RU2290227C2 - Method for treatment of post-traumatic visual disorders - Google Patents

Abstract

FIELD: medicine, namely, neuro-ophthalmology.

SUBSTANCE: in accordance to method, affected transsclerally are vessels of retina and choroids of back section of eyeball by monochrome low intensity radiation with wave length 540 nm. Irradiation 4,5 mWt/cm². Power 0,9 mWt. Continuous operation mode during 5 minutes for field. Treatment course consists of 5-10 procedures.

EFFECT: expanded fields of view, increased visual acuity, normalized bioelectric activity of brain, prevented undesirable effects on eye structures.

2 ex, 4 tbl, 8 dwg

Description

The invention relates to the field of medicine, namely neurology, neuroophthalmology, neurorehabilitation, neurosurgery, and can be used to treat patients with lesions of the visual pathways of traumatic etiology.

A known method of treating post-traumatic visual impairment (RF patent No.2000106299, A 61 F 9/00, 2002). In this case, the patient is preliminarily diagnosed with the nature of visual disturbances using glasses with built-in LEDs that supply green, blue and red light pulses, determine the critical flicker fusion frequency (CFSM) in turn on each eye and sequentially evaluate the three primary colors of light pulses and CPSM functional state of the central zone of the retina and pathology of the optic nerve. Then, in front of the patient’s eyes, a light-protective spectacle frame with LEDs integrated in the front panel connected to a light pulse generator of various wavelengths is placed, and light pulses are supplied for conducting rehabilitation therapy of the visual system, the frequency of which is set 5-10% lower than the CSFM, the color of the pulse they are selected depending on the revealed pathology or individual preference of the patient from the group consisting of visible light colors. Exposure is about 10 minutes in each eye. The course of treatment is 6-10 sessions.

However, the method is extremely time-consuming, multi-stage, requires a special device that does not have serial production on the medical equipment market, highly qualified medical staff for conducting the treatment procedure. In addition, given the pulsed nature of radiation, it can stimulate paroxysmal brain activity.

The prototype of the proposed method is a method of treating visual impairment (RF patent No. 2071301, A 61 F 9/00, 1997). Both eyes are affected by light radiation of the same wavelength lying in the visible region of the spectrum (400-700 nm), the radiation power is from 1.5 mW (for red) to 0.05 mW (for other colors), with one or both eyes are exposed to flashing light radiation with a blinking frequency of 0.06-1 Hz. Exposure is 15 minutes per eye. The course of treatment is 10-20 procedures carried out 1-2 times a day.

The disadvantages of the prototype:

- the use of red spectrum radiation to stimulate the visual pathway, which, in addition to the therapeutic effect, has adverse reactions, increases the excitability of the central and peripheral nervous system and is not well tolerated by all patients. Irradiation with a spectrum of visible light of different wavelengths has multidirectional and different types of effects on the structures of the eyeball and the body as a whole. Red light has the strongest thermal effect, which is not always required in the treatment of visual disturbances, especially traumatic genesis, in addition, red light increases the excitability of the central and peripheral nervous system, increases the speed of mental reactions, speeds up and deepens breathing, increases the number of heart contractions, promotes increase in blood pressure;

- when using the pulsed nature of radiation in patients who have suffered a traumatic brain injury, paroxysmal activity of the brain may increase;

- the duration of exposure in each eye is 15 minutes, in the total - 30 minutes, and if the procedure is carried out 2 times a day - 60 minutes, which is long enough for severe patients who have suffered a head injury that do not tolerate long procedures.

The invention is aimed at creating a method for the treatment of post-traumatic visual disturbances, which provides an increase in the effectiveness of treatment due to a more physiological effect on the visual analyzer, elimination of undesirable side effects and complications, reducing the duration of the procedure.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method for the treatment of post-traumatic visual impairment, including exposure to incoherent monochrome low-intensity radiation, the peculiarity is that they act transsclerally on both eyes with light radiation of a wavelength of 540 nm, irradiation of 4.5 mW / cm ² , the radiation power of 0.9 mW, the continuous mode of operation, on the vascular tract and neuroreceptors of the anterior eyeball for 5 minutes on the field, a course of treatment of 5-10 procedures.

Incoherent monochrome low-intensity radiation of the green spectrum with a wavelength of 540 nm penetrates to a depth of 3-5 mm in the underlying tissue. At the same time, it acts on the light-conducting section of the eyeball (cornea, anterior chamber, lens), the vascular tract, as well as the dense perilimbal network of the blood, nerve, lymphatic plexuses and neuroreceptors. It activates neuro-trophic processes and indirectly acts on the light-perceiving department - retinal pigment epithelium, optic nerve, nuclei of the thalamus and hypothalamus, optic tract, visual radiation, primary visual cortex. From the primary visual cortex, information is also distributed to other areas of the cerebral cortex (parietal, frontal, temporal, and others) associated with visual functions. Incoherent monochrome low-intensity radiation of the green spectrum with a wavelength of 540 nm does not stimulate the paroxysmal activity of the brain and can be used in patients with post-traumatic epilepsy.

The method is as follows.

