RU2405591C1 - Method of treating patients with stage i-ii hypertensive discirculatory encephalopathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology and physiotherapy, and it can be used in treating the patients with stage I-II hypertensive discirculatory encephalopathy. It involves antioxidant and antihypertensive drug therapy and exposure to bipolar low-frequency rectangular electric current pulses of frequency 77 Hz, current intencity 1-2 mA and variable magnetic field. Electromagnetic inductors are arranged to place their N-marked similar poles on the carotid sinus. A magnetic field generation mode is intermittent, the magnetic field shape is sinusoidal, frequency is 50 Hz, magnetic induction is 25 mT. The magnetic field exposure length is 10 min, the initial electrotherapy length is 15 min to be prolonged to 30 minutes during the therapeutic course. The therapy is daily and involves alternating transcranial electric current and variable magnetic field exposures. The therapeutic course makes 10-12 procedures.

EFFECT: method allows improving clinical effectiveness in the patients with stage I-II hypertensive discirculatory encephalopathy due to better clinical functions.

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Description

The invention relates to medicine, in particular neurology and physiotherapy, and can be used in the treatment of patients with hypertensive discirculatory encephalopathy of the I-II stage (DE).

A known method of treating patients with dyscirculatory encephalopathy against arterial hypertension with antioxidants, antihypoxants, antiplatelet agents, neuroprotectors, vasoactivators, drugs that optimize brain metabolism (Klocheva E.G., Alexandrov M.V., Fomina E.B. Use of cytoflavin in patients with hypoxic conditions of the brain of ischemic genesis // Bulletin of St. Petersburg State Medical Academy named after II Mechnikov. - 2002. - No. 2. - P.133-138 .; Karlov A.V. Use of the drug Cavinton Forte in patients with dyscirculatory encephalopathy // Russian medical journal: RZHM. - 2004. - T.12. - No. 10. - S.626-630 .; Shirokov EA. Discirculatory encephalopathy: principles of treatment // Russian medical journal: RZHM. - 2004. - T.12. . - No. 7. - S.471-473.). In the second (II) stage of the disease, if necessary, symptomatic therapy is additionally applied.

According to the authors of the proposed method, this method is not sufficiently effective due to the fact that the leading mechanism of DE is ischemia associated with hypoxia of the brain tissue, which leads to impaired autoregulation of cerebral circulation, while the delivery of drugs to the brain tissue is reduced, making it difficult to create the necessary the concentration of the drug in the tissues of the brain, and there is no stimulating effect on the bioelectric activity of the brain.

For the treatment of patients with discirculatory encephalopathy, low-frequency magnetotherapy is used using an alternating magnetic field.

In this case, a cylindrical emitter is placed contact above the synocarotid zone alternately from two sides. Intermittent mode. The shape of the field is sinusoidal. Magnetic induction 25 mT. Duration of exposure 10 minutes on each side. The course of treatment consists of 10-15 procedures conducted daily (Shiman A.G., Polyakova L.A., Maksimov A.V. Physical factors in the treatment of cerebrovascular diseases: Guidelines. - 1991. - 32 p., C. 29).

In our opinion, the indicated magnetotherapy technique used in the complex treatment of discirculatory encephalopathy is also not effective enough, because when using a cylindrical inductor, due to the larger area of the radiating surface, adjacent anatomical and physiological formations are exposed; a long duration of the procedure due to the sequential effect on two procedural fields; to achieve a therapeutic effect, a long course of magnetotherapy, consisting of 10-15 procedures, is required.

