RU2392985C1 - Method of treating encephalopathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiotherapy, neurorehabilitation, neurology, neurosurgery, and can be used for treating patients with encephalopathy of vascular, traumatic, inflammatory and other genesis. Projections of vertebral arteries along the entire length from the formation to the cranial opening are exposed to low-intensity laser light of wave length 0.86 mcm, frequency 70 Hz, power 30 mWt. Herewith, 4 fields are exposed for 3 min; the exposure starts within a cerebral affection, then it is symmetric. Thereafter, projections of internal carotid arteries at the orbital level within a cerebral affection is exposed to radiation of wave length 0.63 mcm, frequency 70 Hz, power 10 mWt; then the exposure is symmetric and covers 2 fields for 1 minute. The therapeutic course is 5-10 daily procedures.

EFFECT: method provides higher clinical effectiveness due to the balanced improvement of blood flow and brain metabolism.

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Description

The invention relates to medicine, namely physiotherapy, neurorehabilitation, neurology, neurosurgery, and can be used to treat patients with encephalopathy of vascular, traumatic, inflammatory and other genesis.

There is a method of treating encephalopathy by exposure to low-intensity laser radiation (LLLT) with a wavelength of 0.89 μm, a frequency of 80-150 Hz, a power of up to 2-4 W per pulse supraarterially by a contact stable technique. Exposure is 4-8 minutes when localized on the projection area of the common carotid artery in the synocarotid zone and 4-10 minutes when localized on the projection area of the vertebral artery in the suboccipital zone. The total exposure when using single-channel devices up to 20 min (4 fields), two-channel - up to 10 min, per course up to 12 procedures. Irradiation is performed 15-30 minutes after transcerebral exposure to a low-frequency alternating magnetic field (Kochetkov A.V., Gorbunov F.E., Minenkov A.A., Streltsova E.N., Filina T.F., Krupennikov A.I. Optimization of the program of early rehabilitation of patients with cerebral stroke: the use of various methods of magneto- and laser therapy. - Vopr kurortol. - 2000. - No. 3. - P.17-21). However, exposure to the brain with an alternating magnetic field can provoke its epilepticization. Laser stimulation of the highly sensitive synocarotid zone can cause uncontrolled activation of vasomotor and respiratory functions and hypersecretion of hormones (BME, edited by A.N. Bakulev. T.30. - M .: "Soviet Encyclopedia", 1963. - P.259-261). In addition, the method is used to treat patients with encephalopathy only of vascular origin - discirculatory.

A known method of treating encephalopathy by laser irradiation of blood. The LLLT is affected by a wavelength of 0.63 μm with a power flux density of 2-2.5 mW and an exposure of 60 min (Germanovich V.V. Laser blood irradiation in the acute period of severe traumatic brain injury: Abstract of Diss. Candidate of Medical Sciences. - St. Petersburg, 1997. - S. 10). But due to the invasiveness of the method, complications such as infection, thrombosis, endothelial integrity violation, etc. are possible. The method activates the body as a whole and does not provide targeted compensation for brain disorders.

The prototype of the proposed method is a method of treating encephalopathy by exposure to LLLT with a wavelength of 0.89 μm, a frequency of 80 Hz, and a power of up to 2.5 W per pulse on the projection of the main vessels of the head located in the neck - common carotid and vertebral. 4 fields of 4 min, 10-12 procedures per treatment course are irradiated by a stable technique (Filina T.F., Maslovskaya S.G., Streltsova E.N., Radzievsky S.A. Dynamics of cerebral circulation under the influence of laser therapy in patients with discirculatory encephalopathy. - Vopr kurortol. - 1994. - No. 5. - P.15-17).

The prototype is not effective enough, since it is mainly aimed at compensating the blood flow of the cerebral hemispheres through the carotid artery pools, as more powerful, while in patients with encephalopathy cerebrovascular disorders in the vertebrobasilar basin predominate. The impact on the vertebral arteries is limited only to the atlant parts, while in case of degenerative-dystrophic lesions of the spine and osteochondrosis of the cervical spine, the vertebral arteries are compressed at the level of all parts. Atherosclerosis and hypertension involve impaired functioning of the vertebral arteries along the entire length, and the level of arterial discharge from larger arterial trunks is most vulnerable to spasm, compression, blockage, etc.

In the prototype, the energy of laser radiation received by the vertebral arteries is relatively less than the energy received by the carotid arteries. This is due to the fact that the carotid and vertebral arteries vary significantly in diameter, and their laser irradiation duration is the same - 8 minutes each. This ratio can lead to the development of a robbery syndrome, when the blood supply to the cerebral hemispheres from the carotid artery pools exceeds the blood supply to the brain stem structures and cerebellum from the vertebrobasilar pool. In addition, the method is used to treat patients with encephalopathy only of vascular origin - discirculatory.

