NEUROCIRCULATORY DYSTONIA (NCD), vegetative-vascular dystonia (VSD). Doctor forum. Treatment methods.

The pathology of neurocirculatory dystonia has a complex of symptoms from the heart and blood vessels, respiratory organs, and nervous system of the body. If the neuroendocrine regulation of vascular tone and control of hormone production are impaired, symptoms of NCD appear. Because of these failures, the heart and blood vessels react inadequately to physical activity, psycho-emotional stress, hormonal changes, and stressful situations. Neurocirculatory dystonia manifests itself as autonomic failure, which is caused by a dysfunctional peripheral nervous system.

Why does this happen?

The autonomic nervous system permeates the entire human body and is responsible for the innervation of internal organs and systems of lymph and blood circulation, digestion, respiration, excretion, hormonal regulation, as well as tissues of the brain and spinal cord. In addition, the autonomic nervous system maintains the constancy of the internal environment and ensures the body’s adaptation to external conditions.

The operation of all systems is ensured by the equilibrium behavior of its two departments: sympathetic and parasympathetic. When the function of one department predominates over another, changes appear in the functioning of individual systems and organs. With this phenomenon, the adaptive abilities of the body naturally decrease.

Interestingly, damage to certain organs and disruption of the endocrine system can themselves lead to an imbalance in the autonomic nervous system. Neurocirculatory dystonia is the result of an imbalance in the autonomic nervous system , therefore the form of NCD depends on the predominance of a particular part of the ANS (sympathetic or parasympathetic).

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Development mechanism

The condition has an extremely complex origin. The issue is so confusing that even doctors at first glance and after some diagnostics are not always able to identify the nature of the disorder. The reason for this is many factors.

It would be true to talk not about one, but about a whole group of mechanisms that are linked together and create the syndrome.

There is excessive activity of the central nervous system. The excitability of the brain increases due to an excess of neurotransmitters or as a result of the influence of other factors. There are many options here. This may also be a natural feature of a particular person’s body. Signals are sent to all systems.
This results in excessive production of hormones from the adrenal cortex, pituitary gland and thyroid gland. A high concentration of specific substances provokes an acceleration of the functioning of all body structures. Including hearts. Typical symptoms develop, tachycardia, blood pressure rises or falls.
Due to disruption of hormone synthesis, vascular spasm and an increase or decrease in their tone are possible. This determines which clinical picture will prevail in a person. In any case, the heart suffers, the normal regulation of the arteries and veins is disrupted.

Changes affect the nervous, cardiac and endocrine systems. Taken together, this leads to a complex disorder of well-being.

The patient experiences a range of uncomfortable sensations that resemble symptoms of several diseases at once, with different profiles. Sometimes this confuses even doctors.

Paradoxically, violations extremely rarely cause critical disorders of the body. In isolated situations, dangerous complications are possible, but this is rather a statistical error.

Usually everything is limited to lightheadedness and poor health. Although impressionable individuals can “earn” hypochondria in such a simple way and constantly visit doctors, looking for symptoms of non-existent pathologies.

Basically, the process is relatively safe, although it causes a lot of discomfort and can seriously reduce the quality of life.

Statistics:

Neurocirculatory dystonia develops mainly in women. The ratio with men is 3:1.

During puberty, girls and boys suffer with approximately the same frequency.

Manifestation, the first episode of the pathological process, occurs during maturation or peak hormonal conditions. Pregnancy, menopause, menstrual cycle.

The second jump in incidence occurs in later years, 40+ or a little more.

The impetus to the disease

The question of why someone gets sick and someone doesn’t is inherent in VSD just like other diseases. In the etiology of neurocirculatory dystonia, the main factors can be identified:

The family nature of the disease, where heredity plays a significant role, however, it should be borne in mind that it is not the disease that is transmitted, but the characteristics of the organism, which is similar to the parent. In the case of vegetative-vascular dystonia, the mother has a greater chance of transmitting a predisposition to the pathology;
Social environment, which includes living conditions and relationships in the team, affecting the psycho-emotional state;
Temperament and personality traits;
History of traumatic brain injury and neuroinfections;
Hormonal disorders;
Infectious and allergic diseases;
Excessive mental and physical stress;
Change of climatic living conditions.

The combination of several or all factors together leads to the body's reaction to stimuli. This reaction causes the formation of pathological conditions that are manifested by disorders:

Metabolic processes;
Innervation of internal organs;
Works of the gastrointestinal tract;
In the blood coagulation system;
Activities of the endocrine system.

The course of the mother's pregnancy, hypoxia and birth trauma also have a negative impact on the state of the autonomic system and can cause vegetative-vascular dystonia in children.

Inconsistency between the systems ultimately leads to a vascular response—their spasm. Thus, the manifestation of neurocirculatory dystonia begins.

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Treatment of neurocirculatory dystonia

The basis of therapy is the elimination of etiological factors. Often this is enough to stabilize the patient’s condition and even make a full recovery. For example, if the pathology has a neurotic form, then the first step is to eliminate stressful situations from the patient’s life and help him normalize relationships in his family and with friends.

When neurocirculatory dystonia is associated with physical overexertion, stress should be removed. Psychotherapy and auto-training have a positive effect. The patient learns the essence of the disease, understands that it is benign and there is an excellent chance of a full recovery.

Anxiolytics are used to treat neurotic disorders. These include:

Chlordiazepoxide.
Diazepam.
Phenazepam.
Mebicar.
Tofisopam.

To normalize cerebral circulation, cerebroangioprotectors are prescribed: Vinpocetine and Cinnarizine. Such drugs also effectively cope with dizziness and pain.

Types of NDC

Neurocirculatory dystonia occurs differently in everyone. The essence of these phenomena lies in the predominance of a certain part of the autonomic nervous system and in the formation of the type of NCD. One person’s heart hurts or “pops out”, another feels dizzy as soon as the ambient temperature changes a degree or two. And, if God forbid, there is excitement, stress or a sudden change in weather - the reaction is generally uncontrollable. The symptoms of neurocirculatory dystonia are vivid and varied, but the sensations are always unpleasant.

You can feel anything. Dizziness, lightheadedness, accompanied by nausea or an unpleasant “lump” in the stomach. The feeling is such that sometimes you want to lose consciousness in order to get relief later. Often, fainting is a salvation for some people, because after it comes a pleasant languor and relaxation...

Treatment of neurocirculatory dystonia is long-term, due to the undulating course of the process, and is aimed at preventing relapse. In addition, the complex of medications directly depends on the type of NCD and changes in the cardiovascular system.

Types of vegetative-vascular dystonia are divided depending on blood pressure indicators:

Neurocirculatory dystonia of the hypertensive type - blood pressure tends to increase, regardless of age and circumstances;
Neurocirculatory dystonia of the hypotonic type - lethargy, weakness, decreased blood pressure and pulse;
Neurocirculatory dystonia of a mixed type, it’s difficult to keep track of how and when everything will turn out. The worst thing is that the patient does not know in advance and waits with trembling for either an increase or decrease in pressure.

Hypertensive type

Neurocirculatory dystonia of the hypertensive type is characterized by an imbalance of the autonomic nervous system, expressed by the predominance of the tone of the sympathetic system over the parasympathetic department (sympathicotonia) and is expressed by:

Increased blood pressure;
Headaches that depend on physical activity and intensify with it;
Dizziness;
Dependence on weather conditions (headaches, rise in blood pressure);
Rapid heartbeat, sometimes intermittently;
Mitral valve prolapse on ultrasound examination of the heart;
Violation of thermoregulation - high body temperature in children with infectious diseases;
Changes in the gastrointestinal tract in the form of weak peristalsis, and hence a tendency to constipation;
Insufficiency of the function of the lacrimal glands (“dry tears”);
Changes in mood (sadness and melancholy);
Fatigue quickly.

