[MENTAL AND SPEECH DEVELOPMENT IN CHILDREN LIVING IN ECOLOGICALLY UNFAVOURABLE REGIONS OF GEORGIA].

The ecological condition of different cities and regions in Georgia is variable. The level of anthropogenic contamination with xenobiotics in most of them significantly exceed the normal level. In almost 25% of children residing in Tbilisi, Batumi and Kutaisi the level of xenobiotics varies 5.0-10.0 mkg/dL, 16% of children have higher than 10.0 mkg/dL. We have studied the profile of mental and speech development in children living in abovementioned cities according to the level of Pb in blood. On the basis of representative selection we have studied the level of Pb in the range of 5.0 mkg/dL and 10.0 mkg/dL for two groups of children with normal development: 65.5 months- (I study group) and 89.5 months (II-study group). Control group has no Pb in blood. The situation in family was also considered. Intellectual development was assessed by Wexler verbal and nonverbal subtests, neuropsychological methods by Luria-Kristensen and visual-motor and visual-spatial evidence by WBAVMA. According to results of children from group I living in ecologically unfavourable regions average evidence for mental and speech verbal awareness were within normal range and similar to controls. As for group II the difference from normal age range was not found. The development of awareness of false belief of second order for group-I was significantly delayed which could occur due to pitfalls in cognitive field. The redevelopment of structure of motivated behaviour in children from group-I was significantly restricted compared with group-II and controls.

[NEUROLOGICAL DISORDERS OF CHILDREN LIVING IN ECOLOGICALLY AFFECTED REGION OF GEORGIA].

Article discussed the clinical evidence of children with attention deficit hyperactivity disorder (ADHD) living in different regions with polluted air. We have revealed the correlation between severity of neurological impairment and level of Hg, Pb, Zn and Cu in blood of children of three different age group (2-5y, 6-9 y and 10-13y). According to our results we found correlation between living area and level of xenobiotics and essential microelements. Thus we have concluded that beyond the level of xenobiotics and essential microelements in child's blood their primary and secondary role in the development of neurological disorders in regions of various anthropogenic impact has to be considered.

[MODERN ISSUES OF KALCIPHEROL INFLUENCE ON CHILDREN AND ADULTS' HEALTH (REVIEW)].

The purpose of this review is study of literature for the development of biological effect of Kalcipherol (D vitamin group) on children population. Different factors seem, that D- vitamin deficiency disbalance elevated, children specifically negative effect, which have a major impact on health, growth and development of infants, children and adolescents. Vitamin D and calcium deficiencies are preventable global public health problems in pediatric medicine. The laboratory assessment of vitamin D (calcidiol-25(OH)D), epidemiological studies assessing the prevalence of vitamin D deficiency, are performed to analyze the relationships between neuropsychological function and mechanisms of toxic effects in the setting of vitamin D.

INFLAMMATION IN CHILDHOOD EPILEPSY SYNDROMES.

Epilepsy is one of the most common neurological disorder affecting up to 1% of the world population. It is a heterogeneous disorder and includes genetic, structural, metabolic causes, sometimes reason is unknown. In recent 20 years inflammation has been considered as a possible etiologic factor in angiogenesis and epileptogenesis in experimental models but there is still lack of evidence if inflammation could be seen in clinical cases of children with different forms of epilepsy. Epileptic encephalopathies are the group of epilepsies when seizure itself can cause severe cognitive and behavioral abnormalities. Besides seizures occurring in epileptic encephalopathies prone to be highly resistant to medication. Thus any etiological factor contributing to epileptogenesis could have high clinical relevance in modern epileptology. The aim of our research was to study the pro-inflammatory cytokines in different forms of epilepsy in children. We have assessed 56 children from 0-16 years of age. 20 were included in control group (Group 1), 20 children with resolved seizures were involved in study group (Group 2a) and 16 children with resistant seizures were identified as group 2b. The concentration of the following pro-inflammatory cytokines was assessed in blood serum: VCAM-1, CCL2, CCL3, CCL11 as well as a correlation between concentration and seizure repetition rate was also studied. All pro-inflammatory markers were within normal range in controls as well as in both study groups except CCL11. The concentration of CCL11 was elevated in group 2b. Thus we could hypothesize that inflammation could contribute to etiology of resistant epilepsies including epileptic encephalopathies. This evidence could serve as very significant information for pharmaceutical industry for future development of anti-inflammatory medicines as add on therapy with antiepileptic drugs for treatment of drug resistant epilepsies.

