and are therefore unpredictable. Panic attacks are a neurotic disorder and are caused by psychological trauma. The dominant symptoms vary among patients, but common symptoms include sudden palpitations, chest pain, suffocation, dizziness, and a sense of unreality (depersonalization or derealization). Secondary fear of death, loss of self-control or mental disorder. Attacks usually last only minutes, although at times longer; their frequency and course are quite variable. In a state of panic attack, the patient often feels a sharp increase in fear and vegetative symptoms, which lead to the patient hastily leaving the place where he is. If this occurs in a specific situation, such as on a bus or in a crowd, the patient may subsequently avoid the situation. A panic attack often leads to constant fear before possible future attacks. Panic disorder can become the main diagnosis only in the absence of any of the phobias, as well as depression, schizophrenia, and organic brain damage. The diagnosis must meet the following characteristics:
1) these are discrete episodes of intense fear or discomfort;
2) the episode begins suddenly;
3) the episode peaks within a few minutes and lasts at least several minutes;
4) at least four symptoms listed below must be present, and one of them is from the vegetative group.
Autonomic symptoms:
– increased or rapid heartbeat;
– sweating;
– shaking (tremor);
– dry mouth not caused by medications or dehydration.
Symptoms related to the chest and abdomen:
– difficulty breathing;
– feeling of suffocation;
– pain or discomfort in the chest;
– nausea or abdominal distress (eg, burning sensation in the stomach).
Symptoms related to mental state:
– feeling of dizziness, unsteadiness, fainting;
– feelings that objects are unreal (derealization) or that one’s own “I” has moved away or “is not here” (depersonalization);
– fear of loss of control, madness or impending death.
General symptoms:
– hot flashes or chills;
– numbness or tingling sensation.
Treatment. The main treatment intervention is psychotherapy. Among drug therapy, the drug of choice is alprazolam, which has a pronounced anti-anxiety, vegetative-stabilizing and antidepressant effect. Tofisopam is less effective. Carbamazepine and phenazepam can also be used. Balneotherapy and reflexology have a positive effect.

Shy–Drager syndrome (multiple system atrophy)
In this syndrome, severe autonomic failure is combined with cerebellar, extrapyramidal and pyramidal symptoms. The disease is manifested by orthostatic hypotension, parkinsonism, impotence, impaired pupillary reactions, and urinary incontinence. The nature of clinical manifestations depends on the degree of involvement of these systems in the pathological process. The autonomic sphere remains almost intact, but the nature of the damage to the central nervous system is such that it causes disturbances in the regulatory functions of the autonomic nervous system. The disease begins with the development of parkinsonism, with a weak and short-lived effect from drugs of the levodopa group; then peripheral autonomic failure occurs, pyramidal syndrome and ataxia. The content of norepinephrine in the blood and urine practically does not differ from the norm, but its level does not increase when moving from a lying position to a standing position. For more information about the disease, see chap. 27.6.

Progressive hemiatrophy of the face
Slowly progressive weight loss of half the face, caused mainly by dystrophic changes in the skin and subcutaneous tissue, to a lesser extent – ​​muscles and facial skeleton.
The etiology and pathogenesis of the disease are unknown. It is assumed that the disease develops due to insufficiency of segmental or suprasegmental (hypothalamic) autonomic centers. With additional pathogenic influence (trauma, infection, intoxication, etc.), the influence of these centers on the sympathetic vegetative nodes is disrupted, as a result of which the vegetative-trophic (sympathetic) regulation of metabolic processes in the zone of innervation of the affected node changes. In some cases, facial hemiatrophy is preceded by a disease of the trigeminal nerve, tooth extraction, facial contusion, common infections. The disease occurs between 10 and 20 years of age and is more common in women. Atrophy begins in a limited area, usually in the middle part of the face and more often in the left half. The skin atrophies, then the subcutaneous fat layer, muscles and bones. The skin on the affected area becomes depigmented. Horner's syndrome develops. Hair also becomes depigmented and falls out. In severe cases, gross asymmetry of the face develops, the skin becomes thinner and wrinkles, the jaw decreases in size, and teeth fall out. Sometimes the atrophic process spreads to the neck, shoulder girdle, arm, and less often to the entire half of the body (total hemiatrophy). Cases of bilateral and cross hemiatrophy have been described. How the syndrome occurs in scleroderma, syringomyelia, trigeminal nerve tumors. Treatment is symptomatic only.

Under the influence of the autonomic nervous system occurs difficult process regulation of all internal processes of the body. The autonomic (autonomic) nervous system ensures the constancy of the internal environment of the body. Vegetative-neural influences extend to all organs and tissues. The term “autonomic nervous system” reflects the control of involuntary functions of the body. The autonomic nervous system is dependent on the higher centers of the nervous system. There are sympathetic and parasympathetic parts of the autonomic nervous system. Their main difference lies in the functional innervation and is determined by the relationship to the means affecting the autonomic nervous system. The sympathetic part is excited by adrenaline, and the parasympathetic part by acetylcholine. Ergotamine has an inhibitory effect on the sympathetic part, and atropine has an inhibitory effect on the parasympathetic part.

Sympathetic division of the autonomic nervous system

The main formations of the sympathetic part are located mainly in the cerebral cortex, as well as in the spinal cord (in the lateral horns). In the spinal cord, the peripheral formations of the sympathetic division of the autonomic nervous system begin from the lateral horns. Sympathetic trunk located along the lateral surface spinal column. The sympathetic trunk has 24 pairs of sympathetic nodes.

Parasympathetic part of the autonomic nervous system

The formations of the parasympathetic part begin from the cerebral cortex. The craniobulbar region is distinguished in the brain and the sacral region in the spinal cord. In the craniobulbar department there are:

1) the system of visceral nuclei (III nerve), namely paired small-celled nuclei, which are related to the innervation of the pupil (smooth muscle), and an unpaired small-celled accommodative nucleus, which provides innervation to smooth muscle - in the bottom of the Sylvian aqueduct, under the anterior tubercles of the quadrigeminal tubercles;

2) secretory lacrimal cells in the system of nuclei of the facial nerve (VII nerve), located in the pons;

3) secretory salivary nucleus in the glossopharyngeal nerve system (IX nerve) - for the parotid gland and XIII nerve - for the submandibular and sublingual salivary glands - in the medulla oblongata;

4) the visceral nuclei of the vagus nerve in the medulla oblongata, which innervate the heart, bronchi, gastrointestinal tract, digestive glands, and other internal organs.

Features of autonomic innervation

All organs of our body are under the influence of the autonomic nervous system (both of its parts). The sympathetic part changes the functional abilities of organs. Both parts of the autonomic nervous system are interconnected. But there are conditions when one part of the system prevails over the other. Vagotonia (predominance of the parasympathetic part) is characterized by narrow pupils, moist, bluish skin, bradycardia, low blood pressure, constricted (asthmatic) breathing, excessive salivation, increased acidity gastric juice, a tendency to spasms of the esophagus, stomach, spastic constipation, alternating with diarrhea, decreased metabolism, and a tendency to obesity. The state of vagotonia is typical, for example, for a sleeping person. Sympathicotonia (predominance of the sympathetic part) is characterized by shiny, convex, with wide pupils eyes; pale, dry skin with a tendency to piloarrection; tachycardia, high blood pressure, free breathing; dry mouth, achylia, dilation of the stomach, atonic constipation; brisk metabolism, tendency to lose weight. The state of sympathicotonia is characteristic, for example, of affective states (fear, anger, etc.).