The course of treatment is carried out using the apparatus "SPECTR-LC-02" model 02, generating incoherent monochrome low-intensity radiation of the green spectrum with a wavelength of 540 nm (LED radiation). Influenced by transscleral, continuous incoherent monochrome low-intensity radiation of the green spectrum with a wavelength of 540 nm, irradiation of 4.5 mW / cm ² , radiation power of 0.9 mW, the continuous mode of operation on the vascular tract and neuroreceptors of the anterior eyeball for 5 minutes in the field . The total duration of the procedure does not exceed 10 minutes. The course of treatment is 5-10 procedures. Before and after the course of treatment, the patient is examined for visual evoked potentials (VEP), an electroencephalogram (EEG), and a neuroophthalmologist is examined.

The inventive method is developed in RNHI them. prof. A.L. Polenova and passed clinical trials in the treatment of 32 patients. Of these, 18 patients had an acute period of traumatic brain injury, 14 patients were treated with the consequences of a head injury. 9 people suffered a fracture of the cranial vault and base, 9 patients had a subarachnoid hemorrhage, 5 people had an intracerebral hematoma, and 2 people had an epidural hematoma. Paraorbital hematoma was recorded in 3 patients, cerebral arachnoiditis was diagnosed in 8 cases. Post-traumatic epilepsy, confirmed by electroencephalographic studies, in 8 patients. Traumatic brain injury was accompanied by damage to the oculomotor nerves in 3 patients, in 1 patient - damage to the abducent nerve.

Of 32 patients, 8 were operated on. The remaining 24 patients received only traditional drug treatment and photochromotherapy (PCT) according to the proposed method.

At the same time, FHT was carried out at various times after an injury or surgery: from 2-3 days to 1 year. Patients were admitted to PCT only in a somatically compensated state, on average 3-5 days after injury or surgery.

A study of patients before the course of PCT showed that the amplitude of the visual evoked potentials ranged from: N75-P100 3.59-15.9 μV, P100-N145 0.78-22 μV. On average, the amplitude of VIZ before treatment was N75-P100 9.745 μV, P100-N145 11.39 μV, which deviates from the norm. The minimum value of the P100 amplitude according to J.Kjaer is 6.5 μV.

After the course of PCT, the amplitude of the visual evoked potentials returned to normal, a large spread in the indices disappeared: N75-P100 5.13-12.3 μV, P100-N145 3.46-18.0 μV. On average, the amplitude of the visual evoked potentials after treatment was N75-P100 8.7 μV, P100-N145 10.7 μV - lower than the initial values, which indirectly indicates the normalization of the bioelectric activity of the brain. The latency of the P100 peak after a course of PCT decreased on average by 5-10%.

After the course of PCT treatment on the EEG, the bioelectric activity of the brain was stabilized, the alpha rhythm improved, the number of slow waves decreased, diffuse changes in the mediobasal structures decreased and completely disappeared, locally predominant pathological signs and vegetative instability decreased. The well-being of patients significantly changed for the better - a positive emotional mood appeared, the phenomena of asthenoneurotic syndrome significantly decreased.

During an ophthalmological examination, an improvement in visual functions was observed in all patients — an expansion of the visual fields and an increase in visual acuity by 0.1-0.3. Moreover, the positive dynamics continued after the course of treatment with PCT for 2-3 months, which is regarded as the "effect of aftereffect" of radiation.

We give examples - extracts from the medical history.

Example 1

Patient K., 41 years old, No. of case history 366-2004, 1049-2004. Diagnosis: closed craniocerebral trauma, severe brain contusion with the formation of contusion foci and saccular subdural hematoma of the left frontal lobe. Traumatic edema of the left hemisphere. Subarachnoid hemorrhage (clinically). Fracture of the left frontal bone.

Before treatment, examination by a neuroophthalmologist: Vis OD = 0.8, Vis OS = 0.8. Pupils D> S, pupil response to light is satisfactory, eyeball movements are limited up and out. The fundus of the eye - the optic nerve discs are uniformly grayish, the borders are clear, the arteries are narrow, the veins are not changed. Field of view - complete right-sided homonymous hemianopsia.

On the EEG before treatment: on the EEG, the main rhythm is practically absent. Against the background of polymorphic activity, with phenomena of distant synchronization of activity, bilaterally synchronous flashes of slow delta waves are constantly forming, with some prevalence over the period in the leads of the left hemisphere. The EEG picture indicates signs of damage to the brain stem at the mesencephalic level, the predominance of changes in the left hemisphere.

Conducted 10 treatment sessions by the proposed method. The course of treatment was carried out using the physiotherapy apparatus "SPECTR-LC-02" model 02, generating incoherent monochrome low-intensity radiation of the green spectrum with a wavelength of 540 nm (LED radiation).

Influenced transsclerally, continuous incoherent monochrome low-intensity radiation of the green spectrum with a wavelength of 540 nm, irradiation of 4.5 mW / cm ² , radiation power of 0.9 mW, continuous operation, on the vascular tract and neuroreceptors of the anterior eyeball. The total duration of the procedure did not exceed 10 minutes.

