RU2316319C2 - Method and means for treating motor function disorders of pyramidal type - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out of block spinal roots or spinal nerves with local anesthetic introduced in one or several sessions at an effective dose within maximum permissible dose in concentration selected so that it allows to reduce spasticity without returning to initial level.

EFFECT: enhanced effectiveness of treatment.

18 cl, 1 tbl

Description

The invention relates to medicine, namely to neurology, and can be used in the treatment of motor disorders in patients after acute cerebrovascular accident (stroke), traumatic brain injury (TBI), in cancer and other patients.

Among brain diseases, the most common and severe in its consequences is stroke. The share of acute cerebrovascular accidents in the structure of total mortality in our country is 21.4%, and disability after a stroke reaches 3.2 per 10,000 population, taking first place among all the causes of primary disability. In Russia, more than 450,000 people develop stroke annually, of which approximately 35% die in the acute period of the disease. The incidence of stroke is 2.5-3.0 cases per 1000 population per year. The frequency of stroke in a population older than 50-55 years increases 1.8-2.0 times in each subsequent decade of life. In the country, more than 1 million stroke survivors, and more than 80% of them had disabilities of varying severity (Gusev E.I. The problem of stroke in Russia / S.S. Korsakov Journal of Neurology and Psychiatry. Appendix to the journal . - 2003, No. 9, p. 3).

The main factor hindering the restoration of motor functions, significantly limiting the life of a stroke patient, interfering with the implementation of stored functions and improving impaired, is increased muscle tone (spasticity).

In addition to stroke, motor disorders of the pyramidal type, accompanied by increased muscle tone, a decrease in the volume and strength of active movements (paresis) or their absence (paralysis), can lead to diseases such as TBI, cancer, chondrosis, multiple sclerosis, etc.

Currently, the same treatment methods are used to treat motor disorders of the pyramidal and extraliramide types.

The following methods and means of treating motor disorders are known, which are used independently or in combination in various combinations:

- medical methods and means of treatment with the introduction of drugs orally, intravenously or intramuscularly;

- orthosis;

- massage;

- physiotherapy;

- surgical methods;

- physiotherapeutic methods;

- medical blockades.

(Guidelines for the rehabilitation of patients with motor impairments / Edited by A.N. Belova, O.N. Shchepleva. Moscow: MBN, 1999, v.2, p. 20).

Medical methods and means of treatment

The main drugs used in this group of methods are muscle relaxants. According to the mechanism of action, muscle relaxants of central action are distinguished (affect the synaptic transmission of excitation in the central nervous system) and peripheral action (inhibit the direct excitability of striated muscles). When using muscle relaxants, quite significant side effects may occur, which should be carefully evaluated when choosing a drug. These include drowsiness, headache, nausea, menstrual irregularities, decreased sexual potency, and skin lesions. With prolonged use, addiction develops, drug dependence (mental and physical) may occur (Kharkevich D.A. Pharmacology. Moscow: Medicine, 1993, p.196).

Muscle relaxants of central action include baclofen, sirdalud, diazepam (Guidelines for the rehabilitation of patients with motor disorders. Edited by A.N. Belova, O.N. Shchepleva. Moscow: MBN, 1999, v.2, p.20).

Baclofen, an analogue of GABA, being an agonist of presynaptic GABAb receptors, inhibits mono- and polysynaptic reflexes and reduces the activity of gamma efferents by reducing the excretion of excitatory amino acids (aspartate and glutamate) from the terminals. It is most effective for spinal forms of spasticity: it not only lowers the tone and relieves painful muscle cramps, but also improves the function of the pelvic organs by relaxing the external urethral sphincter. In patients with brain damage, it can adversely affect attention and memory processes. The main side effects include general weakness, hypotension, ataxia, which, as a rule, pass with a decrease in the dose of the drug. When using baclofen, all side effects last quite a long time (from 30 minutes to 48 hours). With a sudden cancellation, convulsions and hallucinations can occur.

Peripheral drugs include dantrolene. It inhibits the actinmyosin complex, which is a substrate of muscle contractility: the mechanism of action is associated with a decrease in calcium release in the sarcoplasmic reticulum, which is accompanied by a decrease in muscle fiber contractility. It affects white muscle fibers to a greater extent, therefore it reduces the activity of phase reflexes more strongly (in comparison with tonic ones). Side effects include: drowsiness, nausea, dizziness, diarrhea. It is contraindicated in case of damage to the liver and cardiovascular system (Guidelines for the rehabilitation of patients with motor disorders. Edited by A.N. Belova, O.N. Shchepleva. Moscow: MBN, 1999, v.2, p.21).

A common drawback of medications and methods of treating motor disorders is severe muscle weakness, which interferes with the restoration of active movements. The reason for this is the indiscriminate effect of substances of this group - they affect synaptic transmission throughout the body.

Another disadvantage of drugs and methods is the temporality of reducing muscle tone. 2-3 months after stopping the drug, muscle tone rises to the previous level. During administration, some increase in the volume of active movements is possible. However, 2-3 months after the cessation of medication, the volume of active movements decreases again.

Orthosis - a long laying of a limb in a position when the spastic muscles are stretched. The method reduces tonic (dynamic and static) reflex activity and helps to reduce muscle tone.

Treatment with the position is carried out from one to several hours a day for several months depending on the subjective sensations of the patient and muscle tone (Guidelines for the rehabilitation of patients with motor disorders. Edited by A.N. Belova, O.N. Schepleva. Moscow: MBN , 1999, vol. 2, p. 23).

The use of this method in some patients leads to a decrease in hypertonicity, although it is mild and short-term, in other patients, increased tone does not decrease. Recovery of active movements does not occur.

Physiotherapy. Dosed muscle stretching allows for several hours to reduce muscle tone and increase range of motion (Guidelines for the rehabilitation of patients with motor impairments / Ed. By A.N. Belova, O.N. Shchepleva. Moscow: MBN, 1999, vol. 2, p. 24).

The disadvantage of this method is the unpredictability of the result (there may be a decrease and an increase in spasticity), as well as the short duration of the decrease in muscle spasticity, and the weakness of the therapeutic effect.

Surgical intervention is aimed at constantly interrupting nerve conduction by transection of nerve trunks.

The disadvantage of this method is, firstly, nerve damage and, secondly, indiscriminate interruption of conduction due to transection of the entire nerve, which includes both vegetative and somatic fibers. Nerve damage interferes with the restoration of active movements.

Physiotherapeutic procedures

Local application of cold helps to reduce elevated tendon reflexes, increase the range of motion in the joint, and improve the function of antagonist muscles. But a decrease in tone after the application of ice is observed for a very short time (Guidelines for the rehabilitation of patients with motor impairments / Edited by A.N. Belova, O.N. Shchepleva. Moscow: MBN, 1999, v.2, p.23) .

Local application of heat can also contribute to a temporary decrease in increased tone.

The disadvantage of physiotherapeutic procedures in the treatment of muscle spasticity is the short duration of the effect: a decrease in spasticity and the restoration of active movements takes place only within a few hours.

In addition to the local use of cold and heat, electrical stimulation is also known among the physiotherapeutic methods of treating motor disorders. The mechanism of the effect of electrical stimulation on increased tone is associated with neurotransmitter modulation at the segmental level. Muscle electrical stimulation with increased skeletal muscle tone is carried out mainly with the aim of creating targeted intense afferentation from stimulated muscles, which helps to disinert temporarily inactivated nerve elements near the destruction site, and also helps in training new motor skills, improves trophic muscle tissue (Rehabilitation Guide patients with motor disorders / Edited by A.N. Belova, O.N. Shchepleva, Moscow: MEN, 1999, vol. 2, p. 24). The application of this method leads to electrical stimulation of all nerves, therefore, as a result of electrical stimulation, an increase in tone is also possible.

Medical blockades are aimed at temporarily or permanently interrupting nerve conduction by exposing the nerve to a chemical substance (Guidelines for the rehabilitation of patients with motor disorders. Edited by A.N. Belova, O.N. Shchepleva. Moscow: MBN, 1999, v.2 , p. 28). Thus, with flexion contracture in the elbow joint, blockade of the radial nerve allows you to relax the brachioradialis muscle involved in flexion of the forearm.

Botulinum toxin, as well as alcohol or phenol, together with a local anesthetic (prototypes) are used as drugs for medical blockade. Drugs are injected into the nerve trunks once. Alcohol is injected into the motor points of the muscles in the form of an alcohol-novocaine mixture (1 part of 45% alcohol - 1 part of a 0.25% solution of novocaine).

Both botulinum toxin, and phenol, and alcohol cause chemical transection of the nerve. The effect (reduction in spasticity) lasts from 3 to 6 months. Over time, destroyed axons regenerate, which can lead to a restoration of spasticity. The volume and strength of active movements after nerve transection are reduced and are not restored after nerve regeneration. Since phenol damages not only motor, but also sensitive fibers, dysesthesia and causalgia occur in 10% of patients after blockade.

Other complications include transient weakness in the corresponding muscle, vein thrombosis, with an overdose of the drug - convulsions, inhibition of the functions of the cardiovascular and central nervous systems (Guide for the rehabilitation of patients with motor disorders / Edited by A.N. Belova, O.N. Shchepleva. Moscow: MBN: 1999, vol. 2, p. 30).

Local anesthetics in the above combinations with phenol or alcohol are used as an auxiliary substance for diluting the main substance that causes chemical transection of the nerve (phenol, alcohol), as well as for blocking pain relief.

Blockade of the nerve trunk only by a local anesthetic is ineffective. Spasticity decreases only for the duration of the local anesthetic (this period is different for different anesthetics). After the termination of the anesthetic, the tone returns to its original level or even becomes higher. Active movements are not restored.

Disclosure of inventions

The essence of the proposed method for the treatment of motor disorders of the pyramidal type is as follows. Blockade of the spinal roots or spinal nerves is carried out by the patient with a local anesthetic used in a concentration that allows stably reducing spasticity after one or several sessions without returning it to its original level. This concentration of local anesthetic selectively (differential) blocks in the spinal nerves or spinal roots the autonomic nerve fibers responsible for increased muscle tone. The word "responders" is used here in the sense that blocking these nerve fibers allows one to reduce spasticity after one or several sessions without returning it to its original level and without damaging the nerve fibers.

During the session, the anesthetic is administered in an effective dose in the form of one or a series of injections, each in an effective dose. Spend an effective number of sessions.

The volume and strength of active movements can also increase after one or several sessions, if the patient does not have paralysis, and a decrease in tone allows the muscles to contract.

The essence of the proposed invention means consists in:

- the use of local anesthetic as a means for the treatment of motor disorders of the pyramidal type by blocking spinal nerves or spinal roots;

- the use of local anesthetic as a means for the treatment of motor disorders of the pyramidal type.

Lidocaine and trimecaine are used at a concentration of 0.6% -1%, novocaine at a concentration of 0.75% -1%. Other local anesthetics are used in a concentration selected so that it allows selective blockade of the autonomic nerve fibers responsible for spasticity, i.e. the use of which would consistently reduce spasticity after one or several sessions - without returning it to its original level.

