The protection of motherhood and childhood is a problem of national and medical and social importance. There is reason to believe that some diseases of the nervous system in children arise at different stages of intrauterine development and are realized in the perinatal and postnatal periods [1]. This also applies to perinatal hypoxia.
Perinatal hypoxia is an effect that negatively affects both the central nervous system (CNS) of the fetus and other organs and systems. The works of a number of authors [2, 3] have established a direct correlation between the severity of perinatal hypoxia and its consequences. This corresponds to the data that 19.5% of children in the general population suffer from mental and neurological disorders, in 65% of cases the damage to the central nervous system is hypoxic-ischemic in nature, and only 21% are due to genetic and postnatal factors [4].
The most common outcome of post-hypoxic lesions of the central nervous system is the formation of minimal brain dysfunction (MCD), the frequency of which ranges from 4 to 20%. MMD can manifest as attention deficit hyperactivity disorder (ADHD) [4]. V.M. Troshin et al. [5] observed various neurotic reactions, behavioral disorders, school learning difficulties, impaired maturation of higher brain functions, and various neurosis-like conditions in MMD. Its characteristic signs are also increased excitability, emotional lability, sleep disturbance, mild diffuse neurological symptoms, moderate sensorimotor and speech disorders, perception disorders, increased distractibility, insufficient development of intellectual skills, and specific learning difficulties [3, 6]. In some cases, there are signs of mild local organic brain damage [7, 8].
ADHD is understood [9, 10] as a polyetiological developmental disorder that is formed as a result of a complex interaction of genetic and environmental factors. Children with ADHD have a number of features in the structure and functioning of brain structures, mainly in the prefrontal-striato-thalamo-cortical zones. In these cases, genetic mechanisms and organic damage to the central nervous system in the pre- and perinatal periods can be combined. Clinically, there are three types of ADHD: combined, with a predominance of inattention, and with a predominance of hyperactivity and impulsivity. ADHD is 3-4 times more common in males. They note [10] some differences in the clinical manifestations of ADHD in boys and girls: for girls, attention disorders are more typical than hyperactivity and impulsivity, and among boys, comorbid behavior disorders and affective disorders are more common. ADHD is observed in children in all socioeconomic groups, but the disease is somewhat more common in low-income groups and in regions with high population density [11].
Neuropsychological examination of children with mild brain dysfunction and disordered behavior, according to a number of authors [6, 12], reveals changes in praxis, which are manifested by a violation of the kinesthetic basis of movements and visual-spatial organization. Disorders of spatial and auditory gnosis, modality-nonspecific disorders of memory and attention are noted. The level of verbal and logical thinking is reduced. Studies of the state of higher brain functions in healthy and sick children with ADHD aged 5-7 years, conducted by O.V. Khaletskaya [6–8], showed that differences are especially pronounced at 6–7 years of age in such functions as auditory-motor coordination and speech. At the same time, strengthening motivation and organization of training gives a clear compensatory effect. A characteristic feature is selectivity of attention associated with motivation and pleasure from the activity performed. Such children perform worst at tasks that seem boring, repetitive, difficult, unsatisfying, and not rewarding.
In the pathology under consideration and, in particular, in ADHD, distractibility and impulsivity also occupy a large place. Thus, children with ADHD begin to complete tasks without hearing the condition to the end; they answer at random, without preliminary thinking [13].
Of great interest are works that reflect the dynamics of neuropsychological functions in children of preschool or primary school age who have suffered perinatal hypoxic-ischemic damage. It was found [14, 15] that when observing the development of children from 3 to 12 years old with a history of mild perinatal hypoxic-ischemic damage to the central nervous system, with intact intelligence, delayed development of certain higher brain functions and heterochronicity in neuropsychic development, including periods negative dynamics. Thus, spatial praxis and tactile gnosis do not differ in significant dynamics with age; visual gnosis, auditory-verbal and visual memory, auditory-motor coordination, constructive activity and speech improve gradually and evenly in the period from 3 to 12 years; kinesthetic and dynamic praxis, as well as visual memory, change in waves, the peak of improvement in their development occurs at 5-9 years, but these indicators do not exceed those in healthy children, then by 10-12 years they decrease again.
