Consequences and treatment of neurophysiological immaturity of the cerebral cortex in a newborn child. Physiology of the cerebral cortex

Some data demonstrating the stages of maturation of brain tissue. Different areas of the brain mature at different times. Knowing this helps explain the emotional and intellectual changes in children, adolescents and young adults. Although no two children develop identically, scientists, using magnetic resonance imaging done by the same children over several years, have established a relationship between certain stages of a child’s development and changes in brain tissue.

0 - 4 years
Early development - In the first few years of life, areas of the brain associated with basic functions change most rapidly. By the age of 4, the areas responsible for the basic senses and general motor skills are almost completely developed. The child can walk, hold a pencil and eat independently.

Sensations - areas responsible for sensations, for example, tactile, are developed almost completely.

Vision - The areas of the brain that control vision are fully mature.

6 years

Language, the region of the brain responsible for speech, is immature but continues to develop rapidly in children up to 10 years of age. The brain is already beginning the process of "thinning", destroying unnecessary connections. This process will intensify in subsequent years, which may be one of the reasons why young children, unlike adults, learn a new language so easily.

Mind - these parts of the brain responsible for abstract thinking, the ability to think rationally and emotional maturity, have not yet developed. Their lack of maturity is one of the reasons why it is difficult for young children to take in too much information, and when given too much choice, children have tantrums.

9 years

Fine motor skills - If gross motor skills are well developed by the age of 5, then the development of fine motor skills develops most actively between 8 and 9 years. It becomes easier for children to write, and in crafts they come to new level accuracy.

Mathematics. By the age of 9, the parietal lobes of the brain begin to mature. Their development allows children to master the skills of mathematics and geometry. The rate of learning at this age is very high.

13 years old

Judgment - The prefrontal cortex is one of the last areas of the brain to mature. Until it develops, children lack the ability to adequately assess risk or make long-term plans.

Emotions - deep in the limbic system, the ability to experience emotions grows. But this ability is not held back by the prefrontal cortex, which is retarded. This is why teenagers often find it so hard to contain their emotions.

Logic - At this age, the parietal lobes develop very quickly, which are indicated in blue in the figure. The intelligence and analytical abilities of the child grow.

15 years

Specialization - in adolescence the abundance of nerve connections continues to decrease. Underused links will die to help more active links develop. As a result, the child's brain becomes more specialized and efficient, productive.

17 years

Abstract thinking - in their late teens, children are able to deal with much more complex things than in childhood. The development of these areas leads to a surge in social activity and the manifestation of emotions among older adolescents. Become possible planning, risk assessment and self-control.

21 years old

higher mental functions. Although, at first glance, it seems that the brain is almost fully developed during adolescence, however, a severe lack of emotional maturity, impulse control and the ability to make decisions affects until adulthood.

Maturity - The brain of a 21-year-old young man is almost mature. Even after reaching the official "adult" age, we still have areas in the brain that have the potential for development. Emotional maturity and the ability to make decisions will continue to develop in subsequent years.

The causes of brain atrophy in children can be the following factors:

• genetic predisposition;
• congenital malformations of the central nervous system;
• external influences that provoke or aggravate the process of dying nerve cells brain. These can be various kinds of diseases with complications on the brain, exposure to alcohol consumed by the mother during pregnancy, etc .;
• ischemic or hypoxic damage to brain cells;
• exposure to radiation on the fetus during pregnancy;
• the effect on the fetus of certain drugs used by the expectant mother during pregnancy;
• infectious lesions after diseases in early childhood;
• use of pregnant alcohol, drugs.

Not only cells of the cerebral cortex, but also subcortical formations are subject to death. The process is irreversible. It gradually leads to the complete degradation of the child.

Symptoms

The main cause of brain atrophy, as mentioned above, is a genetic predisposition. A child is born with a normally functioning brain, and the process of gradual death of nerve cells in the brain and neural connections is not detected immediately. Symptoms of brain atrophy in children:

• there is lethargy, apathy, indifference to everything around;
• motor skills are impaired;
• the existing vocabulary is depleted;
• the child ceases to recognize familiar objects;
• cannot use familiar objects;
• the child develops forgetfulness;
• orientation in space is lost, etc.

Unfortunately, today there are no effective methods for blocking the degradation process. The efforts of physicians are aimed at stopping the process of death of nerve cells of the head kind, to compensate for the death of neural connections by the development of others. To date, numerous research work in this direction. Perhaps, in the near future, children with a threatening diagnosis - brain atrophy, can be effectively assisted.

Diagnosis of brain atrophy in children

First of all, in order to diagnose the disease, the doctor will examine in detail the state of health of the mother of the child during pregnancy - all past diseases, bad habits, possible impacts toxic substances, insufficient or poor-quality nutrition, prolongation of pregnancy, toxicosis and other factors. Understanding the root causes, it is easier to diagnose the disease in a child.

In addition, a number of surveys are carried out:

• neurological examination of the child;
• assessment of metabolic indicators;
• Apgar score.

Additional examinations include:

• neurosonography;
• dopplerography;
• various types of tomography: computed (CT), magnetic resonance (MRI), positron emission (PET);
• neurophysiological studies: electroencephalography, polygraphy, diagnostic punctures, etc.

Based on the results of the examinations, the doctor makes a diagnosis and prescribes treatment, which, most often, is symptomatic.

Complications

Complications of brain atrophy are manifested by the extinction of the functions of various organs, up to their complete death. Clinical manifestations- blindness, immobilization, paralysis, dementia, death.

Treatment

What can you do

Having learned that the child has a terrible diagnosis - brain atrophy, you do not need to give up and panic. Now much depends on the relationship of relatives and friends, and most importantly - parents. Surround your child with maximum attention and care. It is necessary to strictly monitor the regimen, nutrition, rest, sleep. It is not recommended to change the familiar environment. From day to day, a repetitive daily routine contributes to the establishment of certain actions, rituals, and, as a rule, new neural connections in the brain. Of course, it all depends on the degree of damage to the area of ​​the cerebral cortex or its subcortical neoplasms, but there is no need to lose hope.