Hypotonic type

When the parasympathetic part of the autonomic nervous system predominates (vagotonia), neurocirculatory dystonia of the hypotonic type develops, the main symptoms of which are:

Reduced blood pressure;
Rare pulse (bradycardia), which can quickly increase in speed (tachycardia);
Pain in the heart (cardialgia);
Dizziness;
Frequent fainting conditions, especially characteristic in the presence of vegetative-vascular dystonia in children (mainly girls) during puberty;
Headaches associated with weather conditions, physical and mental stress;
Increased fatigue and low performance;
Biliary dyskinesia, which is associated with uneven and chaotic contraction of the gallbladder;
Digestive disorders (tendency to diarrhea and flatulence);
Violation of thermoregulation: decreased body temperature and prolonged low-grade fever due to infections in children;
Complaints of “shortness of breath” and “sighs”;
Tendency to allergic reactions;
Pale skin (marbling), cyanosis of the extremities;
Cold sweat.

When there is no agreement between departments

Uncoordinated work of the sympathetic and parasympathetic departments leads to dysfunction of systems and organs. If the pressure “jumps”, if the complexion suddenly turns red or pale in a matter of minutes, if the body reacts unpredictably even to minor events, then a mixed type of vegetative-vascular dysfunction can be suspected.

Signs of mixed-type neurocirculatory dystonia include symptoms characteristic of both hypotonic and hypertonic types. Which part of the autonomic nervous system will prevail at what moment, such signs will be inherent in the patient’s condition.

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Severity

Stress and emotional overload contribute to the exacerbation of symptoms of the disease.
Symptoms of NCD vary depending on the severity of the disease.

With a mild course of the disease, pain in the heart area occurs only under severe stress. There are no autonomic-vascular crises. Physical activity is not accompanied by severe tachycardia. Respiratory disturbances are mild. Working capacity has been preserved.

In moderate cases of NCD, there is a multiplicity of complaints. Pain in the heart area is constant and persistent. There is a tendency to tachycardia at rest. Physical performance is reduced.

Severe NCD is accompanied by persistent symptoms that are difficult to treat. Tachycardia and respiratory disorders are pronounced. There is persistent pain syndrome. Vegetative-vascular crises, cardiophobia, and depression are often recorded. Working capacity is sharply reduced.

Crises of vegetative-vascular dystonia

Neurocirculatory dystonia, which arose in childhood, can become “enriched” with symptoms over time and in young people give more vivid vegetative manifestations in the form of crises. Attacks during neurocirculatory dystonia also depend on its type, although they often do not have a clear picture of the identity, but are of a mixed nature. High activity of the parasympathetic division of the ANS can cause a vagoinsular crisis, which is characterized by the following symptoms:

Sweating and nausea;
Sudden weakness and darkening of the eyes;
Reduced blood pressure and body temperature;
Slowing heart rate.

After a vagoinsular crisis, the patient still feels tired and weak for several days, and is periodically dizzy.

When the sympathetic department takes “primacy,” another type of vegetative-vascular dysfunction develops. Neurocirculatory dystonia with sympathoadrenal crises makes itself felt by the sudden appearance of causeless fear, to which is quickly added:

Intense headache;
Heartache;
Increased blood pressure and body temperature;
The appearance of chills;
Skin redness or pallor.

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Diagnostics

To make a correct diagnosis of NCD, the doctor must have a good understanding of what it is. The signs of the disorder are not very specific, so the approach to diagnosing neurocirculatory dystonia requires care. To determine exactly what kind of disease it is and make a diagnosis of NCD, you need to study the patient’s complaints in detail. First of all, symptoms must have been observed over the past two months. Confirming criteria include complaints about:

cardialgia, rapid heartbeat;
feeling of lack of air;
high fatigue, general weakness;
constant irritability, anxiety.

Symptoms of NCD in adults and adolescents are confirmed by a clear connection with the influence of stressful circumstances and hormonal changes. Reliable physical signs include unstable heart rhythm, tachycardia, labile blood pressure, and respiratory arrhythmias. All these manifestations arise unexpectedly or inappropriately to the circumstances.

The method of diagnostic ECG tests with stress is highly informative for diagnosing neurocirculatory dystonias:

During physiological tests with hyperventilation, an ECG is recorded before and after intense inhalations and exhalations for 45 seconds. An increased pulse rate of one and a half to two times and the appearance of negative T-waves on the cardiogram or an increase in their amplitude are considered a positive test.
During an orthostatic test, a cardiogram is taken with the patient lying down and after assuming a vertical position of the body for a quarter of an hour. A positive test is confirmed by the same result on the cardiogram as in the previous case.
The drug test is preceded by taking beta-blockers or a potassium supplement. After about an hour, an ECG recording is performed. NCD, in contrast to organic pathology, gives negative T waves. The appearance of positive T waves is considered as a negative test for neurocirculatory dystonia and indicates the presence of myocarditis and other organic cardiopathologies.
When diagnosing NCD, bicycle ergometry is expected to show the reduced exercise tolerance typical of this disorder.

Autonomic dysfunction and pregnancy

Although pregnancy is a physiological condition, it is then that vegetative-vascular dystonia can manifest itself, occurring latently (hiddenly), because during pregnancy the body is rebuilt and prepares for the birth of a new life. Hormonal levels, the regulator of all pregnancy processes, undergo significant changes. The internal organs are “packed” differently, making room for the ever-expanding uterus. And all this is under the control of the autonomic nervous system, which could not always cope without such a load, but here...

Women suffering from NCD may find out they are pregnant even before the test, because the first sign may be fainting. Vegetative-vascular dysfunction during pregnancy has a more pronounced clinical picture, so pregnancy is more difficult.

Reaction to everything that is “wrong”, tears for every reason, pain in the heart and hysterics, decreased blood pressure, and it’s better not to get into transport... Pregnant women often experience a feeling of lack of air and stuffiness, and those with vegetative-vascular dysfunction even know “ the smell of a fresh breeze."

But everything may not be so bad and you shouldn’t be upset. There have been many cases of disappearance of manifestations of NCD after childbirth. What is the reason for this - either “restoring order” in a woman’s body, or a responsible occupation associated with caring for a baby - is unknown. But patients themselves often note that if they are distracted by important matters, the vegetative-vascular complex recedes.

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Characteristics of the disease

Neurocirculatory dystonia (NCD) is a disease characterized by respiratory, cardiovascular disorders, disruption of the endocrine and nervous systems.
With dystonia, a person does not tolerate physical activity, sometimes even minimal stress, and stress. There is instability in pressure, weak pulse, and irregular heart rhythm. You can often find an indication that vegetative-vascular dystonia and neurocirculatory dystonia are two names for the same disease, which is not an entirely correct statement. Vegetovascular dystonia is a broader concept, and neurocirculatory dystonia is one of its constant components.

NSD is a disease with a good prognosis, which does not lead to serious structural changes in internal organs even over a long period of time.

There are neurocirculatory dystonia of the hypertensive type, hypotonic type and neurocirculatory dystonia of the cardiac type.

Doctors tried for a long time to find the correct name for the discovered pathology. Scientists decided that it is better to call vegetative-vascular disorders vegetative-vascular dystonia (VSD), because such a term expresses the pathogenesis of the condition in question. The last variant of the pathology was “vegetative dystonia syndrome.”

According to ICD-10, the NDC did not provide disease status. In the classification of neurocirculatory dystonia, the number F45.3 is assigned. The Latin letter indicates the psychogenic origin of the pathological condition. It is assigned the status of “symptom complex”, which develops as a result of inappropriate behavior of the ANS.

There are no exact and specific prerequisites that provoke the occurrence of the disease. Neurovascular dystonia is a consequence of an imbalance of the vegetative-vascular system under the influence of many factors.

The disease can occur for the following reasons:

abuse of alcohol, psychotropic substances and smoking;
unfavorable technogenic situation in the place of residence;
poor quality of nutrition, lack of the amount of proteins, minerals and vitamins necessary for the body;
unfavorable social environment in which a person has to live, study and work;
the presence of temporary or permanent difficulties in the work team, stress, overload and lack of sleep;
a passive lifestyle bordering on sybaritism, which causes melancholy and depression.

