Application of Cortexin in the rehabilitation of children of the first year of life with perinatal hypoxic lesions of the central nervous system

The nootropic drug Cortexin was developed by domestic scientists in 1999. Initially, it was used to restore military personnel after concussion. After additional research, the effectiveness of the drug in treating various neurological pathologies was proven.

The medicine is a lyophilisate powder. It has a recognizable slightly yellowish tint, but can sometimes be white. An injection solution is prepared from the powder for further intramuscular administration. The main active component is polypeptide neuroactive complexes. The auxiliary ingredient is glycine.

You can purchase Cortexin injections for adults and children. The drugs differ in dosage. Cortexin injections, the price of which is 700 - 1300 rubles per pack, improve microcirculation in brain tissue. When used, memory improves and performance increases.

Cortexin: application

Cortexin, the instructions provide for this, is used in the treatment of severe brain diseases that are caused by circulatory problems in combination with other medications. In particular, it is prescribed after hemorrhagic strokes. The drug is also indicated for traumatic brain injuries, as it can accelerate recovery processes.

The drug is effective in combination with other drugs in the following cases:

• Diseases of the nervous system caused by infection with harmful microorganisms.
• Diffuse brain damage, the mildest form of which is concussion.
• Autonomic disorders, manifested by various symptoms: dizziness, panic attacks, migraines, etc.
• Epilepsy, which is a chronic neurological disease characterized by sudden seizures.

As a single drug, Cortexin injections, the instructions for use provide for this, can be used in case of absent-mindedness, decreased concentration, or difficulties in perceiving new information. The drug helps restore brain function during the development of senile dementia and after a stroke.

In pediatrics, Cortexin injections, the instructions indicate this, are used for birth damage to the brain in newborns. The medicine is also indicated for children with motor and speech dysfunction. In complex therapy, the drug is considered effective in the treatment of cerebral palsy.

The solution is prepared directly in the bottle. It is diluted in accordance with the instructions with a 0.5% solution of novocaine, water for injection or saline. In this case, the liquid is added very carefully to avoid foaming.

Adult patients receive Cortexin injections once a day into the gluteal muscle. It is advisable to carry out the manipulation in the first half of the day to eliminate the possibility of sleep disturbance. The duration of the course of treatment is 10 days. This means that one package is enough. Repeated treatment is possible no earlier than after 3 months.

In case of acute massive stroke and in the initial period of recovery of brain function, the dosage is increased by 2 times. Injections are given in the morning and evening for 10 days. In this case, the course can also be repeated after 10 days.

The drug should be administered to children with extreme caution. The dosage for children weighing less than 20 kg is 0.5 mg/kg body weight; for children weighing less than 20 kg, a dose of 10 mg is allowed.

Cortexin in the treatment of cerebral pathology

V.V. Kuznetsov, State Institution “Institute of Gerontology of the Academy of Medical Sciences of Ukraine”, Kyiv

For the treatment and rehabilitation of patients with various forms of cerebral vascular pathology, drugs with a peptide structure that combine nootropic, vasoactive, and neuroprotective effects are effectively used. The drugs in this group include Cortexin.

Cortexin was created at the department of the Military Medical Academy of St. Petersburg. The principle underlying the technology for producing tissue-specific nucleoprotein complexes is the preservation of the structural elements of chromatin, which contain endogenous regulatory proteins with complementary DNA regions. This technology provides high therapeutic properties of Cortexin. Cortexin is a complex of L-amino acids and polypeptides weighing from 1 to 10 kDa, isolated from the cerebral cortex of calves. Cortexin contains microelements that play an important role in the life of neurons, the formation of neuroprotection mechanisms and maintaining the activity of more than 1000 intracellular proteins and enzymes that regulate the processes of cellular dynamics and apoptosis. Thus, lithium helps inhibit the release of excitotoxic amino acids aspartate and glutamate. The neurochemical effect of selenium is characterized by inhibition of apoptosis and stimulation of angiogenesis. Manganese in the central nervous system activates the synthesis of mitochondrial superoxide dismutase. Zinc is an essential trace element that stabilizes the function of NMDA, GABA, acetylcholine and DOPA receptors.

