RU2284198C1 - Method for treating paralyses and pareses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the present innovation deals with treating and rehabilitating patients after insult cases. Electrostimulation should be carried out due to transcranial impact with direct and impulse current with frontal-mastoidal disposition of electrodes, current power being about 2-3 mA, impulse current frequency being 77 Hz, duration being 3.5 msec. Simultaneously, one should affect peripheral nerves of paralyzed and healthy limbs with direct current of 60-90 Hz frequency and voltage up to 70 V. Moreover, at paralyzed limb polarity should be altered every 10-15 min. Therapy should be fulfilled by courses consisted of about 7-10 seances, each being of about 1.2-1.5 h. The innovation enables to increase hemodynamics and enhance cerebral circulation.

EFFECT: higher efficiency of therapy.

1 cl, 2 ex

Description

The invention relates to medicine and can be used in the treatment and rehabilitation of stroke patients.

A known method of treating acute focal lesions of the brain by conducting electrical stimulation of the brain and the introduction of rheological preparations, in which the projection zones of focal lesions from the first days after their occurrence are exposed to direct current of 100-500 μA and lasting 30-40 minutes for 10-15 days, and rheological preparations are administered during and within 5-10 days after exposure to direct current (See IPC A 61 N 1/20, A 61 K 31/522, description of the patent of the Russian Federation No. 2188674, publ. 10.09.2002 g.).

The disadvantage of this method is the prolonged exposure to direct current on the projection zone of focal lesions, which causes burns of the skin at the site of application of the electrodes.

A known method of treating post-stroke paresis, including the effect of rectangular impulse currents on the receptor apparatus of deep and surface sensitivity of the distal extremities and the corresponding segment apparatus of the spinal cord (See IPC A 61 N 1/18, description of the patent of the Russian Federation No. 2192897, publ. 20.11. 2002).

The disadvantage of this method is the low efficiency of treatment, due to the impact of pulsed currents only on the peripheral nerves of the diseased limb, in which there is no stimulation of the central nervous system.

The closest technical solution to the claimed is a method of treating paralysis and paresis by exposure to a magnetic field and pulsed currents, in which first they are exposed to a pulsed magnetic field with a magnetic induction amplitude of 2.0-3.0 T, pulse repetition rate of 0.1-0.2 Hz, applying the inductor sequentially on the projection of the motor zone of the cerebral cortex and the region of the roots of the spinal cord innervating the paretic muscles, paravertebrally, for 1-2 minutes per field, then they are modulated by sinusoidal current (See. IPC A 61 N 1/32, 2/04, the description in the patent of the Russian Federation №2122870, publ. 10.12.98).

The disadvantages of this method are:

- low treatment efficiency with concomitant side effects, namely overheating and burns of areas exposed to pulsed current;

- the use of a harmful magnetic field with a magnetic induction amplitude of 2.0-3.0 T when applying an inductor on the projection of the motor zone of the cerebral cortex and the area of the roots of the spinal cord, leading to overheating of these zones and their burns;

- the use of a too powerful field, the difficulty of obtaining large induction, overheating of the inductor;

The technical result of the proposed method is to increase the effectiveness of treatment.

The technical result is achieved by the fact that in the method of treating post-stroke paresis and paralysis by electrical action on the central nervous system, the effect is carried out simultaneously by supplying direct and pulsed currents to the cortex and direct current to a paralyzed and healthy limb, while a current with by switching polarity every 10-15 minutes for 1.2-1.5 hours, and on a healthy limb with its constant polarity, while a constant current is supplied oh 2-3 mA, and the pulse current - with a frequency of 77 Hz and 3.5 msec.

It is known that with paralysis and paresis the patient undergoes changes both in the central nervous system and in the extremities, characterized by an increase in impulse in the central nervous system due to the redistribution of the load on a healthy limb - arm, leg, transmission of nerve impulse and motor activity. As a result of a constant increase in the load on the limb, partially replacing the function of a paralyzed limb, a pathological impulse dominant is formed in the central nervous system.

Without eliminating this dominant, treatment is ineffective.