There is a method of treating patients with hypertension, which consists in transcranial exposure to electric current with rectangular pulses using the Transair series devices, the electrodes are installed on the skin of the eyebrows and in the region of the mastoid processes, pulse frequency 77 ± 0.5 Hz, pulse duration 3.75 ± 0.15 ms, the ratio of constant and pulsed currents 2: 1, current strength 4-6 mA, exposure time 30 min, procedures are performed daily (Lebedev V.P., Fan A.B., Katsnelson Ya.S., Lebedeva A.V., Kiryanova T.D., Zabolotny V.A. On the state of human central hemodynamics against the background of transcranial electrical influences stimulating the opioid systems of the brain stem // Transcranial electrostimulation.Experimental and clinical studies: Collection of articles. Second edition / Ed. By MD, professor V.P. Lebedeva. - 2001.- T 1. - 527 p., S.409). The duration of the course is not indicated by the authors. However, it is known that the recommended course of transcranial electrostimulation is 6-12-20 procedures (Aleksandrova A.A., Rychkova S.V., Lebedev V.P., Trusov S.V. Application of transcranial electrostimulation in gastroenterology: A manual. St. Petersburg. : Publishing house MALO. - 2002. - 24 p., P.17).

The method is not effective enough, since the treatment is carried out in the form of monophysiotherapy with electric current, and as a result, the normalization of systemic hemodynamics occurs mainly due to the effect on the vasomotor center and on the central links of the vasomotor reflexes of enkephalins, but there is no effect on the rheological properties of blood, to normalize hemodynamics of the brain and lowering blood pressure, it is necessary to use high values of current strength (4-6 mA); after electrotherapy, a short period of aftereffect of 2-3 months.

As a prototype for the closest technical essence, we have chosen a method for the complex treatment of patients with discirculatory encephalopathy developed on the background of arterial hypertension, including the use of transcranial electrical stimulation. The authors of the methodology describe only transcranial electrical stimulation, but since the name of the methodology includes the term “complex”, it seems to us that the prototype method is an integral part of complex treatment, which includes both physical and drug effects, but this is not indicated by the authors.

The method, as described by the authors, consists in transcranial exposure to an electric current with rectangular bipolar pulses using the Transair-02 apparatus, the electrodes are installed on the skin of the brow and in the region of the mastoid processes, pulse frequency 77 Hz, current strength 1-2 mA, duration exposure of 25-45 minutes, a course of treatment of 5-15 procedures that are carried out daily (Babenkov N.V. The use of transcranial electrical stimulation in the complex treatment of discirculatory encephalopathy / Actual problems of TES-therapy // Abstracts reports of the scientific and practical conference dedicated to the 25th anniversary of the development and implementation of the method. - SPb. - 2008. - 168 p., S.9-11).

The method is not effective enough, since the treatment is carried out in the form of monophysiotherapy with electric current, and as a result, normalization of systemic hemodynamics occurs mainly due to the effect on the vasomotor center and on the central links of the vasomotor reflexes of enkephalins, but there is no effect on the rheological properties of the blood after electrotherapy a short period of aftereffect 2-3 months. The impact of transcranial electrical stimulation, according to the time parameters indicated by the authors, eliminates a stepwise increase in the duration of exposure to electric structures on the brain structures, which does not allow for the gradual adaptation of the central nervous system to the action of a therapeutic physical factor.

The technical result of the invention is to increase the effectiveness of treatment of patients with hypertensive discirculatory encephalopathy of the I-II stages due to the improvement of clinical and functional indicators.

The technical result is achieved by the fact that they carry out a medication effect, including antioxidant and antihypertensive drugs, and also act as a rectangular bipolar low-frequency pulsed electric current with a frequency of 77 Hz, a current strength of 1-2 mA and an alternating magnetic field. Inductors-electromagnets are installed with the same poles marked "N" on the area of the synocarotid zones. The magnetic field generation mode is intermittent, the shape of the magnetic field is sinusoidal, the frequency is 50 Hz, the magnetic induction is 25 mT. The duration of exposure to a magnetic field is 10 minutes, the duration of the initial electrotherapy procedure is 15 minutes, which during treatment is increased to 30 minutes. Treatment is carried out daily, alternating every day with a transcranial exposure to electric shock and exposure to an alternating magnetic field. The course of treatment consists of 10-12 procedures.

