Treatment of vegetative-vascular dystonia

Vegetative-vascular dystonia: persistent symptoms

Cardialgia. Pain in the left side of the chest that is not due to heart damage. These symptoms are not specific to VSD; they can occur in many other diseases.
Heartbeat problems . Common symptoms of VSD are rapid or slow heartbeat, irregular heart rhythm (arrhythmia).
Vascular dystonia . Constriction of blood vessels causes blood flow to slow down. Because of this, internal organs suffer, which do not receive enough oxygen and nutrients.
Respiratory disorders . Shortness of breath, difficulty breathing, feeling of lack of air.
Systemic neurotic disorders . The patient suffers from insomnia and nervousness.

Contraindications

Neuromultivitis has a number of contraindications that should be taken into account before prescribing and taking:

Hypersensitivity to the components of the drug. This contraindication concerns vitamin B1.
History of peptic ulcer and intestinal disorders. This rule applies to vitamin B6. It can cause increased stomach acidity.
Vaquez disease, erythrocytosis, embolism: formation of a blood clot in the bloodstream of a vessel.
Acute and chronic heart failure.
Childhood.
Pregnancy.

Treatment of VSD: lifestyle correction and diet

To get rid of VSD, you need to eliminate the cause of the disease and normalize the functioning of the autonomic nervous system. This will help you:

Full sleep. It is important to sleep at least 8 hours a day and go to bed at the same time. To ensure a restful sleep, it is advisable not to overeat at night, open windows for ventilation and ensure a comfortable temperature in the room.
Healthy eating. Animal fats should be replaced with vegetable fats, which are found in nuts, grapes, and olives. It is better to exclude or reduce the amount of fatty, fried foods.
Physical exercise. If there is no time for regular training, morning exercises, regular walking or cycling will be enough.
Massage. Massage of the head and collar area helps against headaches due to VSD, and massage of the torso and limbs helps against low blood pressure.

To find and treat the root cause of VSD, contact the doctors at the Medicenter clinic. Specialists will conduct an examination, identify the problem and prescribe effective treatment.

Vitamin B12 in the treatment of diseases of the nervous system

Since the second half of the twentieth century. and to this day, clinical studies are continuing to study the effectiveness of the use of B vitamins in various neurological diseases. B vitamins (primarily B1 (thiamine), B6 (pyridoxine), B12 (cyanocobalamin)) have been widely used in clinical practice for many years. One of the purposes of prescribing vitamins is to compensate for their deficiency that develops in various conditions: poor nutrition or dietary restrictions in vegetarians, chronic alcoholism, the use of certain medications (for example, isoniazid), after surgical interventions on the gastrointestinal tract, malabsorption syndrome. Studies have shown that a lack of B vitamins, even in developed countries, is not uncommon. Thus, in the USA and Great Britain, vitamin B12 deficiency is observed in 6% of the population, mainly in older age groups [1]. Some genetic diseases, for example, pyridoxine-associated epilepsy, are accompanied by impaired metabolism of B vitamins. A lack of essential vitamins of this group leads to a variety of pathologies, including mono- and polyneuropathies, encephalo- and myelopathy of deficiency origin [2]. However, the use of B vitamins is pathogenetically justified even in the absence of their deficiency - due to the fact that, in the form of their coenzymes, they take an active part in biochemical processes that ensure the normal functional activity of various structures of the nervous system. In this regard, B vitamins are often called neurotrophic or neurotropic vitamins. One of the most significant for the normal development and functioning of the nervous system is vitamin B12 (cyanocobalamin). The history of the discovery of vitamin B12 began in the middle of the 19th century. with a description of the disease, the main manifestation of which was a special form of anemia with a fatal outcome. 20 years later, this disease was called “pernicious anemia.” In 1934, doctors D. Maykot and U.P. Murphy received the Nobel Prize for the discovery of the medicinal properties of vitamin B12, and only 12 years later the production of the drug began [3]. Vitamin B12 is the common name for 2 chemical variants of the cobalamin molecule - cyanocobalamin and hydroxicobalamin. It is the only vitamin that contains essential mineral elements (mainly cobalt), and is also the only water-soluble vitamin that can accumulate in the body - it accumulates mainly in the liver, but also in the kidneys, lungs and spleen. The human body is not capable of its synthesis. At the same time, vitamin B12 is produced by microorganisms in the digestive tract of any animal, including humans, as a product of the vital activity of microflora, but it cannot be absorbed, because it is formed in the large intestine and does not enter the small intestine for absorption [4, 5]. Vitamin B12 in the human body

