RU2280478C1 - Method for reconstructing sensitive and motor function and, also, the function of pelvic organs at affected spinal cord - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the present innovation deals with treating patients with the lesion of spinal cord of uninflammatory character. Electrostimulation should be carried out in three stages: at the first stage due to applying electrodes: anode-needle-electrode should be introduced into inter-spinous space along the middle line being below the site of lesion, and cutaneous electrode-cathode should be located in frontal-parietal area, in projection of motor and promotor cerebral areas. At the second stage, electrostimulation should be conducted by applying electrodes: cathode-needle-electrode by introducing into inter-spinous space along the middle line being above the site of lesion, and cutaneous electrode-anode should be located in projection of a nerve bundle under stimulation. At the third stage electrostimulation should be carried out by changing the polarity of electrodes and applying: electrodes anode-needle-electrode to be kept in inter-spinous space along the middle line being above the site of lesion, and cutaneous electrode-cathode should be located above affected muscles or in areas of affected sensitivity. The innovation enables to accelerate the reconstruction of the functions of spinal cord at its keeping.

EFFECT: higher efficiency of reconstruction.

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Description

The invention relates to medicine, namely to neurology, neurosurgery and rehabilitation, and can be used in the treatment of patients with spinal cord lesions of a non-inflammatory nature.

A known method of treating patients with chronic damage to the spinal cord, including epidural electrical stimulation of the lumbar thickening of the spinal cord with the effect of coordinated locomotor movements (RU 2204423 C2). The essence of the method is the implantation of long-term electrodes in the epidural space at the level of Th12-L1 vertebrae and stimulation in an individually selected mode, providing coordinated locomotor movements.

The disadvantages of the method are: the impact only on the motor segmental apparatus of the spinal cord, cerebrospinal paths are outside the scope of the therapeutic effect; does not affect the restoration of sensitive and trophic functions; does not significantly affect the restoration of the function of the pelvic organs; difficult to perform, requires special equipment and stationary monitoring.

The closest to the essence of the claimed method for the restoration of damage to the spinal cord, accompanied by impaired motor functions, by electrostimulating it with electrodes installed above and below the level of damage (RU 2140798 C1). The essence of the method lies in the fact that one electrode is supplied to the spinal cord by long-term implantation in the epi-subdural space, and the other is implanted in the spinal root.

The disadvantages of the method is that it has an effect on the peripheral nervous system selectively in the region of a single root with an extensive lesion zone, this creates certain difficulties, requires special equipment and stationary monitoring.

The invention is aimed at creating a method for the restoration of diseases of the spinal cord, which provides restoration of disorders of sensitivity, movement and function of the pelvic organs.

The result, which the invention is directed to, is to accelerate the restoration of the functions of the spinal cord while maintaining it.

This is achieved due to the fact that at first one of the electrodes in the form of a needle, being the anode, is inserted into the interspinous gap along the midline below the lesion site, and the cutaneous electrode cathode is located in the frontoparietal region, then the needle electrode, being the cathode, is inserted in the interspinous gap along the midline above the lesion site, and the cutaneous electrode-anode is located in the projection of the nerve bundle, after which the polarity of the electrodes changes on the limb.

The essence of the method consists in electrical stimulation of the structures of the spinal cord through a needle electrode, which is inserted into the interspinous gap along the midline, alternately above and below the site of damage; the second electrode is located on the skin, the area of its location is determined by the stage of the procedure.

The method is carried out in 3 stages:

First step. The electrode needle, being the anode, is inserted into the interspinous gap along the midline below the site of damage (preferably in the cervical or lumbar area), and the cutaneous electrode cathode, with an area of 4-5 cm ² , is located in the frontoparietal region, in the projection of the motor and premotor zones of the brain. Stimulation is carried out by current pulses with a duration of 0.5-1 ms, a frequency of 20 Hz, an amplitude of up to 20 mA (depending on the patient's pain threshold). At this stage, brain motor neurons are activated (the law of the polar action of the Pfluger current, 1859), which helps to restore conduction along the cerebrospinal paths. In addition, an electric current propagating from the anode along the spinal-spinal structures through the damage zone (the theory of linear electric circuits) has a therapeutic effect in the form of improved microcirculation. The selected frequency of 20 Hz is close to the lability of motor neurons. The duration of the first stage is 15 minutes.

