MD29Y - Method for treating the chronic cephalic and facial pains associated with the functional disorders of trigeminal complex - Google Patents
Method for treating the chronic cephalic and facial pains associated with the functional disorders of trigeminal complex Download PDFInfo
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- 206010016059 Facial pain Diseases 0.000 title claims abstract description 10
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 title claims abstract description 7
- 208000035475 disorder Diseases 0.000 title claims abstract description 7
- 230000001684 chronic effect Effects 0.000 title 1
- 238000011282 treatment Methods 0.000 claims abstract description 23
- 210000003901 trigeminal nerve Anatomy 0.000 claims abstract description 17
- 206010019233 Headaches Diseases 0.000 claims abstract description 13
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- 208000004454 Hyperalgesia Diseases 0.000 claims abstract description 10
- 206010053552 allodynia Diseases 0.000 claims abstract description 10
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Abstract
Inventia se refera la medicina, si anume la neurologie, si este destinata pentru tratamentul cefaleelor cronice si durerilor faciale asociate cu dereglari functionale ale complexului trigeminal. Metoda, conform inventiei, consta in aceea ca preliminar se evidentiaza gradul de sensitizare a neuronilor nucleului senzitiv al nervului trigemen si se determina acea parte a lui, la care nivelul sensitizarii este mai inalt. Apoi, ipsilateral partii depistate, in regiunea inervatiei de catre nervul trigemen a pavilionului auricular si a conductului auditiv extern se determina zonele de alodinie statica, pe care se aplica si se fixeaza niste bile metalice sau seminte de plante. Se efectueaza electrostimularea transcraniana a structurilor endorfine ale creierului pe parcursul a 30 min, concomitent pacientul de sine statator efectueaza presopunctura auriculara a zonelor determinate, care, de asemenea, este repetata pe parcursul intregii zile, timp de cateva minute la un interval de 2...3 ore sau la intensificarea durerilor de cap si/sau faciale. Seria de tratament constituie 10...14 sedinte.The invention relates to medicine, namely neurology, and is intended for the treatment of chronic headaches and facial pain associated with functional disorders of the trigeminal complex. The method, according to the invention, consists in the preliminary highlighting the degree of sensitization of the neurons of the sensory nucleus of the trigeminal nerve and determining that part of it, at which the level of sensitization is higher. Then, ipsilateral to the detected part, in the region of the innervation by the trigeminal nerve of the auricle and of the external auditory conduit, the zones of static allodynia are determined, on which some metallic balls or seeds of plants are applied and fixed. Transcranial electrostimulation of the endorphin structures of the brain is performed during 30 minutes, concomitantly the patient stands alone the auricular pre-puncture of the determined areas, which is also repeated throughout the day, for several minutes at an interval of 2. .3 hours or at the intensification of head and / or facial pain. The treatment series consists of 10 to 14 sessions.
Description
Invenţia se referă la medicină, şi anume la neurologie, şi este destinată pentru tratamentul cefaleelor cronice şi durerilor faciale asociate cu dereglări funcţionale ale complexului trigeminal. The invention relates to medicine, namely to neurology, and is intended for the treatment of chronic headaches and facial pain associated with functional disorders of the trigeminal complex.
Este cunoscută metoda de tratament al cefaleelor cronice asociate cu dereglări funcţionale ale complexului trigeminal, care include 10 şedinţe de electrostimulare transcraniană a structurilor cerebrale peptidergice (endorfine) ale creierului, zilnic, câte 30 min. Prima şedinţă se începe cu o valoare medie a curentului de stimulare de 1,0...1,5 mA, apoi puterea curentului se măreşte până la 3,0 mA, în funcţie de toleranţa individuală a pacienţilor şi de manifestările efectului clinic. La baza acestei metode este activarea structurilor endorfine ale creierului, în urma cărui fapt se dezvoltă efectele centrale şi periferice, care apar datorită acţiunii polifuncţionale a neuropeptidelor. În acest caz acţiunea analgezică se realizează indiferent de localizarea şi geneza focarului de impulsuri dureroase [1]. There is a known method of treatment of chronic headaches associated with functional disorders of the trigeminal complex, which includes 10 sessions of transcranial electrostimulation of the peptidergic (endorphin) structures of the brain, daily, for 30 min. The first session begins with an average value of the stimulation current of 1.0...1.5 mA, then the current strength is increased to 3.0 mA, depending on the individual tolerance of patients and the manifestations of the clinical effect. The basis of this method is the activation of the endorphin structures of the brain, as a result of which central and peripheral effects develop, which occur due to the polyfunctional action of neuropeptides. In this case, the analgesic action is achieved regardless of the localization and genesis of the focus of painful impulses [1].