The amino acid spectrum of the drug is represented by 15 amino acids. It should be noted that amino acids are L-forms, that is, left-handed molecular structures, which differs from amino acids synthesized chemically (right-handed). The spatial features of the behavior of Cortexin amino acids contribute to their active inclusion in the metabolism of neurons.

The influence of Cortexin on the functional and biochemical state of the central nervous system is carried out both by restoring the balance between excitatory (aspartate, glutamine, glutamic acid) and inhibitory (GABA, serine, glycine) amino acids-neurotransmitters, and as a result of the influence of the mineral substances contained in the drug on the activity of enzymes regulating apoptosis, the antioxidant system and the functional state of dopamine and acetylcholine neuroreceptors [14].

Using an organ-specific diagnostic method - determining the level of brain fractions of creatine phosphokinase (CPK-BB) - it was shown that Cortexin has a direct effect on the metabolism of nerve cells [1].

The main mechanisms of action of Cortexin:

• regulation of the ratio of inhibitory (glycine, taurine, GABA, serine) and excitatory (glutamic acid, glutamine, aspartate) amino acids;
• increased levels of GABA, serotonin, dopamine;
• antioxidant effect;
• stimulation of reparative and neurotrophic processes;
• neuroprotective effect;
• anti-inflammatory effect (reduction of autoimmune processes, increase in the level of anti-inflammatory (NGF, interleukin-10) and decrease in the level of pro-inflammatory (α-NGF, interleukin-1a) cytokines).

The tissue-specific and nutriceptive properties of Cortexin ensure a reduction in spasticity and muscle rigidity. Cortexin influences the functional state of the immune system. It is known that in ischemic disorders caused by arterial hypertension and cerebral atherosclerosis, titers of autoantibodies (AAT) to NMDA and GluR1 receptors increase [12]. Under the influence of Cortexin, AAT titers to NMDA and GluR1 receptors decrease [2, 3].

Considering the multicomponent effect of Cortexin on the functional state of the nervous, immune systems, reparative and anti-inflammatory systems, the drug is used in the treatment of various clinical forms of cerebrovascular diseases. Thus, as a result of a randomized, double-blind, placebo-controlled study, the beneficial effect of Cortexin on the neuropsychological status and postural stability in patients with dyscirculatory encephalopathy was proven [8]. In patients with dyscirculatory encephalopathy during treatment with Cortexin, there is a significant increase in the performance of neuropsychological tests, reflecting regulatory cognitive and neurodynamic functions. In patients, visual memory indicators and sensorimotor reactions improve, which indicates the activation of intrahemispheric and interhemispheric connections [7]. It should be noted that the maximum improvement in cognitive and motor functions is observed immediately after completion of the course of treatment with Cortexin. In patients, one month after the end of drug administration, the assessment of quality of life according to the EuroQoL questionnaire increases (from 0.42 ± 0.16 to 0.53 ± 0.18, p < 0.05), motor activity increases, and sleep improves.

Complex neuropeptides, and in particular Cortexin, are also effectively used in neurogeriatrics for the treatment of patients with chronic cerebral circulatory failure and symptoms of ischemic stroke. In this category of patients, Cortexin causes regression of neurological symptoms (4–5 points) and improvement of neuropsychological indicators. Thus, the overall total score on the Organzo scale increases from 59.7 ± 2.0 (before treatment) to 82.9 ± 3.1 (after 10 days), and this effect lasts up to 40 days. The severity of subclinical depression in patients decreases (according to the Beck scale 15.6 ± 1.7 before treatment, 10.2 ± 1.3 after treatment). With a nonparametric assessment of indicators on the Sandoz geriatric scale, patients noted a decrease in the frequency and intensity of dizziness, headache, and noise in the head. 10 and 40 days after treatment with Cortexin, patients observed positive dynamics in kinetic motor tests and a statistically significant improvement in visual memory [11].

