RU2168997C1 - Method of treating diseases of subcortical nervous system - Google Patents

Abstract

FIELD: neurology and neurosurgery. SUBSTANCE: spatial position of patient is preliminarily changed from orthostasis to antiorthostasis. If one observes pathological symptomatic regress in patient's position of head below level of legs by 30-45 deg., intratympanical streptomycin is administered on the side opposite to maximally expressed symptomatic. Injection is performed 2 times a week during 1 to 2 weeks in doses 0.5 to 1 g. If necessary, treatment course is repeated but no sooner than 6 months later. EFFECT: achieved more durable and stable remission or completely regressed symptomatic. 4 ex

Description

 The invention relates to medicine, more specifically to neurosurgery and neurology, and may find application in the treatment of extrapyramidal pathology.

Extrapyramidal pathology is represented by a whole group of various pathological neurological disorders, which are combined into clearly defined clinical syndromes, often with nosological certainty. So, the most common extrapyramidal diseases are: parkinsonism, torsion dystonia, Huntington's chorea, cervical dystonia, athetosis, various complex hyperkinesis of topical, phase and mixed nature
Diseases of the extrapyramidal system are so different from each other in the clinical picture that they often have completely opposite features. So, parkinsonism is characterized by poverty, slow motion with a sharp increase in muscle tone, while Huntington’s chorea is characterized by redundancy, slackness, harshness, suddenness of pathological movements against the background of a decrease in muscle tone.

 Diseases of the extrapyramidal system are polyetiological - factors such as heredity, various viral infections, injuries of the nervous system, and various vascular diseases play a role in their development. However, in most cases, the etiological factor in patients definitely cannot be established.

 Diseases of the extrapyramidal system occur at working age, have a progressive course and, ultimately leading to permanent disability, are not only a serious medical problem, but also a subject of significant social significance.

 Such diseases are considered incurable, belong to severe chronic, progressive pathology, and patients are most often attributed to the category of incurable invalids.

 There are conservative and surgical methods for the treatment of extrapyramidal pathology. Currently, conservative (drug) methods are preferred. However, they require constant use of drugs, the dose of which should be steadily increased, which ends with the addition of serious side effects. In other words, conservative therapy in this category of patients is characterized by the occurrence of addiction and dependence with a steady decrease in the effectiveness and increase in the number and severity of adverse events.

 Drug therapy for diseases of the extrapyramidal system is aimed at modulating the activity of the dopaminergic, adrenergic and cholinergic systems in various combinations [1]. In those diseases that are accompanied by poverty of movement, muscle rigidity, hypoxia, drugs that activate dopaminergic (levodopa drugs, direct agonists of dopamine receptors, such as parlodel etc.) and inhibit cholinergic transmission (various representatives of central M-cholinolytics) are prescribed [2]. In diseases accompanied by redundancy of movements in the form of various types of hyperkinesis, drugs that suppress dopaminergic transmission (antipsychotics of various groups) are used [1]. In a disease such as cervical dystonia, the only drug that can achieve a more or less satisfactory result is clonazepam, a drug with a GABAergic effect [3].

 In local forms of dystonia (facial hemispasm, cervical dystonia), which also belong to diseases of the extrapyramidal system, a method has been used in recent decades to treat injections of microdoses of botulinum toxin into “affected” muscles. The method is effective in 71% of patients [4], but the effect lasts on average no more than 2 months and reaches only 75% in 17% of patients [5]. With repeated courses of treatment, the effectiveness of the method decreases with an increase in the frequency of adverse events [6].

 Various physiotherapeutic, psychotherapeutic methods, exercise therapy can be considered as auxiliary methods and do not have independent significance [1].

