RU2372888C1 - Method of health resort therapy in patients with minor craniocerebral injury in early recovery period - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neuropathology. Radon baths are prescribed; 40 min after taking a radon bath, the patient is exposed to pulse low-frequency electromagnetic waves of the device "Inphyto" at frequency 60 Hz, exposition 8 to 11 minutes, every second day. Therapeutic course includes 8-10 procedures.

EFFECT: method improves cerebral blood supply, increases blood oxygenation, improves redox processes and external respiration function, ensures elimination or relief of headaches, dizziness, improved memory, attention, higher working capacity, normalisation of vegetative nervous system indices, improvement of cerebral bioelectric activity indices.

5 tbl, 5 ex

Description

The invention relates to medicine, in particular to neuropathology. Close to the claimed is a method of treating the long-term consequences of a traumatic brain injury (V.N. Ayvazov, L.A. Cherevashchenko, R.G. Krinchiyan, S.M. Ilyaeva, N.V. Ayvazov, N.N. Kulikov. " Cranio-cervical "whip" injury. - Pyatigorsk - State Research Institute of Balneology. - 2000. - P.82-85).

This method involves the use of radon baths with a radon concentration of 1.5 kBK (40 nCi / L), a temperature of 36-37 ° C, a duration of 10-15 minutes, a frequency of 3-4 times a week, a total of 10-12 procedures.

Radon baths have a positive effect on the state of the central nervous system due to a sedative inhibitory effect, improve blood circulation in the pool of carotid and vertebral arteries, and increase the level of adaptive and adaptive reactions. In most cases, this method of treatment provided a reduction in the main clinical symptoms of the disease, however, in some cases, the treatment results were not effective enough; there was insufficient duration of remission of the clinical symptoms of the disease.

Also described is a method of treating children with a traumatic brain injury with an electromagnetic field of an ultrahigh frequency decimeter range (DMV) (L. M. Babina, V. V. Arzumanova, I. I. Iordanova, T. V. Afanasyeva. “Craniocerebral trauma in children, its consequences and treatment methods. ”- Nalchik. - 1999. - P.74-77).

This method involves the use of DMV therapy in the region of the upper cervical sympathetic nodes from the Romashka-2 apparatus with a frequency of 915 MHz at a power of up to 30 W, exposure time of 10 minutes, with a frequency of administration 2-3 times a week, per course of 10 procedures. But the response to exposure at an initial power of 10 watts was mixed. Some children (10 people) increased complaints of headaches after the procedure. Children felt nauseous, dizzy. In this regard, the power of DMV therapy was reduced to 5 watts.

The technical result of the proposed method is to improve the functional state in the central nervous system, correct the bioelectric activity of the cerebral cortex, improve the blood supply to the diencephalic stem structures, eliminate the imbalance of the suprasegmental parts of the autonomic nervous system, and increase the adaptive reserves of the body.

The technical result of the invention is that 40 minutes after taking the radon bath, they are exposed to pulsed low-frequency electromagnetic waves from the Infito apparatus at a frequency of 60 Hz, exposure time from 8 to 11 minutes, every other day, for a course of 8-10 procedures.

Remote exposure to the central nervous system by a pulsed low-frequency electromagnetic field (INEMP) improves cerebral blood supply, increases oxygen saturation of the blood, increases redox processes, and improves the function of external respiration. As a result of studying the effect of INEMP on the body and on the basis of multifaceted studies (Adie U.R. et al., 1989; G.S. Markarov, 1991; T.A. Knyazeva et al., 1994; Markarov G., 1991) the following conclusions were drawn: INEMP has analgesic, sedative and anti-inflammatory effects, has a positive effect on general hemodynamics (Markarov G., 1993), neurohemodynamics, microcirculation (Zaslavsky A., Markarov G, 1993).