What does a doctor do

The treatment of cerebral atrophy is symptomatic, since there is currently no effective ways blocking the process of death of nerve cells in the brain. Despite the unfavorable prognosis of the disease, one should show patience and perseverance, follow all the instructions and recommendations of neurologists. Medicine does not stand still. Scientists are developing new methods for the treatment of the most severe diseases. Maybe very soon ways will be developed to help children with a terrible diagnosis - brain atrophy.

No less difficult than for parents, it is also necessary for the doctor of a sick child. Based on the general condition of the child, the degree of brain damage, the doctor prescribes sedative therapy, physiotherapy, medical preparations- and all this depending on the symptoms.

Prevention

To the group increased risk there are children whose mothers during pregnancy allowed themselves the use of alcoholic beverages, which have a detrimental effect primarily on the brain of the child to be born. Therefore, recommendations for the prevention of the disease are mostly for expectant mothers. Diseases transferred during pregnancy can provoke the development of brain atrophy in the baby. Therefore, you should be especially careful about your health during pregnancy, perform simple recommendations for the conduct healthy lifestyle life and proper nutrition.

It will not be superfluous to repeat once again about the dangers of smoking, as well as drug use. If suspicion is genetic predisposition one of the spouses, then the right decision would be to undergo genetic counseling even before the planned pregnancy.

If the family has already faced the problem of the birth of a child with brain atrophy, then prevention is aimed at preventing the re-birth of offspring with a similar diagnosis. Special genetic tests will determine the presence of a mutant gene in parents.

Articles on the topic

In the article you will read everything about the methods of treating such a disease as brain atrophy in children. Specify what effective first aid should be. How to treat: choose drugs or folk methods?

You will also learn how untimely treatment of brain atrophy in children can be dangerous, and why it is so important to avoid the consequences. All about how to prevent brain atrophy in children and prevent complications.

And caring parents will find on the pages of the service full information about the symptoms of cerebral atrophy in children. How do the signs of the disease in children at 1.2 and 3 years old differ from the manifestations of the disease in children at 4, 5, 6 and 7 years old? What is the best way to treat cerebral atrophy in children?

Take care of the health of your loved ones and be in good shape!

Many parents turn to a neurologist in extreme situations - when the child's behavior becomes inappropriate and even shocking. Meanwhile, the attention of a neurologist is required for many children who are considered "virtually healthy." The fact is that the development of the central nervous system of a child occurs gradually, and at almost every stage a malfunction may occur that will require the attention of a specialist. Symptoms of CNS damage can be both obvious and almost imperceptible. However, if they are not diagnosed in time and the root cause is not eliminated, the child will experience certain developmental difficulties.

What factors of pregnancy and childbirth can adversely affect the development of the child's brain, as well as what features of the first year of a baby's life should be paid attention to.

Invisible connections

The development of the central nervous system does not occur simultaneously. Parts of the brain are formed in utero, they divide and new nerve cells appear. Out of utero (after the birth of a person into the world), the number of nerve cells remains unchanged, but new connections are formed between them. Thanks to this, the child has the potential for development and the ability to learn: motor, mental, speech, etc. The most "ancient" parts of the brain are responsible for the internal environment: breathing, digestion, sleep and wakefulness, regulation of vascular tone, etc. Above are the departments responsible for hearing, body position in space, vision. Even higher are the centers responsible for voluntary movements. The youngest cells are responsible for speech, the ability to independently build a program of action, and control behavior.

If a defect has formed in some place of the brain (tumor, hemorrhage, insufficient blood supply), then not only this area, but also those that are above it, will not be able to function. This is due to the fact that the excitement from the underlying departments goes up. When a barrier appears in the form of dead brain tissue, the impulse goes around this dead area. And therefore, it may not fall into some overlying area at all. As a result, connections between different parts of the brain will not form, and some parts will not turn on. Those cells that were flawlessly laid during pregnancy will not be able to start functioning on time and correctly. There will be no so-called maturation of the brain.

What causes crashes?

The fact is that the brain is laid starting from the third or fourth week of pregnancy. Any infection carried in the first trimester can cause serious damage to it. Any pharmacological drug, eaten by mom during this period, can also lead to fatal consequences.

In the first trimester, it is not the harmful factor itself that is important, but the period in which it acted. Despite the fact that the risk of giving birth to a not entirely healthy child in this case is increased (it is increased, and not "great"), I personally do not share the fears of obstetricians and gynecologists who recommend terminating a pregnancy after any runny nose that has passed in the first trimester. Our experience shows that in case of serious violations in intrauterine development The mother's child has a miscarriage.

Children with severe CNS damage are born, as a rule, when a pregnancy that is not entirely successful in the first trimester is maintained by all means, using hormonal drugs and suturing the cervix. But even here there are no rules without exceptions. We must remember only that only parents are responsible for the birth of a child. And in case of interruption normal pregnancy no doctor will be punished.

In the second and third trimesters, the development of the brain, and most importantly, its resistance to birth trauma, is strongly influenced by the placenta. Accordingly, the poor functioning of the placenta, circulatory disorders in this important organ, its premature maturation can affect the development of the nervous system. So, for example, if a mother suffers from kidney disease, then the placenta may swell, which will disrupt its work.

If the pregnancy went well, then even a not very serious birth injury may have a negative value for the development of the central nervous system. Too much quick delivery(less than two hours), extrusion of the fetus, long standing of the head in the birth canal, tight entanglement of the umbilical cord, etc., can cause small-point hemorrhages in the lower parts of the central nervous system. The consequences of these violations can be very different: from increased muscle tone and speech delay serious problems with physical activity.

If the child has suffered a birth injury, then you need to do it in. At this time, through a large fontanelle, the doctor can look "inside the head" and establish the presence of a hemorrhage. This is important, because by the end of the second - the middle of the third month, traces of birth hemorrhages disappear. And later, doctors will not be able to say for sure whether there was a birth injury and whether it is the cause of the child's neurological problems.

What does it threaten?

Pregnancy and childbirth: risk factors

If you do not or have not had the opportunity to examine your child in a timely manner, you can use our tests to understand how high the risk is that the baby has neurological problems. If you plan to visit a pediatric neurologist, draw his attention to those items on the test for which you gave the baby one point or more.