 In cases where conservative therapy is ineffective or its possibilities are exhausted, surgical treatment is used. It is used in diseases such as parkinsonism, torsion dystonia, choreiform hyperkinesis, cervical dystonia [7]. For all types of extrapyramidal pathology, standard structures are defined - targets that are subject to stereotactic destruction. The most commonly used are thalamotomy and pallidotomy [8, 9], most often bilateral, which with certain types of extrapyramidal pathology (cervical dystonia) can be supplemented by surgical peripheral denervation methods (neurotomy, radicotomy) [8]. In cervical dystonia, specific techniques have been proposed, such as decompression of the accessory nerve [9], stereotactic destruction of the Kakhal nucleus [10]. In the past decade, with parkinsonism, the method of neurotransplantation of embryonic tissue into various formations of the striopallid system has been tested [8, 11].

 All the proposed methods are quite laborious, requiring special equipment, and expensive. A positive result is observed in 80 - 90% of patients, but it is very insignificant [8]. Patients are forced to continue the constant intake of medications to achieve a complete cure.

 All this suggests that the search for more effective, less time-consuming and less expensive methods of treating diseases of the extrapyramidal system is a highly relevant task.

The most common diseases of the extrapyramidal system are:
- Parkinsonism is a chronic polyetiological disease of the human nervous system, which is manifested by disorders of the predominantly motor sphere in the form of symptoms of hypokinesia, tremor and muscle rigidity. The incidence of Parkinsonism reaches 1 - 1.5 per 1000 population. Distinguish between trembling, rigid and zakinetic forms of parkinsonism, although in most cases mixed forms are observed in patients. All modern methods of treating parkinsonism do not prevent the progression of the pathological process. Among patients with parkinsonism, the most commonly encountered is a rigid-akinetic form, for the treatment of which, as mentioned above, a conservative and, as a last resort, surgical treatment is used. Drug treatment for these patients is prescribed for life and, nevertheless, it is not effective enough and is accompanied by numerous serious side effects.

 - Huntington's chorea in most cases is a hereditary disease that is transmitted according to an autosomal dominant principle [12]. Symptoms of the disease boil down to choreatic involuntary movements of the muscles and to a gradually increasing decline in intelligence. The frequency of occurrence of diseases is from 5 to 10 cases per 100,000 population [8]. Huntington's chorea conservative therapy is carried out by oral administration of haloperidol, which has a side effect in the form of a deforming effect in the development of a state of doubt. During surgery - lysis of the ventrolateral thalamus nucleus and subthalamic region - manifestations of choreatic movements may decrease [8].

 - Cervical dystonia or spasmodic torticollis is a disease that occurs in the occurrence of dystonia of the cervical muscles, which is accompanied by a pathological position of the head, affects people of working age, has a progressive character and leads to disability.

 The present invention relates to the treatment of these very severe neurological diseases.

 The mentioned surgical methods for their treatment with clearly insufficient effectiveness are often fraught with serious neurological complications, which are the subject of additional serious disability.

 Closest to the proposed are medical methods that require, as mentioned above, the additional prescription of drugs (for life), a steady increase in their dosages, which is accompanied by the addition of serious side effects while reducing the effectiveness of therapy [2].

 The technical result of the present invention is to reduce the treatment time and lengthen the remission by creating a counterdominant pathological process.

 This result is achieved by the fact that the patient is preliminarily changed the position of the body in space from orthostasis to anti-orthostasis and, if in the head position 30–45 degrees there is a process of pathological symptomatology, then he is intrathymprally 2 times a week for 1–2 weeks on the opposite side maximum severity of pathological symptoms, a solution of streptomycin in the amount of 0.5 - 1.0 g per administration is administered and, if necessary, such administration is repeated no earlier than after 6 months.

