RU158827U1 - DEVICE FOR RESTORING AXON-DENDRITIC LINKS - Google Patents

Abstract

A device for reconstructing axon-dendritic connections, comprising a control unit and a current stimulator unit, including a first microcontroller, the output of which is connected to the input of a digital-to-analog converter, the output of which is in turn connected to the input of a current stimulator, equipped with electrodes, and the output of the current stimulator is connected to the input a stimulus current meter, the output of which is connected to the input of the first microcontroller, while the control unit contains a galvanic isolation device azovatel voltage, a second microcontroller, the power supply from the USB-connector, and the device is adapted to contactless data communication with the computer providing device management, processing and displaying information.

Description

The proposed utility model relates to medicine and can be used to treat paralysis in cerebral palsy (cerebral palsy) with delays in psycho-speech development in children, after a stroke, spinal cord and brain injuries.

Currently, there are many proposals for the treatment of motor disorders in cerebral palsy. They can be divided into several groups:

1. Various types of massage and physiotherapy exercises: techniques of Bobat, Lindenman, Frelikh, Voight, Cabot, Phelps, Bortzeld, imperative corrective gymnastics of Blum, massage with Polish inflatable objects, classes in costumes "Aleli", "Gravistat", hippotherapy, etc. . (about 25 techniques).

2. Methods: surgical cutting of tendons, phased casting; the introduction of drugs such as "Botox" and stem cells; chipping with various pharmacological preparations; the use of orthopedic appliances.

3. Various physiotherapeutic procedures: barotherapy, cryotherapy, kinesiotherapy, electro-neurostimulation of muscles, manual therapy, acupuncture, oxygen therapy, etc.

4. For the development of speech and cognitive functions, various methods of speech therapy and psychological correction, music therapy, color therapy, educational exposure, occupational therapy, etc. are used. Undoubtedly, all practically existing methods make a certain contribution to the treatment of cerebral palsy, but it must be borne in mind that all of them are not radical, but palliative (auxiliary) and can only help in combination with the main pathogenetic treatment, which is proposed for introduction into a wide practice. Many of the methods listed above are used despite the contraindications. The reason for the occurrence of cerebral palsy and affected structures in the brain, its severity, the presence of concomitant syndromes are not taken into account and is not specified. The adaptive and rehabilitation potential of the child is not evaluated. As a result, instead of the expected positive effect of the treatment, the unavoidable consequences appear:

- various contractures of the joints and the forced position of the limbs after surgery on the joints and tendons with severe pain;

- increased weakness in the limbs and loss of walking skills after prolonged casting;

- increased spasticity in the limbs and the appearance of hyperesthesia (unpleasant, pain-intensified sensations after any touch) as a result of using various massage techniques, physiotherapy exercises, kinesitherapy, etc.

- an increase in the frequency and severity of epileptic seizures, after various electrical stimulations, physiotherapeutic procedures and chipping of the farm. drugs.

The pathogenetic basis of the disease (cerebral palsy) is the defeat of neurons of the main central motor (pyramidal) pathway of the brain, which further leads to impaired formation of conditioned motor and antigravity reflexes. As a result, the child cannot walk, perform precise movements, etc.

Known multi-channel programmable electrical neurostimulator (patent for a utility model of the Russian Federation No. 93683, A61N 1/36, 05/10/2010) which is designed to affect the central and peripheral nervous system by remote long-term stimulation using electrodes. The device can be used to treat a number of neurological diseases, in particular: parkinsonism, cerebral palsy, torsion dystonia, spasticity, some forms of epilepsy, the consequences of severe traumatic brain injuries and psychopathological syndromes, by electrical stimulation of various areas of the brain and epidural spinal cord stimulation. - prototype.

The known device includes a control microcontroller with a digital-to-analog converter (DAC), a current stimulus driver (FCS), electrodes.

The essence of the known solution lies in the fact that the electroneurostimulator includes a non-implantable part, in the form of a transmitter block with pulse-width modulated signals, and an implantable part in the form of a receiver block containing stimulation electrodes.

The disadvantage of this solution is the low manufacturability in production and operation, the morbidity of patients during use, and also not high enough efficiency in the treatment of cerebral palsy.

The technical result can be expressed in the exclusion of injuries when using the device while simplifying its design.

The claimed technical result is provided by the following set of essential features.

