RU2250117C2 - Method for treating patients suffering from climacteric syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying low frequency magnetic field of 25-30 mTesla units intensity to front region using magnetic amplipulse galvanotherapy apparatus during 8-10 min. The total treatment course is 10-12 daily procedures long.

EFFECT: enhanced effectiveness of treatment.

Description

The invention relates to medicine, in particular to physiotherapy, namely to the treatment of patients with menopausal syndrome and can be used in a hospital, clinic.

Menopause syndrome - a symptom complex that complicates the natural course of menopause - the physiological period during which, against the background of general age-related changes in the woman's body, involutional processes in the reproductive system develop. The study of the physiological parameters of the climacteric period is actually the study of the health of healthy women of a certain period of life and the correction of those indicators by methods exclusively physiological in order to restore the disturbed or unbalanced parameters that are features of this period of life, taking into account the physiology, history of each woman. The methods used are physiological, exclusively restorative, not medication.

In the menopause in practically healthy women, a decrease in ovarian steroidogenesis, as a rule, leads to the development of dystrophic changes and dysfunction of estrogen-dependent organs.

The leading role in the pathogenesis of menopausal syndrome is given to dysfunction of hypothalamic structures that ensure coordination of cardiovascular, vegetovascular and emotional-behavioral reactions. One of the essential factors in the pathogenesis of pathological manifestations of menopausal syndrome is a deficiency of estrogenic influences, which entails the formation of a symptom complex characteristic of the so-called “estrogen deficiency” disease. Due to the complexity and ambiguity of the mechanisms of occurrence and the variety of clinical manifestations, the treatment of menopausal syndrome presents significant difficulties. The research results of E.M. Vikhlyaeva and co-authors (1997) convince that therapeutic "intervention" in the relatively early stages of the menopause can favorably affect a woman's quality of life in subsequent years.

One of the main methods of treating menopausal disorders is hormone replacement therapy with various analogues of sex steroid hormones (V.I. Kulakov et al, 2001). However, hormone therapy, as one of the methods of drug therapy, has significant disadvantages, both economic (high cost of the drug) and physiological (a large number of side effects and a huge number of contraindications).

The closest in technical essence to the proposed method for the treatment of patients with menopausal syndrome is a method of treatment, which consists in the transcerebral use of rectangular impulse currents according to the electric sleep technique. The procedures are carried out through the use of a rubber half mask with cups mounted in it - electrodes, in which cotton swabs moistened with water are inserted, the sizes of which depend on the shape of the eyes. The eye electrodes are placed on the closed eyelids and connected to the cathode, the occipital electrodes are fixed on the mastoid processes of the temporal bones and attached to the anode. When conducting classical electric sleep, rectangular pulsed currents with a frequency of 10 Hz are used (I.F. Perfilieva, E.M. Orekhova, E.Sh. Chumburidze, G.I. XI. 1978, pp. 48-51). The disadvantages of the prototype are that the peculiarity of the procedure according to the orbital-mastoid technique involves a fairly wide range of contraindications for its use (the presence of a myopic cone with myopia of -5D or more, angle-closure glaucoma in the stage of decompensation, residual effects of cerebrovascular accident, hemorrhage and aneurysm on fundus, uterine fibroids more than 8 weeks). In addition, the prototype is considered a time-consuming procedure due to the need to use electrodes with cotton swabs and an individual approach to the procedure.

The technical result of the proposed method for the treatment of patients with menopausal syndrome is to increase the effectiveness and eliminate contraindications, the possibility of use in concomitant diseases, the simplicity of the method without the use of electrodes.

The specified technical result is achieved by exposure to the frontal region of an alternating low-frequency magnetic field (PeMP) by induction of 25-30 mT for 8-10 minutes, the course of treatment is 10-12 daily procedures.

Justification of the specified parameters

As a result of clinical studies, it was found that exposure to a frontal region by an alternating low-frequency magnetic field by induction of 25-30 mTl exerts a regulatory effect on hypothalamic centers, eliminates the effects of hypersympathicotonia, provides a vasodilating effect and changes in systemic and regional hemodynamics with the active participation of the kinin system, favorably on neurovegetative processes, causes a sedative effect.

Magnetic induction of less than 25 mT is insufficient to provide a therapeutic effect. Magnetic induction of more than 30 mT causes hypotonic reactions.

Description of the method of treatment

The procedure is carried out in the position of the patient lying on his back. A cylindrical inductor from the Sedaton apparatus is installed on the forehead area on a light cotton napkin or filtered paper and exposed to an alternating low-frequency magnetic field by induction of 25-30 mT for 8-10 minutes. Procedures are carried out daily for a course of treatment of 10-12 procedures. Magnetotherapy procedures do not cause any sensations in the area of impact.

