Methods of treatment and diagnosis of astasia-abazia

Neurological and psychiatric problems are often interrelated and intersect with one another, a clear example is dissociative motor disorders, which can manifest as:

• pseudoparadies or pseudo-cuts;
• coordination disorders of movements of different plan;
• astasia-abasia.

The latter form is a combination of two pathological conditions, when a person suddenly loses the ability to stand( astasy) and move without any help( abasia) while retaining muscle strength and the ability to move the limbs in a horizontal position.

As manifested astasy-abasia

Develops suddenly: when trying to get out of bed, a person suddenly, chaotically looking for what to lean on, can not make a single step due to dizziness and loss of coordination, while lying well moves the limbs, performs various exercises. Movements in hands are preserved in full.

There may be different forms of the manifestation of the disease associated with the location of the pathological focus in the nervous system:

• frontal astasia-abasia - with lesions of the corresponding lobes of the cerebral hemispheres. The patient is not able to be in a vertical position, move around and even sit. There may be a combination with other manifestations of the pathology of the frontal lobes, for example with oral automatisms;
• subcortical - when the focus is located in the deep parts of the brain( thalamus region, basal ganglia).With this defeat, the patient is unable to stand or move. If there is no support, then when you try to get up, it falls either forward or backward, and with support can make movements similar to walking;
• is psychogenic - as a manifestation of a hysterical reaction in response to a traumatic situation( the result of stress).The degree of severity of such astasia-abasia can range from mild( insecurity in an upright position, a shaky gait) to complete inability to stand and take steps.

In early childhood, astasia-abasia can be considered as a temporary phenomenon, a variant of the norm.

What are the causes of astasia-abrasion

? At the heart of development are any pathological conditions that disrupt the normal structure of various parts of the brain, more often frontal lobes, thalamus, subcortical ganglia, cerebellum, corpus callosum and conductive pathways connecting all these sections with each other and with other sitescentral nervous system. These include:

• tumor formation of the brain;
• acute or chronic cerebrovascular disorders;
• post-traumatic effects;
• purulent processes in the substance or membranes of the brain( eg, abscess);
• multiple sclerosis and other diseases associated with demyelination of nerve fibers;
• degenerative processes in the nervous system( Alzheimer's disease, dementia);
• hysteria, more often in people with hereditary burden of nervous diseases.

Diagnostic criteria

A patient with the above symptomatology should be referred to a neurologist and a psychiatrist for a thorough examination and differential diagnosis of hysterical( psychogenic) and neurological astasia-abasia.

To do this:

• collect anamnestic data on the disease;
• evaluation of the neurological status - checking the degree of coordination and balance disruption( stability in Romberg's position), determining the strength of muscles in different positions of the body, the presence of reflexes on the legs and hands;
• psychiatric examination for the elucidation of a trauma;
• special studies - computed tomography or MRI to identify pathological foci in the brain.

With hysterical astasia-abasia, the absence of organic brain diseases is characteristic;attachment of the onset of symptoms to the time of a stressful situation the day before;the loss of the ability to commit arbitrary movements that are under the control of the will of man;motor disorders have a different degree of severity in the absence of neurologic symptoms.

Principles of treatment and prevention

1. Elimination of the pathological basis of the disease( removal of the tumor, hematoma, abscess or normalization of the blood circulation of the brain with the help of angioprotectors, nootropics, etc.).
2. Exercises with a physician-physiotherapist to restore coordination of movement.
3. In the case of hysterical astasia-abazia, nootorapes are not shown due to the lack of an application point. Psychotherapy with hypnosis, behavioral therapy, pharmacological treatment with antidepressant drugs, tranquilizers, antipsychotics, beta-blockers and other drugs as directed by a specialist is necessary. Treatment of astasia-abasia is better to be performed in a hospital, especially with adaptation disorders to remove the patient from the traumatic situation and in severe cases for the selection of adequate treatment.

Prevention is reduced to simple rules:

• compliance with the regime of the day with the correct alternation of work and rest;
• rejection of bad habits;
• to avoid psychotraumatic situations whenever possible;
• monitor the blood pressure;
• pay attention to any deviations in the state of health and promptly resort to the help of a neurologist or psychiatrist;
• does not stay with its problems one-on-one, apply to psychological support centers if necessary.

Observance of simple rules will help to avoid a serious illness and its consequences in the form of violation of social and labor adaptation due to pronounced neurological disorders.

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