The device for restoring axon-dendritic bonds contains a control unit and a current stimulator unit. The current stimulator block includes a microcontroller (MK1), an output

which is connected to the input of the digital-to-analog converter (DAC), the output of which, in turn, is connected to the input of the current stimulator former (FCS) equipped with electrodes. The output of the current stimulus driver (FCS) is connected to the input of the real stimulus current meter (ADC), the output of which is connected to the input of the microcontroller (MK1). The control unit contains a galvanic isolation device, a voltage converter (PC), a microcontroller (MK2), a power supply with a USB connector, and the device is capable of contactless data exchange with a computer (PC) that provides device control, processing and display of information. The device is used with the use of surface electrodes.

The claimed technical solution is illustrated in FIG. 1 - Functional diagram of the device, where:

1 - microcontroller (MK1) control the gain and bandwidth of the amplifier channel EMG;

2 - digital-to-analog converter (DAC);

3 - current stimulus former (FCS);

4 - meter real stimulus current (ADC),

5 - galvanic isolation device,

6 - voltage converter (PN);

7 - control microcontroller (MK2) that controls power;

8 - power supply unit (PSU)

9 - USB connector.

Feedback to control the magnitude of the real current of the stimulus through the patient is carried out through the unit (ADC).

Additionally, to illustrate the feasibility and industrial applicability of the proposed technical solution, the following illustrations are provided.

FIG. 2. Scheme of stimulation of the median nerve. 10 - median nerve, 11 - stimulating electrodes, 12 - grounding electrode.

FIG. 3. The international scheme of assignments "10-20".

FIG. 4. An example of recording a 4-channel SSVP during stimulation of the left median nerve.

FIG. 5. Conducting paths of surface sensitivity (circuit).

13 - receptor; 14 - spinal (sensitive) node (I neuron); 15 - zone of Lissauer; 16 - back horn; 17 - lateral cord; 18 - spinothalamic pathway (II neuron); 19 - medial loop; 20 - thalamus; 21 - III neuron; 22 - cerebral cortex.

FIG. 6. Ways of deep sensitivity (scheme).

13 - receptor; 14 - spinal (sensitive) node (I neuron); 18 - spinothalamic pathway (II neuron); 19 - medial loop; 20 - thalamus; 21 - III neuron; 22 - cerebral cortex. 23 - back cord; 24 - internal arcuate fibers;

FIG. 7. Potential action of afferent n.ulnaris fibers in response to stimulation of sensory endings

FIG. 8. SSEP in response to stimulation of n.ulnaris, allocated at the level of C ₆ -C ₇ .

FIG. 9. SSEP in response to stimulation of n.tibialis allocated at the level of L ₂ -L ₃ .

FIG. 10. Spinal and cortical VP stimulation of the ulnar nerve on the wrist.

FIG. 11. The study of the time of the pulse in different parts of the sensory path during stimulation of the left ulnar nerve.

FIG. 12. The study of the time of the pulse in different parts of the sensory pathway during stimulation of the tibial nerve.

To record the EP, silver-silver cup electrodes or subdermal sterile needle electrodes are used (for many hours of recording). The patient’s skin under the cup electrode is rubbed with a special abrasive paste to create a low transition resistance between the skin and the recording electrode. The electrode is fixed with an adhesive electrically conductive paste and a plaster. For multichannel recording of EPs with subsequent mapping, standard electrodes and helmets are used for EEG studies or a special cap with electrodes located in accordance with the international lead system “10-20” (Fig. 2).

To control the recording quality, it is necessary to measure the transition resistance under the recording electrodes (impedance) before recording, which should be no more than 10 kOhm (optimally up to 5 kOhm).

The components of the EP are indicated by polarity (N - negative, P - positive), the average value of the latent period (for example, N20 - a negative wave with an average normal latent period of 20 ms) or serial numbers (P1, N1).

Standard assessment criteria include the time and amplitude parameters of the airspace.

Latent period - the time from the start of stimulus delivery until the response is recorded. The AM amplitudes are measured according to the principle “from peak to peak” - from the maximum of the negative deviation to the nearest maximum of the positive deviation. The obtained amplitude and time parameters are compared with normative data and the contralateral side.

According to the recommendations of the International Federation of Clinical Neurophysiology (IFCN, Recommendations for the practice of clinical neurophysiology: guidelines of the International Federation of Clinical Neurophysiology / edit, by G. Deuschl and A. Eisen, Elsevier, 1999) to present the results studies of brain VP, it is necessary to show the reproducibility of the selected components of the EP, for this a superposition (superposition) of at least two independent registrations is performed. The latent periods and amplitudes of the airspace components should coincide.