The biological effects of INEMP have been studied and are being studied at the cellular, tissue and systemic levels. The main object of INEMP application is the membrane, where many physiological processes necessary for the functioning of the cell occur. The biological action mechanism of INEMP can be associated with inducing a transmembrane potential that changes the functioning of cells and tissues due to the effect on the physicochemical processes on the membranes, the change in the K / Na pump, and the plastic properties of the cell. The induction of charges on the surface of the membranes causes the appearance of EMF and a change in the dipole vectors, resulting in a known variety of biological processes, a change in the activity of enzymes of protein complexes that affect microcirculation, blood coagulation and vascular permeability. There is an expansion of the vessels of the microvasculature, an increase in capillary blood flow, and relief of arterial spasm (A.Yu. Zaslavsky et al., 1994).

A study of the state of autonomic functions, most often suffering from mild traumatic brain injury, was carried out by cardiointervalography (CT). The method is based on a mathematical analysis of the variability of sinus heart rhythm as an indicator of the adaptive-compensatory activity of the whole organism (M.B. Kuberger, N.A. Belokon, 1985). A cardiointervalogram is a continuous recording of at least 100 consecutive cardiocycles (R-R intervals) in one of the electrocardiographic leads. Registration is carried out in supine position after a 10-minute rest. The initial autonomic tone, as well as autonomic reactivity after conducting a clino-orthostatic test, which characterizes the direction and degree of change of indicators reflecting the state of the autonomic nervous system at the time of transition from one state to another, are fixed. The initial vegetative tone (IWT) is evaluated as follows: eutonia (balanced state of the ANS regulatory systems) - the stress index is 30-90 conventional units; vagotonia IN less than 30 srvc; moderate sympathicotonia - IN from 90 to 160 conventional units; hypersympathicotonia - IN more than 160 conventional units Autonomic reactivity (autonomic activity) is evaluated by the ratio of IN2 after a wedge-orthostatic test to IN1 when it is in a horizontal position and characterizes the degree of change in the functioning of the ANS at the time of the transition from one state to another (D.M. .Zarubin, 1993; V.M. Troshin, 1993; D.A. Alymkulov et al., 1997). Thus, this method allows you to obtain objective information about the state of non-specific suprasegmental structures of the autonomic nervous system (most often suffering from mild traumatic brain injury)

The method is illustrated by the following examples:

Example 1. Patient P., 40 years old, was treated in the neurological department of the Pyatigorsk clinic. Upon admission, she complained of periodic headaches in the frontal and temporal areas of a pulsating nature, aggravated by changes in weather, overwork, nausea, dyspeptic dizziness, increased fatigue, poor sleep, irritability, memory loss, fluctuations in blood pressure, periodically occurring pains in all parts of the spine feeling of numbness and tingling in the fingers. From the anamnesis it is known that in January 2007 the patient fell on the back of the head (during ice). Short-term loss of consciousness was noted for several seconds, then nausea, headache, dizziness. The above complaints appeared after the injury. According to cardiointervalography, there is a predominance of the influence of the sympathetic nervous system at rest (IN - 260 units). When conducting a clino-orthostatic test, a hypersympathicotonic type of autonomic reactivity. After carrying out balneological treatment in the form of taking radon baths (according to the prototype method), headaches, dizziness, irritability decreased, sleep improved, sleep capacity improved, spinal pains decreased. According to cardiointervalography, the state of HYPERSIMPATICOTONIA Slightly DECREASED (ID within 150 units). A clinostatic test is a normal type of reactivity. A complete restoration of the autonomic nervous system was not noted.

