Agraphia

The ability to express thoughts on paper, and even just write words correctly, combines several functions: speech, information perception, and motor. A violation of this ability, up to its complete loss, while maintaining hand motor skills and intelligence, is called agraphia (literally, the denial of writing).

Epidemiology

Medical statistics note that various forms of disorganization of written speech are quite often observed in adults as a particular manifestation of broader syndromes of aphasia or cognitive disorders. The most common risk factor for the development of agraphia is acute cerebrovascular accident. Every year, 460 to 560 people out of every 100,000 inhabitants of the planet are hospitalized with this diagnosis.

Congenital disorders of oral and written speech are singled out as a special form, implying a long-term inability to teach a child to read and write, while all other functions of his psyche are within the norm or have minor deviations, including intelligence. Although, of course, such defects are much more common among mentally retarded children with a hereditary burdened family history - children of psychopaths, epileptics, alcoholics.

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Causes agraphy

The partial or complete loss of already formed written speech is caused by the disintegration of mental functions involved in its implementation and control. This pathology is almost never found in isolation. Agraphia is mainly part of a symptom complex in speech disorders, and not even the leading one. The cause of different variations of the inability to write is the localization of damage to the cerebral cortex. With damage to the posterior part of the second frontal gyrus of the dominant hemisphere, isolated agraphia can be observed, the pathological process on the border of the angular and second occipital gyrus leads to a combination with alexia (impaired ability to read and perceive what has been read). Lesions in the parietal-occipital zone cause agraphia as a symptom of motor aphasia, and on the border of the first temporal gyrus with the supramarginal - lead to significant disorders of written speech.

The mentioned areas of the brain can be damaged as a result of neoplasm, traumatic brain injury, inflammatory processes of infectious and non-infectious nature, hemorrhage and ischemia of cerebral vessels, intoxication of various origins, neurosurgical operation.

Risk factors

Risk factors for the development of agraphia in childhood: intrauterine brain damage as a result of pathological pregnancy of the mother, asphyxia of the newborn, birth trauma, severe infectious diseases in the postnatal period.

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Pathogenesis

The pathogenesis of agraphia is associated with disturbances due to any of the above-mentioned reasons of the interhemispheric organization of mental activity. Speech processes are controlled by the dominant hemisphere and are provided by joint coordinated actions of the dorsofrontal, temporal, anterior occipital and lower parietal zones of the cerebral cortex; when they are damaged, the ability to use written speech is impaired.

The pathogenetic links of this rather complex process can be various brain disorders and, therefore, it can manifest itself in different forms, which should be taken into account when restoring the ability to express speech on paper.

1. Disorders of oral speech, unconditional mastery of it, inability to analyze events and coherently express one's thoughts out loud cause speech agraphia, as a symptom of the syndrome of motor or sensory impairment of already formed speech (aphasia). Usually correspond to damage to the cerebral cortex in the area of the upper temporal, dorsal frontal or lower parts of the parietal.
2. Disturbance of sensory and gnostic perception and their interaction causes gnostic (non-speech) agraphia. They are signs of a syndrome of impaired perception (auditory, optical, spatial, their combinations). Usually correspond to damage to areas of the cerebral cortex in the parietal and occipital areas.
3. Disorders of fine motor skills of hands, various types of their adequately coordinated actions (disorders of switching, mobility, etc.), as well as motivation, regulation, control of one's activity cause agraphia as a disorder of purposeful behavior. Corresponds to damage to the frontal areas of the cortex of the left hemisphere of the brain.

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Symptoms agraphy

The first signs of the disease appear when a person needs to write something. He takes a pen or pencil in his hands correctly and cannot remember a single letter and reproduce them on paper, or is unable to connect letters into syllables, and syllables into words. Sometimes the text written by the patient or copied by him is mirror-symmetrical - this form is typical for left-handers. Agraphia can be expressed in the endless repetition of the same letter combination - polygraphia, or in writing letter-word gibberish devoid of any meaning - paragraphia.

In the mild stage of the disease, the patient writes with errors and omissions, but a readable text. It can be copied, although not always correctly, or written under dictation. In severe forms, agraphics cannot reproduce a single letter, they write some circles or dashes, sometimes having written the letters correctly, they cannot connect them into syllables and words.

