Bulbar dysarthria in children: causes, symptoms, treatment and prognosis

Article:

Dysarthria is a complex speech disorder, one of its most common forms is bulbar.
The word “dysarthria” itself comes from the Greek “dys” - “disorder” and “arthroo” - “pronounce clearly”. Bulbar dysarthria manifests itself as slurred, slurred speech with a dull nasal tone. A child with this disorder speaks as if he has porridge in his mouth. A similar disorder occurs due to damage to the speech apparatus of the CNS (central nervous system). The first detailed description of dysarthria appeared more than a century ago. It was compiled by A. Oppenheim and H. Gutzmann. This disorder was studied in more detail in 1888 by A. Kussmaul.

Reasons for the development of bulbar dysarthria in children

The immediate cause of the defect is damage to the bulbar nerves. The glossopharyngeal nerve goes to the muscles of the pharynx, the vagus nerve goes to the palatine, pharyngeal muscles and the upper part of the respiratory tract, and the hypoglossal nerve goes to the lingual muscles.

The damaging factors are:

Perinatal factors - complicated pregnancy, severe gestosis, abnormal fetal position, threat of miscarriage and premature birth, placental abruption, labor abnormalities, birth injuries;
Traumatic brain injuries of any severity and form;
Volumetric formations of the brain - tumors are accompanied by the uncontrolled growth of defective cells that penetrate all layers of the brain and destroy healthy cells, leading to compression;
Neuroinfections - meningoencephalitis, viral encephalitis, echinococcal infection, tuberculosis lead to an inflammatory process and compression of the nuclei of the cranial nerves by the edematous medulla;
Neurodegenerative processes destroy the nuclei of cranial nerves;
Encephalopathy and angiopathy due to somatic diseases - diabetes mellitus, vascular abnormalities. They interfere with blood circulation in the brain.

The mechanism of development of the pathology is associated with the development of paresis in those muscle groups that innervate the damaged nerves. Their strength and tone decreases. The muscles atrophy, due to which the contractile force first weakens and then disappears completely. The soft palate droops.

Prevention

Prevention of bulbar syndrome includes the following measures:

timely vaccination prevention of infectious diseases;
Vaccine prevention is a way to avoid bulbar syndrome of an infectious nature
adequate treatment of atherosclerosis and hypertension;
adequate treatment of diabetes mellitus;
timely diagnosis of tumor processes;
proper nutrition;
feasible physical activity.
Adequate physical activity is an integral part of a healthy lifestyle.

Symptoms of bulbar dysarthria in a child

Depending on which cranial nerves are affected, the symptoms of bulbar dysarthria will vary. Sometimes a child has all the manifestations:

Blurred, slow speech with poor articulation. Stop sounds and the sound “r” are replaced by fricative sounds. For example, instead of “b” children pronounce “v”, instead of “p” - “f”;
There are no voiced consonants. Stressed and unstressed vowels are pronounced the same, the best result is “a”;
The rhythm is disturbed, which is why the pronunciation is inexpressive, monotonous, without dynamism. Expressive speech is challenging;
Swallowing disorders - choking with cough. First of all, problems arise with the intake of liquid food and drinks that flow into the nose. In the future, it becomes difficult to eat solid food;
Voice change - decreased volume, sonority, nasality;
Weakness of facial muscles or facial asymmetry if the nerve damage is unilateral.

Neurological symptoms are also present in bulbar dysarthria. The child may complain of headaches, dizziness, nausea not associated with food intake, paresis of an arm or leg, and gait disturbance.

There will be symptoms of bulbar dysarthria characteristic of each disease: with infection - fever, body aches, perinatal encephalopathy - delayed neuropsychic development.

Forecast

Timely, high-quality treatment of bulbar palsy provides a favorable prognosis, which involves stabilization of body functions and complete restoration of muscles.

If the disease is aggravated by respiratory failure or cardiac dysfunction, there is a high risk of death.

Prevention of bulbar syndrome involves careful monitoring of one’s own health and timely elimination of pathologies that can cause damage to the cranial nerves. To reduce the likelihood of developing neurological pathology, it is recommended to lead an active lifestyle, eat right and give up bad habits.

