RU2315637C1 - Method for treating children for perinatal central nervous system injuries by applying pulsating reversing magnetic therapy approach - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying magnetophoresis with reversing progressive magnetic field from ATOS apparatus operation at modulation frequency of 10 Hz. Matched radiators and drugs are distributed over suboccipital and lumbar regions. 2% glutamic acid solution is used in suboccipital region. 2% magnesium sulfate solution is used in lumbar region. Treatment time is equal to 5 min in the first procedure gradually increasing treatment duration by 1 min every day reaching 10 min to the fifth procedure with gradual exposure time reduction by 1 min in the following period. The total treatment course is 8-10 procedures long.

EFFECT: improved mental and speech development features.

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Description

The invention relates to medicine and relates to the treatment of children with perinatal damage to the central nervous system.

Cerebral palsy (cerebral palsy) remains one of the most serious diseases of the nervous system in children. According to Skvortsova I.A. and Osipenko T.N. (1993), in the structure of neurological disability, cerebral palsy accounts for 24%. The prevalence of cerebral palsy in various regions of Russia is from 2.5-5.6 to 8.9 per 1000 children (Zykov V.P., Shadrin V.N., Komarova I.B., 2003). The term “cerebral palsy” combines syndromes that occur as a result of damage and (or) underdevelopment of brain structures in the early stages of ontogenesis and manifested by the inability to maintain a normal posture and perform arbitrary movements (Badalyan L.O., Zhurba L.T., Timonina O. B., 1988). Motor disorders in children with cerebral palsy, as a rule, are accompanied by impaired development of intellectual-speech and perceptual functions (Evtushenko S.K., Luneva A.G., 1993).

In the treatment of neurological pathology, magnetotherapy is widely used. A running reversible magnetic field (BeMP) provides the maximum set of biotropic parameters, activates metabolic processes, improves the axon conductivity of ganglion cells, and normalizes blood and lymph circulation.

A known method of treating children with cerebral palsy using a running reversible magnetic field from the apparatus "ATOS" with a modulation frequency of 1.5 Hz and a magnetic induction of 35 MT (Babina L.M., Kraslyanskaya G.V., Babina L.M., Ponomareva S .O., Vartanova AG The influence of the course of magnetotherapy on clinical and electromyographic indices in young children with cerebral palsy // Abstract of the scientific-practical conference "Modern non-drug methods of treatment and prevention of diseases." - Samara - 2005. - S.186-188). The procedures were assigned to the lumbar region and lower legs: one of the emitters was superimposed on the lumbar region, the second on the lower leg of one leg, the exposure time was 5-6 minutes, then the second radiator was transferred to the lower leg, and the procedure continued for another 5-6 minutes. The duration of the entire procedure is 10-12 minutes, for a course of 8-10 procedures.

Under the influence of the therapy, a positive dynamics was observed in the general condition of children and an increase in the amplitude of oscillations during the electromyographic study of all the muscles studied, but mainly of the lower limbs.

The closest in technical essence to the proposed method is a method of treating patients with cerebral palsy using a running reversing magnetic field from the ATOS apparatus (Gurova N.Yu., Babina L.M. Neurophysiological parameters assessment according to the results of EMG and REG in children with spastic forms of cerebral palsy after exposure to a pulsed magnetic field // Abstract of the international scientific-practical conference "Natural and preformed physical factors in reducing copper ine "- Perm - 2005. - S.186-187) by the following procedure:.. Emitters installed contact, in a longitudinal arrangement, perpendicular to the backbone, in the lumbar region, and suboccipital magnetic induction 35 mT, frequency 10 Hz, pulse mode. The exposure time is 5 minutes in the first procedure with a gradual increase in exposure time by 1 minute daily to 10 minutes by 5 procedures followed by a gradual decrease in exposure time by 1 minute, 8-10 procedures per course.

