RU2355439C2 - Method of treating patients with neurological manifestations of dorsopatia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: registration and analysis of bioelectrical brain activity (BBA) are carried out. After that preliminary transcranial electroherapeutic influence is performed. After compensatory pause BBA parametres are registered and if 5-15% decrease of interhemispheric asymmetry is observed, course of transcranial electric therapy is carried out. Influence is realised through electrodes placed on head circumference similarly to points FP1, T3, O1, O2, T4, FP2, neutral electrode is placed in point Fpz, reference electrodes A1 and A2 - on ear lobules, electrode polarity is determined by principle of nerve tissue response to electric current: under cathode - depression of activity, under anode - its activation. Influence is realised by means of two- phase exponential current with frequency 60-90 Hz, intensity of current is determined individually and is varied from 0.1 to 3.0 mA, with influence duration from 0.5 to 8 min. Course of treatment includes 6-8 sessions. Procedures are carried out in the first half of day, before other physio-balneo-therapeutic procedures.

EFFECT: most expressed anti-inflammatory, analgesic effect, improvement of neurotrophic functions of central nervous system, patient's psychoemotional condition, reduction of treatment terms, favours recovery of work ability.

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Description

The invention relates to medicine, in particular to restorative medicine and neurology, and can be used in practical health care institutions in the treatment of patients with neurological manifestations of dorsopathy. Back pain is one of the most pressing problems of modern health care. About 20% of the working-age adults suffer from recurring back pain. About a third of patients subsequently develop chronic pain, which persists for more than 12 weeks and causes prolonged disability (Gorbunov F.E. et al., 1993-2006, Voznesenskaya T.G., 2001; Levin O.S., 2005). In recent years, a tendency toward an increase in the frequency of diseases of the musculoskeletal system in the Russian Federation has been recorded (Kamchatov P.R., 2005). Despite all the new medical, physiotherapeutic and surgical approaches in the treatment of pain manifestations of non-deforming dorsopathies, the urgency of the problem does not decrease. Chronization of pain in this category of patients acts as a disadaptive, stressful factor, leading to the development of psychological changes, primarily hypochondriacal and anxiety-depressive ones (Zaitsev V.P., Ayvazyan T.A., Gorbunov F.E. et al., 2002 -2003, Maslovskaya S.G. et al., 2006), impaired neurotrophic functions of the central nervous system, which reduces the effectiveness of the treatment. At the same time, people with reduced resistance to chronic stressful conditions are more prone to chronic pain in dorsopathy with exacerbation of motor stereotype disorders (Wayne A.M., 2001; Borenstein D., 2003). In the pathogenesis of dorsopathies, there are violations of the static-dynamic functions of the spine, degenerative and degenerative changes in the musculo-ligamentous apparatus and the membranes of the spinal cord, autonomic-vascular and reflex disorders.

In recent years, the study of the asymmetry of the structure and functioning, at different levels, of the human nervous system has been gaining more and more development. The predominance of the right or left hemisphere of the brain depends on genotypic and phenotypic characteristics, and the degree of their lateral participation may vary from the task to which the activity is directed, the conditions of the activity itself and environmental factors. Dynamic shifts of interhemispheric asymmetry are an adaptive regulatory act to the current external and internal conditions (Zvonikov V.M., 1989).

With prolonged and overly pronounced effects of external and internal factors, the integrative activity of cortical and subcortical formations is disrupted both horizontally (right - left hemisphere) and vertically (cortical-subcortical-visceral relationships). Obviously, in pathological processes on the part of the internal environment of the body, one can expect changes in the dynamic interhemispheric asymmetry of a disintegrative nature, which reduce the effectiveness of the rehabilitation therapy, in particular, in patients with neurological manifestations of dorsopathy.

One of the most common methods of treating dorsopathy is medication. Drugs are used that have analgesic, anti-inflammatory, trophicostimulating properties, and also have a tranquilizing effect (ambene, voltaren, diclofenac, cardiac, etc.). The disadvantage of the drug method is that the nature of this disease requires long-term administration of drugs. The latter develop resistance over time. It becomes necessary to increase the dose. All sorts of complications (allergic and toxic reactions) occur. In addition, the intake of a number of drugs is limited by the presence of contraindications for their use, for example, in diseases of the gastrointestinal tract, kidneys, etc. The effectiveness of drug therapy is on average 40-58% for periods of 4-8 weeks (Haigh R., Clarke A., 1999).

