RU2651904C2 - Method for treatment of diseases, injuries of the peripheral nervous system, their consequences and consequences of disorders of spinal cerebral circulation and spinal injuries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to neurology and physiotherapy, and can be used for the treatment of diseases, injuries of the peripheral nervous system, their consequences and consequences of spinal cord injury and spinal injuries. To do this, the cholinolytic substance is administered, followed by a therapeutic break and the introduction of anticholinesterase substance into biologically active and motor points. After drug injections, the affected areas are exposed to low-frequency ultrasound in the range of 100 Hz with the subsequent impact on segmental-reflexogenic zones by pulses of electric current with voltage from 500 V to 6100 V for 10-45 minutes.

EFFECT: method provides an increase in the therapeutic effect and a reduction in the duration of treatment as a result of the acceleration and / or normalization of disturbed metabolic processes, increase of humoral and cellular immunity, improvement of carrying out of a neuromuscular impulse at reduction of a medicamental load and, accordingly, possible complications and side effects of drug treatment.

5 cl, 3 ex

Description

The invention relates to medicine and can be used to treat diseases, injuries of the peripheral nervous system, their consequences and the consequences of impaired spinal cerebral circulation and spinal injuries.

There is a method of drug treatment of lesions of the peripheral nerves by the introduction of metacin sequentially subcutaneously and after a time interval of proserin according to the scheme. Doses of drugs and a temporary gap, the number of sessions is determined by the attending physician, depending on the dynamics of the patient's recovery. (Zenkov LR and others. "Functional diagnosis of nervous diseases." M. Medicine, 1991, S. 44-49).

However, this method is ineffective in some forms of paresis and neuropathy with severe dysfunction.

A known method for the combined treatment of peripheral paresis and paralysis, including the administration of an anticholinesterase drug, in particular proserin, followed by electrical stimulation, according to which, depending on the location of the paresis or paralysis on the arm or leg, one bipolar electrode is fixed on the shoulder or thigh of the injured limb, and the second on the healthy limbs of the same name. The contacts of each electrode are located against each other on the extensor and flexion parts of the limbs. During combined neuromyostimulation, a series of pulses are applied to both electrodes simultaneously with the application of electrical irritation to the damaged nerve trunk. In addition, during electrical stimulation, the patient conducts active movements with a healthy limb. (Ushakov A.A. “A Guide to Practical Physiotherapy”. M. ANMI, 1996, p. 53-57).

Part of the disadvantage of this method is its limited scope of treatment only for peripheral paralysis and paresis. In addition, the introduction of the drug by the generally accepted method has an indirect effect on the whole organism, therefore, when it enters the body, a significant part of it, more than 30%, is inactivated, which leads to an extension of the recovery time for impaired functions. The complication of the treatment process is also caused by the fact that during combined electrical stimulation, the patient must conduct additional active cyclic movements with a healthy limb to the accompaniment of an audio or light signal. However, with spinal injuries and the consequences of impaired spinal cerebral circulation, both limbs are paralyzed, which does not allow to fully implement the aforementioned method.

There is a method of treating paralysis and paresis by introducing proserin into acupuncture points. Proserine solution is administered in an age-specific dosage, distributing it in equal parts at three acupuncture points over the affected neuromuscular unit, and after 10-15 minutes, paretic muscles are stimulated with a sinusoidal modulated current, and in case of peripheral paresis and paralysis, II (I) is used mode, 2 kind of work, with a frequency of 30 Hz, a modulation depth of 75-100% with a ratio of current and pause of 2: 3, and with central paralysis and paresis, I mode, 3 kind of work, with a frequency of 50 Hz, a modulation depth of 75%, with a ratio of current and pause 2: 3, k pc 10 treatment sessions (RF Patent №2122394, IPC A61N 39/00, publ. 1998).

The method has significant disadvantages that reduce its effectiveness. The choice of current frequency for electrical stimulation in this method is unphysiological. It is known that during electrical stimulation the use of only one frequency, as the authors suggest - 30 or 50 Hz, leads to the restoration of only slow motor units (DE-I, tonic) in the muscle. It is known that with paresis and paralysis, to a greater extent, fast motor units (DE-II, phase) suffer. To restore them, frequencies of 100-120 Hz are needed. Therefore, the muscle, receiving stimuli from the outside for the work of only slow motor units, finally loses fast motor units, since proteins are synthesized that ensure the growth of extremely slow motor units in the myocyte. In addition, injection methods of administering any medication, and in this method it is proserin, in the area of paretic muscles that have poor trophism, can lead to complications. In this method, the effect is carried out only on the affected muscles, and with paresis and paralysis, the natural coordination of movements is violated due to overloading of healthy muscles, therefore, effects on healthy muscles are also necessary to train their synchronous work.