This technique had a positive effect not only on the bioelectrogenesis of the muscles of the lower extremities, but also of the upper ones, improving the manipulative function in the hands, as well as cerebral hemodynamics. The disadvantage was that when the vast majority of patients had delayed psycho-speech development, there was no positive effect on this indicator.

Considering that a pulsed magnetic field affects the tissues of the body not only through dia- and paramagnetic effects (characteristic of a constant magnetic field), but also through the electric currents generated by it when interacting with an alternating electric field, which occurs with any change in the magnetic field, we calculated it is advisable to use this property of a traveling reversible magnetic field for the administration of drugs that enhance the therapeutic effect in this pathology.

The technical result of the proposed method is to improve the indicators of psycho-speech development and cerebral hemodynamics due to the regulatory nootropic effect of glutamic acid introduced by phoresis.

The specified technical result is achieved by conducting magnetophoresis with a reversing traveling magnetic field with a modulation frequency of 10 Hz with the arrangement of paired emitters and drugs, with a 2% solution of glutamic acid being used on the suboccipital region and a 2% solution of magnesium sulfate on the lumbar region, time exposure is 5 minutes in the first procedure with a gradual increase in exposure time by 1 minute daily to 10 minutes by the 5th procedure, followed by a gradual decrease in exposure time uu 1 minute daily for the course 8-10 procedures.

Acting in a pulsed mode with a modulation frequency of 10 Hz close to the α-rhythm of bioelectrogenesis of the brain, the most pronounced reaction is assumed to be from the regulating substances of the central nervous system (hypothalamus - cerebral cortex - hippocampus - reticular formation of the midbrain), thus defining information - the modulating nature of the effect on the nervous system, which is significant for this pathology in the context of complex rehabilitation therapy, requiring an adequate regulatory factor.

The choice of the above drugs was determined by their biological effect and targeted effect on the condition of patients with this pathology. So glutamic acid, stimulating oxidative processes, improves metabolism in the brain and muscle tissue, and contributing to the synthesis of acetylcholine and ATP, improves transmission of excitation in the synapses of the central nervous system (CNS).

Magnesium sulfate has a vasodilating and antispastic effect. Actually, magnesium ions, whose activity increases under the influence of a magnetic field, exerting a stabilizing effect on neuronal membranes and supporting axonal transport, improve neuromuscular conduction.

The method is as follows: the child is placed on a couch, a pad with a 2% solution of glutamic acid is applied to the suboccipital region, then a layer of oilcloth is applied onto which one of the radiators placed transversely to the spine is contacted; the second emitter is superimposed on the lumbar region, also on the oilcloth applied over the pad with a 2% solution of magnesium sulfate. They turn on the device: on the panel of the ATOS device, the modulation frequency is set at 10 Hz and the “mode” is in the “PER” position, while magnetic induction reaches a power of 33 mT. The exposure time of 5 minutes in the first procedure with a gradual increase in exposure time by 1 minute daily, up to 10 minutes to the 5th procedure, followed by a gradual decrease in exposure time by 1 minute, daily. The course of treatment is 8-10 procedures.

The method is illustrated by the following example.

Patient Amina B., 1 year 11 months, (medical history No. 1986), was admitted to the neuropsychiatric department of the clinic GNIIK 10/18/05. Complaints about the inability to stand and move independently.

A child from the 2nd pregnancy, which proceeded with the threat of interruption from an early date (the 1st ended in spontaneous miscarriage). Childbirth at 26 weeks, against the background of placental abruption. Born with a mass of 1650 g, she screamed immediately, but weakly. For 20 days was in the intensive care unit of newborns on mechanical ventilation. Discharged from the second stage of nursing of premature babies. Early development with a lag: keeps his head from 4 months, sits from 1 year. The diagnosis of cerebral palsy (cerebral palsy) was made at 1 year 10 months. It was treated on an outpatient basis.