The method is as follows

Daily intravenous, drip, the patient is injected with cytoflavin 10 ml in a dilution of 200 ml of 5% glucose solution. The course of treatment is 10-12 days. Antihypertensive drugs are administered orally. At the beginning of the course, the patient takes 5 mg of enalapril once a day with meals. If necessary, increase the dose to 10 mg per day. The duration of enalapril is prescribed individually under the control of blood pressure. On the first day of treatment, an electric shock affects the brain structure. Applied apparatus "Transair-03." The technique is transcranial, with duplicated electrodes installed on the skin of the eyebrows (cathode) and in the region of the mastoid processes (anode). The shape of the bipolar electric current pulses is rectangular, the frequency is 77 Hz, the current strength is 1-2 mA, the duration of exposure increases during treatment from 15 to 30 minutes. The next day they are exposed to an area of synocarotid zones with an alternating magnetic field. Applied apparatus "Pole-2". Paired inductors-electromagnets with a rectangular core are installed with a working surface marked “N” in the contact area of the synocarotid zone, the magnetic field generation mode is intermittent, the shape of the magnetic field is sinusoidal, the frequency is 50 Hz, the magnitude of the magnetic induction is 25 mT, the exposure time is 10 min. Transcranial exposure to electric current and exposure to an alternating magnetic field alternate every day. The course of treatment is 10-12 procedures.

Salient features of the proposed method are:

1) additional exposure to an alternating magnetic field;

2) the mode of generation of the magnetic field is intermittent, the shape of the magnetic field is sinusoidal, the frequency is 50 Hz, the magnetic induction is 25 mT, the exposure time is 10 min;

3) inductors-electromagnets are installed with the same poles marked "N" on the region of the synocarotid zones;

4) the duration of the initial electrotherapy procedure is 15 minutes, which during treatment is increased to 30 minutes;

5) treatment is carried out daily, alternating every day with a transcranial exposure to electric current and exposure to an alternating magnetic field, the course of treatment is 10-12 procedures;

6) carry out drug exposure, including antioxidant and antihypertensive drugs.

A causal relationship between the salient features and the result:

- Additional exposure to an alternating magnetic field allows you to act on different parts of the pathogenesis of the disease.

- The parameters of the electric current and magnetic field are sufficient to affect deeply located anatomical formations, effects on baro- and chemoreceptors, tone of the carotid arteries, effects on the rheological properties of blood.

- An alternating (sinusoidal) magnetic field has a soft, gentle effect and is used to affect reflexogenic zones, the head region, sympathetic ganglia. An intermittent sinusoidal magnetic field generation mode also mitigates the effect. A frequency of 50 Hz is used to reduce the activity of the sympathetic ganglia, with severe vegetative-vascular disorders. Magnetic induction of 25 mT is sufficient to affect the synocarotid zone. A duration of 10 minutes is sufficient to provide a therapeutic effect.

- Installation of inductors-electromagnets of the same name with poles marked "N" on the region of the synocarotid zones can reduce the duration of the procedure due to the simultaneous effect on two therapeutic fields, affect a small area and not affect other nearby anatomical and physiological formations.

- The duration of the initial electrotherapy procedure of 15 minutes, which during treatment is increased to 30 minutes, is sufficient to obtain a therapeutic effect; the electrical load on the central nervous system increases gradually to adapt the structures of the brain to the action of an electric current.

- The impact of electric current on the structure of the brain and the impact of an alternating magnetic field on the area of the synocarotid zones is carried out alternately every other day in order to reduce the electrical load, improve the rheological properties of the blood and activate blood circulation in the brain tissue. Exposure to the magnetic field every other day is sufficient, given the duration of the aftereffect of a one-time procedure due to the cumulative effects of the magnetic field.

A course of treatment of 10-12 days is sufficient to obtain a positive effect.

- Antioxidant drugs of a multidirectional effect with a metabolic effect stimulate respiration and energy formation in brain cells, improve the processes of oxygen utilization by tissues, improve cerebral blood flow, activate metabolic processes in the central nervous system, restore reflex disorders, sensitivity disorders and intellectual and mnemonic functions of the brain. Antihypertensive drugs are used to normalize blood pressure.

The set of essential distinguishing features is new, non-obvious and increases the effectiveness of treatment, which is manifested in the improvement of clinical and functional indicators.