Evaluation of results

Calculate your points. If there are no more than 20, the child may have a mild lesion of the nervous system. This means that such a baby will not fall asleep well, or will not want to roll over from his back to his stomach on his own, later he will sit down. In kindergarten, it will be difficult for teachers to cope with him. At school, he will yawn in the third lesson.

Ideally absolutely. healthy child should not score any points. But as we know, now such children are practically not found. Let's take a simple example. Everything was fine during pregnancy. Clear waters broke, contractions began, then after four or five hours - attempts, the pushing period was not more than twenty minutes, the child was born, and then there was an outpouring of green waters. What does it say?

In medical language - a dry phrase: "The front waters are transparent, and the rear ones are green." On a universal level - the child did not receive enough oxygen during childbirth, it happened oxygen starvation body, the intestines relaxed, and the original feces - meconium - went into the uterine cavity. In principle, the brain might not have suffered, since the head had already been born. But the spontaneous discharge of meconium suggests that there was still a moment of asphyxia in childbirth.

If the patient scored more than 20 points, then he can be suspected of a serious brain lesion. From the very first months, the baby may lag behind in development - not responding to his mother's voice or lying indifferently in wet diapers without submitting a swaddling request. Such children can only sleep and eat up to six months, not be interested in toys. They may have reduced or sharply increased muscle tone. In the first case, the child will "hang" while in his arms. In the second - for swaddling it is impossible to part the legs and arms. Or maybe the other way around. The kid worries about every occasion, requires endless swinging in his arms, increased attention to his own person. In general, the range of clinical symptoms in brain damage is very wide. At the slightest suspicion - address to the children's neurologist.

First year of life: pay attention

If you, dear parents, are worried about something, do not hesitate to disturb the doctor once again. This is our job. If the doctor of the district clinic dismisses you, does not pay attention to your concerns, look for another specialist. The main thing is that you must be sure that everything is in order with the child. Or - to understand what is happening, and start treatment in time.

Babina Anna Melanchenko Elizabeth pediatric neurologist
Article from the magazine "Our Baby", March 2003

As the cerebral cortex matures, neurons migrate from its depths to the outer layers. Two proteins help neurons to pass through the thickness of already formed zones, while one of them belongs to the class of cadherin proteins that resist all kinds of cell migration. One of the biggest and most interesting mysteries in biology has to do with the process of migration of germ cells into developing embryo. Obviously, in order to form an organ, the cells must line up in a certain order. Considering that new cells are formed not "at their destination", but in special zones, from where they then travel to their " workplace", it becomes clear how important role plays routing and movement control of such cells. An incorrectly indicated direction of migration will lead to defects in the structure and functioning of tissues and organs. Actually, there is a whole class of malformations associated with a violation of the "navigation" of cells in the embryo.

Different organs are sometimes formed very different ways. Scientists from the Hutchinson Center for Basic Research on Cell Division (USA) attempted to find out the details of the formation of the cerebral cortex.

Rice.

The mature cortex is like a layer cake: it is represented by horizontal layers of nerve cells; neurons in different layers differ in their prescribed functions, but are combined into vertical conducting circuits. If, during the formation of the cortex, the neuron gets into the wrong layer, then in the future there may be violations in the correct transmission of the signal, up to the development of diseases such as epilepsy, schizophrenia and autism.

In the fetus, the brain is formed as if turning inside out: new neurons form in the depths of the maturing cortex and then make their way through the thickets of already fully differentiated neurons of the overlying layers. Having reached the top, they calm down, lose signs of immaturity and form another layer. It was the details of the journey of neurons that remained a mystery to researchers for a long time.

In a paper published in the journal Nature Neuroscience, the scientists describe a signaling system that guides germline neurons in the right direction. At first, nerve cells purposefully move towards the surface of the cortex until they reach a special zone in the germinal brain called the medulla. There are few actual neurons, but many long conductive processes of nerve cells - axons. Once in this zone, migrating neurons seem to lose their orientation and begin to wander in different directions. But above the intermediate zone lie layers of mature nerve cells, and if a "lost" neuron finds itself in such a layer, it again acquires a clear direction of movement.

A special protein reelin helps young nerve cells to get on the right track. It is produced by the neurons of the overlying nerve layers and, thus, it is as if they light a signal beacon for those wandering in the intermediate zone. Mutations in its gene cause disruption in the formation of nerve layers in the cortex of rodents and humans, but it has not yet been clear what exactly this protein does there.

Reelin is synthesized by the uppermost layer of neurons and diffuses down through all layers to the intermediate zone. But at the same time, it does not itself lead young nerve cells upward, but acts through an intermediary in the form of another protein, N-cadherin. This is a membrane protein, which is generally responsible for communication, stabilization, and fastening of cells to each other. Due to cadherins, cells stay in place (these proteins just counteract migration), so the effect of N-cadherin on cell movement turned out to be a big surprise. Under the action of reelin, the content of cadherin in the neuronal membrane increases, and this plays a decisive role in choosing the direction of movement.

How can parents understand if a child is healthy and has only age and personality characteristics of behavior? Or does a child have MMD (ADHD, ADD), and is it worth asking for advice on raising such a child and possibly treatment from specialists: neurologists, psychologists, speech pathologists, psychiatrists? After all, the timely assistance of specialists can help parents in the proper upbringing of the child and the fastest overcoming of problems in his behavior and learning ability.

One of the modern definitions of Minimal Brain Dysfunction (ADHD, ADD) is a condition that manifests itself as a behavioral and learning disorder, in the absence of intellectual impairment, and occurs as a result of a violation of the maturation of the main regulatory systems of the brain (primarily the prefrontal regions of the frontal lobes, the brain regions that control emotions and physical activity).

Minimal brain dysfunction(MMD) - in a different way: attention deficit hyperactivity disorder(ADHD) or without it (ADD) is a disease state of the central nervous system with a certain set of signs (symptoms), but manifestations of different severity. Therefore, when making a diagnosis, they write about the syndrome.

Why is the manifestation of ADD (ADHD) so diverse and individual? No two children with MMD syndrome (ADHD, ADD) are alike; the cause is related to the origin (etiopathogenesis) of this condition.