The dynamics of changes in spasticity (during the session and from session to session) as a result of the application of the proposed inventions is most often the following. After the introduction of a local anesthetic, spasticity decreases. After the end of the action of the anesthetic, spasticity increases slightly, but usually does not reach the level that it had before the session. And at this level it remains stable. In the next session, a further similar dynamics is observed: after the administration of the anesthetic, spasticity decreases further, after the end of the anesthetic, it increases slightly, but, as a rule, does not reach the level that it had before the second session. And it remains at this level. And so on. In some patients, spasticity after the end of the action of the anesthetic may return to the initial level, however, after several sessions, it decreases already stably, without returning to the initial level.

Using the data of the invention, it is possible to completely remove the tone, but this is not always rational. If the patient has paralysis, then relaxation of the limb will lead to the fact that the patient, who previously had the opportunity to lean on his leg like a crutch, loses this opportunity. In this case, it is more expedient to reduce the interfering tone, but to preserve the compensatory one.

The use of local anesthetics in other concentrations (different from the above) does not allow to obtain a differential block of autonomic nerve fibers responsible for increased tone. In these cases, after the termination of the action of the anesthetic, the increased tone again returns to its original level or even increases. Active movements, if they increased during the action of the anesthetic, decrease again after the termination of its action. The repetition of the blockade sessions does not allow to achieve a stable decrease in increased tone and a stable increase in active movements.

Blockade of the spinal nerves or spinal roots can be carried out by the introduction of a local anesthetic in various ways, for example, a local anesthetic is administered paravertebrally (blockade of the spinal roots) or epidurally or subdurally (blockade of the spinal nerves). For all types of administration, the same (above) concentration of local anesthetic is used.

When epidural or subdural administration of the blockade is carried out by the simultaneous administration of anesthetic (one injection) per session. With epidural administration, lidocaine, novocaine, trimecaine are administered once per session in the amount of 12-40 ml, and with subdural administration, once per session in the amount of 0.5-5 ml. The concentration and volume of the anesthetic in the injection, the dose administered per session can vary, but it (dose) should not exceed the maximum permissible single dose of this anesthetic for a specific route of administration (epidural or subdural).

With paravertebral administration, the anesthetic is administered during the session by a series of injections, each in an effective dose, into the spinal segments from one or, mainly, on both sides of the spine. For example, lidocaine and trimecaine are administered per session by 6-40 injections of 2-15 ml, novocaine is administered by 6-44 injections of 2-15 ml per injection.

The concentration of the anesthetic, its volume in one injection, the number of injections per session and the dose administered during one session can vary, but it (dose) should not exceed the maximum permissible single dose of this anesthetic with the paravertebral route of administration. A more accurate hit in the spinal root, depending on the experience of a specialist, can reduce the volume of each injection, increase the number of injections per session and reduce the number of sessions.

With paravertebral administration, local anesthetic injections can be performed in a different order, mainly sequentially from one segment to the next, etc. from one or, mainly, on both sides of the spine, starting from any segment of the spine and moving up or down. It is advisable to block as many segments as possible during one session.

To implement the course of treatment, an effective number of sessions is carried out, one or more depending on the dynamics of treatment. Sessions are repeated until a significant, clinically significant improvement in the patient's condition, in which there is a decrease in spasticity by 1-3 points (classification by R. Bohannon, 1987).

If the sessions are conducted more than once, then in each subsequent session the segments where the anesthetic is administered are alternated so that for the course of treatment all the spinal roots (or most of them) are blocked 1 or more times, mainly 2-4 times. In some cases (for example, when motor disorders in the arm or leg are treated in isolation), segments of the upper or lower spine are blocked, respectively, also alternating segments so that all spinal roots of the upper or lower spine are blocked 1 or more times during the course of treatment mainly 2-4 times.

A local anesthetic can be administered in combination with other drugs, for example, stabilizers (substances that stabilize the patient’s condition) and / or prolonged action of the anesthetic, etc. A solution of 0.1% adrenaline hydrochloride can be used as a stabilizer (1 drop in 8-10 ml of anesthetic solution - to prevent pressure drop). To prolong the action of a local anesthetic, vitamins B ₁₂ , B ₁ , as well as gelatin, autoblood are used.

The advantages of the proposed method and means in comparison with prototypes are:

1. A stable decrease in spasticity without damage and transection of any nerves. During the observation period (for some patients there are results of long-term observation lasting almost 5 years), none of the patients treated by the proposed method increased spasticity in relation to the level achieved as a result of treatment. A decrease in spasticity of not less than 1 point (according to the R. Bohannon scale, 1987) was achieved in 95% of patients.

2. The physiological effect on nerve fibers (lack of damage) and the possibility of restoring active movements associated with this circumstance.

3. A stable increase in the volume of active movements by about 1-2 points on a five-point paresis scale was achieved in 70% of treated patients (who did not have paralysis). As well as a decrease in increased tone, an increase in active movements persists throughout the observation period (2-5 years).

4. Low toxicity of drugs (anesthetics), the absence of side effects in the form of dysesthesia, causalgia, the practical absence of contraindications.

5. Selective effects on nerve fibers. Advantages 1-5 relate to the invention-method, advantages 1-4 relate to the inventive means.

The implementation of the invention

1. Patient E.V.F., 47 years old, was examined and treated in the neurosurgical department from 10.23.2003 to 11.14.2003.

Diagnosis: hemorrhagic stroke in the basin of the left middle cerebral artery (SMA) with the formation of an extensive intracerebral hematoma in the temporoparietal region on the left. Right-sided hemiparesis syndrome. Afatic syndrome. Arterial hypertension 3 tbsp., Risk 4.

The diagnosis was clarified by the data of a comprehensive clinical and neurological examination and CT (X-ray computer tomography) of the brain.

01/27/04. At the time of the examination, spasticity in the right hand is 3 points - a significant increase in tone, making it difficult to perform passive movements, extremely minor active movements. The arm is bent at the elbow joint and brought to the body. The patient cannot straighten his arm independently. Passive movements in the upper limb are very difficult. In the right leg, spasticity is 3 points - the leg is tense, unbent in the knee joint. Passive movements are sharply limited. He walks on his own, leaning on a crutch.

Conducted 4 treatment sessions using the proposed invention. During each session, a 0.6% solution of lidocaine hydrochloride was introduced paravertebrally.

01/27/04. In the Co1, Co2, S5, S3, S2, S1, L5, L4 segments, a lidocaine hydrochloride solution of 0.6%, 5.0 ml, was introduced on both sides.

01/28/04, In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of lidocaine hydrochloride 0.6%, 4.0 ml, was introduced on both sides.

01/29/04, in segments Th8, Th7, Th6, Th5, Th4, Th2, Th1, a solution of lidocaine hydrochloride 0.6%, 5.0 ml, was introduced on both sides.

01/30/04, in segments L4, L3, L2, a solution of lidocaine hydrochloride 0.6%, 15.0 ml each, was introduced on both sides.

01/31/04, Spasticity in the right hand - 1 point. The volume of active movements increased, the volume of passive movements in the hand is full. There remained a slight increase in tone, felt when bending or flexing in the form of slight resistance at the end of the movement. In the right leg, spasticity is 2 points - a moderate increase in tone, which is detected throughout the movement, but does not impede the performance of passive movements. The patient walks without crutches.

December 1, 04 (after 10 months) spasticity in the right hand - 1 point, the volume of active movements is preserved, the volume of passive movements is complete. Remained a slight increase in tone. Spasticity in the right leg - 2 points, the patient walks without crutches.

2. Patient I.V.M., 67 years old, was treated in 1 neurological department from 04.20.03 to 05.30.03.

Diagnosis: ischemic stroke in the pool of the left, right middle cerebral artery, against the background of arterial hypertension, cerebral atherosclerosis with deep right-sided hemiparesis syndrome, elements of sensory-motor aphasia, left-sided pyramidal insufficiency, right-sided hemigipesthesia.

CT scan of the brain: signs of external hydrocephalus. Cyst of the occipital region of the left hemisphere of the brain. Suspicion of ischemic lesion of the parietal region of the right hemisphere of the brain.

January 28, 04. At the time of examination, spasticity in the right hand is 3 points - a significant increase in tone, making it difficult to perform passive movements, active movements are sharply limited. In the right leg, spasticity is 4 points - the limb is fixed in the extension position. The patient walks with a crutch.

7 sessions were conducted: a solution of lidocaine hydrochloride was introduced paravertebrally.

January 28, 04. In the Co1, Co2, S5, S4, S3, S2, S1, L5 segments, a solution of lidocaine hydrochloride 0.6%, 5.0 ml, was introduced on both sides.

01/29/04, in the segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of lidocaine hydrochloride 0.75%, 5.0 ml, was introduced on both sides.

01/30/04, In segments Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, a solution of lidocaine hydrochloride 0.75% in 5.0 ml was introduced on both sides.

01/31/04, in segments C8, C7, C6, C5, C4, C3, C2, C1, a solution of lidocaine hydrochloride 0.6%, 5.0 ml, was introduced on both sides.

02/01/04. In the Co1, Co2, S5, S4, S3, S2, S1, L5 segments, a solution of lidocaine hydrochloride 0.6% in 5.0 ml was introduced on both sides.

02.02.04 g. In the segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of lidocaine hydrochloride 0.6%, 5.0 ml, was introduced on both sides.

02/04/04. In the Th1 segments Th2, Th3, Th4, Th5, Th6, Th7, Th8, a solution of lidocaine hydrochloride 0.6%, 2.0 ml, was introduced on both sides.

02/06/04, As a result of treatment, spasticity in the arm decreased to 1 point - there is a slight increase in tone, felt when the limb segment is bent or unbent in the form of slight resistance at the end of the movement; active movements in a larger volume. Spasticity in the leg decreased to 2 points - a moderate increase in tone, which is detected throughout the movement, but does not impede the performance of passive movements. The patient walks without crutches.

December 3, 04 (after 10 months) spasticity in the right hand - 1 point, the volume of active movements is preserved. Spasticity in the right leg - 2 points. The patient walks without crutches.

3. Patient K.G.M., 50 years old, was treated in the second neurological department from 10.25.01 to 4.12.01.

Clinical diagnosis: hemorrhagic stroke in the basin of the right middle cerebral artery with the formation of intracerebral hematoma in the subcortical structures on the right with left-sided hemiparesis syndrome, hemigipesthesia with arterial hypertension 3, risk 4.

Concomitant diseases: acute small focal anterospread myocardial infarction from 11.11.01

CT of the brain: in the projection of the subcortical nuclei of the right hemisphere, an intracerebral hematoma of 51 × 30 × 40 mm ^{3 is} determined. The middle structures are shifted to the left by 4.5 mm. The right lateral ventricle is tightened; a small amount of blood is noted in it. Convexital grooves in the right hemisphere of the brain are narrowed. Conclusion: signs of stroke in the SMA system on the right. Intracerebral hematoma (01/26/01).

Diagnosis: hemorrhagic stroke in the right SMA with the formation of intracerebral hematoma in the subcortical structures on the right; Syndrome of left-side expressed hemiparesis (Plegia in the left upper limb, left-side hemigiposthesia). Recovery period. Against the background of arterial hypertension 3 tbsp. discirculatory encephalopathy 2-3 tbsp.

01/26/04. At the time of examination, spasticity in the left hand is 4 points - the limb is fixed in the flexion position; no active movements. Spasticity in the left leg is 3 points: a significant increase in tone, making it difficult to perform passive movements. The patient walks only with outside help.