We give examples from clinical practice.

Example 1. Patient Z., 48 years old, and / b No. 17630.

Complaints: inconsistent headache mainly in the occipital region, inconsistent dizziness, general weakness, fatigue, decreased performance, sleep disturbance (intermittent sleep), emotional instability, rise in blood pressure to 140/90 mm Hg during the last 6 months, therapist recommended taking 2.5 mg of enap per day.

Objectively: Normosthenic physique, skin and mucous membranes of normal color, lymph nodes and thyroid gland are not enlarged, blood pressure 130/85 mm RT. Art., pulse 74 beats / min, percussion borders of the heart are not enlarged, vesicular breathing in the lungs, abdominal palpation is painless.

Neurological status: on the part of the cranial nerves, a 2-sided positional horizontal nystagmus was detected, a symptom of Marinesko-Radovichi on the right; there are no power paresis, slight anisoreflexion from the hands of D≥S, pathological stop signs were not detected, no disturbances in sensitivity were detected. He performs satisfactory coordination tests, in the Romberg position is stable.

According to the scale of subjective assessment of clinical symptoms, the severity of clinical symptoms was 22 points.

Magnetic resonance imaging: a picture of mixed replacement hydrocephalus, the expansion of venous graduates.

Electroencephalography: moderate changes in bioelectric activity (BEA) of the cerebral cortex of an irritative-dystrophic nature. Dysfunction of median structures at the diencephalic level with the provocation of paroxysmal activity of a conditionally epileptiform nature. Focal pathological activity of the deep parts of the left hemisphere. Irritation of the right central parietal region with the formation of easily expressed paroxysmal activity (IP30%), mainly of a conditionally epileptiform nature.

Dopplerographic examination: data for hemodynamically significant stenosis and occlusion were not obtained. Type of flow trunk. Continuous blood flow with stable hemodynamics is detected. Indirect signs of severe cerebrospinal fluid disturbances. Autoregulatory reserve is normal without signs of collateral circulation. There is no cerebral arterial blood flow deficiency. In the vertebrobasilar basin (VBB): without reliable signs of "failure". Asymmetry of the diameter of the vertebral artery (PA). Signs of extravasal compression of PA in the V2 segments when compensating for blood flow through the main artery (OA). Arteriovenous balance is maintained. Venous outflow from the cranial cavity is slightly impaired in VBB.

Diagnosis: Stage I hypertensive discirculatory encephalopathy with micro-focal symptoms, impaired cerebrospinal fluid dynamics.

Treatment: The patient underwent complex therapy for 12 days: cytoflavin 10 ml was administered intravenously in a dilution of 200 ml of a solution of 5% glucose, enalapril was administered orally 5 mg once a day with meals in combination with transcranial electrical stimulation and magnetotherapy.

Results: After the course of treatment by the claimed method, there was a positive trend in subjective and objective indicators. The disappearance of general weakness, fatigue was noted, working capacity was restored, dizziness decreased, sleep improved. The score for the severity of clinical symptoms was 15 points, the difference in the score on the scale before and after treatment was 7 points.

Neurological status: nystagmus regressed, symptoms of oral automatism were not determined, anisoreflexia D≥S persisted.

Electroepcephalography: positive dynamics. Mild irritation of the median structures with photo- and vasoactive provocation of the paroxysmal activity of the conditionally epileptiform nature of IP 10% is preserved. Specific epileptiform, focal pathological activity is not detected. Indirect signs of increased intracranial pressure are not detected.

Dopplerographic examination: dynamic comparison shows normalization of liquorodynamics, a decrease in the manifestations of extravasal compression of PA, and normalization of venous outflow.

Example 2. Patient Ch., 56 years old, and / b No. 16456.

Complaints: inconsistent headache, general weakness, fatigue, decreased performance, sleep disturbance (difficult to fall asleep), inconsistent dizziness, emotional lability, memory impairment, blood pressure rise to 155/90 mm Hg over the past year (began to measure blood pressure). These complaints worry about 4 months; turned to the therapist, enap was prescribed (5 mg), but the drug was not taken regularly.