Dyscirculatory dystonia may well become a complication caused by severe and prolonged illnesses associated with severe physical suffering and a real danger to life. A child may become a victim of this disease due to constant quarrels between parents or a pathological fear of school.

To accurately determine the diagnosis, the patient is prescribed a comprehensive examination.

Diagnostics includes performing the following procedures:

interviewing the patient and conducting an initial examination;
measuring blood pressure in the upper and lower extremities;
taking a cardiogram of the heart;
performing an ultrasound to detect pathology in the heart muscle;
analysis of urine, feces and blood;
study of cerebral vessels using rheoencephalography.

If a patient is diagnosed with neurocirculatory dystonia, treatment should begin immediately, using all available methods.

Today the following treatment methods are used:

Medication. The patient is prescribed tranquilizers, sedatives, antidepressants and antispasmodics. For high blood pressure, medications are taken to improve cerebral circulation. The type and dosage of medications are determined solely by the attending physician.
Physiotherapy. To improve body tone, relieve psychological tension and muscle spasms, the patient is prescribed massage, acupuncture, electrophoresis and UHF. Calming and reducing painful symptoms is achieved by taking baths and contrast showers.

In some cases, when the cause of anxiety is fictitious or not significant, hypnosis and psychotherapy are used. Ridding the patient of difficult thoughts contributes to his speedy recovery.

Disease or syndrome?

When discussing vegetative-vascular disorders and what to call them, scientists still haven’t decided. Vegetative-vascular dystonia is considered a more correct name, since it expresses the pathogenesis of the disease. The most recent trend in defining this condition was the syndrome of vegetative dystonia, which did not become an independent unit in the International Classification of Diseases (ICD).

The ICD 10 code for neurocirculatory dystonia is F45.3 , where the letter F indicates a psychogenic origin, which, in general, is the case. According to the same classification, NCD is recognized not as a disease, but as a symptom complex arising as a result of inadequate behavior of the autonomic nervous system (uncoordinated and unbalanced interaction of two parts of the ANS: sympathetic and parasympathetic). It is unlikely that people who are well acquainted with this complex of symptoms will “get better” from this, but today this is the case.

Vegetative-vascular dysfunction raises many questions when the time comes to repay one’s debt to the Motherland. How are neurocirculatory dystonia and military service compatible? As varied are the manifestations, so should be the approach.

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NEUROCIRCULATORY DYSTONIA (NCD), vegetative-vascular dystonia (VSD). Doctor forum. Treatment methods.

Currently, there is confusion when using the terms NDC and VSD.

Many patients are looking for answers to questions:

—What are these terms, their origin and appropriateness of use?

—NCD (VSD)—is it a disease, syndrome or physiological condition?

—Who should treat?, therapist, neurologist or psychotherapist?

I will answer these three frequently asked questions in order.

The first answer.

The term "neurocirculatory asthenia"

first introduced by the American physician B. Oppenheimer in 1918.

In 1954, the domestic cardiologist N.N. Savitsky, slightly modifying the term, proposed the name “neurocirculatory dystonia”,

highlighting three clinical variants: hypertensive, hypotonic and cardiac types of NCD.

After this, the definition became widespread in the scientific and clinical community of cardiologists and therapists (internists); acquired various synonyms (dysregulatory cardiopathy; functional cardiopathy; neurotic cardiovascular syndrome).

Outstanding cardiologists G.R. Lang and A.L. Myasnikov called this disorder “neurosis of the cardiovascular system.”

However, neurologist-vegetologist, academician Alexander Moiseevich Vein, in his works devoted to the diagnosis and treatment of vegetative dystonia, criticizes the use of the term “neurocirculatory dystonia”.

I quote:

—»Neurocirculatory dystonia

, reflecting instability of blood pressure, lability of the pulse, disruption of the autonomic regulation of heart rhythm, it is more correct to consider
only one
, although the most constant
component of autonomic dystonia
” (1).

—"Neurocirculatory dystonia is only part

autonomic dystonia, and the doctor who diagnosed NCD either did not notice the wider involvement of other body systems in the process of autonomic dysregulation, or did not attach importance to this” (1).

Further A.M.Vein writes:

— “It is completely unacceptable for one disease to be designated differently by representatives of different medical specialties” (1).

To summarize, NCD cannot be used as an independent term, since this concept is only part of a more general and better systematized concept— vegetative dystonia.

Academician Wayne also did not recommend using the term “vegetative-vascular dystonia”

:
—Vegetative dystonia syndrome (VDS) is a manifestation of all forms of autonomic regulation disorder.
In recent years, we have given it preference over the syndrome of vegetative-vascular dystonia, since then it becomes possible to talk about the syndrome of vegetative-visceral dystonia, and the latter can be divided into various systemic dystonias (vegetocardial, vegetogastric, etc.). Therefore, it seems to us that the more general term—SVD (1)—is correct. The answer is second.

As for the nosological self-sufficiency of the term “vegetative dystonia,” here Alexander Moiseevich, as you already understood, is unambiguous: “Vegetative dystonia is a syndrome.”

Definition: syndrome

- a complex of stable signs of a disorder that occurs in various diseases and pathological conditions.

That is, a syndrome is not a disease yet.

—What disease today is the source of complaints from a patient whose symptoms were previously classified as NCD or VSD?

—According to the International Classification of Diseases, 10th revision (adopted in 1989; in Russia, health authorities and institutions made the transition to ICD-10 in 1997), diagnoses such as “neurocirculatory dystonia” and “vegetative-vascular dystonia” are included in the concept: somatoform dysfunction autonomic nervous system.

Which is the main disease and belongs to the section of mental illnesses

(letter F ICD-10).

F45.3 Somatoform dysfunction of the autonomic nervous system.

Complaints are presented to patients as if they were due to a physical disorder of a system or organ that is mainly or completely under the influence of the autonomic nervous system, that is, the cardiovascular, gastrointestinal or respiratory system. (This also partially includes the genitourinary system). The most common and striking examples relate to the cardiovascular system (“neurosis of the heart”), the respiratory system (psychogenic shortness of breath and hiccups) and the gastrointestinal system (“gastric neurosis” and “nervous diarrhea”). Symptoms are usually of two types, neither of which indicate a physical disorder of the organ or system affected. The first type of symptoms, on which diagnosis is largely based, is characterized by complaints reflecting objective signs of autonomic arousal, such as palpitations, sweating, flushing and tremors. The second type is characterized by more idiosyncratic, subjective and nonspecific symptoms, such as sensations of fleeting pain, burning, heaviness, tension, bloating or stretching. These complaints relate to patients to a specific organ or system (which may also include autonomic symptoms). The characteristic clinical picture consists of a clear involvement of the autonomic nervous system, additional nonspecific subjective complaints and constant references by the patient to a specific organ or system as the cause of his disorder.

Many patients with this disorder have indications of psychological distress or difficulties and problems that appear to be related to the disorder. However, in a significant proportion of patients who meet the criteria for this disorder, aggravating psychological factors are not identified.

In some cases, minor disturbances in physiological functions, such as hiccups, flatulence and shortness of breath, may also be present, but these do not in themselves interfere with the basic physiological functioning of the organ or system concerned.

Diagnostic instructions:

All of the following signs are required for a reliable diagnosis:

symptoms of autonomic arousal, such as palpitations, sweating, tremors, redness, which are chronic and distressing;
additional subjective symptoms related to a specific organ or system;
concern and distress about a possible serious (but often uncertain) disease of this organ or system, and repeated explanations and reassurances from doctors on this matter remain fruitless;
there is no evidence of significant structural or functional impairment of this organ or system.

Differential diagnosis:

Differentiation from generalized anxiety disorder is based on the predominance of psychological components of autonomic arousal in generalized anxiety disorder, such as fear and apprehension, as well as the lack of consistent attribution of other symptoms to a specific organ or system. Autonomic symptoms can also occur with somatization disorders, but compared to a number of other sensations, they are neither pronounced nor persistent and are also not always attributed to one organ or system.