In the claimed method for the treatment of paralysis and paresis, the simultaneous electrical action by the sum of direct and pulsed currents through the fronto-mastoid electrodes helps to increase cerebral blood flow, decrease the tone of capillaries, relieve vascular spasms, and the endorphin mechanisms of the brain stem are activated. As a result of the activation of the antinociceptive system, hemodynamics are stabilized.

Simultaneous exposure to direct pulse current without switching polarity to a healthy limb causes suppression of “intrinsic impulse” and atony of the muscles of the flexors and extensors, and electrical stimulation of a paralyzed limb with a polarity reversal every 10-15 minutes for 1.2-1.5 hours does not muscle hypertonicity, followed by muscle atony, and an irritating irritating response in nerve endings. The indicated time limitations of the electrical effects on the limbs are due to the severity of the patient's condition and are limiting for the achieved effect during treatment.

A method for the treatment of paralysis and paresis is as follows. Using the modified Electronarkon 30-1 apparatus, the frontal-mastoid electrodes: the frontal cathode, mastoid anodes, and direct current are supplied with a value of 2-3 Ma, and the pulse current with a frequency of 77 Hz and a duration of 3.5 ms, under the influence of which there is an improvement cerebral circulation and restoration of the functions of the external nervous system. At the same time, a pulsed current is supplied to a healthy and paralyzed limb, with the only difference being that polarity is switched to a healthy limb with a constant polarity, and a polarity is switched to a paralyzed limb every 10-15 minutes for 1.2-1.5 hours.

After the first session, cranial vascular resistance decreases in almost all patients. Headache disappears, cerebral circulation improves, blood pressure decreases, and pulse rate decreases. As a result of stimulation of the nerve endings of a paralyzed limb, tactile sensitivity appears in the fingers. Gradually, as the sessions are conducted, motor activity is restored.

The greatest effect at minimum current occurs at a frequency of 77 Hz, pulse durations of 3-4 ms.

When implementing the method, the effect was carried out transcranially through the fronto-mastoid electrodes (frontal cathode, mastoid double anodes). Stimulation of peripheral nerves was carried out with a frequency of 60 Hz to 90 Hz and voltage up to 70 V.

To confirm the effect of improving the treatment, a clinical assessment, psychological tests were carried out, the dynamics of rheogram and electroencephalogram indicators were observed, the temperature on the thumb of both the feet and hands was measured, hemodynamic parameters were recorded by ultrasound dopplerography.

EXAMPLE 1. Patient D., 67 years old, suffered an acute violation of cerebral circulation in the middle cerebral artery basin according to the ischemic type. After the next course of rehabilitation, there were phenomena of right-sided hemiparesis, weakness in the arm, leg, partial speech impairment, and post-stroke headaches persisted. Blood pressure is unstable 160 / 100-170 / 100 mm Hg, periodically there was a rise in pressure to 200 / 100-200 / 120 mm Hg. Lost tactile and pain sensitivity in the fingers of the right foot and arm. Intravenous administration of neotropes and vasodilator drugs according to the traditional scheme did not bring a significant effect. Neurological symptoms persisted.

After the first session, the patient experienced a headache, blood pressure decreased by 20-30 mm Hg, pulse from 96 beats decreased to 84 beats per minute, and cerebral circulation improved. After the first stimulation of the ulnar and median nerves with switching the polarity of the pulse current for 40 min, tactile sensitivity appeared in the fingers of the right hand. The temperature of the thumb increased from 26.3 ° C to 28.1 ° C.

In subsequent sessions, an increase in peripheral temperature was also noted, after the third session, pain sensitivity appeared in the hand at the fingertips, the range of movements in the hand increased, pain in the elbow joint in the projection of the ulnar nerve disappeared. The time interval of the electric action on the limb did not change. Brain resistance has halved from 40 kOhm. There were 7 sessions of electrical stimulation to achieve stabilization of the results. Further recovery was carried out on simulators. Two months later, motor activity was fully restored. Tactile and pain sensitivity also fully recovered.

Similar electrical stimulation and recovery was carried out for 1.5 months and with the right foot. Hemodynamics stabilized, blood pressure 150 / 90-160 / 90 mm Hg with a pulse of 84 beats per minute. The patient did not take antihypertensive drugs, the increase in blood pressure was not observed within one year of observation.