Second phase. The electrode needle, being the cathode, is inserted into the interspinous gap along the midline above the site of damage; and the cutaneous electrode-anode, with an area of 2-4 cm ² , is located in the projection of the nerve bundle (Erb's point in cervical myelopathy, projection of the sciatic and femoral nerve in lumbar myelopathy). Stimulation is carried out by current pulses increasing exponentially, with a duration of 0.5-1 ms, a frequency of 20 Hz. The current strength is regulated according to the patient’s sensations until the appearance of rhythmic muscle contractions, depends on the pain threshold and varies from 10 to 50 mA. The duration of the second stage is 15 minutes.

In the presence of pelvic disorders, the cutaneous electrode-anode with an area of 4-5 cm ² is located in the perineum and lower abdomen, stimulation is carried out with a frequency of 0.5-2.0 Hz (close to the lability of neurons of the sympathetic nervous system) for 15 minutes.

At this stage, the action potential is formed in the axons of the central efferent neurons in the area of the needle-electrode location (Pfluger current law of polar action, 1859. The dermal electrode sets the direction of the action potential propagation, all this helps to restore the broken interneuronal connections between the spinal neurons.

The third stage. The electrode needle remains at the same point as during the second stage, only the polarity changes to positive. The cutaneous electrode cathode is located above the affected muscles or in areas of impaired sensitivity, which ensures the formation of the receptor potential in the receptors of surface and deep sensitivity and, as a result, the formation of the action potential in afferent sensitive and autonomic neurons. Excitation of afferent pathways promotes the activation of the segmental apparatus of the spinal cord and the restoration of afferent connections with the brain. Electrical stimulation is carried out by current pulses, increasing exponentially, with a duration of 0.5-1 ms, a frequency of 20 Hz in series of 2 pulses after 2 for 10 minutes. Then, a frequency of 0.5-2.0 Hz for another 10 minutes. The current strength is regulated according to the patient’s sensations until the appearance of rhythmic muscle contractions, depends on the pain threshold and varies from 10 to 50 mA.

Clinical examples:

Patient Yu.A., 29 years old, medical history 100609, was admitted to the vertebrology clinic with a diagnosis of comminuted unstable fracture of the L3 vertebra (type B in A / O), vertebro-medial conflict 2-3 with impaired conduction of the roots of the spinal cord. Neurological status: hypoesthesia in the L3 segment, L4 on the right, L3 on the left. Muscle strength on the right 2 points, left 4 points.

Electroneuromyographic (ENMG) study before treatment: interference EMG: slight spontaneous activity of the foot muscles in the muscles of the dorsal and plantar surfaces of the foot and more pronounced m.tibialis anterior on both sides.

stimulation electromyography (EMG):

n.tibialis dex - the amplitude of the M-response is 14.42 mV, SRV - 46.4 m / s;

n.tibialis sin - the amplitude of the M-response is 6.9 mV, SRV - 45.9 m / s;

n.peroneus dex - the amplitude of the M-response is 1.2 mV, SRV - 48.8 m / s;

n.peroneus sin - the amplitude of the M-response 1.48 mV, SRV - 58.5 m / s;

n.femoralis sin - the amplitude of the M-response of 2.38 mV,

n.femoralis dex - the amplitude of the M-response of 0.86 mV.

Conclusion Axonopathy n.Peroneus dex, n.femoralis sin. Violation of the excitation of n.Tibialis sin of moderate severity. Moderate radiculopathy in the segment L4, L5, S1 on both sides, more on the right.

Clinical results after a course of 25 sessions according to the patented method: restoration of sensitivity, increased muscle strength on the right by 4 points, on the left by 5 points, i.e. became close to the norm.