 Having been professionally involved in the treatment of extrapyramidal diseases of the nervous system for many years, we were looking for an opportunity to help this difficult group of patients. We were interested in the work of Magnus in literature [13], who showed in an animal experiment that with a one-sided disturbance of the labyrinth, the experimental animals showed a head turn towards the destroyed labyrinth, it stayed indefinitely and disappeared only after the destruction of the preserved labyrinth. In addition, the author found that if you then rotate the animal around the frontal plane, you can find a position in which the rotation of the head disappears. At the same time, he noted that the severity of head rotation decreased as the evolutionary organization of the animal increased in monkeys, for example, it was almost invisible. Nevertheless, we tried to repeat this process in a patient with cervical dystonia (spasmodic torticollis), which, according to Magnus, he should not have taken place. We managed to find the position of the patient, namely in the position of his head below the level of the legs by 30 - 45 degrees, in which there was a complete regression of the symptoms of cervical dystonia. This allowed us to suggest that the gravity analyzer plays a significant role in the pathogenesis of cervical dystonia. Studying for a long time the problems of neurosurgery and neurology and encountering patients who had the labyrinth apparatus completely turned off on one side (unilateral inflammatory vestibulopathies, auditory nerve neuromas), we never observed cervical dystonia in such patients, which made an assumption about the participation of the vestibular apparatus in pathogenesis of spastic torticollis is unlikely. Despite this, we tried for the treatment of spasmodic torticollis, the method of intracranial transtimpanic vestibular chemical deception, which was the intratympanic administration of a vestibulotoxic antibiotic on the opposite side of the head turn. The results of the treatment of the first patients with cervical dystonia were published by us in order to get feedback from specialists in the treatment of this "incurable" pathology [14, 15]. It should be noted that the reaction of scientists to our speech at a meeting of the Presidium of the Society of Russian Neurosurgeons in May 1999 was mixed, but the results of treatment of patients convinced them, although they were astounded. We decided to continue our research with the aim of expanding the circle of patients to be treated. First of all, we began to use the mentioned test to identify the effect of the vestibular analyzer on the symptoms in other diseases of the extrapyramidal system. To our great surprise, we observed an increase in symptoms in the head position down 30 degrees in patients with parkinsonism (complete cessation of muscle rigidity), and with Huntington's chorea (lack of choreatic involuntary movements), and in a patient with complex extrapyramidal hyperkinesis, i.e. patients with diseases of the extrapyramidal nervous system, precisely those of them who have progressive disorders and disorders of muscle tone. This test later became predictive for the selection of patients for treatment. The first positive results of treating patients with Parkinson's disease and Hastington's chorea further convinced us of the correctness of the choice of the method of intracranial transtimpanal injection of the vestibulotusic drug for the treatment of patients with extrapyramidal pathology.

 The use of streptomycin as a vestibulotoxic drug is justified by the fact that this antibiotic is widely known in medical practice and, in addition, we have tested it in the treatment of cervical dystonia.

 Intrathimpanic administration of streptomycin on the side opposite to the maximum severity of symptoms, in our opinion, causes denervation of the receptors of the statolith apparatus, and according to the Kennon-Rosenbluth law, the phenomenon of denervation hypersensitivity develops in denervated structures, which causes the creation of a counterdominant that compensates for disturbed nervous processes.

 Doses and modes of administration of streptomycin were found by us in the course of treatment and based on its results. Despite a large single dose of streptomycin in no patient, we did not observe its cochleotoxic effect. In our opinion, this is explained by the fact that, with intrathymal administration, streptomycin penetrates the cochleovestibular system by transmembrane diffusion through the membranes of round and oval openings that open into the sac and uterus. It is here that the receptors of the statolith apparatus are located, which, according to Magnus, is involved in the regulation of posture. The remaining parts of the inner ear are located more distant from the diffusion site of streptomycin. An antibiotic that penetrates the endolymph and dissolves in it, apparently, in separate parts of the inner ear, does not reach a toxic concentration. At the same time, with systemic administration, streptomycin reaches the formation of the inner ear through the circulatory system and, accordingly, affects the most blood-supplying organ (cochlea).

 The essence of the method is as follows.