As for ADHD, the maximum severity of its manifestations is observed at the age of 6-7 years. There is insufficient data on the condition of 3-4 year old children in this regard. Nevertheless, there is convincing data indicating that when active correctional work is carried out, a significant regression of symptoms occurs, and in the absence of targeted neurorehabilitation programs, the development of children proceeds less well [2] and can lead to the formation of deviant forms of behavior, the development of cognitive disorders, school and social maladjustment [17].
As part of the consequences of perinatal lesions of the central nervous system, the problem of speech disorders, which is less studied in children 3-4 years old, is becoming increasingly relevant. Parents and teachers often complain about delays in speech development in these cases: children start speaking late, speak little and poorly, their speech is poor and primitive. As special studies have shown, 25% of 4-year-old children suffer from serious disorders in speech development. If in the mid-70s speech deficits were observed in only 4% of children of this age, then over the past 20 years the number of speech disorders has increased more than six times [18].
The above makes it necessary to dwell on modern classifications of speech disorders.
There is a psychological and pedagogical classification
, which takes into account the type and severity of disorders of various components of speech. This classification distinguishes: 1. Phonetic speech disorder (FSD) or disorder of the pronunciation of individual sounds (NPOS). In case of FND, the phonetic aspect of speech (sound pronunciation, sound-syllabic structure of speech, prosody) as a whole or any individual components of the phonetic structure of speech (for example, only sound pronunciation or sound pronunciation and sound-syllabic structure of a word) are impaired. 2. Phonetic-phonemic speech disorder (FFSD). With FFND, along with a violation of the phonetic aspect of speech, there is also an underdevelopment of phonemic processes: phonemic perception (auditory differentiation of sounds), phonemic analysis and synthesis, phonemic representations. 3. Lexico-grammatical speech underdevelopment (LGSD). With LGNR, children have normal sound pronunciation, and phonemic processes are relatively preserved (most often as a result of speech therapy). However, limited vocabulary and impaired grammatical structure of speech are noted. 4. General underdevelopment of speech (GSD levels I, II and III), as well as mild general underdevelopment of speech (GONSD). With OHP in children, all components of the language (speech) system are impaired: the phonetic-phonemic side of speech, vocabulary, grammatical structure.
There is also a clinical and pedagogical classification
, reflecting primarily the clinical features of a speech disorder. It includes: 1. Oral speech disorders.
1.1. Violation of the phonation of a statement (pronunciation aspect of speech). The most significant clinical manifestations of oral speech disorders are disorders associated with dysfunction due to pathological changes, which may be caused by anatomical and physiological defects of the speech and voice-forming apparatus: 1) dysphonia (aphonia) - a disorder (absence) of phonation. Manifests itself in the form of disturbances in the strength, pitch and timbre of the voice; 2) rhinolalia - a violation of the timbre of the voice and sound pronunciation, speech is slurred, monotonous, the pronunciation of all sounds is distorted.
This group of disorders also includes disturbances in the rate of speech: bradyllalia or tachylalia - pathologically slow or accelerated rate of speech; stuttering is a violation of the tempo-rhythmic organization of speech, caused by convulsive contraction of the muscles of the speech apparatus. In addition, dyslalia is a disorder of sound pronunciation with normal hearing and intact innervation of the speech apparatus, and dysarthria is a disorder of the sound pronunciation side of speech caused by organic damage to the central nervous system and disorders of the innervation of the speech apparatus. Common clinical signs of dysarthria are disturbances in muscle tone of the articulatory muscles. Dyspraxia should also be mentioned here (sometimes to focus on a speech problem they talk about “dyspraxia of language”) - difficulties with speech and language mean that the child cannot control the muscles that form speech, produce sounds correctly, pronounce words while controlling breathing [21].
1.2. Violation of the structural and semantic design of the statement. Alalia is the absence or underdevelopment of speech due to damage to the speech zones of the cerebral cortex in the prenatal period or in the early (pre-speech) period of child development (synonyms: dysphasia, early childhood aphasia, developmental dysphasia); aphasia is a complete or partial loss of speech caused by local damage to the speech areas of the cerebral cortex as a result of traumatic brain injury, cerebrovascular accidents, neuroinfections and other diseases of the central nervous system.
2. Impaired written speech. Dyslexia is a partial specific disorder of the reading process. Dysgraphia is a partial specific writing disorder [19].