How does the autonomic nervous system affect the body? Conditions are possible in which the activity of individual organs or systems of the body is disrupted as a result of the predominance of the tone of one of the parts of the autonomic nervous system. Vagotonic crises are, for example, bronchial asthma, urticaria, Quincke's edema, vasomotor rhinitis, seasickness, sympathicotonic - vascular spasms in the form of symmetrical acroasphyxia, migraine, intermittent claudication, Raynaud's disease, transient form of hypertension, cardiovascular crises in hypothalamic syndrome, ganglion lesions.

Methods for studying the autonomic nervous system

The study of autonomic innervation is based, first of all, on assessing the condition and function of the corresponding organs and systems. There are many clinical and laboratory methods for studying the autonomic nervous system. The choice of methodology is determined in accordance with the task and conditions of the study. However, in all cases it is necessary to take into account the initial state of autonomic tone. The study is best carried out in the morning on an empty stomach or 2 hours after meals, at the same time, at least 3 times. In this case, the minimum value of the obtained data is taken as the initial value.

Big practical value and clinical, clinical-physiological and biochemical research methods are used.

The largest group consists cutaneous autonomic reflexes And samples.

Local dermographism– a reaction of the skin capillaries in the form of redness of the skin, which is caused by applying pressure with the handle of a hammer. Most often, a red stripe appears at the site of irritation; its width depends on the state of the autonomic nervous system. Of particular importance is too long (persistent) dermographism; this can be assessed as a predominance of excitability of skin vasodilators.

An even more convincing sign of such excitability (parasympathetic) is elevated dermographism, when, after a stroke, an edematous skin roller forms. A manifestation of increased vasoconstrictive excitability (sympathetic) is white dermographism (spasm). The nature of local dermographism depends on the degree of pressure during stroke stimulation and on the area skin surface. For example, weak irritations usually cause only white dermographism. It is especially pronounced on the skin lower limbs. The reaction of local dermographism can only be used to determine the tone of the sympathetic or parasympathetic part of the autonomic nervous system.

How does the autonomic nervous system affect the body? Reflex dermographism caused by irritation with a sharp object (drawn across the skin with the tip of a pin or needle). The reflex arc of such dermographism is closed in the segmental apparatus of the spinal cord. Some time after the impact, a strip appears with scalloped, uneven edges of varying widths, which lasts for several seconds. Reflex dermographism disappears with lesions of the dorsal roots of the spinal cord, as well as the anterior roots and spinal nerves at the level of the lesion. Above and below the innervation zone, the reflex is usually preserved. The so-called mustard test may also be recommended: thinly cut strips of mustard plasters are applied in a long narrow strip from top to bottom within the expected level of the lesion: the changes correspond to the indications of reflex dermographism (but this is not always accurate).

Pilomotor (piloarrector) reflexes skin are caused by pinching or cold (ice, ether) skin irritations, most often in the back of the head. “Goose bumps” (spinal reflex) should be considered a sympathetic reflex. Piloarrection, especially in a cold room, occurs normally. Pilomotor reflexes may have topodiagnostic value. With transverse lesions of the spinal cord, pilomotor reflexes, when irritated above, do not extend below the zone of preservation of the segments (in this way it is possible to determine upper limit lesions); with irritation below (in the area below the lesion), piloarrection extends upward only to the affected segments (i.e., the lower border of the lesion can be determined). In the area of ​​the affected segments of the spinal cord themselves, the pilomotor reflex is absent.

Both dermographism and piloarrection do not always accurately determine the boundaries of the lesion.

Sweat reflexes skin are of great diagnostic value. Sweat glands have only sympathetic innervation. The mechanism of sweating is different. Violations of the sweating reflex can occur at various locations of the disease process.

Aspirin test(with a glass of hot tea they give 1.0 g acetylsalicylic acid) causes diffuse sweating. With cortical lesions, a monoplegic type of absence or decrease in sweating occurs, with damage to the diencephalic, hypothalamic region - hemiplegic.

Warming the test subject causes spinal sweat reflexes (through cells of the lateral horns of the spinal cord). If the segmental centers of the spinal cord are affected, warming the patient, as well as an aspirin test, establishes the absence or decrease in sweating in the corresponding areas.

Test with pilocarpine(1 ml of a 1% solution of pilocarpine hydrochloride is administered subcutaneously to the patient). The absence or decrease in sweating indicates damage to the peripheral nervous system.

The best way to identify sweating and areas of sweating is to Minor's method. The patient's skin is covered with a solution of iodine mixed with alcohol and castor oil. Some time after drying, the skin is evenly sprinkled with starch powder. Then sweating is induced in various ways; as a result of the combination of iodine with starch, an intense blue-violet, sometimes even black color is formed in the areas of sweating. In those areas where sweating has not occurred, staining does not form. The results are photographed or sketched.

Another method for determining skin sweating (moisture) is electrometric. With this method, the fairly common apparatus of N. I. Mishchuk is used. With this method, it is more difficult to determine areas of impaired sweating.

Interesting, but difficult and difficult to evaluate the results obtained is electrodermal resistance method. The electrical conductivity of the skin is determined by a number of factors: humidity, i.e. sweating of the skin, condition of blood vessels, degree of hydrophilicity of the skin, etc. An increase in electrocutaneous resistance should be considered as a manifestation of the predominance of sympathetic innervation tone in the skin area under study.

Among skin tests, the study is widespread skin temperature. This test is of particular importance in overall assessment visceral innervation, tone and its stability. The constancy of temperature is ensured by the regulating influence of cerebral visceral centers. In addition to mercury thermometers specially adapted for quick and accurate measurement of skin temperature of any areas of the skin, recently the electrometric method (thermocouple) is increasingly used, which is provided by N. N. Mishchuk’s device (combined apparatus PK-5).

Skin temperature reflects the state of blood supply to the skin, which is an important indicator of autonomic innervation. Skin temperature asymmetries (hemisyndrome type) exceeding 1°C are observed with unilateral lesions of the hypothalamic region. There are territorial temperature changes in focal lesions of the cerebral cortex - cerebral hemiplegia.

Skin tests also include the determination skin sensitivity to ultraviolet rays by determining the biodose, i.e. establishing the minimum degree of exposure to rays at which redness occurs.

To ensure the standard, constant irradiation conditions are applied. As a control, the results of irradiation in the same conditions of a symmetrical, "healthy" territory are usually taken into account. Redness occurs by the reflex mechanism: histamine or histamine-like substances are formed in the skin during irradiation. Early onset and intensity of redness is regarded as a parasympathetic effect, delayed onset, low intensity of erythema (redness) is regarded as sympathetic. This method is widely used for topical diagnosis: very clear data are obtained with damage to the peripheral nerves; asymmetries occur with cerebral hemiplegia, diencephalic and spinal lesions.