 A patient with extrapyramidal nervous system disease (cervical dystonia, parkinsonism, Huntington’s chorea and other extrapyramidal hyperkinesis) is intratympanically injected with 0.5-1 g of streptomycin sulfate in 1 ml of 1% novocaine solution 2 times a week for 1 to 2 weeks. The criterion for the end of treatment is the appearance of signs of drug vestibulopathy in the form of dizziness, unsteady gait. Treatment is carried out under electromyographic, electroencephalographic and vestibulocochleometric control.

 In patients with parkinsonism, extrapyramidal muscle rigidity on both sides disappears completely, a significant decrease in oligo- and bradykinesia, an increase in the rate of movement, a revival of facial expressions, and a decrease in characteristic vegetative disorders.

 In patients with extrapyramidal hyperkinesis, a decrease in the amplitude of movements, their reduction, an improvement in voluntary motor activity, and an improvement in self-care are observed.

 In all treated patients with spastic torticollis, a positive effect in the form of a regression of neurological manifestations of the disease was noted six months after the course of treatment. In 15% of patients, symptoms after the first course of treatment did not completely regress (severity of regression - 75%), which was the reason for repeated courses of treatment. Conducting 2–3 courses of treatment was required only in four out of 45 patients; in the rest, pathological symptoms regressed after the first course of treatment for 6–9 months.

 In 2 patients with parkinsonism, 2 patients with Huntington’s chorea, 1 patient with complex extrapyramidal hyperkinesis, a significant improvement was achieved, which has persisted for several months and the effect continues to gradually increase. The results of the treatment of spastic torticollis, the similarity with them of the development of the effect and its gradual increase, which we have also seen in patients with other types of extrapyramidal pathology (parkinsonism, Hastington's chorea) allow us to hope for good and excellent treatment results with these nosological forms of extrapyramidal pathology.

 The essence of the method is illustrated by examples.

 Example N 1. A. Stogov, 56 years old, N East. b-ni 5268, was treated in the neurosurgical department of b-tsu N 23, St. Petersburg from 15.12. on December 27, 1999, with a diagnosis of complex extrapyramidal tonic-clonic hyperkinesis of the neck, upper body, proximal upper limbs, and a person with a predominance of left-sided anterotorticollis.

 Sick for about 5 years. In December 1994, without obvious reason, painful sensations appeared in the cervical muscles and the symptoms of anterotorticollis with left-sided lateralization gradually formed, followed by choreiform hyperkinesis of the proximal upper limbs predominant in the left arm, clonic-tonic hyperkinesis of the facial muscles. Hyperkinesis in the proximal parts of the upper extremities is sometimes paroxysmally enhanced with the occurrence of an attack of bilateral hemiballism.

 Repeatedly treated in various neurological hospitals in Moscow, Moscow region, Tver, including the Research Institute of Neurology without effect. From 11/23 to 12/15/1999 he was treated in the neurosurgical department of NIPNI them. Acad. Ankylosing spondylitis also without effect. Transferred for further examination and treatment in the neurosurgical department of the hospital N 23 of St. Petersburg. A disabled person of the second group over the past 3 years.

 On examination, the head is constantly tilted forward and rotated to the left to 15 degrees. Against this background, as at rest, and more often during physical exertion, there are sharp tonic-clonic nodding and bow violent movements, accompanied by rotation to the left and bringing the left shoulder. We also have small-scaled tremor of the fingers and hyperkinesis of the facial muscles (periodic involuntary frowning of the eyebrows, involuntary sardonic grimace. Because of hyperkinesis, he cannot walk long distances, has recently been practically out of the house, self-care is difficult, night sleep is disturbed. Performing additional methods EEG, CTG examination is impossible due to the severity of violent movements. When conducting a gravity test in the position of the patient lying on his back with the body position from the head Oh, dropped down 30 degrees, there is a disappearance of manifestations of hyperkinesis.