Interferential EMG after treatment:

increased amplitude and frequency of BEA muscles from right to left without change. stimulation EMG:

n.tibialis dex - the amplitude of the M-response is 14.84 mV, SRV - 46.4 m / s;

n.tibialis sin - the amplitude of the M-response of 6.86 mV, SRV - 45.9 m / s;

n.peroneus dex - the amplitude of the M-response is 1.56 mV, SRV - 48.8 m / s;

n.peroneus sin - the amplitude of the M-response 1.92 mV, SRV - 58.5 m / s;

n.femoralis sin - the amplitude of the M-response of 3.26 mV,

n.femoralis dex - the amplitude of the M-response of 3.58 mV,

ENMG result: residual latency of peripheral nerves decreased by 54.8% (from 3.4 to 2.2 ms). The amplitude of the M response n.peroneus dex increased by 30%, the amplitude of the M response n.femoralis dex increased by 316%, n.femoralis sin by 33.5%.

2. Patient E.V., 18 years old, medical history 100361, with a diagnosis of comminuted unstable vertebral L1 fracture (type B in A / O), vertebro-medullary conflict 2-3 with impaired conduction of the roots of the spinal cord. Neurological status: anesthesia in the S2-S4 segment, hypoesthesia in the L4, S1 segment on the right, and L3, L5 on the left. Muscle strength on the right 3 points, left 4 points. Severe bladder dysfunction

ENMG study before treatment:

interference EMG: BEA of the muscles of the foot in the muscles of the dorsal and plantar surfaces of the foot are significantly reduced. At the lower leg levels, muscle asymmetry (dex> sin) is less pronounced.

stimulation EMG:

n.tibialis dex — amplitude of the M-response 9.22 mV, SRV — 46.4 m / s;

n.tibialis sin - the amplitude of the M-response 2.66 mV, SRV - 48.1 m / s;

n.peroneus dex - the amplitude of the M-response is 5.0 mV, SRV - 54.2 m / s;

n.peroneus sin - the amplitude of the M-response 2.78 mV, SRV - 56.2 m / s;

Conclusion Axonopathy of lesion n.Tibialis sin - 28-33% of the norm, n.Peroneus sin 56% of the norm in the distal region in the ankle region moderate radiculopathy in the L4, L5, S1 segment on both sides, more on the left.

Clinical results after a course of treatment of 30 sessions: sensitivity in the L3, L4, L5, S1 segment returned to normal. Normalized muscle strength on both sides. Bladder function has improved.

Interferential EMG after treatment:

The amplitudes and frequencies of BEA muscles on both sides of the large calf muscles increased.

stimulation EMG:

n.tibialis dex - the amplitude of the M-response is 11.2 mV, SRV - 49.3 m / s;

n.tibialis sin - the amplitude of the M-response 12.0 mV, SRV - 46.2 m / s;

n.peroneus dex - the amplitude of the M-response 8.3 mV, SRV - 53.3 m / s;

n.peroneus sin - the amplitude of the M-response is 8.6 mV, SRV - 56.6 m / s;

ENMG result: residual latency of peripheral nerves decreased by 3.5% (from 2.5 to 2.4 ms). The amplitude of the M response n.tibialis dex n increased. 26.3%, tibialis sin 3.6 times, n.peroneus dex 10%, n.peroneus sin 16%.

Claims (1)

A method of restoring sensory and motor function, as well as the function of the pelvic organs in case of damage to the spinal cord, consisting in electrical stimulation of the spinal cord, characterized in that electrical stimulation is carried out in three stages: at the first stage, electrical stimulation is performed by placing electrodes: an anode-needle-electrode is inserted into the interosseous the gap along the midline is below the site of damage, and the cutaneous electrode-cathode is located in the frontoparietal region, in the projection of the motor and premotor zones of the brain; at the second stage, electrical stimulation is carried out by placing the electrodes: the cathode-needle-electrode, is inserted into the interspinous gap in the midline above the site of damage, and the cutaneous electrode-anode is placed in the projection of the stimulated nerve bundle; at the third stage, electrostimulation is performed by changing the polarity of the electrodes and positioning: the anode-needle-electrode electrodes are left in the interspinous gap in the midline above the site of damage, and the cutaneous electrode-cathode is placed over the affected muscles or in areas of impaired sensitivity.