Objectively: Normosthenic physique, skin and mucous membranes of normal color, lymph nodes and thyroid gland are not enlarged, blood pressure 140/90 mm Hg, pulse 78 beats / min, percussion borders of the heart are increased 1 cm to the left, vesicular respiration is increased in the lungs, palpation of the abdomen is painless.

Neurological status: on the part of the cranial nerves, a horizontal middle-spread nystagmus was revealed, slight smoothness of the right nasolabial fold, a 2-sided symptom of Marinesko-Radovici and “proboscis”, no power paresis, deep reflexes from the extremities D> S, pathological stop signs were not detected, sensitivity disorders not found. Coordination tests satisfactorily performed, in the Romberg position stable, tremor of fingers of outstretched hands.

According to the scale of subjective assessment of clinical symptoms, the severity of clinical symptoms was 24 points.

Magnetic resonance imaging: a picture of mixed replacement hydrocephalus, subcortical single foci of a dystrophic nature are determined in the white matter of the frontal lobes.

Electroencephalography: moderate irritative-dystrophic changes in BEA from the surface of the cerebral cortex with suppression of the alpha rhythm and a significant effect of stem structures at the meso- and diencephalic levels with mild paroxysmal activity of a conditionally epileptiform nature. Slow activity of the frontal region of the left hemisphere.

Indirect signs of cerebrospinal fluid disturbances. Specific epiactivity is not detected.

Doppler study: data for hemodynamically significant stenosis and occlusion were not obtained. Type of flow trunk. Continuous blood flow with stable hemodynamics is detected. Mild signs of cerebrospinal fluid disturbances. Hyperperfusion syndrome in the internal carotid artery (ICA) and the midbrain artery (SMA) (tendency to angiospasm). No signs of collateral circulation. There is no cerebral arterial blood flow deficiency. In VBB: without reliable signs of "failure". Arteriovenous balance is maintained. Venous outflow from the cranial cavity is not disturbed both in the carotid and in the WB.

Diagnosis: Stage II hypertensive discirculatory encephalopathy with focal neurological symptoms, impaired cerebrospinal fluid dynamics.

Treatment: The patient was given complex therapy for 10 days: 10 ml of cytoflavin was administered intravenously in a dilution of 200 ml of a solution of 5% glucose, enalapril was administered orally 5 mg once a day with meals in combination with transcranial electrostimulation and magnetotherapy.

Results: After the course of treatment by the claimed method, there was a positive trend in subjective and objective indicators. The disappearance of general weakness, fatigue was noted, and working capacity and sleep were restored. The score for the severity of clinical symptoms was 16 points; the difference in the score on the scale before and after treatment was 8 points.

Neurological status: nystagmus regressed, the symptom of Marinesko-Radovici was not determined, the “proboscis” reflex and D≥S anisoreflexia were preserved.

Electroencephalography: after a course of complex therapy: a distinct positive dynamics in the form of restoration of the main rhythm of the alpha brain, the absence of local focal changes, the disappearance of signs of cerebrospinal fluid disturbances. The effect of diencephalic structures with mild paroxysmal activity of a conditionally epileptiform nature (index of paroxysmal activity 10%) is preserved.

Dopplerographic examination: after a course of complex therapy:

with dynamic comparison, normalization of cerebrospinal fluid dynamics, a decrease in the manifestations of hyperperfusion according to ICA and SMA are noted. Normalization of venous outflow.

Example 3. Patient A., 49 years old, and / b No. 1970.

Complaints: inconsistent headache mainly in the occipital region, inconsistent dizziness, rapid fatigability, decreased performance, general weakness, sleep disturbance, emotional lability, rise in blood pressure to 145/95 mm Hg notes in the last 7 months; She took Arifon for 3 months, at present enap 2.5 mg per day is recommended.

Objectively: Normosthenic physique, normal skin and mucous membranes, lymph nodes and thyroid gland are not enlarged, blood pressure 135/85 mm Hg, pulse 78 beats / min, percussion border of the heart is not enlarged, vesicular breathing in the lungs, painless abdominal palpation .