Known methods of treating patients with neurological manifestations of dorsopathy using spa factors: radon and sulfide baths, silt mud, paraffin, underwater massage shower, etc. However, they can only be prescribed if there is a balneotherapy department and for patients who have no contraindications for balneotherapy (Strelkova N .I., 1989, Schepina T.P., 1979).

Known methods of treatment using various physical factors, for example, exposure to ultrasound, an alternating magnetic field, diadynamic currents (Bernard currents), interference currents (Erin VN, 2000, Gorbunov F.E., 2001., Boskovic K., 1999) , with paravertebral exposure. A common drawback of these methods of treatment is the lack of a direct corrective effect on the central nervous system with the improvement of the neurotrophic functions of the subcortical formations of the brain, their insignificant effectiveness in improving the patient's psychoemotional state, the instability of the therapeutic effect, and the inability to use them in patients with various concomitant diseases.

Known methods of treatment with transcerebral exposure to a preformed electric current. A complex of physical and biophysical shifts, based on the laws of electric current distribution and its primary interaction with various tissues, forms a physiological mechanism of action. The decisive role belongs to the direct action of the pulsed current on the brain structures, while the subcortical-stem formations - the thalamus, hypothalamus, the reticular formation of the brain stem, and the limbic system are most affected. As a result, their functional state, cortical-subcortical relationships significantly change, the vegetative support of various body functions improves, including hormone-correcting, hemodynamic and antalgic effects. Currently, the following methods of transcerebral electrotherapy are used: electrosleep, electrotranquilization, transcerebral amplipulse therapy, transcerebral interference therapy (Bogolyubov V.M. et al. Moscow 2002, "Technique and methods of physiotherapeutic procedures", pp. 45-56). Synchronization of physiological functions against the background of pathological processes in the body, through exposure to cerebral blood flow, aimed at increasing the autonomic regulation of the central nervous system, was performed using transcranial electrotherapy using the TRANSAIR-01 apparatus with a positive effect (Boyko I.P., VI All-Russian Congress of Physiotherapists , St. Petersburg, 2006, p. 32-33).

The closest in technical essence to the proposed invention (prototype) is a method of treating patients with neurological manifestations of dorsopathy using the MEDAPTON device (mesodiencephalic modulator Kareva-4, application for the grant of a patent of the Russian Federation No. 20011116857 of 06.15.2001, authors Karev V.A. , Durnov S.A., Chistyakov A.O.). A processor is installed in the MEDAPTON device, which allows to ensure maximum purity of the electrical signal at the electrodes. In this case, direct and pulse currents are used in a ratio of 0.5-1: 1 in amplitude, the frequency of the pulse current from 70 to 90 Hz changes cyclically in 1 min, 6 pulse shapes, which corresponds to 6 programs on the device (unidirectional rectangles, bidirectional rectangles, unidirectional rectangles with 10 kHz filling, bidirectional rectangles with 10 kHz filling, unidirectional triangles, bidirectional triangles), pulse duration 4 ms.

The disadvantage of this method is the lack of primary diagnosis of the state of dynamic interhemispheric asymmetry, the inability to determine individual tolerance of exposure and to individualize the program of transcranial therapy.

The technical result of the proposed method is the normalization of the dynamic asymmetry of brain activity in both the interhemispheric and cortical-subcortical relationships, which allows you to activate the adaptive capabilities of the body, improve energy supply and trophic tissue in patients, increase the effectiveness of physiotherapy, reduce pain, normalize the psychoemotional state , shorten recovery and return to work.

The indicated technical result is achieved by performing transcranial electrotherapy with feedback, in real time, in the morning, before the planned physiobalneotherapy (TETOS-registration certificate No. FS 022b2006 / 2922-06 of March 29, 2006).