EXAMPLE 2. Patient G., 63 years old. Seven years ago, he was admitted to the city hospital in an extremely serious condition with cerebrovascular accident in the basin of the middle cerebral artery with deep right-sided paresis, speech impairment, and swallowing. For two weeks he was in the intensive care unit, appropriate anti-edema therapy, and neotropic treatment were carried out. All this time, the patient’s condition was regarded as very serious. After this, the patient continued treatment in the hospital for another month. He was discharged from the hospital in a moderate condition as a hopeless patient for symptomatic treatment with deep right-sided hemiparesis, dearthritis, with bulbar disorders, with blood pressure of 240/120 mm Hg. As a result of drug therapy and rehabilitation, memory was fully restored. The act of swallowing was also fully restored. Movement disorders persisted. The gait is circulating. The Wernicke-Mann posture was amplified by walking and unrest, while trying to perform arbitrary movements, pathological synkinesia appeared, contracture of the fourth and fifth fingers of the right hand was observed in the hand and fingers. Hemodynamics was supported by the use of antihypertensive drugs as prescribed by the therapist.

To the patient, together with the physiotherapy and sports complex and massage, the claimed method of treatment was applied. Electrical stimulation of brain structures was carried out in conjunction with stimulation of peripheral nerves. Fronto-mastoid electrodes were worn on the head. A pulse current of 77 Hz, a current of 2 mA, and a duration of 3.5 ms was applied. The polarity on the electrodes changed every 10-15 minutes. At the same time, using the ETNS-100-2 device for percutaneous electrical stimulation, nerve zones of both the paralyzed and healthy legs were stimulated, with the only difference being that the healthy leg was exposed with constant polarity, and the polarity of the affected leg was also changed every 10-15 minutes like on the head.

The treatment was carried out by the course and amounted to 15 sessions. With each session, as the patient becomes accustomed to the apparatus, the current values are increased, without disturbing the patient's comfort. The effectiveness of the procedure was evaluated primarily by changing the temperature of the thumb, which indirectly assessed blood flow in both paratic and healthy muscles. An increase in temperature with each session indicated an increase in blood flow in these muscles. With each session, sensitivity in the nerve endings increased, as evidenced by a faster reaction to touch, pain irritation.

Thresholds of pain and tactile sensitivity decreased. The extension and flexion of the muscles became less painful each time, the amplitude of movements increased. The blood supply to the brain was also restored due to the antispasmodic effect of central stimulation. Speech has improved significantly. Movement disorders are regarded as 2nd degree. When walking, the patient began to lean on his sore leg. For short distances can move with a stick. Synkinesia with movement almost disappeared. He became more calm. A paralyzed hand can perform elementary restraining movements, contracture of the fingers is significantly reduced.

Thus, the above examples show that the proposed method is more effective than the known analogues, allows to stabilize hemodynamics, there is an increase in cerebral blood flow in almost all patients during the first TEV session, a decrease in the tone of the capillary vessels, and acceleration of blood flow.

In total, 185 patients aged 47-75 years were treated during the year. In all cases, transcranial electrical exposure was applied due to the inefficiency of the usual course treatment in the recovery period. Two devices were used for treatment:

Electronarkon - 30-1 for central stimulation, and ETNS-100-2 for peripheral stimulation with courses consisting of 7-10 sessions lasting 1.2-1.5 hours each.

Claims (2)

1. A method of treating post-stroke paresis and paralysis by conducting electrical stimulation, characterized in that the electrical stimulation is carried out by transcranial exposure to direct and pulsed electric current with fronto-mastoid electrodes, a constant current of 2-3 mA, a pulse current frequency of 77 Hz, a duration of 3.5 ms, and simultaneously act on the peripheral nerves of a paralyzed and healthy limb with a constant electric current of 60-90 Hz and voltage up to 70 V, while on a paralyzed limb and the polarity is changed every 10-15 minutes. 2. The method according to claim 1, characterized in that the treatment is carried out in courses consisting of 7-10 sessions lasting 1.2-1.5 hours each.