Neurological status: from the side of the cranial nerves revealed horizontal nystagmus in both directions, a positive "proboscis" reflex; there are no force paresis, slight anisoreflexion from the hands of D≥S, pathological stop signs were not determined. No sensory disturbances. He performs satisfactory coordination tests, in the Romberg position is stable.

According to the scale of subjective assessment of clinical symptoms, the severity of clinical symptoms was 22 points.

Magnetic resonance imaging: internal obstructive hydrocephalus, signs of increased intracranial pressure (expansion of venous graduates).

Electroencephalography: EEG type desynchronous. Irrigation of stem structures at the meso- and diencephalic levels with suppression of thalamocortical synchronization. Focal pathological activity of the temporal region, which is a trigger of mild paroxysmal activity of a conditionally epileptiform nature (IP 10%). Indirect signs of cerebrospinal fluid disturbances. No specific epileptiform activity was found.

Dopplerographic study: data for hemodynamically significant stenosis and occlusion have not been obtained. Type of flow trunk. Continuous blood flow with stable hemodynamics is detected. Indirect signs of cerebrospinal fluid disturbances. Autoregulatory reserve is normal, with no signs of collateral circulation. There is no cerebral arterial blood flow deficiency. In VBB without reliable signs of "failure". Arteriovenous balance is maintained. Signs of venous discirculation in VBB. Extravasal compression on both vertebral arteries.

Diagnosis: Stage I hypertensive discirculatory encephalopathy with micro-focal symptoms, impaired cerebrospinal fluid dynamics.

Treatment: A patient was injected with cytoflavin 10 ml intravenously over 10 days in a dilution of 200 ml of a solution of 5% glucose, enalapril orally 5 mg once a day with meals, and transcranial electrical stimulation was performed at a pulse frequency of 77 Hz, current up to 2 mA, exposure duration 30 minutes, for 10 days daily.

Results: After the course of treatment, there was a positive trend in subjective and objective indicators. A decrease in general weakness, fatigue was noted, working capacity was restored, dizziness decreased, sleep improved. The score for the severity of clinical symptoms was 18 points.

The difference in the scoring on the scale before and after treatment was 4 points.

Neurological status: the severity of nystagmus decreased, the symptoms of oral automatism were not determined, the anisoreflexion D≥S persisted.

Electroencephalography: The type of EEG remains desynchronous. The pronounced irration of the median structures at the mesencephalic level with the suppression of thalamocortical synchronization remains. Light signs of cerebrospinal fluid disorders persist. Positive dynamics is characterized by a regression of focal changes; paroxysmal activity is not recorded.

Dopplerographic examination: with dynamic comparison, there is a decrease in signs of venous discirculation in WBB.

The inventive method was tested in 63 patients with hypertensive discirculatory encephalopathy of the I and II stages (38 women and 25 men) aged 40 to 65 years, the average age is 52.1 years, without contraindications to physiotherapy. The selection criterion for patients was the age of patients 40-65 years old with hypertensive DE of I and II stages, verified by the results of magnetic resonance imaging of the brain. Patients with stage III hypertension, with severe somatic diseases, with myocardial infarction, with acute disturbance of cerebral circulation during the last month, with cancer, neurodegenerative diseases, and also suffering from alcoholism were excluded.

The first (main) group consisted of 38 patients who underwent complex therapy, including transcranial electrical stimulation and magnetotherapy, as well as drug exposure, including cytoflavin and enalapril. The second (control) group consisted of 25 patients, in the treatment of which transcranial electrostimulation was applied in the form of a monofactor effect, as well as a drug effect, including cytoflavin and enalapril. Excluded the use of vascular, nootropic, other metabolic drugs

Cytoflavin is a domestic complex antioxidant, antihypoxant. The drug was administered daily intravenously, drip, at a dose of 10 ml in a dilution of 200 ml of 5% glucose solution for 10-12 days. At the beginning of the course, patients took Enalapril 5 mg once daily with meals. If necessary, the dose was increased to 10 mg per day. The duration of enalapril is prescribed individually under the control of blood pressure.

