RU2786141C1 - Method for preventing an unfavourable outcome in children with peripheral pareses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to neurology, and can be used to prevent an unfavourable outcome in children with peripheral pareses. Physiotherapy is performed therefor. Simultaneously with physiotherapy, Magne B6 is administered in maximum age-appropriate dosages. After 7 days from the beginning of treatment, the level of C-terminal telopeptide of type 1 collagen is determined. If the value of said indicator falls below 1.5 mmol/l, oral administration of chondroitin sulphate in an average age-appropriate dosage is additionally prescribed. The duration of medication therapy is one week longer than the duration of physiotherapy.

EFFECT: lower risk of developing an unfavourable outcome in children with peripheral pareses due to the correction of metabolic disorders in connective tissue.

1 cl, 3 ex

Description

The technical field to which the invention belongs

The invention relates to medicine, namely to neurology. State of the art

Different mechanisms of damage to the nerve trunks of the peripheral nervous system account for 1-10% of the total number of injuries. Peripheral paresis occurs due to damage to the peripheral motor neuron, which leads to a rupture of the reflex arc, which is accompanied by hypotension and hyporeflexia; muscle atrophy and fascicular twitching are noticeable on examination. Treatment of peripheral paresis is possible both surgically and conservatively and is determined by the cause of the disease. The effectiveness of treatment is significantly affected by the presence of connective tissue dysplasia, tk. it determines the ability of the child's body to reparative processes in the connective tissue surrounding the nerve trunk. This invention is based on the clinical experience of the authors, indicating the negative impact of the presence of severe connective tissue dysplasia on the treatment of a child with peripheral paresis.

Known (analogue) "Method of treatment of paralysis and paresis" (RF patent for invention No. 2122394 dated 12/24/1993). The method is carried out "... by introducing prozerin into the acupuncture points, characterized in that the prozerin solution is administered in an age dosage, distributing it in equal parts over three acupuncture points over the affected neuromuscular unit, and after 10-15 minutes, electrical stimulation of the paretic muscles is performed with a sinusoidal modulated current, while for peripheral paralysis and paresis, mode 11 (1) is used, the 2nd kind of work, with a frequency of 30 Hz, a modulation depth of 75-100% at a ratio of current and pause of 2: 3, and for central paralysis and paresis, mode I is used, 3rd kind of work, with a frequency of 50 Hz, a modulation depth of 75%, with a current-to-pause ratio of 2:3, a course of treatment of 10 sessions.

This method has the following disadvantages:

- the use of intramuscular injection of prozerin solution has age restrictions and is limitedly used in children of the younger age group;

- unilateral application of electrophysiotherapy can lead to asymmetries of muscle groups;

- the peculiarities of the metabolism in the child are not taken into account.

Known (prototype) "Method of treatment of paresis and paralysis" (RF patent for invention No. 2445990 dated 11/12/2010). The method consists in carrying out "... drug therapy followed by electrical stimulation of paretic muscles with a modulated current, characterized in that drug therapy is carried out by administering galanthamine by means of electrophoresis endonasally and in the region of the upper thoracic spine, and electrical stimulation is carried out with a complexly modulated bipolar current, with a frequency of 20 up to 120 Hz, with a ratio of bursts and pauses of 1:1, additionally exercise in the same mode in the area of muscles symmetrical to the paretic ones, as well as in the projection of the main trunks of the peripheral and autonomic nervous system from both sides, the duration of the procedure is 10-30 minutes, while the course of treatment for each type of exposure is 10-15 procedures, daily or every other day, depending on the patient's condition.

However, this method has the following disadvantages:

1) galanthamine is used, which improves the conduction of impulses in the cholinergic synapses of the central nervous system and enhances excitation processes, causes an increase in smooth muscle tone and increased secretion of the digestive and sweat glands, it easily penetrates the blood-brain barrier, which limits its use in children;

2) the peculiarities of the child's metabolism are not taken into account;

3) prevention of the development of cicatricial deformities of tissues in the places where the nerve trunks pass is not carried out.

Thus, it is required to develop a new method for preventing the development of an unfavorable outcome in children with peripheral paresis. In the claimed method, the listed disadvantages are eliminated.

Disclosure of invention

The objective of the invention is to improve the quality of medical care for children with peripheral paresis.

The technical result of the method is to reduce the risk of developing an unfavorable outcome in children with peripheral paresis due to the correction of metabolic disorders in the connective tissue.