Însă la utilizarea acestei metode de tratament al cefaleelor cronice şi durerilor faciale asociate cu dereglări funcţionale ale complexului trigeminal deseori efectul tratamentului nu este satisfăcător, deoarece nervul trigemen posedă multiple legături neuronale aferente şi eferente cu diverse structuri ale creierului, inclusiv formaţia reticulară. Ţinând cont de particularităţile anatomo-funcţionale ale complexului trigeminal, în disfuncţia lui apare un sindrom dureros cronic deosebit de rezistent, care manifestă un polimorfism clinic. However, when using this method of treatment of chronic headaches and facial pain associated with functional disorders of the trigeminal complex, the effect of the treatment is often not satisfactory, because the trigeminal nerve has multiple afferent and efferent neuronal connections with various brain structures, including the reticular formation. Taking into account the anatomical and functional peculiarities of the trigeminal complex, in its dysfunction a particularly resistant chronic pain syndrome appears, which manifests clinical polymorphism.
Problema pe care o rezolvă invenţia propusă este sporirea eficienţei tratamentului. The problem that the proposed invention solves is increasing the efficiency of treatment.
Problema se soluţionează prin aceea că preliminar se evidenţiază gradul de sensitizare a neuronilor nucleului senzitiv al nervului trigemen şi se determină acea parte a lui, la care nivelul sensitizării este mai înalt. Apoi, ipsilateral părţii depistate, în regiunea inervaţiei de către nervul trigemen a pavilionului auricular şi a conductului auditiv extern se determină zonele de alodinie statică, pe care se aplică şi se fixează nişte bile metalice sau seminţe de plante. Se efectuează electrostimularea transcraniană a structurilor endorfine ale creierului pe parcursul a 30 min, concomitent pacientul de sine stătător efectuează presopunctura auriculară a zonelor determinate, care, de asemenea, este repetată pe parcursul întregii zile, timp de câteva minute la un interval de 2...3 ore sau la intensificarea durerilor de cap şi/sau faciale. Seria de tratament constituie 10...14 şedinţe. The problem is solved by first highlighting the degree of sensitization of the neurons of the sensory nucleus of the trigeminal nerve and determining that part of it, where the level of sensitization is higher. Then, ipsilateral to the detected part, in the region of innervation by the trigeminal nerve of the auricular pinna and the external auditory canal, the areas of static allodynia are determined, on which some metal balls or plant seeds are applied and fixed. Transcranial electrostimulation of the endorphin structures of the brain is performed for 30 min, at the same time the patient independently performs auricular acupressure of the determined areas, which is also repeated throughout the day, for several minutes at an interval of 2...3 hours or when the headaches and/or facial pains intensify. The treatment series consists of 10...14 sessions.