Included:

cardiac neurosis;
da Costa syndrome;
gastroneurosis;
neurocirculatory asthenia;
psychogenic form of aerophagia;
psychogenic form of cough;
psychogenic form of diarrhea;
psychogenic form of dyspepsia;
psychogenic form of dysuria;
psychogenic form of flatulence;
psychogenic form of hiccups;
psychogenic form of deep and frequent breathing;
psychogenic form of urination;
psychogenic form of irritable bowel;
psychogenic form of pylorospasm. (5).

Third answer.

The tasks of the therapist (internist) and neurologist when identifying vegetative dystonia syndrome (VDS) in a patient are as follows:

1) confirm or exclude the presence of organic damage to the visceral systems or peripheral/central nervous system;

2) if organic causes are excluded, it is necessary to refer the patient to a psychotherapist (according to Osokina G.G., 1988, 78% of those examined with VSD do not have organic pathology), to establish a nosological diagnosis and prescribe etiotropic treatment.

Thus, all work on the final diagnosis and treatment of somatoform autonomic dysfunction is undertaken by a psychotherapist after consulting the patient with therapeutic doctors.

—And, in fact, why does the patient (and the doctor) need this very clinical diagnosis of “autonomic dysfunction”? what does it give? how does it advance the doctor's message and how does it alleviate the patient's condition?

Cure! This is what both the doctor and the patient need. A homeopathic diagnosis leads to it, but not a clinical one. The last one is just an intermediate stage...

Used Books:

1. Vein A.M., Yakovlev N.A., Slyusar T.A. Vegetative dystonia. 1996.

2. Gindikin V.Ya. Lexicon of minor psychiatry. 1997.

3. Information and methodological letter: the use of the international statistical classification of diseases and health-related problems, tenth revision (ICD-10) in the practice of domestic medicine. Ministry of Health of the Russian Federation, 2002.

4. Okorokov A.N. Diagnosis of diseases of internal organs: T.7. Diagnosis of heart and vascular diseases. 2003.

5. Mental disorders and behavioral disorders (F00 - F99), (Class 5 ICD-10, adapted for use in the Russian Federation) / Under the general editorship of Kazakovtsev B.A., Holland V.B., 2003

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VSD and homeopathy.

VSD, or NDC. An abbreviation meaning “vegetative-vascular dystonia” and “neurocirculatory dystonia”.

The terms have long been outdated in scientific circles and in ICD-10, but have not lost their popularity among patients. However, many doctors, in the old fashioned way, continue to use this terminology.

If you open the International Classification of Diseases, Tenth Revision (ICD-10), then the so-called. VSD, we will find in the register of mental illnesses (letter F). Designated as somatoform dysfunction of the autonomic nervous system, F45.3.

Somatoform means that the disorder, with its symptoms, is similar to a somatic disease, but doctors do not find an organic factor during examination. However, there must be the presence of a psychotraumatic factor (otherwise, this disorder cannot be included in the register of mental disorders).

Here, of course, questions arise: if the patient has somatoform autonomic disorders and there is no psychotraumatic factor (distress), then is such a diagnosis valid - F45.3?

Is it necessary to look for a mental factor and “tailor” the patient’s case to this definition?

These are very important questions! Since these issues are related to the so-called. “mental stigma”; a factor that cannot be avoided. Who should the patient be treated by? A general practitioner or a psychiatrist?

If you undergo treatment from a neurologist, therapist, gastroenterologist, pulmonologist, endocrinologist, then that’s one thing!

And, if you see a psychiatrist, then... accept the mental stigma “as a burden” and sign!

As a result, confusion with terminology, conservatism of doctors, mental stigma, modernization and optimization of domestic healthcare lead to complete confusion for the patient who wants to quickly, reliably and, if possible, easily, solve the problem of vegetative symptoms.

Classical homeopathy takes a completely different approach.

. In homeopathic diagnosis, the patient is not divided into “our patient” and “not our patient”. Do not reduce it to “pathology of a therapist,” “pathology of a neurologist,” or “pathology of a psychiatrist.”

The diagnostic principle is holistic, phenomenological: the doctor, interviewing the patient, collects an individual set of symptoms

.
In addition, it reveals bright, unusual symptoms
.

After this, he carries out repertorization of symptoms - identifying the correspondence of a symptom to a particular homeopathic medicine. After which, he checks the homeopathic medicine reference book and prescribes medicine to the patient.

Thus, it will be an individually selected drug for the symptoms of a particular patient. In contrast to universal “vegetative correctors”, which only suppress the symptom and do not allow a complete cure to be achieved.

Conclusion.

Homeopathic approach to the treatment of the so-called. VSD (NCD) does not have the disadvantages of the traditional (allopathic) approach: there is no terminological confusion and no negative iatrogenic impact. There is no need to “tailor” the patient’s case to any nosological label. Homeopathic diagnosis clearly and clearly reflects the individual set of symptoms of the patient, and, therefore, contributes to the selection of a more accurate medicine.

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Neurocirculatory dystonia and da Costa syndrome.

Historical connection of da Costa syndrome with the still popular term “neurocirculatory dystonia”. Diagnosis and treatment.

When analyzing the literature on neurocirculatory dystonia, attention is drawn to the identity of the concepts— NCD

and
da Costa syndrome
.

In particular, in the International Classification of Diseases, 10th revision (ICD-10), these concepts are placed on the same level and included in the nosology “Somatoform dysfunction of the autonomic nervous system”

If you want to know what the aforementioned “da Costa syndrome”

", then the following becomes clear.

In 1876, physician Da Costa described a disorder in soldiers during combat that included fear, hypervigilance, and cardiac arrhythmias, which he termed "soldier's heart." (Jacob Mendos da Costa, American surgeon, 1833-1900.)

Later, this disorder was called “da Costa syndrome” or “irritable heart syndrome,” which was synonymous with the modern term
neurocirculatory dystonia
.

In fact, doctor da Costa described the consequences of combat distress, what today is included in the concept: an acute reaction to stress; acute stress disorder; post-traumatic stress disorder (PTSD)

F43.1 Post-traumatic stress disorder.

Occurs as a delayed and/or protracted response to a stressful event or situation (short-term or long-term) of an exceptionally threatening or catastrophic nature, which in principle can cause general distress in almost any person (for example, natural or man-made disasters, battles, serious accidents, surveillance for the violent death of others, being a victim of torture, terrorism, rape or other crime).

Typical signs include episodes of re-experiencing the trauma in the form of intrusive memories (reminiscences), dreams, or nightmares, accompanied by a chronic feeling of “numbness” and emotional dullness, alienation from other people, lack of responsiveness to the environment, anhedonia, and avoidance of activities and situations that resemble about the injury. Typically, the individual fears and avoids what reminds him of the original trauma. Rarely, there are dramatic, acute outbursts of fear, panic, or aggression, triggered by stimuli that evoke an unexpected memory of the trauma or the original reaction to it. Usually there is a state of increased autonomic excitability with increased levels of wakefulness, increased fear response and insomnia.

Anxiety and depression are usually associated with the above symptoms and signs; suicidal tendencies are common; Excessive alcohol or drug use may be a complicating factor.

The onset of this disorder occurs following trauma after a latency period that can vary from several weeks to months (but rarely more than 6 months). The course is undulating, but in most cases recovery can be expected. In a small proportion of cases, the condition may show a chronic course over many years and transition to a persistent personality change after experiencing a catastrophe (F62.0).

Russian psychiatrist V.M. Voloshin identifies four types of chronic PTSD:

1. Anxious type of PTSD;

2. Dysphoric type of PTSD;

3. Apathetic type of PTSD;

4. Somatoform type of PTSD.

It is interesting that the clinical picture of the somatoform type of PTSD completely coincides with the clinical picture of the NCD syndrome.

Based on this, we can assume the following: certain clinical cases that general practitioners (internists) interpret as neurocirculatory dystonia

, is
a somatoform type of
post-traumatic stress disorder (ICD-10 F 43.1).