The International Classification of Diseases, 10th Revision (ICD-10) identifies the following categories related to speech development disorders:
F80.0 Specific articulation disorder. A specific developmental disorder in which a child uses speech sounds below a level appropriate for his or her mental age, but in which language skills are normal.
F80.1 Expressive language disorder. A specific developmental disorder in which a child's ability to use expressive spoken language is markedly below the level appropriate for his mental age, although speech comprehension is within normal limits. There may or may not be articulation disorders.
F80.2 Receptive language disorder. A specific developmental disorder in which a child's ability to use spoken language is markedly below the level appropriate for his mental age or absent, is associated with decreased or absent speech comprehension. [10]
Clarification of the features of the formation and nature of speech and behavioral disorders in children aged 3-4 years with the consequences of hypoxic-ischemic damage to the central nervous system has important practical significance in relation to the choice of therapy and correction of existing disorders. Children with speech disorders are recommended to undergo speech therapy and psychological correction in combination with the prescription of nootropic drugs (encephabol, Cerebrolysin, Cortexin, Pantogam) and physiotherapeutic methods of treatment (transcranial micropolarization) [20]. It should, however, immediately be noted that when carrying out drug correction, doctors in these cases face great difficulties due to the short-term effect of drugs, the development of side effects and age restrictions on the use of certain drugs.
In this regard, the drug tenoten for children, which relatively recently became part of clinical recommendations for the treatment of ADHD, attracts attention [19]. It is considered safe when used in children over 3 years of age with motor and speech disorders who have suffered perinatal hypoxic-ischemic damage to the central nervous system.
Tenoten for children contains release-active antibodies to the brain-specific protein S100 (PA-AT S100). Children's RA-ATs included in tenoten modify the functional activity of the S100 protein, which couples synaptic (information) and metabolic processes in the brain, increases the activity of stress-limiting systems, providing a GABA-mimetic and neurotrophic effect, promotes the restoration of neuronal plasticity processes without causing sedation, muscle relaxant , anticholinergic actions.
The purpose of this study is to evaluate the effectiveness of children's tenoten (Materia Medica Holding LLC, Russia) in the treatment of motor and speech disorders in children 3-4 years old who suffered perinatal hypoxic-ischemic damage to the central nervous system.
Material and methods
The study included 80 children, 56 boys and 24 girls aged from 3 years to 3 years 11 months with two types of consequences of perinatal damage to the nervous system (PPNS) - dysontogenetic and encephalopathic. The distribution of these children by age is presented in Table. 1. The ratio of boys and girls included in the study reflects the prevalence of this pathology by gender in the child population. The same applies to the identified variants of the consequences of perinatal damage to the nervous system at this age. The dysontogenetic variant with milder neurological and dysphasic manifestations is much more common when examining children of early preschool age than the encephalopathic (complicated) variant with pronounced cerebrasthenic or hyperkinetic disorders (see Table 1).
Table 1. Distribution of examined children by age
According to our data, the reasons contributing to PPNS, and subsequently to motor and speech disorders, include pathological conditions during pregnancy (90%): toxicosis of the first half of pregnancy (52.3%), threat of miscarriage (27.7%), nephropathy (7.5%), anemia (12.5%). Pathology during childbirth was identified in 92.5% of cases: rapid labor was most often observed - 11.3%, prolonged labor - 3.8%. During the neonatal period in the examined group the following were observed: malnutrition - 7.5%, postmaturity - 5%. There was a history of prematurity in 12.5% of children. Diagnoses related to the perinatal period were as follows: “hypoxic-ischemic encephalopathy” - in 80% of children, “motor disorder syndrome” - in 37.5% (in the form of muscular dystonia with hypotonicity or hypertonicity). In 17.5% of cases, a syndrome of increased neuro-reflex excitability was detected, in 6.3% - hypertensive-hydrocephalic syndrome. In combination with the noted manifestations, 12.5% of children had a delay in early psychomotor development.
One of the main and significant features of the children’s condition, which parents paid attention to, was motor awkwardness (92.5%). Compared to their peers, the children lagged behind in motor development; awkwardness and lack of coordination of movements were noted, especially noticeable in physical education and rhythm lessons. The nature of the movements was slow and irregular. Impairments in fine motor skills of the hands were detected when drawing, modeling from plasticine, assembling construction sets, and laying out small parts. Parents often noted in their children increased motor activity, restlessness, signs of infantilism (inconsistency of mental reactions with age), as well as emotional and behavioral disorders. Such children were also distinguished by dysarthria. The distribution of other disorders in the examined groups of children is shown in Table. 2.
