RU2248818C1 - Method for treating teenagers for hypothalamic syndrome of pubertal period - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying bitemporal progressing alternating magnetic field. Motion frequency is 1-12 Hz working surface inductance is equal to 10-30 mTesla units. The field moves from temporal to occipital lobe with gradually growing motion frequency by 1-2 Hz from session to session, beginning from lower boundary of frequency interval and changing field movement direction every 1-1.5 min when session is 8-12 min long.

EFFECT: enhanced effectiveness of treatment.

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Description

The invention relates to medicine, namely endocrinology and physiotherapy, and can be used to treat adolescents with hypothalamic syndrome of puberty (GSPP).

Common treatments for HSPP include a low-calorie diet, exercise therapy, dehydration therapy, antihypertensives, and vascular drugs. The deep location of the interstitial brain creates difficulties in treatment, the blood-brain barrier prevents the penetration of drugs, in most cases, patients receive symptomatic treatment.

A known method of treating patients with hypothalamic obesity using bitemporal diathermy [2]. The disadvantage of this method is that it creates a heating of the brain tissue, and the surrounding tissue warms up more than the hypothalamus. In this regard, this method is not currently applied.

Closest to the proposed method is a method of bitemporal inductothermy, developed by I.V. Tereshchenko in 1987 [A.S. No. 1138171 USSR, MKI A 61 N 1/42]. [1] The main influencing factor of bitemporal inductothermy is the high-frequency eddy currents that are induced in tissues under the influence of an electromagnetic high-frequency field. The disadvantage of the prototype is that bitemporal inductothermy has a thermal effect on the diencephalon, is contraindicated in the presence of a history of traumatic brain injuries.

We first proposed a method for treating adolescents with hypothalamic syndrome of puberty using bitemporal exposure to a running alternating magnetic field with a frequency of movement of 1-12 Hz and induction on the working surface of 10-30 mT, moving in the direction from the temporal lobe to the occipital for 8-12 minutes , with a gradual increase in the frequency of movement from session to session, starting from the lower boundary of the frequency interval, and a change in the direction of movement of the field to the opposite during the session every 1-1.5 minutes. The course of treatment is 10-12 procedures. The therapeutic effect is associated with the ability of the traveling PeMP to intensify the transmembrane transfer of ions, which can significantly affect synaptic transmission and improve the conductivity of the nerve impulse [3]. In addition, PeMP has a vasodilating, anti-inflammatory and sedative effect [4]. It is known that arterial and cerebrospinal fluid hypertension, autonomic disorders, and metabolic disorders are common manifestations of HSPP. Due to the vasodilating effect, traveling PeMP has a hypotensive effect, normalizes cerebrospinal fluid dynamics, and improves microcirculation of the hypothalamic-pituitary region.

Unlike high-frequency electromagnetic fields used to treat HSPP, an alternating magnetic field does not have a thermal effect, and at the same time it has high penetrating power, which allows it to affect the deep structures of the brain.

The method is as follows. Exposure to a traveling alternating magnetic field is carried out from the Atos apparatus, which is approved for use in medical practice (license No. 42 / 97-0137-0073 of 09.15.97), while the patient is lying on his back. Specially made inductors for impact on the head have induction on the working surface of 10-30 mT and are located bitemporally. The frequency of the magnetic field is in the range from 1 to 12 Hz, the duration of the procedure is 8-12 minutes. The course of treatment is 10-12 procedures daily.

The most appropriate for exposure to the hypothalamus, we consider the use of PEMP intensity of 10-30 MT. A further increase in the field strength from 30 to 40 mT did not affect the impact efficiency. Using higher intensity magnetic fields can have an undesirable effect. According to published data, in the induction of a field of 50 mT or higher, tissue respiration is inhibited [5] and adaptation reactions become pathological [4]. The lower limit of the interval is determined by the technical characteristics of the device.

The frequency range of 1-12 Hz is justified clinically and according to the results of cardiointervalography (CT). Examination and treatment was conducted for 96 adolescents with GSPP at the age of 11 to 15 years.

Patients (96 people) were divided into four groups, comparable in quantitative composition, age, sex, timing and severity of the disease.