 On December 17, 20, 12, December 23, 1999, intratympanic administration of 1 g of streptomycin sulfate diluted in 2 ml of 1% novocaine solution to the right was carried out. The effect in the form of a weakening of the severity of hyperkinesis was observed 1 day after administration, however, it was unstable in the first 3 days when the severity of hyperkinesis fluctuated both during the day and from day to day. After carrying out subsequent intrathympanic procedures, the stability of the effect and its severity increased. Violent nodding and bowing movements occurred much less frequently, the severity and duration of which decreased significantly, the attacks of hemiballism disappeared, the head turned to the left, the night's sleep was normalized. The patient was discharged under the supervision of a neurologist at the place of residence (Tver region) on 12/27/1999, he independently purchased a ticket and left unaccompanied, although he came to Petersburg accompanied by his daughter and for the last 2 years he did not even travel for short distances on his own.

 Example No. 2. Dobrovolskaya Z.A., 68 years old. I was treated in the neurosurgical department of the hospital N 23 of St. Petersburg from 7.02 to 02.23.2000 with a diagnosis of Chorea Huntington.

 Considers himself ill for about 5 years. The onset of the disease for no apparent reason was characterized by the appearance of violent phase movements in the left hand. The structure of hyperkinesis gradually expanded, violent movements appeared in the right hand, lower extremities with the addition of postural and athetoid disorders (torso to the left, tonic athetoid movements in the distal upper and lower extremities), the possibility of self-care, independent movement, sharply decreased in the last 3 years does not leave the house, takes food with outside help. According to her husband, a decrease in memory, intelligence, emotional impoverishment is noted. The last 3 years - a disabled person of the first group. Takes occasionally haloperidol. He receives up to two annual inpatient courses at the War Veterans Hospital.

 On examination, marked hyperkinesis of the extremities, trunk, and face pays attention. Violent movements are explosive generalized in nature, starting with the proximal left hand. The patient is constantly in motion, while the muscles of the upper and lower extremities are involved in hyperkinesis, hyperkinesis begins with the choreic component and goes into athetoid hyperkinesis with a short fixation of the pathological posture, the muscles of the trunk are involved in hyperkinesis with sudden flexion, like bows, and extension of the trunk, which are accompanied by its rotation to the left. In aggregate, hyperkinesis vaguely resembles traditional Indian or Japanese dances in their caricature performance. Hyperkinesis of mimic muscles and muscles of the upper respiratory tract is also noted in the form of grimaces, grimaces, accompanied by pathological additional puffs, sometimes with involuntary vocalization. When walking, hyperkinesis retains its structure, sharply deforming the gait, slowing it down, while walking even for short distances requires high energy costs, cannot reach the toilet in the department and sends natural necessities to the vessel. It accepts liquid food from a spoon only with the help of others. In the supine position, hyperkinesis is less pronounced and extends only to the muscles of the limbs and facial muscles. Such additional examination methods as CTG and EEG cannot be carried out due to pronounced motor artifacts. When conducting an entigravity test in the head position 30 degrees below the horizontal, all hyperkinetic manifestations completely disappeared. Given the predominant left-sided lateralization of symptoms, intrathymal administration of streptomycin was carried out on the right. Streptomycin sulfate was administered at a dose of 1 g, respectively, according to the proposed method. 4 procedures were performed. The effect was observed after the first injection, however, as in the previous example, it was unstable, changing throughout the day and day to day. A stable effect was achieved after 4 injections. A marked weakening of the amplitude of hyperkinesis, a decrease in their frequency, a significant weakening of the severity of postural disorders, improved gait (can make up to 4 normal step movements), can use liquid food on his own with a spoon, started to walk along the corridor of the department, goes to the toilet on his own, enrichment of the emotional sphere is noted , increasing the pace of thought processes. Discharged under the supervision of a local neuropathologist. By telephone on 04/23/2000, the husband said that the achieved effect of the treatment remains and there is a tendency to increase, the patient can wash the dishes, which she could not do for the past two years.

