Frequent attacks of weakness, dizziness, pallor and sweating, which are accompanied by unpleasant sensations behind the breastbone, interruptions in the work of the heart are the main manifestations of diseases of the cardiovascular system. A huge number of diseases associated with organic changes must be differentiated from neurocirculatory dystonia - a pathology that is determined only by dysfunction without the formation of morphological disorders. A correctly established diagnosis promotes the choice of adequate therapy, which prevents the progression of the disease.
What is neurocirculatory dystonia?
Neurocirculatory dystonia (NCD) is a medical opinion, which is established mainly by cardiologists in the countries of the former CIS (as well as vegetative-vascular dysfunction). Pathology belongs to the category of diagnoses of exclusion, which are determined in the absence of signs of other diseases.
NCD is more often diagnosed in adolescents, during the second growth spurt and is characterized by a cyclical course with periods of crises (sympathoadrenal, vagoisnular) and remissions.
The development of dystonia is associated with a dysregulation of vascular tone due to functional disorders of the nervous, endocrine system and the metabolic process in general. Activation of subcortical centers in the brain (hypothalamus, reticular formation and other structures) transmits impulses to the vegetative regions, which contributes to the development of characteristic changes and complaints of the patient.
The symptomatology of NCD is diverse, therefore, pathology options are distinguished depending on the prevailing syndrome:
- cardiac (hypo-, hypertensive or mixed variant);
- neurological;
- mixed.
Diagnostic measures and patient management depend on the course option.
Cardial variant and its types
A feature of cardiac-type neurocirculatory dystonia is the ambiguity of symptoms associated with the involvement of the autonomic nervous system (sympathetic or parasympathetic part) in the process. The main types and their clinical manifestations are presented in the table.
| Subspecies | Symptoms of pathology |
|---|---|
| Cardialgic |
|
| Hypotonic (due to the predominance of the parasympathetic autonomic system) |
|
| Hypertensive (with an increase in the tone of the sympathetic section) |
|
Hypertensive type neurocirculatory dystonia is a risk factor for the future development of arterial hypertension with structural damage to target organs.
Neurological option
NCD manifestations mainly from the nervous system are more common in middle-aged men and are characterized by two syndromes:
- asthenic: weakness, morning fatigue, decreased mood and performance, memory impairment, concentration, sleep disturbances (mainly insomnia);
- vascular (due to dystonia of the cerebral vessels): headache, lability of blood pressure ("now high, then low"), periodic visual disturbances, "flies" before the eyes, tinnitus and pulsation in the head.
The occurrence of these symptoms is often associated with chronic fatigue syndrome, which is of an infectious nature, and is associated with the herpes simplex virus type 6, for which differential laboratory diagnostics is carried out.
Mixed option
The diagnosis of "Mixed type neurocirculatory dystonia" is established with the simultaneous presence of symptoms of two variants of neurological and cardiac pathology (any of the three types).
This form is most common and requires an integrated approach to diagnosis and treatment.
Causes of pathology
Neurocirculatory dystonia belongs to the group of functional pathologies, the causes of which are not fully understood.
There are risk factors for the development of NCD, which cause constant activation of the autonomic nervous system with the formation of an imbalance:
- chronic and acute stress (at home and at work);
- smoking;
- alcohol consumption;
- violation of the regime of work and rest;
- traumatic brain injury;
- occupational hazards: chemical compounds, noise, vibration, ionizing radiation and high temperatures.
Dysregulation of the functions of internal organs at the level of the hypothalamus and pituitary gland leads to increased activity of the sympathoadrenal system with the release of biologically active substances. The interaction of the latter with sensitive receptors located in organs and tissues contributes to the onset of characteristic symptoms.
Symptoms
The clinical picture of neurocirculatory dystonia is determined by the variant of the pathology. The most common signs of the disease are:
- pressing pain behind the sternum, discomfort;
- interruptions in work, heart palpitations;
- headache;
- weakness, fatigue, decreased ability to work;
- noise in ears;
- "Flies" before the eyes;
- pallor or redness of the skin (depending on the predominance of the component of the autonomic nervous system);
- on the cardiogram in such patients, extrasystoles (extraordinary contractions) are often recorded.
To diagnose the disease, a standard clinical examination by a cardiologist, measurement of the blood pressure level, recording of an electrocardiogram (ECG), and, if necessary, ultrasound and X-ray research methods are used.
In some cases, special functional tests are used to exclude organic pathology.
Treatment
Therapy of neurocirculatory dystonia implies an integrated approach with an impact on all links of pathogenesis, as well as on predisposing factors.
Non-drug methods include:
- normalization of wakefulness and sleep;
- balanced diet;
- adequate physical activity (in the mode of physiotherapy exercises with a gradual systemic approach);
- rejection of bad habits.
Drug therapy
The choice of pharmacological drugs for the treatment of NCD is carried out depending on the sensitivity of the patient, individual characteristics (including the profession) and the course of the disease. The basic drug therapy for all patients with dystonia is considered to be sedatives (sedatives) that suppress the pathological activity of the nervous system.