The curve obtained in the study of VIZ before treatment is presented in figure 1, after treatment - figure 2.

After treatment, examination by a neurophthalmologist: Vis OD = 0.9, Vis OS = 1.0. Pupils D = S, pupil response to light is satisfactory, eyeball movements in full. The fundus of the eye - the optic nerves are pink, the borders are clear, the vessels are not changed. Field of view - expanded by 5-10 °, incomplete homonymous hemianopsia remains.

EEG after treatment: on the repeated EEG, a distinct positive dynamics is observed, consisting in a decrease in the slow-wave activity, a shift in the frequency range of the rhythm to the left, a decrease in the severity of distant synchronization, and leveling of delta wave bursts.

The curves obtained during the EEG study before treatment are presented in figure 3, and after treatment - figure 4.

The dynamics of the latency of the VIZ are presented in table 1. The dynamics of the amplitude of the VIZ are presented in table 2.

Table 1 Stimulus Channel Component Latency ms Latency change before after ms % left eye 30 ms one N75 72.6 70 -2.6 3,7 P100 98.8 94.6 -4.2 4.4 N145 125 124 -one 0.8 right eye 30 ms one N75 73.9 68.7 -5.2 7.5 P100 98.8 92 -6.8 7.3 N145 128 127 -one 0.7 table 2 Stimulus Channel Components Amplitude μV Amplitude change before after μV % left eye 30 ms one N75-P100 4.91 5.9 +0.99 twenty P100-N145 7.61 11.7 +4.09 54 right eye 30 ms one N75-P100 3.76 4.84 +1.08 29th P100-N145 9.53 11.6 +2.07 22

Example 2

Patient A., 47 years old, No. of medical history 1853-2004. Diagnosis: open head injury, severe brain contusion, fracture of the base of the skull in the anterior cranial fossa, subarachnoid hemorrhage (clinically).

Inspection by a neuroophthalmologist before treatment: Vis OD = 1.0, Vis OS = 0.8, post-traumatic opacification of the vitreous body of the left eye, paraorbital hematomas of both eyes, when examining the visual field using a manual perimeter, narrowing of the borders along all meridians is observed, sharply bitemporal.

EEG before treatment: on the EEG, the main rhythm is deformed, irregular. Background activity is polymorphic, alpha-beta-theta ranges. In the left frontal leads, along with the artifacts of the RR-cardiogram, a local predominance of pointed activity in combination with slow theta waves is revealed. The EEG picture indicates diffuse changes in bioelectric activity with a predominance of changes in the left frontal region.

Conducted 10 treatment sessions by the proposed method. Influenced transsclerally, continuous incoherent monochrome low-intensity radiation of the green spectrum with a wavelength of 540 nm, irradiation of 4.5 mW / cm ² , radiation power of 0.9 mW, continuous operation, on the vascular tract and neuroreceptors of the anterior eyeball. The total duration of the procedure did not exceed 10 minutes.

The curve obtained in the study of VIZ before treatment is presented in figure 5, and after treatment - figure 6.

Inspection of a neuroophthalmologist after treatment: Vis OD = 1.0, Vis OS = 1.0, in the study of border visual fields within normal limits.

EEG after treatment: a distinct positive dynamics is observed due to an improvement in the severity of the main rhythm (alpha activity dominates in all leads with signs of distant synchronization), a decrease in diffuse slow activity, as well as local manifestations. In this EEG, only higher amplitude and pointed oscillations in the left frontal leads are only occasionally recorded. A distinct desynchronization reaction to single and rhythmic photostimulation is revealed. Hyperventilation - without significant changes.

The curves obtained during the EEG study before treatment are presented in Fig.7, and after treatment - Fig.8.

The dynamics of the latency of the VIZ are presented in table 3. The dynamics of the amplitude of the VIZ is presented in table 4.

table 3 Stimulus Channel Component Latency ms Latency change ms % before after left eye 30 ms one N75 74.9 72 -2.9 four P100 96.9 95 -1.9 2 N145 121 116 -5 4.3 right eye 30 ms one N75 74,2 72 -2.2 3 P100 97.2 96 -1.2 1,2 N145 122 119 -3 2,5 table 4 Stimulus Channel Components Amplitude μV Amplitude change before after μV % left eye 30 ms one N75-P100 21.9 eighteen -3.9 21.6 P100-N145 17.8 12.6 -5.2 41 right eye 30 ms one N75-P100 16.6 14.6 -2.0 fourteen P100-N145 15.9 10.6 -5.3 fifty

Using the proposed method improves the treatment of patients with traumatic lesions of various departments of the visual pathway, and can also be used in patients with concomitant post-traumatic epilepsy.

Claims (1)

A method for the treatment of post-traumatic visual impairment, including exposure to incoherent monochrome low-intensity radiation, characterized in that they act transsclerally on both eyes with light radiation with a wavelength of 540 nm, irradiation of 4.5 mW / cm ² , radiation power of 0.9 mW, the operation mode is continuous, on the vascular tract and neuroreceptors of the anterior eyeball for 5 minutes on the field, the course of treatment is 5-10 procedures.

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