Differences between bulbar and pseudobulbar dysarthria

These two forms of speech disorders have many similarities. But there are signs that will help distinguish bulbar dysarthria from pseudobulbar:

in the bulbar form of dysarthria, the paralysis is peripheral, in the pseudobulbar form - central;
with the first type of defect, both voluntary and involuntary movements are impaired, with the second - only voluntary;
characteristic of bulbar dysarthria is the extensiveness of motor impairments, pseudobulbar dysarthria is characterized by limited and selective pathology (complex articulatory movements suffer);
with a bulbar lesion, the pronunciation of vowels is closer to a neutral sound, with a pseudobulbar lesion - it is moved back;
deafening of vowels and voiced consonants, characteristic of the bulbar form of dysarthria. In addition to this, voicing occurs in the second type of disease.

Etiology

The etiopathogenetic factors of paralysis are very diverse: impaired blood supply to the brain, head injury, acute infections, neoplasms, swelling of brain tissue, inflammation, exposure to neurotoxins.

Bulbar syndrome is a manifestation of various mental and somatic diseases, which, based on their origin, can be divided into the following groups:

genetic - acute intermittent porphyria, Kennedy's disease, Chiari malformation, paroxysmal myoplegia;
vascular - ischemic and hemorrhagic stroke of the brain, hypertensive crisis, thrombosis of the venous sinuses, dyscirculatory encephalopathy;
degenerative - syringobulbia, Guillain-Barré syndrome, myasthenia gravis, dystrophic myotonia, Alzheimer's disease;
infectious – encephalitis, tick-borne borreliosis, polio, neurosyphilis, Lyme disease, diphtheria polyneuropathy, botulism, meningitis, encephalitis;
oncological – cerebellar tumors, gliomas, ependymomas, tuberculomas, cysts;
demyelinating – multiple sclerosis;
endocrine - hyperthyroidism;
traumatic – fractures of the base of the skull.

Factors provoking the development of the syndrome:

abuse of salty foods,
frequent inclusion of high-carbohydrate and fatty foods and dishes in the diet,
chronic stress, frequent conflict situations,
excessive physical stress.

Diagnosis of bulbar dysarthria in children

The bulbar form of dysarthria is diagnosed on the basis of a neurological, speech therapy examination and data from instrumental research methods.

The stages are:

A neurological examination can reveal the localization of bulbar dysarthria and its symptoms (dysphonia and dysphagia), as well as other signs of a neurological disease (facial asymmetry, tongue deviation, muscle atrophy, decreased reflexes). The doctor assesses the prevalence of the pathological process, makes an accurate diagnosis and determines the severity. At this stage, it is important to study the medical history: the course of pregnancy and childbirth, features of early development, previous diseases and injuries;
Examination by a speech therapist - assessment of voice, speed, rhythm of speech, mobility and coordination of articulatory muscles, the state of facial muscles and breathing. The specialist identifies the characteristics of bulbar dysarthria and determines treatment tactics;
CT, MRI, electroencephalography, ultrasound, Dopplerography provide information about vascular disorders, organic pathology, space-occupying formations, inflammatory process, degenerative pathology;
Lumbar puncture is needed to identify the causative agent, therefore it is performed if the infectious-inflammatory nature of the pathology is suspected.

If necessary, the child may be referred for additional research methods and for consultation with other doctors.

Doctors are faced with the task of differentiating the bulbar form of dysarthria from pseudobulbar syndrome, which is caused by damage to the corticobulbar tracts. It is also necessary to exclude motor, acoustic-mnestic and dynamic aphasia.

Clinical picture

Pseudobulbar syndrome is characterized by the same triad of symptoms as bulbar syndrome - dysarthria, dysphonia, dysphagia. As with bulbar palsy, the cause of these manifestations is a violation of the innervation of the muscles of the pharynx, soft palate, tongue, and vocal cords.