For research hydrophilicity 0.2 ml of physiological saline is injected intradermally into the skin and the resorption time of the resulting papule is taken into account. The speed of resorption varies in different areas of the skin. On average it is 50–90 minutes. This test differs in considerable sensitivity (as well as electroskin resistance); the use of the results of this test to assess the general condition and lesions of the nervous system requires caution, since the hydrophilicity of tissues changes significantly, for example, with fever, edema, cardiovascular disorders, etc.

Skin tests include the study of local reactions to sympathicotropic And vagotropic substances. Sympathicotropic drugs include adrenaline (administered in a solution of 1: 1000 in an amount of 0.1 ml intradermally). At the injection site, a spot of blanching and piloarrection (“goose bumps”) appears within 5-10 minutes, which is surrounded by a red border of varying size and intensity. If the reaction is severe and lasts for a long time, a conclusion is drawn about a sympathetic effect.

Acetylcholine is used as a vagotropic (parasympathicotropic) substance (0.1 ml of a 1: 10,000 solution is injected intradermally). A pale papule with a reddish border appears at the injection site; after some time, the area of ​​redness increases to a maximum and after 15–25 minutes completely disappears. Greater intensity of the reaction is regarded as a parasympathetic effect.

Enough wide use in clinical practice received research cardiovascular reflexes.

Oculocardial reflex– the subject lies on his back in a free position, after some time his pulse is counted. After this, pressure is applied, preferably on both eyeballs simultaneously with a large and index fingers hands. It is recommended to apply pressure not on the anterior chamber, but on the lateral parts of the eyeball, and it should be quite intense, but not painful. After 20–30 s, without stopping the pressure, count the pulse for 20–30 s. The pulse rate before and after pressure is compared. Normally, the pulse slows down slightly (up to 10 beats). Large deceleration is regarded as a vagotonic effect, absence of deceleration or paradoxical acceleration - as sympathicotonic.

Neck reflex caused by pressing with the thumb on the area anterior to the sternocleidomastial muscle, at the level of its upper third, below the angle lower jaw- until you feel the pulsation of the carotid artery. Normally, the heart rate slows down by 6-12 beats per minute. A high degree of deceleration, as well as changes in breathing, intestinal peristalsis and other signs, are regarded as a manifestation of increased tone of the vagus nerve system.

Epigastric (solar node) reflex is called when the patient is in the position on the back with the most relaxed muscles of the abdominal press; measure blood pressure and pulse. Using your fingers, apply pressure to the area between the xiphoid process and the navel, gradually increasing the pressure until you feel a clear pulsation of the abdominal aorta. As a result, the heart rate slows and blood pressure decreases; a sharp degree of these reflex phenomena is regarded as an indicator of increased excitability of the parasympathetic department. Sometimes reflexes of the sympathetic order also occur simultaneously - dilation of the pupils, etc. This is explained by the presence of both sympathetic and parasympathetic innervation in the solar plexus.

How does the autonomic nervous system affect the body?

When studying the autonomic nervous system, various hormonal studies due to the possibility of developing neuroendocrine disorders. A number of studies are also being conducted to determine the emotional and personal characteristics of a person to determine his mental state.

A detailed study of changes in autonomic innervation in diseases of internal organs can help make an accurate diagnosis and determine the area for the use of reflex therapy.

Dysfunctions of the autonomic nervous system are usually present in the clinic of every disease of the nervous system. But there are diseases in which autonomic disorders are leading. They are caused by damage to the autonomic formations of the nervous system. The forms of diseases are distinguished depending on the level of damage to the autonomic nervous system.

Vegetative-vascular dystonia (VSD) is a very common disease, which can masquerade as many others, or may have minor clinical manifestations. According to statistics, about 80% of people have some symptoms of VSD. One third of these people require medical care.

What is the autonomic nervous system?

The autonomic nervous system (ANS) consists of two subsystems - sympathetic and parasympathetic, the joint and coordinated activity of which allows, on the one hand, to maintain the internal constancy of the body (homeostasis), and on the other hand, to adapt to changing environmental conditions. The ANS directs autonomous (consciously uncontrolled) regulatory mechanisms, such as:

• vascular tone (blood pressure);
• heart rate;
• secretion of glands external and internal secretion(sweating, salivation, secretion of gastric juice, adrenaline, and so on);
• regulation of motor activity of smooth muscles (intestinal motility, gallbladder, etc.).

Due to various stress factors, chronic lack of sleep, neuroticism and other things, the sympathetic and parasympathetic systems can lose control and start working on their own. As a result, a polymorphic clinical picture vegetative-vascular dystonia.

The action of the sympathetic nervous system is realized with the help of the sympathetic-adrenal system, the central link of which are catecholamines (adrenaline and norepinephrine). A sharp increase in their concentration (release from the adrenal medulla) leads to sympatho-adrenal crisis ("panic attack") : tachycardia, rise in blood pressure, fear, followed by exhaustion of the nervous system.

The parasympathetic nervous system is realized through parasympathetic nerve fibers, the main representative of which is nervus vagus(nervus vagus). Chemical substance, which is released at the endings of this nerve - acetylcholine, which causes a decrease in blood pressure, heart rate, increases intestinal motility, constricts the pupils, increases perspiration and salivation, increases the activity of the glands of external and internal secretion. Excessive activation of the parasympathetic nervous system leads to vagoinsular crisis , which is manifested by fainting, “bear sickness”, abdominal pain, the concentration of insulin in the blood increases, which leads to hypoglycemia (a decrease in the concentration of sugar in the blood), which causes excessive sweating.

Depending on which component of the ANS predominates (sympathetic or parasympathetic), there are three main types of this disease:

1. hypotonic type- the action of the parasympathetic nervous system prevails;
2. hypertensive type– the action of the sympathetic nervous system predominates;
3. normotonic type– there is no predominance of one system or another, but there is their dysfunction.

Symptoms of vegetative-vascular dystonia

Symptoms from the cardiovascular system:

• increased heart rate (tachyarrhythmia);
• decreased heart rate (bradyarrhythmia);
• interruptions in the functioning of the heart, palpitations;
• pain in the heart area;
• increased vascular tone (hypertension);
• decreased vascular tone (hypertension);
• inability to maintain the proper level of blood pressure when necessary, up to the development of fainting;
• due to spasm or vasodilation, both local and general paleness or redness of the skin is possible with a decrease or increase in temperature in this area, respectively.

From the outside respiratory system shortness of breath may occur.

Gastrointestinal symptoms:

• diarrhea, constipation;
• spasmodic pain;
• irritable bowel syndrome.

Symptoms from the central nervous system:

• apathy;
• hypochondria;
• depression;
• nervousness;
• weather sensitivity;
• changes in body temperature;
• headache;
• insomnia.