MRI studies have revealed changes in the brain with MMD:

• a decrease in the volume of the brain substance in the left frontoparietal, left cingular, bilateral parietal and temporal cortex;
• as well as shrinkage of the cerebellum in children with ADHD;
• focal lesions of the medial and orbital PFC (prefrontal cortex) have also been associated with features of ADHD.

Positron emission tomography of the brain revealed functional insufficiency the work of neurons (nerve cells) of the prefrontal sections of the frontal lobes and the violation of their connections with the mesencephalic sections (areas of the brain located under the cerebral cortex) and upper divisions brain stem. This is manifested in a decrease in the production of neurotransmitter substances by the cells of these parts of the brain: dopamine and norepinephrine. Deficiency in the work of these neurotransmitter systems leads to manifestations of MMD (ADHD or ADD).

Thus, modern methods studies (neuroimaging methods) reveal areas of brain damage in MMD syndrome in all examined children from the moment of birth and in subsequent years of life.

The CNS continues to develop in a child from the moment of birth until the age of 12-14, so areas of brain damage that occurred during the birth of a child can disrupt the normal development of the child’s brain not only immediately after birth, but also in subsequent years of life, while development is underway. central nervous system (CNS).

The main cause of damage to areas of the child's brain is hypoxia during childbirth, that is, a decrease in the supply of a sufficient amount of oxygen to the brain. Moreover, hypoxia is dangerous, which occurs quickly within a few minutes (acute hypoxia or fetal distress), with which defense mechanisms fetuses do not cope. Acute hypoxia can cause suffering and death of areas white matter brain. Such hypoxia can occur, first of all, during childbirth.

Chronic fetal hypoxia, which develops during pregnancy due to causes usually associated with maternal health and placental insufficiency, does not lead to brain damage, as the fetal defense mechanisms have time to adapt. The nutrition of the entire body of the fetus is disrupted, but there is no damage to the fetal brain. Fetal hypotrophy develops - low birth weight (not corresponding to the height of the child and the gestational age at which he was born). If childbirth takes place without acute hypoxia, then a child born with malnutrition, with sufficient nutrition, will quickly gain normal weight, and will not have problems with the development of the central nervous system.

During cerebral hypoxia during childbirth, the cells of the cerebral cortex (neurons of the cerebral cortex) suffer the least, since they begin to work only after the birth of the child, during childbirth they need a minimum of oxygen.

During hypoxia during childbirth, the blood is redistributed and, first of all, it goes to the cells of the brain stem, where the most important centers for life are located - the center for regulating blood circulation and the center for regulating respiration. (From it, after the birth of the child, a signal will be received to take a breath.) Thus, the most sensitive to hypoxia in the fetus are neuroglial cells (oligodendrocytes) located in in large numbers between the cortex and the brain stem, in the subcortical zone - the area of ​​​​the White Matter of the brain (BVM).

Neuroglial cells after the birth of a child must ensure the process of myelination. Each cell of the cerebral cortex - a neuron - has processes that connect it to other neurons, and the longest process (axon) goes to the neurons of the brain stem. As soon as myelination occurs - covering these processes with a special sheath, the neurons of the cerebral cortex can send signals to the subcortex and brain stem and receive response signals.

The more neuroglial cells suffer from hypoxia during childbirth, the greater the difficulties for the neurons of the cerebral cortex in establishing connections with the subcortex and brain stem, since the myelination process is disrupted. That is, the neurons of the cerebral cortex cannot fully and during (according to the program recorded in their genes) regulate and control the underlying parts of the brain. Part of the neurons of the cortex simply die when it is impossible to perform their functions.

The regulation of muscle tone and reflexes is disturbed. By the age of 1-1.5 years, cortical neurons usually establish enough connections for muscle tone and reflexes to normalize and the child to walk on its own (as recorded in the gene program for the development of the organism). In the development of movements, not only the frontal, but also other parts of the brain are involved, which provides great compensatory opportunities for normalization movement disorders.

From 1.5 - 2 years old, the social development of the child begins. The child has a genetically inherent fear of adults (parents), the desire to repeat actions and words after adults, obey the comments of adults, understand the word “no” (albeit not always obey), be afraid of punishment and enjoy praise from adults (parents). That is, the possibility of raising a child is provided at the genetic level in the program for the development of the child's central nervous system. Moreover, this genetic program for the development of social maturation (social adaptation and behavior) is evolutionarily honed and selected, otherwise the child would not have survived among the surrounding world, full of real dangers to preserve health and life itself.

With insufficient connections in the neurons of the cortex responsible (according to the gene program) for this social development, behavioral disorders that do not correspond to the age norm appear - violations of social adaptation. Behavioral disorders may in some cases be simply inherent this child, in connection with its individual characteristics or be a reflection of certain periods of the development of the child.

Behavioral disorders include: problems with education, with communication, with discipline of behavior, with food, with sleep, difficulties in acquiring neatness skills, hyperactivity. High degree activity and a tendency to noisy games is typical for children from 2 to 4 years old, and, as it were, is considered the age norm. But hyperactivity, combined with inattention and impulsivity, persisting in a child after 4 years, indicates the presence of the MMD syndrome (ADHD, ADD).

First of all, the regulation of one's emotions and sensations is disturbed. Children are emotionally labile (unstable), irritable, quick-tempered. But, on the other hand, they are characterized by increased vulnerability and low self-esteem.

Intellect usually develops successfully, but its implementation is hindered by poor concentration of attention: children cannot fully listen to the conditions of the problem, impulsively make rash decisions. They quickly get bored with monotonous work, mechanical memorization of a large amount of material, they often do not complete the work they have begun ...

The main signs of MMD (ADHD, ADHD)

The main signs of MMD (ADHD, ADD) primarily include:

1. Inattention - easy distractibility, difficulty concentrating on tasks that require prolonged attention strain.
2. Impulsivity - a tendency to rash actions, difficulties in switching, difficulties in organizing work. constant transitions from one activity to another.
3. Hyperactivity, which is understood as excessive mobility, the inability to stay still, sit quietly. In general, hyperactive children are children who are "constantly on the move".

