RU2613187C1 - Method of treating hyperkinetic syndrome in patients in vegetative state and minimally conscious state - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: clonidine is introduced intravenously by microstream way in dose 0.2-1 mcg/kg/h. Simultaneously clonazepam is introduced in enteral way in dose 2-6 mg per day. Course of treatment is 7-14 days.

EFFECT: method makes it possible to stop hyperkinetic syndrome in said group of patients effectively.

2 ex

Description

The invention relates to medicine, namely neurology, neuroresuscitation, and can be used to reduce the severity and relief of hyperkinetic syndrome, manifested in the form of myoclonus (jerks) in patients in a vegetative state and a state of small consciousness.

Hyperkinetic syndrome complicates the rehabilitation of patients, limits and slows down the appearance of signs of consciousness. The relief of hyperkinetic syndrome, as a rule, is accompanied by the appearance of signs of consciousness in patients in a vegetative state or an expansion of contact with patients in a state of "low consciousness".

A known method of treating hyperkinetic syndrome with high doses of piracetam. With cortical myoclonia, the initial dose is 7.2 g / day, then if necessary, a dose increase of 4.8 g / day every 3-4 days is possible to a maximum dose of 24 g per day; gradual cancellation of the drug (Mashkovsky MD, Medicines. - 15th ed., revised., rev. and add. - M.: RIA "New Wave": Publisher Umerenkov, 2007. - S.113-115) . However, this method is effective only in some patients with Lans-Adams syndrome; consciousness in this category of patients is usually preserved.

Closest to the claimed is a method of treating hyperkinetic syndrome with antipsychotics, adopted as a prototype (Shtok V.N., Ivanova-Smolenskaya I.A., Levin O.S. Guidelines for diagnosis and treatment. "Extrapyramidal disorders". MEDpress-inform, 2002 . - p. 289). Use "soft" antipsychotics: sulpiride, 100-400 mg / day; tiapride, 200-400 mg / day, or atypical antipsychotics, for example risperidone, 0.5-4 mg / day, or olanzapine, 2.5-5 mg / day.

The disadvantage of the prototype is that these forms of antipsychotics are generally ineffective in generalized hyperkinesis. Treatment is carried out for a long time, which leads to the development of pronounced side effects: sedative, antipsychotic syndrome. In some patients, after the abolition of antipsychotics, an increase in the severity of hyperkinetic syndrome is observed.

The invention is aimed at creating a method for the treatment of hyperkinetic syndrome in patients in a vegetative state and a state of small consciousness.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of treating hyperkinetic syndrome in patients in a vegetative state and in a state of small consciousness by administering drugs that reduce hyperkinesis, the peculiarity is that clonidine is injected intravenously microjet at a dose of 0.2-1 μg / kg / h in combination with enteral administration of clonazepam at a dose of 2-6 mg per day, course duration 7-14 days.

The method is as follows. Clonidine is administered intravenously in a microjet at a dose of 0.2-1 mcg / kg / h. In parallel, clonazepam is administered enteral at a dose of 2-6 mg per day in two divided doses. The duration of the course is 7-14 days.

The inventive method is developed and passed clinical trials on the basis of the intensive care unit of FGU RNHI im. A.L. Polenova in the treatment of 8 patients in a vegetative state with generalized hyperkinesis. The etiology of the vegetative state was hypoxia in 6 cases, in two cases - encephalitis. A positive result was obtained in 6 patients.

We give examples - extracts from medical records.

Example 1. Patient G., 18 years old, suffered encephalitis of herpetic etiology. After a long period of coma, the patient met the criteria for the diagnosis of BC. During the first months, the first signs of consciousness began to appear - fixing the gaze, tracking objects. The hyperkinetic syndrome in the form of multiple twitches (jerks) of the muscles of the face, neck, and arms developed quite quickly. Midazolam monotherapy reduced the number of myoclonus, however, to maximize their relief, high doses were required, causing respiratory depression. According to the claimed method, the patient was prescribed clonidine at a dose of 0.7 μg / kg / h in combination with the enteral administration of clonazepam at a dose of 4 mg / day. Against this background, a decrease in the severity of hyperkinesis was noted. The duration of the course was 7 days. The patient was transferred to a rehabilitation hospital in satisfactory condition.

Example 2. Patient U., 23 g., As a result of an accident, received a severe combined injury: CCT, UGM, contusion of the chest, heart, closed fracture of the right femur with displacement, open multi-fragmented fracture of the right patella, closed polyfragmental fracture of the left femur, traumatic shock II Art. He was conscious. The operation was performed - blocked intramedullary osteosynthesis of the right and left femurs, metal osteosynthesis of the right patella. In the first postoperative day, asystole (fat embolism?) Occurred, cardiopulmonary resuscitation was performed, cardiac activity was restored after 3-4 minutes. The level of consciousness of coma I-II, according to MSCT, cerebral edema was noted. On day 2-3, the patient developed common myoclonic twitches (face, trunk, arms). The selection of therapy was carried out, without a significant effect. Upon admission to the intensive care unit, the level of consciousness corresponds to the vegetative state. Frequent myoclonic twitches in the facial and skeletal muscles are noted, occurring spontaneously and intensifying against the background of tracheal debridement, when overloaded. According to the claimed method, clonidine was prescribed at a dose of 0.5 μg / kg / h intravenously micro-jet in combination with clonazepam at a dose of 4 mg per day. During the first day, a distinct effect was observed in the form of a decrease in myoclonus, which allowed the patient to transfer to spontaneous breathing. The duration of the course was 14 days. After drug withdrawal, myoclonus did not resume.

Claims (1)

A method of treating hyperkinetic syndrome in patients in a vegetative state and in a state of small consciousness by administering drugs that reduce hyperkinesis, characterized in that clonidine is administered intravenously in a micro jet at a dose of 0.2-1 μg / kg / h in combination with enteral administration of clonazepam at a dose of 2- 6 mg per day, the duration of the course is 7-14 days.