8 sessions were conducted with paravertebral administration of anesthetic.

01/26/04, in the segments Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5 on both sides introduced a solution of lidocaine hydrochloride 0.75% in 2.0 ml.

01/27/04, in the segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, L4, L3, L2, Th12, Th11, Th10, Th9, Th8 on both sides introduced a solution of lidocaine hydrochloride 0.75% in 2.0 ml.

01/28/04, in the segments Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5 on both sides introduced a solution of lidocaine hydrochloride 0.75% in 2.0 ml.

01/30/04. In the segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, L4, L3, L2, Th12, Th11, Th10, Th9, Th8 on both sides introduced a solution of lidocaine hydrochloride 0.75% in 2.0 ml.

01/31/04, in the segments Co1, Co1, S5, 84, S3, S2, S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5 on both sides introduced a solution of lidocaine hydrochloride 0.75% in 2.0 ml.

02/01/04, in the segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, L4, L3, L2, Th12, Th11, Th10, Th9, Th8 on both sides introduced a solution of lidocaine hydrochloride 0.75% in 2.0 ml.

02.02.04, in the segments Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5 from both sides introduced a solution of lidocaine hydrochloride 0.75% in 2.0 ml.

02/03/04. In segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, L4, L3, L2, Th12, Th11, Th10, Th9, Th8, a solution of lidocaine hydrochloride 0 was introduced on both sides. 75% 2.0 ml each.

02/04/04, as a result of treatment, spasticity in the left hand is 2 points (a moderate increase in tone, which is detected throughout the movement, but does not impede the performance of passive movements); active movements in small volume. In the left leg, spasticity is 1 point - a slight increase in tone, felt when the limb segment is bent or unbent in the form of slight resistance at the end of the movement. The patient walks without assistance.

December 2, 04 (after 10 months) spasticity in the left hand is 2 points, active movements in a small volume are preserved. Spasticity in the left leg - 1 point. The patient walks without assistance.

4. Patient T.F.H., born in 1951, diagnosis: CVB. Ischemic stroke in the system of the left internal carotid artery. Right hemiplegia. Motor aphasia. He was in the neurological department from 05/11/98 to 06/15/98. Entered after prolonged alcohol abuse. Movements in the left hand in full.

02.10.00 g. At the initial examination, spasticity in the right hand is 4 points, the hand is pressed to the body, fixed in the flexion position; no active movements. Spasticity in the right leg is 3 points - a significant increase in tone, making it difficult to perform passive movements. The patient walks with outside help within the room.

Conducted 6 sessions with paravertebral administration of anesthetic.

02.10.00, In segments Co1, Co2, S5, S4, S3, S2, S1, L5, a solution of lidocaine hydrochloride 0.75% in 5.0 ml was introduced on both sides.

02.12.00, In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of lidocaine hydrochloride 0.75% in 5.0 ml was introduced on both sides.

02/14/00 g. In the segments Th1, Th2, Th3, Th4, Th5, Th6, Th7, Th8, a solution of lidocaine hydrochloride 0.75%, 5.0 ml, was introduced on both sides.

02.16.00, In segments C8, C7, C6, C5, C4, C3, C2, C1, a solution of lidocaine hydrochloride 0.75% in 5.0 ml was introduced on both sides.

02/18/00, In segments L5, S1, S2, S3, S4, S5, Co2, Co1, a solution of lidocaine hydrochloride 0.75% in 5.0 ml was introduced on both sides.

02.20.00, In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of lidocaine hydrochloride 0.75%, 5.0 ml, was introduced on both sides.

May 29, 00, Spasticity in the right hand - 0 points. Passive movements in full. Active movements are not in full. In the right leg, spasticity is 1 point - a slight increase in tone, felt when the limb segment is bent or unbent in the form of slight resistance at the end of the movement. The patient goes out on his own, without crutches.

November 28, 04 (after 4.5 g) - the treatment result is stably maintained. There is no spasticity in the right hand, passive movements in full. Active movements are still not in full. In the right leg, spasticity is 1 point. The patient goes out on his own, without crutches.

5. Patient S.Yu. B., born 1946 Diagnosis: CVB. ONMK in the carotid pool on the right. Left-side hemiparesis.

02/11/00, the tone in the left hand - 3 points (a significant increase in tone, making it difficult to perform passive movements). There are practically no active movements, only movement in the flexor muscles. Spasticity in the left leg - 3 points (a significant increase in tone, making it difficult to perform passive movements). The patient walks around the room with outside help.

Conducted 7 sessions with paravertebral administration of anesthetic.

02/11/00, in segments C8, C7, C6, C5, C4, C3, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02.13.00, In segments Th8, Th7, Th6, Th4, Th3, Th2, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02.15.00, In segments L4, L3, L1, Th12, Th10, Th9, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02.17.00, In segments Co1, S5, S4, S2, S1, L5, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02/19/00, in the segments Co2, S5, S3, S2, S1, L5, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02.21.00, In segments L4, L3, L2, Th12, Th11, Th9, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02.24.00, In segments Th8, Th7, Th5, Th4, Th2, Th1, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02.26.00 g. The tone in the left hand is 1 point - a slight increase in tone, felt when the segment of the limb is unbent, as a slight resistance at the end of the movement; passive movements in full. Active movements are weakly expressed. In the left leg, spasticity is 1 point - a slight increase in tone, felt when the limb segment is bent in the form of slight resistance at the end of the movement. The patient is trying to walk around the room with crutches.

November 28, 04 (after 4 years 9 months) the tone in the left hand is 1 point, passive movements in full. Active movements are expressed - the patient is able to fasten buttons. In the left leg, spasticity is 1 point. The patient walks along the street without crutches, slight lameness.

6. Patient Sh.V.A., born in 1960 Diagnosis: CVB. Ischemic stroke in the system of the internal carotid artery on the left. Complete aphasia. Right hemiplegia.

02.10.00 g. At the time of examination, spasticity in the right hand is 3 points (a significant increase in tone, making it difficult to perform passive movements). The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. In the right leg, spasticity is 3 points (a significant increase in tone, making it difficult to perform passive movements). He walks around the room with outside help.

Conducted 4 sessions with paravertebral administration of anesthetic.

02/11/00, in segments L4, L2, L1, Th11, Th10, Th9, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02.12.00, In segments Co1, S5, S4, S3, S1, L5, a solution of lidocaine hydrochloride 1%, 5.0 ml, was introduced on both sides.

02/13/00, in segments C1, C2, C3, C5, C6, C8, a solution of lidocaine hydrochloride 1% 2.0 ml was introduced on both sides.

02/14/00 g. In both segments Th8, Th7, Th6, Th4, Th3, Th1, a solution of lidocanne hydrochloride 1% 3.0 ml was introduced on both sides.

02.16.00, The tone in the right hand is 0 points. Active bending movements are possible; there are practically no bending movements. The tone in the right leg is 0 points. Trying to walk around the room with crutches.

November 28, 04 (after 4 years 9 months). The tone in the right hand is 0 points. Passive and active movements in full. The tone in the right leg is 0 points. Walks down the street without crutches.

7. Patient G.T.R., 72 years old. Diagnosis: a condition after suffering a stroke (2001) in the pool of the right SMA. Left-side hemiparesis.

05/12/04. At the time of examination, the tone in the left hand is 4 points. The arm is fixed in the flexion position. The tone in the left leg is 3 points (a significant increase in tone, making it difficult to perform passive movements). Active movements on the affected side are absent. Conducted 5 sessions with paravertebral administration of anesthetic.

05/12/04, In segments Th11, Th10, Th9, Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, C8, C7, a solution of novocaine 0.75%, 2.0 ml, was introduced on both sides

05/14/04. In segments C6, C5, C4, C3, a solution of novocaine 0.75%, 15.0 ml each, was introduced on both sides of the left.

05/16/04, In the Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L2, L1, Th12 segments, a solution of novocaine 0.75%, 2.0 ml, was introduced on both sides.

05/18/04, In segments L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5, a 0.75% novocaine solution of 4.0 ml was introduced on both sides.

05/20/04, In segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, a solution of novocaine 0.75%, 6.0 ml, was introduced on both sides.

05/21/04, at the time of examination, the tone in the right hand and in the right leg is 1 point (a slight increase in tone, felt when the limb segment is bent or unbent, as a slight resistance at the end of the movement). Active movements on the affected side are weakly expressed.

November 20, 04 (after 6 months), tone in the right hand and in the right leg - 1 point. Active movements on the affected side are weakly expressed.

8. Patient S.T.I., 64 years old. Diagnosis: condition after suffering a stroke (2002) in the pool of right SMA. Left-side hemiparesis.

05/13/03, at the time of examination, the tone in the left hand is 3 points (a significant increase in tone, making it difficult to perform passive movements). The tone in the left leg is 2 points (a moderate increase in tone, which is detected throughout the movement, but does not impede the performance of passive movements). He walks around the room with a crutch. Conducted 5 sessions with paravertebral administration of anesthetic.

05/15/03, In the Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3, L2, L1, Th12 segments, a solution of novocaine 0.75% 3.0 ml was introduced from both sides.

05/17/2003. In the segments Th11, Th10, Th9, Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, C8, C7, a solution of novocaine 0.75%, 2.0 ml, was introduced on both sides.

05/19/2003. In segments C6, C5, C4, C3, C2, C1, Co1, Co2, S5, S4, S3, S2, S1, a 0.75% novocaine solution of 4.0 ml was introduced on both sides.

05/21/03, in segments L5, L4, L3, L2, Th12, Th11, Th9, Th8, Th6, Th5, a solution of novocaine 0.75% in 6.0 ml was introduced on both sides.

05/23/03, In segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, Co1, a solution of novocaine 0.75% in 5.0 ml was introduced on both sides.

05/25/03, at the time of examination, the tone in the right hand is 1 point (a slight increase in tone, felt when the segment of the limb is bent or unbent, as a slight resistance at the end of the movement). The tone in the right leg is 0 points. He walks around the apartment with a crutch.

12/02/04 (after 1.5 g) the tone in the right hand is 1 point, the tone in the right leg is 0 points. He walks with a crutch.

9. Patient N. S. M., 54. Diagnosis: hemorrhagic stroke (1998) in the pool of the right middle cerebral artery with the formation of intracerebral hematoma in the subcortical structures on the right with the syndrome of left-side hemiparesis.

08/20/03, During the initial examination, spasticity in the left hand is 4 points, the hand is fixed in the flexion position (pressed to the body), there are no active movements. Spasticity in the left leg - 3 points (a significant increase in tone, making it difficult to perform passive movements). The patient walks with outside help within the room.

Conducted 7 sessions with paravertebral administration of anesthetic.

08/20/03, In the Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3 segments, a solution of novocaine 1% 5.0 ml was introduced from both sides.

08/22/03, In segments L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5, a solution of novocaine 1% 4.0 ml was introduced on both sides.

08/24/03, In segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, a solution of novocaine 1% in 5.0 ml was introduced on both sides.

08/26/03, In segments S3, S2, S1, a solution of novocaine 1%, 15.0 ml, was introduced on both sides.

08.28.03, In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, a solution of novocaine 1% 3.0 ml was introduced on both sides.