Table 2. Frequency of disturbances in the state and behavior of children of different groups with motor disorders and dysarthria
As can be seen from table. 2, against the background of delayed motor development, in addition to complaints about awkward movements (92.5%), in most children, parents noticed certain difficulties in pronouncing words (85.2%), the severity of which correlated with motor dysfunction. Complaints of restlessness and hyperactivity were quite common (36.3%). At the same time, signs of ADHD were almost twice as common in the dysontogenetic variant of the consequences of PPNS. Moodiness and disobedience were less common (25%). Cerebrasthenic symptoms: physical and, to a greater extent, mental exhaustion were 3 times more common in the group of children with the encephalopathic variant of the consequences of PPNS - 13 people (38.2%), while anxiety and fears occurred with almost the same frequency (6, 5 and 5.9%). The difficulty of learning during educational games was noted by parents of children in both groups, but more than half in the group with a predominantly encephalopathic variant (18 children, 52.9%). Neurological symptoms such as tics and enuresis were also more common in this group (29.4 and 15.2%, respectively).
As for the neurological status, in the group of children with the dysontogenetic variant, changes were noted in the coordination sphere in the form of staggering with deviation from the line, excessive movements, auxiliary hand positions, instability in the Romberg test, as well as misses when performing the finger-nose test, hypermetry and asynchrony of movements, synkinesis of facial muscles when performing a test for diadochokinesis. Disturbances from the cranial nerves were represented by weakness of convergence, bilateral under-extension of the eyeballs (oculomotor nerves III, IV, VI). In children with the encephalopathic variant, changes in muscle tone in the extremities of the hypotonia, dystonia, or plastic type hypertension prevailed; tendon reflexes (moderate increase or decrease) according to hemitype; local hyperkinesis (tics), urination disorders. In addition, a violation of cranial innervation was represented by elements of horizontal nystagmus and convergent strabismus (oculomotor nerves III, IV, VI); facial asymmetry (smoothness of the right or left nasolabial fold) (facial nerve VII); deviation of the tongue (glossopharyngeal nerve XII). The frequency of identified symptoms is summarized in Table. 3.
Table 3. Frequency of neurological symptoms in groups of examined children
Our study confirmed the existing position in child psychiatry and neurology that overcoming speech disorders in dysarthria is impossible without examination and development of the child’s motor sphere. The level of development of children's speech depends on the degree of development of fine movements of the fingers. In children with dysarthria, the kinesthetic and kinetic basis of movements is insufficiently developed. Based on this, the development of the motor system of children is a factor stimulating the development of speech. The movements of the fingers are of particular importance, as they influence the development of the child’s higher nervous activity. Fine motor skills are motor activities that are determined by the coordinated work of the small muscles of the hand and eye. Based on the objectives, the methodology for studying motor praxis included: 1) studying the state of general motor skills; 2) study of the state of voluntary motor skills of the fingers; 3) study of articulatory praxis.
In each section of the methodology, the result is assessed in points: from 4 (when the task is completed correctly and independently) to 0 points (when the task is not completed or is performed with numerous errors without criticism of them).
Our results indicate that in children with a dysontogenetic variant of the consequences of PPNS, the severity of symptoms of delayed general motor development was less significant. This also applies to indicators of general voluntary motor skills (the average score is 2.56, and in the group with the encephalopathic variant - 1.87) and to the performance of the Head test - the average score in this study in the group with the dysontogenetic variant was 2.25, and in the group with encephalopathic - 1.63 points.
Children in both groups showed loss of balance, deviations to the sides, slowness and imprecision of movements. However, coordination of movements was worse in the group with the encephalopathic variant of PPNS - when completing tasks, they scored less than half of the possible points (46.8%), difficulty was noted in dynamic tests - they had difficulty catching the ball and passed it to the researcher inaccurately. The same results were noted when studying visuospatial organization: in the Head test in the group with the encephalopathic variant, echopraxia occurred during the first task and persisted during subsequent tasks; some children did not correct errors on repeated tests; the average score of completed tasks was 40.8%. Indicators of general motor skills assessed in children with the dysontogenetic variant were slightly higher: they were more accurate in performing coordination tests (64% of possible) and when repeating movements after the researcher in the Head test (56.3%).
