Гиперкинезы

Гиперкинезы -                                    |                         |                                            | распространиться  | размашистые;       |                       | при волнении,         | васкулит)                 |                         | |                                  |                                   | головного мозга   |                                        |                         |                                            | на мышцы всего    | больные                 |                       | движениях,             |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | тела, часто по       | гримасничают,       |                       | произвольное          |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | гемитипу               | пританцовывают    |                       | подавление             |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | (гемихорея);          | при ходьбе            |                       | невозможно            |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | участвуют             |                              |                       |                                |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | мышцы-                 |                              |                       |                                |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | антагонисты и       |                              |                       |                                |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | мышцы-                 |                              |                       |                                |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | синергисты            |                              |                       |                                |                                 |                         | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Эпилепсия                 | Клещевой энцефалит | Моторные,           | Не установлены              | В любом           | Прогрессирующее, затем    | Преимущественно | Постоянный           | Неритмичен    | Наблюдается в       | Периодически —      | Спастический   | | Кожевниковская        |                                   | премоторные       |                                        | возрасте          | стабильное                          | в мышцах лица,     | клонический           |                       | покое, во сне не      | большие                   | тонус,               | |                                  |                                   | зоны коры            |                                        |                         |                                            | руки                      | гиперкинез в          |                       | исчезает                 | судорожные             | дистония          | |                                  |                                   | больших              |                                        |                         |                                            |                              | определенной        |                       |                                | припадки                  | мышц               | |                                  |                                   | полушарий           |                                        |                         |                                            |                              | группе мышц          |                       |                                |                                 |                         | |                                  |                                   | головного мозга   |                                        |                         |                                            |                              |                              |                       |                                |                                 |                         | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Эпилепсия                 | Опухоли,                    | Моторные,           | Не установлены              | В любом           | Зависит от течения              | Судороги               | Клонические          | Неритмичен    | Приступ                  | Как правило, потери | Пирамидный     | | кортикальная             | сосудистые,               | премоторные       |                                        | возрасте          | основного заболевания        | начинаются в        | судороги                |                       | продолжается в      | сознания не             | тонус,               | | (джексоновская)        | паразитарные,            | зоны коры            |                                        |                         |                                            | определенной        |                              |                       | течение нескольких | происходит, после   | дистония          | |                                  | инфекционные            | больших              |                                        |                         |                                            | части тела (чаще   |                              |                       | минут                      | приступа возможен  |                         | |                                  | заболевания               | полушарий           |                                        |                         |                                            | в руке, лице),        |                              |                       |                                | паралич                   |                         | |                                  | головного мозга          | головного мозга   |                                        |                         |                                            | затем                    |                              |                       |                                | конечностей, в         |                         | |                                  |                                   |                            |                                        |                         |                                            | распространяются |                              |                       |                                | которых были           |                         | |                                  |                                   |                            |                                        |                         |                                            | на мышцы той же  |                               |                       |                                | судороги, в ряде      |                         | |                                  |                                   |                            |                                        |                         |                                            | стороны, могут      |                              |                       |                                | случаев переходит   |                         | |                                  |                                   |                            |                                        |                         |                                            | переходить на       |                              |                       |                                | в большой                |                         | |                                  |                                   |                            |                                        |                         |                                            | другую сторону;    |                              |                       |                                | судорожный             |                         | |                                  |                                   |                            |                                        |                         |                                            | участвуют             |                              |                       |                                | припадок                  |                         | |                                  |                                   |                            |                                        |                         |                                            | мышцы-                 |                              |                       |                                |                                 |                         | |                                  |                                   |                            |                                        |                         |                                            | антагонисты          |                              |                       |                                |                                 |                         | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Клиническими признаками Г. стволового уровня являются ритмичность, стереотипность и простая структура движений. Для Г. подкоркового происхождения характерны аритмичность, асинхронность, разнообразие двигательных проявлений и их сложная структура, например, атетозный Г. представляет собой медленные, червеобразные, вычурные движения (обычно кистей, пальцев рук и ног) с их тоническим напряжением. Он может быть обусловлен сосудистыми, инфекционными и другими заболеваниями головного мозга (так называемый симптоматический атетоз), а также наследоваться по аутосомно-рецессивному типу с развитием симметричного Г. в детском возрасте (двойной атетоз, болезнь Хаммонда). Гемибаллизм характеризуется быстрыми, бросковыми движениями конечностей большой амплитуды и силы; наблюдается при поражении сосудистого и опухолевого генеза субталамического ядра Льюиса и его связей с бледным шаром. Лечение Г. должно быть комплексным. Применяют препараты, влияющие на этиологические факторы (вазоактивные, противовоспалительные и другие средства). Патогенетическая и симптоматическая терапия Г. включает назначение холинолитических и дофаминергических средств, миорелаксантов, ганглиоблокирующих, седативных, дегидратирующих препаратов, а также средств, влияющих на метаболизм головного мозга. При наличии показаний проводят нейрохирургические стереотаксические операции с деструкцией ядер таламуса, базальных ганглиев (см. Функциональная нейрохирургия), при спастической кривошее возможно нейрохирургическое вмешательство на шейных корешках и черепном добавочном нерве. См. также Атетоз двойной, Гентингтона хорея, Дрожание, Миоклония, Миоклонус-эпилепсия, Писчий спазм, Судороги, Тик, Торсионная дистония, Хорея. Библиогр.: Бархатова В.П. Нейротрансмиттеры и экстрапирамидная патология, М., 1988; Гусев Е.И., Боголепов Н.Н. и Бурд Г.С. Сосудистые заболевания головного мозга, М., 1979; Петелин Л.С. Экстрапирамидные гиперкинезы (современное состояние проблемы), М., 1983.