The exposure is carried out through electrodes oriented along the circumference of the head similarly to the points (FP1, T3, O1, O2, T4, FP2) of the international classification "10-20". The neutral electrode (N) is located at the point Fpz, and the reference electrodes A1 and A2 are located on the earlobes. An electroconductive gel is introduced under the electrodes and the TETOS session is started, the electrodes should fit snugly on the skin of the head, and the skin resistance during the session should not exceed 4 kOhm.

One TETOS session is from one to three cycles of a strict sequence of actions:

1 - registration and analysis of bioelectric activity of the brain (BAM),

2 - electropulse therapeutic stimulation of brain structures,

3 - compensatory pause,

4 - registration for 1.5-2 minutes and analysis of BAM.

The choice of correction tactics for THETOS therapy is based on the preliminary assessment of patient complaints, the results of clinical and laboratory examinations, and the results of neurophysiological examinations.

In a healthy adult, the genotypic asymmetry of BAM does not exceed 10-15%. The phenotypic asymmetry of BAM in 15-30% reflects minor functional disorders, 30-65% - high, more than 65% - very high. This level of asymmetry is accompanied by a deviation of the parameters of the main BAM rhythms from the norm. These are reduced activity and inversion of alpha rhythm, increased activity of slow rhythms (delta and theta) and pathological horizontal-vertical redistribution of activities of all rhythms in the brain.

To correct the functional state of the patient, according to the initial BAM, the electrode application scheme and the polarity of the exposure were selected:

under the cathode (-) - depression, under the anode (+) - activation. THETOS therapy began with bitemporal expert exposure. A two-phase exponential current was used, the exposure time was 15 seconds, the current strength was 20% less than the threshold of pain sensitivity. After 10 minutes of a compensatory pause, the BAM parameters are removed. Three types of reaction were recorded: a) diagnostic - a decrease in interhemispheric asymmetry in the analyzed BAM points by 5-15%, equalization of asynchrony in the activity of the main rhythms and the tendency of the amplitude gradient in the alpha rhythm to a normal distribution; b) corrective - expert influence is enough to normalize the recorded potentials of BAM, characteristic of an optimal, functional state; c) excessive (one observation) - an expert effect causes an inverted neurophysiological reaction. With a corrective and excessive reaction, further exposure was not carried out. Preliminary expert exposure allows you to select the optimal dose of the corrective signal and actually prevents the risk of side effects.

The current strength of the corrective action is determined by a value of 20% less than the threshold of pain sensitivity, but no less than the value of the current strength with an electric skin resistance of 4 kOhm. The duration of exposure is determined by the reaction of the BAM to the expert signal: a) with a pronounced reaction (high efficiency in almost all parameters of the BAM), it is minimal and amounts to 0.5-3.0 minutes; b) with a significant response to an expert signal (high efficiency in more than half of the BAM parameters) - from 2.0 to 6.5 minutes; c) with a slight reaction to an expert signal (efficiency is observed in less than 30% of the registered BAM parameters) - from 5.0 to 8.0 minutes. The arrangement of the electrodes and the shape of the current for the corrective signal are similar to the expert signal. Compensatory belly after corrective signal for 20 minutes. The removal and analysis of BAM occurs similarly to the study of the effectiveness of an expert signal. Further tactics of course treatment is determined by the effectiveness of the first session and the preservation of positive changes a day after the session THETOS-therapy. After normalizing the objective parameters of BAM, 1-2 sessions were performed.

EXAMPLE 1. Patient M., born in 1976, was admitted to the rehabilitation department of patients with diseases of the nervous system with a diagnosis of

Dorsopathy: vertebrogenic radiculopathy L5-C1, moderate pain, stage of incomplete remission. Two months before hospitalization, the patient at the Moscow City Center for Neurosurgery had an intervertebral hernia at the L5-C1 level.

Complaints of admission for heaviness in the lumbar region, periodic pains in the left leg, aggravated by a statodynamic load, a feeling of fatigue, decreased mood background.

From the anamnesis it is known that the patient has been suffering from pain in the lumbar region with radiation to the left leg for the last three years, the treatment carried out brought unstable remission. The latter exacerbation led the patient to a neurosurgical clinic, where an intervertebral hernia at the level of L5-C1 was diagnosed on magnetic resonance imaging. The operation was performed as planned, the wound healed by first intention, the pain syndrome significantly regressed, but did not completely stop.