Accordingly, the correct tactics for diagnosing NCD syndrome is to refer the patient to a psychotherapist.

Once the diagnosis of PTSD is confirmed (verified), effective treatment options are possible:

1) Psychopharmacotherapy (antidepressants, tranquilizers, antipsychotics, mood stabilizers);

2) Homeopathic medicinal treatment (complex and single preparations);

3) Psychotherapy (determined by the method used by the doctor treating the patient at a given time).

The outcome of therapy will be determined by various factors, the main one of which is the working alliance

doctor and patient.

List of used literature:

1. Voloshin V. M. Post-traumatic stress disorder: phenomenology, clinical picture, systematics, dynamics, and modern approaches to psychopharmacotherapy. 2000.

2.
Gindikin V.Ya.
Lexicon of minor psychiatry. 1997. 3. Okorokov A.N. Diagnosis of diseases of internal organs: T.7. Diagnosis of heart and vascular diseases. 2003.

4. Mental disorders and behavioral disorders ( F 00 - F 99), (Class 5 ICD-10, adapted for use in the Russian Federation) / Generally edited by Kazakovtsev B.A., Holland V.B., 2003.

5. Reshetnikov M.M. Mental trauma. 2006.

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An anonymous review - a question from a patient from the psi forum and my comment (November, 2019):

"..., I need treatment for generalized anxiety disorder. I tried EVERYTHING (and different blood pressure medications, tranquilizers... I read a lot of literature... I understand the “physiology” of the disorder, but I can’t “conduct” cognitive psychotherapy on myself)... I can’t live like this anymore! Who has successfully treated this type of disorder?

I was diagnosed after two visits to the diagnostic center by a neurologist at the same center.
We carried out an ultrasound scan of the neck vessels, MRI and MSCT of the brain, and a few months later an MRI with the introduction of contrast. The second time I came across a very good neurologist, who talked to me for quite a long time - and it was she who made this diagnosis - generalized anxiety disorder with frequent autonomic-vestibular paroxysms and senestopathies. Before this, I went through many different examinations and tests in my city, visited various “specialists”, did an ECG, and took various blood tests... and much more... in 1.5-2 years you can’t remember everything.... There was a church and a conspiratorial grandmother... There were antidepressants for large sums of money... and in general other pills that were prescribed by different doctors... injections... droppers...... I was in a local hospital... There was a time when I simply could not get up for several months bed - the weakness and dizziness were so strong... They took me to the toilet...
When I realized that this was all empty, I began to study various literature... Understanding came... VSD (this diagnosis was also often given to me) is just a symptomatology... a manifestation of the “true disease”... Then I “came” to neuroses... I understood and figured it out, what is a “conflict of the subconscious with consciousness”, and that this is what leads to neuroses... I read Kurpatov’s books... I talked with psychotherapists on websites, with people diagnosed with VSD from different cities of Russia... And when the diagnosis of “GNT” was made, I read about him, and became convinced that this was “my case.” Now I have started studying specialized literature on cognitive psychotherapy.
Almost constantly dizziness and a feeling of weakness, unsteadiness, a feeling of semi-fainting, darkening and blurriness in the eyes... - This is the worst thing for me... Walking is not possible.... With such symptoms as sweating of the extremities, fever, difficulty breathing - in a year and a half I “reconciled”, so to speak, because... I understand that my autonomic system simply reacts to my condition this way.....
After analyzing, I realized that this happens when I start to worry about something - I need to go somewhere, do something... Etc....
Previously, the muscles were always incredibly tense... now I can control it..." I coped" with this symptom... Something like this... From blood pressure and tranquilizers I took - Asentra and Aterax - the pressure dropped to an impossible level... Fluoxetine more or less helped, but it hurt a lot with his heart…and blood pressure is just a help in relieving symptoms and improving mood in general...”

1) Indeed, as I wrote above: autonomic dysfunction syndrome (VSD or NDS) is only a collective image of those symptoms that bother the patient.

We need to go further in diagnosis and look at nosology.

However, the problem is that it is very difficult to obtain a clear clinical diagnosis in such cases. Precisely because of numerous complaints and discomfort. At best, it will be... well, let it be a generalized anxiety disorder with a number of comorbid pathologies. Yes Yes! The same somatoform autonomic dysfunction, obsessive-compulsive disorder, depressive episode, cyclothymia, derealization-depersonalization syndrome, dissomnia syndrome, etc.

Cases that can be described within just one disorder are extremely rare!

2) Let’s add to this problem the shortage of psychiatric doctors; low effectiveness of psychotropic drugs.

Hence... “there was both a church and a conspiratorial grandmother...”. Out of despair.

Psychics, hereditary magicians, sorcerers and healers... No effect.

3) Unfortunately, homeopathic medicine is in a “blind spot”! Few people remember the doctors of this official medical method!

While such cases are an indication for treatment by a psychiatrist who knows the homeopathic method. I would say: by the method of choice—answering the patient’s question!

**********************************************

Feedback from a patient, 2019, psychiatric workshop:

“Last May, I fainted on the train. It was very stuffy, there were a lot of people, at first I felt very hot, I started sweating, then my nose got stuffy (a residual effect of a recent cold), it became even harder to breathe, my vision began to darken, and as a result - a short-term loss of consciousness. I woke up a couple of moments later, at the station passengers helped me get some air. I called my husband from the station so that he would come pick me up. She spent another 15 minutes in a pre-fainting state, her eyes were getting dark, she was squatting, holding onto the fence. Then gradually the condition returned to normal, I even left the station myself, and when my husband arrived, we went to the store and that same evening we left for the country for the weekend. This was not the first fainting spell in my life, there were about five of them in total, always due to stuffiness. Then for several days I felt fine and didn’t think about this situation, I went to work - everything was as usual. But after 4-5 days, while traveling on the subway, I again felt that it was stuffy in the car and it was difficult for me to breathe - from that moment it all started. I got out of the car, my palms were wet, I was shaking all over, my head was spinning... Riding the subway became torture. Then it got worse on the bus too. A couple of weeks later, I simply couldn’t get on the subway, I called my boss crying, and she literally took me by the hand to her neurologist. The diagnosis is vegetative-vascular dystonia, adaptol and glycine are prescribed. I started taking it and it became a little easier to travel in public transport. Over the summer, I experienced the whole spectrum of symptoms of VSD - pressing sensations in the heart area, inability to breathe, dizziness, nausea, palpitations, derealization, agorophobia and everything, all, everything that happens to VSD sufferers. Moreover, I felt one thing, then another, then several symptoms in various combinations. Naturally, I took tests, an ECG, an echo-kg, and an MRI of the brain. They didn't find anything bad. I was getting ready to go on vacation to Cyprus, all the doctors recommended not to cancel the trip - like a change of scenery would be beneficial. It turned out not. It's hot in Cyprus. Panic attacks every other day. For some reason, I switched to food; trips to cafes were almost always accompanied by steps. It became a little easier at the end of the rest. We were at the zoo, standing in line for the bird show. PA, I want to run away, my head is spinning, but I kept myself in place, we went inside, sat down, and the bird show began. I abstracted myself from my condition and focused on the show. At the end of the show, I already felt normal, and in the future it became easier for me to cope with PA. Upon returning to Moscow, I was generally like a cucumber, the first day I even went to work as a white person - I felt absolutely normal. But a couple of days later I felt bad again on the subway - and everything started all over again. I tried to take adaptol again - it caused persistent headaches. I had to give up the adaptol. In the fall, the main symptoms of VSD were headaches and nausea, which only went away in the evening. I ate through the day. With the onset of cold weather, life became easier - it was not stuffy, plus the office moved and the trip to the metro was reduced to two stations. I also took a course of Actovegin, and then a course of Mexidol. I generally felt great on Mexidol. Now I’ll add the cherry to this cake - I’ve been trying to become a mother for three years now, and have not been successful yet. I can’t say that this situation causes me strong feelings, because... I am sure that sooner or later we will achieve results. But there are suspicions that hormonal changes during treatment provoke attacks of VSD. Now I have changed doctors, I tried to get pregnant on hormones, but it was unsuccessful. Naturally, I was nervous, plus I refused Mexidol. The result was a panic attack on the subway, then for 10 days a nervous state and a feeling of heartbeat, occasional nausea, two migraine attacks, the last few days a pressing sensation in the head - pressing on the bridge of the nose, on the ears, on the temples from the inside. As if the head was stuffed up. I try to relax, do breathing exercises, but nothing helps. I took a vacation, I try to distract myself, they started renovations, but the sensations in my head interfere with my life. I really want to improve my health and prevent deterioration during the next attempt at hormonal treatment!”