The main complaints in all examined patients were headache (84.1%), shakiness and uncertainty when walking (63.5%), dizziness of a non-systemic nature (76.2%), sleep disturbance (96.8%), fatigue (93 , 6%), impaired memory (36.5%), decreased performance (57.1%), increased anxiety (54.0%), emotional lability (90.5%), noise in the head (27.0%) .

To assess the severity of the patient's condition, a formalized scale of 10 leading clinical symptoms was used. In the absence of a symptom, “0” points were assigned on a scale, with a mild symptom - “1” point, moderately expressed - “2” points, significantly expressed - “3” points.

According to a subjective assessment, the severity of clinical symptoms in the first group was 23.7 ± 1.3 points, in the second - 24.3 ± 1.8 points.

When assessing the neurological status in patients in both groups, neurological symptoms were determined. In patients with stage I hypertensive DE, anisoreflexia, mild discoordination disorders, horizontal nystagmus, and symptoms of oral automatism were detected. In patients with stage II DE, an increase in the frequency of memory impairment, a decrease in the level of working capacity, and emotional disturbances were noted. In neurological status, more distinct focal neurological symptoms were revealed: signs of pyramidal, extrapyramidal and cerebellar failure, impaired cranial nerve function. Hypertensive stage I DE was diagnosed in 28 (44.4%) and stage II in 35 (55.6%) patients.

To verify the diagnosis and clarify the stage of the disease, all patients underwent magnetic resonance imaging of the brain, electroencephalography, ultrasound dopplerography (UZDG and TKDG) with an assessment of the state of cerebral hemodynamics in the extracranial and intracranial arteries of the head and neck, and also examined clinical and biochemical blood parameters. If it is necessary to clarify the lesions of the vascular pool, magnetic resonance angiography was performed. All indicators were evaluated in dynamics before and after the course of treatment.

As a result of the treatment courses, there was a positive dynamics in the clinical picture according to the main clinical and neurological indicators of cerebrovascular insufficiency, such as cephalgic syndrome, dizziness, shakiness when walking, sleep disturbance, fatigue, decreased working capacity, emotional lability (Table 1 - Dynamics of clinical indicators in result of treatment). The difference in the scoring of the severity of clinical symptoms on a formalized scale according to 10 leading clinical symptoms before and after treatment was on average by the claimed method 7, 9 points, by the prototype method - 5, 6 points, i.e. the effectiveness of the proposed method according to the severity of clinical symptoms is 1, 4 times higher compared to the prototype method.

A decrease in focal neurological symptoms in assessing neurological status was observed in 81.6% (group I) and 60.0% (group II) of cases.

According to EEG data, in patients with hypertensive DE I and II stages, polymorphic dysrhythmia, paroxysmal activity were noted before treatment, in some patients focal pathological activity, signs of stem structure dysfunction, indirect signs of liquorodynamic disturbances.

Evaluation of cerebral electrogenesis after a course of therapy indicated positive dynamics in both groups (Table 2 - EEG study results in patients of groups I and II after a course of treatment). Changes in the bioelectric activity of the brain (according to the EEG) were characterized by a decrease in the degree of dysfunction of the stem structures, restoration of the alpha rhythm, a decrease in the signs of paroxysmal activity of the brain, and a decrease in the severity of liquorodynamic disturbances.

The positive dynamics according to the EEG results in the main and control groups were 94.7% and 88.0%, respectively, however, in the group of patients who received treatment by the present method, the results with pronounced positive changes were 60.5%, and by the prototype method 40.0%, i.e. the effectiveness of the proposed method according to the EEG results are 1.5 times higher compared to the prototype method.