Stabilirea părţii mai afectate (stângă sau dreaptă) a nucleului senzitiv al nervului trigemen permite de a determina pavilionul drept sau stâng şi conductul auditiv extern respectiv, unde acţiunea asupra zonelor de alodinie statică în regiunea enervaţiei de către nervul trigemen permite maximal de a acţiona asupra stării funcţionale a nucleului senzitiv al nervului trigemen. Fixarea bilelor metalice sau a seminţelor de plante în aceste zone permite de a realiza acţiunea în orice timp pe măsura apariţiei necesităţii. Combinarea stimulării transcraniene a structurilor endorfine ale creierului, în timpul căreia se elimină neuropeptide, ce posedă acţiune analgezică generală, cu autostimularea zonelor de alodinie statică ale pavilioanelor auriculare, ce acţionează asupra stării funcţionale a nucleului senzitiv al nervului trigemen, permite jugularea eficientă a accesului de cefalee. Totodată, îmbinarea acţiunii stimulării transcraniene a structurilor endorfine ale creierului şi autostimulării zonelor de alodinie statică ale pavilioanelor auriculare contribuie la formarea unei interacţiuni funcţionale dintre căile aferente trigeminale şi structurile cerebrale care elimină neuropeptide, ce duce în cele din urmă la aceea că în timpul autostimulării pavilioanelor auriculare are loc şi o activare funcţională a structurilor endorfine ale creierului. Determining the most affected side (left or right) of the sensitive nucleus of the trigeminal nerve allows to determine the right or left pinna and the external auditory canal, respectively, where the action on the zones of static allodynia in the region of innervation by the trigeminal nerve allows to maximally act on the functional state of the sensitive nucleus of the trigeminal nerve. Fixing metal balls or plant seeds in these areas allows to carry out the action at any time as the need arises. The combination of transcranial stimulation of the endorphin structures of the brain, during which neuropeptides are released, which have a general analgesic effect, with self-stimulation of the zones of static allodynia of the auricular pinna, which act on the functional state of the sensitive nucleus of the trigeminal nerve, allows to effectively suppress the headache attack. At the same time, the combination of the action of transcranial stimulation of the endorphin structures of the brain and self-stimulation of the static allodynia areas of the auricular pavilions contributes to the formation of a functional interaction between the trigeminal afferent pathways and the brain structures that eliminate neuropeptides, which ultimately leads to the fact that during self-stimulation of the auricular pavilions, a functional activation of the endorphin structures of the brain also takes place.
Rezultatul invenţiei este diminuarea nivelului de sensitizare a nucleului senzitiv al nervului trigemen. The result of the invention is the reduction of the level of sensitization of the sensory nucleus of the trigeminal nerve.
Avantajul metodei propuse constă în aceea că pacientul poate acţiona de sine stătător, pe măsura necesităţii, asupra stării funcţionale a nucleului senzitiv al nervului trigemen, diminuând astfel accesul de cefalee şi durerea facială. The advantage of the proposed method is that the patient can act independently, as needed, on the functional state of the sensitive nucleus of the trigeminal nerve, thus reducing headache and facial pain.
Metoda se realizează în felul următor. Pentru stabilirea gradului de sensitizare a neuronilor nucleului senzitiv al nervului trigemen se înregistrează componentele potenţialului somatosenzorial trigeminal evocat printr-o metodă cunoscută (Гнездицкий В.В. Вызванные потенциалы мозга в клинической практике. Москва, Медпресс-информ, 2003, с. 95-106). Se stabileşte partea dreaptă sau stângă, unde nivelul sensitizării nucleului senzitiv al nervului trigemen este mai înalt (respectiv perioada latentă este mai scurtă). Apoi se examinează pavilionul auricular ipsilateral cu scopul determinării zonelor de alodinie statică (senzaţie de durere la apăsarea cu o sondă) în regiunea inervaţiei pavilionului auricular de către nervul trigemen: meatul auditiv extern în părţile anterioară şi anteriosuperioară, rădăcina şi o parte a helixului, conca, tragusul, şanţul superior şi inferior al tragusului, foseta triunghiulară, antehelixul, o parte a fosetei naviculare, jumătatea superioară a lobului auricular. Zonele de alodinie evidenţiate se marchează cu un pix şi la sfârşitul cercetării pe ele se aplică bilele metalice (cu diametrul de 1...2 