There are different types of written speech disorders. Isolated agraphia is extremely rare, as a rule, it is combined with alexia - a disorder of semantic perception, comprehension and retention of read information in memory. Sometimes only the fluency of reading is impaired, in severe cases the patient does not recognize letters and cannot put them into words, confuses visually similar letter symbols. Alexia and agraphia are part of the symptom complex of various types of speech function disorders (aphasia).

If agraphia is the loss of the ability to write, then dysgraphia in children is the inability or great difficulties in the process of mastering writing, expressed in writing with constant errors, in the absence of hearing defects and mental retardation. Usually, difficulties with written speech are inextricably linked with the inability to master reading (dyslexia). Heredity plays a major role in the genesis of these pathologies.

Secondary dysgraphia and dyslexia in childhood include writing and reading disorders if the child cannot cope with the workload in primary school, failing to meet the time limits for reading speed, making mistakes in written assignments or, not having a good auditory memory, cannot retell the assigned text. Secondary dysgraphia and dyslexia in children are not considered pathological.

Dysgraphia in adults is a partial or complete inability to write, considered in the symptom complex of different types of aphasia syndrome.

Agnostic disorders often go together, so agraphia (inability to write) can manifest itself simultaneously with acalculia – a disorder of number perception, loss of the ability to count and perform arithmetic operations. The patient cannot remember and write down not only a series of letters, but also a series of numbers, and has no ability to compare numerical values. Sometimes the disease manifests itself as an inability to perform a specific arithmetic operation, for example, the patient cannot subtract numbers, but addition does not cause him any difficulty. Or a person does not perceive numbers that contain a specific digit, for example, “5”.

Often, the inability to count and write is accompanied by disturbances in oral speech and loss of the ability to read. In cases of damage to the temporal zone, acoustic perception is impaired, in the occipital zone, visualization, and in the prefrontal zone, planning and control functions are impaired.

Motor agraphia occurs when the functions of the dorsal frontal cortex of the brain are impaired. It is subdivided into efferent, when the kinetic basis of oral speech is impaired, that is, the ability to pronounce syllables and words in their entirety. In this case, the patient does not observe the necessary letter sequence in syllables and words when writing, and the writing of the letter symbols themselves does not suffer. And afferent, when the patient does not distinguish individual sounds that are close in pronunciation - the execution of articulatory movements.

Symptoms of efferent motor agraphia include multiple errors in written text, up to and including complete inability to write. A person may write very slowly, with altered handwriting with angular, unfused letters. There are permutations and omissions of letters, repetitions of syllables and words, unfinished words in the text, the structure of a sentence and understanding of its meaning are disrupted. In severe cases of damage, patients cannot write anything except speech stereotypes (name, surname, address, country of residence, etc.).

In patients with the afferent form, the kinestatic basis of speech motor skills is disrupted. It is often found in the symptom complex of motor aphasia. This type of agraphia is characterized by the loss of the sensation of articulatory boundaries when differentiating sounds that are similar in reproduction. Typical symptoms: replacement of some letters with others when writing words and sentences, denoting sounds with a similar articulatory technique of reproduction; omission of letters denoting consonants when they coincide or vowels; syllables may be omitted in the middle of words. This type of agraphia is characterized by disruption of all types of writing, except for rewriting text. The process of writing under dictation and expressing one's thoughts on paper is most disrupted. Automatism of writing is practically absent. A complete or partial misunderstanding of the meaning of what is written is typical, however, the linear unit of speech and the layout of the written phrase are more or less preserved.

Amnestic or pure agraphia is detected when the patient cannot match a sound unit of language with its image on paper. In the text written by ear or independently, there are gross grammatical errors, missing letters in words, missing words in phrases, and broken punctuation. Sentences can be written from right to left (mirror image). The most readable text is obtained by rewriting.