With pseudobulbar syndrome, there is a more uniform severity of paresis of muscles, the innervation of which is provided by the cranial nerves of the caudal (bulbar) group, than with bulbar syndrome. Paresis is central (spastic) in nature. At the same time, muscle tone increases, and the disorder of differentiated voluntary movements is especially pronounced. Atrophy of the lip muscles and loss of the pharyngeal and palatal reflexes, the arcs of which close in the medulla oblongata, are not observed. At the same time, with pseudobulbar syndrome, the reflex from the lower jaw usually increases and reflexes of oral automatism appear.

Pseudobulbar palsy is characterized by the presence of violent crying, less often laughter. Patients may cry or laugh for any reason. Involuntary crying in a patient with pseudobulbar palsy can occur when baring teeth, holding a piece of paper across the lips, etc.

Often, pseudobulbar palsy can be combined with signs of central tetraparesis, due to the involvement of the pyramidal tracts in the pathological process.

With pseudobulbar palsy, unlike bulbar palsy, there are no disorders of the respiratory and cardiovascular systems, since the pathological process does not affect the vital centers, developing above the medulla oblongata.

Oral automaticity reflexes

The mandibular or mandibular reflex (Bechterew's) is caused by tapping the chin with a hammer or a spatula placed on the lower teeth with the mouth slightly open. The reflex is deep, periosteal. The response is a contraction of the masticatory muscles, causing the jaws to close (raising the lower jaw). Reflex arc

: sensory fibers of the mandibular nerve (third branch of the trigeminal nerve → sensory nucleus of the trigeminal nerve → its motor nucleus in the pons → motor fibers of the same third branch of the trigeminal nerve. The reflex is not very constant normally and increases sharply with pseudobulbar palsy.

Reflexes of oral automatism include numerous reflexes, the response of which is the stretching of the lips forward (sucking or kissing movement of the lips). They are caused by touching the lips, tapping with a hammer on the upper lip or around the mouth in the area of the orbicularis oris muscle (lat. m.orbicularis oris) - proboscis reflex

, and even when the hammer approaches the lips -
Korchikyan’s distance-oral reflex
.
The same response can occur when tapping the back of the nose with a hammer ( Astvatsaturov’s naso-labial reflex
).
The palmar-chin reflex Marinescu-Radovic
is also adjacent to the symptoms of oral automatism .
It is caused by streak irritation of the skin in the area of the eminence of the palmar surface of the thumb. The response - contraction of the mental muscle - is usually noted on the same side. Sometimes, with pseudobulbar paralysis, a “bulldog” reflex is caused ( Yanyshevsky’s symptom
) - convulsive clenching of the jaws in response to irritation with a spatula of the lips, gums or hard palate.

Treatment and correction of bulbar dysarthria in children

Treatment of the pathology is complex, aimed at the cause, as well as the symptoms of bulbar dysarthria. Treatment of neurological diseases and speech disorders is carried out, which is consolidated by a rehabilitation program.

Neurological help is to eliminate the cause of the disorders. If an infectious-inflammatory process occurs, antibacterial or antiviral drugs and infusion therapy are used. In case of space-occupying formations, surgery followed by a rehabilitation program is indicated.

It is also necessary to restore brain cells. Neurometabolic therapy is used for this: nootropics, neuroprotectors, vitamins.

Speech therapy assistance is aimed at eliminating the external characteristics of bulbar dysarthria. A speech therapist helps develop articulatory muscles, get rid of speech defects, establish the correct pronunciation of sounds, and make speech smooth and expressive. Massage, exercises, and breathing exercises are used. Let us remind you that the effect of speech therapy will be zero if the cause is not eliminated.

The rehabilitation program is carried out through general massage, physiotherapist, physical therapy, swimming. You may need help from a psychologist.

Parents should be aware that treatment is usually long-term: it may take more than one month until speech returns to normal. Therefore, you need to be patient and persistent.

Classification

Bulbar palsy is classified into three main types:

acute paralysis, developing rapidly against the background of some catastrophe in the brain: infectious lesion or acute circulatory disorder;
progressive paralysis, which is a natural component of degenerative diseases of the nervous system;
alternating syndrome, in which damage to the bulbar nuclei is combined with damage to the muscles of half the body.
Bulbar syndrome can be acute and progressive

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