mm) din oţel inoxidabil sau seminţe (de păducel, chimen, mărar, ş.a.), care la începutul procedurii sunt fixate pe un emplastru. Apoi se efectuează stimularea transcraniană a structurilor endorfine (STSE) ale creierului cu utilizarea unor aparate care se produc în serie («Трансаир-01», «Ритм 99» ş.a.). Şedinţele de electrostimulare transcraniană se efectuează zilnic. Fiecare şedinţă durează 30 min. Electrozii se aplică în regiunile cutanate frontale şi bimastoidale, pacientul fiind culcat pe spate. Sub fiecare electrod se aplică câte o pernuţă, confecţionată din 10...12 straturi de flanea, care se îmbibă bine cu apă caldă. Apoi electrozii se conectează la aparat. Regimul de acţiune este asigurat de către curentul sumar pe contul componentei active şi continue. Raportul dintre curentul continuu şi cel alternativ este de 2:1. Frecvenţa impulsurilor de stimulare a curentului alternativ este constantă şi constituie 77 Hz pentru o durată a impulsului de 3...4 ms. Regimul tratamentului se stabileşte individual. La prima şedinţă se aplică o valoare minimă a curentului de stimulare de 1,0....1,5 mA. În continuare puterea curentului se măreşte până la 3 mA, ţinând cont de toleranţa individuală a pacientului şi de expresivitatea efectului clinic. The method is carried out as follows. To determine the degree of sensitization of neurons of the sensitive nucleus of the trigeminal nerve, the components of the evoked trigeminal somatosensory potential are recorded using a known method (Gnezditsky V.V. Evoked potentials of the brain in clinical practice. Moscow, Medpress-inform, 2003, pp. 95-106). The right or left side is determined, where the level of sensitization of the sensitive nucleus of the trigeminal nerve is higher (respectively, the latent period is shorter). Then the ipsilateral pinna is examined in order to determine the areas of static allodynia (painful sensation when pressed with a probe) in the region of innervation of the pinna by the trigeminal nerve: the external auditory meatus in the anterior and anterosuperior parts, the root and part of the helix, the concha, the tragus, the upper and lower grooves of the tragus, the triangular fossa, the antehelix, part of the navicular fossa, the upper half of the ear lobe. The highlighted areas of allodynia are marked with a pen and at the end of the examination, metal balls (1...2 mm in diameter) made of stainless steel or seeds (hawthorn, cumin, dill, etc.) are applied to them, which at the beginning of the procedure are fixed on a plaster. Then transcranial stimulation of endorphin structures (STSE) of the brain is performed using mass-produced devices («Трансаир-01», «Ритм 99», etc.). Transcranial electrostimulation sessions are performed daily. Each session lasts 30 minutes. Electrodes are applied to the frontal and bimastoid skin regions, with the patient lying on his back. A pad made of 10-12 layers of flannel is applied under each electrode, which is well soaked in warm water. Then the electrodes are connected to the device. The mode of action is provided by the sum current at the expense of the active and continuous component. The ratio between the direct and alternating current is 2:1. The frequency of the alternating current stimulation pulses is constant and is 77 Hz for a pulse duration of 3-4 ms. The treatment regimen is established individually. At the first session, a minimum stimulation current value of 1.0...1.5 mA is applied. Subsequently, the current strength is increased to 3 mA, taking into account the individual tolerance of the patient and the expressiveness of the clinical effect.
În corespundere cu metoda propusă autostimularea pavilioanelor auriculare cu o putere moderată timp de 30...40 s, peste fiecare 2...3 min, se efectuează concomitent cu şedinţele de electrostimulare transcraniană. Autostimularea se efectuează, de asemenea, şi la sfârşitul fiecărei proceduri de electrostimulare transcraniană pe parcursul întregii zile, în decursul a câtorva minute la un interval de 2...3 ore. Autostimularea se efectuează, de asemenea, în cazul intensificării cefaleei sau a durerilor faciale. In accordance with the proposed method, self-stimulation of the auricle with moderate power for 30...40 s, every 2...3 min, is performed simultaneously with transcranial electrostimulation sessions. Self-stimulation is also performed at the end of each transcranial electrostimulation procedure throughout the day, for a few minutes at intervals of 2...3 hours. Self-stimulation is also performed in case of intensification of headache or facial pain.
