synergists; diseases of the peripheral nervous system; hemiparesis; equinus deformities; children


Recent years are characterized by an increase in the representation of motor disorders in the general structure of lesions of the nervous system in childhood. One of the most common causes of severe damage to the motor system in children is polyneuritis.
Purpose of the study. To assess the possibility of early diagnosis of spasticity in children with diseases of the peripheral nervous system.
Materials and research methods. Under observation were 109 children with diseases of peripheral nerves (89 with polyneuritis and 20 with plexalgia of various etiologies) aged 3 to 16 years, 50 girls and 59 boys, who made up the first group consisted of 22 children (11 boys and 11 girls) with HMSN type I; mean age - 12.3±4.2 years.
Clinical research methods included the study of anamnesis, assessment of neurological, orthopedic, somatic statuses, ophthalmological, speech therapy, psychological and other special examinations. Standard laboratory, neuroimaging (CT and MRI) and neurophysiological examinations accepted in a neurological clinic (ECHO- encephaloscopy , EEG, etc.) were carried out.
Instrumental research methods included MRI-study and neurophysiological techniques - TMS and ENMG. MRI was performed on tomographs " Broker Tomikon " or " Pinker ". In all cases, the brain and, if indicated, the spinal cord were examined.
Research results. When conducting CT and MRI studies in children with PNS diseases, the following changes were found: 1) expansion of the ventricular system and subarachnoid spaces, as a rule, asymmetric - 49.5%; 2) local changes in the form of hemispheric cysts - 15.6%; 3) change in the density of the medulla in the periventricular region - 71.6%; 4) anomalies in the development of the brain in the form of micro- and pachygyria , hypoplasia and flattening of the corpus callosum, anomalies of Arnold - Chiari and Dandy-Walker, vascular malformations - 21.1%. When conducting TMS in patients with PNS diseases, the most striking changes were a decrease in the amplitude of the HME, a change in its shape, and, sometimes, an increase in its duration (Fig. 1). An increase in VCMP was also found, which was especially significant in children with PNS diseases. VCMP in the study of leg muscles exceeded the normative data by more than 3 standard deviations in 67% of patients in almost all age groups, which indicates a violation of the cortico -spinal pathway.

Conclusions: Registration of the ipsilateral response in patients with PNS diseases (in 58.3% in children with polyneuritis and in 70% with plexitis) is combined with the presence of severe paresis and the appearance of plus-symptoms in the neurological status in the form of mirror movements in the unaffected limb and/or synergistic friendly movements on the side of hemiparesis.