Treatment of vegetative-vascular dystonia

Both drug and non-drug methods are used to treat VSD. Moreover, the latter should be given more attention. Non-drug treatment methods include the following.

Maintaining a healthy lifestyle. It all starts with normalizing your daily routine. In the morning you need to get up at 6-7 o'clock and go to bed at 10-11 o'clock. Thus, your sleep time should be about 8 hours. The human body is accustomed to a diurnal lifestyle and if “daytime” hormones are released during the day, then “nighttime” hormones are released at night. For example, the hormone intermedin, which is responsible for preserving youth, is released from the middle lobe of the pituitary gland from 00:00 to 03:00 am and only if the person is sleeping. If he is awake at this time, then intermedin is not released or not released in large quantities. Of course, this has an impact on health. And for the money that you are paid for night hours on duty, in essence, you are selling your youth.

Sleeping conditions should also be optimal. The room where you sleep should be comfortable for you in terms of temperature, humidity, noise level, and so on. Mattresses, pillows, bed sheets should also not cause inconvenience. It is optimal if they are orthopedic. If you suffer from snoring, you should try to eliminate it, as it can cause the so-called Ondine's curse syndrome or sleep apnea syndrome. This is a condition when, due to snoring or other reasons, the sleeping person stops breathing. At the same time, he may not even wake up, but his REM sleep phase is replaced by the superficial sleep phase. And if this happens quite often during the night, then the person simply will not get enough sleep.

You cannot engage in monotonous activities for a long time at work. During breaks, you should switch from mental to physical stress, and vice versa. It is advisable to minimize the time spent working at the computer. The same goes for watching TV. You cannot sit in one position for a long time; periodically you should do gymnastics, stretch your joints and muscles, and do eye exercises.

At work (and in life) you need to try to be less nervous. If you are angry with someone and cannot tell them about it, write what you think about them on paper. You don’t have to give this paper to that person. Some of the accumulated aggression can be burned off in the gym. In this case you can also use autogenic training, conversations with a psychotherapist, familiarization with relevant psychotherapeutic literature.

Quitting alcohol and smoking is mandatory. These habits reduce the body's reserve abilities and often lead to various ailments. Alcohol can help you get through a stressful situation, like anesthesia during surgery. But in general, its use has an adverse effect on life and health. Drinking alcohol does not help combat stress problems; it only displaces them and puts them off for later. And then they come back in even larger volumes and, accordingly, more “anesthetic drugs” are required. But, nevertheless, it is recommended to sometimes drink a glass (50 ml) of expensive high-quality vodka or a glass (250 ml) of good wine a day before meals. This will be useful for those for whom the smell, sight and taste of alcohol does not cause a violent chain reaction.

Smoking is no less harmful to the body, as it keeps it in a state of chronic hypoxia and toxemia (intoxication). Of course, this reduces the body's reserve capabilities. In addition, smoking increases the incidence of respiratory system diseases - from colds to cancer.

Physical education class. Morning exercises tone your body for the whole day, especially if it is combined with hardening. It not only wakes you up from sleep, but is also an ideal preventative against many diseases.

In addition to exercise, you should sign up for some sports section. The best options would be yoga, swimming, race walking, hiking, and the like. You should avoid sports that can create excessive stress on the cardiovascular system (bodybuilding, sprinting), as well as in which it is necessary to make sudden movements with a large amplitude and lowering the head below the abdomen, due to the possibility of fainting.

Nutrition should be rational and balanced. In addition, to improve the conduction of nerve impulses and heart function, you should always consume foods high in magnesium and potassium. Food should contain a lot of vitamins and other useful substances. The diet should help normalize body weight. For hypertension, it is better to drink soothing teas, and for hypotension, stimulating teas.

Physiotherapy is also used in the treatment of VSD. These procedures may be as follows:

• treatment using laser radiation;
• magnetic therapy;
• electropheresis with various medications on the neck area;
• baths, various showers.

Acupuncture and manual therapy. Depending on the various forms of VSD, the chiropractor selects one or another type of massage.

Spa treatment.

Drug treatment of vegetative-vascular dystonia

Treatment of VSD with the help of medications is carried out in the case of sharp deterioration states - crises.

So, during sympathoadrenal crisis, caused by an excess of catecholamines, treatment consists of prescribing medications that block the action of adrenaline and norepinephrine - adrenergic blockers(metoprolol, propranolol, atenolol).

Anxiolytics (tranquilizers) have a sedative and anti-anxiety effect. Their administration stops the sympathoadrenal crisis. The main representatives of this group: phenazepam, diazepam.

During vagoinsular crisis, occurring due to excess acetylcholine, a drug is used that blocks its action - atropine. This is a 0.1% solution, which is administered subcutaneously in 1 ml doses. To maintain on the right level blood pressure and heart function use a 1% solution cordiamine. It is administered in an amount of 3 ml intramuscularly. For the same purpose, 1 ml of a 10% solution is injected subcutaneously caffeine.

For severe bronchospasm, inhaled bronchodilators are used: atrovent, salbutomol, berotec, berodual. Intramuscular administration of a 5% ephedrine solution in a volume of 1 ml may help.

Lack of glucose in the blood ( hypoglycemia) it is eliminated intravenous administration. You can administer 20 ml of 40% glucose intravenously as a bolus.

Vestibular disorders (dizziness, nausea, vomiting) treated with intramuscular injection of 2 ml of 5% solution haloperidol.

If saved dizziness, then they are treated with cinnarizine And vinpocetine, who take 1 tablet 3 times a day.

Treatment of vegetative-vascular dystonia in children

Treatment of VSD in children is fundamentally the same as in adults. Crises in children are less common, so treatment will consist of normalizing lifestyle, diet, behavior, habits and other things as described above. Drug therapy is carried out in accordance with the age (body weight) of the child. The drugs used are approved in pediatric practice. As a rule, if VSD appeared in childhood, the risk of developing VSD in adulthood greatly increases. Therefore, for such people, prevention of VSD should be considered throughout life.

Vegetative-vascular dystonia - treatment with folk remedies.

Herbal medicine – treatment of vegetative-vascular dystonia with herbs. This treatment should be given great attention. There are many herbs that can both stimulate the body’s activity and calm its excessive activation.

Treatment of hypertensive type VSD

For the hypertensive type of VSD, herbs are used that have a calming, hypnotic effect on the body. These herbs are not an alternative to drug treatment, but only a significant addition to this treatment. They should be taken only if the symptoms of the disease are mild. They are taken for a long time, about 20-30 days. Moreover, they should be taken no more than the specified period to avoid side effects. It is better to use several types of herbs with the same effects, which are used alternately.

Here are the main representatives of herbs with a calming and hypnotic effect: valerian, lemon balm, St. John's wort, motherwort, chamomile, hops, linden, mint, clover, dill, blackberries, strawberries and some others.

Valerian is one of the best herbs this series, which also has no contraindications. It is best to use valerian tincture, which is taken 15 ml (1 tablespoon) 2 times a day. This treatment lasts one week, then a break is taken for 2 weeks.

