RU2206345C1 - Method for treating diencephalic syndrome - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out anode polarization of solar plexus ganglia in treating them with constant electric current of 800- 1000 mcA for 35-45 min daily during 10-15 days. The drug dose is step-by-step reduced beginning from 5-6 treatment day to cancel them reach their completely to the treatment end. The treatment is repeated when needed not earlier than in two months. EFFECT: accelerated treatment course.

Description

 The invention relates to medicine, namely to neurology, and may find application in the treatment of central autonomic disorders.

 Diencephalic syndrome (hereinafter - DS) refers to the most common types of neurological pathology. The most common form of DS, known as vegetative-vascular dystonia, occurs in 31% of urban residents over 10 years of age, with a significant predominance among women. Its frequency increases during the period of greatest disability. The consequences of DS in the form of vascular cardiological and cerebral disasters, severe endocrine pathology in more than 40% of cases lead to persistent disability. The incidence of DS shows a clear tendency to increase, especially in industrial countries. A characteristic feature of this disease is its pronounced resistance to all currently available treatment methods.

 DS is a polyetiological disease with polymorphic symptoms. Isolation of DS in an independent clinical diagnostic form is due to a common pathogenetic mechanism, the core of which is a persistent increase in the excitability of diencephalic (hypothalamic) brain structures, leading to dysregulation of various visceral, neurohumoral and psychoemotional functions.

 Currently, conservative methods of treatment, such as drug therapy, physiotherapy, radiotherapy, diet and balneotherapy, are used to treat DS. Drug therapy is primarily symptomatic and is aimed primarily at normalizing the functions impaired in this form of DS: blood circulation, digestion, internal secretion, and psychoemotional tone.

 Closest to the proposed is a method of drug therapy of DS through the introduction of medicinal benzodiazepine groups (Relanium), which reduce the excitability of the nerve substrate, in particular the brain stem structures, as well as symptomatic agents. This method is taken by us as a prototype (Vane A.M., Solovyova A.D., Kolosova O.A. Vegetative-vascular dystonia. - M .: Medicine, 1981, p. 276; Schaefer D.G. Hypothalamic syndromes. - M.: Medicine, 1971, p. 340).

It consists in the fact that patients with DS are given orally relanium in an amount of up to 10 mg per day, and the following drugs are administered as symptomatic therapy, depending on the prevailing symptomatology:
1) vasodilator: cinnarizine 25 mg 3 times a day, cavinton 5 mg 3 times a day or other vasodilator;
2) hypotensive: clonidine at 0.075-0.15 mg 2-3 times a day;
3) antispasmodics: no-spa at 40-80 mg 1-2 times a day;
4) regulators of peristalsis: cerucal 10-20 mg 1-2 times a day;
5) adrenergic blockers: anaprilin 10-40 mg 2-3 times a day, pyroxan 15-30 mg 2-3 times a day;
6) antidepressants: ametriptyline 25 mg 2-3 times a day;
7) vitamins of group B, C;
8) electrolytes and trace elements: panangin 1 tablet 3 times a day, potassium orotate 0.5-1 g 3 times a day;
9) antihistamines: suprastin 25 mg 1-2 times a day;
10) diuretics: furosemide 40 mg once a day.

 Vegetative paroxysms in patients with DS with this method of treatment are stopped by parenteral administration of a 0.5% solution of Relanium in a dose of up to 4-6 ml.

 This method of treatment of DS allows in most cases to achieve a positive effect in the form of improving the general well-being of patients, some weakening of the main symptoms of the disease, and in some cases - reduction of vegetative paroxysms and a decrease in their severity. In isolated cases, the onset of short-term remission lasting up to 1-2 months is possible. Relapses of the disease are usually associated with the influence of exogenous factors (geomagnetic fluctuations, weather dependence, stress), as well as with the cessation of medication. With the constant use of individually selected drugs, the course of the disease is wave-like, periods of deterioration and well-being of patients can also be associated with addiction to the drugs used, which forces either to increase doses to acceptable limits, or to switch to the use of analogues. The duration of hospital stay in such patients is from 5 weeks to 2-3 months, depending on the severity of the condition, outpatient treatment is carried out for life. There is no cure for DS.