In accordance with IFCN recommendations, the components of SSEP recorded in the first 60 ms after presentation of the stimulus are classified as short-latent. Components with an LP of more than 60 ms are classified as medium latent (having an LP of 60 ms to 150 ms after the stimulus) and long-latent EP (with an LP of more than 150 ms after the stimulus).

Method of recording short-latency somatosensory evoked potentials (SSEP).

In the study of patients, a record of SSEP from the upper extremities is used, in particular SSEP of the median nerve. Registration of SSEP from the lower extremities is used less often, due to several reasons. Firstly, when testing somatosensory pathways from the caudal parts of the spinal cord, the possibility of the influence of extracerebral factors on the results of the study (for example, with combined craniocerebral and spinal injuries, and other concomitant diseases) increases. Secondly, a paradoxical distribution of the cortical components of the tibial nerve cortex on the scalp is possible (paradoxical lateralization of the response - recording the maximum amplitude of the cortical components in the ipsilateral hemisphere with respect to the stimulated limb, Cruse R., 1982; Lesser RP, Lueder SH et al., 1987) , which entails the inclusion of additional leads and increases the examination time. Testing only in standard leads can lead to false positive results. Therefore, it is more convenient to record the median nerve SSEP.

The median nerves are stimulated by a pair of surface disk electrodes with a distance between them of 2-2.5 cm, located on the wrist in the area of the projection of the median nerve, the negative electrode (cathode) in the proximal direction, and the positive electrode in the distal. Stimulation intensity is selected based on the motor threshold; the current strength is increased to an intensity level at which the visible movement of the first finger of the brush will be determined. The maximum stimulus intensity is 100 mD. The standard stimulus duration is 0.2-0.3 ms, the stimulation frequency is 3.1-4.7-5.1 Hz. With an increase in the frequency of stimulation, examination time is reduced.

To register the brachial plexus potential, the active electrode is placed at the Erb point, and the inactive electrode is located at the contralateral Erb point or at the Fpz point according to the international scheme “10-20” (Fig. 2). The potential of the brachial plexus N9 (Erbi) is recorded - a negative deviation with an average normal latent period of 9 ms (Fig. 3, Table 1).

To register the spinal components of the SSEP, the active discharge electrode is located in the projection area of the spinous process of the fifth cervical vertebra (C5), and the inactive electrode (reference) is located in the contralateral Erb point or in the Fpz point. In this assignment, the spinal component N13 is recorded, the source of which is the activity of postsynaptic collaterals of the anterior and posterior horns of the spinal cord (Desmedt L.E., et al., 1981; Lueder H. et al., 1983; Emerson R.G., et al., 1984). Also, in this lead, a lower-amplitude component of N11 can be recorded, which reflects the distribution of excitation along the posterior roots of the spinal cord.

The subcortical (stem) components of the SSEP are recorded in the lead with an extracephalic arrangement of the reference electrode, usually in the contralateral at the Erb point. Active electrodes are placed at points C3 ′ and C4 ′ (2 cm posterior to electrodes C3 and C4 of the international lead system “10-20”, Fig. 2). The components P14, N18 are registered. The P14 component is believed to reflect the activity of the fibers of the medial loop (Desmedt J.E., Cheron G., 1980, 1981; Mauguiere F. et Couijon J., 1981; Emerson R.G., et al., 1984). Information about the genesis of component N18 over two decades of research has been quite controversial. In earlier studies, it was assumed that this component, which is widely distributed on the scalp, reflects the activity of multiple generators: midbrain nuclei and ventroposterolateral thalamic nuclei (Desmedt J.E., Cheron G., 1981). However, in recent works, experimental data have been obtained that testify to the location of generators of component N18 at the midbrain level, but not rostral to it (TombergC-, etal., 1991; Noel P. et al., 1996; Sonoo M. et al., 2000).

The cortical components of the SSWP are recorded when the active electrodes are located at the points C3′C4 ′ (Fig. 2), and the reference electrode at the point Fpz. The primary cortical response is recorded - the complex N20-P23, as well as the later components N30-P45.

The N20-P23 complex represents the primary cortical activation of the somatosensory zone of the cortex. Components N30 and N45 reflect the activity of the associative zones of the brain, are widely distributed on the scalp, are recorded in the ipsilateral and contralateral hemispheres, are more sensitive to the level of anesthesia and state of consciousness (Allison T., et al., 1980, 1981; Desmedt JE, Cheron G. 1981; Mauguiere F. et al., 1981). Basically, the late fluctuations of the EP are due to the afferent influx from the subcortical nuclei and the formations of the mediobasal parts of the brain, as the LP component increases, the contribution of nonspecific CNS structures increases.