The amino acid neurotransmitters contained in the drug help suppress the pathologically enhanced impulses of central motor neurons in the reticular formation, as well as inhibit mono- and polysynaptic reflexes in the spinal cord. The majority of stroke patients with speech impairment under the influence of a course of treatment with Cortexin (2.0 ml IM for 20 days) experience restoration or improvement of speech [12].

In patients under the influence of Cortexin, cerebral circulation improves, the volumetric velocity of blood flow increases, and the asymmetry of cerebral hemodynamics decreases [8].

Thus, in elderly patients, a course of treatment with Cortexin causes an increase in motor activity, memory, and an improvement in the emotional and motivational sphere, which is probably due to the effect of the drug on the cortical-subcortical structures of the brain. Improvement in cognitive functions is associated with an increase in the functional activity of frontostriatal and thalamocortical connections [15]. The mechanisms of activation of neurodynamic processes are determined by the regulatory effect of Cortexin on the ratio of inhibition and excitation processes. The presented data provide grounds for including Cortexin in complex therapy of patients with different stages of dyscirculatory encephalopathy. Given the neurotrophic effect of the drug, repeated courses of therapy are necessary.

The activating effect of Cortexin on the rehabilitation processes in patients who have suffered an ischemic stroke has been established. Thus, in patients who received a course of treatment with Cortexin, at different stages of the rehabilitation period (3, 6, 12 months) and in the residual period, there was a more statistically significant increase in the clinical score of motor disorders and a reduction in the clinical score of sensory disorders than in the group of patients receiving only on basic pharmacological rehabilitation. A similar picture occurred when analyzing the results of functional recovery scores using the Barthel scale and the Nottingham scale. The integral sum of recovery scores in the group of patients taking Cortexin was statistically significantly higher than in the control group. During a course of treatment with Cortexin, patients' rates of anxiety and depression decreased. Dynamic neuroimaging revealed a significantly larger number of patients in the control group with signs of increasing dyscirculatory encephalopathy and brain atrophy.

Also, in the group of patients receiving Cortexin, there were higher rates of restoration of lost neuropsychological functions. It is noteworthy that neurodynamic and regulatory errors were more common in patients of the main group, and operating errors - in the control group. This once again emphasizes the greater severity of neuropsychological disorders in patients in the control group who did not receive treatment with Cortexin [10].

A comparative clinical study of the effectiveness of neurometabolic protection of the brain in patients during the acute period of stroke with Cortexin (10 mg IM once a day No. 10) and nootropil (12 g IV No. 10) indicates that the restoration of motor functions in patients is more pronounced during therapy with Cortexin. Thus, the restoration of motor activity in the form of an increase in the total score in the affected upper limb in patients treated with Cortexin is 1.6 points, in the group of patients treated with nootropil - 0.8 points (p ≤ 0.05), and in the affected lower limb limbs -1.75 and 0.94 points, respectively (p ≤ 0.05). Restoration of sensitivity and speech was more often observed in patients receiving Cortexin. The results of a comprehensive analysis of the course effect of Cortexin on clinical, biochemical and immunological parameters in patients with ischemic stroke in the acute period indicate an improvement in the psycho-emotional state, mnestic functions and an increase in motor activity, an increase in interhemispheric connections, an improvement in cerebral blood flow, a decrease in the content of pro-inflammatory cytokines, a decrease in the content of antibodies to myelin protein and neuronal growth factor [3]. Analysis of clinical manifestations in patients with ischemic stroke treated with Cortexin in the acute period of the disease showed its positive effect on both general cerebral and focal neurological symptoms (assessed on the NIHSS scale). Already on the 3rd–7th day of treatment, patients receiving Cortexin showed positive dynamics in the restoration of impaired functions compared to the group of patients taking placebo, reaching a degree of significance (9.1 and 5.6 points, respectively, p < 0.05 ) by the 11th day. A significant improvement in the recovery of neurological functions was observed in the group of patients included in the study within the first 6 hours from the onset of stroke symptoms and receiving Cortexin (8.8 and 4.62 points compared with the placebo group, respectively). By the 28th day from the onset of stroke, in the group of patients receiving Cortexin, mortality was 3.1%, and in the placebo group - 10%.