On examination: No changes on the part of internal organs. In neurological status: FMN - slight convergent squint. Do not stand alone, do not walk. Reliance on socks, with a cross in the lower third of the legs. Restriction of the range of active movements in the lower extremities and dilutions in the hip joints, unfixed contractures of the ankle joints. The feet are flat. Manipulative function is also reduced, but to a lesser extent. SZHR from the lower extremities high, D = S. Pathological reflexes of Babinsky, Nonne on both sides. Sensitivity is not impaired. He understands conversations, speaks separate words. On the electroencephalogram (EEG) - the dominant beta rhythm of high amplitude low frequency. Sharp waves. With photostimulation, paroxysmal activity is recorded. On the electromyogram (EMG) - the amplitude of the oscillations of the extensors of the hand 128 μV, flexors 100 μV, the anterior tibial muscle 149 μV, gastrocnemius 144 μV. On rheoencephalography (REG) - venous outflow is difficult, peripheral vascular resistance is increased, indirect signs of the presence of intracranial hypertension.

The clinical diagnosis is cerebral palsy. Spastic diplegia of moderate severity. Delay in psycho-speech development, dysarthria.

Comprehensive treatment was carried out, including massage, exercise therapy, speech therapist exercises and course physiotherapy treatment - magnetophoresis with a running reversing magnetic field from the ATOS apparatus from paired radiators, 2% glutamic acid solution on the suboccipital region and 2% sulfate solution magnesium on the lumbar region. 8 treatments per course.

The child's treatment tolerance was good.

After the course of treatment, the condition improved. The muscle tone of the lower extremities decreased, the foot began to lower to the heel, and the support improved. Strength in the hands increased, manipulative function improved, began to hold a spoon. The vocabulary has increased.

On EMG, the amplitude of oscillations in the flexors of the hand increased by 48 μV, (100-148 μV), in the extensors - 86 μV (128-214 μV), in the calf - 16 μV (144-161 μV), and the anterior tibial - 66 μV (149 -215 μV).

The EEG is dominated by an alpha rhythm with pointed waves. Paroxysmal activity during photostimulation is maintained.

On REG, the spasm of peripheral vessels decreased slightly, venous outflow from the cranial cavity improved.

Based on clinical and electrophysiological indicators, we rated the treatment results as a significant improvement.

The proposed method of treatment was tested on a group of children: the main group - 20 people, 20 children - a control group.

Both groups of patients were clinically equivalent (Table 1.).

Characterization of clinical forms of cerebral palsy and correlation according to severity in the studied groups

Table 1 Clinical forms Main group Control group amount Percent amount Percent Spastic tetraparesis four twenty 5 25 Spastic diplegia fourteen 70 12 60 Spastic hemiparesis 2 10 3 fifteen Severity: Heavy 10 fifty 8 40 Moderate 8 40 9 45 light 2 10 3 fifteen Age: 1-3 years 13 65 fourteen 70 5-7 years old 7 35 6 thirty Gender: Boy 10 fifty eleven 55 girl 10 fifty 9 45

Among the patients of the main group, five did not hold their heads confidently in an upright position, 13 did not sit without support, 14 did not stand and did not walk, clonuses and clonoids were called in 13 children. Manipulative function was grossly impaired in 10 and partially in eight people, psycho-speech development retardation in 17, while speech was absent in four, gross dysarthria was detected in seven, dyslalia in 6 children. Epiparoxysms in the anamnesis in two.

Of the observed patients in the control group, six did not hold their heads steady, eight did not sit on their own, 13 children could not walk on their own. Clonuses were caused in nine people. Manual motor skills were impaired in 16 children. Delay in psycho-speech development was observed in 18 children, speech was absent in eight, severe dysarthria was observed in six, dyslalia in four children.

All patients underwent treatment, including a sanatorium regime, a balanced diet, physiotherapy exercises, massage, and a speech therapist. In addition, the children of the main group received physiotherapeutic procedures according to the proposed method of administering medicinal solutions by means of magnetophoresis from the ATOS apparatus, and in the control group, magnetotherapy from the ATOS apparatus by the same method of laying inductors, but without the use of medicinal solutions. The number of procedures is from 8 to 10 per course, depending on the age of the child (up to three years, 8 procedures were prescribed, older than 10).