Exemplu Example
Pacientul D., s-a adresat cu acuze de cefalee. Durerile apar zilnic, de 5...7 ori pe zi şi se supun cu greu jugulării cu analgezice. S-a stabilit diagnosticul: migrenă cronică cu implicarea în procesul patologic a complexului trigeminal. A fost efectuat tratamentul conform metodei propuse. Datele perioadei latente a componentei nr. 5 a potenţialului somatosenzorial trigeminal evocat (r. maxilaris) până la tratament şi după sunt prezentate în tabelul 1. Patient D., complained of headache. The pain occurs daily, 5...7 times a day and is difficult to suppress with analgesics. The diagnosis was established: chronic migraine with involvement of the trigeminal complex in the pathological process. The treatment was carried out according to the proposed method. The data of the latent period of component no. 5 of the evoked trigeminal somatosensory potential (r. maxillaris) before and after treatment are presented in Table 1.
Tabelul 1 Table 1
Valoarea normală Până la tratament După tratament Pe stânga Devierile de la normă, % Pe dreapta Devierile de la normă, % Pe stânga Devierile de la normă, % Pe dreapta Devierile de la normă, % 5,78 ms 2,9 ms - 49,8 4,9 ms - 15,2 4,6 ms -20,4 5,2 ms - 10Normal value Before treatment After treatment On the left Deviations from the norm, % On the right Deviations from the norm, % On the left Deviations from the norm, % On the right Deviations from the norm, % 5.78 ms 2.9 ms - 49.8 4.9 ms - 15.2 4.6 ms -20.4 5.2 ms - 10
La realizarea metodei de tratament propuse esenţial se micşorează numărul zonelor de alodinie statică depistate pe pavilionul auricular în regiunea inervaţiei nervului trigemen (până la tratament se depistează 5 zone de alodinie, după tratament - o zonă). When implementing the proposed treatment method, the number of static allodynia zones detected on the auricle in the region of the trigeminal nerve innervation is significantly reduced (before treatment, 5 zones of allodynia were detected, after treatment - one zone).
Dinamica expresivităţii cefaleei până şi după tratament după datele scării analogice vizuale (SAV) la bolnavii cu migrenă cronică cu implicarea în procesul patologic a complexului trigeminal este prezentată în tabelul 2. Durerea s-a redus cu 60%. The dynamics of headache expressiveness before and after treatment according to the visual analogue scale (VAS) data in patients with chronic migraine with involvement of the trigeminal complex in the pathological process is presented in Table 2. The pain was reduced by 60%.
Tabelul 2 Table 2
SAV, % Până la tratament După tratament Diferenţa: până - după tratament 80 20 - 60SAV, % Before treatment After treatment Difference: before - after treatment 80 20 - 60
La utilizarea chestionarului McGill Pain Questionnaire sensibil la modificarea intensităţii durerii, s-a stabilit că aplicarea metodei propuse permite de a micşora esenţial atât componentele senzoriale, cât şi cele afective (psihoemoţionale) ale durerii (tab. 3). When using the McGill Pain Questionnaire, which is sensitive to changes in pain intensity, it was established that the application of the proposed method allows for a significant reduction in both the sensory and affective (psychoemotional) components of pain (Table 3).
Tabelul 3 Table 3
Până la tratament, puncte După tratament, puncte Componenta senzorială a durerii Componenta afectivă a durerii Punctajul total al durerii Componenta senzorială a durerii Componenta afectivă a durerii Punctajul total al durerii 22 9 31 10 3 13Before treatment, points After treatment, points Sensory component of pain Affective component of pain Total pain score Sensory component of pain Affective component of pain Total pain score 22 9 31 10 3 13
Курушина О.В. Коррекция алгических проявлений и психовегетативных нарушений у женщин с пременструальным синдромом, автореферат на соискание ученой степени кандидата медицинских наук. Волгоград, 2004, с. 8-9 Kurushina O.V. Correction of allergic manifestations and psychovegetative disorders in women with premenstrual syndrome, abstract for the competition of the academic degree of the candidate of medical sciences. Volgograd, 2004, с. 8-9
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