The number of patients with good recovery increased significantly faster in the group of patients receiving Cortexin compared with the group of patients receiving placebo. Advanced recovery of the functional state was evident from the first day of stroke; a significant difference (p < 0.05) between the groups was observed on the 3rd–7th days of treatment.

When analyzing the functional activity of patients admitted to the clinic during the first 6 hours and receiving Cortexin, a significantly higher score on the Barthel scale was revealed compared to the group of patients receiving placebo (81.8 and 68.3, respectively, p < 0.05 ).

When assessing the dependence of functional recovery on the Rankin scale in patients receiving Cortexin on the depth of ischemic damage, the best recovery was observed in subcortical localization of the ischemic focus. A significantly higher Rankin scale score was observed from the 3rd day of stroke, reaching the maximum difference compared to the group of patients with cortical localization of ischemia by the 11th day of treatment (3.5 and 1.7, respectively, p < 0.05). In addition, in patients receiving Cortexin, there was a smaller increase in the volume of the lesion by the 3rd day of the disease and the absence of glial transformation by the 28th day.

The effect of Cortexin depends on the time of initiation of therapy: the earlier treatment is started, the more pronounced the effect. All this indicates the advisability of using Cortexin in the first hours after a stroke in an emergency setting [13].

Thus, the use of Cortexin in the treatment of stroke gives a more pronounced effect in restoring motor, speech and sensory functions, which is due to the fact that the drug stimulates reparative processes in the brain, and this gives grounds to recommend Cortexin in the treatment of stroke, both acute and during recovery periods [14].

During therapy with Cortexin, no side effects or adverse events were registered in patients. There was no effect of Cortexin on basic vital signs (blood pressure, heart rate, respiratory rate, body temperature) and laboratory parameters of blood and urine (erythrocyte content, hemoglobin level, hematocrit, glucose, creatinine and liver trans-aminases in the blood).

The results of a clinical analysis of the use of Cortexin in patients with traumatic brain injuries also indicate the advisability of using this drug in the treatment regimen for patients in this category. During treatment with Cortexin, the majority of patients with traumatic brain injuries showed a clear improvement in neurological status, motor activity, memory, emotional and motivational sphere, a decrease in the increased titer of autoantibodies to NMDA and glutamate receptors by 1.5–1.7 times, an increase content of serotonin and dopamine [12]. After a course of treatment with Cortexin, patients experience restoration of the zonal distribution of the alpha rhythm, a weakening of the severity of irritative activity, and an increase in the number of normal EEG types. Hemodynamic changes are characterized by an increase in the linear velocity of blood flow, a decrease in peripheral resistance indices in the vessels of the carotid and vertebrobasilar areas. Cortexin is recommended to be used in courses of 10 to 20 injections at intervals of 3–6 months, depending on the severity of the injury and clinical syndrome. Rational and timely use of Cortexin in the treatment of the consequences of traumatic brain injury allows one to achieve full recovery, reduce the consequences of injury and achieve maximum psychosocial rehabilitation [4].

The GABAergic effect of the polypeptide nootropic drug Cortexin determined the use of this drug in the treatment of certain forms of epilepsy. In patients with cerebrovascular pathology and epileptic syndrome, the inclusion of Cortexin in complex therapy contributes to a significant improvement in the well-being of patients: complaints of headaches are reduced, memory and sleep are improved. It has been established that in this category of patients Cortexin leads to a significant improvement in the EEG by normalizing the frequency-amplitude characteristics of the main rhythms and reducing focal pathological activity [6].

Thus, Cortexin, which is a complex of balanced neuropeptides, vitamins and microelements, has a nootropic, neuroprotective effect and is effectively used to treat patients with various forms of discirculatory encephalopathy, traumatic brain injuries, epilepsy and for the rehabilitation of patients with stroke during the recovery period.