The main sources of vitamin B12 for humans are meat, beef liver, kidneys, fish, milk, and eggs. The daily requirement for vitamin B12 for adults is from 2 to 3 mcg/day, for children – from 0.3 to 1 mcg/day, for pregnant and lactating women – from 2.6 to 4 mcg/day [4]. Cyanocobalamin (vitamin B12), converted in the body with the help of enzyme systems into active coenzymes (methylcobalamin and deoxyadenosylcobalamin), participates in the process of hematopoiesis and maturation of red blood cells, in the synthesis of creatinine, methionine, nucleic acids, and is necessary for cell growth and replication. Vitamin B12 plays an important role in amino acid and carbohydrate metabolism, acetylcholine biosynthesis, the formation and functioning of protein and fatty structures of the myelin sheath of nerve fibers, regulates the functioning of the blood coagulation system, and reduces the release of excitatory neurotransmitters (glutamate). Vitamin B12 and methionine, as well as vitamin C, play a significant role in the functioning of the central and peripheral nervous system, participating in metabolism in the production of monoamines [6–8]. The cause of vitamin B12 deficiency in 50–70% of patients (more often in young and middle-aged people, somewhat more often in women) is insufficient secretion of the gastric mucosa of intrinsic factor Castle (IFC), caused by the formation of antibodies to parietal cells of the stomach that produce IFC, or to the binding site of VPA with vitamin B12. In approximately 20% of cases, there is a hereditary history of VPA deficiency [9]. In these cases, the consequence of vitamin B12 deficiency is the development of so-called pernicious anemia. In addition, vitamin B12 deficiency can be caused by a stomach tumor, gastrectomy, malabsorption syndrome, helminthiasis and dysbacteriosis, and an unbalanced diet. Other causes include hereditary diseases characterized by a defect in the production of proteins that bind to vitamin B12 or a defect in the formation of active forms of the vitamin; metabolic disorders and/or increased need for vitamins (thyrotoxicosis, pregnancy, malignant neoplasms), as well as long-term use of H2 receptor blockers and proton pump inhibitors. It should be noted that the reserve of vitamin B12 in the body, even with limited supply, is enough for 3–4 years [7–9].

Neurological disorders due to vitamin B12 deficiency

Cyanocobalamin deficiency, in addition to pernicious anemia, leads to damage to the nervous system in about a third of patients. The main neurological manifestations of vitamin B12 deficiency are: damage to the spinal cord (subacute combined degeneration of the lateral and posterior columns, or funicular myelosis), brain (dementia), optic nerves and peripheral nerves of the extremities with the development of distal sensory polyneuropathy [8]. Combined damage to the central and peripheral nervous systems is also possible. The immediate causes of neurological disorders are impaired methionine synthesis, slower oxidation of fatty acids with an odd number of carbon atoms, and the accumulation of methyl malonate, which is toxic to the nervous system, causing fatty degeneration of neurons and demyelination of nerve fibers [10]. In addition, accumulation of neurotoxic substances and a decrease in the content of neurotrophic factors were noted in the cerebrospinal fluid (CSF). In experimental studies on laboratory rats, it was established that a lack of vitamin B12 is accompanied by an increase in the content of tumor necrosis factor in the CSF, a decrease in the concentration of epidermal nerve growth factor and interleukin-6. Correction of vitamin B12 intake eliminates these disorders [11]. A number of studies have found that a deficiency of vitamin B12 and vitamin B9 (folic acid) in the mother can lead to defects in the development of the neural tube and the formation of pathology of the nervous system in the fetus. Disruption of the formation of the neural tube during pregnancy is manifested by pathology of the skeletal structures (underdevelopment of the limbs, cleft palate, spina bifida), spinal (myelomeningocele) and brain (underdevelopment, cysts, malformations, hydrocephalus) of newborns. Several studies have shown that including foods rich in folic acid in the pregnant diet, taking adequate doses of folic acid and vitamin B12 significantly reduce the risk of developing neural tube defects in the fetus [12–14]. It has now been proven that deficiency of vitamins B6, B12 and B9, resulting from dietary habits and/or malabsorption, is one of the main risk factors for the development of hyperhomocysteinemia, which is an independent risk factor for the development of atherosclerosis, thrombosis, cerebrovascular diseases and dementia [15].