The US Psychiatric Association has identified 14 signs attention deficit disorder, the presence of any 8 of which makes it possible to diagnose this disorder. So child:

1. makes constant movements with arms and legs, fidgets in a chair;
2. cannot sit still for a long time when necessary;
3. easily distracted by external stimuli;
4. hardly tolerates the situation of waiting for changes in games or group activities;
5. often begins to answer without listening to the end of the question;
6. when performing tasks, experiences difficulties that are not related to negativism or insufficient understanding of the essence of the request;
7. unable to concentrate for a long time both in games and when performing tasks;
8. often moves from one unfinished business to another;
9. unable to play calmly and quietly;
10. overly talkative;
11. often interrupts others, is annoying;
12. gives the impression of not hearing the speech addressed to him;
13. often loses the necessary (for classes) things, both at school and at home;
14. often engages in (and commits independently) risky, physical well-being threatening activities without being aware of their possible consequences.

Other symptoms (signs) of MMD (ADHD, ADD):

increased mental fatigue, distractibility, difficulty in memorizing new material, poor tolerance noise, bright light, heat and stuffiness, motion sickness in transport with the appearance of dizziness, nausea and vomiting. Headaches, overexcitation of the child by the end of the day in kindergarten in the presence of choleric temperament and lethargy in the presence of phlegmatic temperament are possible. Sanguine people are excited and inhibited almost simultaneously.

There are significant fluctuations due to deterioration or improvement in somatic condition, season, age.

To the maximum extent, the signs of MMD are manifested in the primary grades of the school.

A.I. Zakharov describes ADHD as the following complex of disturbed behavior: “increased excitability, restlessness, distraction, disinhibition of drives, lack of restraining principles, feelings of guilt and feelings, as well as criticality accessible to age. Often these children, as they say, “without brakes”, cannot sit still for a second, jump up, run, “without understanding the road”, are constantly distracted, interfere with others. They easily switch from one activity to another without finishing what they started. Fatigue sets in much later and is less pronounced than in children with ADD. Promises are easily made and immediately forgotten, playfulness, carelessness, mischief, low intellectual development (?!) are characteristic.

The weakened self-preservation instinct is expressed in frequent falls, injuries, bruises of the child.

The conclusion according to the statistics of childhood trauma is terrible, the growth of injuries, taking into account the decrease in the number of children in the population over 13 years, amounted to a 3-4-fold increase. What happened to the children? Less and less children are involved in sports, which means that sports injuries have not grown. The number of cars on the roads is growing from year to year, but not due to an increase in accidents has such an increase in child injuries occurred!

The constant growth of child injuries is taking place in our country due to the constant growth of children with the MMD syndrome (ADHD, ADD).

Causes of Minimal Brain Dysfunctions

In the literature, you can find several similar terms:

• ММН - minimal cerebral insufficiency;
• MMD - minimal brain dysfunction;
• MDM - minimal brain dysfunction.

A.I. Zakharov considers minimal cerebral insufficiency (dysfunction) to be the most common type of neuropsychiatric disorders.

A set of official, usually listed causes of MMD (ADHD, ADD):

1. 70-75% of cases of brain development disorders in MMD are, according to the leaders of domestic medicine, genetic causes. Moreover, this conclusion is voiced without any scientific evidence.
2. In other cases, the following are listed:
   • severe course of pregnancy, especially its first half: toxicosis, the threat of miscarriage.
   • harmful effects on the body of a pregnant woman ecology: chemical substances, radiation, vibration.
   • harmful effects on the fetus during pregnancy of infectious diseases: microbes and viruses.
   • premature and post-term birth, weakness of labor activity and its long course, lack of oxygen (hypoxia) due to compression of the umbilical cord, entanglement around the neck.
   • After childbirth, adverse effects on the brain have poor nutrition, frequent or severe illnesses and infections in newborns and infants accompanied by various complications, helminthic infestations and giardiasis, brain bruises, poisoning and the ecological situation in the region.
   • A number of authors (B.R. Yaremenko, A.B. Yaremenko, T.B. Goryainova) consider damage during childbirth to be the main cause of MMD. cervical spine. Completely unsubstantiated and unscientific opinion!

In fact, muscle tone is regulated by the brain. With hypoxic brain damage, muscle tone is disturbed, including in the neck muscle group, which causes displacement of the cervical vertebrae. That is, changes in the position of the vertebrae are secondary. Primarily - damage to the brain, causing violations of muscle tone and reflexes in the neck, trunk and limbs of a newborn child.

Official medicine also claims about the heterogeneity (heterogeneity) of the causes of the appearance of MMD (ADD, ADHD). The development of this syndrome is associated with organic brain lesions in the perinatal period, as well as with genetic and socio-psychological factors (so to speak, with poor education, bad educators, an unfavorable social environment - “?”) - (Prof. Zavadenko N.N. ''Modern approaches to the diagnosis and treatment of ADHD” M., 2003)

About genetics, as an unproven cause of MMD, have already been written above. Socio-psychological factors and social environment are very important for the social development and adaptation of a child with MMD, but are not the cause of the appearance of MMD in a child.

It remains to consider the most important period of life for maintaining a healthy central nervous system of a child - the perinatal period. Perinatal period - perinatal period - before, during and immediately after childbirth.

The perinatal period is divided into the prenatal (antenatal) period, the birth itself - the intranatal period and 7 days after birth - the postnatal period. Intra- and postnatal periods are a stable value.

Antenatal - the period from 28 weeks of pregnancy, which was considered the boundary period between childbirth and abortion. At the same time, not only the gestational age (pregnancy) remains a criterion, but also the weight of the fetus - more than 1000 g. In the past twenty years, doctors in advanced countries have shown that the fetus can survive even with a shorter gestational age, and then the antenatal period in most developed countries count from 22-23 weeks and a fetal weight of 500 g. In our country, from January 1, 2012, they also began to count for newborns (and not for late miscarriages) of children born weighing more than 500 grams.

What has changed during the perinatal period in our country (and in the world) over the past 40-50 years? Pregnancy in the antenatal period proceeds, like thousands of years ago, even better and more reliably, thanks to the observation of pregnant women in antenatal clinics. The postnatal period for newborns, thanks to the achievements of modern neonatology, has been constantly improving over the past 20-30 years. The intranatal period (the period of childbirth) has changed dramatically over the past 40-50 years.

