RU2012293C1 - Method for determining indications for magnetic stimulation of vascular genesis optic nerve atrophy - Google Patents

Abstract

FIELD: medicine, in particular, ophthalmology. SUBSTANCE: concept of new method resides in that first were measured velocity of blood flow in carotid and supratrochlear artery, electrical sensitivity threshold and light sensitivity of central zone of retina. Next, blockade of upper cervical ganglion was made using 2 to 3 mg/kg lidocaine solution in combination with prescole taken in amount of 0.1 to 0.15 mg/kg. After 40 to 60 min lapsed, above parameters were measured again. If results of measurement exceeded original values by 20 to 30 % , indication for magnetic stimulation was considered as prescribable. EFFECT: ease of determining indication for magnetic stimulation of optic nerve atrophy.

Description

 The invention relates to medicine, and in particular to ophthalmologists, and is intended to determine indications for treatment with magnetostimulation of optic atrophy of the optic nerve of vascular etiology.

 Currently, treatment with magnetostimulation of optic atrophy is carried out without specifying indications, which leads to unjustified economic costs, since the course of treatment with magnetostimulation is long and treatment results are not expressed in some patients, since the positive effect is short-lived or completely absent.

 The objective of the invention is the determination of indications for treatment with magnetostimulation of atrophy of the optic nerve.

 The problem is solved by initially measuring the linear velocity of blood flow in the carotid and suprablock arteries, the threshold of electrical sensitivity and photosensitivity of the central zone of the retina, then blocking the upper cervical ganglion with a solution of lidocaine at a dose of 2-3 mg / kg in combination with prescol 0.10-0 , 15 mg / kg, after 40-60 min, these indicators are again determined and, when they are increased by 20-30% of the initial value, magnetostimulation shown is considered.

 The method is based on the total vasodilating effect of the combined action of the blockade of the upper cervical ganglion and prescall, an increase in the linear and volumetric blood flow velocity in the pool of the carotid arteries and their terminal branches, an increase in blood supply to the retina and blood vessels supplying the optic nerve. The result of this effect is an increase in the photosensitivity of the central zone.

 The method is as follows. In the patient’s supine position, blood pressure (BP) and heart rate (HR) are measured. Using an ultrasonic dopplerograph-DUD-400 of the company "Dina Electronique" (France) determine the linear blood flow velocity (LSC) in the carotid and suprapubic arteries with simultaneous registration of dopplerograms. Then, using the method of computer static perimetry (UPC) on the field of view analyzer of the company "Hamfry" (USA), the photosensitivity of the central zone of the retina and the threshold of electrical sensitivity (PEC) are studied on the EOS-1 apparatus manufactured by the Experimental Workshops of the USSR Academy of Medical Sciences.

Then, a small roller is placed under the patient’s shoulders and the upper cervical ganglion is blocked from the homolateral side. The blockade is performed with a 20 ml syringe. A 2% lidocaine solution of 2–3 mg / kg and a presol of 0.1–0.15 mg / kg are drawn into the syringe, and the syringe is connected to a standard needle with a length of 50 mm and a diameter of 0.6 mm. At the level of the thyroid cartilage, having twice treated the skin with alcohol, the sternocleidomastoid muscle is displaced posteriorly with the index finger and the needle is punctured perpendicularly to the stop in the spinous process of the 6th cervical vertebra. 2.0 ml of the solution is injected, then the needle is pulled up by 3-5 mm and ^the needle is moved deeper at an angle of 30 ° and a mixture of solution is fed up to a depth of 4 cm. Advancing the needle to a predetermined depth, make sure that it is outside the vascular bed, for which they slightly pull the syringe plunger towards themselves, and without detecting any blood impurities in the syringe, slowly introduce the remainder of the solution. After that, the needle is removed, and the injection site is pressed for 1 min with a swab moistened with alcohol.

 After 40-60 minutes, the whole complex of studies is repeated and the results are compared with the initial ones. If the indicators increased by 20-30% of the initial ones, consider magnetostimulation shown.

 47 studies were conducted confirming the effectiveness of the method.

 PRI me R 1. Patient D., 72 years old, a / c 12495. Diagnosis: condition after cerebrovascular accident, cerebrosclerosis, descending atrophy of the optic nerve in both eyes.

 Anamnesis. In January 1988, he noticed a sharp deterioration in vision in his left eye. After 2 weeks, vision on the right eye decreased sharply. 4 months before that, he was undergoing treatment in the neurological department with a diagnosis of cerebrovascular accident. He visited an optometrist only in December 1989.