Motherwort can significantly lower blood pressure, so it should be used with caution.

Mint and lemon balm are used in the form of teas and tinctures. Long-term use is not recommended, as it may cause Negative influence on the human reproductive system.

Treatment of hypotonic type of VSD

For the hypotonic type of VSD, herbs are used that increase the tone of the body and, in particular, the cardiovascular system. Such herbs include: ginseng, eleutherococcus, coffee, black and green tea.

Ginseng is an adaptogen. Tincture from its root is taken 20 drops 30 minutes before meals. It should be taken in the first half of the day to prevent insomnia. Ginseng not only stimulates the nervous and cardiovascular systems, but also increases potency. Treatment with ginseng should not be continued for too long, otherwise depletion may occur.

Eleutherococcus is also an adaptogen. It selectively stimulates the functioning of the nervous system, improves the transmission of nerve impulses. Take it in the same way as ginseng: in the first half of the day, 30 minutes before meals, 30 drops. The course of treatment is 15-20 days.

Collection of herbs for the treatment of VSD

Make a mixture of the following herbs: marsh cudweed (30 gr.), Astragalus wooliflora (40 gr.), horsetail (40 gr.), sweet clover (40 gr.) Make a decoction from the mixture and take 15 - 30 ml (1- 2 tablespoons) for 1-2 months.

Video: VSD, panic attacks. Occurrence and treatment.

In physiology, there is such a thing as cardiac automaticity. This means that the heart contracts under the influence of impulses arising directly within itself, primarily in the sinus node. These are special neuromuscular fibers located in the area where the vena cava flows into the right atrium. The sinus node produces a bioelectrical impulse, which spreads further through the atria and reaches the atrioventricular node. This is how the heart muscle contracts. Neurohumoral factors also influence the excitability and conductivity of the myocardium.

Bradycardia can develop in two cases. First of all, a decrease in the activity of the sinus node leads to a decrease in heart rate when it generates few electrical impulses. This bradycardia is called sinus. And there is a situation when the sinus node is working normally, but the electrical impulse cannot fully pass through the conduction paths and the heartbeat slows down.

Causes of physiological bradycardia

Bradycardia is not always a sign of pathology, it can be physiological. Thus, athletes often have a low heart rate. This is the result of constant stress on the heart during long-term training. How to understand whether bradycardia is normal or pathological? A person needs to do active physical exercise. In healthy people, physical activity leads to an intense increase in heart rate. If the excitability and conductivity of the heart is impaired, physical exercise is accompanied by only a slight increase in heart rate.

In addition, the heartbeat also slows down when the body is hypothermic. This is a compensatory mechanism due to which blood circulation slows down and blood is directed from the skin to the internal organs.

The activity of the sinus node is influenced by the nervous system. The parasympathetic nervous system reduces the heart rate, the sympathetic nervous system increases it. Thus, stimulation of the parasympathetic nervous system leads to a decrease in heart rate. This is a well-known medical phenomenon, which, by the way, many people encounter in life. So, when pressing on the eyes, the vagus nerve (the main nerve of the parasympathetic nervous system) is stimulated. As a result, the heartbeat is briefly reduced by eight to ten beats per minute. The same effect can be achieved by pressing on the carotid sinus area in the neck. Stimulation of the carotid sinus can occur when wearing a tight collar or tie.

Causes of pathological bradycardia

Bradycardia can develop under the influence of a wide variety of factors. The most common causes of pathological bradycardia are:

1. Increased tone of the parasympathetic system;
2. Heart diseases;
3. Hypothyroidism;
4. Taking certain medications (cardiac glycosides, as well as beta-blockers, calcium channel blockers);
5. Poisoning (FOS, lead, nicotine).

Increased tone of the parasympathetic system

Parasympathetic innervation of the myocardium is carried out by the vagus nerve. When activated, the heartbeat slows down. There are pathological conditions in which irritation of the vagus nerve (its fibers located in the internal organs or nerve nuclei in the brain) is observed.

An increase in the tone of the parasympathetic nervous system is observed in the following diseases:

• Increased intracranial pressure (due to traumatic brain injury, hemorrhagic stroke, cerebral edema);
• Peptic ulcer;
• Neoplasms in the mediastinum;
• Cardiopsychoneurosis;
• Condition after surgery in the head, as well as neck, mediastinum.

As soon as in this case the factor stimulating the parasympathetic nervous system is eliminated, the heartbeat returns to normal. This type of bradycardia is defined by physicians as neurogenic.

Heart diseases

Heart diseases (cardiosclerosis, myocardial infarction, myocarditis) lead to the development of certain changes in the myocardium. In this case, the impulse from the sinus node passes much more slowly in the pathologically altered area of ​​the conduction system, which is why the heartbeat slows down.

When a disturbance in the conduction of electrical impulses is localized in the atrioventricular node, they speak of the development of atrioventricular block (AV block).

Symptoms of bradycardia

A moderate decrease in heart rate does not affect the person’s condition in any way; he feels well and exercises. business as usual. But with a further decrease in heart rate, blood circulation is disturbed. The organs are insufficiently supplied with blood and suffer from a lack of oxygen. The brain is especially sensitive to hypoxia. Therefore, with bradycardia, it is the symptoms of damage to the nervous system that come to the fore.

With attacks of bradycardia, a person experiences dizziness, weakness. Pre-fainting and fainting are also characteristic. The skin is pale. Shortness of breath often develops, usually due to physical exertion.

When the heart rate is less than 40 beats per minute, blood circulation is significantly impaired. With slow blood flow, the myocardium does not receive adequate oxygen. As a result, chest pain occurs. This is a kind of signal from the heart that it does not have enough oxygen.

Diagnostics

In order to identify the cause of bradycardia, it is necessary to undergo an examination. First of all, you should undergo an electrocardiogram. This method is based on the study of the passage of a bioelectric impulse in the heart. Thus, with sinus bradycardia (when the sinus node rarely generates an impulse), there is a decrease in heart rate while maintaining normal sinus rhythm.

The appearance of such signs on the electrocardiogram as an increase in the duration of the P-Q interval, as well as deformation of the ventricular QRS complex, its loss from the rhythm, larger number atrial contractions than the number of QRS complexes will indicate the presence of AV block in a person.

If bradycardia is observed inconsistently, but in the form of attacks, daily ECG monitoring is indicated. This will provide data on the functioning of the heart for twenty-four hours.

To clarify the diagnosis and identify the cause of bradycardia, the doctor may prescribe the patient to undergo the following tests:

Treatment of bradycardia

Physiological bradycardia does not require any treatment, as does bradycardia that does not affect general well-being. Therapy of pathological bradycardia is started after finding out the cause. The principle of treatment is to influence the root cause, against the background of which the heart rate is normalized.

Drug therapy consists of prescribing medications that increase heart rate. These are medications such as:

The use of these drugs has its own characteristics, and therefore only a doctor can prescribe them.

If hemodynamic disturbances occur (weakness, fatigue, dizziness), the doctor may prescribe tonic medications to the patient: tincture of ginseng, eleutherococcus, caffeine. These drugs increase heart rate and increase blood pressure.