Examples of the method:

Example 1. Patient A., 50 years old. Diagnosis: premenopause, climacteric syndrome of moderate severity with vegetovascular manifestations. Arterial hypertension.

Upon admission, the patient complained of frequent flashes of weak and medium intensity from 10 to 16 times a day with profuse sweating. Headache, instability of blood pressure. Along with the complaints of a vegetovascular nature, there was a complex of psychoemotional disorders in the form of severe depression, irritability, a decrease in vital interests, insomnia, and tearfulness. The patient noted these symptoms for 9 months. Despite periodic medical treatment by a neurologist and gynecologist, these disorders progressed.

From the anamnesis it was revealed that during the year menstruation became irregular, with delays of up to two to four months. There were 5 pregnancies, one birth, four artificial terminations of pregnancy without visible complications. A hormonal examination revealed: a decrease in sex steroid hormones, while the level of luteinizing (LH) and follicle-stimulating (FSH) hormones in the blood serum remained within normal limits. A violation in the lipid spectrum was also detected, in particular, the atherogenic coefficient was higher than normal (3.1).

Assessment of the state of the emotional-personal and intellectual-mnestic sphere was carried out on the basis of a number of tests: a shortened multi-factor personality questionnaire (SMOL), well-being, active mood (SAN), short-term verbal memory, etc.

In the clinical and neurological picture of the patient, first of all, the phenomena of stem-cerebellar insufficiency (gait instability, discoordination in the palatine specimen, nystagmus, diplopia, etc.) and the initial manifestations of pyramidal deficiency (anisoreflexia, elements of praxis disorder, etc.) prevailed .). Cerebro-stenic symptoms dominated: decreased physical and mental performance, increased fatigue, impaired memory, sleep-wake cycle, and severe affective disorders.

According to ultrasound dopplerography (Doppler ultrasound) of the main arteries of the head (MAG), organic obstruction of blood flow was revealed: stenosis in the carotid artery basins. Signs of venous discirculation in the vertebral-basilar system, a tendency to angiospastic reactions in the basins of the carotid arteries.

The results of the SMOL test made it possible to identify mainly an increase in indicators on the "psychoasthenia" scale. SAN test data was characterized by a decrease in values on all scales. A comprehensive assessment of psychological testing data indicates the predominance of psychoasthenic changes, a decrease in the actual energy potential of life and the emotional level of well-being.

Along with the above studies, the Kuperman index was calculated with an assessment of symptoms (hot flashes, sweating, sleep disturbances, neurosis, impaired attention concentration, depression, headaches, arthralgia, palpitations). In this patient, the Kuperman index corresponded to 24 points, which corresponds to a climacteric syndrome of moderate severity.

Analysis of the initial immunological parameters revealed a violation in the T-cell link of immunity.

Given the history of the disease, the patient’s complaints, the data of clinical and special research methods, as well as the lack of effect of the previous therapy with drugs of both the hormonal and non-hormonal series in a hospital setting, treatment with an alternating low-frequency magnetic field by induction of 25-30 mT onto the frontal region , every day for 8-10 minutes, each lasting a course of 10-12 procedures.

Tolerance to magnetic therapy was good. At 1-3 procedures, changes characteristic of increased emotional tension were noted (during adaptation, an increase in blood pressure by 10-15 mm Hg, an increase in heart rate by 10-15 beats per minute). There was a feeling of hot flush, which decreased by the fifth procedure. During and after the procedure, a drowsiness occurred, blood pressure and pulse stabilized.

After the course of treatment, there was a regression, first of all, of cerebrosthenic manifestations: decreased irritability and fatigue, improved short-term memory functions, positive shifts in the sleep-wake cycle (increased overall duration, improved sleep quality, decreased frequency of nocturnal awakenings, etc.). Along with this, at the end of the course of treatment, a decrease in the frequency and duration of hot flashes was noted.

Assessment of the Kuperman index revealed a positive trend and a decrease in the number of points to 13, which corresponds to a mild severity of menopausal syndrome.

At the end of the course of treatment and during the observation period of the patient for 6 months, an assessment of the menstrual function showed that the duration of the menstrual period ranged from 40 to 45 days with normal values of the volume of blood lost and the duration of menstruation.

According to the hormonal examination, a tendency to increase the values of steroid hormones was revealed, while the level of luteinizing (LH) and follicle-stimulating (FSH) did not change. The atherogenic coefficient at the end of the course of treatment was within normal limits (2.1).