Sensory agraphia is associated with disturbances in sound perception associated with a disorder of sound discrimination (defects in the sensorimotor mechanism of acoustic perception of speech sounds), therefore, the main symptom of this form of the disease is the inability to write at all and, mainly, under dictation. Independent writing also disintegrates, the ability to rewrite texts may partially be preserved, but the automatism of this action disappears and only the ability to copy one letter at a time remains. Patients are either completely incapable of writing or have severe disturbances in this ability. Idiogram writing may be preserved, with mild degrees of damage the text is abundantly filled with letter paragraphs, while the replacement of letters occurs according to a kinesistatic feature (meaning sounds similar in reproduction). This type of agraphia is usually part of the symptom complex of sensory aphasia syndrome - a disorder of active speech and independent writing, as well as its perception and understanding.

Some specialists distinguish another form of agraphia – acoustic-mnestic, which occurs as a result of some morphological features of the structure of the second temporal gyrus of the left hemisphere. This is an insufficiently studied pathology and not all specialists agree with its classification as a separate type of agraphia.

Acoustic-mnestic agraphia is characterized by a disorder of the higher processes of writing organization. The symptoms of this type are the patient's subjective feeling that he cannot write. It is not the skill of written speech that is impaired, but its level, the automatism of the process disappears, the patient is completely unable to write independently, although his skills are not affected and the perception of the sound series is not impaired. In patients, the one-time perception of information (simultaneous) is replaced by a step-by-step (successive) one, stretched out in time. When step-by-step actions are impaired, the holistic picture of the text read or listened to does not form. The patient's volume of sound perception is impaired, he confuses the names of actions and objects, repeats himself, confusion arises in letter symbols, while other forms of perception are preserved, attention, general motivation, purposefulness and verbal behavior are not impaired.

With this form of agraphia, writing is conscious, voluntary and very slow. Typical spelling errors are unfinished words, substitution of parts of words.

Apraktic agraphia usually occurs with the ideational form of speech disorder. In this case, the patient loses the skills for habitual systematic and goal-oriented actions. He is unable to remember how to pick up a pen and the sequence of further actions is also unknown to him. Since the motor organization of the writing process itself is disrupted, all types of written speech are impaired, even simple copying is not possible. The text is obtained with gross distortions, the spatial relationship of its elements is disrupted, in severely ill patients, instead of letters, only chaotically located dashes are obtained. In this case, the border between the supramarginal gyrus and the angular gyrus is affected; much less often, this form of agraphia accompanies foci in the rear of the second frontal gyrus.

Opto-spatial agraphia is a variant of optical agraphia, affecting the visual image of a letter corresponding to a certain sound, and its spatial form. In addition to this type, optical, optomnestic, and apraktognostic forms of pathology are also distinguished. The latter is extremely rare. All four types are related to the fact that the graphic image of the sound is not perceived as a visual object, with preserved audio perception.

Such forms of agraphia correspond to foci in the lower sections of the parietal region of the cerebral cortex. In this case, the visualization of the image and its comparison with the graphic form is impaired. The patient hears and distinguishes sounds, but cannot reproduce a letter on paper, it is especially difficult for him to depict spatially oriented letter symbols, which are the majority in the alphabet. The symptoms include spatial distortions of letters, their elements and combinations, difficulties in selecting the desired letter.

Optical agraphia – differs from the previous form of the disease in that the patient does not remember the visual image of the letter at all, denoting a specific sound, he has a disordered recognition of the visual image of the letter symbol. Characteristic symptoms are the substitution of letters similar in appearance, a long search for the desired letter, very slow and arbitrary written speech. For the optical form of the disease, the ability to write, for example, only in printed letters or, conversely, in handwritten letters, with the impossibility of switching from one type of writing to another, is often preserved.

Optic-amnestic agraphia – the disorder is expressed in the fact that the patient remembers what letter symbols look like, can write them, but does not remember their meaning, and denotes sounds with existing, but not corresponding to them, letters. This form of agraphia is usually a symptom of amnestic aphasia, in which the patient cannot remember the names of objects.

Aprakto-agnostic agraphia is characterized by distortion of the spelling of letters, while the grapheme is preserved.

In case of psychological disorders, such types of agraphia as dynamic agraphia may develop, when the order of sentence structuring, the agreement of words within it and sentences in the text are disrupted, and semantic agraphia, when difficulties arise when using complex logical grammatical constructions that convey shades of meaning, comparisons, etc. In such disorders, written speech is disrupted at the highest levels of its organization as a means of expressing thoughts. There are no disturbances in the sensory and motor skills of written speech.