Literature 1. Batysheva T.T. New opportunities in the treatment of cerebral ischemia // Health of Ukraine. - 2006. - pp. 57-58. 2. Batysheva T.T., Biletsky P.S., Boyko A.N. Neuroprotection - current issues of chronic cerebrovascular insufficiency // Sudinny brain diseases. - 2006. - No. 6. - P. 57-64 3. Batysheva T.T., Biletsky P.S., Boyko A.N., Dyakonov M.M., Korenko A.N., Levin O.S. , Pugacheva V.A., Skoromets A.A., Skoromets A.P., Shumilina M.V. Chronic cerebrovascular insufficiency and neuroprotection, new in diagnostics // Neuroprotection of acute and chronic cerebral circulatory insufficiency. - St. Petersburg: Nauka, 2007. - P. 98-115. 4. Burtseva M.S., Dolzhich G.I. The influence of peptide drugs on visual functions in patients after closed traumatic brain injury // Neuroprotection of acute and chronic cerebral circulatory failure. - St. Petersburg: Nauka, 2007. - pp. 172-179. 5. Gerasimova M.M. The influence of Cortexin on the therapy of the acute period of ischemic stroke // Cortexin. 5 years of experience in domestic neurology. - Moscow: Science, 2006. - pp. 82-89. 6. Golovkin V.I. Cortexin in the treatment of epilepsy // Cortexin. 5 years of experience in domestic neurology. - Moscow: Nauka, 2006. - P. 147-156. 7. Danchenko I.Yu. Dynamics of cognitive impairment in vascular lesions of the brain during treatment with Cortexin // Proceedings of the 1st International Competition of Young Scientists and Specialists “Young Hippocrates”. - St. Petersburg: IITs VMA, 2006. - pp. 17-18. 8. Levin O.S., Sagova M.M. The influence of cortexin on neuropsychological and motor disorders in dyscirculatory encephalopathy // Terra Medica. - 2004. - pp. 15-18. 9. Luria A.R. Important human cortical functions and their disturbances in local brain lesions. - M.: Moscow State University Publishing House, 1969. - 504 p. 10. Melnik E.A. Neuroprotection, neurological and neuropsychological disorders in ischemic stroke in the non-dominant hemisphere of the brain // Neuroprotection of acute and chronic cerebrovascular insufficiency. - St. Petersburg: Nauka, 2007. - pp. 48-67. 11. Pugacheva V.A., Shumilina M.V., Korenko A.N. Cortexin in complex therapy of patients with mild dyscirculatory encephalopathy // Proceedings of the 1st International Competition of Young Scientists and Specialists “Young Hippocrates”. - St. Petersburg: IITs VMA, 2006. - pp. 31-32. 12. Skoromets A.A. Secondary cerebral ischemia in the acute period of traumatic brain injury: Abstract of thesis. Dis... Dr. med. Sciences: 01/14/15. - M., 2002. - 41 p. 13. Skoromets A.A., Stakhovskaya L.V., Belkin A.A., Shekhovtsova K.V., Kerbikov O.B., Meshkova K.S., Burenchev D.V., Gavrilova O.V., Skvortsova V.I. Cortexin: new opportunities in the treatment of ischemic stroke // Neuroprotection of acute and chronic cerebral circulatory failure. - St. Petersburg: Nauka, 2007. - pp. 7-17. 14. Skorokhodov A.P. Experience of using Cortexin in the treatment of ischemic and hemorrhagic stroke // Cortexin. 5 years of experience in domestic neurology. - Moscow: Science, 2006. - P. 68-82. 15. Bowler JV, Hachinski V., Erkinjuntti JT, Gauthier S. The Concept of Vascular Cognitive Impairment // AMJ. - 2002. - P. 9-26.

Treatment of minimal brain dysfunctions in children at CORTEX MC.