According to Doppler ultrasound, an improvement in cerebral hemodynamics was noted due to a significant decrease in arteriospasm and venous discirculation. There were signs of the development of collateral circulation in the basins of the carotid arteries, a decrease in venous discirculation in the vertebrobasilar system.

According to the initial data of electroencephalography (EEG), pronounced general changes, dysfunction of the formations of the limbic-reticular complex, and irritation phenomena are noted. As the analysis of EEG data in dynamics showed, the state of the bioelectric activity of the brain, in response to magnetotherapy, was unchanged in most observations. This fact is important, since it indicates the absence of negative reactions from the central nervous system (CNS) when using magnetotherapy. Positive dynamics was more pronounced in rheoencephalography (REG): an improvement in blood supply, a decrease in cerebral vascular dystonia, and an improvement in venous blood outflow were noted.

According to the SMOL test, as a result of the treatment, a decrease in the psychoasthenia scale indicators is observed (from 51.8 before treatment and 41.3 after treatment), which indicates a weakening of emotional tension, a decrease in anxiety, anxiety, and an increase in adaptive capabilities; hypochondria (52.9 before treatment and 46.6 points after treatment), which indicates a decrease in excessive fixation on the manifestations of the disease, a decrease in the phenomenon of "flight to the disease", the emergence of a more positive vital th mood. According to the SAN test, there is a slight increase in indicators on the activity scale (5.4 before treatment, 5.9 after), which indicates an increase in the actual energy potential of life.

That is, according to psychological testing, as a result of the treatment, this group of patients has a weakening of emotional tension, an increase in vitality, and an improvement in psychological adaptation.

An analysis of immunological parameters revealed that after the treatment, a significant decrease in T-lymphocytes was noted, both in percentage (24.4 ± 1.9% to 18.9 ± 1.3%) and in absolute value (269.2 ± 36 , 0 to 170.6 ± 12.7).

Ultrasound examination of the pelvic organs showed the absence of negative dynamics in the state of the organs of the female reproductive system.

Example 2. Patient V., 51 years old. Diagnosis: menopausal syndrome of moderate severity with vegetovascular and psychoemotional manifestations. Arterial hypertension.

Upon admission, the patient complained of frequent flashes of weak and medium intensity from 14 to 20 times a day with profuse sweating. Headache, instability of blood pressure. Along with the complaints of a vegetovascular nature, there was a complex of psychoemotional disorders in the form of severe depression, irritability, a decrease in vital interests, insomnia, and tearfulness. Despite periodic treatment by a neurologist and gynecologist with medications, these disorders progressed.

From the anamnesis it was revealed that for two years menstruation began to come irregularly, with delays of up to two to four months. There were 3 pregnancies, one birth, two artificial terminations of pregnancy without visible complications. During a hormonal examination revealed: a decrease in sex steroid hormones, while the level of luteinizing (LH) and follicle-stimulating (FSH) in the blood serum remained within normal limits. A deviation of the lipid spectrum was also detected, in particular, the atherogenic coefficient was higher than normal (3.9).

Assessment of the state of the emotional-personal and intellectual-mnestic sphere was carried out on the basis of a number of tests: SMOL, SAN, short-term verbal memory, etc.

In the clinical and neurological picture of the patient, first of all, the phenomena of stem-cerebellar insufficiency (gait instability, discoordination in the palatine specimen, nystagmus, diplopia, etc.) and the initial manifestations of pyramidal deficiency (anisoreflexia, elements of praxis disorder, etc.) prevailed .). Cerebro-stenic symptoms dominated: decreased physical and mental performance, increased fatigue, impaired memory, sleep-wake cycle, and severe affective disorders.

According to ultrasound dopplerography (Doppler ultrasound) of the main arteries of the head (MAG), organic obstruction of blood flow was revealed: stenosis in the carotid artery basins. Signs of venous discirculation in the vertebral-basilar system, a tendency to angiospastic reactions in the basins of the carotid arteries with a decrease in the linear velocity of blood flow (LSC).

The results of the SMOL test revealed a predominantly increase in indicators on the "psychoasthenia" scale. SAN test data was characterized by a decrease in values on all scales. A comprehensive assessment of psychological testing data indicates the predominance of psychoasthenic changes, a decrease in the actual energy potential of life and the emotional level of well-being.

Along with the above studies, the Kuperman index was calculated with an assessment of symptoms (hot flashes, sweating, sleep disturbances, neurosis, impaired attention concentration, depression, headaches, arthralgia, palpitations). In this patient, the Kuperman index corresponded to 26 points, which corresponds to a climacteric syndrome of moderate severity.

Analysis of the initial immunological parameters revealed a violation in the T-cell link of immunity.