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Complications and consequences

Since the loss of the ability to write, partial or complete, is provoked by pathological processes developing in the cerebral cortex, the consequences of even minor signs of agraphia can be very serious. Therefore, the appearance of the first signs of a disorder of written speech should be a reason for a serious examination of the brain, since it can signal the presence of a developing tumor, ischemic process, microstroke, the timely treatment of which can lead to a complete restoration of functions, and an advanced process is fraught with aggravation, disability and even mortality. A person who has lost the ability to write texts has a greatly reduced level of self-esteem, quality of life, the likelihood of finding a job and leading an independent existence.

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Diagnostics agraphy

It is not difficult to establish that the patient has lost the ability to use written language to any extent. After examining the patient's complaints, he is asked to complete tests on writing under dictation, rewriting, independent and idiogram writing. The patient's capabilities and the types of errors made during the test are analyzed.

Not only the patient's speech processes are examined. The state of his motor and cognitive functions is also assessed comprehensively.

It is much more difficult to establish the cause of the pathology that has arisen. Sometimes it lies on the surface, if the appearance of agraphia was preceded by trauma, severe infection, in other cases more hidden causes must be discovered. Laboratory and instrumental diagnostic methods are used to establish the causes and depth of the pathology that has arisen.

The patient is prescribed clinical tests. They, of course, cannot indicate the immediate cause of agraphia, but they are necessary to assess the general condition of the patient and identify inflammatory, intoxication processes, and concomitant diseases.

Modern instrumental studies – electro- and echoencephalography, skull radiography, examination of blood circulation in the vessels of the brain (rheovasography), magnetic resonance or computed tomography, if necessary with the use of contrast, will help to accurately determine the location of the lesion of the cerebral cortex.

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Differential diagnosis

Differential diagnostics is performed at the final stage of the examination. Having combined the anamnesis data, they are considered from the point of view of determining the brain pathology that caused the written speech disorder.

Treatment agraphy

The process of restoring the ability to write is multi-stage and multi-component. First of all, the underlying disease is treated, sometimes surgical intervention is required. The patient is registered with a psychiatrist or neurologist, he undergoes a course of drug treatment. In parallel, classes with a speech therapist are prescribed, who, with the help of special classes, restores the work of areas of the cerebral cortex. Music classes are especially beneficial - singing, playing musical instruments. They develop (restore) fine motor skills of the hands and fingers. Speech therapy rhythm, dictations, summaries, reading - such regular classes, both individual and group, can be very effective, especially if the problem is addressed to specialists in a timely manner.

Drug therapy is designed, first of all, to provide nutrition to brain cells, stop the growth of the ischemic focus and restore blood circulation in this area.

Cereton can be prescribed to restore brain functions. The active ingredient of the drug is choline alfoscerate. When it enters the body, it is converted into acetylcholine (a conductor of interneuronal impulses) necessary for the normal functioning of the nervous system and a building material for damaged neuronal membranes - phosphatidylcholine. Impaired cerebral circulation and the functions of nerve endings are restored. The effect of the drug is manifested in the acceleration of impulses between neurons and the regeneration of damaged cell membranes, which becomes noticeable by the elimination of the patient's reactive inhibition, improvement of his memory, concentration, and learning ability. Neurological symptoms disappear and behavioral stereotypes improve.

The drug is eliminated mainly through the lungs with exhaled carbon dioxide (approximately 85%), the rest is excreted with the kidneys and intestines. As a restorative drug, capsules are taken for six months, while it is recommended to swallow two capsules in the morning, and one more during lunch. The drug is recommended for adult patients. It should not be taken by pregnant and lactating women and in case of allergy to the components. The most common side effect after taking is nausea, sometimes dyspeptic and neurological disorders can be observed.