As noted above, fine motor skills are motor activity that is determined by the coordinated work of the small muscles of the hand and eyes, and the level of speech development in children depends on the degree of development of fine movements of the fingers. When we studied kinesthetic praxis (Table 4), children with dysontogenetic variant of disorders coped with tasks significantly better, their movements with their hands were more accurate and coordinated (53.3% of possible points). Kinetic praxis tasks were completed after prompting and instructions from the researcher (51.3% of the maximum possible score). In the group with the encephalopathic variant, errors and inaccuracies were noted significantly more often, which were not corrected even after comments (38.3% of completed tasks), synkinesis was observed when performing tasks on kinetic praxis, the rate of movement of the fingers was slow, more often these children performed tasks with with the help of an adult or not at all (31.3%).
Table 4. State of fine motor skills of the hand in the examined children, average score
In order to assess the state of articulatory and facial motor skills of children (Table 5), the child is asked to hold the organs of articulation in the desired position for 5-7 s. 20 exercises with functional load are used: “fence” - “window” - “bridge” - “sail” - “shovel”, “tasty jam”, etc. The accuracy of the movements was taken into account (exact execution, approximate, search for articulation, replacement one movement to another), the duration of holding the articulatory posture (sufficient, rapid exhaustion), symmetry, the presence of synkinesis, hyperkinesis, salivation. More correct and accurate performance of the exercises was noted in the group of children with the dysontogenetic variant - their average score when studying kinetic oral praxis was 2.36 (59% of the maximum possible). Children with the encephalopathic variant of developmental delay were more likely to experience rapid exhaustion, slow response to performing exercises, and inaccuracies in their execution. They quickly lost interest in the lesson and showed reactions of protest and disobedience. Muscle tone and mobility of the lips and tongue were assessed by the accuracy of task performance, the presence of violations of the tone of the labial muscles (hypertonicity, hypotonia, dystonia; salivation, which increases with functional load, deviation of the tongue). The children had difficulty completing the task; they completed it only with the help of an adult; their movements were slow and uncertain. Tightness of the lips and limited mobility were noted. It should be noted that in children with a severe violation of the muscle tone of the tongue, constant salivation, hyperkinesis, blue discoloration of the tip of the tongue and its deviation, other neurological symptoms were most often detected, which were described earlier. In the vast majority of cases, such significant disorders were observed in the group of children with the encephalopathic variant of the consequences of PPNS (84% of all children). In table Figure 5 shows differences in the severity of the tone of the lips and tongue. Children with the dysontogenetic form were able to score 67% of the maximum possible score, while children with the other form were able to score only 46.8%.
Table 5. State of articulatory motor skills in the examined children, average score
To assess the effectiveness of the medication and speech therapy measures, all children were divided into the main (50 children) and control (30 children) groups. In the main group there were 30 children with the dysontogenetic variant and 20 with the encephalopathic variant, in the control group there were 16 and 14, respectively.
In the main group, a combination of standard speech therapy techniques was used with a course of treatment with the drug tenoten for children according to the scheme: 1 tablet 3 times a day for 12 weeks. In the control group, only speech therapy classes were conducted 2 times a week (duration of classes - no more than 15 minutes). When carrying out correctional speech therapy work, the following speech therapy methods were used: differentiated speech therapy massage, passive and active articulatory gymnastics (to correct sound pronunciation) and a technique aimed at improving fine motor skills of the hands.
In table Figure 6 reflects the dynamics of the state of general motor skills, fine motor skills of the hands and articulatory motor skills in children of the examined groups.
Table 6. Dynamics of the state of general motor skills, fine motor skills of the hands and articulatory motor skills in the examined children, average score and % of the maximum Note.* - p<0.05; ** — p<0.01.
When comparing the results of tenoten therapy for children in combination with speech therapy sessions in the main group with the results of speech therapy interventions only in the control group, the following conclusions can be drawn.