Example 2. Patient S., 43 years old, was treated in the neurological department of the Pyatigorsk clinic. Upon admission, she complained of periodic headaches in the occipital areas of a aching character, aggravated by a change in head position, overwork, moderate dizziness, fatigue, superficial sleep, irritability, memory loss, fluctuations in blood pressure. An injury was noted 1.5 weeks ago. According to cardiointervalography, the influence of the sympathetic nervous system at rest is predominant (PN - 330 units). When conducting a clino-orthostatic test, a vagotonic type of autonomic reactivity. The balneological treatment was carried out in the form of radon baths (according to the prototype method), as well as receiving 40 minutes after the radon bath pulsed low-frequency electromagnetotherapy with a frequency of 60 Hz, exposure 8 minutes in the amount of 8 procedures. According to cardiointervalography, the initial vegetative status is EYTHONIA (PN within 80 units). Clinoorthostatic test is a normal type of vegetative reactivity. A complete restoration of the indices of the autonomic nervous system in normal and under stress (which reflects an improvement in the work of non-specific brain structures) was noted.

Example 3. Patient S., 49 years old, was treated in the neurological department of the Pyatigorsk clinic. Upon admission, he complained of periodic headaches of a diffuse nature without a clear localization, aggravated by emotional stress, overwork, dysfunctional dizziness, fatigue, irritability, memory loss, mood swings. An injury was noted 1.5 weeks ago. According to cardiointervalography, the prevalence of the influence of the PARASIMPATHIC nervous system at rest is noted (IN - 25 units. When conducting a clino-orthostatic test - a vagotonic type of autonomic reactivity. Balneological treatment was carried out in the form of radon baths (using the prototype method), as well as receiving pulsed 40 minutes after the radon bath low-frequency electrotherapy with a frequency of 60 Hz, exposure time of 11 minutes in the amount of 10 procedures.According to cardiointervalography, the initial vegetative status is EYTHONIA (IN within 80 units. ) A clino-orthostatic test is a normal type of autonomic reactivity, and a complete restoration of the autonomic nervous system parameters under normal conditions and under loads was noted (which reflects an improvement in the work of nonspecific brain structures).

Example 4. Patient M., 45 years old, was treated in the neurological department of the Pyatigorsk clinic. Upon admission, she complained of periodic headaches in the parietal areas of a pulsating nature, aggravated by changes in weather, overwork, irritability, periodically occurring pains in all parts of the spine, numbness and tingling sensations in the fingers. From the anamnesis it is known that she was injured 2 weeks ago. According to cardiointervalography, there is a predominance of the influence of the sympathetic nervous system at rest (IN - 180 units). When conducting a clino-orthostatic test, a normal type of autonomic reactivity. Balneological treatment was carried out in the form of radon baths (according to the prototype method), as well as receiving pulsed low-frequency electromagnetic therapy with a frequency of 60 Hz, exposure time of 15 minutes in an amount of 12 procedures 20 minutes after the radon bath. According to cardiointervalography, the initial vegetative status - HYPERSYMPATICOTONIA STRENGTHENED (ID within 250 units). When conducting a clino-orthostatic test - HYPERSYMPATHIC TYPE of vegetative reactivity. An increase in the tension of the indices of the autonomic nervous system in normal and under load was noted.

Example 5. Patient A., 43 years old, was treated in the neurological department of the Pyatigorsk clinic. Upon admission, he complained of asthenia, drowsiness, emotional stress, overwork, dyspeptic dizziness, irritability, decreased concentration, mood swings. An injury was noted 2 weeks ago. According to cardiointervalography, the influence of the PARASIMPATHIC nervous system at rest is predominant (IN - 20 units). When conducting a clino-orthostatic test, a HYPERSYMPHATIC type of autonomic reactivity. Balneological treatment was carried out in the form of radon baths (according to the prototype method), as well as exposure to pulsed low-frequency electromagnetic therapy with a frequency of 30 Hz, exposure time of 7 minutes, in the amount of 8 procedures, 30 minutes after taking a bath. According to cardiointervalography - the initial vegetative status - VAGOTONIA IS SAVED (ID within 27 units). Clinoorthostatic test - HYPERSIMPATICOTONIC type of autonomic reactivity. A complete restoration of the autonomic nervous system was not noted.