As you can see, the disadvantages of this method of drug therapy of DS are:
1) the indiscriminate, diffuse nature of the effect on the body;
2) long periods of stay in the hospital, which is associated with an individual selection of therapy;
3) the need for constant, almost lifetime, medication;
4) the possibility of side effects from potent drugs,
5) the possibility of getting used to certain drugs, in the first place - to tranquilizers;
6) polyprogramia;
7) the mandatory need for repeated inpatient treatment to change the scheme of drug therapy.

 The use of other, known to us from the literature and permitted, methods of treating DS (physiotherapy, balneotherapy, spa treatment, etc.) does not significantly affect the condition of the ballroom.

 To date, methods of local conservative effects on solar ganglia in diencephalic syndrome have not been used.

 The technical result of the present invention consists in reducing the length of hospital stay to 10-14 days, reducing the number of drugs used to 1-2 drugs and reducing their dosages by 2-3 times, until they are completely canceled.

 This result is achieved by the fact that in addition to the described method of drug therapy for patients with DS, anodic micropolarization of the solar plexus ganglia is performed by applying direct current of 800-1000 μA for 35-45 min daily for 10-15 days, and starting from 5-6 day, the number of drugs administered is gradually reduced until they are completely canceled by the end of treatment, and this effect is repeated if necessary not earlier than after 2 months.

 Having been treating patients with focal brain lesions for several years, we, along with surgical treatment and drug therapy, tried to apply anodic polarization according to the transcranial micropolarization technique - TCMP (Bogdanov O.V. et al. RF Patent 2122443 from 01.07.1997 ), applying electrodes to the scalp in the areas of projection of acute lesions (Naryshkin A.G., Shelyakin A.M., Tyulkin O.N., Gorelik A.L. A method for the treatment of acute focal lesions of the brain. RF patent 2188674 from 10.09 .2002).

 At the same time, we observed a high efficiency of such an effect and the absence of side effects. Attempts to apply this method for the treatment of DS are unknown to us.

 Observing recently, patient O., 50 years old, about a post-hilar toxic toxic solaritis with daily, violent, autonomic crises and the lack of effect of the use of drug therapy with ganglioblockers, tranquilizers and antispasmodics, we tried to conduct anodic polarization of the solar plexus by applying electrodes to solar points the front surface of the abdomen and using the same exposure parameters as with TCMP.

 After the fifth procedure, it suddenly turned out that for three days our patient had no solar vegetative crises. This prompted us to extend the polarization course to 10 procedures, which led to a regression of autonomic symptoms. This observation gave us the idea to clinically investigate the state of the solar plexus ganglia in patients with DS, since most of them had similar symptoms. It was found that in almost all patients with DS there is pain in the solar points, and objective clinical signs of autonomic irritation of one degree or another are noted.

 Then we tried to apply a similar method for the treatment of patients with DS, choosing experimentally the optimal exposure parameters. Depending on the specific situation and the severity of the pathological manifestations, the current strength ranged from 800 to 1000 μA, and the duration of one procedure was 35-45 minutes. The criteria for the optimal direct current when exposed to the solar ganglia and its duration were subjective sensations of drowsiness, the appearance of unpleasant sensations under the electrodes.

 With a direct current of less than 500-600 μA, these changes were not observed. With an increase in current strength above 1000 μA (1 mA), patients experienced unpleasant sensations under the electrodes, accompanied by redness of the skin. At an exposure time of less than 20 minutes, characteristic changes did not have time to develop, and with prolonged exposure over 45 minutes, some patients experienced unpleasant sensations in the form of heaviness in the head and epigastric region, feelings of anxiety, weakness.

 As our experience shows, this method of exposure to the ganglia of the solar plexus during DS allows you to effectively stop autonomic paroxysms, significantly reduce, up to the complete cancellation, the dose of drugs, as well as achieve persistent and long-term remissions. Moreover, this result is achieved by us in 1-2 weeks, depending on the severity of the disease.

 The essence and effectiveness of the method is illustrated by the following examples.

