RU2464051C2 - Method of treating pathological synkinesias and contractures of mimic muscles - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, neurosurgery, neurorehabilitation and may be used for treating the patients with facial nerve damage and the onset of pathological synkinesias and contractures of mimic muscles of various aethilogies. A damaged face side is irradiated along massage lines for 6-7 min. alternated with massage lines of a healthy side for 3-4 min. The exposure is contact and labile and generated by a light-emitting diode at wave length 540 nm. Total power density is 28.8 mWt, power level is 100%, an operation mode is continuous. The therapeutic course is 10 procedures.

EFFECT: method provides higher clinical effectiveness ensured by improved metabolic processes and normalised vascular and mimic muscular tones, reduces labour input and length of the procedure.

4 tbl, 4 ex

Description

The invention relates to medicine, namely, neurology, neurosurgery, neurorehabilitation, and can be used to treat patients with facial nerve damage and the occurrence of pathological synkinesias and contractures of facial muscles of various etiologies.

A known method of treating pathological synkinesias and contractures of facial muscles (RF patent No. 2123321, 1997). The skin is affected by tangential movements with massage sticks, and the effect is performed separately on each half of the cervical-facial region by successively moving one or two massage sticks from bottom to top at acupuncture points, acupuncture points and massage lines or along massage lines alternately in any combination with a total duration 15-45 minutes

However, the method is extremely time-consuming, multi-stage, requires the training of a doctor in special techniques for acupuncture massage with knowledge of the location of biologically active points. In addition, the method is quite long in execution time.

There is a method of treating pathological synkinesias and contractures of facial muscles (Livshits L.Ya., Shirokov S.L. Magnetophoresis of drugs in the complex treatment of peripheral prosopoparesis // Advances in modern natural sciences. - 2003. - No. 5. - P.73, Clinic of nervous diseases Saratov State Medical University Saratov, Russia). Magnetophoresis of antispasmodics is used in certain areas of the face with simultaneous stimulation of the nerve by a “running” pulsed magnetic field at the junction of the facial muscles, where contracture genesis was observed. In this case, a mixture consisting of 1 part of dimethyl sulfoxide and 2-3 parts of 2% novocaine (and / or 10% midcalm) is transcutaneously administered.

However, the method is associated with invasive procedures - subcutaneous injections of 2 or 3 drugs, which is not always well tolerated by patients and can cause an allergic reaction. In addition, the doctor should clearly be able to identify areas of contracture genesis.

A known method of treating patients with pathological synkinesia and contractures of facial muscles (RF patent No. 2223799, 2002). Electroneurostimulation is carried out 30-40 minutes after peat applications with rectangular rectangular pulses with a duration of 0.1 ms and a delay of 5 ms between them with a discrete increase in the stimulation frequency from 1 to 10 Hz, with an exposure at each frequency of 5-10 s, at each point 30 s. The procedure begins at the exit point of the facial nerve trunk. Then the electrode is moved to the motor points (DT) of the chewing muscle, upper edge of the subcutaneous muscle of the neck, chin, circular muscle of the mouth, buccal muscle, circular muscle of the eye, zygomatic muscle, and also the muscle that lifts the upper lip and wing of the nose, and frontal muscle. The procedure is completed by repeated stimulation of the DT of the output of the facial nerve trunk, the total duration of the procedure is 25 minutes, the number of procedures is 10.

The disadvantage of this method is the use of paired pulses of a rectangular shape, which can enhance the existing pathological synkinesia and / or contracture of the facial muscles, the complexity, multi-stage and duration of the procedure, because preliminary peat application is necessary and only after 30-40 minutes after that they are affected by a physical factor for 25 minutes.

Closest to the claimed is a method of treating pathological synkinesias and contractures of facial muscles by laser therapy (Moskvin SV, Achilov AA Fundamentals of laser therapy. M., 2008. S. 171), adopted as a prototype. The intact face of the face is irradiated with a wavelength of 0.89 μm, a power of 7-10 W, a frequency of 80-150 Hz, for 1.5-2 minutes per zone, contact, labile, acting in the area of exit from the skull of the facial nerve trunk and in the projection its ramifications. The damaged side of the face is irradiated with a wavelength of 0.63 μm, a power of 7-10 mW, for 0.5 min for each painful point along the nerve. In addition, they produce an additional effect on the region of the superior cervical and stellate sympathetic nodes and on the projection of the common carotid artery and its branches. To improve metabolism, they affect the region of the liver and pancreas, 2 minutes per each zone, using additional biologically active points.

The disadvantages of the prototype: the complexity, multi-stage, duration of execution time, requires the doctor to know the location of biologically active points; cannot be used in patients with facial neuropathies of oncological origin, because laser therapy is contraindicated in patients with cancer.