08/30/04, In segments Th6, Th5, Th4, Th3, Th2, Th1, C8, C7, C6, C5, a solution of novocaine 1% 2.0 ml was introduced from both sides.

09/01/03, In segments Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, a solution of novocaine 1% 5.0 ml was introduced from both sides.

September 3, 2003. On examination, spasticity in the left hand is 1 point (a slight increase in tone, felt when the limb is bent or unbent, as a slight resistance at the end of the movement). Spasticity in the left leg is 1 point (a slight increase in tone, felt when the limb is extended as a slight resistance at the end of the movement). The patient walks with a crutch within the room.

12/03/04 (after 1 year 3 months) spasticity in the left hand - 1 point, spasticity in the left leg - 1 point. The patient walks with a crutch within the room.

10. Patient T.K.S., 51 g., Diagnosis: CVB. Ischemic stroke in the system of the left internal carotid artery (2001). Right-sided mild hemiparesis.

08/21/03, During the initial examination, spasticity in the right hand and right leg is 1 point. The patient walks on his own, there is a slight limp. Myself fully serviced. One session was conducted with paravertebral administration of anesthetic.

08/21/03, in the segments Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5, Th4 on both sides, a solution of novocaine 1% 2.0 ml.

08/25/03, On examination, spasticity in the left hand is 0 points, in the left leg - 0 points. Lameness is absent.

11. Patient N.V.D., 67 years old. Diagnosis: condition after suffering a stroke in 2002 (MCA) in the MCA basin. Right hemiplegia.

02.10.03, At the time of the examination, spasticity in the right hand is 3 points, the hand is brought to the body. Active movements are practically absent, only bending is possible, there are no movements for extension. Spasticity in the right leg - 3 points. Walks around the ward with outside help.

03/10/03, Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.6% 0.5 ml was injected, paresthesia to the clavicle was obtained.

03/14/03, Subdurally at the level of L4, L3, a solution of lidocaine hydrochloride 0.6% 2.0 ml was injected, paresthesia to the clavicle was obtained.

March 16, 2003. Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.6% 5.0 ml was injected, paresthesia to the clavicle was obtained.

03/18/03, at the time of the examination, spasticity in the right hand is 0 points, there is no tone. Passive movements in full. Active movements are practically absent. Spasticity in the right leg - 1 point. A patient walks around the apartment with a crutch. There is no active flexion in the knee joint.

November 15, 04 (after 1 year, 8 months) spasticity in the right hand - 0 points, passive movements in full, (insignificant) volume of active movements is preserved; spasticity in the right leg - 1 point. A patient walks around the apartment with a crutch. There is no active flexion in the knee joint.

12. Patient G.T.M., 69 years old. Diagnosis: condition after suffering a stroke in 2002 (MCA) in the MCA basin. Left-sided hemiplegia.

03/10/03, at the time of inspection spasticity in the left hand - 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. Spasticity in the left leg - 3 points. The patient walks around the ward with a crutch.

03/10/03, Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.6% 3.0 ml was added; received paresthesia to the clavicle.

March 14, 2003. Subdurally at the level of L4, L3, a solution of lidocaine hydrochloride 0.6% 3.0 ml was added; received paresthesia to the clavicle.

March 16, 2003. Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.6% 2.0 ml was injected, paresthesia to the clavicle was obtained.

04/22/03, At the time of the examination, spasticity in the left hand is 0 points. Passive movements in full. Active movements are practically absent. In the left leg, spasticity is 1 point. A patient walks around the apartment with a crutch. No knee flexion.

November 16, 04 (after 1.5 g) spasticity in the left hand - 0 points, passive movements in full. A small volume of active movements is preserved. Spasticity in the left leg - 1 point. A patient walks around the apartment with a crutch. No knee flexion.

13. Patient O.T.I., 52 g. Diagnosis: condition after suffering a stroke (May 30, 2000). Ischemic stroke in the system of the right middle cerebral artery with pronounced left-side hemiparesis (in the hand - Plegia), left-side hemigipesthesia. Severe impaired limb function. Dyscirculatory encephalopathy 3 tbsp., Cerebral atherosclerosis. Hypertension 2 tbsp.

Magnetic resonance imaging 02/10/2000, conclusion: ischemic stroke of the right parietal lobe with the phenomena of edema of the brain tissue, with the phenomena of dialdezny hemorrhage. Strokes of the right subcortical formations, the right thalamus are also likely. Internal hydrocephalus of non-obstructive nature. Cyst due to a stroke in the right thalamic region.

Magnetic resonance imaging 02.03.01, conclusion: cyst of the right parietal lobe due to ischemic stroke.

02/14/04. At the time of the examination, spasticity in the left hand is 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. Spasticity in the left leg - 3 points. Walks around the ward with a crutch.

02/14/04, Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.75% 1.0 ml; received paresthesia to the clavicle.

02.16.04, Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.75% 3.0 ml was added; received paresthesia to the clavicle.

02/18/04, Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.75% 5.0 ml; received paresthesia to the clavicle,

04/22/04, Spasticity in the left hand - 0 points, no tone. Passive movements in full. Active movements are practically absent. Spasticity in the left leg - 1 point. Walks around the ward with a crutch. There is no active flexion in the knee joint.

November 17, 04 (after 7 months) spasticity in the left hand - 0 points, no tone. Passive movements in full. Active movements are practically absent. Spasticity in the left leg - 1 point. Walks around the ward with a crutch. There is no active flexion in the knee joint.

14. Patient S.T.K., 67 years old. Diagnosis: a condition after suffering a stroke (2000) in the MCA basin. Left-sided hemiplegia.

03/12/04. At the time of the examination, spasticity in the left hand is 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. Spasticity in the left leg - 3 points. Walks around the ward with outside help.

03/12/04, a subdural solution at the level of L4, L3 was injected with a solution of lidocaine hydrochloride 0.75% 3.0 ml, paresthesia to the clavicle was obtained.

03/14/04. Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.75% 3.0 ml was injected, paresthesia to the clavicle was obtained.

03.16.04. Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 0.75% 3.0 ml was injected, paresthesia to the clavicle was obtained.

03/22/04. At the time of the examination, spasticity in the left hand is 0 points, there is no tone. Passive movements in full. Active movements are practically absent. Spasticity in the left leg - 1 point. Walks around the ward with a crutch. No knee flexion.

November 20, 04 (after 8 months) spasticity in the left hand - 0 points, no tone. Passive movements in full. Active movements are practically absent. Spasticity in the left leg - 1 point. Walks around the ward with a crutch. No knee flexion.

15. Patient L.N.F., 46 years old. Diagnosis: hemorrhagic stroke in the basin of the left middle cerebral artery with the formation of an extensive intracerebral hematoma in the temporoparietal region on the left. Right-sided hemiparesis syndrome. The diagnosis was clarified by the data of a comprehensive clinical and neurological examination and brain CT.

01/27/04. At the time of the examination, spasticity in the right hand is 3 points, passive movements are sharply hampered, the arm is bent at the elbow joint and brought to the body. Active movements are extremely insignificant, the patient cannot straighten his arm independently. Spasticity in the right leg is 3 points, the leg is tense, unbent in the knee joint. Passive movements in the leg are sharply limited. The patient walks on his own, leaning on a crutch.

Conducted 3 treatment sessions using the proposed invention.

01/27/04, a subdural solution at the level of L4, L3 introduced a solution of lidocaine hydrochloride 1% 3.0 ml, received paresthesia to the clavicle.

01/28/04, a subdural solution at the level of L4, L3 introduced a solution of lidocaine hydrochloride 1% 2.0 ml, received paresthesia to the clavicle.

01/29/04, a subdural solution at the level of L4, L3 introduced a solution of lidocaine hydrochloride 1% 3.0 ml, received paresthesia to the clavicle.

01/30/04, Spasticity in the right hand is 1 point. The volume of active movements increased, the volume of passive movements in the hand is full. There is a slight increase in tone, felt during flexion or extension in the form of slight resistance at the end of the movement. Spasticity in the right leg 2 points. The patient walks without crutches.

December 1, 04 (after 10 months) spasticity in the right hand is 1 point, the volume of active movements is preserved, the volume of passive movements in the hand is full. Spasticity in the right leg is 2 points. The patient walks without crutches.

16. Patient A.D.F., 57 years old. Diagnosis: ischemic stroke in the pool of the left, right middle cerebral artery (from 04.20.03) against the background of arterial hypertension, cerebral atherosclerosis with deep right-sided hemiparesis syndrome, elements of left-sided pyramidal insufficiency, right-sided hemihypesthesia.

CT scan of the brain: signs of external hydrocephalus. Cyst of the occipital region of the left hemisphere of the brain. Suspicion of ischemic lesion of the parietal region of the right hemisphere of the brain.

January 28, 04. At the time of the examination, spasticity in the right hand is 3 points, active movements are sharply limited. In the right leg, spasticity is 4 points - the limb is fixed in the extension position. The patient walks with a crutch.

01/28/04, Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 1% 3.0 ml; received paresthesia to the clavicle.

01/30/04, Subdurally at the level of L4, L3 a solution of lidocaine hydrochloride 1% 3.0 ml; received paresthesia to the clavicle.

02/01/04, Subdurally at the level of L4, L3, a solution of lidocaine hydrochloride 1% 2.0 ml; received paresthesia to the clavicle.

02/06/04, as a result of treatment, spasticity decreased in the arm to 1 point, active movements in a larger volume. In the leg, spasticity decreased to 2 points. The patient walks without crutches.

December 3, 04 (after 10 months) spasticity in the right hand - 1 point, the volume of active movements is preserved. Spasticity in the leg - 2 points. The patient walks without crutches.

17. Patient O.A.A., 48 years old. Diagnosis: residual effects of stroke (2001). Right hemiparesis.

January 27, 04. At the time of the examination, spasticity in the right hand is 3 points, passive movements are sharply hampered, active movements are extremely insignificant. The arm is bent at the elbow joint and brought to the body. The patient cannot straighten his arm independently. In the right leg, spasticity is 3 points - the leg is tense, unbent in the knee joint. Passive movements are sharply limited. The patient walks on his own, leaning on a crutch.

Conducted 2 treatment sessions using the proposed invention. During each session, a solution of novocaine was administered subdurally.

01/27/04, a solution of novocaine 1% 0.5 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

01/28/04, a solution of novocaine 1% 5.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

01/30/04, Spasticity in the right hand is 1 point. The volume of active movements increased. The volume of passive movements in the hand is full; slight increase in tone. In the right leg, spasticity is 2 points. The patient walks without crutches.

November 15, 04 (after 9.5 months) spasticity in the right hand is 1 point, the volume of passive movements in the hand is full, a slight increase in tone, the volume of active movements is preserved. Spasticity in the right leg is 2 points. The patient walks without crutches.

18. Patient N. B.C., 60 years old. Diagnosis: ischemic stroke in the pool of the left, right middle cerebral artery (2003) against a background of arterial hypertension, cerebral atherosclerosis with deep right-sided hemiparesis syndrome, elements of sensorimotor aphasia, left-sided pyramidal insufficiency, right-sided hemigipesthesia.

CT scan of the brain: signs of external hydrocephalus. Cyst of the occipital region of the left hemisphere of the brain. Suspicion of ischemic lesion of the parietal region of the right hemisphere of the brain.