Somatic status of the patient without features. In neurological status: Patient is emotionally labile, mobility in the lumbar spine is determined, cm Lasega on the left at an angle of 40 °, weak back flexion of 1 finger of the left foot, lack of Achilles reflex, wetness of the palms, feet.

Rheoencephalography - FM abduction: the tone of the arterioles and precapillaries is moderately increased on the left, sharply increased on the right, peripheral vascular resistance is moderately increased on the left, significantly increased on the right. OM abduction: the asymmetry of pulse blood supply is pronounced, peripheral vascular resistance is slightly increased on the left, sharply increased on the right.

Leg rheovasography - pulse blood supply is moderately increased on the right, sharply increased on the left, the asymmetry of pulse blood supply is moderate, rheo-signs of vascular spasm on the left.

During psychological testing using the SAN test and the Luscher test, poor health, apathy, the need for peace, and anxiety reduction were determined.

TETOS-therapy was carried out by the patient before the planned physiobalneotherapy. The initial registration of BAM showed pronounced interhemispheric asymmetry in Δ rhythm with a predominance in the right hemisphere of up to 45%, after 8 sessions of exposure, the asymmetry in the main rhythms of BAM did not exceed 20%. The patient subjectively noted an improvement in overall well-being, the occurrence of pain only in the form of short-term "lumbago", with awkward movements. In neurological status, Mr. Lasega regressed, the volume of active movements in the lumbar spine increased.

Rheoencephalography - FM abduction: the tone of arterioles and precapillaries is moderately elevated on the right, peripheral vascular resistance is normal. OM abduction: the asymmetry of pulse blood supply is insignificant, peripheral vascular resistance is moderately increased.

Leg rheovasography - pulse blood supply is moderately increased on the left, significantly increased on the right; asymmetry within physiologically permissible limits; there are no rheo-signs of vasospasm. Psychological tests: SAN - excellent health, a feeling of freshness, fullness of strength; Lusher - the need for emotional security, social activity. After a course of rehabilitation therapy, the patient returned to her previous work. A survey conducted 6 months after treatment showed the stability of the clinical and functional state.

Thus, the proposed method for the treatment of patients with neurological manifestations of dorsopathy allows, by restoring the functioning of the central regulatory systems (physiological distribution of the main rhythms of BAM), to increase the adaptive capabilities of the functional systems of the body and the neurotrophic function of the central nervous system, to strengthen the antalgic and trophic-stimulating effect of physiological balneotherapy.

The proposed method of treatment was applied in the Department of Rehabilitation of Patients with Nervous System Diseases of the Federal State Institution RSCVM and K ROSZDRAVA in 60 patients with neurological manifestations of dorsopathy aged 18 to 60 years. The portability of the procedures was good. Toward the end of the course of treatment, pronounced positive dynamics of the psychoemotional state of patients and the main clinical symptoms was noted, and exercise tolerance increased. The results were statistically significant in comparison with the control group in which THETOS therapy was not performed.

Claims (1)

A method of treating patients with neurological manifestations of dorsopathy on the background of physiobalneotherapy by transcranial electrotherapy, characterized in that they record and analyze the bioelectrical activity of the brain (BAM), after which a preliminary transcranial electrotherapeutic effect is performed, after compensatory pause, the BAM parameters are removed and, with a decrease in interhemispheric asymmetry, BAM 5-15% conduct a course of transcranial electrotherapy, while the effect is carried out through electrodes located around the head circumference, similarly to points FP1, T3, O1, O2, T4, FP2, the neutral electrode is located at the point Fpz, and the reference electrodes A1 and A2 are located on the earlobes, the polarity of the electrodes is determined by the principle of the reaction of nerve tissue to electric current: depression under the cathode activity, its activation under the anode, the effect is carried out by a two-phase exponential current with a frequency of 60-90 Hz, the current strength is determined individually and varies from 0.1 to 3.0 mA, with a duration of exposure from 0.5 to 8 minutes, the course of treatment 6- 8 sessions, in the morning, to other physio alneoterapevticheskih procedures.