1. In the hands of obstetricians appeared: 1) the most powerful means for inducing and stimulating labor, and, on the contrary, for inhibiting and stopping labor,
2. active programmed (according to a plan prepared in advance (?!) by an obstetrician) management of childbirth,
3. monitoring the condition of the fetus (fetal heart rate) by CTG (often used),
4. ultrasonic devices for monitoring the state of uteroplacental blood flow and cerebral blood flow of the fetus (very rarely used),
5. labor pain relief (epidural analgesia), etc.

Has such a modern provision of childbirth for the last 40 years improved the health status of Russians born?

No, it hasn't improved!

Judging by the statistics, there is a constant growth of children with cerebral palsy, with syndromes of impaired social adaptation and behavior, including: MMD (ADHD and ADHD) and autism syndrome, with problems in the development of the musculoskeletal system (when from 1-1.5 years of age are formed: stoop, scoliosis, valgus flat feet and crooked feet, walking on toes, etc.), with speech development disorders, with syndromes autonomic dysfunction, sleep disorders, etc.

Domestic neurologists, neonatologists, pediatricians, orthopedists, kindergarten teachers, school teachers, speech therapists and speech pathologists, child psychiatrists and psychologists, do not at all try to understand the reasons for such a terrifying, catastrophic growth of children with MMD (ADD, ADHD) and other developmental pathologies CNS.

Different figures are given in our country for the detection of MMD from 7.6% to 12% of school-age children, that is, from 76 to 120 children per 1000 children under 16 years of age. From 1966 to 2001, the autism syndrome increased 1,500 times in our country and reaches 6.8 per 1,000 children under 14 years of age. Elements of the autism syndrome - autism spectrum disorders (ASD), are observed in many children with MMD syndrome (ADD, ADHD).

The MMD syndrome (ADD, ADHD) and the RAS syndrome are found in the majority of sick children with cerebral palsy, that is, in addition to severe motor disorders, they also suffer from brain areas on which social development and social adaptation depend, which further complicates the rehabilitation of such children . Most children with MMD (ADD, ADHD), autism, cerebral palsy have a syndrome of autonomic dysfunction (in modern terms, somatoform disorders of the autonomic nervous system).

And this proves the complete similarity of the causes of disorders in the development of the central nervous system in children: cerebral palsy, MMD and the syndrome of autism and ASD, the syndrome of autonomic dysfunction, disorders in the formation of the musculoskeletal system, syndromes of speech development disorders, syndromes of disorders in the brain of the centers of vision and hearing and other developmental disorders CNS in young children. What will be clinically more pronounced, and in what combination these syndromes will appear, depends only on the number and size of lesions in the white matter of the brain (WCM) and their location (localization).

The significance of the cells of the white matter of the brain (neuroglia) in establishing connections between the neurons of the brain is described in detail above.

What is being done by medicine to improve the diagnosis of brain damage to the fetus and newborn, to clarify what brain damage underlies neurological disorders in children?

Ultrasound methods (neurosonography - NSG) do not allow to accurately determine the nature and extent of the pathological process.

Accurate diagnosis is provided by CTG (computed tomography), MRI (nuclear magnetic resonance imaging), positron emission tomography, etc. neurological problems.

There is not a single work with MRI (CT) data that would track changes in the brain from the moment a child is born (with suspicion of hypoxia during childbirth) and in subsequent periods of life, while the development of the central nervous system occurs. In clinical studies describing neurological pathology in children (cerebral palsy, MMD, autism, etc.) that occurs in the perinatal period, there is no scientific basis for morphological changes in the brain.

This is clearly written in the unique work of V.V. Vlasyuk “Morphology and classification of strokes of the white matter of the cerebral hemispheres in fetuses and newborns”.

Why do white matter strokes (heart attacks) occur in children?

Because, as described above, during fetal hypoxia, the blood is redistributed towards the brain stem of the child, where the centers for regulating blood circulation and respiration are located. The cerebral cortex does not work at the time of childbirth, therefore, the cortical neurons consume a minimum of oxygen (they are, as it were, in a “sleepy” state). The white matter of the brain (the so-called subcortex of the brain), which consists of neuroglial cells and processes of nerve cells, suffers from hypoxia, decreased and impaired blood circulation. White matter hypoxia can result in necrosis (death) of the white matter of the brain. Depending on the size, prevalence and severity of necrosis (infarctions) of the white matter of the brain (WMS), Vlasyuk V.V. publishes the Classification of necrosis (heart attacks, strokes) of MVM:

1. single
2. multiple (common)

1. small focal (1-2mm)
2. macrofocal (more than 2 mm)

1. coagulation (with the formation of scar tissue at the site of cells and tissues that died from a heart attack)
2. colliquative (with the formation of cysts, from small to large with liquid content)
3. mixed (both cysts and scars)

1. incomplete (processes of loosening, encephalodystrophy, edematous-hemorrhagic leukoencephalopathy, telencephalopathy - when only neuroglial cells die)
2. complete (periventricular leukomalacia, when all glia, vessels and axons (neuronal processes) die

D According to the localization of the focus or foci of necrosis:

1. periventricular (PVL) - usually occur with hypoxia and ischemia due to arterial hypotension in the zone of borderline blood supply between the ventriculofugal and ventriculopetal arterial branches
2. subcortical (SL-subcortical leukomalacia)
3. central (TG - telencephalic gliosis)
4. mixed (for example: the presence of foci of necrosis in the periventricular and central parts of the semi-oval centers - indicates DFL - diffuse leukomalacia, widespread ischemia of the BVM.

As can be seen from this classification of MBM strokes in newborns who died in childbirth or in the first weeks of life (neonatal period), without modern neuroimaging methods - CTG and MRI, it is very difficult to clinically establish an accurate diagnosis of brain damage. The NSG method is very inaccurate and uninformative for the detection of small-focal and small-scale infarctions of the MBM. Moreover, as shown clinical researches, the assessment of the state on the Apgar scale also does not give an idea of ​​the possible damage to the newborn's OVM. That is, the assessment of the newborn on the Apgar scale does not provide an assessment of the state of the brain of the newborn.