To restore mental functions impaired as a result of strokes, intoxications, injuries and operations, other drugs with nootropic properties are also used. For example, Nootropil (active component - piracetam). This drug is represented by many synonyms (Cerebropan, Cyclocetam, Encephalux, Eumental, Noocephal, Piratam, Pyrrhoxil, Euvifor, Neutrophin, Noocebril, Norotrop and others). It has a positive effect on metabolic processes, in particular, glucose absorption, and cerebral circulation, activates enzymes of oxidation-reduction reactions, helps to reduce the area of ischemic areas of the cerebral cortex, increases the resistance of nerve cells to oxygen starvation and the effects of toxic substances. The nootropic effect is based on an increase in the production of dopamine and norepinephrine in brain cells, as well as acetylcholine in intercellular synapses. Eliminated by the kidneys, remains in the cerebrospinal fluid longer than in other organs and tissues, i.e. has the greatest affinity for brain tissue. Can be used to treat children from one year of age, pregnant and lactating women can use it, weighing the risk/benefit ratio. Use with caution in allergy sufferers with fructose intolerance. Side effects are neurological and dyspeptic in nature. The treatment is long-term, used in a daily dose of 2.4 g, divided into three doses before meals. Over time, the dosage is reduced to the minimum effective, gradually discontinued. The maximum daily dose that can be prescribed at the beginning of treatment is 4.8 g. The dose for children is calculated by a pediatric neurologist (no more than 0.03-0.05 g per day).

Neuroamino acid preparations may be prescribed. For example, Phenibut, which improves blood circulation in the vessels of the brain and restores metabolic processes in its cells. Increases intellectual performance, reduces negative psychoemotional symptoms. As a result of taking the drug, attention, memory, speed of perception and accuracy of responses improve quite quickly. It is well absorbed, tropic to brain tissue. It is eliminated mainly by the kidneys. It is not prescribed to children under eight years of age, pregnant and lactating women, or if there is intolerance to it. Side effects are similar to the previous drugs, it is low-toxic, but the dosage prescribed by the doctor should not be exceeded. The standard dose is 0.75-1.5 g per day, divided into three doses. The drug is taken before meals. It is not recommended to prescribe a higher dosage to elderly people; for adults, if necessary, the daily dose can be 2.25 g. Children aged 8-14 years usually take 0.75 g of the drug per day.

Glycine, a combination of the active component of the same name with vitamins B1, B6, B12, regulates metabolism, mental activity and other areas of neuropsychic activity. It easily crosses the blood-brain barrier, does not accumulate in organs and tissues, and is excreted as metabolites: water and carbon dioxide. It is contraindicated only in cases of allergy to the components. The drug should be prescribed by a doctor, the standard dosage involves taking one tablet two to four times a day.

Metabolic processes in the cerebral cortex, nutrition of its cells and blood circulation can be normalized with the help of preparations containing only vitamins. For example, Ascorutin, containing vitamin C and P (rutin), strengthens blood vessels, has a beneficial effect on erythropoiesis, and prevents thrombus formation. It is used together with blood thinning preparations.

In case of cerebrovascular accidents, depending on the patient’s condition, the doctor may prescribe different complexes containing B vitamins.

Angiovit (vitamins B6, B9, B12) is prescribed when the concentration of serum homocysteine increases to normalize it in cerebrovascular accidents. Take one tablet per day for three to four weeks.

In addition to those already listed, Pentovit contains vitamins B1 and B3, compensates for the deficiency of the vitamins included in its composition, which is often observed in neuropsychiatric disorders, improves tissue nutrition and metabolism of proteins, fats and carbohydrates. Prescribed from six to 12 tablets three times a day after meals for about a month.

It should be remembered that vitamins are taken only as part of a complex treatment and only as prescribed by a doctor.

All the above-described medications, including vitamins, are not compatible with alcohol.

Physiotherapeutic treatment increases the body's sensitivity to drug therapy, allowing to reduce the duration of drug intake and their dosage. At the initial stages of the disease, it can be used independently, but usually it is included in the treatment complex.

In neurological practice the following are used: laser therapy, magnetic therapy, darsonvalization, medicinal electrophoresis, oxygen and iodine-bromine, as well as dry carbon dioxide baths.

Folk remedies

At home, you can also organize classes with the patient - write dictations and essays or just letters with him. In order to nourish the brain cells and activate cerebral circulation, you can use traditional medicine recipes in complex treatment. However, before restoring brain functions in this way, you must consult with your doctor about the safety of using the methods you have chosen and their combination with the prescribed medications.

