RU2594252C1 - Method for rehabilitation of patients with alcohol polyneuropathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to neurology and addictology, and concerns treating patients suffering from alcohol polyneuropathy. Method comprises injection administration of drugs: - cerebrolysin in biologically active points T20, T21, R13, 14, milgamma in E32 (pair), PN105 (pair) with additional injection of milgamma in interfinger area of upper and lower extremities daily for 10 days.

EFFECT: method enables to achieve stable remission of disease with no side effects.

1 cl, 2 ex

Description

The invention relates to medicine, namely to neurology and narcology, and can be used for the rehabilitation of patients with chronic alcoholism with impaired motor functions - gait, balance and coordination of movements, which are the most disabling factors that severely limit the patient's ability to move and self-care, in clinical and outpatient practice of neurological departments.

Chronic alcoholism (HA) is a serious medical, economic and social problem. Disorders of motor function and intellectual and mental disorders, which are the most frequent manifestations of CA, have been known for more than two centuries as "alcohol paralysis" caused by polyneuropathy (PUP). Despite the successes in the study of pathogenesis and the emergence of effective methods of treatment of alcoholic polyneuropathy (ANPN), more than 60% of patients become partially disabled or disabled.

Among neurological complications of somatic diseases, PUP syndrome takes a leading place. Often, it is the defeat of the peripheral nervous system (PNS) that determines the disability and disability of this category of patients and, as a result, there are violations of the quality of life. PNP is also the most common neurological CA syndrome, found in 30-50% of those treated in drug treatment hospitals, and subclinical options in most patients [Stewart N.A. et all. Substrate changes in peripheral nerve during ischemia and Wallerian degeneration // J. Neurochem. 1995. - Vol. 12. - N. 8. - P. 719-727].

Symptoms of PNP are due to the simultaneous defeat of more or fewer peripheral nerves. Therefore, the symptoms of PNP are composed of widespread sensory and motor deficits, loss of tendon reflexes and the further development of muscle atrophy. In general, the full syndrome of PUP is a complex of sensory, motor and autonomic symptoms [O. Vorobyova Polyneuropathy. The potential of alpha lipoic acid in the treatment of polyneuropathies associated with somatic diseases. Consilium Medicum, T. 8, No. 2, 2006 - S. 52-53].

Currently, the direct toxic effect of alcohol itself is considered by most researchers as the predominant pathogenetic mechanism. It is believed that alcohol damages the protective barrier system of the peripheral nervous system [Kucera Ρ, et all. Pathogenesis of alcoholic neuropathy. Bratisl Lek Listy 2002; 103 (1): 26-9]. The toxic effect of alcohol does not come down to one mechanism or process. A number of works describe a whole range of different body reactions in response to the direct and indirect effects of alcohol, for example [Husain K, et all. Dose response of alcohol-induced changes in BP, nitric oxide and antioxidants in rat plasma. Pharmacol Res 2005; 51 (4): 337-43]. Alcoholism is the second most common cause of damage to the peripheral nervous system after diabetic PNP. At least 2% to 7% of individuals may have ANP [Szigeti, K. Charcot-Marie - Toothdisease // Eur. J. Hum. Genetics 2009. - No. 17. - C. 703-710]. NSAIDs are found in 10-30% of people chronically abusing alcohol, while latent asymptomatic forms of NSAIDs during complex electroneuromyographic studies are found in 97-100% of patients chronically abusing alcohol [Dyck P.J., et all. Peripheral neuropathy. Vol II. 1984. W.B. Saunders Company. P. 1912-1931].

All this allows us to consider the problem of rehabilitation treatment of PNP as an important medical and socio-economic problem. PNP is not an independent disease, but a complication of other conditions or causes that are outside the nervous system [Manvelov L.S. Guillain-Barré syndrome: pathogenesis, clinical features, diagnosis, treatment / L.S. Manvelov // Doctor. - 2003. - No. 3. - S. 1416]. Search and development of new optimal treatment methods for patients with PNP continues to be an urgent task [Zakharov V.V. et al. The use of tanakan in cases of cerebral and peripheral circulation disorders // Rus. honey. journal 2001. - T. 9, No. 5. - C.3-9].

A known method of treating ANPP, proposed as an analogue, using antioxidant therapy using alpha-lipoic acid (ALA). The drug is well tolerated by patients, therapy is safe for them. It has been shown that ALA is effective in 70% of patients with ANS, affects sensory and motor symptoms, and also has a positive effect on pain and paresthetic manifestations of neuropathy. The average duration of treatment was 2 months. An improvement in symptoms of neuropathy was observed on average after 4 weeks. treatment. The authors conclude that the preventive use of ALA in combination with cytostatics is useful for the treatment and prevention of PNS damage.