Doctor's comment:

1) The diagnosis is correct.

2) Absolutely incorrect treatment, which is more likely to chronicize the pathology and lead to personality changes than to give any result!

3) The reason is still the same: they do not know the dynamics of the disease and do not know how to treat such disorders! Ignorance, negligence, self-importance and dependence on gifts from pharmaceutical companies.

4) The most correct treatment option is homeopathic medicines individually selected by a doctor.

The doctor's consultation.

Preparing for military duty: NDC and the army

Of course, some are so eager to join the ranks of defenders of the Fatherland that they forget about the disease. Or are they hiding? Others, on the contrary, having had an entry on their card since childhood - NDC, are trying to save themselves from military duties. In this regard, the commission’s approach should be objective and versatile. On the one hand, seeing a conscript for the first time, who does not show any complaints and is “eager to fight”, who is only identified by low or high (below 100/60 or above 160/100) blood pressure and obvious vegetative disorders on the “face”, in breathing and heart rhythms, you can satisfy his desire. However, a qualified commission must find out this for the first time, periodically or permanently. The situation is the same with those who present a lot of complaints, and only meager entries in the child’s card indicate illness. Of course, there is also an average: the clinic also has complaints indicating the presence of autonomic disorders. In all cases, the commission’s task is to find out:

Are the complaints persistent?
Is blood pressure persistently high or low?
Do you have cardialgia and heart rhythm disturbances?
To what extent do NCD symptoms affect a conscript’s performance?

To study the health status of a young person, related specialists (neurologist, cardiologist, ophthalmologist, endocrinologist, otolaryngologist) are required to be involved.

In addition, when deciding on suitability for military service in the case of neurocirculatory dystonia, differential diagnosis is carried out with other diseases to clarify the diagnosis and exclude diseases of the gastrointestinal tract, heart and lungs, which may be similar to VSD in symptoms.

Who does “Farewell of the Slav” sound like?

For an objective approach to resolving the issue, the conscript is sent to a hospital for examination, after which he may be declared temporarily unfit under Article 48. In this case, the young man is subject to treatment for vegetative-vascular dystonia, but if it turns out to be ineffective, and the symptoms indicate persistent disorders of autonomic innervation, then the conscript is not subject to military service and receives a military ID with a mark of unfitness under Art. 47 "a".

The commission acts similarly with those young men who clearly have persistent vegetative-vascular disorders with an increase or decrease in pressure, there are clear signs of heart rhythm disturbances, and pain in the heart is constant.

Well, the one who had the only record of a disease of the autonomic nervous system, but did not confirm it, must go with honor to serve the Motherland and Fatherland. Ancient, but still unchanged and unique, the march of Vasily Ivanovich Agapkin with its solemnity will make his own mother and his beloved girl cry... Nothing terrible - a little time will pass and yesterday’s healthy, mature and self-confident conscript will return home, completely forgetting about the illness.

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Classification

Now there are two classifications of NCD, etiological and according to the severity of symptoms.

The etiological classification was developed by S. A. Abbakumova and V. I. Makolkin, they identified the following main factors:

Essential – manifests itself due to hereditary predisposition.
Psychogenic, occurs against a background of constant stress.
Infectious-toxic.
Due to constant physical stress.
Features of a person's profession.

There are also three forms of the disease according to severity: mild, moderate and severe.

And yet: what to do with it?

We can talk about neurocirculatory dystonia for a long time and a lot, fortunately there are numerous names for this pathology, and this allows for diversity. But those who have such “happiness” are looking for ways to escape from this symptom complex, which pretty much poisons life and manifests itself in the most unforeseen situations. In general, a significant part of humanity is occupied with the question of how to treat neurocirculatory dystonia, which has a dozen other names. After all, changing the name will not affect the patient’s well-being in any way.

Oddly enough, vegetative-vascular dysfunction does not like physical inactivity. And despite the fact that the manifestations of the disease are especially noticeable after physical activity, physical exercise not only does not harm the patient, but is also indicated. True, we should be talking about targeted, therapeutic physical education, dosed and deliberate.

Mandatory adherence to the work and rest regime is also an integral part of the treatment process. Of course, working night shifts, lack of sleep, and spending a long time near the monitor are unlikely to help you feel light in your head and body. But fresh air, quiet evening walks, a warm bath with soothing herbs, on the contrary, will ensure good healthy sleep and improve your mood.

Patients should pay special attention to their psycho-emotional state. Avoid stressful situations, engage in auto-training, take soothing tea and do everything possible to create a calm, friendly environment at home and in the team for yourself and those around you.

No matter how trivial it may sound, diet also plays a significant role here. Neurocirculatory dystonia does not like spices, spicy foods, or alcohol. Anything that excites the nervous system can aggravate the process, so it is better to avoid excesses and not overexert yourself. But foods rich in potassium (eggplants, potatoes, bananas, prunes and apricots) will “like” the “capricious” nervous system.

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Etiology

Causes of neurocirculatory dystonia

severe fatigue;
sedentary, or, conversely, too active lifestyle;
all kinds of household and industrial radiation or vibrations;
drinking large quantities of alcohol and nicotine abuse;
excessive absorption of drinks that contain large quantities of caffeine - natural coffee, strong black tea, energy-boosting drinks;
very hot and dry climate conditions.

The internal culprits of neurocirculatory dystonia are:

inherited predisposition;
an increase in the amount of hormones in the body due to pregnancy or during puberty in young people;
personal temperament of each person;
chronic infectious processes in the body;
disturbances in the functioning of internal organs of a chronic nature;
disorder of the nervous and endocrine systems;
period of cessation of menstruation in a woman;
allergy.

The etiology of this disease is quite diverse, but there is no organic damage to the internal systems of the human body.

Treatment prescribed by a doctor

It is highly advisable to carry out drug treatment for vegetative-vascular disorders with general health measures and physiotherapy. Therapeutic massage, electrophoresis with sedatives on the collar area, electrosleep and a circular shower will help strengthen the nervous system and give the positive emotions that patients with vegetative-vascular dystonia so need.

What a wonderful procedure - acupuncture. Using it, you can stop taking medications for a long time and feel great only thanks to the annual repetition of acupuncture. Thin gold or platinum needles placed in the neuromuscular bundles will lead to long-term and stable remission, and the disease will recede...

Vitamin therapy and an antioxidant complex (Doctor Theiss, Gerovital, etc.) will be an excellent addition to general strengthening measures.

Medicines for the treatment of neurocirculatory dystonia are taken on the recommendation of a doctor and prescribed by him.
No advice from friends or the Internet is inappropriate here, since drug treatment is prescribed taking into account blood pressure, the presence of cardialgia and the state of the heart rhythm. It is clear that what will help a patient with high blood pressure can have a detrimental effect on the condition of a person with low blood pressure, so it is unlikely that egilok (a beta-blocker) will be indicated for the hypotensive type.
Drugs that regulate heart rate are serious and require special care, so “amateur” in such cases is useless. Often, patients with autonomic disorders are prescribed drugs from the group of tranquilizers - adaptol, afobazole, grandaxin. The herbal preparation Gelarium, which has antidepressant properties, has a remarkable effect. To relieve spasms, bellataminal is often prescribed, which also gives a sedative effect.

Hawthorn, valerian, motherwort – alcoholic infusions of these plants are very familiar to patients with neurocirculatory dystonia; they are constantly stored in the home medicine cabinet and serve as an “ambulance”.

