Vegeto-vascular dystonia (neurocirculatory dystonia) in children

To date, there is no consensus among doctors of various specialties (pediatricians, cardiologists, neurologists) in our country on the interpretation of the concept of vegetative-vascular dystonia in children and adolescents. The term "neurocirculatory asthenia" has been accepted throughout the world; it was first introduced into clinical practice by the American doctor B. Oppenheimer in 1918, and is used to this day and is included in the ICD-10 revision in the section "Somatic diseases of presumably psychogenic etiology".

In its expanded formulation, neurocirculatory asthenia is "a painful condition characterized by a large number of symptoms that, depending on their statistical significance, can be arranged in the following order: palpitations, anxiety, fatigue, pain in the heart, difficulty breathing, and obsessive symptoms. They are observed in the absence of any organic heart disease that could justify their occurrence." In our country, the term neurocirculatory dystonia is most often used, although it continues to be the subject of debate. This term was first proposed by G.F. Lang (1953), who considered it a syndrome predisposing to the development of hypertension. In the late 1950s, N.N. Savitsky united in vegetative-vascular dystonia pathological conditions designated in medical literature as "cardiac neurosis", "Da Costa syndrome", "neurocirculatory asthenia", "effort syndrome", "excitable heart", etc., which differ from other clinical forms of vegetative dysfunction by a number of features. Among them are the predominance of cardiovascular disorders in clinical manifestations, the primary functional nature of disorders in the regulation of vegetative functions and the absence of their connection with any outlined form of pathology, including neurosis. From this point of view, vegetative-vascular dystonia is a variant of primary functional vegetative dysfunction not associated with neurosis, which is an independent disease (nosological form).

There is also a diametrically opposed point of view - vegetative-vascular dystonia cannot be an independent disease, and its development must be preceded by organic lesions of the ENT organs, gastrointestinal tract, nervous or other systems. According to this, vegetative-vascular dystonia is a consequence of secondary disorders of neurohumoral and vegetative regulation of vascular tone in pathologies of various organs and systems. Other authors believe that vegetative-vascular dystonia should be considered, first of all, as a neurosis, taking into account that according to ICD-10, vegetative-vascular dystonia is related to mental disorders. SB Shvarkov, considering vegetative-vascular dystonia as one of the variants of vegetative dysfunction, believes that the time has come when pediatricians should abandon the term vegetative-vascular dystonia altogether.

The definition of vegetative-vascular dystonia given by V.I. Makolkin and S.A. Abakumov is used more often than others in medical literature and clinical practice: “vegetative-vascular dystonia is an independent, polyetiological disease, which is a particular manifestation of vegetative dystonia, in which there are dysregulatory changes mainly in the cardiovascular system, and arising as a result of primary or secondary deviations in the suprasegmental and segmental centers of the autonomic nervous system.”

Neurocirculatory dystonia is the most common form of vegetative neurosis, observed mainly in older children, adolescents and young people (50-75%). Accurate statistics of vegetative-vascular dystonia is difficult, first of all, due to the insufficiently uniform approaches of practicing doctors to the criteria of diagnosis and its terminology (very often the concepts of "neurocirculatory dystonia" and "vegetative-vascular dystonia" are used as synonyms in practice). At the same time, most pediatricians believe that children and adolescents are characterized by generalization and systemic nature of vegetative disorders, which leads to multiple and diverse clinical manifestations indicating the involvement of almost all organs and systems in the pathological process - cardiovascular, respiratory, digestive, endocrine and immune. In such cases, the diagnosis of vegetative dysfunction syndrome is valid.

Causes of vegetative-vascular dystonia

The most significant causes of vegetative-vascular dystonia are unhealthy lifestyle habits and, above all, low physical activity, prolonged (more than 3-6 hours) work on the computer and watching TV, alcohol abuse, toxic and drug addiction, leading to destabilization of the autonomic nervous system with the formation of vegetative-vascular dystonia. Chronic foci of infection, hypertension-hydrocephalic syndrome, osteochondrosis, syncope contribute to the development of vegetative-vascular dystonia. A major role in the occurrence of vegetative-vascular dystonia belongs to a burdened heredity for arterial hypertension, other cardiovascular diseases, diabetes mellitus, especially the presence of these diseases in parents under the age of 55. Both excess and insufficient body weight, as well as excessive salt consumption, have a negative effect.

Causes of vegetative-vascular dystonia

Symptoms of vegetative-vascular dystonia

The severity of subjective and objective manifestations of vegetative-vascular dystonia varies widely: from monosymptomatic, often observed in the hypertensive type of vegetative-vascular dystonia (increased blood pressure in the absence of complaints), to a full-blown picture with an abundance of complaints indicating dysfunction of the cardiovascular system.

In the clinical picture of vegetative-vascular dystonia, hypotensive and hypertensive variants are distinguished, the leading manifestation of which is changes in blood pressure, as well as a cardiological variant with a predominance of pain in the heart area.

The severity of vegetative-vascular dystonia is determined by a complex of various parameters: the severity of tachycardia, the frequency of vegetative-vascular crises, pain syndrome, and tolerance to physical activity.

Symptoms of vegetative-vascular dystonia

Diagnosis of vegetative-vascular dystonia

Despite the high prevalence of the disease, it is quite difficult to diagnose vegetative-vascular dystonia due to the absence of specific symptoms, and in each specific case it is necessary to demonstrably exclude diseases with similar symptoms, i.e. differential diagnostics is always necessary. The range of diseases that must be excluded is very wide: organic pathology of the central nervous system (neuroinfections, tumors, consequences of traumatic brain injury): various endocrinopathies (thyrotoxicosis, hypothyroidism), symptomatic forms of arterial hypertension and arterial hypotension, ischemic heart disease, as well as myocarditis and myocardial dystrophy, defects and other heart diseases. The occurrence of symptoms of vegetative-vascular dystonia during transitional (critical) age periods (puberty) cannot be a weighty argument for substantiating the diagnosis of vegetative-vascular dystonia without differential diagnostics, since many other diseases often arise or worsen during these periods.

Diagnosis of vegetative-vascular dystonia

Treatment of vegetative-vascular dystonia

An important place in the treatment of children with vegetative-vascular dystonia should be given to individual rational psychotherapy. The results of treatment of children with vegetative-vascular dystonia are largely determined by the depth of contact with the doctor.

Treatment should begin with normalizing the daily routine, while regulating the child's physical and mental activities. Mental and emotional stress are well eliminated by physical exercise (swimming, skiing, skating, cycling, measured walking, table tennis, badminton). Not only children, but also their parents should understand that the main thing in treating vegetative-vascular dystonia is normalizing the daily routine and optimizing physical activity, the main components of a healthy lifestyle. It is necessary for the child to be outdoors for at least 2-3 hours daily. It is very important that night sleep lasts 8-10 hours. At the same time, TV viewing should be limited to 1 hour per day. Computer activities should be dosed taking into account the child's condition and age.

Treatment of vegetative-vascular dystonia

Prevention of vegetative-vascular dystonia

Prevention should begin with non-drug measures - normalization of the daily routine, nutrition, walks in the fresh air, water procedures. Prevention of vegetative-vascular dystonia is possible only with its early diagnosis, determined long before the child's complaints appear. Prevention is based on a healthy lifestyle. Optimization of physical activity and a balanced rational diet with low calorie content and anti-sclerotic focus are the main components of the prevention of vegetative-vascular dystonia and other diseases, primarily cardiovascular diseases.