The disadvantages of the analogue method include the fact that the treatment according to this method is characterized by a high drug load, a significant increase, in this regard, the number of side effects, the high cost of drug treatment. When applying treatment with ALA, frequent intravenous administration of a drug (LP) is necessary, which negatively affects the state of the vessels of some patients. The need to use ALA in combination with cytostatics with pronounced side effects is also negatively reflected in the body.

As a prototype, the method of complex treatment of patients with ANS was chosen using a combination of polyoxidonium (6 mg 1 time per day, intramuscularly, No. 10), hypoxene (7% - 2.0, 1 time per day, intramuscularly, No. 5) and magneto-infrared laser (MIL) therapy (No. 10 after 24 hours at biologically active points (BAP)). The use of the complex polyoxidonium - hypoxene - MIL - therapy corrects impaired immune, oxidative parameters and is effective for the treatment of patients with ANS. Laboratory indicators and clinical symptoms make it possible to judge the dynamics of ANPP, the effectiveness of treatment and predicting its outcome. Therefore, it is clinically justified to include correction methods with an immunomodulatory and antioxidant orientation in the complex treatment of patients with APNP.

The disadvantages of the prototype method include the fact that the treatment by this method is characterized by a high drug load, a significant increase, in this regard, the number of side effects, the high cost of drug treatment. LPs have an immunomodulating and antioxidant effect, which is ineffective for restoring the motor functions of muscles. Persistent remission is not always achieved and its duration is short. After treatment, insufficient stability in the Romberg position.

We first proposed a method for the rehabilitation of patients with ASN with impaired motor function using intramuscular injections of drugs for metabolic therapy using the pharmacopuncture method directly in BAP, similarly used for acupuncture in traditional oriental medicine with PNP, as well as by analogy with a course of reflexology for cerebral and peripheral blood flow disorders, paresis and paralysis of muscles, dizziness [Samosyuk I.Z. et al. Acupuncture. Encyclopedia. Ukrainian Encyclopedia named after M.P. Bazhana (Kiev), publishing house ACT - Press. Moscow, 1994. The language is Russian. - S. 27-174], as well as additional injection of a certain drug into the interdigital region of the upper and lower extremities). The essence of metabolic therapy is the periodic use of a complex of drugs that contribute to the restoration of nerve impulses, which activate and normalize the functioning of the central and peripheral nervous system, as well as improve the general metabolism in the body.

The clinical implementation of this method has a pronounced positive effect in case of impaired movement, because LP injections were carried out directly in the BAP on the projection of the muscles involved in the act of movement, as well as in the areas associated with the activation of cerebral circulation. In the proposed rehabilitation method, in addition to the introduction of the drug: - cerebrolysin at points T20, T21, T13, T14 - 0.25 ml each, - milgamma at points E32 (paired) - 0.25 ml each, - at points PN105 ( paired) - 0.25 ml each, an additional milgamma was introduced into the interdigital areas of the upper and lower extremities of 0.1 ml.

The proposed rehabilitation method was applied in 25 patients aged 20 to 50 years old with a diagnosis of ANS. The course of rehabilitation measures included 10 sessions, and each session, in turn, consisted of daily injections of cerebrolysin and milgamma injected into the BAP according to the scheme given above, and additional injection of milgamma into the interdigital areas of the upper and lower extremities. During the courses and in the intervals between them, physical therapy sessions were held individually with an emphasis on restoring the performance of weakened paretic muscles, taking into account the degree of their atrophy in each patient.

The comparison group consisted of 27 patients with APNP, comparable by sex, age, clinical and morphological patterns of the course of the disease, who received treatment using the drug according to the method of the prototype, the rehabilitation group - according to the proposed method with a similar diagnosis of the disease - from 23 patients. The averaged values of the temporal criteria for the symptomatology of the condition of patients with ALS when comparing the methods of the prototype and proposed with the additional introduction of milgamma into the interdigital areas of the upper and lower extremities are shown in Table 1.

We first established that the additional injection of milgamma into the interdigital areas of the upper and lower extremities in combination with the pharmacopuncture of cerebrolysin and milgamma significantly increased the effectiveness of the rehabilitation of patients with ANS.