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How can traditional medicine help?

The variety of recipes for treating neurocirculatory dystonia with folk remedies is even more striking than the variety of clinical manifestations. The contrasting souls, breathing exercises of Tibetan monks and the Austrian healer Rudolf Breuss are undoubtedly wonderful, but for some reason people prefer the Russian “creation”. A popular drink made from the church “Cahors” and a mixture of garlic, lemon, beet, carrot and radish juices, flavored with natural honey, is passed down “from mouth to mouth and from generation to generation.”

However, to treat VSD with folk remedies, one should not forget about pressure, so traditional healers also recommend different treatments. For example, for high blood pressure, people use infusions of mint and white birch leaves, calendula flowers and dill seeds. Alcohol infusions of magnolia and mistletoe are good for reducing blood pressure.

Strong tea and coffee are not recommended for the hypertensive type of NCD, but in the morning you can drink amazing tea prepared at home:

Dry blueberries, chokeberries, currants and barberries are taken in equal parts, ground, mixed and consumed, poured with boiling water.

With normal blood pressure levels and a downward trend, prepare infusions of elecampane and immortelle, drink freshly squeezed juices of carrots and rose hips. They say it helps a lot.

Of course, valerian root (you can take it internally, you can take baths), hawthorn, hot milk with honey at night - everyone knows. Such folk remedies are, perhaps, in every home, even where vegetative-vascular disorders are not found.

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Treatment

Unlike most diseases, more attention is paid to non-drug therapy in the treatment of neurocircular dystonia. It is aimed at introducing the following processes into the patient’s daily life, which the patient can carry out independently:

hardening;
meditation;
yoga;
small but constant physical activity and running;
putting in order the regime of daily, work and educational activities;
complete rest.

Non-pharmacological treatment of symptoms in a clinical setting consists of:

psychotherapy;
electrosleep;
massages;
acupuncture;
electrophoresis;
reflexology;
medicinal baths.

The sanatorium type of treatment also plays an important role.

For successful treatment of dystonia of the cardiac and hypertensive type, medications are prescribed that can eliminate various problems with the functioning of the heart. To treat hypotonic neurocirculatory dystonia, the doctor may prescribe the use of ginseng tinctures and caffeine.

To avoid attacks of this disease, doctors recommend daily intake of tinctures of valerian, motherwort, and hawthorn. To treat constant feelings of anxiety, tranquilizers are used, the use of which should not exceed three weeks.

Non-drug treatment for pregnant women is the same as for ordinary people. Drug treatment is a little different - it is gentle, but no less effective. The treatment takes place entirely under the supervision of doctors.

Treatment of neurocirculatory dystonia with folk remedies will help enhance the effect of the above methods. The basis of folk methods are alcohol tinctures of various herbs and fruits:

valerian;
motherwort;
passion flowers;
peonies;
hawthorn.

Decoctions and tinctures from:

mixtures of flowers of hawthorn, oregano, motherwort and St. John's wort;
compounds of adonis, lemon balm and valerian root;
a set of oregano, hawthorn, chamomile, mint, lemon balm, sage and motherwort.

Treatment of neurocirculatory dystonia

Physiotherapeutic procedures for NCD

Neurocircular dystonia of the hypertensive type is treated with psychotherapy and hypnosis. But in our country, such methods of treating the disease have not yet become widespread. In case of NCD, the patient is indicated for sanatorium-resort treatment in areas where there is no sharp temperature change. The patient's physical activity should be moderate.

A patient suffering from neurocircular dystonia is recommended to attend the following physiotherapeutic procedures:

massage of the cervical-collar area;
electrosleep;
balneotherapy;
electrophoresis;
cryotherapy;
acupuncture;
galvanization.

Pathogenesis

Neurocirculatory dystonia - what is it? The complex results from disorders of neuroendocrine regulation. It becomes an addition to the deterioration of well-being against the background of already existing stress.

What is normal: the endocrine glands secrete hormones into the blood, they are controlled by the central nervous system and exert their neurohumoral effect on homeostasis and human reactions. A person constantly adapts to circumstances thanks to the interaction of these systems. They interact in both directions. If they were not there, in a moment of stress or danger a person would not be able to survive - the body would simply destroy itself in a matter of seconds. In case of imbalance, the leader becomes a disturbance and lesion in the hypothalamus, its structures that play the role of coordinator. Dysregulation manifests itself in a malfunction of the cholinergic (secretes acetylcholine) and sympathetic-adrenal systems.

What is neurocirculatory dystonia? Its essence is a violation of control over the functioning of certain organs and systems, starting with the cardiovascular system. Because it is the myocardium that turns out to be the most sensitive to these changes and reacts with jumps in function and tone: inappropriate tachycardia, fluctuations in vascular tone, regional vascular spasms. Thus, a symptom complex of a certain type of NCD develops as a stable response to the influence of the external environment.

Symptoms of the disease

Symptoms of pathology in patients may differ, as there are several forms of the disease. Common signs of the disease include:

fast fatiguability;
general weakness;
feeling of inner trembling;
sleep disturbance;
increased and causeless irritability;
memory loss;
deterioration in concentration;
tachycardia;
desire to inhale air in large gulps;
cardiac dysfunction;
shortness of breath;

A common manifestation for all types of neurocirculatory dystonia is a neurosis-like state, characterized by fatigue, weakness, sleep disturbance, irritability

pain in the sternum;
lack of air;
decreased blood pressure;
short-term increases in body temperature;
feeling of coldness in the extremities;
fainting;
muscle weakness;
attacks of nausea;
panic attacks and unfounded fears;
headache and dizziness;
dampness of palms;
pallor of the skin.

The above symptoms may appear individually or complexly, under the influence of a provoking factor. Sometimes, to make a diagnosis of NDC, four criteria from the above list are enough. As for the performance of a person with NDC, it is preserved, the only thing is that the body’s endurance decreases. Inpatient treatment is required only in severe cases when symptoms of cardiac dysfunction are pronounced.

The hypertensive type of neurocirculatory dystonia is characterized by a transient increase in blood pressure to 130-140/85-90 mm Hg. Art., which in half of the cases is not accompanied by a subjective change in well-being

In women, similar symptoms may appear during pregnancy, as they are afraid of encountering complications of their situation. Most often, such nervous disorders occur during pregnancy with the first child, because the woman has no idea what awaits her and does not know how to prepare for the upcoming birth. In this case, treatment for NDC is not required; a conversation with a psychologist and the use of valerian infusion is sufficient.

Principles of diagnosis and differential diagnosis

The doctor will suspect neurocirculatory dystonia based on the patient’s multifaceted complaints and the history of his life and illness (impressionability, disruption of work and rest, stress, and so on), as well as on the results of an objective examination (pallor, increased skin moisture, sweating, white/red dermographism , palpitations, slightly elevated blood pressure, respiratory arrhythmia, and so on). To confirm or refute the diagnosis, he will prescribe an additional examination to the patient, the main methods of which are:

ECG + tests (orthostatic, with beta blockers, with hyperventilation and others);
24-hour Holter ECG monitoring;
bicycle ergometry (VEG) and/or treadmill;
Ultrasound of the heart (EchoGK);
thermometry every 2-3 hours for several days in a row with keeping a diary of measurements.

NCD should be differentiated from diseases such as:

cardiac ischemia;
acute rheumatic fever;
acquired heart defects;
hyperfunction of the thyroid gland.

Drug treatment of NDC

For the treatment of cardiac-type NCD, if pressure surges are recorded, adrenergic blockers are prescribed, such as:

"Atenolol";
"Anaprilin";
"Trazicore".

To normalize the condition of a patient suffering from cardiac type NCD in the presence of depression, the drugs “Belloid”, “Bellataminal”, “Picamilon” and “Persen” are prescribed. The treatment of cardiac type NCA should receive the most attention, because this is the most serious form of the disease, it can provoke heart failure or a heart attack. To eliminate hypertensive type NCD, drugs that improve metabolism in the heart are prescribed:

"Riboxin";
potassium-based preparations,
B vitamins.