In group I (28 people), patients were prescribed magnetotherapy according to the claimed method with a field frequency of 0.2-0.9 Hz, in group II (28 people) - with a frequency of 1-12 Hz, in group III (24 people) - frequency of 13-20 Hz. The use of higher frequencies of field motion is devoid of practical meaning, since in this case, the frequency of the field (more than 20 Hz) is comparable to the frequency of the solenoid supply (50 Hz) and the device solenoids cease to give a given induction. Group IV (control) consisted of 16 people who received placebo in the form of turned off inductors.

Most patients tolerated single PeMP procedures well, noted improved sleep, decreased headache intensity, decreased systolic and diastolic blood pressure. A negative effect in the form of headaches against arterial hypertension was noted during the first procedures in 2 patients, which served as the basis for interrupting treatment.

After completing the course of treatment, the following results were obtained:

In group II, headaches completely stopped in 76% of patients and their intensity decreased in 15%. A persistent antihypertensive effect was obtained in 82% of patients. A decrease in striatal syndrome was noted in 57% of cases. When analyzing cardiointervalograms in group II, normalization of the initial vegetative tone was found in 86% of patients with initial sympathicotonia and in 51% of patients with initial vagotonia. Of the 20 patients with hypersympathicotonic autonomic reactivity, 13 (65%) showed a positive dynamics when conducting an orthostatic test in the form of a decrease in the stress index and mode amplitude, an increase in mode and variation range.

In groups I and III, headache stopped in 50% and 57% of patients, respectively. A decrease in blood pressure was observed in 48% of patients of group I and in 63% of patients of group III. Reduction and blanching of striae was observed in 27% of patients of the first group and in 40% of patients of the III group. Normalization of autonomic tone in the initial sympathicotonia was found in half of patients of group I and 1/3 of patients of group III, with initial vagotonia - 25% of patients in both groups. When conducting an orthostatic test, positive dynamics of autonomic reactivity was observed in 30% of patients of group I and 25% of patients of group III.

In the control group, only 25% of children showed positive dynamics in the form of a decrease in headache intensity and a decrease in blood pressure. Manifestations of the striatal syndrome remained virtually unchanged. When analyzing cardiointervalograms, an improvement in autonomic regulation was observed in 12.5% of patients with initial vagotonia, and in sympathotonic patients, the CIG indices remained almost unchanged with conventional therapy.

Thus, the best treatment results were obtained using magnetic field frequencies in the range of 1-12 Hz.

The next stage of the study was that adolescents with hypothalamic syndrome of puberty were prescribed magnetotherapy in the frequency range from 1 to 12 Hz, while the frequency of movement of the field gradually increased from session to session by 1-2 Hz, starting from the lower boundary of the frequency interval. The study included 30 adolescents with hypothalamic syndrome, which we divided into 2 groups. In the first group (16 people), patients received magnetotherapy with a smooth increase in frequency from session to session by 1-2 Hz. In the second group, physiotherapy was prescribed at a fixed frequency throughout the course (10-12 sessions). The criteria for evaluating the effectiveness of treatment were the timing of the onset of clinical improvement (decrease in headache intensity, normalization of blood pressure), the number of patients with improvement, and the duration of remission.

Table 1 presents the distribution of patients in both groups in accordance with the period of onset of clinical improvement.

As can be seen from the table, in group 1, clinical improvement by 4-6 days from the start of treatment occurred in 94% of patients, while in the second group - in 28.6% of patients. By the end of the course, the percentage gap narrowed and amounted to 94% and 86% for patients of the first and second groups, respectively. However, the periods of remission in the first group of patients averaged 6-8 months, which was 3-4 months higher than the average periods of remission in the second group.

Similar studies confirm the feasibility of changing the direction of movement of the field during bitemporal exposure. The claimed interval of reversal of field movement (1-1.5 min) is clinically justified in three groups of patients. In the first group (10 patients), the interval ranged from 30 to 50 seconds, in the second (14 patients) - 1-1.5 minutes, and in the third (11 patients) - 1.6-3 minutes. An increase in the reversal time of more than 3 min is impractical because becomes comparable to exposure time.

It was experimentally established that by reversing the direction of field movement with an interval of 1-1.5 min, the treatment results are significantly improved by an additional 5-7% in the second group compared with the first and third. Moreover, in all groups, patients were assigned a running alternating magnetic field bitemporally with a frequency of movement of 8-12 Hz, an exposure of 10-12 minutes and a course of 10-12 procedures.

Example 1

Patient B-th A. 14 years old was admitted to the clinic of propaedeutics of childhood diseases 01.01.2001

Clinical diagnosis: Hypothalamic syndrome of the puberty period, primary, mixed variant (hypercorticism, neurocirculatory disorders, obesity), acute stage, rapidly progressing course.