The closest solution is a method of treating the peripheral nervous system, their consequences, including the introduction of a cholinolytic substance, a subsequent therapeutic break and the subsequent introduction of an anticholinesterase substance into biologically active and motor points. Proserine is used as an anticholinesterase substance, and metacin is used as a cholinolytic substance. (Patent RU No. 2344805, 01/27/2009).

However, the known method has inherent disadvantages, expressed in violation of microcirculation, swelling, swelling of the tissues, the effects of trauma, inflammatory and compression processes that do not allow for full electrical stimulation.

The basis of the present invention is the task of increasing the therapeutic effect, which is expressed in reducing the number of drugs used, recommended by medical and economic standards, while avoiding possible complications and side effects from drug effects that are addictive.

Another task is to accelerate and / or normalize impaired metabolic processes, vascular disorders, increase humoral and cellular immunity, improve neuromuscular impulse conduction and thereby reduce the treatment time, the period of disability and improve the quality of life of the patient.

This object is achieved in that the claimed method involves the introduction of a cholinolytic substance followed by a therapeutic break and the subsequent introduction of an anticholinesterase substance into biologically active and motor points, and after drug injections they affect the affected areas with preliminary low-frequency ultrasound in the range from 100 Hz with subsequent exposure to segmental reflexogenic zones with electric current pulses of voltage from 500 V to 6100 V for 10-45 minutes. At the same time, during treatment, an individual selection of the number and duration of the procedures is carried out taking into account the disease, the patient's condition and the response to the treatment with a course of 10 to 40 procedures, and the therapeutic break is taken to be 10-30 minutes. Metacin is used as a cholinolytic substance, and proserin is used as an anticholinesterase substance.

The implementation of the method is as follows.

Given the pharmacokinetics of cholinolytic and anticholinesterase drugs, the severity of the pathological process, the physiological response of the body to their use, treatment is carried out in the following methodological sequence:

- we use an anticholinergic substance, in particular metacin in a dose of 0.2 to 8 mg per dose, administered either orally or by injection;

- after 10-30 minutes of a therapeutic break in the biologically active and motor points of the body, we inject an anticholinesterase drug, in particular, proserin in a dose of 0.5-1.5 mg, the zone of biologically active and motor points is determined by the attending physician within 10-40 procedures taking into account the disease, the condition of the patient and the response to the treatment;

- we apply pulses of high-voltage electric current from 500 V to 6100 V to the interested segmental-reflexogenic zones using the POLITERAS apparatus according to the patent for utility model No. 45629, IPC A61N 39/00, for 10 to 45 minutes, course from 10 up to 40 procedures. The number of treatment courses depending on the severity of the pathological process is set individually by the attending physician.

Targeted delivery of an anticholinesterase drug to motor and biologically active points and subsequent effects on segmental-reflexogenic zones, carried out in a programmed mode by electric current pulses from 500 V to 6100 V for 10-45 min, courses from 10 to 40 procedures, allowed from two to five times to reduce the recovery time of impaired motor functions of the limbs.

The following are examples of the use of the method in the treatment of patients.

Example No. 1, patient G. 34 years

Diagnosis: a gunshot wound to the upper third of the left shoulder, multi-fragmented open fracture of the upper third of the left shoulder, left shoulder joint and left clavicle. Traumatic damage to the neurovascular bundle. Sluggish upper monoparesis on the left. Operation: osteometallosynthesis.

On admission: complaints of pain in the left hand, a sharp restriction in the shoulder, elbow and wrist joints. Lack of movement in the fingers of the left hand. He was treated in the regional hospital for 2 months. Discharged with these complaints. When contacting the center, the following studies were performed: SKT consolidated fracture of the left humerus, left clavicle, shoulder neck with displacement of fragments, ENMG from 02.09.2015, damage to the left brachial plexus mainly of the lower middle and upper bundle with the current denervation activity of the muscles studied. In the deltoid biceps, triceps, voluntary activity was not detected. The strength in the muscles is 0-1 point.