The invention is aimed at creating a method for the treatment of encephalopathy, which provides an increase in the effectiveness of treatment due to a balanced improvement in blood flow and brain metabolism.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of treating encephalopathy by acting on the projection of the main vessels of the neck of the LLLT, the peculiarity is that it affects the projections of the vertebral arteries at the level of their formation and at the level of entry into the cranial cavity on the side of the brain lesion then symmetrically with a wavelength of 0.86 μm, a frequency of 70 Hz, a power of 30 mW in 4 fields of 3 min each, then they affect the projections of the internal carotid arteries at the level of the orbits on the affected side brain, then symmetrically wavelength of 0.63 microns, frequency of 70 Hz, 10 mW to 2 fields of 1 min, 5-10 daily treatment procedures.

The laser effect on the vertebral arteries throughout the neck from the level of their departure from the subclavian arteries, where they are often compressed by the prevertebral muscles changed due to osteochondrosis, to the suboccipital level provides the most effective improvement in blood flow in the vertebrobasilar pool. Accordingly, the improvement of blood supply to the centers of the caudal group of cranial nerves VII-XII and the conduction paths of the motor and sensory analyzers, stem centers for the regulation of the respiratory and cardiovascular systems. In the supraclavicular region, the vertebral arteries pass along with the common carotid arteries (Sinelnikov R.D., Sinelnikov Y.R. Atlas of human anatomy. Volume 3. - M., 1996. - P.58, 65, 70-79, 81-82 ), which are also subjected to laser exposure with the effect of improving blood flow in the cerebral hemispheres.

Laser action on the projections of the brain parts of the internal carotid arteries at the level of the orbits (inner corners of the eyes) and on the ocular arteries (branches of the brain parts of the internal carotid arteries) improves blood supply to the cerebral hemispheres. The blood supply to all the nerves of the orbit (I-VI cranial nerves) and their nuclei, the median structures of the brain and the ancient cortex with the limbic centers located in this projection responsible for the emotional-vegetative sphere improves.

The duration of exposure of 12 minutes to the vertebral arteries exceeds that of the carotid arteries for 8 minutes (6 minutes for the common carotid and 2 minutes for the internal carotid arteries), which, due to the difference in the diameter of the vessels (the vertebrates are much narrower than the carotid), also contributes to a balanced improvement in brain metabolism as a whole .

The impact on the vessels, blood supplying brain structures on the side of the lesion, optimizes the metabolism of the affected brain formations and prevents the possibility of the formation of the robbery syndrome if you first act on the vessels supplying the unaffected parts of the brain.

In total, the laser exposure in the present method provides a balanced brain blood circulation (in the basins of the internal carotid arteries and vertebrobasilar pool) improvement of cerebral blood flow and metabolism (the dominant effects of laser therapy). That is why the blood supply to the midbrain formations of the brain is optimized, in particular the subcortical stem, which feed the terminal branches of the cerebral vessels from all pools. The method can be used to treat patients with encephalopathy of various origins, not only discirculatory, but also traumatic, post-infectious, degenerative-dystrophic, which are characterized by diffuse damage to the brain substance - cerebral hemispheres, mid-stem formations and cerebellum.

The method is as follows.

Use laser devices that generate a pulsed LLLT of infrared and red ranges. Set the frequency to 70 Hz (average normal heart rate, normal 60-80 beats per minute). They act percutaneously, contact by a stable technique.

A fiber with a magnetic nozzle (permanent magnet) is installed in the supraclavicular region in the outer triangle of the neck at the abdomen of the sternocleidomastoid muscle, directing radiation almost perpendicular to the spinal column to guide the projection of the prevertebral part of the vertebral artery and the common carotid artery adjacent to it. They are affected by LLLT with a wavelength of 0.86 μm and a power of 30 mW on the side of the greatest brain damage.

Then the light guide is installed at the outer edge of the paravertebral muscles directly under the occipital bone (suboccipitally) to irradiate the atlantic part of the vertebral artery before entering the cranial cavity. Affected by LLLT with the same parameters on the same side of the greatest brain damage. Thus, 2 projections of the vertebral artery on the affected side are irradiated.

Then, symmetrically with the above duration, 2 projections of the vertebral artery on the contralateral side are irradiated.