Classical works by K.NELSON et al. to study the significance of the Apgar score for a correct understanding of the state of the central nervous system of the newborn.

49,000 children were examined, who were assessed by Apgar at 1 and 5 minutes after birth and by the state of the central nervous system later in life:

99 children scored 3 points at 5-10-15-20 minutes, received intensive care and survived. Of these children, 12 developed cerebral palsy, 8 had less significant neurological impairment. The remaining 79% (!), after intensive therapy, were healthy according to the central nervous system.

On the other hand, of the children who later developed cerebral palsy, 55% had an Apgar score of 7-10 points at the 1st minute of life, and 73% of children with cerebral palsy had an Apgar score of 7-10 points at the 5th minute. . Waynberg et al. believes that the Apgar scale is not informative in the prognosis of hypoxic brain damage. In their opinion, it is important to assess the violations of the neurological status of the newborn in dynamics.

Despite this, neonatologists, obstetricians and neurologists adopted in 2007 the Classification of PEP (perinatal encephalopathy), where only the presence of signs of asphyxia at birth, that is, an Apgar score below 7 points, suggests the need to study the brain of the newborn.

Although the reflexes with which the child is born can be almost within the normal range. Since these reflexes reflect the state of the brain stem, and are not connected with the higher parts of the central nervous system (subcortex, cerebral cortex) at the time of birth. These reflexes do not in any way reflect the state of the white matter of the brain, and MBM infarcts are not diagnosed. Newborns born in childbirth with obstetric intervention, with induction and stimulation, do not even undergo a brain examination using ultrasonic NSG, especially CT and MRI of the brain.

After birth, the child begins to develop acquired LUR (labyrinth-adjusting) reflexes, which, according to the brain development program laid down in the genes, should help the child stand up and start walking. The process of development of LUR depends on the establishment of connections between the cerebral cortex and the underlying parts of the brain. If a newborn has a stroke (heart attack) of MVM, the development of the central nervous system is disturbed, but this can become noticeable only after some time. For example, the formation of the cerebral palsy syndrome is noticeable by the age of one, the formation of the MMD syndrome (ADD, ADHD) from 1.5 years and later, the syndrome of autism and ASD after 2-2.5 years and later.

I repeat, there are still no works by radiologists on the development of the brain with different options strokes of the MVM in children from the neonatal period to the end of the development and formation of the brain.

To process the data of CT and MRI of the brain, children with cerebral palsy of different age groups are taken, the general conclusion is incorrectly made about the alleged predominance of genetic disorders in the development of the brain in children with cerebral palsy, MMD and autism. As evidence, in 50% of cases, macroscopically identified disorders in the formation of the brain are described: “focal microgyria, a decrease in individual lobes of the hemispheres, underdevelopment of secondary and tertiary cortical furrows,” etc. Such conclusions would make sense if such children were examined by CT or MRI from birth and then regularly as the brain develops and grows. Since it is MBM infarctions that cause damage, leading to impaired development of neurons in the cerebral cortex and to disruptions in their connections with each other and the underlying parts of the brain. Which leads to a change in the normal structure and arrangement of the layers of neurons in the cerebral cortex and their pathways.

There are no works with dynamic observation of any forms of MBM infarcts from birth and further as the child develops in domestic physicians.

However, peremptory statements are published and voiced officially that in 75-80% of cases of brain development disorders in cerebral palsy, MMD, autism are genetic causes.

Over the past 30 years, there has been a marked increase in the number of children and adults with ADHD (ADHD). This growth is noticed not only by medical specialists, but also ordinary people. Mainstream medicine spends public money to research the causes of the increase in ADHD (ADD) in any direction, but only without connection with childbirth. Officially, several dozen genes, lead in exhaust gases, poor nutrition, ecology, poor upbringing, complex school program, bad teachers and parents, etc. etc.

If only one obstetrician would have the conscience to admit that over the past 30 years we have almost no natural childbirth left. Natural childbirth is the safest for preserving the fetus and newborn from brain damage.

Almost all births involve medical intervention by medical manipulations (punctures of the fetal bladder, perineal incisions, kelp and catheters (to “prepare” the cervix for childbirth, etc.) and medical methods for the induction and stimulation of labor and contractions.

Such insane scale medical intervention in childbirth began abroad 40-50 years ago (immediately after the invention and use of oxytocin to stimulate labor, and then other drugs and medical methods). As a result, today more than 3 million American schoolchildren with ADHD are on a daily intake of psychostimulants - amphetamines - before attending school.

Psychostimulants (amphetamines) make it possible for a child with ADHD to sit quietly for half a day at school in the classroom. And then at home, after the end of the action of amphetamine, you can “stand on your head”. According to Peter Gray, professor of psychology at Boston College, “this is the machinations of teachers and the school curriculum, this is a conspiracy of psychiatrists” who see almost every child as a mentally ill person with ADD (ADHD), and even ADHD with aggressiveness (this is in those who who annually shoots classmates and teachers).

Why psychiatrists? Because the diagnosis of ADD (ADHD) belongs to the group mental illness associated primarily with a violation of the social development and social adaptation of the child.

Why conspiracy? Because in 1962 in the US there were only 30,000 to 40,000 children under 15 diagnosed with MMD syndrome (minor brain dysfunction - that's what the ADHD / ADHD syndrome was called in those days). And now in the US, about 8% of children aged 4 to 17 years (12% of boys and 6% of girls) have a diagnosis of ADHD. P. Gray believes that the school curriculum has changed, teachers have become "stricter" and psychiatrists have become "more professional and meaner", and there has been an explosive increase in the number of children and schoolchildren with ADD (ADHD). “The reason for the diagnosis of ADHD is, according to P. Gray, the school’s intolerance to ordinary human diversity.”

The objection to this conclusion of P. Gray is obvious!

Could a child who does not obey adults, does not adopt their experience, does not imitate their actions, survive and maintain his health in a primitive communal society? Yes, humanity would have degenerated already at this uncivilized stage of its development. In our country, active obstetric intervention in childbirth by induction and stimulation has begun everywhere over the past 30 years.