Pharmacological effects of B vitamins

It has been shown that the use of B vitamins, including B12, can reduce the level of homocysteine in the blood. It has been established that the administration of high doses of B vitamins significantly reduces the progression of atherosclerosis in the early stages of the process. A study of 779 healthy people and 188 patients with ischemic strokes and transient ischemic attacks showed that low levels of vitamins B9 and B12 in the blood, especially in cases of their combined deficiency, increases the risk of developing cerebral ischemia [16, 17]. Thus, further prospects for the use of B vitamins (B9, B1, B6, B12) in vascular and neurodegenerative diseases of the brain are undoubted, but clinical controlled studies are necessary to assess the effectiveness and safety of drugs. Currently, the participation of B vitamins and, in particular, vitamin B12 in the implementation of human cognitive abilities has been proven. Thus, at the University of Oxford (UK), the cognitive functions of 1648 subjects in various age groups were assessed for 10 years. It was found that low levels of vitamin B12 in the blood serum were combined with an increase in the concentration of methylmalonic acid and correlated with a faster rate of cognitive decline in the examined individuals [17,18]. J. Kalita and UK Misra (India) assessed cognitive functions using the technique of cognitive evoked potentials of the brain in 36 patients with megaloblastic anemia aged from 16 to 80 years [19]. It was found that clinical and neurophysiological indicators of the state of cognitive functions in the examined patients were reduced and corresponded to those at the age of 14. MRI of the head revealed white matter changes and signs of cortical atrophy. Similar changes in the brain substance, according to MRI data, were identified by other researchers [20, 21]. It has been established that there is a correlation between the content of vitamin B12 and methylmalonic acid in the blood plasma, the rate of atrophy of the brain substance and the decrease in human cognitive abilities. In a prospective study involving 107 subjects aged 61 to 87 years, the above parameters were assessed over a 5-year period. Scientists have concluded that low levels of vitamin B12 in blood plasma are the cause of progressive atrophy of the brain substance and subsequent impairment of cognitive functions [22].