Under the influence of treatment, changes in the clinical status were noted in the main group (see Table 2): two out of five children (40%) improved the function of keeping their head upright, four began to sit with little support (37.5%), this 1 (20%) - on their own, 2 children were able to stand up, holding on to the support (33.33%), 1 - on their own (12.5%), 2 (28.57%) learned to walk, holding on to one hand. Clonuses were preserved in 6 children (46.15%). Manipulative function improved in 8 children (40%), attention in 4 (20%), vocabulary expanded - 3 people (15%), positive dynamics in the emotional-volitional sphere in 5 children (25%).

The emergence of new functional capabilities was facilitated by a decrease in the initially increased muscle tone and an increase in muscle strength. In patients of the control group, the positive changes were slightly lower: only one (11.11%) began to walk with support, and manual motility improved only in three children (16.67%), clonuses persisted in 7 (77.77%). Comparative dynamics are presented in table 2

The dynamics of clinical indicators

table 2 Clinical sign Patient groups Main group Control group quantity percent quantity percent Began to hold his head 2 out of 5 40 1 from 6 16.67 Steel with support: sit 3 out of 8 37.5 1 from 4 25 to stand 2 out of 6 33.33 1 from 7 14.29 to walk 2 from 7 28.57 1 from 9 11.11 Independently: sit 1 out of 5 twenty 0 of 4 0 to stand 1 from 8 12.5 0 out of 6 0 to walk 0 of 7 0 0 of 4 0 The presence of clonuses 6 from 13 46.15 7 out of 9 77.78 Improvement: hand motility 8 from 18 44,44 3 from 16 18.75 speech 4 from 17 23.53 2 from 18 11.11

The study of electromyographic indicators revealed a significant increase in the amplitude of the oscillations during the movement of the muscles of the hand and lower leg. By the end of the course of treatment, the oscillation amplitude in the main group significantly increased compared to the initial value in the muscles of the hand by 24.41%, in the calf muscle by 26.92%, in the anterior tibial by 37.64%, increasing on average by no less than 40.0 μV. In the control group, bioelectrogenesis in the muscles of the hand improved by 15.68%, in the muscles of the lower leg by 19.48%, increasing by an average of 30.0 μV. The results are presented in table.3.

EMG Oscillation Amplitude Dynamics

Table 3 Indicators Dynamics of indicators Main group Control group R Before treatment M ± m After treatment, M ± m Before treatment M ± m After treatment, M ± m m.flexor carpi 163.65 ± 6.89 204.3 ± 8.52 187 ± 12.08 223 ± 10.89 <0.05 m.extensor carpi 166.61 ± 8.54 206.54 ± 9.49 184 ± 9.8 205 ± 8.45 <0.05 m.gastrocnemius 132.11 ± 5.04 167.67 ± 7.27 148 ± b, 56 177 ± 10.12 <0.05 m.tibialis 134.76 ± 5.37 185.48 ± 6.54 161 ± 8.28 191 ± 9.13 <0.05

Analyzing the main parameters of the bioelectric activity of the brain, we found a decrease in the number of EEG with the presence of pathological elements. Paroxysms of slow waves before treatment were recorded on the EEG in 16 (80%) patients, after treatment, the number of such patients decreased to 9 (45%), sharp waves were noted before treatment in 18 (90%), and after treatment in 14 (70%) children. Significantly positive trend in the differentiation of the leading rhythm: before treatment, the leading alpha rhythm was on the EEG in 4 children (20%), after treatment - 10 (50%). The following dynamics of indicators was observed in the control group: paroxysmal activity was recorded on EEG in 14 (70%) patients before treatment, after treatment the number of such patients decreased to 2 (10%), sharp waves and adhesions were observed before treatment in 14 (70%), and after treatment in 10 (50%) children, with no clear positive dynamics in the differentiation of the leading rhythm.