From the anamnesis it is known that over the past 2 years there has been a “jump” in growth and rapid weight gain (increased by 20 cm and recovered by 15 kg), striae appeared 4 months before admission to the hospital, headaches began to disturb, gradually acquiring headaches persistent character.

On examination: Physical development is above average: height 178 cm, goes beyond 97 centile, body weight 76 kg, BMI 24. Sexual development IV tbsp. by Tanner. On the skin of the hips, shoulders, lower back, bright crimson striae are determined. The skin is moist with a marbled tint, folliculitis is pronounced. Blood pressure 110/70 mm Hg

REG: vascular tone is unstable with a tendency to decrease, the intensity of pulse blood supply is diffusely reduced, moderate spasm of small-sized veins.

Cardiointervalography: severe sinus arrhythmia. Vagotonia. Hypersympathicotonic autonomic reactivity. Dysregulation with a predominance of parasympathetic influences. Moderate weakening of the activity of the subcortical nerve centers.

The patient was treated with BPeMP with bitemporal exposure with a gradual increase in the frequency of field motion from session to session from 1 to 10 Hz, induction on the working surface of 20 mT, and reverse after 1-1.5 minutes. The duration of the procedure was 10-12 minutes, a course of 10 procedures. The treatment was carried out against the background of a sub-calorie diet.

Against the background of treatment, the headache stopped by the fifth session. By the end of the course of treatment, the venous outflow was restored on the rheoencephalogram, the intensity of the pulse blood supply improved by 25%. The dynamics of indicators of cardiointervalography (CIG) are presented in table 2:

Parameters of the CIG of a patient of B. A. at admission and after a course of treatment for BPeMP.

R-Rcp - average duration of the R-R interval

D is the dispersion

ΔX - variation range

IN1 - stress index in the patient lying position

IN2 - voltage index in orthostasis position

BP - vegetative reactivity

ADV - the amplitude of the respiratory waves

AMB1 - the amplitude of the slow waves of the first order

AMB2 - the amplitude of the slow waves of the second order

Table 2 KIT parameters Before treatment After treatment R-Rcp, sec 0.8 0.86 D 0,07 0,042 Ah sec 0.59 0.34 IN1, c.u. 16.3 24.6 IN2, cu 82.8 54.3 BP 5.1 2.2 ADV 83 48 AMB1 34 26 AMB2 34 24

As can be seen from the table, after the course of treatment, there was a tendency to normalize the initial vegetative tone, as evidenced by an increase in IN1 from 16.3 cu up to 24.6 cu A decrease in variational range and variance indicated a decrease in parasympathetic effects on the heart. The indicator of vegetative reactivity after treatment was normal. The ADV index decreased by 1.7 times and almost equaled the total amplitude of the slow waves, which indicated the normalization of the activity of the subcortical nerve centers.

Upon examination of the patient a month after the treatment, body weight decreased by 4 kg, BMI of 22.5, striae turned pale, new striae were not found, health was not affected, bulimia decreased, blood pressure - 100/70 mm Hg

Thus, this example illustrates the positive effect of bitemporal magnetotherapy on the state of autonomic regulation and cerebral circulation, as evidenced by indicators of cardiointervalography, rheoencephalography. The use of BPeMP in combination with a sub-calorie diet allowed to reduce BMI, reduce striatal syndrome.

Example 2. S-in D. 14 years old was admitted to the clinic 04/17/2000

Diagnosis: Hypothalamic syndrome of puberty, mixed form, moderate, progressive course.

Complaints on admission to headache, fatigue, increased appetite, overweight (weight gain over the past 2 years was 15 kg).

An objective examination: Height 182 cm, weight 95 kg, BMI 28.5. Physical development is above average, goes beyond the 97th centile, obesity II degree. Sexual development corresponds to stage III according to Tanner. When examining the skin, bright cyanotic-purple striae on the skin of the hips, lower legs and lower back, folliculitis on the skin of the shoulders and thighs, acrocyanosis of the palms and feet, distal hyperhidrosis, and gynecomastia on palpation of the breasts attracted attention.

From the cardiovascular system: heart sounds are muffled, tachycardia 92-96 in 1 min, blood pressure 120 / 90-140 / 90 mm Hg

REG: vascular tone is unstable, eitonia. The intensity of the pulse blood supply is sufficient.