January 28, 04. At the time of the examination, spasticity in the right hand is 3 points, active movements are sharply limited. In the right leg, spasticity is 4 points - the limb is fixed in the extension position. The patient walks with a crutch.

3 sessions were conducted.

01/28/04, a solution of novocaine 1% 3.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

02/01/04, Subdurally at the level of L4, L3 a solution of novocaine 1% 3.0 ml; received paresthesia to the clavicle.

02/04/04, a solution of novocaine 1% 3.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

02/06/04, as a result of treatment, spasticity decreased in the arm to 1 point. The volume of active movements increased. In the leg, spasticity decreased to 2 points. The patient walks without crutches.

November 22, 04 (after 9.5 months) spasticity in the right hand - 1 point. The volume of active movements is saved. Spasticity in the leg - 2 points. The patient walks without crutches.

19. Patient K.S.D., 49 years old. Diagnosis: the condition after suffering a stroke in the ischemic type (2001) in the pool of the right SMA. Left-side hemiparesis.

07/15/04. At the time of examination, the tone in the left hand is 4 points. The hand is brought to the body, fixed in the flexion position, there are no active movements. In the left leg, spasticity is 3 points. The patient cannot walk. Conducted 3 treatment sessions using the proposed invention.

07/15/04, Subdurally at the level of L4, L3 a solution of novocaine 0.75% 3.0 ml was added; received paresthesia to the clavicle.

07/17/04, Subdurally at the level of L4, L3 a solution of novocaine 0.75% 2.0 ml was added; received paresthesia to the clavicle.

07/19/04, Subdurally at the level of L4, L3 a solution of novocaine 0.75% 3.0 ml was added; received paresthesia to the clavicle.

07/21/04. At the time of examination, the tone in the left hand is 2 points. In the left leg - 1 point. Walks with outside help.

November 20, 04 (after 4 months), the tone in the left hand is 2 points. In the left leg - 1 point. The patient walks with outside help.

20. Patient K.M.A., 64 g. Diagnosis: condition after suffering a stroke in the ischemic type (2003) in the left MCA pool. Right hemiparesis.

05/12/04. At the time of examination, the tone in the right hand is 3 points. The tone in the right leg is 3 points. There are no active movements.

05/12/04, a solution of novocaine 0.75% 3.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

05/14/04, a solution of novocaine 0.75% 3.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

05.16.04, Subdurally at the level of L4, L3 a solution of novocaine 0.75% 3.0 ml was added; received paresthesia to the clavicle.

05/18/04. At the time of examination, the tone in the right hand is 1 point. The tone in the right leg is 1 point. There are no active movements.

November 19, 04 (after 6 months), the tone in the right hand is 1 point. The tone in the right leg is 1 point. There are no active movements.

21. Patient K.N.M., 52. Clinical diagnosis: hemorrhagic stroke in the pool of the right middle cerebral artery (2002) with left-sided hemiparesis syndrome. Diagnosis confirmed by CT scan of the brain.

01/26/04, At the time of examination, spasticity in the left hand is 4 points - the limb is fixed in the flexion position; no active movements. In the left leg, spasticity is 3 points. The patient walks only with outside help.

01/26/04, a solution of lidocaine hydrochloride 0.6% 40.0 ml was epidurally administered at the level of L4, L3.

01/28/04, a solution of lidocaine hydrochloride 0.6% 16.0 ml was epidurally administered at the level of Th10, Th9.

02/01/04, a solution of lidocaine hydrochloride 0.6% 12.0 ml was epidurally administered at the level of Th4, Th3.

02.03.04, As a result of treatment, spasticity in the left hand decreased to 2 points, active movements in a small volume. In the left leg, spasticity is 1 point. The patient walks without assistance.

November 26, 04 (after 9 months 3 weeks) spasticity in the left hand is 2 points, active movements in a small volume. Spasticity in the left leg - 1 point. The patient walks without assistance.

22. Patient L.P.V., 47 years old. Diagnosis: hemorrhagic stroke in the basin of the left middle cerebral artery with the formation of an extensive intracerebral hematoma (2001). Right-sided hemiparesis syndrome. Diagnosed by CT scan of the brain.

January 27, 04. At the time of the examination, spasticity in the right hand is 3 points, passive movements in the upper limb are sharply hampered. The arm is bent at the elbow joint and brought to the body. The patient cannot straighten his arm independently. Active movements are extremely small. In the right leg, spasticity is 3 points - the leg is tense, unbent in the knee joint. Passive movements are sharply limited. The patient walks on his own, leaning on a crutch.

Conducted 2 treatment sessions using the proposed invention.

01/27/04, a solution of lidocaine hydrochloride 0.6% 24.0 ml was epidurally administered at the level of L4, L3

01/29/04, a solution of lidocaine hydrochloride 0.6% 12.0 ml was epidurally administered at the level of Th10, Th9.

01/30/04, Spasticity in the right hand is 1 point. The volume of active movements increased, the volume of passive movements in the hand is full. Spasticity in the right leg is 2 points. The patient walks without crutches.

December 2, 04 (after 10 months) spasticity in the right hand - 1 point, the volume of passive movements in the hand is full, the volume of active movements is preserved. Spasticity in the right leg - 2 points. The patient walks without crutches.

23. Patient T.A.A., 51 g. Diagnosis: CVB. Ischemic stroke in the system of the left internal carotid artery (1997). Right hemiplegia.

02.10.00, Right hand: tone - 4 points, pressed to the body, fixed in the flexion position, there are no active movements. Right leg - tone 3 points; the patient walks with outside help within the ward.

02/10/00, a solution of lidocaine hydrochloride 0.75% 24.0 ml at the level of L4, L3 was epidurally administered.

02/12/00, a solution of lidocaine hydrochloride 0.75% 16.0 ml was epidurally administered at the level of Th10, Th9.

02/14/00, a solution of lidocaine hydrochloride 0.75% 12.0 ml at the level of Th4, Th3 was epidurally administered.

05/29/00, Spasticity in the right hand - 0 points, no tone. Passive movements in full. Active movements are not in full. Spasticity in the right leg - 1 point. The patient goes out on his own, without crutches.

November 28, 04 (after 4 years 6 months). Spasticity in the right hand - 0 points. Passive movements in full. The volume of active movements is saved. The patient walks without crutches, independently.

24. Patient L.E.A., born in 1960 Diagnosis: a consequence of severe traumatic brain injury (1999), brain contusion. Central left hemiparesis, moderate in the hand, rough in the hand.

05/11/04, Tone in the left hand - 3 points. There are practically no active movements, only movement in the flexor muscles. The tone in the left leg is 3 points. The patient does not walk.

05/11/04, a solution of lidocaine hydrochloride 0.75% 24.0 ml at the level of L4, L3 was epidurally administered.

05/13/04, a solution of lidocaine hydrochloride 0.75% 16.0 ml was epidurally administered at the level of Th10, Th9.

05/17/04, a solution of lidocaine hydrochloride 0.75% 12.0 ml at the level of Th4, Th3 was epidurally administered.

05/26/04, Tone in the left hand - 1 point, passive movements in full. Active movements are poorly expressed. The tone in the left leg is 1 point. The patient is trying to walk with crutches.

November 19, 04 (after 6 months), the tone in the left hand is 1 point, passive movements in full. Active movements are poorly expressed. The tone in the left leg is 1 point. The patient walks with crutches.

25. Patient V.L.A., born in 1964 Diagnosis: CVB. Ischemic stroke in the system of the internal carotid artery on the left (from 30.01.00). Right hemiplegia.

02/10/00 g. Tonus in the right hand - 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. The tone in the right leg is 3 points. The patient walks only with outside help.

Conducted 3 sessions.

02/11/00, a solution of lidocaine hydrochloride 1% 24.0 ml at the level of L4, L3 was epidurally administered.

12.02.00, a solution of lidocaine hydrochloride 1% 16.0 ml was epidurally administered at the level of Th10, Th9.

02/13/00, a solution of lidocaine hydrochloride 1% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02.16.00, The tone in the right hand is 0 points. Active bending movements are possible; there are practically no bending movements. The tone in the right leg is 0 points. The patient is trying to walk around the room with crutches.

11.28.04 g. (After 4 g. 9 months). The tone in the right hand is 0 points. Passive and active movements in full. The tone in the right leg is 0 points. Walks down the street without crutches.

26. Patient N.V.D., 67 years old. Diagnosis: condition after suffering a stroke in 2002 (MCA) in the MCA basin. Left-sided hemiplegia.

03/10/03, Tone in the left hand - 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. The tone in the left leg is 3 points. Walks around the ward with outside help.

03/10/03, a solution of lidocaine hydrochloride 1% 40.0 ml at the level of L4, L3 was epidurally administered.

03/12/03, a solution of lidocaine hydrochloride 1% 16.0 ml was epidurally administered at the level of Th10, Th9.

03/14/03, a solution of lidocaine hydrochloride 1% 12.0 ml at the level of Th4, Th3 was epidurally administered.

03/18/03, Tone in the left hand - 0 points, no tone. Passive movements in full. Active movements are practically absent. The tone in the left leg is 1 point. Walks around the ward with a crutch. There is no active flexion in the knee joint.

November 26, 04 (after 1 year 8 months) spasticity in the left hand - 0 points, passive movements in full; active movements are practically absent. Spasticity in the left leg - 1 point. The patient walks around the room with a crutch. No knee flexion.

27. Patient S.A.M., 53 years old. Clinical diagnosis: hemorrhagic stroke in the basin of the right middle cerebral artery with the formation of intracerebral hematoma in the subcortical structures on the right with left-sided hemiparesis syndrome (2001).

01/26/04. At the time of examination, spasticity in the left hand is 4 points - the limb is fixed in the flexion position, there are no active movements. Spasticity in the left leg is 3 points. It goes only with outside help.

Conducted 5 sessions.

01/26/04, a solution of novocaine 0.75% 40.0 ml at the level of L4, L3 was epidurally administered.

01/27/04, a solution of 0.75% 16.0 ml novocaine was epidurally administered at the level of Th10, Th9.

01/28/04, a solution of novocaine 0.75% 12.0 ml at the level of Th4, Th3 was epidurally administered

01/29/04, a solution of novocaine 0.75% 24.0 ml at the level of L4, L3 was epidurally administered.

02/01/04, a solution of novocaine 0.75% 16.0 ml at the level of Th10, Th9 was epidurally administered.

02.03.04, As a result of treatment, spasticity in the left hand decreased to 2 points, active movements appeared in a small volume. In the left leg, spasticity is 1 point. The patient walks without assistance.

November 17, 04 (after 9.5 months), the tone in the left hand is 2 points, active movements in a small volume are preserved. The tone in the left leg is 1 point. The patient walks without assistance.

28. Patient D.F.M., born in 1955 Diagnosis: CVB. Ischemic stroke in the system of the left internal carotid artery (1998). Right hemiplegia.

02.10.00, During the initial examination, spasticity in the right hand is 4 points, the hand is pressed to the body, it is fixed in the flexion position, there are no active movements. Spasticity in the right leg - 3 points, walks with outside help within the ward. Conducted 6 sessions.

02.10.00, a solution of novocaine 0.75% 24.0 ml at the level of L4, L3 was epidurally administered.

12.02.00, a solution of novocaine 0.75% 16.0 ml at the level of Th10, Th9 was epidurally administered.