The easiest and safest way to cleanse the body, remove toxic substances and renew all organs is to suck a tablespoon of vegetable oil in the morning on an empty stomach. Apologists of this method claim that it works flawlessly, only the time spent on treatment depends on the degree of neglect of the disease: acute conditions can be eliminated in literally two days, and getting rid of chronic ones can take years. Any vegetable oil is suitable for this method, in particular, sunflower oil, which is not in short supply in our area. The oil is taken unrefined. After waking up in the morning, take about a tablespoon of oil in your mouth and suck it like a candy in your mouth, trying to get it under your tongue. This should be done for at least a quarter of an hour, you can not swallow the contents, since it becomes toxic. At the end of the process, you need to spit it out into the sewer or even bury it in the ground. During the sucking process, the oil first thickens, then becomes liquid and turns white - you can spit it out. After the procedure, rinse your mouth with clean water.

More labor-intensive, but also much more enjoyable is cleansing the body with beet kvass. It is prepared as follows: wash three medium-sized root vegetables with a vegetable brush (do not peel!), cut as for a salad (into small cubes) and put in an enamel pan with a capacity of three liters (you can use a glass jar), pour in two tablespoons of granulated sugar. Close the lid. Infuse for two days at a temperature of about 20 ℃, stirring the contents twice a day. Then pour two glasses of clean raisins (seedless) into the dish. Leave for another week, stirring the contents as before twice a day. The cleansing process begins on the eighth day: take a tablespoon of kvass before four meals. It is recommended to take a three-month course, then take a break. This cleansing is not suitable for hypotensive patients, since beets lower blood pressure.

The leaves of the relict tree Ginkgo Biloba have long been recognized by official medicine as a universal remedy for improving cerebral circulation and metabolism. The plant increases the resistance of brain cells to hypoxia, has antioxidant properties, has an antispasmodic effect and prevents the development of cerebral edema. With its help, rehabilitation after brain surgery, stroke and traumatic brain injury occurs much faster. Pharmacies offer various forms of herbal preparations made from Ginkgo Biloba leaves. These are over-the-counter products: tinctures, capsules, extracts and oils. Each form of release is accompanied by instructions for use.

These drugs should not be used in cases of ulcerative and erosive lesions of the gastrointestinal tract, acute cerebrovascular and coronary disorders, as well as in hypotensive patients, pregnant and lactating women, and people taking blood thinners.

Traditional healers do not object to the external use of Ginkgo Biloba leaves for the treatment of children, but official pediatrics does not approve of this.

Herbal treatment is used to stimulate metabolic processes in folk medicine. For example, it is recommended to prepare the following multi-component remedy on herbal infusion: take 100 g of yarrow and wormwood herbs, and the same amount of pine buds per three liters of cold water. Boil in an enamel pan and leave overnight, strain in the morning. Pour a kilogram of granulated sugar into the pan with the infusion, pour in one glass of aloe juice, boil it all and leave until the next morning. Strain again and boil again, then leave for seven hours. Add a kilogram of light flower honey, 500 ml of high-quality cognac, 100 g of befungin to this infusion. Mix well, put into glass jars and leave in a warm, dark place for a week. Drink one tablespoon three times a day half an hour before meals. It is recommended to undergo a three-month course of treatment.

Fresh birch sap is used for the same purpose, and not in season - leaves or buds. Birch products remove all unnecessary things from the body, stimulate metabolic processes and promote rejuvenation of all organs and tissues - the patient feels a surge of strength, becomes energetic and smart. For infusion, both young leaves and buds and dried ones (sold in pharmacies) are used. They are brewed at the rate of 10 g per 200 ml of boiling water.

To restore cerebral circulation during the rehabilitation period after its acute impairment, it is recommended to take a third (quarter) of a glass of herbal infusion three or four times a day for two to three months. First, mix the dried and crushed parts of the plants: a handful of thyme and oregano; two handfuls of mint leaves, valerian roots and hop cones; four each of geranium leaves, meadowsweet flowers, motherwort and St. John's wort. Add five handfuls of fireweed and mix well. Pour two tablespoons of the dry mixture into a thermos and pour in ½ liter of boiling water. Leave overnight, strain in the morning and take during the day.