Registration conditions: amplifier sensitivity - 10-20 μV / D, amplifier passband 10 (1-30) -3000 (2-4000) Hz, analysis era 50-100 ms, averaging amount - up to 2000.

Physiological factors influence temporal and / or amplitude parameters of SSEP. The latent period of CAP correlates with growth (Verroust J. et al., 1990; Liverson LA, Dong R., 1992), with age (Verroust et al., 1990), and fluctuations in body temperature (Freye E., 1990; Guerit JM , 1993), with gender (Freye E., 1990; Verroust J. et al., 1990). On the background of controlled hypothermia, the rate of propagation of excitation and the amplitude of the VP significantly decreases. For example, at 20 degrees Celsius, the cortical components of SSEPs cease to stand out, and at 16 degrees Celsius, the subcortical components of SSEPs are not recorded.

Barbiturates (sodium thiopental), benzodiazepines, narcotic analgesics (fentanyl) have a great influence on the parameters of cortical SSEPs, mainly of late components. All of the above drugs can increase the medication of cortical cardiovascular system by 10% and reduce the amplitude of cortical cardiovascular system by 10-20%.

Criteria for pathology in the study of SSVP:

1. The increase in latent periods and peak intervals.

The latent periods of the main components of SSEP (N9, N13, N18, N20), the main peak-to-peak interval N9-N20 are measured. For example, an increase in the latent periods of all the studied components of the SSEP with the normal main inter-peak interval N9-N20 can be detected in patients with concomitant diseases of the peripheral nervous system. For a more accurate determination of the level of damage, the main peak-to-peak interval is divided into component peak-to-peak intervals. For the study of patients, the measurement of peak-to-peak intervals reflecting central conduction (N13-N20) and stem conduction (P14-N18) is relevant. The results are compared with regulatory data and with the contralateral side. 2. Decrease in amplitude or absence of one or several components of SSEP. The amplitudes of the subcortical components in healthy subjects are quite variable and significantly lower than the amplitudes of the cortical components, therefore the presence or absence of stem components is of fundamental importance. If the amplitude of one of the components does not exceed the background noise level, the PL of the previous component and its amplitude are measured. For example, in the absence of the N20 component, we can assume damage not only at the level of the primary somatosensory cortex, but also subcortical damage to the somatosensory pathways. The level of subcortical damage (peripheral, spinal, stem) can be determined by the temporal and / or amplitude parameters of the earlier components and interpeak intervals.

It is known that by stimulating the terminals of nerve fibers with electric current, the action potential of the afferent portion of the nerve can be recorded, and when stimulating the efferent fibers, the muscle response can be used to indirectly judge the state of the motor portion of the nerve during stimulation ENMG. Given that SSEPs are subdivided into short- and long-latent, in practice a well-developed technique is used to isolate and analyze short-latent SSEPs, which are most often near-field potentials. The genesis and clinical significance of long-latent SSEPs are not fully understood,

SSEP of nerve trunks is usually recorded using surface electrodes located at the site of nerve projection; the active electrode is installed above the nerve trunk, the reference electrode is on the opposite side of the limb or over the bone protrusion. Registration is performed at one or more points along the nerve trunk. A rather high level of amplification is applied (from 20 μV per 10 mm), the number of averagings is up to 3000-6000, but not less than 500. Registration of the SSEP of a nerve makes it possible to calculate the propagation velocity of excitation along sensory fibers (SRVs) according to the formula:

CPB _c = l / T

where l is the length of the nerve site on which SRV is studied;

T - latent time SSVP.

Normally, CPB _c averages 50-80 m / s (Fig. 6).

SSEPs of the spinal cord are recorded from electrodes located above the spine at the site of projection of the cervical or lumbar enlargement, the reference electrode is installed above the bone protrusion distant from the site of stimulation (spine of the scapula, knee of an unstimulated leg). The gain level is 1-5 μV / 10 mm, the number of averages is 1000-6000 (Fig. 7).

It is believed that peak N ₉ is associated with activity of the brachial plexus, N ₁₁ - with the conduction of an impulse along the posterior columns of the spinal cord at the local level, N ₁₃ - partly with the activity of postsynaptic neurons at the level of the corresponding segment of the spinal cord (posterior horns) and fibers of the medial loop on level of the lower parts of the trunk.

The complex N ₁₈ -P ₂₀ -N ₂₂ reflects the activity of spinal structures at the level of lumbar enlargement.