When a person registers severe bradycardia and against this background, heart failure develops - they resort to implantation of a pacemaker in the heart. This device independently generates electrical impulses. A stable preset heart rhythm favors the restoration of adequate hemodynamics.

Grigorova Valeria, medical observer

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FUNCTIONAL STUDY OF THE AUTONOMIC NERVOUS SYSTEM

"A living organism is more than the sum of its parts." Life processes in individual organs are united by higher regulatory mechanisms into a wonderful whole, full of deep meaning, without which maintaining life would be impossible.

The autonomic nervous system is part of these regulatory mechanisms. In a complex interaction, it is closely related to the endocrine glands and many other regulatory apparatuses of vegetative functions (mineral, vitamin, acid-base balance etc.), which ensures the integrity and consistency of all functions within the body itself.

In contrast, the central nervous system regulates the active and passive interactions of the body with the outside world, which, through positive and negative impulses arising in the brain, are decisive in the nervous regulation of autonomic functions. At the same time, the interstitial brain is the center of the unified regulation of the most important vegetative processes in the body: blood circulation, respiration, metabolism, blood system, water metabolism and heat regulation.

Bykov, continuing his work on the conditioned reflexes of his great teacher Pavlov, proved that all reflex processes of nervous activity in the body proceed through the mechanism of conditioned reflexes, i.e. through the cerebral cortex, which is capable of establishing time-limited connections with any part of the body and such ensure its adaptation to the constantly changing conditions of the internal and external environment.

With such diverse interconnections, relationships and continuously changing interactions, a number of difficulties are created in conducting functional tests of the autonomic nervous system. The main disadvantage of most of these tests is the lack of sufficient specificity. The action of a given stimulus in one part of the autonomic regulatory mechanism often causes the entire functional system. Therefore, almost all tests for the study of the autonomic nervous system suffer from certain shortcomings from the very beginning. Thus, the values ​​of blood pressure, blood sugar or pulse rate detected at rest in no way give the right to draw any conclusions about the state of compensatory processes, in relation to which the autonomic nervous system plays a leading role.

In addition, when conducting most functional tests, unilateral loads that are not encountered under normal conditions are used, which are also carried out in an environment (hospital) alien to the actual living conditions of the test subject. Moreover, most of the loads that are related to the profession or work are precisely absent in these samples.

Therefore, one usually has to be content with only a general statement of functional deviations of the autonomic nervous system from the norm. However, this is already valuable. It is also of great importance to be able to use some of these samples to distinguish organic disorders from purely functional.

In the main regulatory mechanisms of the autonomic nervous system, there is a polarity of two types of influences, which are generally antagonistic: the sympathetic and parasympathetic (vagus nerve) nervous system. Basically, all organs are supplied to the same extent with fibers from both departments. The predominance of the influence of one of the departments is clinically manifested by a number of symptoms, observation of which makes it possible to come to important conclusions regarding the functional state of autonomic regulation.

In the table on page Determination of the type of reactivity using anamnesis, this antagonism of the functions of the sympathetic and parasympathetic nervous system is clearly compared according to the data given by Hoff. Functional antagonism between the sympathetic and parasympathetic nervous systems does not have universal significance, since it is not found in a number of organs and is often absent even in organs with double autonomic innervation.

From among the numerous methods at our disposal for studying the functions of the autonomic nervous system, only a few have been selected and presented below, which have proven themselves in practice and do not require special equipment or high costs.

Carrying out functional tests requires strict adherence to certain general rules. In this case it is necessary:

a) Carefully establish initial values ​​by conducting repeated tests on different days, if possible on an empty stomach, with the patient in complete physical and mental rest, without changing the therapeutic regimen (for example, prescribing or stopping treatment affecting the autonomic nervous system).

b) Always carry out tests at the same hours of the day (changes in the nature of autonomic reactions depending on fluctuations in the daily rhythm of physiological functions) and under the same biological state of the body, especially in women.

c) To identify the nervous regulation of autonomic functions, it is not so much static indicators at a given moment (like a cross section), such as, for example, a single measurement of blood pressure or a single determination of blood sugar, that are suitable, but rather systematic observations of changes in a number of indicators in the form of daily, weekly and monthly curves (like a longitudinal section), giving a more complete picture. The most valuable insights can be obtained through stress testing. These loads can be either of a somatic nature (in the form of bending the knees, climbing stairs, exposure to cold and heat, etc., or in the form of using medications), or of a mental nature.

Sympathetic nervous system

Parasympathetic nervous system

Increasing minute volume, enhancing the function of automaticity, conductivity, contractility and excitability

Decrease in cardiac output, inhibition of automatic function, conductivity, contractility and excitability

Increased blood supply to working skeletal muscles.

Increased blood circulation in the coronary and pulmonary arteries, decreased blood supply to the skin and mucous membranes

Decreased blood supply to skeletal muscles

Reduced blood circulation in the coronary and pulmonary arteries, increased blood supply to the skin and mucous membranes

Increased excitability of the respiratory center

Increased tidal volume

Increasing blood supply and blood filling of the lungs

Decreased excitability of the respiratory center

Decreased tidal volume

Decreased blood supply and blood filling to the lungs

Energy consumption, decay processes

Increase metabolism

Increased body temperature

Increased protein breakdown

Tendency towards acidosis

Decrease in K/Ca ratio

Conservation of energy, rest, synthesis processes

Decreased metabolism

Decreased body temperature

Minor protein breakdown

Tendency towards alkalosis

Increasing the K/Ca ratio

Release of blood from the depot

Increase in the number of red blood cells

Sympathetic nervous system

Tendency towards a shift towards myeloid elements in the white blood picture

Decreased eosinophil count

Accumulation of blood in the depot

Decreased red blood cell count

Parasympathetic nervous system

Tendency towards lymphatic cells in the white blood pattern

Increased number of eosinophils

Closing the entrance (cardia)

Stomach: weakening of tone and inhibition of peristalsis

Inhibition of secretion of the glands of the fundus of the stomach

Small and large intestines: decreased tone and inhibition of peristalsis

Opening the entrance (cardia)

Stomach: increased tone and increased peristalsis

Increased secretion of the glands of the fundus of the stomach

Small and large intestines: increased tone and increased peristalsis

Inhibition of insulin production and external secretion

Increased insulin secretion and external secretion

Widening of the palpebral fissure to bulging eyes (exophthalmos)

Narrowing of the palpebral fissure (enophthalmos)

Inhibition of urination, relaxation of the muscle that empties the bladder (m. detrusor)

Increased sphincter tone

Increased urination, increased tone of the muscle that empties the bladder (m. detrusor)

Vasodilation and erection

d) When stress tests it is necessary to pay attention to the exact dosage, as well as the speed of administration of a particular substance, and when repeating or conducting several tests, to a sufficient period of time between them. The reaction to the load must completely subside before starting a new test.

e) To assess the general condition, it is always necessary to conduct several additional studies suitable for clarifying the question posed to the researcher. In fact, almost everything functional studies individual organs, provided that they do not indicate damage to these organs, can also be used as functional tests of the autonomic nervous system.

f) When discussing the results, Wilder's law on initial quantities should be observed. According to this law, a person, even with strict adherence to experimental conditions, does not have a constant, characteristic reaction for a given person to substances acting on the sympathetic and parasympathetic parts of the nervous system. The more active a given organ is, the less its excitability in relation to activating influences and the greater its sensitivity in relation to inhibitory influences. When the initial value of irritation reaches its maximum strength, excitability simultaneously becomes equal to zero, and vice versa.