Each of the 4 fields is irradiated for 3 min in 4 fields. The duration of the laser exposure to the infrared range in one procedure is 12 minutes

After infrared magnetic laser exposure, a fiber without a magnetic nozzle is installed in the inner corner of the eye to irradiate the projection of the cerebral part of the internal carotid artery at the level of the orbit. The LLLT is affected by a wavelength of 0.63 μm, a frequency of 70 Hz, and a power of 10 mW, contact, stable first on the side of the greatest brain damage, then symmetrically on the contralateral side. Each of 2 fields is irradiated for 1 min. The duration of the red laser exposure in one procedure is 2 minutes.

In cases of diffuse symmetric brain damage, when neurological symptoms and additional research methods do not reveal the most affected part of the brain, they act first on the left (from the side of the dominant hemisphere), then on the right.

The duration of laser exposure in one procedure is only 14 minutes The course of treatment consists of 5-10 daily procedures.

The method has passed clinical trials in the treatment of 34 patients aged 19 to 77 years with encephalopathy due to brain diseases of various origins. 23 patients had cerebrovascular disease, of whom 17 had symptoms of cerebrovascular accident in the vertebrobasilar pool, and in 5 patients - in the pool of internal carotid arteries. Encephalopathy due to a sustained intracranial injury occurred in 4 patients, neuroinfection in 3, lesions of the subcortical structures of the brain in 5 patients.

All 17 patients with dyscirculatory encephalopathy and vertebrobasilar insufficiency complained of a headache of varying intensity, mainly occipital localization and coordination disorders. Visual disorders were observed in 4 patients, trigeminal neuralgia in 2, facial neuropathy in 1, dizziness in 5, tinnitus in 3 and hearing impairment in 1 patient. According to MRI, hydrocephalus was detected in most patients and was more pronounced in 5 of them. EEG data mainly indicated dysfunction of the mid-stem structures of the brain.

Dyscirculatory encephalopathy with a predominant disturbance of cerebral circulation in the pool of internal carotid arteries occurred in 5 patients. Among them, the syndrome of motor disorders (spastic cerebral paresis) was detected in 3 and visual disturbances in 3 patients. EEG data indicated the predominance of slow-wave activity with interhemispheric asymmetry.

Of 5 patients with damage to the subcortical formations of the brain, including vascular origin, 4 had Parkinson's syndrome, and one had torticollis.

All 4 patients with encephalopathy due to an intracranial injury had a syndrome of motor disorders, signs of cerebral asthenia, intellectual and mnemonic disorders. EEG data mainly reflected dysfunction of the mid-stem structures, slow-wave activity within the most affected areas of the cerebral hemispheres.

In the clinical picture, 3 patients with encephalopathy due to previous neuroinfection (meningitis, meningoencephalitis) were dominated by symptoms of hydrocephalus, especially headaches, and coordinating disorders.

All patients underwent laser therapy courses according to the claimed method of 5-10 daily procedures. The result of the treatment was a significant improvement and regression of neurological symptoms in 22 patients, improvement in 10, and no change in 2 patients. No deterioration was noted. The positive dynamics consisted in reducing headaches, tinnitus and other complaints to a complete relief, increasing the mood and tone of the nervous system as a whole, restoring impaired brain functions and regressing neurological symptoms, which made it possible to reduce the dose of maintenance drug therapy. In EEG, as a rule, a decrease in the severity of markers of pathological activity was recorded.

We give examples - extracts from medical records.

Example 1. Patient B., 61 years old, medical history No. 1134, was hospitalized on November 6, 2007. Diagnosis: Cerebrovascular disease. Atherosclerosis of the cerebral vessels. Stenosis of the right vertebral artery. Encephalopathy. Osteochondrosis of the cervical spine with vertebrobasilar insufficiency syndrome. Asthenic syndrome. Leading complaints of headaches of a constricting nature, insomnia, tinnitus, visual fatigue and visual impairment are more on the right. In neurological status, dynamic ataxia, intentional tremor, mild symptoms of oral automatism, a positive Bare symptom on the right.

Ophthalmologic examination 06.11.2007: VOD = 0.04 with correction of -11.0 D to 0.9-1.0; VOS = 0.04 with correction of -11.0 D to 1.0. OD - partial atrophy of the optic nerve according to the primary type - ischemic optoneuropathy. Disks of the optic nerves are pink, on an OD disc with a grayish tint in the temporal half. Arteries are narrow, veins are not dilated. Retina without foci. Fields of vision: on the OD in the lower nasal quadrant - peripheral relative scotoma. Radiography of the cervical spine reflected osteochondrosis C3-7 and osteochondrosis of the unvertebral joints C5-6 (anatomical confirmation of compression of the vertebral arteries). MRI data indicated a moderately pronounced mixed hydrocephalus. In the EEG on November 7, 2007, the main rhythm was observed in all the leads, polymorphic activity, deformed “acute-slow” wave complexes in the middle and posterior leads. The reaction to photostimulation was manifested in the form of an increase in slow-wave and epileptiform activity in the right temporal region. Dysfunction of stem structures is expressed at the mesencephalic level.