 Example No. 3. Becker R.M., 64, was treated in the neurosurgical department of the hospital N 23 of St. Petersburg from 02.15 to 03.16.2000. Diagnosis: parkinsonism. Rigid-akinetic form of the second stage.

 Considers himself ill since 1990, when he first drew attention to the violation of the letter. The disease was gradually progressive in nature: stiffness, slowing down of movements increased, difficulties in self-care gradually increased, difficulties appeared in initiating movements, the voice changed. He was treated and examined in various hospitals of the city. Currently, cyclodol 0.002 is constantly taken at 1 t. 3 times a day, but 1 t. 2 times a day. The disease continues to progress steadily.

 On examination, the movements are slowed down, motor acts are significantly impoverished, gait shuffling, with “sticky legs”, slowing and exhaustion of motor acts, amimia, voice is quiet, damping, anteropulsation. Muscle tone is significantly increased in plastic type with the symptom of a “gear wheel” more in the right extremities, achiurokinesis, aykoria, bent posture. The patient had significant difficulties with self-care, getting out of bed, using cutlery during breakfast (receiving nakoma at 10 a.m.). When conducting an anti-gravity test in the upside down position by 30 degrees, a decrease in muscle tone to normotonia with its equalization on both sides is noted, an increase in the rate of active movements, a decrease in their exhaustion. After the test in an upright position for about 2 to 3 minutes, normalization of gait, the disappearance of anteropulse, straightening of the torso, and the appearance of the hand signal when walking are observed. The effect lasted about 1 to 2 minutes and was gradually depleted.

 Given the predominant severity of symptoms on the right, the patient received an intratympanic administration of streptomycin on February 23, 2000 according to the described scheme on the left. After the first injection over the next 3 days, the patient showed a gradually progressive decrease in muscle tone in the right (contralateral) limbs, mainly in the arm. On the 2nd - 3rd day, a decrease in tone in both lower limbs and in the muscles of the trunk on the right was noted, as a result of which asymmetry appeared in the position of the shoulders. Since the patient continued the dynamics of the existing symptoms with its daily change, the next injection was postponed until the condition stabilized. By the time of the second injection, the patient’s symptoms were much less pronounced (about 50%), the symptoms had stabilized. 02/29/2000, repeated intrathymal administration of 1 million units. streptomycin sulfate on the left. After the procedure, the next day, a decrease in muscle tone to hypotension on both sides was symmetrical and the appearance of severe dizziness with large-scaled nystagmus to the left, staggering gait, an increase in oligo- and bradykinesia. The development of signs of severe vestibulopathy required its treatment: iv administration of sodium bicarbonate 3% was carried out in increasing doses for 6 days, dexamethasone 4 mg daily i / m N 5. Against the background of the treatment, regression of the manifestations of left-sided vestibulopathy and an increase in the therapeutic effect concerning symptoms of parkinsonism. When discharged March 16, 2000 - normotonia in the limbs, the tone is symmetrical on both sides, normalization of the posture (disappearance of stiffness of the posture), decrease in brady and oligikinesia, increase in the rate of movement, significant improvement in gait, the step became wider, the anteropulses disappeared, normal synkinesia was restored (there was a go-ahead while walking), hypomimia, greasiness of the face decreased, self-service significantly improved. When interviewing the patient by telephone on 04/27/2000, the effect continued to increase, stopped taking Nakoma, and continued to take cyclodol, 1 tab. 3 times a day.

 Example No. 4. Komissarenko O.I. 30 years old, medical history N 883. She was treated at the clinic of the Brain Institute of the Russian Academy of Sciences from 11.11 to 12.19.1990. Diagnosis: chronic arachnoencephalitis with cerebrospinal fluid syndrome. Subcortical hyperkinetic syndrome with a predominance of right-sided spastic torticollis (torticolis).