For sleep disturbances and irritability, it is possible to prescribe sedatives: motherwort, valerian, valocordin, tranquilizers

Medicines to lower blood pressure, such as Hypothiazide, Indapamide, Carvedilol or Concor, are also required. The selection of drugs is carried out exclusively by a qualified doctor. Self-prescribing the above remedies is strictly prohibited. For the treatment of hypotonic type NCD, tincture of ginseng, lemongrass, aralia, and caffeine.

Physiotherapy

A course of cryotherapy complements the treatment of patients with NCD.
Treatment with physical methods, as a rule, begins immediately after the patient’s admission to the hospital. Usually he is prescribed 2 methods: one electrical procedure and one hydrotherapy method.

Galvanic collar according to Shcherbak. The duration of the procedure ranges from 6 minutes at the beginning of therapy to 16 minutes at the end of the course of treatment. The course of treatment includes 10-12 procedures performed once a day.
Bromine electrophoresis on the collar area. Used for severe neurotic syndrome and sleep disorders. Act for 15-20 minutes. The course of treatment includes 10 sessions, performed every day or once every 2 days.
Electrophoresis on the collar zone of magnesium. It is one of the methods of choice for the hypertensive type of NCD. The duration, frequency and course of treatment are similar to those for bromine electrophoresis.
Electrosleep. Prescribed for severe neurosis-like syndrome. The frequency of influences ranges from 5 Hz at the beginning to 100 Hz at the end of the course of treatment (the upper limit applies specifically to the hypertensive form of NCD; with a tendency to hypotension, it is significantly lower). The duration of the procedure ranges from 20 minutes at the beginning to 50 minutes at the end of the course of treatment, which consists of 10 procedures performed every day.
Carbon dioxide baths. Temperature – 34-36 °C. Take for 15 minutes once every 2 days in a course of 15 procedures.
Pine baths. Temperature – 35-36 °C. Take for 15 minutes every day in a course of 15 procedures.
General cryotherapy. The temperature of the mixture is -160 °C, the duration of the session is 3 minutes, the frequency is every day, the course is 10 exposures.
Hypoxytherapy. Perform daily 30-40-minute treatments in a course of 10-12 sessions.

Also, patients with neurocirculatory dystonia are recommended to rest in sanatoriums with a mild climate - in Crimea, Sochi, as well as in local hospitals. In a complex of sanatorium procedures, methods such as drinking mineral waters, balneotherapy, health path, climatotherapy, exercise therapy and the above-mentioned methods of physiotherapy can be used.

Concluding the article, we repeat that neurocirculatory dystonia of the hypertensive type, as a rule, responds well to treatment. The patient should treat his illness correctly and follow all the doctor’s recommendations - receive therapy, the components of which include lifestyle modification, a couple of medications and physical therapy.

Clinic “Be Healthy”, story on the topic “Vegetative-vascular dystonia”:

How can traditional medicine help?

However, to treat NCD with folk remedies, one should not forget about pressure, so traditional healers also recommend different treatments. For example, for high blood pressure, people use infusions of mint and white birch leaves, calendula flowers and dill seeds. Alcohol infusions of magnolia and mistletoe are good for reducing blood pressure.

Strong tea and coffee are not recommended for the hypertensive type of NCD, but in the morning you can drink amazing tea prepared at home:

Dry blueberries, chokeberries, currants and barberries are taken in equal parts, ground, mixed and consumed, poured with boiling water.

With normal blood pressure levels and a downward trend, prepare infusions of elecampane and immortelle, drink freshly squeezed juices of carrots and rose hips. They say it helps a lot.

Causes

A feature of neurocirculatory dystonia is that it is not caused by the presence of any organic damage. The cause of the development or exacerbation of the disease is often nervous disorders. Children and adolescents more often suffer from this disease due to the disproportionate development of systems that regulate processes and executive bodies. Other causes of hypertensive type NCD include:

fatigue caused by mental or physical stress;
stress;
physical inactivity;
past acute infectious diseases;
heredity;
smoking;
unfavorable environmental conditions;
traumatic brain lesions.

Vegetovascular dystonia: symptoms and treatment of VSD in adults and children
Arterial hypertension syndrome: symptoms and treatment of the disease
Cerebral hypertension - what it is, signs, symptoms, diagnosis and treatment

Diagnostics of NCD

To make a diagnosis, consultation with a neurologist and cardiologist is necessary. Since changes in blood pressure in neurocirculatory dystonia of the hypertensive type are episodic in nature, it is necessary to carry out a differential diagnosis to exclude the following disorders:

hypertonic disease;
vascular atherosclerosis;
menopausal syndrome;
neurosis;
depression;
myocarditis.

The peculiarity of NCD is the symptoms clearly described by the patient in the absence of visible disorders. This is what doctors start from when making a diagnosis. Since the disorder is psychogenic in nature, you should definitely undergo a comprehensive examination by a neurologist.

Forecasts

Mixed neurocircular dystonia does not lead to the development of heart failure or other life-threatening disorders in the functioning of the cardiovascular system. However, this does not mean that over time, against the background of the syndrome, another disease cannot develop, the cause of which will be completely different factors.

It should also be remembered that heart failure associated with NCD increases the risk of developing hypertension, that is, chronic high blood pressure. The later NCD is diagnosed and treatment is started, the higher the chance of a chronic form, and, consequently, its negative consequences. That is why it is necessary to contact specialists when the first symptoms appear, even if unexplained heart pain or pressure surges appear relatively rarely. The reason for diagnosing mixed-type NCD is the manifestation of symptoms within a month.

Cardiologists consider neurocirculatory dystonia to be a borderline condition separating normal and organic pathology. Full recovery is possible with timely detection of deviations from the norm in children and their correct treatment. When the disease is detected at an older age (teenager, adult), the prognosis for complete recovery will not be such a joyful one. The presence of crises negatively affects the quality of life and human performance.

NDC for conscripts

What kind of neurocirculatory dystonia is this is of interest to many conscripts. They are very different in their aspirations. Not everyone wants to rush into the embrasures and serve at all costs.

Many, having very scant records in their outpatient records, try to convince doctors that their condition is incurable and life-threatening. To prevent this from happening at the commission, the conscript is sent to a hospital for a month.

Here the examination will be complete and objective. The result may be an entry in the “temporary unsuitability” column (Article 48). Then the patient is treated further. If the treatment turns out to be ineffective, the conscript is recognized as “unfit” under Art. 47a.

How is the diagnosis made?

Autonomic dystonia syndrome is not based solely on patient complaints. Before the doctor makes a diagnosis, the patient must undergo tests and undergo instrumental examinations, therefore the main stages “on the path” to NDC will be:

General blood and urine tests, which do not deviate from the norm for this disease;
Blood pressure profile for 10-14 days to establish the type of NCD;
Ultrasound of the kidneys and heart to exclude independent diseases of these organs;
Rheoencephalography;
ECG, FCG, echoCG;
Consultations with an endocrinologist, otolaryngologist, neurologist, ophthalmologist.

In addition, to determine the cause, there is often a need for a detailed study of the function of the kidneys, adrenal glands, hypothalamus and thyroid gland.

The essence of the problem

The basis of the disorders is a violation of neurohumoral regulation for various reasons. Even the most severe clinical manifestations of NCD have a benign course and a good prognosis. The course of the pathology is undulating, with relapses.

The diagnosis of NCD is made only when studies confirm the absence of organic changes. Very often, NCD is determined as part of another disease or becomes an external reaction.

Among visits to a cardiologist or neurologist, 70% of patients have NCD. Most often, dystonia is characteristic of adolescents, middle age - in the range from 12-13 to 45 years.

In women it occurs 4 times more often. Why? Because their bodies experience hormonal fluctuations every month - the menstrual cycle is one of them, not to mention pregnancy.

Neurocirculatory dystonia in children is characteristic of the puberty period, during the restructuring of the body. At the same time, a person is very sensitive to external influences.