 Example 1

 Patient M., born in 1950, IB 4698/2001, was admitted 10.09.2001 with a diagnosis of "Cerebral arachnoiditis with diencephalic syndrome." Upon receipt of a complaint of intense headaches in the parietal-temporal sections, more on the right, persistent, compressive in nature, a feeling of interruption in the heart rhythm, a feeling of constant discomfort in the abdomen, tachycardia attacks with chills, trembling and a feeling of constriction in the limbs, a rise in temperature to subfebrile values, lasting up to 5-6 hours, by the resolution of which marked pollakiuria and diarrhea are noted.

 This deterioration within 6 months, the attacks became daily, anorexia appeared, in connection with which the patient lost 17 kg of weight, as well as insomnia, signs of a depressed state.

 From the anamnesis: similar symptoms from the age of 20, with a frequency of seizures up to twice a month, rheumatism, cerebral rheumatic vasculitis, minor chorea in the puberty, dull abdominal trauma without surgery at the age of 13, at the age of 36 - spontaneously developed severe pain in the lumbar-thoracic spine, forcing the patient to use crutches for 4 months, without convincing objective violations. Annual depressive episodes. It is observed by a physician with a diagnosis of coronary heart disease: atherosclerotic cardiosclerosis, paroxysmal tachyarrhythmia, urolithiasis, 2-sided nephroptosis of the 2nd degree, calculi of both kidneys.

 Constantly receives relanium up to 20-25 mg per day, with paroxysms - in the form of injections, amitriptyline 25 mg 2 times a day, ranitidine 0.3 g 3 times a day, anaprilin up to 40 mg per day, papazol and no-shpu with rises in blood pressure, as well as potassium orotate and multivitamin complexes.

 On examination: the skin is pale, dry, skin turgor is reduced. Heart sounds are muffled, heart rate of 76 per minute, occasionally - increased to 110 per minute with frequent extrasystoles, blood pressure 130/80 mm, vesicular breathing, abdomen soft, painful in all departments, with deep palpation - intolerable pain in the solar points, with a perverted pupil a reaction against which, at the time of the examination, a reduced vegetative paroxysm developed with chills, tremors, and redness of the skin of the upper body. Severe soreness with sliding palpation of large arteries, more on the right. Markelov's index of autonomic irrigation is 3. Neurologically: transient, weakly pronounced anisocoria on the right, deep reflexes somewhat enhanced on the right, coordinative tests with a slight intentional tremor, prevailing on the left.

 Blood, urine tests - without features.

 ECG - signs of left ventricular hypertrophy.

 Optometrist: small myopia.

 Computed tomography of the abdominal cavity - without pathological changes.

 Electroencephalogram: pronounced cerebral changes in the diffuse-organic type with signs of deep stem dysfunction of a predominantly diencephalic level.

 Based on the data of the clinical examination, the diagnosis was established: "Diencephalic syndrome of toxic-metabolic etiology with mixed-type vegetative paroxysms and generalized vegetative irrigation."

The patient was prescribed the following therapy:
1) Relanium - 20 mg per day;
2) anaprilin - 40 mg per day;
3) pyroxan - 30 mg 2 times a day;
4) cavinton - 5 mg 3 times a day;
5) panangin - 2 tablets 2 times a day.

 Against the background of this therapy, the headache somewhat decreased for three days, but the rest of the symptoms persisted, autonomic paroxysms were observed daily. Then she was offered a course of anodic polarization of the ganglia of the solar plexus. The current strength was 800 μA, with increasing current the patient had burning sensations under the electrodes, with a decrease - irritability and anxiety. When the procedure lasted more than 45 minutes, weakness and drowsiness occurred, the effect in the form of a feeling of general comfort and relaxation came on the 30th minute of exposure. After the third procedure, the patient stopped paroxysms, after the fifth - pain and discomfort completely regressed. From this moment, the patient herself stopped taking any medications, primarily tranquilizers. At the end of a course of 10 complaints procedures, neurological and somatic symptoms completely disappeared, the patient was discharged after spending 15 days in a hospital. Two months later, she went on an outpatient basis in connection with the resumption of discomfort in the epigastric region and dyspeptic complaints. A patient underwent a repeated course of anodic micropolarization. Subsequent remission is maintained to this day.