When functional mobility immediately before excitation exceeds a certain limit, a paradoxical reaction occurs, possibly as a consequence of an antagonistic effect. This corresponds to those patterns that are designated as “restructuring”, “change in functional state”, “antagonistic regulation” and which are, as it were, a protective reaction of the body.

When discussing and assessing the results of tests on the function of the autonomic nervous system, it is recommended to proceed from the division of the initial reactive state according to Birkmeier-Winkler, according to which we distinguish:

a) Increased tone of the sympathetic nervous system, which is a fixation of increased excitation in the sympathetic nervous system (sympathicotonia - sympathicotonic reactive phase of switching of the autonomic nervous system).

Signs: test indicators are very labile, lying above the normal limits of fluctuations, hyper-regulatory (irritable) type under load.

b) A decrease in the tone of the sympathetic nervous system, which often occurs secondary to long-existing sympathicotonia and occurs when the sympathetic nervous system fails and is exhausted (Selie's state of exhaustion).

Signs: the readings of many samples are determined below the normal limits of fluctuation; absence positive reactions after exercise; refractory (rigid) type or even paradoxical reactions; various vegetative functions often do not occur in parallel, but are dissociated.

c) Increased tone of the parasympathetic nervous system, which is expressed in the predominance of vagal innervation. Indicators of tests at rest are determined significantly below the norm, reactions to loads are similar to the type of reactions indicated in section “b”.

Despite this, after exercise there is not lability, but, on the contrary, stability of the ratios (for example, basal metabolism).

d) Amphotonia, which is characterized by the same degree of overstrain of both the sympathetic nervous system and the vagus nerve. However, it is often impossible to clearly distinguish between these conditions, so in these cases we can only talk about a general functional disorder of the autonomic nervous system in the sense of autonomic dystonia as a reactive state.

Physical and mental signs

Increased tone of the sympathetic nervous system

Increased tone of the parasympathetic nervous system

Decreased tone of the sympathetic nervous system

Short sleep or insomnia, late falling asleep, restless sleep, disturbing dreams

Deep, long, dreamless sleep; slow transition to wakefulness in the morning

Sleep is possible at any time of the day or night due to exhaustion of nervous activity

General health and ability to work

Variable ratios: relatively good performance, especially in the evening, high but short-term performance

Maximum performance before lunch, rapid decrease in energy. Long-term performance

Performance only for a short period: very rapid fatigue during physical and mental stress

For vegetative disorders caused by physical factors, the greatest performance is in the morning, and for vegetative disorders caused by mental factors, in the evening

Intolerance to excessively hot and crowded rooms, extreme cold; tendency to sweating or chilliness, as well as febrile infection

Feeling of heat, increased sensitivity to dry heated air

Chilling, great sensitivity to cold, often low temperature. Patients feel well only in warm rooms

Reduced excitability, but extremely increased sensitivity; need for peace and protection; ideas of depersonalization

Often complaints from the heart (palpitations, feeling of pressure, stabbing, squeezing).

Headaches in the evenings, flickering in the eyes, fog before the eyes, migraines

Feeling of a lump (globus) in the throat, dry mouth, hoarseness, especially when excited

Polyuria, decreased potency or libido, dysmenorrhea or amenorrhea

Cold hands and feet, numbness in the fingers at night, numbness and loss of strength in the hands and feet in the morning

In the foreground, depending on mental stress, complaints from the gastrointestinal tract (burning throat, nausea, cramping pain in the upper abdomen, diarrhea or constipation)

A feeling of tightness in the heart area combined with arrhythmias, especially at night and when lying down

Transient catarrh of the respiratory tract

Absence of potency disorders, sometimes early ejaculation (ejaculatio praecox)

Balance disturbances with darkening of the eyes, rapid visual fatigue. When under strain, rapid fatigue, palpitations and shortness of breath. Feeling of pressure after eating, constipation. Significant potency disorders with weakened libido in both sexes

The idea of ​​the functional state and compensatory capabilities of the autonomic nervous system is of practical importance for the doctor. By objectively identifying dysfunctions of the autonomic nervous system, it is possible to make a more correct judgment about patients with complaints who do not have significant changes in the organs, and based on the data of determining the nature of the reactive state, justify the choice of a drug and its dosage.

Effects of the sympathetic and parasympathetic nervous system

45. The main symptoms characteristic of the prevalence of the influences of the sympathetic and parasympathetic departments. Vagotonia, sympathotonia, normotonia.

Vagotonia (obsolete; vagotonia; vago- + Greek tonos tension; synonym parasympathicotonia) - the predominance of the tone of the parasympathetic part of the autonomic nervous system over the tone of its sympathetic part. Manifested by bradycardia, decreased blood pressure, hypoglycemia (, a pathological condition characterized by a decrease in blood glucose concentration below 3.5 mmol/l, peripheral blood below normal, resulting in hypoglycemic syndrome .), hyperhidrosis (excessive sweating).

Most common reasons development of vagotonia are

• neuroses,
• non-rough organic lesions of the brain,
• stem and hypothalamic disorders.

• cold and damp skin,
• sweating,
• hypersalivation, Hypersalivation (another name is ptyalism) - increased secretion of salivary secretion due to increased activity of the salivary glands.
• bradycardia,(Bradycardia- this is a violation of the heart rhythm (arrhythmia) in the direction of reducing the frequency of contraction. Normally, the frequency of contractions in adults ranges from (at rest) to 140 (during physical activity) times per minute. A pulse below 60 times per minute is considered rare and such a heart rhythm disorder is called bradycardia.)
• a tendency towards orthostatic hypotension, this is a long-term condition characterized by low blood pressure - less than 100/60 mmHg. due to decreased vascular tone. Previously, the term vegetative-vascular dystonia (VSD) was used for the hypotonic type.
• respiratory arrhythmia,
• tendency to faint.

Patients are slow, phlegmatic, indecisive, prone to depression, and have little endurance.

Vagotonia is manifested by disturbances in the functioning of the respiratory system, periodic sensations of lack of air and poor tolerance low temperatures. Disorders may occur digestive system– diarrhea or constipation, abdominal pain, various allergic reactions, swelling under the eyes. All these symptoms can appear both periodically and constantly. Frequent night pains - in the legs, abdomen.