Analgesic effect

Since the 1950s. B vitamins are actively used to treat pain syndromes of various etiologies. It should be noted that until recently the analgesic effect of vitamins B1, B6 and B12 was repeatedly questioned. Since the analgesic mechanism of action of these substances remained unclear for a long time, many scientists believed that the analgesic effect of B vitamins was just a placebo effect. However, research in recent years has made it possible to create a serious theoretical basis confirming the analgesic effect of B vitamins in nociceptive and neuropathic pain. Currently, the results of more than 100 studies have been published showing clinical improvement with the use of B vitamins in patients with pain syndromes. It is assumed that vitamin B12 has the most pronounced analgesic effect [23, 24]. In 2000, the first randomized controlled trial of the effectiveness of intramuscular injections of vitamin B12 for chronic back pain was conducted. The results of a clinical neurological examination of 60 patients aged 18 to 65 years showed a significant decrease in the severity of pain and improvement in motor functions. Another controlled study compared the effectiveness of vitamin B12 and the antidepressant nortriptyline in treating neuropathic pain in 100 patients with diabetic polyneuropathy (DPN). There was a significant reduction in pain intensity on the visual analogue scale (VAS) in the group receiving vitamin B12 injections compared with the group receiving nortriptyline. In addition, during therapy with vitamin B12, patients with DPN showed a significant decrease in the severity of paresthesia, burning and chilliness of the legs [23, 25, 26]. A number of experimental studies have shown the presence of an analgesic effect of individual B vitamins and their complexes in neuropathic pain [27, 28]. When the dorsal ganglion was compressed or a ligature was applied to the sciatic nerve, vitamins B1, B6 and B12 administered intraperitoneally reduced temperature hyperalgesia. Repeated administration of B vitamins caused a persistent reduction in temperature hyperalgesia, and the combination of B vitamins had a synergistic effect in both models of neuropathic pain. The effect of B vitamins on the activity of nociceptive neurons of the central nervous system was studied. It has been established that the activity of nociceptive neurons upon stimulation of C-fibers of the sciatic nerve decreases in a dose-dependent manner following injections of vitamin B6 and a complex of vitamins B1, B6 and B12. An experiment on laboratory rats revealed suppression of nociceptive responses not only in the dorsal horn of the spinal cord, but also in the thalamus optica. Injections of vitamins B6 and B12 reduced nociceptive activity to a greater extent than vitamin B1. An experimental study of a formaldehyde model of nociceptive pain also revealed an antinociceptive effect of a combination of B1, B6 and B12, which suggests the effect of the B vitamin complex on the synthesis and functional activity of inflammatory mediators [29]. It has also been established that the B complex of vitamins enhances the effect of the main antinociceptive neurotransmitters - norepinephrine and serotonin. Vitamin B12 is able to reduce the release of the excitatory neurotransmitter glutamate in the terminals of the central nervous system [30, 31]. In a study by M. Eckert, P. Schejbal (Germany), a significant decrease in the intensity of pain and paresthesia was noted during treatment with a complex of B vitamins (pyridoxine, thiamine, cyanocobalamin) in patients with pain syndromes and paresthesias caused by polyneuropathies, neuralgia, radiculopathies and mononeuropathies [32 , 33]. In clinical studies and experimental animal models, it has been shown that in neuropathies, B vitamins enhance the analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs), as well as the antiallodynic effect of gabapentin, dexamethasone and valproate [34]. As a result of complex therapy, treatment time and the risk of developing side effects of the drugs used are reduced. The effectiveness of the combined use of B vitamins and NSAIDs for back pain was especially noted. It has been established that adding a combination of B vitamins to diclofenac leads to a more rapid achievement of the analgesic effect and makes it possible to reduce the dose of NSAIDs [35]. In 2009, a randomized, double-blind study was conducted in Brazil on the effectiveness of adding a B complex of vitamins to diclofenac in patients with lumbago. After 3 days of treatment, pain disappeared in 46.5% of patients receiving diclofenac in combination with a B complex of vitamins, while with diclofenac monotherapy, pain regressed in only 29% of patients [36].