The results of comparing the changes in symptoms after therapeutic measures showed a positive effect in both groups, but in the second group, in which rehabilitation was carried out using the proposed method, as can be seen from Table. 1, in an earlier period, the unsteadiness of the gait decreased (approximately 2 times), increased muscle strength, decreased dizziness, decreased spasticity of the muscles. In the same rehabilitation group, a more stable remission of the disease was noted (during the year compared to 6 months in the comparison group achieved using the prototype method), social adaptation more fully passed.

EXAMPLE 1. Patient S., 37 years old, diagnosis: dysmetabolic polyneuropathy (alcoholic) with moderate tetraparesis. Complaints: upon receipt of weakness in the legs and arms, a reduced background of mood. Over the past two months, he abused alcohol and did not eat well, which is associated with a psychoemotional trauma. The range of active movements is limited in all limbs. Muscle strength is reduced in the proximal arms to 3.5 points, legs to 2 points, in the distal sections of 4 limbs to 3.5 points. Muscle hypotension in all limbs. Hypotrophy of the muscles of the shoulder and pelvic girdle, back and proximal limbs. The patient underwent a rehabilitation course according to the proposed method in BAT for 10 days by injection of a medicinal product: - cerebrolysin at points T20, T21, T13, T14 - 0.25 ml each; - milgamma at points E32 (paired) - 0.25 ml in each, - at points ΡΝ105 (paired) - 0.25 ml in each, an additional milgamma was introduced into the interdigital areas of the upper and lower extremities of 0.1 ml.

After the treatment course, the patient's condition improved significantly. Therapy according to the proposed method led to the clinical recovery of the patient. At an earlier time, gait shakiness decreased (about 2 times), muscle strength increased, dizziness decreased, muscle spasticity decreased, mood improved.

EXAMPLE 2. Patient K., 48 years old, diagnosis: dysmetabolic polyneuropathy (alcoholic) with moderate tetraparesis. Complaints: upon receipt of weakness in the legs and arms, unsteady gait. He has been abusing alcohol for the past 6 months. The range of active movements is limited in all limbs. Muscle strength is reduced in the proximal arms to 3.0 points, legs to 2 points, in the distal sections of 4 x limbs to 3.0 points. Muscle hypotension in all limbs. Hypotrophy of the muscles of the shoulder and pelvic girdle, back and proximal limbs. The patient underwent a rehabilitation course according to the proposed method in BAT for 10 days by injection of a medicinal product: - cerebrolysin at points T20, T21, T13, T14 - 0.25 ml each; - milgamma at points E32 (paired) - 0.25 ml in each, - at points PN105 (paired) - 0.25 ml in each, an additional milgamma was introduced into the interdigital areas of the upper and lower extremities of 0.1 ml.

After the treatment course, the patient's condition improved. Therapy according to the proposed method led to the clinical recovery of the patient. At an earlier time, gait unsteadiness decreased (approximately 2 times), muscle strength increased significantly, dizziness decreased, muscle spasticity decreased.

The proposed method included the use of the complex of drugs in courses of 10 days, with virtually no adverse effects on the body, the introduction of which in the BAT gave a much more pronounced effect than the use of a treatment regimen according to the prototype method, in addition:

- increased stability in the Romberg position (up to 20 sec);

- contributed to the restoration of impaired motor functions, increased the efficiency of rehabilitation of patients with AP, helped to achieve stable remission, social adaptation of the patient, reduce the possibility of disability at a young age;

- limited the use of glucocorticoid hormones, cytostatics and other drugs with significant side effects while reducing the economic cost of treatment;

- reduced shakiness when walking, spasticity of paretic muscles, increased walking distance and strength of leg muscles, range of possibilities for homework.

The application of the proposed method involves the use of courses of 10 days of a complex of drugs that have virtually no adverse effects on the body, the introduction of which in BAP and milgamma in the interdigital areas of the upper and lower extremities gives a much more pronounced effect to extend the period of remission during rehabilitation to 1.5 years than using a prototype treatment regimen. This makes it possible to increase the efficiency of rehabilitation of patients with ASA, achieve stable remission, socially adapt the patient, reduce the possibility of disability at a young age, limit the use of cytostatics and other drugs with significant side effects while reducing the economic cost of restoring the health of patients with ASA during rehabilitation.

Claims (1)

A method of treating patients with alcoholic polyneuropathy, including the injection of drugs: - cerebrolysin in biologically active points T20, T21, T13, T14 - 0.25 ml each, - milgamma at E32 points (paired) - 0.25 ml each , - milgamma to PN105 points (paired) - 0.25 ml to each point, characterized in that an additional injection of milgamma into the interdigital areas of the upper and lower extremities of 0.1 ml daily was carried out for 10 days.