According to the report of prof. O.R. Baeva at the All-Russian Obstetric Forum "Mother and Child 2010" from 70 to 80% of women in all regions of our country in 2009 went through pregnancy quite normally and gave birth in the so-called group of births low risk. But more than 65% of these women gave birth with complications and medical interventions.

Over the past 30 years, there has been a sharp increase in the number of children with various CNS developmental disorders. Figures for the health of the child population (children under 15):

• for cerebral palsy in 1964 - 0.64 per 1000 children, in 1989 - 8.9 per 1000, in 2002 up to 21 per 1000;
• on autism growth from 1966 to 2001 by 1500 times to 6.4 per 1000 children;
• even higher growth figures for children c ADHD- up to 28% of schoolchildren.

One of the authors of this article, when he came to school in 1964, had 46 students in his class, and one teacher from grades 1 to 4 did an excellent job of teaching them. There were four such first classes, each with 44 to 46 children. What has happened to children in the last 30 years if teachers cannot maintain discipline in modern classrooms out of 15-25 students?

If an MRI scan reveals the consequences of brain damage in all children with ADHD, what reasoning can there be that it is genes, nutrition or ecology that have damaged these parts of the brain of children with ADHD (cerebral palsy, autism, ASD, VSD, etc.)? Official medicine should not take the rest of the people for simpletons.

Each case of damage to areas of the brain has specific causes. In the vast majority of cases, this is hypoxia of these parts of the brain during aggressive obstetric intervention in the process of childbirth (intranatal period of childbirth)! And only a small proportion of children get ADHD (ADD) from injuries and infections after birth.

If the medical and pedagogical community is silent, it means that the prevention of such violations is on the shoulders of parents.

If you want more guarantees of the birth of healthy children without MMD (ADD, ADHD) and other neurological disorders of the central nervous system - do not let us induce and stimulate your childbirth. If the fetus suffers, then any induction and stimulation of labor will only increase the suffering (distress, hypoxia) of the fetus.

indicative modern example, changes in the attitudes of obstetricians, to the management of the birth of premature babies born before 32 weeks of pregnancy. According to the All-Russian Clinical Protocol “Preterm birth” of 2011, obstetricians have already been banned from stimulating, only expectant management was recommended until spontaneous labor develops, or cesarean section if the fetus or woman in labor begins to suffer.

Why did this new protocol appear? premature birth. Because since 1992, obstetricians during the reception of premature births acted on the order of the Ministry of Health of the Russian Federation dated December 4, 1992 No. 318/190 “On the transition to the criteria for live birth and stillbirth recommended by the World Health Organization”. In the “Instructive and Methodological Recommendations”, “rules for the management of preterm labor at a gestational age of 22 weeks or more” were prescribed (Appendix 2).

In these instructions, when labor was weak, stimulation with oxytocin and prostaglandins was allowed. The issue of delivery by caesarean section up to 34 weeks of pregnancy was carried out according to vital indications on the part of the mother. In the interests of the fetus, CS was performed: in breech presentation, transverse, oblique position of the fetus, in women with a burdened obstetric history (infertility, not bearing), in the presence of intensive care neonatal service.

The official approval of labor induction during preterm pregnancy led to the fact that the percentage of brain damage in premature babies during labor induction was reflected in the colossal incidence of CNS development (for example, among those born prematurely in 2006, it turned out up to 92% of patients in terms of health to year of life).

And since 2012, according to a new order of the Ministry of Health, they began to nurse in incubators and on mechanical ventilation, children born weighing from 500 g. Until January 1, 2012, a newborn weighing from 500 g to 1000 g was considered a born child, and not a late miscarriage, if he lived more than 7 days (168 hours). If we continue the tactics of stimulating premature births, then we cannot avoid a sharp increase in infant mortality and disability due to the addition of a large group of newborns (and not late miscarriages) from 500 g to 1000 grams of weight from 01/01/2012.

Therefore, a new Clinical protocol "Premature birth" of 2011 appeared, created by leading experts of the N.I. V.I. Kulakov and the Institute of Family Health. This protocol aims to improve the management of labor in preterm pregnancies in order to maximize the health of the fetus and preterm newborn.

In place of the criminal order of 1992 No. 318, which recommended the induction of preterm labor before 32 weeks of gestation, the new 2011 protocol recommends: “In the absence of active labor and the chances of a quick birth of a child, the method of choice is caesarean section.” The waiting time for the onset of labor is no longer regulated, with premature discharge of fetal water. The waiting time for the independent development of labor activity can now be hours and days and weeks. The main thing is to ensure the control of the woman's condition (prescribe antibiotics to prevent infection) and control the condition of the fetus (listening to the fetal heartbeat and, if necessary, CTG).

Since the child receives oxygen and nutrition through the umbilical cord, the presence of fetal fluids or their outflow does not affect his condition at all. But, everywhere, the popular opinion is widespread that "a child without water suffers and suffocates." This opinion exists among the “masses of citizens” obviously not without the “hints” of obstetricians.

Therefore, for babies born after 32 weeks of gestation, induction and stimulation is still recommended as possible way active childbirth. And then, “suddenly a child without water will begin to suffocate”!

Thus, a decrease in the incidence of our children with MMD (ADD, ADHD), autism, cerebral palsy and other disorders of the development of the central nervous system, with such an attitude towards childbirth on the part of official obstetrics, is not to be expected!

The main cause of impaired development of the central nervous system of a child is damage (infarctions) of the BVM (white matter of the brain) during acute hypoxia (distress) and birth trauma of the fetus during childbirth (intranatal period).

The main threat and cause of the development of acute hypoxia and birth trauma of the fetus during childbirth is induction (drug and mechanical “preparation” of the cervix) and stimulation of labor, contractions and attempts.

Only a strict, complete prohibition for obstetricians, the use of "modern" in childbirth medications and medical manipulations to induce and stimulate labor, can reduce the risk of brain damage to newborns, and dramatically reduce the number of newborns with brain damage.

Only the refusal of obstetricians from active aggressive delivery will return our women natural childbirth without induction or stimulation.

Natural childbirth is the only safe childbirth that gives the most more likely preservation of the intact central nervous system of the newborn child!

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