Vitamin B12 and folic acid in oncology

The question of the possibility of using vitamin B12 in the treatment of patients with cancer is relevant. It is known that vitamin B12 and folic acid are involved in the synthesis of nucleic acids and in the process of cell replication. In this regard, there is a widespread opinion among doctors that if there is a malignant neoplasm in the body, the use of these vitamins can promote the replication of tumor cells and the growth of the tumor, i.e., have a carcinogenic effect. However, this hypothesis has not been confirmed in clinical and experimental studies. Moreover, vitamin B12 and folic acid are widely used in oncological practice to reduce the neurotoxic effect of chemotherapy drugs. It is known that patients suffering from cancer often develop anemia, including due to a deficiency of vitamin B12 and folic acid. Thus, in a study by S. Tandon, NR Moulik et al. (India) studied the effectiveness of chemotherapy in children with acute lymphoblastic leukemia. According to the authors, deficiency of folic acid and vitamin B12 was observed in 36–66% of patients. Replacement therapy with vitamin B12 and folic acid before the start of chemotherapy significantly reduced the incidence of side effects of the cytostatics used, without reducing the effectiveness of treatment and without affecting long-term survival and the duration of the relapse-free period [37, 38]. In addition, it was found that patients with vitamin B12 deficiency had impaired cellular and humoral immunity, which were associated with a higher risk of death from the toxic side effects of chemotherapy [39]. The work of Chinese scientists Ch. Zhou and Yin. Qin (2015) and a number of previous studies have shown a lower incidence of side effects of chemotherapy and better tolerability of treatment in patients with lung adenocarcinoma who received a single injection of high doses of folic acid and vitamin B12 before starting chemotherapy. At the same time, the use of B vitamins did not have a negative effect on the antitumor activity of chemotherapy drugs [40, 41]. The results obtained allow us to draw a preliminary conclusion about the safety of using B vitamins in patients with cancer. In general, the important role of vitamin B12 and the wide possibilities of its use in the treatment of diseases of the central nervous system and peripheral nervous system, both caused by its deficiency in the body and as adjuvant neurotropic and analgesic therapy, are beyond doubt. It should be noted that the use of a combination of vitamins B1, B6 and B12 is a more effective drug than monotherapy with any of these vitamins. The original drug containing a complex of B vitamins is Neurobion (Merck, Germany), which has been successfully used for more than 50 years to treat a wide range of diseases of the nervous system in more than 70 countries around the world. Neurobion is a combination of neurotropic vitamins: thiamine (vitamin B1), cyanocobalamin (vitamin B12) and pyridoxine (vitamin B6). An important advantage of Neurobion is the availability of oral (tablets) and parenteral (injection solution) dosage forms, which makes it possible to individualize the treatment regimen as much as possible, to effectively combine relatively short-term courses of parenteral administration and subsequent long-term oral administration of the drug. Another important advantage of the drug is the optimally balanced ratio of dosages included in Neurobion vitamins. 1 tablet of Neurobion contains thiamine disulfide (a lipophilic compound of thiamine) - 100 mg, pyridoxine hydrochloride - 200 mg and cyanocobalamin - 240 mcg. Thus, Neurobion contains the maximum dose of thiamine compared to similar drugs in combination with high doses of pyridoxine and cyanocobalamin. However, there were no cases of sensory polyneuropathy described with the use of high doses of pyridoxine. One ampoule of Neurobion also contains 3 B vitamins: thiamine 100 mg, pyridoxine 100 mg and cyanocobalamin 1 mg, which provides maximum neuroprotective effect. The absence of lidocaine in Neurobion injection solution allows you to avoid unwanted effects associated with this substance, such as allergic reactions and cardiac conduction disorders. A special randomized, double-blind study was devoted to studying the effectiveness of the drug Neurobion for the prevention of relapses in back pain. The drug was used 1 tablet 3 times a day. In accordance with the study protocol, after the end of acute phase therapy (not exceeding 3 weeks), patients received prophylactic treatment with the drug for 6 months. During the study, 59 patients were observed, 30 of whom received Neurobion, and 29 received placebo. As a result, it was shown that in the group receiving Neurobion, there was a significantly greater number of cases of relapse-free course of the disease [23]. The effectiveness of the combination drug Neurobion for parenteral administration was studied using a retrospective analysis of 1082 patients with various pain syndromes. Regardless of the clinical nosological form causing the pain syndrome, 481 patients received treatment with Neurobion in ampoules without the use of any other drugs. In 78% of all cases of treatment with Neurobion in ampoules, a positive analgesic result was obtained. In patients with polyneuropathies, a positive result was observed in 86% of cases. In patients with back pain, in 45% of cases the therapeutic effect was rated as “good” or “very good.” Tolerability of the drug was assessed by doctors as “good” and “very good.” It has been shown that the recommended doses of vitamins B1, B6 and B12 either do not lead to the development of adverse effects, or their severity is insignificant and does not require discontinuation of the drug or a reduction in its dosage [6, 23, 42]. As a rule, it is advisable to begin treatment of severe forms of damage to the central nervous system and peripheral nervous system with parenteral administration of a complex of B vitamins, which ensures a more rapid onset of the therapeutic effect. Neurobion injections are carried out deep intramuscularly, 3 ml (1 ampoule) 1 time per day until acute symptoms subside. For less severe conditions or during the rehabilitation period, 1 injection of the drug 2 or 3 times per week is recommended. Then, as maintenance therapy, Neurobion is recommended to be used in tablet form. The duration of treatment with the drug in a dosage of 1 tablet 3 times a day varies from 1 to 3 months. depending on the severity of the clinical manifestations of the disease. In general, today the pathogenetic significance, clinical effectiveness and safety of the use of the drug Neurobion in the treatment of poly- and mononeuropathies, tunnel neuropathies of various origins, as well as other diseases of the peripheral nervous system and pain syndromes have been proven.