Given the history of the disease, the patient’s complaints, the data of clinical and special research methods, as well as the lack of effect of the previous therapy with drugs of both the hormonal and non-hormonal series in a hospital setting, treatment with an alternating low-frequency magnetic field by induction of 25-30 mT onto the frontal region , every day for 8-10 minutes, each lasting a course of 10-12 procedures.

Tolerance to magnetic therapy was good. At 1-3 procedures, changes characteristic of increased emotional tension were noted (during the adaptation period, an increase in blood pressure by 15-20 mm Hg, an increase in heart rate by 10-18 beats per minute). There was a feeling of hot flush, which decreased by the fifth procedure. During and after the procedure, a drowsiness occurred, blood pressure and pulse stabilized.

After the course of treatment, there was a regression, first of all, of cerebrosthenic manifestations: decreased irritability and fatigue, improved short-term memory functions, positive shifts in the sleep-wake cycle (increased overall duration, improved sleep quality, decreased frequency of nocturnal awakenings, etc.). At the end of the course of treatment, a decrease in the frequency and duration of hot flashes was noted.

Assessment of the Kuperman index revealed a positive trend and a decrease in the number of points to 14, which corresponds to a mild severity of menopausal syndrome.

According to the hormonal examination, a tendency to increase the values of steroid hormones was revealed, while the level of luteinizing (LH) and follicle-stimulating (FSH) did not change. The atherogenic coefficient at the end of the course of treatment was within normal limits (2.3).

According to Doppler ultrasound, an improvement in cerebral hemodynamics was noted due to a significant decrease in arteriospasm and venous discirculation. There were signs of the development of collateral circulation in the basins of the carotid arteries, a decrease in venous discirculation in the vertebrobasilar system.

According to the initial data of electroencephalography (EEG), pronounced general changes, dysfunction of the formations of the limbic-reticular complex, and irritation phenomena are noted. As the analysis of EEG data in dynamics showed, the state of the bioelectric activity of the brain, in response to magnetotherapy, was unchanged in most observations. This fact is important because it indicates the absence of negative reactions from the central nervous system (CNS) when using transcerebral physiotherapy. Positive dynamics was more pronounced in rheoencephalography (REG), an improvement in blood supply, a decrease in the phenomenon of cerebral vascular dystonia and an improvement in venous blood outflow were noted.

According to the SMOL test, as a result of the treatment, a decrease in the psychoasthenia scale indicators is observed (from 52.8 before treatment and 41.6 after treatment), which indicates a weakening of emotional tension, a decrease in anxiety, anxiety, and an increase in adaptive capabilities. There was also a slight decrease in the indicators on the hypochondria scale (53.8 before treatment and 46.1 points after treatment), which indicates a decrease in excessive fixation on the manifestations of the disease, a decrease in the phenomenon of “flight to the disease”, and the emergence of a more positive attitude in life. According to the SAN test, there is a slight increase in indicators on the activity scale (5.2 before treatment and 5.8 after), which indicates an increase in the actual energy potential of life.

So, according to psychological testing, as a result of the treatment, this group of patients has a weakening of emotional tension, an increase in vitality, and an improvement in psychological adaptation.

An analysis of immunological parameters revealed that after the treatment, a significant decrease in T-lymphocytes was noted, both in percentage (24.1 ± 1.6% to 18.0 ± 1.2%) and in absolute value (266.2 ± 35 , 1 to 171.0 ± 11.1).

Ultrasound examination of the pelvic organs showed the absence of negative dynamics in the state of the organs of the female reproductive system.

The long-term results of treatment testified to the preservation of the achieved immediate results of treatment for 8 months of observation.

The proposed method for the treatment of patients with menopausal syndrome was applied to 60 patients aged 41 to 58 (49.4 ± 6.9) years.

As a result of treatment with the proposed method, there was a regression, first of all, of cerebrosthenic manifestations: decreased irritability and fatigue, improved short-term memory functions, positive changes in the sleep-wake cycle (increased overall duration, improved sleep quality, decreased frequency of nocturnal awakenings, etc. )

The terms of treatment were reduced in comparison with the prototype to 18-20 days (prototype - 28-32 days).

Long-term results of treatment testified to the preservation of the achieved immediate results of treatment for 6-8 months of observation.

Claims (1)

A method for the treatment of patients with menopausal syndrome by exposure to a physical factor, characterized in that the exposure is carried out by an alternating low-frequency magnetic field by induction of 25-30 mTl on the frontal area from the Sedaton magneto-amplipulse-galvanotherapy apparatus, lasting 8-10 minutes, per treatment course 10 -12 daily treatments.