 Thus, the use of anodic micropolarization on the projection area of the solar ganglia made it possible not only for the first time and to fully alleviate the condition of a chronic patient, but also to eliminate drug dependence.

 Example 2

 Patient I., born in 1926, IB 1012/2002, was admitted on February 18, 2002, and we have observed it (A. G. Naryshkin) for more than 20 years. Complains of frequent, with worsening daily, seizures in the form of an intense burning-squeezing headache, pollakiuria, accompanied by pulling pains in the left abdomen, a rise in blood pressure to 250/120 mm, myasthenic-like symptoms, cooling and numbness of the limbs. The duration of the attack is usually 2-3 hours, stopped by the introduction of 2 to 6 ml of Relanium intramuscularly.

 History: malaria, tuberculous bronchadenitis, frequent stressful situations, strumectomy at the age of 7, measles with neurological complications, purulent appendicitis complicated by peritonitis, dysentery, tonsillocardial syndrome. Since 1978, attacks of burning pains in the left abdomen began to disturb, and in 1980, the above described attack first developed. Repeatedly examined and treated in various medical institutions. In 1984, in the clinic of the IEM of the Academy of Sciences of the USSR, complex therapy was selected, including gangleron and relanium, against which the frequency of attacks decreased by 2 times. Subsequently, she continued to use this scheme, independently adjusting the dose of drugs. Appealed in connection with the increase in seizures after the withdrawal of the drug gangleron from production.

 On admission: the skin is pale yellowish, dry, turgor is reduced, pronounced pastes of the legs, elements of alopecia. Slight trembling of the head and hands at rest. Sharp pain on palpation of the upper, middle, lower solar points, ribs, crests of the ilium. Soreness with sliding palpation of the vessels of the upper and lower extremities up to a. tibialis on the feet and a. radialis on the wrists, also - pain on palpation a. temporalis on both sides, more on the left. Emotionally unstable, tearful.

 Ophthalmologist: beginning cataract, retinal atherosclerosis.

 Therapist: chronic bronchitis, pneumosclerosis, pulmonary emphysema, respiratory failure 0-1 degree, hypothyroidism, coronary heart disease: atherosclerotic cardiosclerosis, circulatory failure 1-2 degrees.

 X-ray of the spine: common involutive osteochondrosis, pseudospondylolisthesis L5.

 Computed tomography of the abdominal cavity: no pathological changes in retroperitoneal tissue were detected. Atherosclerosis of the abdominal aorta.

 ECG: migration of the supraventricular pacemaker, incomplete blockade of the right leg of the bundle of His, deflection of the electrical axis to the left, left ventricular hypertrophy, impaired repolarization.

 EEG: pronounced diffuse changes in bioelectric activity with signs of deep stem dysfunction.

 Based on the medical history and the results of the clinical examination, the diagnosis was confirmed: "Diencephalic syndrome of infectious-metabolic genesis with autonomic paroxysms."

 Treatment was prescribed according to a scheme similar to that described in example 1, with the addition of aminophylline 15 mg 3 times a day, clonidine 0.075 mg per day and L-thyroxine, which the patient takes constantly. Additionally, the patient was offered a course of polarization of the solar ganglia with exposure parameters similar to those described in example 1.

 On the 4th day of hospitalization and after two sessions of micropolarization, paroxysms stopped and did not resume. After 6 treatments, overall well-being improved significantly, the emotional background increased, signs of vegetative irritation were reduced to an index of 1 according to Markelov. From this moment, a gradual abolition of drugs began: on day 5 - relanium, on day 6 - sympatholytics, on day 7 - vascular drugs. From day 8 of treatment, the patient did not take any medications except L-thyroxine. A total of 12 sessions were conducted. Discharged from the hospital on the 18th day. After discharge, she still feels well to this day; the only attack in a reduced form was noted in August 2002.

