METHOD of AUDIOVISUAL STIMULATION IN the TREATMENT of HYPERACTIVITY AND ATTENTION DEFICIT disorder in CHILDREN
TIC hyperkinesis is one of the urgent problems of modern neurology because of their frequency of occurrence among the child population , according to different authors, is 6% [6,7].
When studying the problem of ticks, special attention is paid not only to the relief of the TIC hyperkinesias, and treatment of related mental disorders, as it is the latter define the quality of life of the patient, the degree of adaptation and social rehabilitation. Many patients with tics, there are various psychopathological condition . Thus, several authors identified a direct relationship between the severity of hyperkinetic disorders and associated behavioral disorders. Hyperkinesis in children is often combined with attention deficit and hyperactivity disorder (ADHD) [1]. Often, the initial symptoms of ADHD precede the development of TIC disorders [4]. In 50-75% of patients with the syndrome of Gilles de La Tourette's have symptoms that meet the criteria of attention deficit disorder and hyperactivity [3]. The nature of the relationship between these two syndromes has not been studied. Still not resolved the question of whether ADHD is a result of the TIC disorder or a concomitant disorder.
In recent decades abroad, attempts to use a method of audiovisual stimulation (ABC) in the treatment of ADHD. Technology ABC - exposure to flickering light and the sound frequency in the range of bioelectric activity of the brain [5]. H. Russell (1991) investigated the positive influence of the method ABC with frequency beta-rhythm in cognitive functions of children suffering from ADHD [5]. L. B. Ivanov (2000) noted the positive impact of the method of audiovisual stimulation on cognitive function and the nature of the EEG of children with attention deficit disorder and hyperactivity.
While improved, the cortical rhythm according to the spectral power analysis of EEG [2]. The group of patients who underwent therapy by using ABC made up of 27 people (4 girls and 23 boys). Of these, Tourette's syndrome was diagnosed in 10, common the TEC - 10, the local tick in 7 patients. The main selection criterion of patients was the presence of ADHD, Held 10 sessions in ABC mode 8-12 Hz. The holding of this method was carried out in a horizontal position the patient for 20 minutes In this regard, the ABC method was performed in children older than 6 years. At the time of treatment by this method, patients did not receive drug therapy about ticks.
To assess the effectiveness of therapy was used, counting the ticks for 20 minutes before and after treatment. For the diagnosis of ADHD was used the diagnostic criteria of attention deficit disorder with hyperactivity DSM-IV prior to treatment and через1 month after treatment. To study the properties of the memory ( dynamics of the process of remembering, volume, productivity) used the technique of "10 words" A. R. Luria , to analyze the properties of attention (self-regulation of attention, retention of the instructions) used the technique of es Krasil'nikova, "Yes" and "No" not to say." These techniques were carried out before and after a course of ABC. The effectiveness of therapy by using ABC were also evaluated by EEG parameters.
After conducting the ABC course clinically positive result of reducing the number of ticks in the 39.6% set in 7 patients suffering from common ticks and 68,2% in patients with localized tics. Reduction of the TIC hyperkinesias were observed in patients with Tourette's syndrome in 3 patients with common ticks with a standard-status period of the disease and the burdened heredity by ticks. After treatment by the method of ABC also noted a positive effect on ADHD. In tests on attention and memory before the treatment method ABC obtained the following results: when performing the methods of Luria's "10 words" a normal type of curve was found in 12 (44,4%) patients, in 11 (40,7%) children - rigid and in 4 (14.8%) patients seen; the technique of es Krasil'nikova, "Yes" and "No" don't say" high level of results was observed in 2 (7.4%) have children, the average - 14 (51,8%) patients and low in 11 (40,7) patients. Thus, the obtained results showed a change in focus from 92,6% , and memory in 55.6% of patients suffering from TIC hyperkinesias and ADHD. After treatment by the method of ABC noted the positive dynamics in the implementation of tests for attention and memory in 13 patients (48.1 percent). In 16 (59.2 per cent) patients 1 month after treatment marked decrease from 2 to 5 symptom of hyperactivity, impulsivity and attention disorders according to the diagnostic criteria of ADHD in DSM-IV.
After the course, ABC was also positive dynamics in the EEG pattern of patients. To treatment by this method changes in elektroentsefalograficheskih pattern was observed in 23 children. I moderate disorganization of the basic cortical rhythm was recorded in 9 (33,3%) olenych, severe disruption - in 11 (40,7%) children, I diureticeskie manifestations have z (11.1%) and relatively preserved cortical rhythm in 4(14.8%) patients. Pathological activities in the form of flashes of acute waves slightly above or at the level of background records was found in 21 (77,7%) children.
After treatment by visual assessment of native EEG was a trend towards better organization of the basic rhythm in 17 patients., the decrease in the magnitude of the frequency and amplitude of sharp waves were detected in 11 patients. The spectral analysis revealed the growth of the power peak of the dominant frequency on average by 12.3% D in 8 patients. The narrowing of the range of the basic rhythm was registered in 7 patients. The shift of the dominant frequency in the direction of acceleration, where a credible account of the offset of at least 0.5 Hz, 9 patients, which coincided with pronounced clinical improvement in 4 patients.
Analysis of coherence revealed the features of the integrative state of the brain in 23 (85.2 percent). For vnutripolostny pairs in 5 patients were detected asymmetry of the average coherence between pairs Fp1-T3 and Fp2-T4 and was 24.2%. Also, when the coherent analysis vnutripolostny couples found in violation of the anteroposterior ratio of the magnitudes of coherence. 9 (36.4%) of patients showed a smoothing of the ratio of anteroposterior (a decrease in anterior regions and higher in the rear), and 2 patients had inversion of the anteroposterior relation. A study of the average coherence megalochary relations showed a reduction in the level of coherence in pairs Fp2 -Fp1 and F4-F3 in 13 (48,1%) patients, 16 (59.3%) of patients had an increase in values of coherence in pairs of C4-WT and P4-RZ to an average of 0.57±0.02 and 0.52±0.01 respectively. In 7 (25.9%) patients showed a reduction in the average interhemispheric coherence in average in the Laramie C4-WT and P4-RZ . During coherent analysis of the EEG after the course ABC noted vnutripolostno -a trend towards normalization of the anterior-posterior ratio 6 patients. The average values of coherence for the average megalochary relations revealed a tendency to decrease the level of integration in parieto-Central areas and increase in frontal departments in 7 patients.
Thus, the received results testify to efficiency of application of the method ABC in the treatment of children diagnosed with TIC hyperkinesias and attention deficit disorder and hyperactivity.
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