The invention is aimed at creating a method for the treatment of pathological synkinesias and contractures of facial muscles, which reduces the complexity and duration of the procedure in patients with different origin of facial neuropathy, including and oncological genesis.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of treating pathological synkinesias and contractures of the facial muscles, including irradiation of the facial area, characterized in that they are exposed to contact, labile LED radiation with a wavelength of 540 nm, total radiation power of 28, 8 mW, level 100% power, continuous operation, on the affected side of the face for 6-7 minutes, on the healthy side for 3-4 minutes, a course of treatment 10 procedures daily.

Upon contact exposure, LED radiation with a wavelength of 540 nm (green light) penetrates to a depth of 3-5 mm into the underlying tissues, normalizes the vascular tone of both venules and arterioles, which, in turn, helps to normalize muscle tone at the site of application of the factor. Face irradiation is carried out for 10 minutes, since a large dose can contribute to an increase in blood coagulation.

The method is as follows. The course of treatment is carried out using the apparatus "SPECTR-LC-02", generating LED radiation with a wavelength of 540 nm. They act by contact, labile by LED radiation with a wavelength of 540 nm, a total radiation power of 28.8 mW, a power level of 100%, and continuous operation. Start from the frontal area of the affected side along the massage lines of the face, alternating with exposure along the massage lines of the healthy side of the face. The total exposure time on the affected side is 6-7 minutes, on the healthy side 3-4 minutes. The course of treatment is 10 procedures conducted daily. Before and after the course of treatment, the patient is examined by the method of interference surface electromyography (EMG) and a neurologist is examined.

The inventive method is developed in RNHI them. prof. A.L. Polenova and passed clinical trials in the treatment of 24 patients. The main group of patients were patients aged 17 to 60 years. In this case, irradiation was carried out at different times after the appearance of facial contractures: from 6 months to 2-3 years. Patients were admitted to a course of physiotherapeutic treatment (FT) only in a somatically compensated state.

The study of surface EMG in patients before the FT course showed that the amplitude of the interference pattern of rest of the facial muscles (the circular muscle of the eye and the circular muscle of the mouth) ranged from 50-150 μV, with the presence of fasciculations. On average, the amplitude of the interference pattern was 100 μV, which is 2.5 times higher than normal. The normal amplitude values obtained from 20 healthy subjects using the Neuro MVP multifunctional computer complex during the study of resting activity are 30–40 μV, and there are no normal fasciculations. The minimum value of the resting amplitude was 20 μV.

After the FT course, the amplitude of the pattern decreased by 2 times, pathological fasciculations disappeared. On average, the amplitude of the pattern was 50-60 μV. Moreover, the effect was observed after 1 procedure.

A neurological examination showed a decrease in friendly movements, a decrease in the mechanical excitability of muscles and tone of facial muscles from the affected side. All detected changes were objectively noted by patients.

Moreover, the positive dynamics continued after the course of FT treatment for 2-3 months, which is regarded as the “aftereffect” of LED radiation.

The high efficiency of the proposed method of treatment is explained by the peculiarities of the effect of FT as a factor stimulating metabolic processes and normalizing the vascular and muscle tone of facial muscles in patients with facial nerve damage. We give examples - extracts from the medical history.

Example 1

Patient K., 36 years old, No. of medical history 681-2005.

Diagnosis: Condition after total removal of cholesteatoma of the left lateral and anterior cistern, Varoliev bridge from 03/28/2005.

On clinical examination, moderate paresis of facial muscles on the left (3.5-4 points), palpebromandibular synkinesia.

In the study of surface EMG before treatment with the circular muscle of the eye: the maximum resting amplitude is 64.4 μV; circular muscle of the mouth: maximum resting amplitude of 109 μV, frequent fasciculations. Conducted 10 treatment sessions by the proposed method. The course of treatment was carried out using a physiotherapeutic apparatus "SPECTR-LC-02", generating LED radiation of the green spectrum, wavelength 540 nm.

We acted transcutaneously, by continuous LED emission of the green spectrum, a wavelength of 540 nm, a total radiation power of 28.8 mW, a radiation power level of 100%, a continuous mode of operation, starting from the frontal region of the affected side, along the facial massage lines for 6-7 minutes, alternating with exposure along the massage lines of the healthy side of the face for 3-4 minutes, a course of treatment of 10 procedures.

The total duration of the procedure did not exceed 10 minutes.

The curves obtained in the study of surface EMG before treatment are presented in figure 1, after treatment - figure 2.

In the study of surface EMG after treatment with the circular muscle of the eye: the maximum resting amplitude is 48.6 μV; circular muscle of the mouth: maximum resting amplitude of 56.7 μV, fasciculations are not recorded.

The dynamics of the amplitude-amplitude analysis of surface EMG are presented in table 1.

Table 1 Amplitude Amplitude change Curve μV μV % before after Circular muscle of the eye 64,4 48.6 -15.8 24.5 Circular muscle of the mouth 109 56.7 -52.3 47.9

Example 2

Patient R., 13 years old, No. of medical history 2782-2009.