In both groups, before treatment, changes in dopplerographic parameters were detected in all patients, acceleration of speed indicators was observed in 46.0%, mainly in intracranial arteries, both systolic and average blood flow velocities, an increase in peripheral resistance and a decrease in the elastic properties of the vascular wall in all the studied pools, a decrease in the hypercapnic load coefficient, which in general can be regarded as a tendency to angiospasm. 54.0% of patients showed a decrease in speed indicators for the studied arteries (average, systolic and diastolic blood flow velocities) and also an increase in the level of peripheral resistance and a decrease in the elastic properties of the vascular wall, which was regarded as hypoperfusion syndrome.

The ratio of Doppler parameters: frequency distribution in the spectrum, blood flow direction, sound characteristics of the Doppler signal, asymmetry coefficient in the examined group did not change significantly.

After treatment by the claimed method, 86.8% of patients showed a clear normalization of dopplerographic parameters, a significant improvement in dopplerographic parameters was noted in 7.9% of patients; in the control group (prototype method) in 80.0% and 12.0% of patients, respectively.

Thus, the inventive method of treating patients with hypertensive discirculatory encephalopathy of stage I and II is much more effective than the prototype method, helps to reduce the severity of clinical and neurological symptoms, as well as functional indicators: restoration of brain electrogenesis in the form of restoration of alpha rhythm, reduction of signs liquorodynamic disorders, reducing the degree of stem structure dysfunction (according to EEG), restoration of cerebral hemodynamics improvement of venous outflow.

Table 1
The dynamics of clinical indicators as a result of treatment Sign I group II group Before treatment After treatment Δ Before treatment After treatment Δ Headache 2,4 1.4 1,0 2.6 1.8 0.8 Precariousness 1.4 0.6 0.8 1,5 0.8 0.7 Dizziness 2.6 1,6 1,0 2.7 2.0 0.7 Noise in the head 2.2 2.0 0.2 2,3 2.2 0.1 Sleep disturbance 2.0 1,2 0.8 2.1 1,5 0.6 Fatigability 2.6 1.7 0.9 2,8 2.2 0.6 Impaired memory 2.7 2,4 0.3 2.6 2,4 0.2 Decreased performance 2.7 1.3 1.4 2.6 1.7 0.9 Increased anxiety 2.6 2.2 0.4 2.5 2,3 0.2 Emotional lability 2,3 1,2 1,1 2,4 1,6 0.8 Average points 23.5 ± 1.3 15.6 ± 1.2 7.9 * 24.1 ± 1.8 18.5 ± 1.1 5,6 Δ is an indicator reflecting the dynamics of the severity of symptoms as a result of treatment
* p <0.01, the coefficient of reliability of the results when assessing the dynamics of the severity of clinical symptoms between groups I and II

The total indicator Δ testified to a significant difference (p <0.01) in reducing the severity of clinical symptoms.

table 2
Evaluation of the results of an EEG study in patients of groups I and II after a course of treatment The result of the treatment I group (n = 38) II group (n = 25) Strong positive dynamics 60.5% 40.0% Moderate positive dynamics 34.2% 48.0% No effect 5.3% 12.0%

Table 3
Evaluation of the results of the study of ultrasound scan in patients of groups I and II after a course of treatment The result of the treatment I group (n = 38) II group (n = 25) Normalization of dopplerographic indicators 86.8% 80.0% Dopplerographic improvement 7.9% 12.0% No effect 5.3% 8.0%

Claims (1)

A method for the treatment of patients with stage I-II hypertensive dyscirculatory encephalopathy, consisting in drug therapy and transcranial exposure to a rectangular bipolar low-frequency pulse current, characterized in that the transcranial exposure to bipolar pulse electric current is carried out every other day and is additionally exposed to an alternating magnetic field, installing poles of the same name marked "N" in the region of the synocarotid zones, the magnetic generation mode I am intermittent, the shape of the magnetic field is sinusoidal, the frequency is 50 Hz, the magnetic induction is 25 mT, the exposure time is 10 minutes, the duration of the initial electrotherapy procedure is 15 minutes, which is increased to 30 minutes during treatment, and the treatment is carried out daily, alternating transcranial electric current every day and exposure to an alternating magnetic field, the course of treatment is 10-12 procedures, and they also carry out drug exposure, including antioxidant and antihypertensive drugs.