02/14/00, a solution of novocaine 0.75% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02.16.00, a solution of novocaine 0.75% 40.0 ml at the level of L4, L3 was epidurally administered.

02/18/00, a solution of novocaine 0.75% 16.0 ml was epidurally administered at the level of Th10, Th9.

02.20.00, a solution of novocaine 0.75% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02/29/00, Spasticity in the right hand - 0 points, no tone. Passive movements in full. The volume of active movements increased (not full). Spasticity in the right leg - 1 point. The patient goes out on his own, without crutches.

November 28, 04 (after 6 months) there is no tone in the right hand. Passive movements in full. The volume of active movements is saved. Spasticity in the right leg - 1 point. The patient goes out on his own, without crutches.

29. Patient S.A.B., 62 years old. Diagnosis: CVB. ONMK in the carotid basin on the right (1997). Left-side hemiparesis.

02/11/00 g. Tonus in the left hand - 3 points. There are practically no active movements, only movements in the flexor muscles. The tone in the left leg is 3 points. The patient walks with outside help.

Conducted 5 sessions.

02/11/00, a solution of novocaine 1% 24.0 ml at the level of L4, L3 was epidurally administered.

02/13/00, a solution of novocaine 1% 16.0 ml at the level of Th10, Th9 was epidurally administered.

02.17.00, a solution of novocaine 1% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02/19/00, a solution of novocaine 1% 36.0 ml at the level of L4, L3 was epidurally administered.

02.24.00, a solution of novocaine 1% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02/26/00 g. Tonus in the left hand - 1 point, passive movements in full. Active movements are weakly expressed. The tone in the left leg is 1 point. The patient is trying to walk with crutches.

November 28, 04 (after 4 years 9 months) tone in the left hand 1 point, passive movements in full. Active movements are expressed - the patient is able to fasten buttons. The tone in the left leg is 1 point. The patient walks along the street without crutches, slight lameness.

30. Patient S.A.Yu., 60 years old. Diagnosis: CVB. Ischemic stroke in the system of the internal carotid artery on the left (1999). Right hemiplegia.

02/10/00 g. Tonus in the right hand - 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. The tone in the right leg is 3 points. Walks around the ward with outside help.

Conducted 4 sessions.

02/11/00, a solution of novocaine 1% 24.0 ml at the level of L4, L3 was epidurally administered.

12.02.00, a solution of novocaine 1% 16.0 ml at the level of Th10, Th9 was epidurally administered.

02/13/00, a solution of novocaine 1% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02/14/00, a solution of novocaine 1% 24.0 ml at the level of L4, L3 was epidurally administered.

02.16.00, The tone in the right hand is 0 points. Active bending movements are possible; there are practically no bending movements. The tone in the right leg is 0 points. Tries to walk with crutches.

November 28, 04 (after 4 years, 9.5 months). The tone in the right hand is 0 points. Passive and active movements in full. The tone in the right leg is 0 points. Walks down the street without crutches.

31. Patient N.V.A., 47 years old, stroke dated October 21, 2002. Diagnosis: hemorrhagic stroke in the basin of the left middle cerebral artery with the formation of an extensive intracerebral hematoma in the temporoparietal region on the left. Right-sided hemiparesis syndrome.

01/27/04. At the time of the examination, spasticity in the right hand is 3 points, passive movements are sharply complicated, extremely insignificant active movements. The arm is bent at the elbow joint and brought to the body. The patient cannot straighten his arm independently. Spasticity in the right leg - 3 points. The leg is tense, straightened in the knee joint. Passive movements are sharply limited. He walks on his own, leaning on a crutch.

Conducted 3 treatment sessions using the proposed invention. During each session, a solution of trimecaine in 5.0 ml paravertebral.

01/27/04, in the Co1, Co2, S5, S4, S3, S2, S1, L5 segments, a solution of trimecaine 0.6% 5.0 ml was introduced on both sides.

January 28, 04. In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of trimecaine 0.6% 5.0 ml was introduced on both sides.

01/29/04, in the segments Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, a solution of trimecaine of 0.6%, 5.0 ml, was introduced on both sides.

01/30/04, Spasticity in the right hand - 1 point. The volume of active movements increased, the volume of passive movements in the hand is full. A slight increase in tone, felt when bending or flexing in the form of slight resistance at the end of the movement. Spasticity in the right leg - 2 points (a moderate increase in tone, which is detected throughout the movement, but does not impede the performance of passive movements). The patient walks without crutches.

November 25, 04 (after 10 months) the tone in the right hand is 1 point, the volume of passive movements in the hand is full. The volume of active movements is saved. The tone in the right leg is 2 points. The patient walks without crutches.

32. Patient R.V.M., 66 years old, stroke from 05.19.03. Diagnosis: ischemic stroke in the pool of the left, right middle cerebral artery against the background of arterial hypertension, left-sided pyramidal insufficiency, right-sided hemihypesthesia.

CT of the brain: cyst of the occipital region of the left hemisphere of the brain. Suspicion of ischemic lesion of the parietal region of the right hemisphere of the brain.

January 28, 04. At the time of the examination, spasticity in the right hand is 3 points, active movements are sharply limited. Spasticity in the right leg - 4 points; the limb is fixed in the extension position. The patient walks with a crutch.

5 sessions were performed: a trimecaine solution of 2.0 ml was introduced paravertebrally.

01/28/04, in the segments Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5 on both sides introduced a solution of trimecaine 0.6% 2.0 ml.

01/31/04, in the segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, L4, L3, L2, Th12, Th11, Th10, Th9, Th8 on both sides introduced a solution of trimecaine 0.6% 2.0 ml.

02/01/04, in the segments Co1, Co2, S5, S4, S3, S2, S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5 on both sides introduced a solution of trimecaine 0.6% 2.0 ml.

02.02.04, in the segments Th4, Th3, Th2, Th1, C8, C7, C6, C5, C4, C3, C2, C1, L4, L3, L2, Th12, Th11, Th10, Th9, Th8 on both sides introduced a solution of trimecaine 0.6% 2.0 ml.

02/04/04. In the segments Co1, Co2, S5, S4, S3, S2. S1, L5, L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5 from both sides was introduced a solution of trimecaine 0.6% in 2.0 ml.

02/06/04, as a result of treatment, spasticity in the arm decreased to 1 point, active movements in a larger volume. In the leg, spasticity decreased to 2 points. The patient walks without crutches.

12/15/04 (after 10.5 months) spasticity in the right hand - 1 point, the volume of active movements is preserved. Spasticity in the right leg - 2 points. The patient walks without crutches.

33. Patient S.G.V., 55 years old, stroke from 10.25.01. Diagnosis: hemorrhagic stroke in the right SMA with the formation of intracerebral hematoma in the subcortical structures on the right, syndrome of left-side pronounced hemiparesis (plegia in the left upper limb, left-side hemigiposthesia) . Dyscirculatory encephalopathy 2-3 tbsp.

CT of the brain: in the projection of the subcortical nuclei of the right hemisphere, an intracerebral hematoma of 51 × 30 × 40 mm ^{3 is} determined. The middle structures are shifted to the left by 4.5 mm. The right lateral ventricle is tightened; a small amount of blood is noted in it. Conclusion: signs of stroke in the SMA system on the right. Intracerebral hematoma (01/26/01).

01/26/04. At the time of examination, spasticity in the left hand is 4 points - the limb is fixed in the flexion position, there are no active movements. Spasticity in the left leg is 3 points. It goes only with outside help.

Conducted 5 sessions with paravertebral administration of anesthetic.

01/26/04, in the Co1, Co2, S5, S4, S3, S2, S1, L5 segments, a solution of trimecaine 0.75% in 5.0 ml was introduced on both sides.

01/27/04. In the segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5, Th4, Th3, a solution of 0.75% trimecaine, 5.0 ml each, was introduced on the right.

01/28/04, in the segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, a solution of 0.75% trimecaine, 5.0 ml, was introduced on the left.

01/29/04 g. In the segments Co1, Co2, S5, S4, S3, S2, L5, C8, C7, C6, C5, C4, C3, C2, C1, a right solution of trimecaine 0.75% in 5.0 ml was introduced.

02/01/04. In the segments Co1, Co2, S5, S4, S3, S2, S1, L5, C8, C7, C6, C5, C4, C3, C2, C1, a solution of 0.75% trimecaine of 3.0 ml was introduced on the left.

02/03/04, As a result of treatment, spasticity in the left hand is 2 points, active movements in a small volume. In the left leg, spasticity is 1 point. The patient walks without assistance.

November 22, 04 (after 9.5 months) spasticity in the left hand - 2 points, active movements in a small volume. Spasticity in the left leg - 1 point. The patient walks without assistance.

34. Patient E.F.F., born in 1951 Diagnosis: CVB. Ischemic stroke in the system of the left internal carotid artery. Right hemiplegia. Stroke from 05/11/98

02/10/00, During the initial examination, the tone in the right hand is 4 points, the hand is pressed to the body, fixed in the flexion position, there are no active movements. The tone in the right leg is 3 points. He walks with outside help within the room. Conducted 6 sessions with paravertebral administration of anesthetic.

02/10/00. In segments Co1, Co2, S5, S4, S3, S2, S1, L5, a solution of trimecaine 0.75% in 5.0 ml was introduced on both sides.

12.02.00 g, In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of trimecaine 0.75% in 5.0 ml was introduced on both sides.

02/14/00 g. In the segments Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, a solution of trimecaine 0.75% in 5.0 ml was introduced on both sides.

02.16.00, in segments C8, C7, C6, C5, C4, C3, C2, C1, a solution of trimecaine 0.75% in 5.0 ml was introduced on both sides.

02/18/00, in the Co1, Co2, S5, S4, S3, S2, S1, L5 segments, a solution of trimecaine 0.75% in 5.0 ml was introduced on both sides.

02.20.00, In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of lidocaine hydrochloride 0.75%, 5.0 ml, was introduced on both sides.

05/29/00, Spasticity in the right hand - 0 points, no tone. Passive movements in full. The volume of active movements is not complete. Spasticity in the right leg - 1 point. The patient goes out on his own, without crutches.

November 28, 04 (after 4.5 g) there is no tone in the right hand. Passive movements in full. The volume of active movements is maintained. The tone in the right leg is 1 point. The patient goes out on his own, without crutches.

35. Patient S.K.V., born in 1946 Diagnosis: CVB. ONMK in the carotid pool on the right. Left-side hemiparesis. Stroke on January 15, 1999

02/11/00 g. Tonus in the left hand - 3 points. There are practically no active movements, only movements in the flexor muscles. The tone in the left leg is 3 points. The patient walks around the room with outside help.

Conducted 7 sessions with paravertebral administration of anesthetic.

02/11/00, in the Co1, Co2, S5, S4, S3, S2 segments, a solution of trimecaine 1% 5.0 ml was introduced on both sides.

02/13/00 g. In segments L4, L3, L2, L1, Th12, Th11, Th10, Th9, a solution of trimecaine 1% 2.0 ml was introduced on both sides.

02.15.00, In segments Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, a solution of trimecaine 1% 3.0 ml was introduced on both sides.

02.17.00, in segments C8, C7, C6, C5, C4, C3, a solution of trimecaine 1% 5.0 ml was introduced on both sides.