Parallel registration of SSEPs of the nerve trunks that make up the plexus of the spinal cord and cortical SSPS (near-field SSPS) allows calculating the propagation time of the sensory impulse at different stages of the procedure, determining the difference in latent periods of the main peaks, comparing these indicators with the “sick” and “healthy” sides.

To register cortical SSEP, an active electrode is placed on a counter-laterally stimulated limb above the projection area of the sensory cortex (2 cm posteriorly and 7 cm outward from C _z at points C ₃ -C ₄ ), the reference ones in F _pz , F _z or A _j , A ₂ , grounding - on an unstimulated limb. The maximum impedance is 5 kOhm (Fig. 9).

The negative-positive complex N ₂₀ -P ₂₃ characterizes the activation of the primary somatosensory cortex.

The peak-to-peak intervals N ₉ -N _{13 are} calculated (predominantly radicular and posterolateral conduction at the cervical level); N ₁₃ -N ₂₀ (medial loop and thalamocortical radiation). The most commonly used indicator is the central time of the sensory impulse (CVP), defined as the inter-peak interval N ₉ -N ₂ o (Fig. 10).

Elongation of CVP is characteristic for patients with multiple sclerosis, cerebrovascular pathology (in this case, the study of CVP on both sides and in dynamics during treatment is especially valuable).

When SSEP is isolated in response to stimulation of the nerves of the lower extremities, using modified techniques, the time of spinal conduction can also be measured.

For this, additional conductive electrodes are placed in the projection of the C _vn vertebra and C ₃ -C ₄ on the patient's head. A component recorded at the cervical level and having a latency of about 30 ms (N ₃₀ ) is a potential of a distant field and characterizes the activation of subcortical structures. The cortical complex P ₃₇ -N ₄₅ demonstrates the activation of the primary somato-sensory cortex. Peak intervals N ₂₂ -N _{30 are} calculated (spinal conductivity); N ₃₀ -P ₃₇ (medial loop, thalamo-cortical radiation); N ₂₂ -P ₃₇ (analogue of the CVP) (Fig. 11).

The clinical interpretation of these indicators is carried out in the same way as in the case of evaluating SSEP with stimulation of the peripheral nerves of the hands.

DISADVANTAGES: since when the EPs of the brain are removed from the skin of the scalp, they have a low amplitude, to identify and clearly record an undistorted EP, it is necessary to: repeatedly amplify an ultra-weak signal (an amplifier with a high gain of 100000-1000000 must be built in), and to isolate an ultra-weak signal against the background of “noise”, it is necessary to use the method of coherent accumulation (averaging) of the signal — the smaller the initial amplitude of the VP, the more averagings will be needed to separate it from the background of noise, to select its useful frequency (f ltration), repeatedly suppressing “noise” not related to the stimulus, and to cut out network interference with a frequency of 50 Hz, a special filter called “notch-filtr” (“filter-plug”) should be used, which repeatedly suppresses the amplitude of incoming signals in a narrow range of a given frequency .

At least two memory buffers are required for two independent registrations under the same conditions in order to evaluate the reproducibility of the response with repeated averaging.

The stimulus intensity should be higher than the threshold of the motor reaction (by 5 V or 0.1 mA); for fingers and toes - 10-25 mA, for nerve trunks - 10-30 mA with a stimulus duration of 0.1 ms and a stimulation frequency of 1-7 Hz. The applied electrical stimulation is not a natural irritant, accompanied by unpleasant sensations (“shock”), which limits the use of the technique in children, emotionally unbalanced patients, and in patients with hyperesthesia.

The proposed technical solution is aimed at the treatment of cerebral palsy, based on the method of restoring the pyramidal motor pathway, by stimulating the efferent fibers, which are the motor portion of the nerve that goes to the muscles.

The therapeutic effect is based on stimulation of the primary motor centers in the cerebral cortex and secondary in the cervical and lumbar enlargements, which are the main generators of the formation of efferent nerve impulses in order to form the human motor act. As a result of the treatment, a persistent reflex arc of the lost unconditioned reflex is formed and pathological proprioceptive afferent impulse is eliminated with a further restoration of the kinesthetic perception of the regulation of normal muscle tone.