 Sick from 13 years old, when after the transferred flu appeared hypertensive headaches, dizziness of paroxysmal nature, since February 1990, the appearance and increase in manifestations of right-sided spasmodic torticollis have been noted. She was treated in various clinics of Ukraine without a significant effect. Upon admission, a violent turn of the head by 70 - 75 degrees to the right, a sharp increase in the tone of the left sternocleidomastoid muscle with its hypertrophy, atony and atrophy of the right muscle of the same name, cannot turn the head to the left, cannot bring out and keep the head in a straight position. Nystagmus when looking to the left, generalized muscle hypotension. Tonic hyperkinesis of oral muscles. In the right hand is an athetose-like hyperkinesis with periodic rhythmic pronation in the right shoulder joint. When conducting an anti-gravity test in the position of the patient upside down at an angle of 30 degrees, the normalization of the position of the head is determined, the patient can freely turn his head to the left, keeps the head straight for unlimited time. The patient underwent a course of treatment: intrathymal administration of streptomycin sulfate 0.5 g in the left ear N 4 with a frequency of 2 times a week, followed by observation. The effect was noted the day after the first injection and slowly increased after each procedure. At discharge, there was a decrease in the violent turn of the head to the right to 45 degrees, it can turn the head to the left and hold the head in this position for a short time, the effect is mostly pronounced at rest, although the head turned to the right decreased while walking. After discharge, the effect gradually continued to progress; in April 1991, it can keep the head in a straight position while walking for a long time. In June 1991, participated in a kayaking trip. Repeated admission to the clinic on September 9, 1991 (N case history 690). Received with complaints of some difficulty turning the head to the left. When viewed from the normal position of the head, the tone of both sternocleidomastoid muscles is symmetrical on both sides. The head rotation is limited to 10 - 15 degrees. There is no hyperkinesis in the muscles of the facial muscles and in the right hand. Intratympanic administration of streptomycin sulfate to the left ear was carried out in a dose of 0.5 g with an interval of 3 days N 4. At discharge, an increase in the volume of active head rotation to the left to 70 - 80 degrees. There are moderate manifestations of vestibulopathy in the form of periodic dizziness. Discharged under the supervision of a local neuropathologist on 10/16/1991, the patient is still in contact with the patient, there are no manifestations of torticollis, hyperkinesis in the muscles of the face and right upper limb. Follow-up 10 years.

 The method in comparison with the known has significant advantages.

 1. The method significantly reduces the treatment time (from 2 to 4 weeks), while the existing methods involve lifelong administration of drugs with periodic hospitalizations up to 2 times a year to work out the necessary dose and correct side effects.

 2. The method provides the most pronounced effect both in terms of duration and severity. So, in patients with spastic torticollis, the symptoms completely regress and a positive remission occurs (up to a maximum of 10 years. With other types of extrapyramidal pathology (parkinsonism, Huntington’s chorea), the remission is currently several months and is expressed to such an extent that patients stop taking medications .

 3. The method is inexpensive, non-toxic, has no serious side effects, is not addictive, does not require the appointment of maintenance therapy.

List of references
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 5. Jedynak C.P., de Saint Victor J. F. Traitement du torticolis spasmodique par injections locales de toxine botulinique // Rev. Neurol. (Paris). - 1990. - Vol. 146, N 6 - 7. - P. 440 - 443.

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Claims (1)

A method of treating diseases of the extrapyramidal nervous system with drugs, characterized in that the patient is previously positioned in space from orthostasis to anti-orthostasis, and if in the patient’s head position below the level of the legs 30 - 45 ^o there is a regression of pathological symptoms, he is given intrathimpanically streptomycin on the side , the opposite of the most severe symptoms, and it is administered 2 times a week for 1 to 2 weeks, 0.5 to 1 g per administration and, if necessary, such a course of treatment is repeated ryayut not earlier than 6 months.