Minimum

Brain dysfunctions (MMD) in children are the most common form of neuropsychiatric disorders in childhood: the incidence rate among preschool and school-age children reaches 5–20%. With MMD, there is a delay in the rate of development of the functional systems of the brain that provide such complex integrative functions , such as speech, attention, memory, perception and other forms of higher mental activity. In terms of general intellectual development, children with MMD are at the normal level, but at the same time they experience significant difficulties in school learning and social adaptation. Due to focal damage, underdevelopment or dysfunction of certain parts of the cerebral cortex, MMD in children manifests itself in the form of motor and speech development, formation of writing skills (dysgraphia), reading (dyslexia), counting (dyscalculia). The term “minimal brain dysfunction” became widespread in the 1960s, when it began to be used in relation to a group of conditions of varying etiology and pathogenesis, accompanied by behavioral disorders and learning difficulties not associated with a general lag in intellectual development. Due to the diversity of clinical manifestations and the heterogeneity of factors underlying the etiology and pathogenesis of MMD, diagnostic criteria have been developed for a number of conditions previously considered within the framework of MMD.

List of nosological forms considered according to ICD 10 within the framework of the MMD.

The reasons for the development of minimal brain dysfunction are not fully understood.

The main factors influencing the appearance of cerebral dysfunction are:

• hereditary predisposition;

• hemolytic disease occurs in the fetus, which develops in the event of a Rh conflict with the mother, which leads to the destruction of the child’s red blood cells;

• various diseases and infections that a woman suffered during pregnancy;

• maternal anemia: malnutrition, vitamin deficiency, etc.;

• severe toxicosis;

• threat of termination of pregnancy (miscarriage), for example, due to severe stress, hypertonicity or hypotonicity of the uterus, etc.;

• any harmful external influences on a woman during pregnancy: radiation, viruses, infections, bacteria, etc., this also includes poor environmental conditions;

• lack of oxygen (hypoxia), suffocation of the fetus (asphyxia) during labor, for example, the umbilical cord entwining the baby’s throat, or a long passage of the fetus through the birth canal;

• premature birth;

• weak labor activity or, conversely, rapid labor;

• damage to the spinal cord during childbirth;

• lack of nutrition in infancy and early childhood;

• development of diseases in the baby such as heart disease, bronchial asthma, infectious diseases, etc.

MMD begins to manifest itself most clearly when children are preparing for school or in the lower grades. It can be observed that the child does not assimilate new information well and has difficulty remembering it; he has problems with handwriting and writing in general. And the point is not that the child has a low intellectual level or does not want to learn, the problem is that MMD affects every sphere of life.

Clinical manifestations of minimal brain dysfunction vary depending on the age of the child:

In infants, the main symptoms of MMD are:

• increased tearfulness and moodiness;

• increased heart rate, sweating, breathing rate;

• presence of spasms and convulsions;

• disorders of the gastrointestinal tract: frequent regurgitation, diarrhea, etc.;

• difficulty sleeping and falling asleep.

The main syndromes that occur in school-age children:

Hyperactivity and attention deficit disorder: - fidgeting in a chair, inability to sit in one place); - the child leaves games and other things unfinished, cannot concentrate on one thing for a long time, begins many actions at once; - often loses things, falls, collides with objects and others; - enters into conflicts, is capricious, aggressive towards loved ones and himself; - problems arise with subjects that require high concentration of attention, long-term mental operations (mathematics, essays, memorizing poems). Sphere of attention: voluntary memorization is impaired, concentration and volume are reduced. It manifests itself mainly in the fact that the child is absent-minded and cannot do the same thing for a long time, especially if it requires mental stress. Speech sphere: the first thing you should pay attention to is the child’s articulation - unclear pronunciation of words and sounds. You can also notice that the child sometimes does not perceive other people’s speech well and does not assimilate information by ear (impaired auditory-verbal memory). This manifests itself in poor vocabulary, difficulty in retelling what was heard or read, and difficulty constructing long sentences. Memory disorders: manifest themselves mainly in difficulties in mechanical memorization, i.e. through repeated repetition. Motor sphere: in such children one can often observe violations of fine motor skills of the hands. This mainly manifests itself in general awkwardness of movements and handling of objects. The child has difficulty fastening small buttons, tying shoelaces, using scissors, and sewing; at school, difficulties arise with neat handwriting and reading speed. Spatial orientation: such children often confuse “left” and “right”, can write all letters in mirror images, etc. Emotional sphere: lability of emotional state. Children with this disorder rapidly change their mood from depressed to euphoric. Unreasonable outbursts of aggression, anger, and irritability may occur, both towards others and towards oneself. One can observe traits of infantility (capriciousness), hysterical personality, and lack of independence.