[THE CALCIUM-PHOSPHORIC METABOLISM AND DEVELOPMENT OF BONE ORGANIC MATRIX AT CHILDREN AND ADOLESCENTS ON D-AVITAMIN BACKGROUND (REVIEW)].

The purpose of the review is to study the literature data on the manifestation of D-deficient rickets in children of various age groups. It is shown that the rapid growth of the musculoskeletal system requires timely intake of both macronutrients and vitamin D, its biologically active metabolites. The role of the relationship between the intestines, liver, kidneys and bone tissue in regulating the necessary level of phosphorus-calcium salts in bone tissue, the synthesis of its organic matrix is shown. Modern data on the content of phosphorus, calcium and d vitamin in women's milk during various periods of lactation are presented. It is shown that the prevention of their deficiency should begin already in the antenatal period of the child's development. The article presents prevalence of vitamin D deficiency in children of puberty and pre-puberty age, The hypo Vitamin D status in children with complicated forms orthopedic pathology is descid. The level of vitamin D and calcium-phospharic metabolism are presented summarizing the literature data. Vitamin D availability and vitamin D insufficiency in pediatric clinical practice is analysed, showing high prevalence of vitamin D difficiency in children in the first part of life. Analyses of results demonstrated differences of vitamin D serum concentration in length of age and food additives. Its manifestation, with confusing and wildly differing guidance being change the structure and volume of each components. Vitamin D, calcium-phosphoric deficiencies and osteomalacia are global public health problems in infants, children and adolescents.

[MODERN INSUES OF ESSENTIAL TRACE ELEMENTS LEVEL INFLUENCE ON CHILDREN AND ADULTH HEALTH (REVIEW)].

Systematic review article reported that essential trace elements, mainly microelements Copper and Zinc (deficiency and high values concentration disbalance in blood) play significant roles in neurodevelopmental processes and are associated not only with inattention and hyperactivity, impulsivity symptoms among children and adolescents in the most critical active growth and development periods (between 3 and 16 years old). In the same time previous studies have proposed that clinical symptoms are significant associated their levels and positively correlated with cognitive symptomatology as trace bioactive substances. Their functional connectivity is different and is one of the serious problems for clinical pediatric.

IMPACT OF INTERNET GAMBLING ON MENTAL AND PSYCHOLOGICAL HEALTH OF CHILDREN OF VARIOUS AGES.

The aim of the study was to assess the impact of internet gambling on children's mental and physical health and find correlation between the age, duration of internet use and type of comorbidity associated with internet gambling. The study assessed 50 patients with internet gambling (35 boys, 15 girls) from 2013-2016 y. The age range was 3-15 years. 15 patients were from 3-7 y of age, 20 patients from 7-12 y and 15 - from 12-15 y of age. The core problem common for all patients were internet overuse by computer games, mobile device and other gadgets. The main problem occurring in these children were insomnia, language delay, stuttering, behavioral disturbances, aggressive behavior phobias. These complaints were correlated with age of patients. The group of patients from 3-7 years of age exhibited sleep disturbances and language impairment, mainly presented with stuttering. The complaints occurring in children from 7-12 y of age are: tics, insomnia, phobias, emotional disturbances, daily fatigue, and attention-deficit. The group of children aged 12-15 years mainly revealed poor academic performance, refuse to play sport games, refuse to play music, insomnia, aggressive behavior, attention deficit, conflict with parents, coprolalia. Thus internet overuse affects physical and psychological aspects of child development which has to be managed by parental and psychologist's joint effort.

[REASONS AND CONSEQUENCES OF SOMATOFORM DISORDERS IN CHILDREN AND ADOLESCENTS].