The treatment according to the proposed method was carried out for 30 patients with a condition after suffering a mild traumatic brain injury with cerebrospinal syndrome and 23 patients with the same pathology (control group) who received treatment according to the prototype method, i.e. reception of isolated radon baths. Both groups of patients according to the main clinical characteristics were approximately the same (table 1).

Table 1 Clinical characteristics of patients Sign Groups Primary (n = 30) Control (n = 23) Abs. % Abs. % Floor women 19 63.3 10 43.5 men eleven 35.6 13 56.5 Age 17-30 10 33.3 8 34.7 31-50 twenty 66.7 fifteen 65.3

Analysis of the treatment results by the proposed and known methods revealed clinical and paraclinical parameters in patients of both groups, but it turned out to be more significant in patients treated with the proposed method (table 2).

table 2 Clinical Symptom Dynamics Symptoms Dynamics The main group n = 30 Control group n = 23 Before treatment After treatment P1 Before treatment After treatment P2 Headache one hundred 30.1 <0.001 one hundred fifty > 0.05 Dizziness 73,4 6.7 <0.001 26 Nausea 36.6 - - 52.1 39.1 Vomiting 25.6 - - 43,4 30,4 > 0.05 Fast fatiguability one hundred 6.7 <0.001 one hundred 69.5 Sleep disturbance 66.6 16.6 <0.01 34.7 26.0 > 0.05 Coordination violations 56.6 6.6 <0.01 65,2 30,4 > 0.05 Tremor 56.6 6.7 <0.01 43,4 21.7 > 0.05 Violation of FMN:
Visual 13.3 6.7 > 0.05 52.1 26.0 Oculomotor 16.6 6.7 > 0.05 65,2 47.8 > 0.05 Facial 60 26.6 <0.05 86.9 60.8 <0.05 Reflex disorder 40 16.6 <0.05 82.6 65,2

The data in the table indicate that patients of the main group significantly reduced headache, dizziness, and symptoms of autonomic dysfunction. No vomiting or nausea was observed. Patients became calmer, asthenic manifestations decreased, memory, attention improved, anxiety significantly decreased, sleep improved, mood improved.

When examining the neurological status from the side of the craniocerebral innervation, positive dynamics was observed in more than half of the cases, from the reflex sphere in 33.5%. In patients, tremor of outstretched arms decreased, eyelid trembling - 49.7%, and coordinating disorders - in 55%.

Among the patients of the control group of 17 main signs of the disease, only 7 had significantly positive changes.

Studies of the bioelectric activity of the brain revealed some changes (table 3).

Table 3 The dynamics of electroencephalography Indicators Dynamics Main group Control group Before treatment After treatment R Before treatment After treatment R α-index (%) 54.03 ± 2.9 67.5 ± 2.0 <0.05 53.23 ± 2.87 53.25 ± 3.5 - Amplitude of α waves (μV) 75.65 ± 4.74 89.78 ± 5.60 <0.05 79.70 ± 3.37 79.41 ± 4.10 - Amplitude asymmetry coefficient (%) 26.8 ± 0.6 20.4 ± 0.5 <0.01 25.11 ± 1.21 26.58 ± 1.20 > 0.5

During the spa treatment, the number of patients with a regular alpha rhythm increased in patients of the main group. The leading beta rhythm was preserved in 5 out of 8 patients who had it before. Of 43.4% of cases in which disorganization of biopotentials was detected before treatment, dysrhythmia persisted in 34.7%. After treatment, slow-wave activity was observed only in 4 patients, paroxysmal activity - in 3 patients. In patients there was an increase in the alpha index and the amplitude of the alpha waves. The coefficient of amplitude asymmetry tended to decrease.

In the control group, the type of electroencephalogram practically did not change. An increase in the number of patients with a regular alpha rhythm did not occur, in 2 patients a slow activity appeared on the background of the alpha rhythm, in 6 the initial background rhythm was preserved, in patients there was dysrhythmia, which indicates a deterioration in bioelectric activity.