The maximum severity of MMD manifestations often coincides with critical periods of psychospeech development.

— The first period includes the age of 1–2 years, when intensive development of cortical speech zones and active formation of speech skills occur. - The second period occurs at the age of 3 years. At this stage, the child’s stock of actively used words increases, phrasal speech improves, and attention and memory actively develop. At this time, many children with MMD exhibit delayed speech development and articulation disorders. — The third critical period refers to the age of 6–7 years and coincides with the beginning of the development of written language skills (writing, reading). Children with MMD of this age are characterized by the development of school maladjustment and behavior problems. Significant psychological difficulties often cause various psychosomatic disorders and manifestations of vegetative-vascular dystonia. During adolescence, a number of children with MMD experience increased behavioral disturbances, aggressiveness, difficulties in relationships in the family and school, academic performance deteriorates, and a craving for alcohol and drug use appears.

Therefore, the efforts of specialists should be aimed at timely detection and correction of MMD.

Treatment of MMD is complex and includes several areas: - Psychological and pedagogical measures: 1. The child should be provided with sufficient physical activity: in the case of hyperactivity, it is necessary to give vent to emotions and mobility, and in cases of hypoactivity it is necessary that the loads are not unbearable, but at the same time time stimulated activity. 2. It is necessary to ensure a healthy psychological atmosphere in the family and environment. It is important to create calm and stability, because they will help correct mood swings. Overly strict discipline should not be allowed, but one should also not be overprotective or indulge in whims. 3. It is necessary to observe certain routine moments (go to bed and get up at the same time, set aside time for work and rest, etc.). 4. Contribute to the development of the child’s weaknesses: play games that require fine motor skills, memorize fairy tales and poems, but not mechanically - try to interest the child in the content, etc. An important condition for treatment will be classes with a psychologist, special teachers and speech therapist. Drug therapy occupies an important place in the treatment of MMD along with methods of psychological and pedagogical correction. Drug therapy is prescribed according to individual indications in cases where cognitive impairment and behavioral problems in a child with MMD are so pronounced that they cannot be overcome only with the help of psychological and pedagogical measures. Currently, various groups of drugs are used in the treatment of MMD, including antioxidants (Mexidol, Actovegin), nootropic drugs (Cerebrolysin, Encephabol, Semax, Cortexin). However, the above methods, while affecting individual symptoms of MMD, do not affect the causes of the disease as a whole and, as a result, do not always give a pronounced positive effect overall.

Specialists of the CORTEX MC have developed a new highly effective method of treating children suffering from various forms of mental and speech developmental delays, including MMD - BIOPHYSICAL ACTIVATION of speech centers of the brain. The main neurospecific treatment - BPA - affects the brain through the projection zones of speech, praxis, gnosis; on the articulatory apparatus, promotes their activation, stimulates the development of stable connections and improves the functioning of the first and second signaling systems of the brain, which integrate all signals from the outside world and form the child’s meaningful responses, his speech, memory, attention, and promotes his socialization. The treatment technique is based both on the activation of the speech centers themselves (Broca's area, Wernicke's area, angular gyrus, etc.), and on the restoration of lost connections not only between centers, but also interhemispheric ones. In addition, scattered interneuronal connections of speech centers with other areas of the brain involved in speech function are restored. Treatment of MMD should be comprehensive, which leads to a more pronounced and lasting positive effect. Specialists from CORTEX MC have developed a new highly effective treatment complex for children suffering from various forms of mental retardation and MMD. The components of the treatment process are: diagnosis, the main neurospecific pathogenetic treatment - BFA of the speech centers of the brain and a complex of auxiliary treatment. At the CORTEX MC, each patient must undergo a comprehensive, comprehensive examination : an initial examination by a pediatric neurologist, consultation with a pediatrician, testing of speech functions by a speech therapist-speech pathologist, psychological counseling, computer EEG and evoked potentials of the brain and spinal cord, as well as a neuroimmunological examination of blood for neurotropic viruses (cytomegalovirus, rubella, Epstein-Barr, herpes simplex and others), study of the level of antibodies to specific proteins of the central nervous system in order to determine the degree of damage and hypoxia of nervous tissue. The study allows us to identify a hidden neuroinfection that inhibits the maturation of speech, gnostic and praxis centers. All of the above diagnostic methods make it possible to predict the further course of the disease and formulate the most optimal treatment complex for each patient, as well as confirm, clarify or change the diagnosis.