Indicators of general motor skills and spatial coordination improved in the main group of children with dysontogenetic and encephalopathic variants of the consequences of PPNS, especially in the Head test, where the improvement became significant - from an average score of 2.25 to 2.89 ( p
<0.05) and from 1.63 to 1.84 points (
p
<0.05). Children completed tasks correctly and independently corrected mistakes; Echopraxia occurred during the first task, but did not recur during subsequent tasks. In the control group, indicators of general motor skills (according to the Head test) also improved, but did not reach significance (the average score increased from 2.25 to 2.45 and from 1.63 to 1.71 for two different options); the children remained unstable in balance and vagueness in performing visual coordination tests (Fig. 1).
Rice.
1. Dynamics of indicators of general motor skills and spatial coordination (% of the maximum score). * — p<0.05; **— p<0.01. According to the design of the study, speech therapy sessions were conducted with children in the main and control groups 2 times a week, which used exercises aimed at improving fine motor skills of the fingers and improving articulatory motor skills. Therefore, it was quite natural to expect positive results on these indicators. Indeed, in children of both groups, the average score in the study of fine motor skills of the hands, both in terms of kinesthetic and kinetic praxis, increased, the pace of completing tasks increased, and movements became more accurate. In the main group, upon objective assessment, improvement in results with a greater degree of reliability occurred in children with a dysontogenetic variant of the consequences of PPNS: in kinesthetic (from 2.13 average score to 3.15; p
<0.01) and kinetic praxis (from 2.05 average score to 3.43;
p
<0.01);
in the group with the encephalopathic variant, the reliability of the improvement in indicators was slightly lower (from 1.51 to 2.15 points, respectively; and from 1.25 to 2.35 points; p
< 05). In the control group, some improvement was also observed mainly in children with dysontogenetic form, but it did not achieve reliable results. According to the specialists who conducted speech therapy sessions, children who took tenoten for children had a noticeable improvement in behavior, objectively reduced symptoms of increased excitability, hyperactivity, restlessness, and improved contact when performing tasks. Parents also noted such changes in the behavior of children; at home, after taking the drug, children became calmer, more obedient, and cases of moodiness and disobedience decreased (Fig. 2, 3).
Rice. 2. Dynamics of indicators of fine motor skills of the hands (% of the maximum score). * — p<0.05; **— p<0.01.
Rice.
3. Dynamics of articulatory motor skills indicators (% of the maximum score). * — p<0.05; **— p<0.01. Speech therapy classes, which included differentiated speech therapy massage, as well as passive and active articulatory gymnastics, objectively improved the results of the repeated study, especially the average score for kinetic oral praxis in children of the main group with a dysontogenetic variant of the disorder increased significantly - from 2.36 to 3.65 points ( R
<0.01): the execution of movements became more accurate, the duration of holding the articulatory pose and its symmetry increased, the number of synkinesis and hyperkinesis decreased.
Muscle tone and lip mobility in children of the main and control groups during articulatory gymnastics improved equally with the dysontogenetic and encephalopathic variant of disorders - from 1.63 to 2.28 ( p
<0.05) in the main group and from 1.63 to 2.24 average score (
p
<0.05), and a significant improvement in children with encephalopathic variant disorders was noted only when using the drug tenoten for children - from 1.23 to 1.75 average score (
p
<0.05).
Thus, a common speech disorder in preschool children who have undergone PPNS is dysarthria. It is often combined with delayed motor functions in the form of a slow pace of movements, awkward, imprecise and undifferentiated movements in the area of both gross and fine motor skills of the hands and rapid fatigue. Severe impairments of motor functions in dysarthria are quite difficult to correct and negatively affect the formation of phonemic and lexico-grammatical aspects of speech, complicating the process of schooling for children. Timely correction of speech development disorders is a necessary condition for the psychological readiness of children to study at school and creates the prerequisites for the earliest social adaptation of preschoolers with speech disorders.
Based on the data obtained, the following conclusions can be drawn:
1. In children who have suffered PPNS of various etiologies, in early preschool age (3-4 years), delayed motor development and speech development disorders (dysarthria) are detected.
2. The severity of dysarthria depends on the severity of motor disorders: they are milder in children with the dysontogenetic variant of the consequences of PPNS in comparison with the group of children with the encephalopathic variant.
3. To correct speech disorders, it is necessary to use techniques that stimulate the development of gross motor skills, spatial coordination and fine motor skills of the hands.