 During the examination: the fundus - the optic disc is pale, the contours are clear, the arteries are narrowed.

 VIS OD = 0.02 eccentric from the temple.

 VIS OS = 0.09 eccentric at the nose.

 Threshold of electrical sensitivity at OD 230 μA; OS 200 μA. Lability: at OD 30 Hz; on OS 34 Hz.

 Central photosensitivity: at OD 22 dB; on OS 24 dB. LSC in the carotid artery on the right 18 cm / s. LSC in the suprapubic artery on the right 4 cm / s.

 Computed tomography revealed an intense expression of the internal carotid arteries at the siphon level. The patient underwent a blockade of the right upper cervical ganglion with 0.15 mg / kg prescol and 2 mg / kg lidocaine. After 40 minutes, the patient was examined. The threshold of electrical sensitivity decreased: by OD to 152 μA; on OS up to 160 μA. Central photosensitivity increased: by OD up to 29 dB; on OS up to 30 dB. BFV in the carotid artery on the right increased to 22 cm / s. BFV in the suprapubic artery on the right increased to 5 cm / s.

 The patient underwent 10 magnetostimulation sessions. A permanent magnet with the possibility of rotation was used, with a maximum induction of 0.1-0.25 T. The rotation frequency of the magnet was synchronized with the pulsation frequency of the carotid artery. The treatment was carried out according to the following procedure: they affected nine areas corresponding to the intra- and extrabulbar parts of the optic nerve, the optic tract and the central cortical department. The duration of exposure in each area is 5 minutes.

 After treatment: OD = 0.09; OS = 0.2.

 Threshold of electrical sensitivity at OD 160 μA; OS 180 μA. Lability: at OD 45 Hz; on OS 40 Hz. Central photosensitivity: on OD 26 DB; on OS 30 dB. LSC in the carotid artery on the right 19 cm / s; LSC in the suprapubic artery on the right 4 cm / s.

 PRI me R 2. Patient M. 79 years old, and / to 28577.

 Diagnosis: atrophy of the optic nerve in both eyes, after cerebrovascular accident in the pool of the optic nerve.

 On admission: the fundus - the optic disc is pale, the contours are clear, the arteries are narrowed and convoluted.

 VIS OD count of fingers in the face.

 VIS OS 0.1.

 Threshold of electrical sensitivity: at OD 260 μA; on OS 200 μA.

 Lability: at OD 14 Hz; on OS 22 Hz.

 Central photosensitivity: on OD 18 DB; on OS 24 dB.

 LSC in the carotid artery on the left 19 cm / s; LSC in the suprapubic artery on the left 3 cm / s.

 Conservative treatment was carried out, including B vitamins, nicotinic acid, fibrinodizin, heparin. There was no positive effect after treatment.

 The patient underwent blockade of the left upper cervical ganglion with 0.15 mg / kg prescol and 2 mg / kg lidocaine. After 60 minutes, the patient was re-examined. Threshold of electrical sensitivity: at OD 234 μA; on OS 156 μA.

 Central photosensitivity: on OD 19 dB; on OS 30 dB.

 LSC in the carotid artery on the left 24 cm / s; LSC in the suprapubic artery on the left is 4 cm / s.

 The patient underwent 10 sessions of magnetostimulation according to the technique described in the first example.

 After treatment: VIS OD counts fingers in the face.

 VIS OS 0.25.

 The threshold of electrical sensitivity at OD 260 μA; on OS 180 μA.

 Lability: at OD 15 Hz; on OS 26 Hz.

 Central photosensitivity: on OD 18 DB; on OS 28 dB.

 LSC in the carotid artery on the right 20 cm / s; LSC in the suprapubic artery on the right 4 cm / s.

Claims (1)

 METHOD FOR DETERMINING INDICATIONS FOR TREATMENT OF MAGNETOSTIMULATION ATROPHY OF VISUAL NERVOUS VISUAL NERVOUS NERVOUS NERVOUS, which consists in initially measuring the linear blood flow velocity in the carotid and supralateral arteries, the electrical sensitivity and the photosensitivity of the central retinal ligand block are performed with a solution of thenbolose 2-3 and then mg / kg in combination with prescol 0.10 - 0.15 mg / kg, after 40 - 60 min these indicators are again determined and, if they are increased by 20 - 30% of the initial value, magnetostimulation is considered by billed.