In the process of stimulation, spatio-temporal modulation of the electrochemical processes of the cytolemma of neuro and gliocytes occurs, leading to stabilization of their membrane potential and ionic composition of the intercellular fluid in the brain tissue. This determines the activation of the function of morphologically preserved neurons and a decrease in the polarization of the membranes of damaged cells. The summation of the effects leads to the activation of tissue respiration, an increase in the synthesis of macroergs, neurotransmitters and peptide neuromodulators, the development of sprouting processes and, as a result, the activation of non-specific adaptation mechanisms with the development of complex compensatory-adaptive reactions in the functional systems of the body, primarily in the central nervous system itself.

Practical studies have shown positive results in the restoration of interhemispheric axon-dendritic connections through the brain for the upper extremities, in the restoration of connections through the spinal cord for the upper extremities, and also when stimulating the articulating muscles of the face (Cerebral Palsy).

Efferent fibers are stimulated with a rectangular stimulus with an intensity significantly lower than the threshold of a motor reaction: for fingers and toes - 2-8 mA, for nerve trunks - 2-10 mA with a stimulus duration of 0.1 ms and a stimulation frequency of 1-5 Hz. The applied electrical stimulation is a natural irritant and is not accompanied by unpleasant sensations (“does not shock”), which allows the use of this technique in children, emotionally unbalanced patients, and in patients with hypersensitivity.

Stimulation time from 4 to 8 minutes per projection point, total exposure time 20-30 minutes. This allows in this case to accurately reproduce the main characteristics of the stimuli and synchronize the supply of the reference signal. Long-term stimulation of efferent nerve impulses of physiological intensity contributes to their cumulative effect in the thalamus, where they undergo primary processing and additional amplification for transmission to the cortical projection primary zones. With pathology, there is no cumulative effect in the thalamus and impulses practically do not reach the cortex.

The use of the proposed device is illustrated by the following examples.

Example No. 1.

Patient V. was admitted for treatment during restoration of axon-dendritic connections in the pyramidal pathway and along the posterior cords of the spinal cord (Gaulle and Burdach bundles) through the upper and lower extremities to restore balance and walking No. 15 sessions from 13.10. - 10/29/2012. Admitted with a clinical diagnosis:

The consequence of perinatal damage to the central nervous system- (IUI in the form of transferred generalized mixed herpes virus (CMV, HSV 1-2,) neuroinfection), severe hypoxic-ischemic encephalomyelopathy of premature infants, ventriculitis, dislocation of the spine in segments C2-C3, C3-C5 L4, hemodynamic impairment in these segments, with an outcome in

1. Periventricular leukopathy, cortical-subcortical subatrophy, ventriculomegaly with impaired reverse cerebrospinal fluid absorption.

2. Chronic persistent sluggish mixed herpesvirus neuroinfection of the type of glioso-cystic periventricular arachno-encephalitis, inactive phase with immune deficiency of the cell type and persistent moderate violation of the permeability of the blood-brain barrier.

Syndrome of motor disorders in the form of central tetraparesis: 2 degrees in the arms, 2 degrees in the legs with impaired motor function of 3 degrees. Syndrome of moderate cerebellar and posterior column insufficiency 2 tbsp. Hypertension syndrome with hemorrhagic distension. Delay in psycho-speech development. Epi Syndrome.

On admission: In the mind, meningeal signs (-), asthenic, labile, quickly depleted. Active speech in the form of babbling, responds to conversational speech, malnutrition. Physically quickly depleted due to the high exhaustion of nervous processes. Attention is erratic. Takes toys - shifts. Fine motor skills are not available. Independently rolls over badly, does not sit, does not walk, walks with a cross with support on toes. Flinches. Skull with an enlarged subcutaneous venous network on the face, especially on the forehead and face. Painful percussion of the skull to the right. He holds his head uncertainly. FMN: strabismus, gaze fixes, asymmetry of nasolabial folds, photoreactions are normal, phonation from the soft palate is reduced, slowly chewing, swallowing. Positive reflexes of oral automatism. Strength in the hands: 3 points., In the legs: proximal 3 points, distally in the legs 3 points, paresis of the extensors of the foot - 2.5 points. The muscle tone is of a mixed type, reduced in the muscles of the back, high in the limbs. Tendon and periosteal reflexes are animated by the organic type. Pathological reflexes from the legs and arms. Abdominal slightly reduced. There are no sensitive disorders. Moderate trunk stato-motor and sensitive ataxia. The patient underwent a comprehensive examination of multimodal EP from 10/13/12:

Patient: B, 5 years old

Short-latent auditory stem stem

Peak intervals I-V with asymmetry: D-3,57; S-4.29 due to an increase in left stimulation (somewhat shortened). When stimulated on both sides, the amplitudes of the III peaks are reduced. The amplitudes of I peaks are sharply reduced (developmental variant or sensorineural hearing loss?). The amplitude I / V ratios are normally reduced on both sides, more with stimulation on the left. Conclusion: dysfunction of stem auditory conduction during stimulation on the left. A pronounced bilateral decrease in the functional activity of the auditory nuclei at the level of the bridge and auditory nerves, more to the left.