Vagotonia is often accompanied by various cardiovascular disorders. First of all, these are pain in the heart area, low blood pressure or sudden periodic drops in pressure. In this case, the heart has a reduced tone, the number of beats per minute can decrease from 65-70, which is normal for a child, but the physical size of the heart muscle can be increased. In addition, bradyarrhythmia - irregularities in the heart rhythm - can be periodically recorded.

Drug therapy is prescribed in combination with non-drug drugs or if the latter are ineffective.

Treatment should begin with herbal preparations that have the least side effects. Considering the duration of treatment, several medications should not be prescribed at the same time; it is advisable to replace one drug with another.

Sympathotonia (increased sympathetic tone) People with sympathicotonia are characterized by temperament, ardor, volatility of mood, increased affectivity towards pain, neurotic conditions. Objectively, more frequent beating and breathing, increased blood pressure, and pallor are determined skin, chill-like hyperkinesis (involuntary movements in various muscle groups).

46. ​​Basic functional tests aimed at diagnosing the prevalence of influences of the sympathetic and parasympathetic departments

(sympathicotonia; Sympathico- + Greek tonos tension)

the predominance of the tone of the sympathetic part of the autonomic nervous system over the tone of its parasympathetic part.Sympathicotonia – the relative predominance of the tone of the sympathetic part of the autonomic nervous system over the parasympathetic, for example, with melancholic depression, manifested by symptoms such as mydriasis, tachycardia, a tendency to arterial hypertension, dry mucous membranes, pale skin, tendency to constipation, decreased secretion of tears, etc.). In psychopathology, symptoms of sympathicotonia are most often accompanied or manifested by melancholy, melancholic and, possibly, hidden depression.

49. The main differences in the mechanism of information processing by the right and left hemispheres of the human brain

The brain consists of two hemispheres, left and right. The cortex of one hemisphere is not connected to the cortex of the other. Information is exchanged between the hemispheres corpus callosum. If we draw an analogy with a computer, the left hemisphere of the brain functions as a serial processor. Information is processed by the left hemisphere in stages. The right hemisphere works as a parallel processor; it can process a lot of different information simultaneously. Left hemisphere responsible for logic and analysis. It is it that analyzes all the facts, systematizes them. The right hemisphere thinks in images, intuition, fantasies and dreams are in its power.

According to all the laws of general symmetry of the human body, the left and right hemispheres are almost exact mirror images of the other. Both hemispheres are responsible for controlling and controlling the basic movements of the human body and its sensory functions, with the right hemisphere controlling the right side of the human body, and the left hemisphere controlling the left.

There are several types functional organization two hemispheres of the brain:

dominance of the left hemisphere - the verbal and logical nature of cognitive processes, a tendency to abstraction and generalization (left-hemisphere people);

dominance of the right hemisphere - concrete imaginative thinking, developed imagination (right-hemisphere people);

lack of pronounced dominance of one of the hemispheres (equihemispheric people).

Slightly less than half of people belong to unilaterally represented right-hemisphere and left-hemisphere response types.

50. Manifestations of functional asymmetry of the brain.

Functional asymmetry of the cerebral hemispheres, understood as the participation of the left or right hemispheres of different nature and unequal importance in the implementation of mental function, is not global, but partial in nature. In different systems, the nature of functional asymmetry may be different. As is known, motor, sensory and “mental” asymmetries are distinguished, and each of these asymmetries is divided into many partial types. Within motor asymmetries, manual (manual), foot, oral, oculomotor, etc. can be distinguished. Manual asymmetries are considered to be the leading among motor asymmetries, but other types of motor asymmetries and their connection with manual asymmetries have not yet been sufficiently studied. Sensory forms of asymmetry include visual, auditory, tactile, olfactory, etc. “Mental” forms include asymmetry in the brain organization of speech and other higher mental functions (perceptive, mnestic, intellectual).

Analyzing the relationship of only three types of asymmetries (hand - eye - ear), A.P. Chuprikov and his colleagues identified 8 variants of functional brain asymmetries in the normal population. When taking into account other types of motor and sensory asymmetries, their number should be many times greater.

Thus, there are many variants of normal functional asymmetry of the cerebral hemispheres when assessing even only elementary motor and sensory processes. An even greater variety of asymmetry options will be revealed if the characteristics of all higher mental functions are taken into account. Introduction to right-handed people (with presenter right hand) as a homogeneous group of the population is unlawful. Even more complex and homogeneous are the groups of left-handers (with the leading left hand) and ambidextrous people (with the leading both hands).

The real picture of asymmetries and their combinations in normal conditions is very complex. Of course, only “asymmetry profiles” (i.e., certain combinations, patterns of asymmetries of different functions) are very diverse. Their study is one of critical tasks modern natural science, including neuropsychology.

Each specific form of functional asymmetry is characterized by a certain degree, measure. Taking into account quantitative indicators, we can talk about strong or weak (motor or sensory) asymmetry. To accurately characterize the severity of a particular asymmetry, some authors use indicators such as the asymmetry coefficient. Therefore, partial characteristics of asymmetry must be supplemented with quantitative data.

Functional asymmetry of the cerebral hemispheres in an adult is a product of the action of biosocial mechanisms. As studies conducted on children have shown, the foundations of the functional specialization of the hemispheres are innate, however, as the child develops, the mechanisms of interhemispheric asymmetry and interhemispheric interaction improve and become more complex. This fact is noted both in terms of bioelectric activity of the brain and in experimental psychological indicators, in particular, using the dichotic listening technique. The asymmetry of bioelectrical indicators manifests itself in the motor and sensory areas of the cortex earlier than others, and later in the associative (prefrontal and posterior-parietal-temporal) areas of the cerebral cortex. There is evidence of a decrease in EEG indicators of asymmetry in old age. Thus, there is an ontogenetic and generally age factor that determines the nature of functional asymmetry.Functional asymmetry of the brain – this is a complex property of the brain, reflecting the difference in the distribution of neuropsychic functions between its right and left hemispheres.

The study of interhemispheric differences is of great importance for solving problems in education. According to Joseph Bogen, the current emphasis in the educational system on the acquisition of verbal skills and the development of analytical thinking causes neglect of the development of important non-verbal abilities. And under such conditions, one half of the brain is “starving” and its potential contribution to the development of the individual as a whole is ignored.

According to Springer and Deitch, the study of laterality should be in those directions that relate to dexterity and spatial orientation, it should be an indispensable factor in assessing the school maturity of a child upon entering school. It is important in all cases: educational difficulties, behavioral disorders. It is necessary to carefully study the state of the child’s health, organ functions, motor skills - here the problem of laterality arises - the manifestation of the action and interaction of the cerebral hemispheres.

Research on brain asymmetry has sparked interest in common problem disparities between the right and left hands and showed differences between left and right hands in relation to the organization of the brain, which allows us to ask a number of questions: what is the significance of these differences, if any, for intelligence and creative abilities?

What factors primarily cause left-handedness (genes, life experiences, minor brain damage)?

The problem of functional asymmetry of the cerebral hemispheres is very complex because differences in the functioning of the left and right hemispheres are masked by the redundancy of brain activity, which ensures duplication and increases its reliability.