Diagnosis: Post-traumatic (trauma from 2008) neuropathy of the right facial nerve according to the peripheral type with moderate paresis of the facial muscles.

On clinical examination, paresis of the facial muscles of the right half of the face 2-3 points, palpebromandibular synkinesia. In the study of surface EMG before FT treatment with the circular muscle of the eye: the maximum resting amplitude is 50.4 μV; circular muscle of the mouth: maximum resting amplitude of 89 μV, frequent fasciculations. Conducted 10 treatment sessions by the proposed method.

The curves obtained in the study of surface EMG before treatment are presented in figure 3, after treatment - figure 4.

In the study of surface EMG after treatment with the circular muscle of the eye: maximum resting amplitude of 29.1 μV; with the circular muscle of the mouth: the maximum resting amplitude of 32.9 μV, fasciculations are not recorded.

The dynamics of the amplitude-amplitude analysis of surface EMG are presented in table 2.

table 2 Amplitude Amplitude change Curve μV μV % before after Circular muscle of the eye 50,4 29.1 -21.3 42.3 Circular muscle of the mouth 89.1 32.9 -56.2 63.1

Example 3

Patient A., 51 years old, No. of medical history 487-2009.

Diagnosis: Condition after a transient ischemic attack in the vertebrobasilar basin from 08/09/2008, facial neuropathy on the left. On MRI of the brain - a variant of the development of the Willis circle in the form of a lack of blood flow in both posterior connective arteries. Signs of decreased blood flow in the intracranial segment of the left vertebral artery. When dopplerography of brachiocephalic vessels, a pronounced asymmetry of the linear blood flow velocity (LSC) in the vertebral arteries (PA) is recorded - on the left PA, LSC is reduced, on the right PA there is compensatory hyperperfusion; signs of hypoplasia of the left PA in the extracranial region; Willis circle failure in the posterior brain; during rotational tests, vertebrogenic effect on the left PA in the bone canal, on the right PA at the C1-C2 level.

On clinical examination, moderate paresis of facial muscles on the left (3.5-4 points), palpebromandibular synkinesia.

In the study of surface EMG before treatment with the circular muscle of the eye: the maximum resting amplitude is 53.4 μV; circular muscle of the mouth: maximum resting amplitude of 87 μV, frequent fasciculations. Conducted 10 treatment sessions by the proposed method.

The curves obtained in the study of surface EMG before treatment are presented in figure 5, after treatment - figure 6.

In the study of surface EMG after treatment with a circular muscle of the eye: maximum resting amplitude of 35.6 μV; circular muscle of the mouth: maximum resting amplitude of 44.7 μV, fasciculations are not recorded.

The dynamics of the amplitude-amplitude analysis of surface EMG are presented in table 3.

Table 3 Amplitude Amplitude change Curve μV μV % before after Circular muscle of the eye 53,4 35.6 -17.8 33,4 Circular muscle of the mouth 87 4.7 -52.3 48.6

Example 4

Patient A., 24 years old, No. of medical history 110-2008.

Diagnosis: Condition after the transferred flu from 07.2008, complicated by herpetic eruptions in the nasolabial triangle, neuropathy of the facial nerve on the right.

On clinical examination, paresis of facial muscles on the right (1-2 points), moderate palpebromandibular synkinesia.

In the study of surface EMG before treatment with the circular muscle of the eye: the maximum resting amplitude is 73.9 μV; circular muscle of the mouth: maximum resting amplitude of 101 μV, frequent fasciculations. Conducted 10 treatment sessions by the proposed method.

The curves obtained in the study of surface EMG before treatment are presented in Fig.7, after treatment - Fig.8.

In the study of surface EMG after treatment with a circular muscle of the eye: maximum resting amplitude of 39.6 μV; circular muscle of the mouth: maximum resting amplitude of 56.2 μV, fasciculations are not recorded.

The dynamics of the amplitude-amplitude analysis of surface EMG are presented in table 4.

Table 4 Amplitude Amplitude change Curve μV μV % before after Circular muscle of the eye 73.9 39.6 -34.3 46.4 Circular muscle of the mouth 101 56.2 -47.8 47.3

Using the proposed method provides a reduction in the duration and complexity of the procedure in patients with various origins of facial neuropathies, without causing side effects and complications in the form and appearance of pathological synkinesias and contractures of facial muscles.

Claims (1)

A method for the treatment of pathological synkinesias and facial muscle contractures, including irradiation of the facial area, characterized in that they act by contact, labile with LED radiation at a wavelength of 540 nm, a total radiation power of 28.8 mW, a power level of 100%, continuous operation, on the affected side of the face for 6-7 minutes and on the healthy side for 3-4 minutes, a course of treatment of 10 procedures.

Images