Auxiliary treatment is a complex that includes the most advanced medical technologies for the symptomatic treatment of various forms of mental retardation, mental retardation and malignant retardation:

1. Neuroprotective therapy for regulating the integrative activity of the brain, lymphatic intercellular therapy and endonasal cortexin electrophoresis are techniques that allow small doses of cerebroprotectors to be delivered endolymphatically; they directly enter the brain tissue, bypassing the blood-brain barrier.

2. Transcranial and transvertebral micropolarization successfully combines non-invasiveness and selectivity of influence, allowing to improve or restore motor, mental, and speech functions. The direction of influence is achieved through the use of small areas of electrodes located on the corresponding cortical (frontal, motor, temporal, etc.) or segmental (lumbar, thoracic, cervical, etc.) projections of the brain or spinal cord.

3. Differentiated segmental massage, which helps normalize muscle tone and has relaxing and sedative effects in case of hyperexcitability of the child.

4. For the purpose of neurophysiological regulation of the stato-kinetic function of the central nervous system, the CORTEX MC uses a unique development of the Center for Aerospace Medicine - the plantar support load simulator “Corvit”. The device allows you to simulate indicators of the physical impact on the foot when walking, which helps to normalize the processes of excitation and inhibition in the central nervous system, the development and restoration of coordination of movements. The device ensures the occurrence of an impulse and its delivery to the cerebellar cortex, allowing indirect formation and improvement of speech skills and perception of the surrounding world.

5. Speech therapy correction includes diagnosis of the degree of speech disorders, daily classes aimed at improving speech function and speech therapy massage to correct various types of dysarthria and dysphagia;

6. Psychological assistance includes: individual consultations, pathopsychological tests (study of attention, memory, thinking, characteristics of the emotional and personal sphere) and neuropsychological tests (study of lateral preferences, motor and sensory asymmetry, general awareness, cognitive, speech, mnestic, intellectual functions). An experimental psychological report is drawn up and given to parents. The specialist selects an individual psychological program for correcting disorders in a particular area for a particular child and further recommendations.

7. Method of audiovocal training RUSTOMATIS according to the method of A. Tomatis. In the 50s of the 20th century, while the author was studying the method of influencing the human brain with sounds of different frequencies, it was discovered that the ear not only hears sounds of different frequencies and laterality - the vibrations are converted into electrical impulses that enter the brain. Currently, a special device for recording high-frequency and low-frequency components has been developed - the “electronic ear”. By alternating such music through tension and relaxation, the child’s middle ear apparatus – the hammer and stapes – is trained, with the help of which the range of perception of external factors expands, concentration of attention increases, new information enters the brain and, as a result, many disorders and disorders disappear. The audio correction system configures, trains and “trains” the vestibular apparatus and auditory analyzer systems to correctly process incoming information.

In the process of complex treatment, a physiological, consistent interaction of all areas of the brain associated with speech production, involved in the control of higher cognitive functions and associative systems of the brain, is formed. The child’s memory improves, attention increases, fine motor skills develop, and thinking becomes more active. During treatment, it is possible to significantly improve speech and behavior, children become calmer, better assimilate new information, and their success in school increases.

Early detection and correction of symptoms of minimal brain dysfunction is very important when the processes of morphofunctional development of the central nervous system continue, its plasticity and reserve capabilities are great. If the diagnosis was made accurately and on time, parents and teachers, doctors interact actively and were able to develop the necessary tactics of communication with the child, then with age the person will compensate for almost all the disorders, and he will be able to live a full life.