 Example 3

 Patient M., 53 years old, a disabled person of the 2nd group, came out on an outpatient basis, on the recommendation of the attending physician, in June 2002 complaining of constant weakness and high fatigue, frequent polymorphic headaches with dizziness and nausea, sleep disorders, various dyspeptic disorders , frequent rises in blood pressure with a picture of hypertensive crises (from 2 to 6 times a month), stopped only by ambulance teams, allergic manifestations in the form of urticaria, rhinitis, bronchial asthma with more frequent asthma attacks, accompanied by chills, paresthesias , cooling and numbness of limbs. Constantly takes Relanium 5 mg up to 4 times a day, various anti-allergic and antihypertensive drugs.

 He suffers from this disease from the age of 26 when he suffered a hypertoxic form of influenza. The disease is progressively progressive in nature. She was repeatedly examined and treated in hospitals with diagnoses of: diencephalic syndrome, neurasthenia, infectious-allergic bronchial asthma, coronary heart disease: atherosclerotic cardiosclerosis, hypertension 2 tbsp., Cholelithiasis, chronic pancreatitis, chronic enterocolitis. The last seven years has a 2nd disability group.

 History: measles, scarlet fever, dysentery, frequent sore throats, tonsillectomy, vegetovascular dystonia, twice a concussion in the youth, there is also a chronic psychotraumatic situation in the family: the son suffers from a mental illness.

 On examination: the skin is pale, moist, pasty, pronounced red dermographism. Heart sounds are muffled, blood pressure -150/90, in the lungs - hard breathing. The abdomen is soft, painful in all departments. There is a sharp pain in the solar points, the index of vegetative irritation is 3 according to Markelov.

 EEG: pronounced trunk dysfunction with a predominance at the level of the diencephalic region, with a decrease in the threshold of convulsive readiness.

 A patient was given an outpatient course of anodic micropolarization of the solar plexus ganglia with a current strength of 1000 μA, since at a lower current strength a characteristic effect in the form of drowsiness and relaxation did not occur. The duration of the procedure was 35 minutes, since with increasing exposure time the patient appeared discomfort and a sense of anxiety. Improvement of health was noted with the fifth in a row procedure, asthma attacks stopped, blood pressure was established at 130/80 mm. Since then, relanium has been canceled, a gradual decrease in clonidine doses has been started according to the generally accepted scheme (in order to avoid withdrawal syndrome). A total of 12 procedures were performed. At the end of the course, there is a regression of pain and discomfort, manifestations of allergies, an improvement in the psychoemotional state, restoration of night sleep, and stabilization of blood pressure at 125/80 mm. Taking medications is completely stopped.

 In the future, after a two-month remission, a partial resumption of the previous symptoms in a reduced form was noted, the patient again began to take relanium - 1-2 tablets per week. A repeated course of micropolarization is currently underway.

To date, the proposed method has treated 6 patients with a diagnosis of "Diencephalic syndrome": 4 women and 2 men. Age - from 26 to 73 years, the disease is from 5 to 33 years old. All patients showed marked and persistent improvement in well-being, positive dynamics of clinical and laboratory tests. Four of them completely stopped taking medications, two switched from a constant to an episodic intake of tranquilizers with rare and mild attacks of the disease. Three patients of retirement age switched to an active lifestyle, two, having a disability of the 2nd group, returned to work. The number of courses ranged from 1 to 3, the timing of the currently observed remissions is from 2 to 8 months. The available observations, therefore, indicate the high efficiency of the proposed method, which, in comparison with known other methods, has several advantages:
1) significantly reduces the treatment time - up to 2-2.5 weeks, while the treatment time for patients with DS in other ways is from 5 to 6 weeks;
2) reduces the number of drugs administered to 1-2 drugs and allows to reduce their dosage, up to the complete cancellation, while conventional drug therapy includes a large (up to 5-7 drugs for an individual patient) number of drugs and often allows increase in dosages.

 The method was developed and passed clinical testing in the neurosurgical department of the City Hospital 23 of St. Petersburg.

Claims (1)

 A method of treating diencephalic syndrome by means of tranquilizers and symptomatic drugs, characterized in that they additionally conduct anodic micropolarization of the ganglia of the solar plexus, exposing them to a constant electric current of 800-1000 μA for 35-45 min daily for 10-15 days, moreover, starting from the 5-6th day, the amount of drugs administered is gradually reduced until they are completely canceled by the end of treatment, and such effects are repeated if necessary no earlier than 2 months later.