scholarly journals Evaluation of Autonomic Nervous System in Children With Cerebral Palsy: Clinical and Electophysiological Study

Author(s):  
Hanan Galal Azouz ◽  
Ali M Abdel Mohsen ◽  
Rana M Mohamed ◽  
hayam mostafa abdelghany

Abstract Cerebral palsy (CP) is the most prevalent severe motor disability among children. The aim of this work was to assess autonomic dysfunction in children with cerebral palsy clinically and electrophysiologically .The study was carried out on forty children with cerebral palsy their age ranged from 4-12 years and twenty healthy children with matched age and sex as control group. CP children were subjected to questionnaire for autonomic dysfunction symptoms. Both CP children and Control group were assessed for Sympathetic Skin Response and Heart rate variability. Most of children had quadriplegic spastic cerebral palsy (82.5%). Based on Gross motor function classification system (GMFCS) classification the majority of children were in levels 4 and 5. The prevalence of autonomic dysfunction symptoms was 80% for thermoregulatory abnormalities (cold extremities), chronic constipation 65%, sleep disturbance 52.5%, loss of appetite 47.5%, sweating abnormalities 40% , recurrent nausea and/or vomiting 25%, increased sensitivity to light or dark 22.5% and bloating 15%. The percentage of unelicited Sympathetic skin response in CP children was 47.5% and 60% in upper limbs and lower limbs respectively, all of them were in level 4 and 5 of GMFCS. 20% of CP children had postural hypotension. Mean Heart rate of CP children was significantly increased more than healthy children upon head tilt test. Sympathetic Skin Response and Heart rate variability were proven to be simple and non invasive procedures in investigating autonomic dysfunction in CP children.

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
Hanan G. Azouz ◽  
Ali M. AbdelMohsen ◽  
Hayam M. Abdel Ghany ◽  
Rana M. Mohamed

Abstract Background Cerebral palsy (CP) is the most prevalent severe motor disability among children. The aim of this work was to assess autonomic dysfunction in children with cerebral palsy clinically and electrophysiologically. Results Age of the studied children ranged from 4 to 12 years. Quadriplegic type of spastic cerebral palsy constituted 82.5% of CP children while diplegic type constituted 17.5%. Based on Gross Motor Function Classification System (GMFCS), the majority of children were in levels 4 and 5. The prevalence of autonomic dysfunction symptoms were 80% for thermoregulatory abnormalities (cold extremities), 65% for chronic constipation, 52.5% for sleep disturbance, 47.5% for loss of appetite, 40% for sweating abnormalities, 25% for recurrent nausea and/or vomiting, 22.5% for increased sensitivity to light or dark and 15% for bloating. As regards sympathetic skin response, 19 CP children had unobtainable response in both upper and lower limbs while 5 children had unobtainable response in lower limbs only. All of them were in levels 4 and 5 of GMFCS. Postural hypotension was present in 20% of CP children. Mean Heart rate of CP children was significantly increased more than healthy children upon head tilt test. Conclusions Autonomic dysfunction has been objectively proven in CP children through absent sympathetic skin response, presence of orthostatic tachycardia and postural hypotension.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O V Sidorovich ◽  
S Y U Elizarova ◽  
A V Khizhnyak ◽  
N A Kuznetsova ◽  
E E Prosova

Abstract   Within the framework of the research into pathological conditions and syndromes associated with undifferentiated connective tissue dysplasia (UCTD), an emphasis needs to be placed on the changes in heart rhythm. In puberty, the severity of neurovegetative disorders caused by the presence of UCTD might increase manifold. The features of heart rate variability (HRV) in pubertal children against the background of UCTD have been studied insufficiently and require more detailed analysis. This study aims to assess heart rate variability and tone of the autonomic nervous system (ANS) in puberty-aged children with UCTD. Two groups of children were examined, with methods including electrocardiography and cardiointervalography. The main group consisted of 36 puberty-aged children with UCTD, the control group consisted of 30 healthy children. ANS tone was assessed based on the HRV. In the control group of children aged 11, the value of variation range (VR) was 0.18±0.4, mode amplitude (MA) 35.2±2.4, stress index (IN) 72.8±4.3, which corresponds to the state of vegetative balance. As the puberty progresses, the state of eutonia is replaced by the activation of the sympathetic division of the ANS, which becomes most pronounced at the age of 13 years. In the control group of children aged 13, the value of VR was 0.08±0.02, MA 61.7±2.1, SI 210.6±8.6, which corresponds to moderate sympathicotonia. By the end of puberty, in healthy children, the severity of sympathetic activation begins to decrease, and at the age of 15 years, vegetative balance is again observed. However, this pattern is violated in children with UCTD. Upon entering puberty, moderate activation of the sympathetic division of the ANS is already observed in children with UCTD. At the age of 11 years in this group, the value of VR is 0.06±0.02, MA 72.4±3.1, SI 211.2±8.6. At the age of 13, pronounced sympathicotonia is observed, which is confirmed by the values of VR - 0.04±0.01, MA 80.2±4.3 and SI 34.3±14.7. By the end of puberty in children with UCTD, in contrast to the control group, the analyzed parameters indicate not an equilibrium of the ANS, but the predominance of parasympathetic activation. The research provides an insight into heart rate variability in puberty-aged children with UCTD. It was established that healthy children enter puberty in a state of equilibrium of the autonomic nervous system, which in the middle of puberty is replaced by moderate sympathicotonia, and then returns to its original values. Children with the presence of UCTD enter puberty with moderately pronounced sympathicotonia, which gradually increases to pronounced values and is replaced by moderate vagotonia. FUNDunding Acknowledgement Type of funding sources: None.