The aim of our study was to find the reason of various forms of somatoform disorders (phobias, behavioral disorders, insomnia, tics, stuttering, enuresis, encopresis) in children and adolescents of various social status for diagnosis and treatment. We have examined 202 patients who referred to our clinic from 2012-2016. The age range was 2-18 years. After examination we have concluded the following recommendations: - to implement neuropsychological rehabilitation in order to stimulate mental development; - to work with speech therapist to improvement the speech; - to work individually with psychotherapist to improve the behavior; - to train the parent to manage the behavior at home; - to give the personal card containing information about exercises, games and puzzles to stimulate the development and in some cases to give individual educational program; - to give separate information to parents and in some cases to teachers of kindergartens and schools.

THE CAUSES AND SYMPTOMS OF SOMATOFORM DISORDERS IN CHILDREN (REVIEW).

The causes of somatoform disorders in children and adolescents and clinical description of various syndromes like hypochondric impairment, non epileptic paroxysmal disorders, chronic fatigue syndrome, trauma and headache are presented in this review. The modern epidemiological evidences of mentioned conditions are also considered which indicate on progressive increase of these diseases for recent 20 years. We have also discussed the standardized methods of prevention, differential diagnosis and treatment of somatoform diseases.

[MITOCHONDRIAL DYSFUNCTION: MODERN ASPECTS OF THERAPY (REVIEW)].

Mitochondrial diseases are considered as one of the major problems of modern interdisciplinary neonatology and pediatrics. Mitochondrial pathology can be revealed as refractory myoclonic or multifocal seizures, craniofacial dysostosis, dysmetabolic manifestations and respiratory disorders. Central nervous system (CNS), muscles, heart, liver and kidneys is involved in this pathological process. An important criterion for diagnosis of mitochondrial dysfunction is increases in blood lactate and pyruvate levels; the absolute criterion - molecular genetic diagnostic studies of mitochondrial DNA. Polymorphism of clinical symptoms complicates the process of early diagnostics, the lack clear recommendations complicates therapy. Modern aspects of treatment of mitochondrial dysfunction in various neurological syndromes are based primarily in improving the efficiency of the processes of oxidative phosphorylation at the system level. Dietary carbohydrate restriction, and medication (Coenzyme Q10, Idebenonum, Cofactors, drugs which reduce lactic acidosis- Dimephosphon, Dichloroacetate, Antioxidants, Anticonvulsants and Antidiabetic agents, vitamins C, E, K, hemotransfusions) is prescribed. Such complex approach allows us to achieve a reduction in lactate-acidosis, and improve the condition of patients in 70% of cases.

[The role of lactate acidosis in the development and treatment of various neurologic syndromes in children and adolescents].

The aim of the study was to detect the role of lactate acidosis, also to find the share of mitochondrial insufficiency in development of various neurologic syndromes in children and adolescents. The detection of cellular energetic metabolism and acid based imbalance is also important for finding the specific method of management. We have studied 200 patients with various degree of neurodevelopment delay with epilepsy and epileptic syndromes, headache, vertigo, early strokes, floppy infant syndrome, atrophy of ophthalmic nerve, cataracta, neurosensory deafness, systemic myopathy, cerebral palsy. In 27% of cases with various ages we have detected lactate acidosis and increase level of pyruvate. Mitochondrial insufficiency was seen in 8% of cases which gives us opportunity to find the specific method of treatment in this group of patients. Each patient with neurological symptoms requires correction of parameters of energetic and oxidative metabolism.

Management of burning mouth syndrome taking into consideration various etiologic factors.

The aim of the research was to detect the stomatologic, endocrine and psycho-neurologic status in patients with burning mouth syndrome, elaborate different diagnostic criteria and effective therapy for the patients with burning mouth syndrome. 92 patients with burning mouth syndrome were studied. Patients ranged in age from 28 to 72 years. The conducted studies gave the possibility to make conclusions, the most important of which are: burning mouth syndrome (BMS) is not only stomatologic problem; this psychosomatic syndrome belongs to gerontologic disease and tendency of its "rejuvenation" was revealed as well (in the current study --2 women (28 and 32 year old, and 38 year old man); degree of revelation of the symptoms of depression, anxiety, obsession and somatization is closely related with duration of the diseases. These symptoms are progressing together with aging and reach the peak at 60-70 years old. Individual scheme of therapy was developed on the background of clinico-paraclinical study.