Patient: V., 5 years old

Visual AF on the flash primarily

When stimulated by an outbreak of PL, the main components of the visual EP P1N1 P2N2 P3N3 are significantly increased (see protocol above), the amplitudes P1N1 P2N2 with distinct asymmetry (in the left hemisphere are higher than in the right hemisphere when stimulating both eyes, possible causes are hypersynchronization in the left hemisphere or decreased functional activity in the right, see clinical and other data).

Conclusion: with flash stimulation, pronounced bilateral dysfunction of central visual conduction was revealed. Functional activity of the visual cortex with asymmetry: in the projection of the left hemisphere is higher than in the right.

Doctor, Ph.D. G.

Patient: V., 5 years old

Cognitive VP P300

The primary cortical response N1P2 is recorded with normal amplitude at stimulus intensities of 85 and 106 dB. LP within the age norm.

Upon presentation of auditory stimuli with an intensity of 85 dB of different tonality, a P300 wave with a PL-514 ms is recorded, with a stimulus intensity of 106 dB with a PL of 473 ms.

The amplitude of the P300 wave is increased (a sign of hypersynchronization).

Conclusion: during differentiation of auditory stimuli of various physical characteristics, a decrease in the speed of cognitive processes was revealed: pronounced - at a lower intensity of stimuli, moderate - at a high intensity of stimuli.

Doctor, Ph.D. G.

Patient: B, 5 years old

Short-latent somatosensory VP

(median nerve stimulation)

During stimulation, a migratory cortical response N20 is recorded on the right, with increased LP during primary stimulation, and normalization of LP N20 during repeated stimulation. The increased peak-to-peak interval N13-N20 during stimulation on the right up to 14.1 ms normalized upon repeated stimulation to 5.29 ms, the average age norm: 6.7 ± 0.6 ms. Amplitudes of cortical responses N20-P23: during stimulation on the right, normal, with stimulation on the left increased (D- 3.8 μV, S-5.5 μV, normal 3.4 ± 1.2 μV). During stimulation on the left, the amplitude of the thalamic component N18 is sharply reduced to the level of background noise.

Conclusion: during stimulation of the right median nerve, functional disorders of the central somatosensory conduction were revealed at the thalamo-cortical level as a reversible conduction dysfunction; during stimulation on the left, signs of a pronounced decrease in functional activity at the level of the thalamic nuclei, and possibly hypersynchronization of excitation processes at the level of the somatosensory cortex, were revealed.

Doctor, Ph.D. G.

Patient: V., 5 years old

Evoked potentials

Short-latent somatosensory VP

Short-latent somatosensory VP

With stimulation of the tibial nerves, the amplitudes of the spinal components of N22 are within normal limits. The amplitude of the cortical components of P38 during stimulation on the left is sharply reduced - 0.86 μV, during stimulation on the right it is normal - 6.18-4.68 μV (normal 4.1 ± 1.2 μV for 2-6 years) - the first amplitude is greater - or there was a one-time hypersynchronization (6 μV, due to Epiact.) or a decrease in funct. activity with repeated stimulation. The inter-peak interval N22-P38 with left stimulation - 21.8 ms, with right stimulation - 21.4 ms (normal for 2-6 years - 19.2 ± 1.2) - are easily increased? (a group should have its own norms)

Conclusion: upon stimulation of the tibial nerves, a marked decrease in the functional activity of the somatosensory cortex was revealed in the projection of the right hemisphere, to a mild degree, in the projection of the left hemisphere.

Doctor, Ph.D. G.

T.O. comprehensive multimodal examination revealed functional disorders of the central somatosensory conduction at the thalamo-cortical level; during stimulation on the left, signs of a marked decrease in functional activity at the level of the thalamic nuclei were revealed.

The patient underwent the following course of treatment:

1. Restoration of axon-dendritic connections in the pyramidal path and along the posterior cords of the spinal cord (Gaulle and Burdach bundles) through the upper and lower limbs to restore balance and improve walking No. 16.

2. Restoration of interhemispheric dendritic connections No. 16.

After a month, the patient underwent a repeated multimodal examination on 11/15/12.