1999 ◽  
Vol 56 (10) ◽  
pp. 1248 ◽  
Author(s):  
Khema R. Sharma ◽  
Jose G. Romano ◽  
D. Ram Ayyar ◽  
Francisco T. Rotta ◽  
Alicia Facca ◽  
...  

2020 ◽  
Vol 26 (3) ◽  
pp. 68-70
Author(s):  
N. N. Kaladze ◽  
А. Уи. Iushchenko ◽  
V. N. Lukyanenko ◽  
М. Е. Kutkin

The purpose of the study is to study the effectiveness of medical rehabilitation in children operated on for a ventricular septal defect, based on the dynamics of heart rate variability indicators. Material and methods of research. Heart rate variability was evaluated in 75 children operated on for ventricular septal defect. The control group (CG) consisted of 30 healthy children. The effectiveness of medical rehabilitation was assessed by the dynamics of heart rate variability indicators. Children of the 1st group (20 people) took the cardiometabolic drug Elkar at a dose of 30 mg/kg/day for 1 month. With children of the 2nd group (20 people) for 3 months, Nordic walking classes were held (NW). In addition, children of the 2nd group received the drug Elkar for 1 month (30 mg/kg). Results. According to the time analysis of heart rate variability, operated children had significantly lower values of SDNN 82 [69;103] (p<0.001), SDANNi 50.5 [39;87] (p<0.05), SDNNi 69.5 [54;80] (p<0.05), rMSSD 50.5 [39;87] (p<0.05), pNN50 % 18.4 [6.7;28.3] (p<0.05) lower power in the high-frequency range of the spectrum (p<0.001) and a change in the vegetative balance towards the predominance of the sympathetic division of the autonomic nervous system (LF/HF=3.16, p=0.009) than in the control group. After the treatment, there was no reliable HRV dynamics in children who received Elcar. There was a significant difference between SDNN and rMSSD with KG. In the second group, there was a significant increase in HRV according to SDNN data by 37.7 % (p<0.01), SDANNi by 45.6 % (p<0.05), rMSSD by 6.5 % (p<0.05), pNN50 % by 32.7 % (p<0.05). The difference in indicators with CG is leveled. Conclusions. In children operated on for VSD, there was a decrease in the parameters of the time analysis of HRV in comparison with healthy peers (p<0.05). The combined use of Nordic walking and Elkar have a normalizing effect on the HRV, causing a decrease in the tension of the Central circuit of heart rate regulation, significantly increasing the parasympathetic effect on the heart rate.


Sensors ◽  
2021 ◽  
Vol 21 (22) ◽  
pp. 7590
Author(s):  
Ashwini Sansare ◽  
Ann Tokay Harrington ◽  
Henry Wright ◽  
James Alesi ◽  
Ahad Behboodi ◽  
...  

Recumbent stationary cycling is a potential exercise modality for individuals with cerebral palsy (CP) that lack the postural control needed for upright exercises. Functional electrical stimulation (FES) of lower extremity muscles can help such individuals reach the cycling intensities that are required for aerobic benefits. The aim of this study was to examine the effect of cycling with and without FES assistance to that of a no-intervention control group on the cardiorespiratory fitness of children with CP. Thirty-nine participants were randomized to a FES group that underwent an 8-week FES-assisted cycling program, the volitional group (VOL), who cycled without FES, or a no-intervention control group (CON) (15 FES, 11 VOL, 13 CON). Cadence, peak VO2, and net rise in heart rate were assessed at baseline, end of training, and washout (8-weeks after cessation of training). Latent growth curve modeling was used for analysis. The FES group showed significantly higher cycling cadences than the VOL and CON groups at POST and WO. There were no differences in improvements in the peak VO2 and peak net HR between groups. FES-assisted cycling may help children with CP attain higher cycling cadences and to retain these gains after training cessation. Higher training intensities may be necessary to obtain improvements in peak VO2 and heart rate.


2021 ◽  
Vol 74 (1-2) ◽  
pp. 33-40
Author(s):  
Mecbure Nalbantoglu ◽  
Mehmet Ali Akalin ◽  
Aysegul Gunduz ◽  
Meral Kiziltan

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.


2004 ◽  
Vol 132 (7-8) ◽  
pp. 214-218 ◽  
Author(s):  
Radoje Stevanovic ◽  
Olivera Jovicic

Cerebral palsy is one of the commonest children's physical handicaps with frequency of 1.5-3/1000. Beside many other disturbances, these children may have serious disorders caused by dental diseases. Concerning this fact, the objective of our study was to examine children with cerebral palsy in our country and determine condition of dental health and suggest adequate protective measures. A total of 116 children, 3-18 years old, with cerebral palsy were examined and the results were compared to the control group of healthy children of the same age. Among healthy children, 7-10 years old, 66.3% had healthy parodontium, while none of children with cerebral palsy had healthy parodontium. Children, 11-14 years old with cerebral palsy had higher percentage of untreated caries, but lower percentage of filled teeth (18.7%) compared to healthy children (55.0%). Children, 15-18 years old with cerebral palsy had significantly higher percentage of extracted teeth (10.6%) than healthy children (4.1%) and more often orthodontic anomalies (70.6%), compared to healthy children (46.9%). Results of these study indicate that children with cerebral palsy need special and planned dental care.


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