Changes in cerebral hemodynamics are as follows: the index of venous outflow (IVO) increased by 33.31%, which is 10.86% more than in the control group, the rate of propagation of the early pulse wave, which characterizes the elastic properties of blood vessels, underwent an equal positive dynamics by 10 -12%. Increased peripheral vascular resistance (PPSS) in the main group decreased by 15%, while in the control group by 10%. Thus, in the compared groups, significant positive dynamics are noted: there is an increase in blood flow to the brain against the background of an improvement in the elastic properties of blood vessels, an improvement in venous outflow due to a decrease in spasm and normalization of vascular tone is also recorded, the latter being more pronounced in the main group. Comparative dynamics of rheographic indicators are presented in table 4

The dynamics of the rheographic parameters of cerebral vessels

Table 4 Indicators Dynamics of indicators R Main group R Control group Before treatment M ± m After treatment, M ± m Before treatment M ± m After treatment, M ± m Rheographic
RI index (OM) is initially below normal) 0.126 ± 0.004 0.167 ± 0.007 <0.05 0.127 ± 0.003 0.166 ± 0.006 <0.05 Venous outflow index (%) IVO (initially above normal) 45.96 ± 1.12 30.65 ± 0.97 <0.05 49 ± 2.53 38 ± 2.46 Peripheral
vascular vascular resistance PPSS (%): - below normal 61.27 ± 0.98 77.8 ± 1.17 <0.05 58 ± 1,59 70 ± 1.92 <0.05 - above the norm 96.91 ± 1.19 81.55 ± 0.78 <0.05 100 ± 1.53 90 ± 1,71 <0.05 The propagation time of the early pulse wave RVRV (ms): - below normal 87.88 ± 1.02 104.61 ± 1.63 <0.05 97 ± 0.86 109 ± 3.04 <0.05 - above the norm 132.31 ± 2.23 118.5 ± 2.27 <0.05 136 ± 1.84 119 ± 2.79 <0.05

After analyzing the clinical and functional state of patients after treatment in both groups, we ascertained the following results (Table 5).

The results of treatment of patients with cerebral palsy under the influence of treatment

Table 5 Indicators Patient groups Main Control R amount Percent amount Percent Significant improvement 5 35 2 10 <0.05 Improvement eleven 55 9 45 Slight improvement four twenty 9 45 No improvement - - - -

The data obtained indicate a more pronounced positive effect of magnetophoresis of 2% glutamic acid and 2% magnesium sulfate, introduced by means of a traveling reversing magnetic field from the ATOS apparatus according to the proposed technique in complex treatment with exercise therapy, massage and a speech therapist on clinical, neurophysiological and hemodynamic indicators in children with spastic forms of cerebral palsy, which we associate with an increase in the biological effect of a traveling reversing magnetic field on metabolic processes, neuromuscular transmission and regional blood circulation with targeted medicinal substances, additionally enhancing the nootropic (glutamic acid) and neuroprotective effects (magnesium sulfate).

This method is more effective in the treatment of children with cerebral palsy and can be recommended for use in the complex treatment of children with spastic forms of cerebral palsy both in spa conditions and in the inpatient phase of rehabilitation therapy.

Claims (1)

A method of treating children with perinatal damage to the central nervous system, including the effect of a reversible traveling magnetic field from the ATOS apparatus, characterized in that the magnetophoresis is performed by a reversible traveling magnetic field with a modulation frequency of 10 Hz with the location of paired emitters and drugs, while using 2 suboccipital areas % glutamic acid solution, and on the lumbar region a 2% magnesium sulfate solution, the exposure time is 5 minutes during the first procedure, with a gradual increase in the exposure time Twist for 1 min daily to 10 min by the 5th procedure, followed by a gradual decrease in exposure time by 1 min daily, for a course of 8-10 procedures.