4. The inclusion of the drug tenoten for children in a comprehensive speech therapy program promotes significantly more successful development of both gross motor skills and spatial coordination, as well as fine motor skills of the child’s hands.
5. In children treated with tenoten for children, signs of dysarthria decreased in comparison with children who received only speech therapy assistance, and in the group with the dysontogenetic variant of PPNS these changes were more pronounced.
6. Along with improving motor and speech functions, a course of tenoten for children helps to normalize the child’s behavior, reduce hyperactivity, excitability, restlessness, and increase productive contact. According to parents, at home, after taking the drug, children became calmer and more obedient.
Tenoten for children
Tenoten children's tablet d/rassas x40 Composition
Active components: antibodies to the brain-specific protein S-100, affinity purified - 0.003 g*. Excipients: lactose monohydrate (lactose) 0.267 g, microcrystalline cellulose 0.03 g, magnesium stearate 0.003 g.
* applied to lactose monohydrate in the form of a water-alcohol mixture containing no more than 10-16 ng/g of the active form of the active substance.
Description
Tablets are flat-cylindrical, scored and chamfered, from white to almost white. , On the flat side with a notch there is the inscription MATERIA MEDICA, on the other flat side there is the inscription TENOTEN KID.
Pharmacotherapeutic group
Anxiolytics, nootropics.
ATX codes
N05BX, N06BX.
pharmachologic effect
The drug has a calming, anti-anxiety (anxiolytic) effect without causing unwanted hypnogenic and muscle relaxant effects. Improves tolerance to psycho-emotional stress. It has stress-protective, nootropic, antiamnestic, antihypoxic, neuroprotective, antiasthenic, antidepressant effects. In conditions of intoxication, hypoxia, and in conditions after acute cerebrovascular accident, it has a neuroprotective effect, limits the area of damage, and normalizes learning and memory processes in the central nervous system (CNS). Inhibits lipid peroxidation processes. Modifies the functional activity of the S-100 protein, which carries out the coupling of synaptic (information) and metabolic processes in the brain. Providing a GABA-mimetic and neurotrophic effect, it increases the activity of stress-limiting systems and helps restore the processes of neuronal plasticity.
Indications for use
Neurotic and neurosis-like disorders, accompanied by increased excitability, irritability, anxiety, behavioral and attention disorders, autonomic disorders. Attention deficit hyperactivity disorder.
Contraindications
Increased individual sensitivity to the components of the drug, children under 3 years of age.
Pregnancy and lactation
The safety of using Tenoten for children in pregnant women and during lactation has not been studied. If necessary, the risk/benefit ratio should be taken into account.
Directions for use and doses
Inside. For one dose - 1-2 tablets (keep in mouth until completely dissolved - not during meals). If necessary, the tablets can be dissolved in a small amount of boiled water at room temperature. Neurotic and neurosis-like disorders. Take 1 tablet 1 to 3 times a day, course of treatment - 1 - 3 months. If necessary, the course of treatment can be extended to 6 months or repeated after 1 - 2 months. Attention deficit hyperactivity disorder. Take 2 tablets 2 times a day, course of treatment is 1-3 months. If there is no sustained improvement within 3-4 weeks after starting treatment, you should consult a doctor.
Side effect
When used according to the indicated indications and in the indicated dosages, no side effects were identified. Individual hypersensitivity reactions to the components of the drug are possible.
Overdose
No cases of overdose have been identified to date.
Interaction with other drugs
No cases of incompatibility with other drugs have been reported to date.
special instructions
The drug contains lactose, and therefore it is not recommended for use in patients with congenital galactosemia, glucose or galactose malabsorption syndrome, or congenital lactase deficiency. Due to the presence of activating properties in the drug, Tenoten for children, the last dose should be taken no later than 2 hours before bedtime.
Release form
Lozenges. 20 tablets each in a blister pack made of polyvinyl chloride film and aluminum foil. 1, 2 or 5 blister packs along with instructions for use are placed in a cardboard pack.
Storage conditions
At a temperature not higher than 25ºС. Keep out of the reach of children. During the period of use of the drug, store the blister pack in a cardboard box provided by the manufacturer.
Best before date
3 years Do not use after expiration date.
Conditions for dispensing from pharmacies
Over the counter.