02/19/00, in the Co1, Co2, S5, S4, S3, S2, S1 segments, a solution of trimecaine 1% 4.0 ml was introduced on both sides.

02.21.00, in the segments Th12, Th11, Th10, a solution of trimecaine 0.6% 15.0 ml each was introduced on both sides.

02.24.00, In segments Th8, Th7, Th6, Th5, Th4, Th3, Th2, Th1, a solution of trimecaine 1% 2.0 ml was introduced on both sides.

02/26/00 g. Tonus in the left hand - 1 point, passive movements in full. Active movements are weakly expressed. The tone in the left leg is 1 point. The patient is trying to walk around the room with crutches.

November 28, 04 (after 4 years 9 months) the tone in the left hand is 1 point, passive movements in full. Active movements are expressed - the patient is able to fasten buttons. The tone in the left leg is 1 point. The patient walks along the street without crutches, slight lameness.

36. Patient V.V.B., born in 1961 Diagnosis: CVB. Ischemic stroke (from 1999) in the system of the internal carotid artery on the left. Complete aphasia. Right hemiplegia.

02/10/00 g. At the time of examination, the tone in the right hand is 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. The tone in the right leg is 3 points. He walks around the room with outside help.

Conducted 4 sessions with paravertebral administration of anesthetic.

02.11.00 g. In the Co1, Co2, S5, S4, S3, S2 segments, a solution of trimecaine 1% 5.0 ml was introduced on both sides.

12.02.00, in segments L4, L3, L2, L1, Th12, Th9, a solution of trimecaine 1% 5.0 ml was introduced on both sides.

02/13/00 g. In the segments Th8, Th7, Th6, Th5, Th3, Th1, a solution of trimecaine 1% 5.0 ml was introduced on both sides.

02/14/00, in segments C8, C7, C6, C5, C3, C2, a solution of trimecaine 1% 5.0 ml was introduced on both sides.

02.16.00, The tone in the right hand is 0 points. Active bending movements are possible; there are practically no bending movements. The tone in the right leg is 0 points. Trying to walk around the room with crutches.

November 28, 04 (after 4 years 9.5 months), the tone in the right hand is 0 points. Passive and active movements in full. The tone in the right leg is 0 points. Walks down the street without crutches.

37. Patient Y. N.V., 56 years old. Clinical diagnosis: hemorrhagic stroke in the basin of the right middle cerebral artery (2002) with left-sided hemiparesis syndrome. Diagnosis confirmed by CT scan of the brain.

01/26/04. At the time of examination, spasticity in the left hand is 4 points - the limb is fixed in the flexion position, there are no active movements. In the left leg, spasticity is 3 points. It goes only with outside help.

01/26/04, a solution of trimecaine 0.6% 40.0 ml at the level of L4, L3 was epidurally administered.

01/28/04, a solution of trimecaine 0.6% 16.0 ml at the level of Th10, Th9 was epidurally administered.

02/01/04, a solution of trimecaine 0.6% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02.03.04, As a result of treatment, spasticity in the left hand decreased to 2 points, there are active movements in a small volume. In the left leg, spasticity is 1 point. The patient walks without assistance with a crutch.

December 16, 04 (after 10.5 months), tonus in the left hand - 2 points, active movements in a small volume. The tone in the left leg is 1 point. The patient walks with a crutch without assistance.

38. Patient A.R.V., 47 years old. Diagnosis: hemorrhagic stroke in the basin of the left middle cerebral artery with the formation of an extensive intracerebral hematoma (2001). Right-sided hemiparesis syndrome. The diagnosis was verified by CT scan of the brain.

01/27/04. At the time of the examination, spasticity in the right hand is 3 points, passive movements are sharply hindered, the arm is bent at the elbow joint and brought to the body. The patient cannot straighten his arm independently. Active movements are extremely small. In the right leg, spasticity is 3 points - the leg is tense, unbent in the knee joint. Passive movements are sharply limited. The patient walks on his own, leaning on a crutch.

Conducted 2 treatment sessions using the proposed invention. Trimecaine solution was introduced during each session.

01/27/04, a solution of trimecaine 0.6% 24.0 ml at the level of L4, L3 was epidurally administered.

01/29/04, a solution of trimecaine 0.6% 16.0 ml at the level of Th10, Th9 was epidurally administered.

01/30/04, Spasticity in the right hand - 1 point. The volume of active movements increased, the volume of passive movements in the hand is full. A slight increase in tone, felt when bending or flexing in the form of slight resistance at the end of the movement. In the right leg, spasticity decreased to 2 points. The patient walks without crutches.

12/15/04 (after 10.5 months) the tone in the right hand is 1 point, the volume of passive movements in the hand is full. The volume of active movements is saved. The tone in the right leg is 2 points. The patient walks without crutches.

39. Patient T.V.N., 52 years old. Diagnosis: CVB. Ischemic stroke in the system of the left internal carotid artery (1997). Right hemiplegia.

02.10.00, Tone in the right hand - 4 points, the hand is pressed to the body, fixed in the bending position, there are no active movements. The tone in the right leg is 3 points. The patient walks with outside help within the ward.

02.10.00, a solution of trimecaine 0.75% 24.0 ml at the level of L4, L3 was epidurally administered.

12.02.00, a solution of trimecaine 0.75% 16.0 ml at the level of Th10, Th9 was epidurally administered.

02/14/00 g. A solution of trimecaine 0.75% 12.0 ml at the level of Th4, Th3 was epidurally administered.

02/19/00, Spasticity in the right hand - 0 points, no tone. Passive movements in full. Active movements are not present in full. Spasticity in the right leg - 1 point. The patient goes out on his own, without crutches.

November 28, 04 (after 4.5 g) there is no spasticity in the right hand. Passive movements in full. The volume of active movements is saved. Spasticity in the right leg - 1 point. The patient goes out on his own without crutches.

40. Patient P.O.A., born in 1961 Diagnosis: a consequence of severe traumatic brain injury (1999), brain contusion. Central left hemiparesis, moderate in the hand, rough in the hand.

05/11/04, Tone in the left hand - 3 points. There are practically no active movements, only movements in the flexor muscles. The tone in the left leg is 3 points. The patient does not walk.

05/11/04, a solution of trimecaine 0.75% 40.0 ml at the level of L4, L3 was epidurally administered.

05/13/04, a solution of trimecaine 0.75% 16.0 ml at the level of Th10, Th9 was epidurally administered.

05/17/04, a solution of trimecaine 0.75% 12.0 ml at the level of Th4, Th3 was epidurally administered.

05/26/04, Tone in the left hand - 1 point, passive movements in full. Active movements are weakly expressed. The tone in the left leg is 1 point. The patient tries to walk with the help of 2 crutches.

November 20, 04 (after 6 months) the tone in the left hand is 1 point, passive movements in full. Active movements are weakly expressed. The tone in the left leg is 1 point. The patient walks with the help of 2 crutches.

41. Patient T.R.G., 52 years old. Stroke on 03/18/02. Diagnosis: hemorrhagic stroke in the basin of the right middle cerebral artery with the formation of intracerebral hematoma in the region of the subcortical nuclei on the right with left-sided hemiplegia syndrome. Conclusion CT (computed tomography) - signs of hemorrhagic stroke in the MCA pool on the right, open hydrocephalus. In the area of the subcortical nuclei on the right, an acute intracerebral hematoma of irregular shape with uneven contours of 30-14.1-40 mm ³ with a breakthrough in the right lateral ventricle is determined.

02/10/04. At the time of examination, the tone in the left hand is 3 points. The hand is brought to the body, there are no active movements. The tone in the left leg is 3 points. The patient walks around the ward with outside help.

Conducted 3 sessions.

02/11/04, a solution of trimecaine 1% 40.0 ml at the level of L4, L3 was epidurally administered.

02/12/04, a solution of trimecaine 1% 16.0 ml was epidurally administered at the level of Th10, Th9.

02/13/04, a solution of trimecaine 1% 10.0 ml at the level of Th4, Th3 was epidurally administered.

02.16.04. The tone in the left hand is 0 points. Active flexion movements are possible; extension movements are weakly expressed. The tone in the left leg is 0 points. He walks around the room with a crutch.

November 28, 04 (after 9.5 months) there is no tone in the left hand. Passive movements - in full, active movements - 3 points on the paresis scale. The tone in the left leg is 1 point. Walks down the street without crutches.

November 28, 04 (after 9.5 months) there is no tone in the left hand. Passive movements in full, active movements - 3 points on the paresis scale. The tone in the left leg is 1 point. Walks down the street without crutches.

42. Patient O.T.S., 55 years old. Stroke from 01/30/2000. Diagnosis: ischemic stroke in the system of the right middle cerebral artery with severe left-sided hemiparesis (in the hand - plegia), left-sided hemigipesthesia. Severe impaired limb function. Dyscirculatory encephalopathy 3 tbsp., Cerebral atherosclerosis. Hypertension 2 tbsp.

CT - conclusion: ischemic stroke of the right parietal lobe with the phenomena of edema of the brain tissue, with the phenomena of diapedetic hemorrhage. Strokes of the right subcortical formations, the right thalamus are also likely. Internal hydrocephalus of non-obstructive nature. Cyst due to a stroke in the right thalamic region.

02/10/03, at the time of examination, the tone in the left hand is 3 points. The hand is brought to the body, there are no active movements. The tone in the left leg is 3 points. He walks indoors with outside help.

03/10/03, a solution of trimecaine 1% 40.0 ml at the level of L4, L3 was epidurally administered.

03/12/03, a solution of trimecaine 1% 16.0 ml was epidurally administered at the level of Th10, Th9.

03/14/03, a solution of trimecaine 1% 12.0 ml at the level of Th4, Th3 was epidurally administered.

03/18/03, at the time of examination, the tone in the left hand is 0 points (no tone). Passive movements in full. The degree of paresis is 3 points. The tone in the left leg is 1 point. He walks around the ward without a crutch. The degree of paresis of the muscles of the lower limb 3 points.

December 1, 04 (after 1 year 8.5 months), the tone in the left hand is 0 points, passive movements in full. The tone in the left leg is 1 point. Walks without a crutch. The degree of paresis of the muscles of the upper and lower extremities is 3 points.

43. Patient K.G.M., 50 years old. Stroke on 10.25.01

Clinical diagnosis: hemorrhagic stroke in the basin of the right middle cerebral artery with the formation of intracerebral hematoma in the subcortical structures on the right with left-sided hemiparesis syndrome.

CT of the brain: in the projection of the subcortical nuclei of the right hemisphere, an intracerebral hematoma of 51 × 30 × 40 mm ^{3 is} determined. The middle structures are shifted to the left by 4.5 mm. The right lateral ventricle is tightened; a small amount of blood is noted in it. Conclusion: signs of stroke in the SMA system on the right. Intracerebral hematoma (01/26/01).

02/10/03, at the time of examination, the tone in the left hand is 3 points. The hand is brought to the body, there are no active movements. The tone in the left leg is 3 points. Walks around the ward with outside help.

03/10/03, a solution of trimecaine 0.6% 5.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

1403.03 g. Subdurally at the level of L4, L3 a solution of trimecaine 0.6% 3.0 ml was added; received paresthesia to the clavicle.