From 09.11 to 11.23.2007 a course of laser therapy was carried out in accordance with the claimed method. A fiber with a diameter of 18 mm with a magnetic nozzle (total diameter 36 mm) from the emitter ILGSh-114 of the SHATL-combi laser apparatus was installed in the right supraclavicular region at the outer edge of the abdomen of the sternocleidomastoid muscle, directing radiation to the spinal column. The LLLT was affected by a wavelength of 0.86 μm, a frequency of 70 Hz, a power of 30 mW, contact, stable for 3 minutes. Then the fiber was installed at the outer edge of the paravertebral muscles directly under the occipital bone on the right. Affected LLLT with the same parameters. Thus, 2 projections of the vertebral artery on the affected side were irradiated. Then 2 projections of the left vertebral artery were also irradiated. Each of 4 fields was affected for 3 minutes. The duration of the laser exposure to the infrared range for one procedure was 12 minutes.

After that, a fiber optic cable 7 mm in diameter from the helium-neon emitter LGN-118 of the SHATL-combi laser apparatus was installed in the inner corner of the right eye. The LLLT was affected by a wavelength of 0.63 μm, a frequency of 70 Hz, a power of 10 mW, contact, stable for 1 min. Then acted symmetrically on the left. Each of the 2 fields was irradiated for 1 min. The duration of the red laser exposure in one procedure was 2 minutes. The duration of laser exposure in one procedure was 14 minutes. The course of treatment consisted of 10 daily procedures.

The result immediately after treatment was a significant improvement in the patient's condition, which consisted in a decrease in the intensity and duration of headache and tinnitus, improved sleep, increased tolerance to visual, as well as physical and mental stress. A follow-up ophthalmologic study on November 21, 2007 showed a decrease in scotoma by OD. In the control EEG on November 27, 2007, a decrease in the severity of slow-wave activity, the disappearance of epileptiform activity, and smoothing of interhemispheric asymmetry were observed. A well-modulated basic alpha rhythm dominated. Signs of stem structure dysfunction at a diencephalic level are mild.

Example 2. Patient R., 55 years old, medical history No. 979-2008. Diagnosis: Dyscirculatory encephalopathy. The consequences of acute ischemic cerebrovascular accident in the pool of the right midbrain artery 04/15/2008. Spastic cerebral paresis. The study revealed paresis of facial muscles 2 points and arm muscles 4 points to the left of the central type. Signs of trophic disorders in the form of pain and limitation of movements in the left shoulder joint, swelling of the hand, malnutrition of the small muscles of the hand. Left-sided hemianopsia. Intellectual-mnestic disorders. Duplex Doppler study revealed an atherosclerotic plaque in the right common and internal carotid arteries.

On September 16, 2008, a laser therapy course was conducted according to the claimed method of 8 daily procedures. The LLLT of the infrared range through the magnetic nozzle first affected the projection of the right vertebral artery, then the left. The LLLT of the red range first acted on the projection of the right internal carotid artery, then the left. The result of the treatment was a significant improvement in the patient’s condition, relief of the pain syndrome, increase in the volume of active movements of the facial muscles to 3 points and arm muscles to 4.5 points with the leveling of signs of edema and dystrophy of the hand.

Example 3. Patient K., 60 years old, medical history No. 647. Received June 4, 2007. Diagnosis: Dyscirculatory encephalopathy. Parkinson's Syndrome. Complaints about stiffness, weakness of voluntary movements in the limbs. The patient considers himself for 5 years. The examination revealed angiopathy of the retinal vessels. The EEG pattern indicated moderate diffuse changes in the functioning of the cerebral cortex and impaired interaction of the cortical-subcortical formations of the brain. The treatment plan included the selection of a dose of specific drug therapy for Parkinson's syndrome - nakoma. In accordance with the claimed method, a laser therapy course of 9 daily procedures was carried out. Both types of LLLT were affected first from the left - from the side of the dominant hemisphere of the brain, then from the right. The result was a significant reduction in dyskinesia and dystonia. At the same time, it was possible to achieve the optimal therapeutic effect on a daily dose of 1Ѕ tablets, whereas in most patients the therapeutic dose is 3-6 tablets per day.