Echoencephaloscopy: MDT = 81 mm, DWT = 80 mm, MST = 70 mm, SKU = 145 mm, m = 9 mm (normal 7 mm). Conclusion: the displacement of the middle structures of the brain by 1 mm from right to left. Signs of expansion of the III ventricle.

Cardiointervalography: ΔX - 0.23 s, V (coefficient of variation) - 1.5%, IN1 - 164 cu, IN2 - 59.2; ADV - 32, AMV1 - 27, AMV2 - 22. Conclusion: IVT - sympathicotonia, autonomic reactivity - hypersympathicotonic. Dysregulation of the central type. Moderate increase in the activity of subcortical nerve centers.

The patient was prescribed a course of magnetotherapy in accordance with the claimed method. The treatment was carried out in combination with a subcaloric diet.

Against the background of treatment, headaches stopped, lost 2 kg. After each session, a decrease in high blood pressure by 10-20 units was noted, by the 7th day from the start of treatment, blood pressure had stabilized at 120/70 mm Hg. With repeated echoencephaloscopy, no signs of intracranial hypertension were detected, m-ECHO decreased to 6 mm. Cardiointervalography: in comparison with the initial parameters, a decrease in IN1 to 34.5 cu, IN2 to 28.5; an increase in ΔX is 0.29 s and V is 2.5%, which corresponds to eutonia, vegetative reactivity is normal. An increase in the slow-wave components of the spectrum (ADV - 45, AMV1 - 37, AMV2 - 33) testified to an improvement in the activity of the subcortical nerve centers.

During a follow-up examination 6 months after treatment, he complained of rare headaches that the patient associated with stressful situations, overwork. On examination: body weight 85 kg, height 183 cm, BMI 25, i.e. lost 10 kg, BMI decreased by 3.5. On the outer surface of the thighs, white thin striae are determined, the phenomena of folliculitis decreased. HELL 120/80 mm Hg By organs and systems without significant changes.

Thus, under the influence of BPeMP, in combination with the subcaloric diet, arterial and intracranial pressure stabilized, and vegetative regulation indicators improved. It was possible to achieve a persistent decrease in BMI, a decrease in the manifestations of hypercorticism (reduction and blanching of striae).

Based on the results of the study and the examples cited, it can be concluded that the inclusion of a traveling alternating magnetic field in the therapeutic complex of patients with HSPP can significantly increase the effectiveness of treatment. Bitemporal exposure to a traveling alternating magnetic field made it possible to achieve a steady decrease in blood pressure, improve vegetative regulation, improve cerebral circulation, and reduce manifestations of hypercorticism, which indirectly indicates the restoration of functional connections in the hypothalamus-pituitary-adrenal system. A comparative analysis of the effectiveness of treatment in the group of patients using combination therapy yielded significantly more significant positive results than in the group of patients who received only traditional treatment. The most effective was the use of BPeMP with a gradual increase in the frequency of movement in the range from 1 to 12 Hz, starting from the lower boundary of the interval, that is, from the least biologically active frequency, which avoids the formation of resistance to this physical factor.

List of references

2. Andreeva I.N. Ultrahigh-frequency electric field in the complex treatment of girls with hypothalamic pubertal syndrome with physical factors / Materials of the 76th APMA Conference. - Astrakhan. - 1999.

3. Bobreshova OV, Golitsin V.Yu., Timashev S.F. The effect of an inhomogeneous magnetic field on the intensity of electromigration transport // Electrochemistry. - 1990. - T.26. - No. 1. - S. 58-61.

4. Demetsky A.M., Alekseev A.G. Artificial magnetic fields in medicine. - Minsk. - 1981.

5. Aristarkhov V.M., Klimenko L.L. The influence of the magnetic field on the processes of lipid peroxidation / The use of the magnetic field in medicine, biology and agriculture. - 1978. - S.10-11.

Claims (1)

A method of treating the hypothalamic syndrome of puberty using a course of physiotherapy, characterized in that the patient undergoes bitemporal exposure to a traveling alternating magnetic field with a frequency of movement of 1-12 Hz and induction on the working surface of 10-30 mT, moving in the direction from the temporal lobe to the occipital a gradual increase in the frequency of movement from session to session by 1-2 Hz, starting from the lower boundary of the frequency interval, and a change in the direction of movement of the field to the opposite during the session every 1-1 , 5 minutes with a session duration of 8-12 minutes.