03/16/03, a solution of trimecaine 0.6% 0.5 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

03/18/03, Tone in the left hand - 0 points, no tone. Passive movements in full, degree of paresis - 2 points. The tone in the left leg is 1 point. Walks around the ward with a crutch.

12/02/04 (after 1 year 8.5 months) spasticity in the left hand - 0 points, passive movements in full, degree of paresis - 2 points. The tone in the left leg is 1 point. He walks around the room with a crutch.

44. Patient I.A.N., 67 years old. Stroke of March 20, 2003. Diagnosis: ischemic stroke in the pool of the left, right middle cerebral artery against the background of arterial hypertension, cerebral atherosclerosis with deep right-sided hemiparesis syndrome, right-sided hemigipesthesia.

CT of the brain: CT - signs of external hydrocephalus. Cyst of the occipital region of the left hemisphere of the brain.

02/14/04. At the time of examination, the tone in the right hand is 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. The tone in the right leg is 3 points. Walks around the ward with outside help.

03/10/04, Subdurally at the level of L4, L3 introduced a solution of trimecaine 0.6% 2.0 ml; received paresthesia to the clavicle.

03/14/04, a solution of trimecaine 0.6% 5.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

03/16/04, a solution of trimecaine 0.6% 1.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

04/22/04. At the time of examination, the tone in the right hand is 0 points. Passive movements in full, degree of paresis - 2 points. The tone in the right leg is 1 point. Passive movements in full. He walks indoors with a crutch. There is no active flexion in the knee joint.

November 25, 04 (after 7 months), the tone in the right hand is 0 points. Passive movements in full, degree of paresis - 2 points. The tone in the right leg is 1 point. Passive movements in full. He walks indoors with a crutch. There is no active flexion in the knee joint.

45. Patient E.V.F., 47 years old. Stroke on October 23, 2003

Diagnosis: hemorrhagic stroke in the basin of the left middle cerebral artery with the formation of intracerebral hematoma in the temporoparietal region on the left. Right-sided hemiparesis syndrome. The diagnosis was verified by CT scan of the brain.

October 23, 2003. According to vital indications, the patient underwent surgery: the application of an expanded traction hole in the left parietal region, removal of an extensive intracerebral hematoma.

04/14/04. At the time of examination, the tone in the right hand is 3 points. The hand is brought to the body, active movements are practically absent, only flexion is possible, there are no movements to extend. The tone in the right leg is 3 points. Walks around the ward with a crutch.

04/14/04, a solution of trimecaine 0.75% 1.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

04/16/04, a solution of trimecaine 0.75% 3.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

04/18/04, a solution of trimecaine 0.75% 5.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

04/22/04. At the time of examination, the tone in the right hand is 0 points. Passive movements - in full. Active movements are poorly expressed. The tone in the right leg is 1 point. He walks around the room on his own without a crutch. There is no active flexion in the knee joint.

11/23/04 (after 7 months) the tone in the right hand is 0 points. Passive movements in full. Active movements are poorly expressed. The tone in the right leg is 1 point. He walks around the room on his own without a crutch. There is no active flexion in the knee joint.

46. Patient D.YU.G., 71. Stroke on 04/08/04. Diagnosis: ischemic stroke in the pool of the right internal carotid artery with a large softening center in the frontal, temporal and parietal lobes to the right, paresis of the gaze to the left, deep central hemiparesis left (plegia in hand).

CT 04/14/04: in the posterior-frontal, parietal and temporal regions, an extensive focus of reduced density of the heterogeneous structure is visualized due to small sections of blood imbibition with sizes of 135-60-100 mm ³ . On the right, foci of pathological density of the substance of the brain were not detected. The middle structures are displaced to the left to 5 mm. The ventricles of the brain are not dilated. The lateral ventricles are asymmetric due to compression of the anterior horn and the body of the right lateral ventricle. Convexital grooves of the subarachnoid space and the lateral gap of the right hemisphere are smoothed. Tank spaces are not deformed. Calcification of the pineal gland and choreoid plexuses of the posterior horns of the lateral ventricles is noted. Conclusion: ONMK ischemic type in the right hemisphere.

October 12, 2004. At the time of examination, the tone in the left hand is 1 point, there are no active movements. The tone in the left leg is 2 points. Can’t walk.

10/12/04, a solution of trimecaine 0.75% 0.5 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

10/14/04, a solution of trimecaine 0.75% 2.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

10.16.04, Subdurally at the level of L4, L3, a solution of trimecaine 0.75% 3.0 ml was added; received paresthesia to the clavicle.

10/22/04. At the time of examination, the tone in the left hand is 0 points. Passive movements in full. Active movements are practically absent. The tone in the left leg is 1 point. He walks indoors with outside help.

November 19, 04 (after 1 month), the tone in the left hand is 0 points. The tone in the left leg is 1 point. Passive movements in full. Active movements are practically absent. He walks indoors with outside help.

47. Patient D.G.G., 67 years old. Stroke on December 7, 2002

Diagnosis: hemorrhagic stroke in the left middle cerebral artery with the formation of intracerebral hematoma in the projection of the temporal lobe by CT with right-sided hemiplegia syndrome.

CT scan of the brain (December 9, 2002): in the left temporal lobe, the hyper-intensive section of 34-39 mm is irregular in shape, inhomogeneous, with uneven contours, surrounded by a narrow hypo-intensive area. The left ventricle is compressed, displaced to the right, the middle structures are displaced from left to right by 8 mm. Conclusion: hemorrhagic stroke in the left SMA.

January 27, 04. At the time of the examination, spasticity in the right hand is 3 points, passive movements are sharply hampered. The arm is bent at the elbow joint and brought to the body. The patient cannot straighten her arm on her own. Active movements are extremely small. Spasticity in the right leg - 3 points, the leg is tense, unbent in the knee joint. Passive movements are sharply limited. Walks with outside help. Conducted 3 treatment sessions using the proposed invention.

09/27/04, a solution of trimecaine 1% 1.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

09/28/04, a solution of trimecaine 1% 3.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

09/29/04, a solution of trimecaine 1% 5.0 ml was introduced subdurally at the level of L4, L5; received paresthesia to the clavicle.

09/30/04, Spasticity in the right hand - 1 point. The volume of active movements increased, the volume of passive movements in the hand is full. Spasticity in the right leg - 2 points. The patient walks without crutches around the room.

November 20, 2004 (after 2 months). Spasticity in the right hand - 1 point. Spasticity in the right leg - 2 points. The volume of active movements increased, the volume of passive movements in the hand is full. The patient walks without crutches around the apartment.

48. Patient A.V.A., born in 1959 A non-contrast MRI tomographic study of the brain was performed. On a series of tomograms is determined:

- multiple irregular foci and areas of a hyper-intense signal in the area of the subcortical nuclei, in the periventricular white substance with a diameter of 5-8 mm to 10-15 mm without perifocal edema;

- single hyperintensive foci in the legs of the brain, in the bridge;

- diffuse dystrophic changes in the cerebral cortex;

- racemic expansion of the optochiasmal tank with a size of 0.9 × 1.1 cm; the pituitary is pushed caudally, squeezed by the tank.

Conclusion: morphological manifestations of encephalopathy of vascular origin in the form of multifocal lesions of white matter, subcortical structures of the brain. External and internal hydrocephalus of a substitutional nature. Compared with the study from 11/12/02. - without significant dynamics.

10.28.04 g. At the time of examination, spasticity in the right hand is 3 points, there are no active movements. In the right leg, spasticity is 4 points; the limb is fixed in the extension position. Walks with a crutch.

10/28/04, a solution of trimecaine 1% 0.5 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

10/30/04, a solution of trimecaine 1% 3.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

11/01/04, a solution of trimecaine 1% 4.0 ml was introduced subdurally at the level of L4, L3; received paresthesia to the clavicle.

November 6, 04. As a result of treatment, spasticity decreased in the arm to 0 points - there is no tone, active movements - 2 points. In the leg, spasticity decreased to 2 points. The degree of paresis is 3 points.

Table

Spasticity Scale by R. Bohannon (1987) Points Muscle tone (hereinafter, the term "spasticity" is used as a synonym for increased tone) 0 No increase one A slight increase in tone, felt when bending or unbending a segment of a limb in the form of slight resistance at the end of the movement 2 A moderate increase in tone that is detected throughout the movement, but does not impede the performance of passive movements 3 Significant increase in tone, making passive movements difficult four The affected segment of the limb is fixed in the flexion or extension position. The degree of paresis. 0 - paralysis: the absence of palpation of muscle contractions with the active effort of the patient, aimed at performing a given movement. 1 - paresis: the presence of palpation determined and visible contractions that do not go into a given movement. 2 - a significant weakening of the muscles: the implementation of active movement is possible at various initial positions, but without burdening. 3 - slight weakening of muscle strength: movement is possible with additional burdening. 4 - normal muscle strength.

Claims (18)

1. A method of treating motor disorders according to the pyramidal type, including drug blockade of nerve trunks, characterized in that they block the spinal roots or spinal nerves with a local anesthetic, while the local anesthetic is administered for one or several sessions in an effective dose within the maximum permissible dose concentration selected in such a way that it allows to reduce spasticity without returning to the initial level. 2. The method according to claim 1, characterized in that lidocaine or trimecaine is used as a local anesthetic. 3. The method according to claim 2, characterized in that lidocaine or trimecaine is used at a concentration of 0.6-1%. 4. The method according to claim 1, characterized in that novocaine is used as a local anesthetic. 5. The method according to claim 4, characterized in that novocaine is used in a concentration of 0.75-1%. 6. The method according to claim 3 or 5, characterized in that the local anesthetic is administered epidurally. 7. The method according to claim 6, characterized in that the local anesthetic is administered with one injection per session of 12-40 ml. 8. The method according to claim 3 or 5, characterized in that the local anesthetic is administered subdurally. 9. The method according to claim 8, characterized in that the local anesthetic is administered with one injection per session of 0.5-5 ml. 10. The method according to claim 3, characterized in that lidocaine or trimecaine is administered paravertebrally. 11. The method according to claim 8, characterized in that the patient during the session produce from 6 to 40 injections of lidocaine or trimecaine of 2-15 ml each. 12. The method according to claim 5, characterized in that novocaine is administered paravertebrally. 13. The method according to p. 12, characterized in that the patient for the session produce 6-44 injections of novocaine 2-15 ml each within the maximum permissible dose. 14. The method according to any one of claims 4, 5, 12, characterized in that the local anesthetic is administered predominantly sequentially in adjacent segments on one or mainly on both sides of the spine, starting from any part of the spine and moving up or down the spine. 15. The method according to 14, characterized in that the effective number of sessions is carried out, alternating segments in subsequent sessions so that all spinal roots (or most of them) are blocked one or more times, mainly 2-4 times. 16. The method according to claim 1, characterized in that the local anesthetic is used together with stabilizing substances (for example, adrenaline hydrochloride) and / or with prolonging substances (for example, vitamin B12, B6, B1, gelatinol). 17. The use of a local anesthetic as a means for the treatment of motor disorders of the pyramidal type in a dose and concentration, allowing to reduce spasticity without returning it to its original level. 18. The use of a local anesthetic as a means for the manufacture of a means for the treatment of motor disorders of the pyramidal type in a dose and concentration, allowing to reduce spasticity without returning it to its original level.