RU2078565C1 - Method of vegetative-vascular paroxysm treatment - Google Patents

Abstract

FIELD: medicine, neuropathology. SUBSTANCE: after paroxysm type determination all patients were given antidepressants, adrenolytics, finlepsin and tranquilizers of benzodiazepine order. Antidepressants without cholinolytic effect or adaptogens were administrated to patients with sympatho-adrenal attacks; adrenolytics in combination with lithium carbonate were administrated to patients with sympatho-adrenal and mixed paroxysms and treatment is continued for 18-20 days. EFFECT: enhanced therapeutic efficacy.

Description

 The invention relates to the field of health and will find application in the treatment of sympatho-adrenal, vago-insular and mixed vegetative-vascular paroxysms.

 Vegetative-vascular paroxysms (sympathoadrenol, vago-insular and mixed so-called "panic attacks") have various etiologies and are clinically manifested: a) sympatho-adrenal suddenly causes tachycardia, fear of death, rising blood pressure, chills and trembling urination; b) vago-insular fear, dizziness, nausea, feeling of suffocation, "there is no fullness of a sigh", bradycardia, drop in blood pressure, rumbling in the stomach, urge to stool; c) mixed there is tachycardia, dizziness, rising blood pressure, suffocation, fear of death, rumbling in the stomach, chills, trembling, urge to stool or rapid urination.

 This disease is very common, so, according to G.N. Dyukova, Kh.K. Aliyeva (Journal of Neuropathology and Psychiatry named after S. S. Korsakov, T. 10, 1989, p. 130) in a population of 3 cases per 100 people. People of different ages get sick, but more often from 20 to 40 years old, i.e. the most productive age, which makes them disabled.

 Since these conditions have many symptoms in the clinic, the traditional treatment aimed at eliminating certain symptoms (prescribe sedatives of the benzodiazepine group, amitriptyline, beta-blockers, antihypertensive drugs, etc.), which, of course, does not give a sufficient effect and not only does not stop the attack, but also does not prevent its development in the future.

 Conducted research on the medical-scientific and patent literature revealed a number of methods for the treatment of vegetative-vascular paroxysms. So, in the work of G.M. Dyukov, Kh.K. Aliyev "Vegetative-vascular paroxysms (" panic attacks ")" ("S. Korsakov Journal of Neuropathology and Psychiatry" N 10 1989 p. 131) are considered treatment methods used abroad, mainly using large doses of amitriptyline and benzodiazepines. The disadvantage of these methods is that in the doses given these medications cause significant side effects.

 As a prototype taken the method of treatment of vegetative-vascular paroxysms described in / 1 /, which is carried out using amitriptyline and clonazepam. The disadvantages of this method are the long duration of treatment (30 days or more) and the absence of a persistent clinical effect. This happens because there is no theoretical justification for the drugs used, the conditions are not typified: sympatho-adrenal, vago-insular and mixed paroxysms, and as a result of this, empirical selection of doses, the duration of the relief of seizures, often leading to a worsening of the condition during treatment and even to categorical refusal of patients from drug therapy.

 The aim of the invention is to reduce the treatment time, achieve a lasting clinical effect, stop paroxysms and prevent their occurrence in the future.

 This goal is achieved by typing the clinical picture (sympathoadrenal, mixed and vago-insular paroxysm), stress relief, the use of adaptogens, antidepressants; then exposure to adrenergic and cholinergic systems of the brain using drugs that block these mechanisms; effects on paroxysmal mechanisms, the use of antiparoxysmal drugs and increased inhibitory mechanisms by the use of benzodiazepines.

 So, with sympathoadrenal paroxysms (clinical signs: fear, tachycardia, increased blood pressure, chills, trembling, rapid urination), adaptogens or antidepressants that do not have anticholinergic effects are prescribed to relieve stress. For example, Eleutherococcus 5 8 drops in the morning 30 minutes before meals once a day or pyrazidol 0.01-0.025 daily once in the morning. Then, adrenolytics are prescribed drugs that affect the adrenergic systems of the brain, for example, haloperidol at a dose of 0.000375-0.0015 daily per day, lithium carbonate 0.1-0.3 per day, benzodiazepines are prescribed to enhance the inhibitory process of excited brain structures, for example phenazepam at a dose of 0.0005-0.0015 per day daily. All drugs are prescribed throughout the course of treatment. And finally, finlepsin at a dose of 0.1-0.6 per day.

In case of mixed paroxysm (clinical signs: fear, dizziness, nausea, suffocation, rumbling in the abdomen, tachycardia, increased blood pressure, urge to stool or rapid urination), antidepressants, for example, amitriptyline, are prescribed in order to relieve stress and brain cholinergic structures 0.01-0.025 at night once a day. To affect the excited adrenergic structures of the brain, adrenolytics are prescribed, for example, haloperidol at a dose of 0.000375-0.0015 per day daily and lithium carbonate at a dose of 0.1-0.3 per day daily. To enhance the inhibitory process in the brain structures, benzodiazepines are prescribed, for example, phenazepam at a dose of 0.0005-0.0015 per day daily. To influence paroxysmal activity, antiparoxysmal drugs are prescribed, for example, finlepsin at a dose of 0.1-0.6 per day daily for the entire course of treatment
In case of vago-insular paroxysms (clinical manifestations: fear, dizziness, nausea, suffocation, bradycardia, drop in blood pressure, rumbling in the abdomen, urge to bowel movements), antidepressants, for example, amitriptyline at a dose of 0, are prescribed to relieve stress and simultaneously affect the cholinergic structures of the brain. , 01-0.025 at night once a day. Then, to prevent the excitation of adrenergic brain structures, adrenolytics that do not have a hypotensive effect are prescribed, for example, haloperidol at a dose of 0.000375-0.0015 per day daily. To enhance the inhibitory process in the brain structures, benzodiazepines are prescribed, for example, phenazepam at a dose of 0.0005-0.0015 per day daily, all drugs are prescribed during the entire course of treatment. Also, antiparoxysmal drugs, for example, finlepsin at a dose of 0.1-0.6 per day daily, are prescribed to affect paroxysmal activity.