Example 4. Patient D., 51 years old, medical history No. 558, was admitted 05/14/2007. Diagnosis; Post-traumatic encephalopathy. Motor disorder syndrome. In October 2006, he suffered an intracranial injury, a fracture of the arch and base of the skull, a severe brain contusion with compression by a subdural cerebrospinal fluid hygroma on the right. Subarachnoid hemorrhage. In 1 day after the injury, the hygroma was evacuated through the milling holes, then the repeated hygroma was removed. Examination revealed right-sided hemiparesis of 3 points, motor aphasia. In the EEG, dysfunction of the middle structures was observed, the prevalence of slow waves in the anterior temporal regions. Doppler ultrasound showed a decrease in cerebral perfusion and vascular reactivity in the presence of signs of insufficient blood flow in the vertebrobasilar pool. From 17 to 24.05.2007 a course of laser therapy was performed according to the claimed method of 5 daily procedures. Both types of LLLT were affected first from the left - from the side of the functionally more affected cerebral hemisphere (right-side hemiparesis), then from the right. The improvement is regarded as significant. It consisted in increasing the volume of active movements of the right paretic limbs to 3.5 points, which allowed the patient to try to write with a paretic right hand. A control speech therapy study showed the leveling of symptoms of motor aphasia, some difficulty in the pronunciation of the speech due to dysarthria of a pseudobulbar nature.

Example 5. Patient P., 22 years old, medical history No. 426. Received April 16, 2007. Diagnosis. Consequences of transferred viral meningoencephalitis. Encephalopathy Complained of an almost constant headache, double vision, dizziness. During the examination revealed installation nystagmus, bilateral pathological signs. On MRI, cystic arachnoiditis, multiple foci of cerebral demyelination of a dystrophic nature. In the EEG, dysfunction of stem structures and a decrease in the threshold of convulsive readiness. On April 20, 2007, a course of laser therapy was completed according to the claimed method of 5 daily procedures. Both types of LLLT were affected first from the left - from the side of the dominant hemisphere of the brain, then from the right. Headache completely stopped after 3 treatments. At discharge, 04/26/2007 regression of neurological symptoms. The result is regarded as a significant improvement.

Example 6. Patient C., 53 years old, medical history No. 10. Received January 11, 2007. Diagnosis: Cerebrovascular disease. Circulatory disturbance in the area of chiasma 12/22/2006. The consequences of neuroinfection on the background of right-sided otitis media in 1993. Encephalopathy of mixed origin. On admission, they were disturbed by a constant headache and a decrease in vision in the right eye. During an ophthalmological examination 11.01.2007 VOD = 0.8-0.9 and VOS = 1.0; the chiasmal type of narrowing of the visual fields, more on the right, in the nasal and upper halves. Absolute central scotoma of a sectoral type in the nasal half of OD. An MRI scan revealed internal hydrocephalus, cerebrospinal arachnoid changes. In the EEG on January 11, 2007, pronounced dysfunction of the stem structures, the predominance of slow waves, a decrease in the threshold of convulsive readiness, is more pronounced in the right frontotoparietal-temporal region. Since January 19, 2007, a laser therapy course has been completed according to the claimed method of 7 daily procedures. Both types of LILI were affected first on the right - from the side of the predominant damage to the brain structures, then on the left. After treatment, a significant improvement in the patient's condition, relief of headache and improvement in vision were noted. A follow-up ophthalmological study on January 23, 2007 showed an increase in visual fields and a decrease in the central scotoma by 50%, and the transformation of the absolute scotoma into relative.

Using the proposed method provides an increase in the effectiveness of the treatment of encephalopathy due to the balanced improvement of blood flow and metabolism of the brain as a whole, brain structures supplied from the basins of the internal carotid arteries and vertebrobasilar pool. The result is the restoration of impaired brain functions, reduction and relief of motor, visual disturbances, headache, other manifestations of hypertension-hydrocephalic syndrome, cerebroasthenia. Compensation of impaired brain functions is achieved in patients with encephalopathy of various origins - vascular (due to a violation of cerebral circulation in the vertebrobasilar or basin of the internal carotid arteries), traumatic, post-infection.

Claims (1)

A method of treating encephalopathy by exposure to the projection of the main vessels of the neck with low-intensity laser radiation, characterized in that it affects the projections of the vertebral arteries at the level of their formation and at the level of entry into the cranial cavity on the side of the brain lesion, then symmetrically with a wavelength of 0.86 microns, frequency 70 Hz, with a power of 30 mW in 4 fields for 3 min, after that they act on the projections of the internal carotid arteries at the level of the orbits on the side of the brain lesion, then symmetrically with a wavelength of 0.63 μm, a frequency of 70 Hz, and a power of 10 mW 2 fields of 1 min, a course of treatment of 5-10 daily procedures.