The amplitudes of alpha waves and the alpha index in the vast majority of patients remained the same as before treatment, the coefficient of amplitude asymmetry tended to increase.

As shown by the analysis of the rheoencephalogram, the state of blood supply and peripheral resistance underwent a number of positive changes. In the main group, the amplitude pulse blood supply increased on average from 0.15 ± 0.01 to 0.18 ± 0.01 (p <0.05), the initially increased vascular tone decreased (from 80 to 52%, P <0.05) ) Patients in the control group showed a slight decrease in pulse arterial blood filling - from 0.18 to 0.17 Ohms and an increase in the asymmetry coefficient. There was also a slight increase in the tone of cerebral vessels (by 1.2%) along with a decrease in vascular resistance (by 10%) (table 4).

Table 4 Dynamics of rheoencephalogram indicators Indicator Dynamics Main group Control group Before treatment After treatment R Before treatment After treatment R RI, Ohm On right 0.17 ± 0.006 0.19 ± 0.007 > 0.05 0.18 ± 0.001 0.17 ± 0.002 > 0.5 Left 0.18 ± 0.006 0.19 ± 0.007 > 0.05 0.17 ± 0.001 0.17 ± 0.001 > 0.5 A / T (%) On right 12.08 ± 0.03 13.05 ± 0.54 > 0.05 13.3 ± 0.63 14.28 ± 0.45 > 0.5 Left 11.6 ± 0.29 12.3 ± 0.28 > 0.05 13.37 ± 0.30 13.74 ± 0.39 - VA (%) On right 52.7 ± 2.4 60.5 ± 2.1 <0.01 68.28 ± 4.98 55.31 ± 4.29 <0.05 Left 56.48 ± 3.37 58.67 ± 2.36 > 0.1 69.62 ± 4.64 59.78 ± 5.23 > 0.1 KA (%) 34.6 ± 3.2 32 ± 2,4 > 0.5 21.71 ± 3.64 26.47 ± 3.5 > 0.1

Summarizing the dynamics of clinical and functional indicators in patients of the main and control groups, we evaluated the treatment results as follows (table 5).

Table 5 The results of the treatment of the proposed and known methods Treatment Evaluation Criteria Main group Control group Abs. % Abs. % Significant improvement 5 16.7 - - Improvement 25 83.3 fourteen 60.8 Slight improvement - - 6 26.2 No change - - 3 13

The advantage of the proposed method of treatment is associated with exposure to the central nervous system, realized through the hypothalamic-pituitary-adrenal system. Correcting its functional state, as well as the bioelectric activity of the cerebral cortex (Markarov G., 1993), it affects the entire body. The therapeutic effect of the method is carried out through the opto-thalamo-and hypothalamic-pituitary system due to the regulation of subcortical-cortical bioelectric processes, the exchange of neurotransmitters of the endorphin and immune systems, hormonal activity of the endocrine glands, the improvement of neuro- and general hemodynamics, as a result of which microcirculation in tissues is normalized, general and peripheral circulation, blood rheology, analgesic and anti-inflammatory effects are manifested by enhancing the production of hormones (Markarov G., 1991, 1993). Blood supply to the diencephalic stem structures improves (through the arterial system of the vertebro-basilar basin), oxygen saturation is noted, oxidation-reduction processes increase, and therefore, neurodynamic and hemoliquorodynamic processes in the central nervous system are improved, and the imbalance in the suprasegmental parts of the autonomic system is eliminated , adaptive reserves of the body increase.

The proposed method of treatment is more effective and can be used at the stage of spa treatment.

Claims (1)

The method of spa therapy of patients in the early recovery period after a mild traumatic brain injury, characterized in that 40 minutes after taking the radon bath, they are exposed to pulsed low-frequency electromagnetic waves from the INFITA apparatus with a frequency of 60 Hz, exposure time from 8 to 11 minutes every other day course of 8-10 procedures.