Patient: V., 5 years old

Visual Flash VP

When stimulated by an outbreak of PL, the main components of the visual EP P1N1 P2N2 P3N3 are within the age norm. The amplitudes P1N1, P2N2 with slight asymmetry during stimulation of both eyes (in the left hemisphere are slightly higher than in the right).

Conclusion: in comparison with the study of October 13, 2012, there is a positive electrophysiological dynamics: against the background of a decrease in the severity of hypersynchronization processes, normalization by age of central visual conduction is recorded. The hemisphere asymmetry (S> D) of the functional activity of the visual cortex was significantly less pronounced. Some deprivation of the functional activity of the visual cortex is noted in comparison with the previous study, apparently against the background of the therapy (decrease in the amplitude of the VIZ).

Doctor, Ph.D. G ..

Patient: V., 5 years old

Short-latent somatosensory EP (median nerve stimulation)

Re-2

Short-latent somatosensory VP

During stimulation, a stable N20 cortical response is recorded on the right, with a slightly increased amplitude - 5.14 μV (average age norm 3.4 ± 1.2 μV). The peak-to-peak interval N13-N20 is 6.29 (average age norm: 6.7 ± 0.6 ms).

Conclusion: in comparison with the study of October 13, 2012, there is a positive electrophysiological dynamics during stimulation of the right median nerve in the form of improved synchronization of somatosensory conduction at all levels - spinal, trunk, thalamo-cortical (the amplitude increased, the shape and stability of evoked potentials of the corresponding levels improved) .

Doctor, Ph.D. G.

Patient: V., 5 years old

Short-latent somatosensory VP

(stimulation of the tibial nerves)

re-2

With stimulation of the tibial nerves, the amplitudes of the spinal components of N22 are within normal limits. The amplitudes of the cortical components of P38 on both sides are moderately reduced, without pronounced asymmetry: with stimulation on the left - 1.9 μV, with stimulation on the right - 1.37 μV (normal 4.1 ± 1.2 μV for 2-6 years). The inter-peak interval N22-P38 with left stimulation is 23.2 ms, with right stimulation it is 30.2 ms (normal for 2-6 years - 19.2 ± 1.2).

Conclusion: in comparison with the previous study of October 13, 2012, multidirectional electrophysiological dynamics were noted: interhemispheric asymmetry of the functional activity of the somatosensory cortex during stimulation of the tibial nerves became significantly less pronounced, an increase in the time spent on somatosensory tracts of the right lower limb was noted.

Doctor, Ph.D. G.

Patient: B, 5 years old

Cognitive VP P300

(again - 2)

Cognitive VP P300

The primary cortical response N1P2 is recorded with a normal amplitude at a stimulus intensity of 85 dB. LP within the age norm.

When standard and deviant auditory stimuli are presented with an intensity of 85 dB, the primary wave P300 is recorded with a PL of 449 ms (the average age norm is 409 ms), and when re-presentation of stimuli, stimuli are presented with a PL of 365 ms. The amplitude of the P300 wave is within normal limits.

Conclusion: in comparison with the study dated October 13, 2012, there is a positive electrophysiological dynamics in the form of an increase in the speed of cognitive processes during differentiation of auditory stimuli of various physical characteristics, improved synchronization of excitation processes at the level of the primary auditory cortex, and a decrease in the severity of hypersynchronization processes diagnosed in the previous study.

General conclusion: repeated multimodal examination confirmed positive electrophysiological dynamics in the form of improved synchronization of excitation processes at the level of primary cortical zones, improved synchronization of somatosensory conduction at all levels - spinal, trunk, thalamo-cortical (amplitude increased, shape and stability of evoked potentials of corresponding levels improved) and reducing the severity of hypersynchronization processes diagnosed in a previous study.

Upon re-examination, a positive dynamics also appeared: it was physically stronger, it began to chew better, the left handle opened, began to turn over, and began to shift toys from one hand to another. She speaks one word and many syllables, decreased muscle tone.

Claims (1)

A device for reconstructing axon-dendritic connections, comprising a control unit and a current stimulator unit, including a first microcontroller, the output of which is connected to the input of a digital-to-analog converter, the output of which is in turn connected to the input of a current stimulator, equipped with electrodes, and the output of the current stimulator is connected to the input a stimulus current meter, the output of which is connected to the input of the first microcontroller, while the control unit contains a galvanic isolation device azovatel voltage, a second microcontroller, the power supply from the USB-connector, and the device is adapted to contactless data communication with the computer providing device management, processing and displaying information.

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