 Examples. Case 1. Patient K., 35 years old, from childhood often suffered from SARS, tonsillitis. A year ago, after physical exertion, a headache of a bursting nature suddenly appeared, tachycardia arose: "The heart was beating in the whole chest, and even in the throat." There was a strong fear of death, a chill-like trembling, "the hands and feet were freezing," thrashing, calling for help. An ambulance caused a high blood pressure of up to 190/110 mm. Hg. Art. Dibazole, papaverine was introduced, but no relief came. The attack lasted about an hour and ended with frequent urination. Subsequently, such attacks were repeated, the patient was treated in various therapeutic and neurological hospitals without effect. Was admitted to the psychiatry clinic of RSMU. Mental status was typed as sympatho-adrenal vegetative-vascular paroxysm. Pyrazidol 0.025 was prescribed to relieve stress, daily in the morning, adrenolytics were prescribed to stop the excited brain adrenergic structures: haloperidol 0.000375 • 3 times a day, lithium carbonate 0.1 • 3 times a day. To enhance the inhibitory process, benzodiazepine phenazepam was prescribed at 0.0005 • 3 times a day. Finlepsin was influenced on paroxysmal activity by 0.1 • 3 times a day. On the second day of treatment, the attacks disappeared and were no longer repeated, on the 20th day the patient was discharged. Follow-up for six months, the patient works in her specialty.

 Case 2. Patient R., 40 years old, has suffered from frequent SARS and tonsillitis since childhood. After another sore throat at the age of 30, an attack suddenly occurred, accompanied by a fear of death, with dizziness, nausea, palpitations, a feeling of suffocation, a rise in blood pressure to 170/90 mm. Hg chills trembling. He was treated twice in the neurological department without effect. He was hospitalized in the psychiatry clinic of the Russian State Medical University, where the status is typed as a mixed vegetative-vascular paroxysm. To relieve stress and simultaneously affect the cholinergic structures of the brain, amitriptyline was prescribed at a dose of 0.025 at night once a day. To affect the excited adrenergic structures of the brain, adrenolytics are prescribed: haloperidol 0.000375 • 3 times a day, lithium carbonate 0.1 • 3 times a day. To enhance the inhibitory process, benzodiazepine-phenazepam was prescribed at 0.0005 • 3 times a day. To affect paroxysmal activity, finlepsin was prescribed at 0.1 • 3 times a day. On the second day of taking the medications, the attacks disappeared and did not resume. Discharged on the 18th day of stay in the clinic, follow-up 2.5 years, works, no seizures.

 Case 3. Patient Z., 28 years old, had seizures at 27 years of age after severe excitement: suddenly he felt dizzy, vomited, developed a fear of death, a feeling arose that his heart stopped. Turned pale, "the hands and feet were frozen," the ambulance caused the bradycardia to 54 beats per minute, lowering blood pressure. The attack ended with rumbling in the stomach and a urge to chair. He was hospitalized in the psychiatry clinic of the Russian State Medical University, the attack is typed as a vago-insular autonomic-vascular paroxysm. To relieve stress and simultaneously affect the cholinergic structures of the brain, amitriptyline 0.025 was prescribed at night once a day. To prevent the excitation of adrenergic brain structures, an adrenolytic haloperidol was prescribed at a dose of 0,000375 • 3 times a day daily. To enhance the inhibitory process, benzodiazepine-phenazepam was prescribed at 0.0005 • 3 times a day. Finlepsin at a dose of 0.2 • 3 times a day was prescribed to affect paroxysmal activity. On the second day of taking the medications, the attacks passed, but with a sharp rise from bed there was a short-term dizziness. Discharged on the 20th day, follow-up period of 4 months, works, attacks no longer repeated.

 Thus, in comparison with the prototype, the proposed method provides the following advantages: 1) the speed of relief of paroxysms; 2) the duration of the patient’s stay in the clinic is reduced to 20 days; 3) small doses of drugs are used; 4) repeated paroxysms are prevented; 5) the proposed method is feasible on an outpatient basis while maintaining operability.

Claims (1)

 A method of treating vegetative-vascular paroxysms by differentiated administration, taking into account the type of paroxysm of drugs, including tranquilizers and antidepressants, in the accepted therapeutic doses, characterized in that all patients are given antidepressants, adrenolytics, finlepsin as an anticonvulsant drug, and benzodiazepine drugs are used as tranquilizers and at the same time, patients with sympatho-adrenal crises are given antidepressants that do not have anticholinergic effects, or adaptogens and in patients with sympatho-adrenal and mixed paroxysms, the administration of adrenolytics is combined with the administration of lithium carbonate, treatment is continued for 18 to 20 days.