The dissertation is devoted to the scientific solution of the actual scientific problem: to substantiate clinically pathologically and to optimize diagnostic and therapy criteria of traumatic brain injury (TBI) effects in Anti-Terrorist Operation(ATO) participants on the basis of autonomic system state study and syndrome complex study in different TBI periods.
The structure and clinical dynamics of the modern combat TBI effects in ATO participants, as well as features of patients’ autonomic portrait after TBI in military conflict on the background of constitutional personality traits, clinical course, dynamics and polymorphism of subsequent autonomic changes in the remote posttraumatic period and period of residual phenomena were studied. It was proved, that in the clinical manifestations of traumatic brain damage (TBD) in ATO participants affected by modern combat mine-explosive injury, regardless of the period, prevailed cephalic syndrome and autonomic distonia with permanent disorders, as well as disorders of the ANS with a predominance of pathological types of vegetative tonus with increasing parasympathicotonia, pathological vegetative reactivity with her increasing by parasympathicotonic type. Features of post-traumatic headache in the remote period with the predominance of chronic tension headache after mild trauma have been identified. The frequency of post-traumatic epilepsy(PTE) depending on the severity of the trauma, autonomic response, age, premorbid and psychological personality traits were studied.
Neurophysiological differences between symptomatic PTE and paroxysmal vegetative states: in most patients with symptomatic PTE the hypersynchronous type of electroencephalogram (EEG) prevailed (type II according to O.O. Zhirmunska), and in paroxysmal vegetative manifestations – EEG type II (hypersynchronous type) and IV (paroxysmal type) according to O.O. Zhirmunska.
The state of psycho-emotional sphere, separate mental functions of patients who have endured a combat trauma in different periods of TBD are supplemented with new data, the leading role of anxiety-depressive syndrome was shown.Most veterans were diagnosed with post-traumatic stress disorder (PTSD), according to the Mississippi scale, these indicators were in a high correlation range, and the length of participation in ATO did not affect its development.
As a result of the conducted researches the diagnostics of vegetative and psycho-emotional changes and other disorders in the remote period of TBI in patients with TBD for carrying out differential diagnostics, and also for the purpose of reduction of disability and improvement of quality of life of patients was optimized.
The dissertation pathogenetically substantiates differentiated therapy of autonomic dysfunctions, PTE, psychovegetative syndrome, trembling functional hyperkinesis.
The efficiency of a new algorithm for correction of epileptic seizures according to the vegetative profile is proposed and proved, what reduced the number of epileptic seizures to single ones, improved brain bioelectrogenesis, ANS condition due to vegetative tonus normalization, and relieved vegetative crisis states in most cases.