He underwent treatment with the claimed method, in the amount of 30 sessions. There is a significant improvement in the patient's condition. An active movement appeared in the fingers of the left hand. Active supination and pronation appeared in the left forearm, adduction and abduction of the shoulder, holding the arm in front of him at an angle of 70 degrees. Movement is limited due to bone deformation of the shoulder joint. Strength is rated at 4 points. On the repeated ENMG dated December 2, 2015, in comparison with the ENMG dated September 2, 2015, an improvement in conduction along the studied nerves, the appearance of reinnervation changes in the biceps, triceps muscles are noted. The denervation activity and the absence of voluntary activity in the deltoid muscle persist. The dynamics are positive. During the treatment, a video was taken to record the course of the disease and the results of treatment.

Example No. 2, patient 3. 68 years

He complained of severe weakness in the arms and legs, the inability to self-service, to move independently, and take letters. Sick for 3 months, when sharp pains, weakness in the legs, gradually spreading to the arms, first appeared. A microstroke was diagnosed in the district hospital, then during an additional examination, acute inflammatory demyelonizing polyneuropathy, Guillain-Baret syndrome was established. He underwent a course of treatment in the regional hospital, was discharged with improvement, the pain polyneuritic syndrome was stopped, however, sharp weakness and inability to self-care remained in the arms and legs, muscle strength 1-2 points. After discharge, before starting a course of treatment with the claimed method, an ENMG was performed.

He underwent 1 course of treatment of the claimed method in the amount of 30 sessions. The condition improved significantly: there were active movements in the arms and legs, the patient went to bed on his own and gets up. He moves around the house on his own with a cane, independently serves himself.

A month later, a second course of treatment was performed in an amount of 30 sessions. Currently, the condition is satisfactory, the range of motion in the arms and legs is good, stable. Strength in hands, legs 4 points. He moves independently without a cane, independently ascends the stairs to the 3rd floor without stopping, he notes a significant improvement in self-service. Conducted ENMG reveals a significant improvement in indicators - as M - response, and increase the speed of propagation of the pulse. The dynamics are positive. During the treatment, a video was taken to record the results of treatment.

Example No. 3, patient B. 32 g.

Transverse myelitis. Lower paraparesis. Violation of the functions of the pelvic organs as a delay. Ill acutely. My back was ill, my legs became weak, after 2 days I felt a sharp backache in the lumbar region, after which my legs refused.

An ambulance was delivered to the city hospital. Passed a course of treatment. Discharged home. The condition is satisfactory. There is a violation of the functions of the pelvic organs by the type of delay, weakness in the legs, slight movements in the feet are noted. It can independently bend its legs slightly in the knee joints, independently sit on the bed. Trying to get on the walker, however, because of the sharp weakness in the legs, this can not be done.

I contacted 4 months after discharge. The condition is the same. He underwent treatment with the claimed method in the amount of 30 sessions. At the 5th session, he began to raise his legs, tearing his heels off the bed by 50-60 cm. He notes the appearance of strength in the legs.

After 10 sessions, he began to get out of bed on his own, holding onto the walker. After 15 sessions, holding on to a walker began to go up to 3 m, after 20 sessions holding on to a walker went 10-15 m, strength appeared in the flexors and extensors of the legs. Holding on to a walker, he could sit down and get out of bed at the expense of legs 25-30 times. 2 months after the end of treatment and training, exercise therapy began to walk independently, without resorting to walkers and canes. Follow-up for 4 years. He walks on his own, sure. She feels well.

This ultrasonic effect on biological objects causes fluctuations that affect the physicochemical processes occurring in them, changing in particular the effective rate of reactions, they can lead to a restructuring of the kinematic regime to a qualitative change in the final result.

Claims (5)

1. A method for the treatment of diseases, injuries of the peripheral nervous system, their consequences and the consequences of spinal circulation disorders and spinal injuries, including the introduction of a cholinolytic substance, followed by a therapeutic break and the subsequent administration of an anticholinesterase substance in biologically active and locomotor points, characterized in that after drug injections affect the affected areas with pre-low frequency ultrasound in the range from 100 Hz with subsequent exposure to the segment arno-reflexogenic zones with electric current pulses of voltage from 500 V to 6100 V for 10-45 minutes. 2. The method according to p. 1, characterized in that during the treatment an individual selection of the number and duration of the procedures is carried out taking into account the disease, the patient’s condition and the response to the treatment with a course of 10 to 40 procedures. 3. The method according to PP. 1 and 2, characterized in that the therapeutic break is taken equal to 10-30 minutes. 4. The method according to PP. 1, 2 and 3, characterized in that metacin is used as a cholinolytic substance. 5. The method according to p. 1, characterized in that as anticholinesterase substances use proserin.