The psychological aspects of burning mouth syndrome.

It should be emphasized that at the present stage there is no consensus achieved regarding the etiopathogenesis of BMS. Almost all researchers point to lots of factors, simultaneously participating in genesis and development of BMS and at the same time most of them agreed on one - psychological factors play a crucial role in formation and maintenance of painful sensations. The aim of the study was the identification of psychological or psychiatric deviations (changes) among the patients with BMS to perform an adequate differentiated therapy. Clinico-psychological examination (dentist, neurologist, psychiatrist) was carried out in 39 patients from 46 to 70 years of age. Among them women - 36 and men - 3. To identify clinical types of BMS a classification of P.J. Lamey (1996) was used and as a result, depression, insomnia, cancerophobia, severe neurologic disorders, phobic syndrome were revealed. Three main categories - a chronic somatoform dysfunction (23 cases), chronic vegetative disorders (8), and chronic pain phenomenon (12) were identified. Only in one case was revealed a paranoid syndrome. Alongside with the well-known scheme of treatment (antidepressants, anticonvulsants, or neuroleptics) Psychotherapy was conducted, while EEG-feed back (Biofeed back, Neurofeed back) method was used for the first time. A number of important decisions were made the most important of which are the following: BMS - must be regarded as a psychosomatic problem rather than a psychiatric disorder. In addition to psychotherapy, using of EEG - feedback method greatly improved patients' condition and in 4 cases BMS clinical manifestations were evened-out completely.

[Role of various etiologic factors in the development of burning mouth syndrome].

Burning mouth syndrome (BMS) has been comparatively recently isolated as the separate nosologic diagnosis. This disease is characterized by the feeling of burning, dryness, numbness, pricking and seldom by pain in the tongue or mouth cavity area (palate, lips, alveoli) without any changes in mucous membrane. Absence of visible causes of the disease complicates its treatment and makes the patients to address the physicians of various profiles, often without any result. All the above stated made the authors to define the etiologic factors of various clinical versions of BMS and to carry out their differential diagnostics along with the development of pathogenetic therapy of BMS. 30 women of 40 to 70 year of age were examined. According to the anamnesis, BMS was developing gradually and in most cases it was associated with the aggravation of the existing disease (hypertension, diabetes mellitus, aggravation of climacteric state) or with deterioration of psycho-emotional sphere due to conflicting situation. The carried out studies enabled the authors to select and divide patients with BMS into groups according to clinical values and the etiologic factors. In most cases diverse clinical versions of the burning mouth syndrome are cause-and-effect expressions of various somatic diseases, the timely determination and adequate therapy of which give the best results in the struggle against BMS.

[Peculiarities of epileptic syndrome in children with metabolic disorders of nervous system].

Metabolic diseases of the nervous system vary considerably in their clinical and pathological aspects. In neurological presentations of these disorders dominate mental retardation and epileptic syndrome. We have studied 27 patients of age from 3 months to 3 years: PKU -- 15 cases; homocystinuria -- 4; hyper-prolinemia -- 1; methylmalonic acidemia -- 5 and combined disorders -- 2. Epileptic syndrome was revealed in 21 patients, mental retardation in 1, spasticity in 5 and ataxia in 1 patient. Epileptic syndrome was presented with generalized seizures (grand mal -- 6 cases, myoclonic absences -- 13 cases) and partial seizures (simple motor -- 2 cases). Investigations did not found reliable correlations between certain forms of enzymophaties and EEG patterns. Patients were treated by pathogenic (dietary management with protein-modified diet and vitamin therapy) and symptomatic (anticonvulsants) treatment. We have achieved the positive therapeutic effect by pathogenic and anticonvulsive treatment in 11 patients. All these patients were from the first group (1-3 year). The best outcome was observed in the cases of the early diagnosed PKU. The most severe mental retardation and resistant epilepsy were revealed in patients with combined disorders of metabolism and vitamin-non-responsive forms of MMA and HCS.