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Homeopathy

Complex homeopathic preparations included in treatment regimens or prescribed as monotherapy can improve the nutrition of brain cells and blood microcirculation in its vessels.

Ubiquinone compositum cleanses the body of toxins and waste, stimulates metabolic processes and tissue respiration, binds free radicals, and reduces inflammatory and allergic manifestations.

Coenzyme compositum has the same properties due to a slightly different composition of homeopathized components. These complex drugs can be used with any drugs. They are used both in acute cerebrovascular accidents, any inflammatory and infectious processes, neoplasms, and during the rehabilitation period to increase resistance to hypoxia and restore impaired nutrition, respiration and blood circulation. The manufacturer recommends alternating these two drugs to achieve a quick therapeutic effect and does not even exclude the possibility of their simultaneous use. The standard course includes at least ten injections, but the frequency of administration and duration of treatment should be prescribed by a doctor. The drugs can be prescribed to children, Ubiquinone compositum is not recommended for use in the treatment of pregnant and lactating women, and the use of Coenzyme compositum in such cases is permissible at the discretion of the doctor.

Cerebrum compositum has a multifaceted effect on the functioning of the brain, including improving the interaction between the left and right hemispheres. Strengthens the walls of blood vessels, prevents their fragility, has a moderate vasodilatory and antispasmodic effect, activates cellular nutrition. It is used in the rehabilitation period after brain injuries, acute cerebrovascular accidents, neurosurgeries, inflammatory and infectious diseases.

All the above-mentioned drugs are injections, administered by any means. Agraphia becomes noticeable in children, usually from the age of six, they are already prescribed adult dosages. The drugs are administered with a frequency of one to three times a week, one ampoule at a time.

Ubiquinone and Cerebrum compositum can be taken orally by diluting one ampoule in 50 ml of clean water and drinking the contents throughout the day in equal portions.

For more effective and rapid rehabilitation after a nervous system disorder, especially in patients with increased nervous excitability, drops or tablets Nervoheel can be used. This drug has a beneficial effect on memory, improves psychoemotional status. Can be used at any age.

Of course, the most stable and effective drug will be the one prescribed by a homeopathic specialist individually. The homeopathic arsenal is used in different periods of illness, both acute and chronic. Arnica is a first aid remedy for injuries of various localizations, including craniocerebral ones.

The consequences of trauma and/or surgical interventions on the brain are well treated with the following drugs: Natrium sulfuricum and Helleborus niger. For hemorrhagic and ischemic strokes, homeopathic granules Veratrum viride, Baryta carbonica and Baryta iodata can be prescribed. To restore the blood vessels of the brain in the ischemic zone, Ambra grisea, Lachesis and Phosphorus are used.

Surgical treatment

Surgical treatment may be indicated for patients with written speech disorders due to acute cerebrovascular accident, craniocerebral trauma, and brain tumors. These may include open-type surgeries and minimally invasive interventions, such as selective thrombolysis – dissolution of blood clots blocking a vessel, removal of hematomas resulting from a stroke or trauma, and tumors. The scope of the surgery is determined by the type of pathology and the patient’s condition. Sometimes surgical intervention gives noticeable and rapid results.

However, sometimes neurosurgical operation itself becomes the cause of agraphia.

Prevention

Measures to prevent the development of agraphia in a person who has written speech skills include rational behavior that allows one to avoid traumatic brain injury and intoxication as much as possible, and a healthy lifestyle that prevents the development of neoplasms, inflammation, and acute circulatory disorders in the vessels of the brain.

Prevention of congenital agraphia can be achieved through a conscious and pragmatic attitude towards the birth of children, which will help prevent pathologies of pregnancy and childbirth.

If parents have discovered symptoms of agraphia in their child, then immediate medical attention, timely diagnosis and treatment will guarantee successful elimination of the pathology. At home, it is necessary to do speech exercises with the child more often, enroll him in developmental clubs, focusing on music and dance classes.

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Forecast

Treatment of this pathology can be long, however, in isolated agraphia the probability of restoring the lost function is quite high (much higher than in the symptom complex of aphasia). The timeliness of the treatment started and its complexity play a major role.