Most often prescribed: Valerian extract, Glycine, Novo-Passit, Validol.
Other groups of drugs that affect the nervous system:
- antipsychotics;
- tranquilizers.
Antipsychotics
Neuroleptics (antipsychotic drugs) are a group of drugs that are used mainly in neurology and psychiatry to suppress productive symptoms and psychomotor agitation in patients.The use of such drugs in patients with NCD is due to the increased activity of the autonomic nervous system with the primary source of signals in the brain.
Most used tools:
- Chlorprothixene (Truxal) - 30-50 mg 4 times a day;
- Chlorpromazine (Aminazine) - 50-100 mg once a day;
- Levomepromazine (Tizercin) - 50 mg once a day.
Antipsychotics are available from pharmacies only with a prescription.
The peculiarity of the use of antipsychotics is a gradual selection of the dose: from a minimum with an increase to a therapeutic one. In addition, there is a withdrawal syndrome - an increase in the symptoms of the underlying disease with an abrupt discontinuation of the drug.
Tranquilizers
The group of tranquilizing (anti-anxiety, anxiolytic) drugs is considered the means of choice for the treatment of NCD, since it differs from neuroleptics in a milder effect on the nervous system.
Pharmacological effects of medicines:
- anti-anxiety - reducing fear, anxiety and emotional stress;
- sedative - a pronounced sedative effect;
- muscle relaxant - relaxes muscle tension;
- sleeping pills - when using high doses, which is recommended for patients with insomnia;
- stabilization of the autonomic nervous system is the main property that is used in the treatment of NCD.
The classification of tranquilizers distinguishes between classical and "daytime" drugs, which differ in the severity of the hypnotic effect. The drug is selected depending on the type of activity of the patient and the need for precise coordination of movements, concentration of attention.
The most prescribed drugs and method of administration are presented in the table.
| Group | Drug and release form | Use for mild anxiety (mg / day) | Reception for severe symptoms (mg / day) |
|---|---|---|---|
| Classic | Diazepam (tablet 10 mg) | 5-20 | 20-40 |
| Phenazepam (tab. 1 mg) | 0,5-3 | 3-10 | |
| Elenium (tablet 10 mg) | 20-40 | 40-100 | |
| Daytime | Gidazepam (tab 20 mg) | 60-120 | 120-500 |
| Mebikar (tablet 300 mg) | 1000-1500 | 1500-3000 | |
| Phenibut (tab.250 mg) | 750-1500 | 1500-3000 |
According to the recommendations, treatment with anxiolytics is prescribed for a course of 4-6 weeks, followed by control of the effectiveness and dose adjustment. With the onset of remission, most often the drug is canceled or the frequency of use is reduced.
Tranquilizers are means for long-term therapy with the prevention of sympathoadrenal or vagoinsular crises, the result of which is preserved with constant use.
Psychotherapy
The work of psychologists in the complex treatment of neurocirculatory dystonia is aimed at:
- resolution of internal problems;
- reducing fears and anxiety levels;
- increasing emotional stability;
- adaptation of a person with a violation of autonomic regulation to society.
In practice, various techniques are used to achieve a result. In severe cases, hypnosis sessions are prescribed, during which the patient reveals constrained sensations and fears. More often, group classes and auto-training are used with the use of multimedia and integrative techniques.
Psychotherapy is not a panacea in the treatment of NCD, but it significantly reduces the influence of risk factors for the occurrence of vegetative crises.
Symptomatic treatment
The severity of signs, a decrease in the quality of life due to headache, insomnia, hypertension and heart palpitations require the appointment of symptomatic therapy:
- non-steroidal inflammatory drugs (Ibuprofen, Smazmalgon), which are used for headaches, feeling of weakness and aches throughout the body;
- beta-blockers (Bisoprolol, Carvedilol), which are more often used in the hypertensive variant of the cardiac form of NCD;
- sleeping pills (Zopiclone) - with severe insomnia;
- vitamin preparations: Salbutiamine (Enerion), which is effective for severe asthenic syndrome in patients with a feeling of shortness of breath.
Hypotonic neurocirculatory dystonia requires the appointment of analeptics and herbal stimulants: Caffeine, Schisandra tincture or Echinacea.
Physiotherapy
In the treatment of neurocirculatory dystonia, physiotherapy methods are widely used, which improve blood flow in organs and systems, and accelerate metabolic processes.
The most commonly prescribed:
- physiotherapy;
- cold and hot shower;
- franklinization (in a constant electric field with high voltage);
- phototherapy (using ultraviolet radiation);
- balneotherapy (baths with water of increased mineralization, mud).
Patients with NCD report the high effectiveness of physiotherapy, which improves overall well-being and reduces the severity of symptoms.
Conclusions
Neurocirculatory dystonia is a functional disorder that develops against a background of risk factors and is accompanied by polymorphic symptoms without structural changes in organs and tissues. An integrated approach to differential diagnosis and the choice of adequate treatment contributes to the improvement of the patient's quality of life and the complete elimination of symptoms. The prognosis for a patient with NCD is favorable, provided that all the recommendations of the attending physician are followed.