Implementation of the invention

The claimed technical result can be achieved as follows:

- when prescribing physiotherapy, drugs containing organic magnesium salts (for example, magnesium lactate or magnesium citrate, or magnesium pidolate) are additionally prescribed in combination with pyridoxine in average age dosages;

- 7 days after the start of physiotherapy, the level of the C-terminal terminal telopeptide of type 1 collagen is determined;

- with a decrease in the level of the C-terminal terminal telopeptide of type 1 collagen below 1.5 mmol / l, oral administration of chondroitin sulfate is additionally prescribed in an average age dosage, otherwise the treatment regimen does not change;

- the use of additional drug therapy is completed one week after the completion of physiotherapy.

The novelty of the proposed method lies in the fact that:

- For the first time in the treatment of children with peripheral paresis, it is supplemented with pathogenetic correction of metabolic disorders in the connective tissue.

- For the first time, in the middle of physiotherapy, the severity of connective tissue dysplasia is determined at the metabolic level.

- For the first time, an additional enhancement of pathogenetic therapy is used by the appointment of a chondroprotector, in the presence of signs of a pronounced dysplastic process.

Distinctive features of the method:

- from the first days of physiotherapy, preparations containing organic magnesium salts in combination with pyridoxine are prescribed in average age dosages;

- after 7 days from the start of physiotherapy, the level of the Terminal terminal telopeptide of type 1 collagen is determined and, if its value drops below 1.5 mmol / l, oral administration of chondroitin sulfate is additionally prescribed at an average age dosage;

- the duration of drug therapy exceeds the duration of physiotherapy by one week.

The proposed method is illustrated by the following examples.

Example #1

An 8-year-old child with peripheral paresis of the left arm. History of trauma resulting from a traffic accident. Physiotherapy was prescribed for the area of the affected neuromuscular unit (SMT, according to a stimulating method: 2nd kind of work, non-rectified mode with a modulation frequency of 30 Hz, a modulation depth of 100%, a send-pause of 2-3 seconds from an apparatus of the "Amplipulse" type and muscle stimulation red LEDs from devices "Spektr", "Rainbow") lasting 10 days. From the first day of physiotherapy, "Magne B6" was additionally prescribed - 2 tablets 3 times a day for 17 days. On the 7th day, the level of the Terminal terminal telopeptide of type 1 collagen was determined, which amounted to 1.50 mmol/l. No additional appointments were made. A month later, electromyography was performed - a positive trend was revealed. The long-term prognosis is favorable.

Example #2

A 14-year-old child with peripheral paresis of the right hand. History of trauma resulting from a traffic accident. Physiotherapy was prescribed for the area of the affected neuromuscular unit (SMT, according to a stimulating method: 2nd kind of work, non-straightened

mode modulation frequency 30 Hz, modulation depth 100%, send-pause 2-3 sec. from the apparatus of the "Amplipulse" type and muscle stimulation with red LEDs from the apparatuses "Spectrum", "Rainbow", in combination with EHF-therapy on pain zones: duration of exposure - 10-15 minutes; procedures are carried out every other day 5 days), lasting 10 days. From the first day of physiotherapy, "Magne B 6" was additionally prescribed - 2 tablets 3 times a day for 17 days. On the 7th day, the level of the C-terminal terminal telopeptide of type 1 collagen was determined, which amounted to 1.34 mmol/L. Additionally appointed chondroitin sulfate 750 mg 2 times a day for 10 days. A month later, electromyography was performed - a positive trend was revealed. The long-term prognosis is favorable.

Example #3

A 9-year-old child with peripheral paresis of the left arm. History of trauma resulting from a traffic accident. Physiotherapy was prescribed for the area of the affected neuromuscular unit (SMT, according to a stimulating method: 2nd kind of work, non-rectified mode with a modulation frequency of 30 Hz, a modulation depth of 100%, a send-pause of 2-3 seconds from an apparatus of the "Amplipulse" type and stimulation muscles with red LEDs from the devices "Spectrum", "Rainbow") for 10 days. No additional appointments were made - treatment according to the protocol. On the 7th day, the level of the C-terminal terminal telopeptide of type 1 collagen was determined, which amounted to 1.18 mmol/l. No additional appointments were made - treatment according to the protocol. A month later, electromyography was performed - the restoration of neuromuscular conduction did not occur. Recommended surgical intervention with intraoperative electromyography. During the operation, compression of the nerve trunk area by scar tissue was revealed. Further treatment is required. The long-term prognosis is not favorable.

Thus, under equal initial conditions (peripheral paresis of the hand caused by an accident), the additional prescription of drugs containing organic magnesium salts in combination with pyridoxine and, in case of a pronounced dysplastic process, the prescription of chondroitin sulfate improved the results of treatment of children with peripheral paresis.

of connective tissue dysplasia at the metabolic level.

- For the first time, an additional enhancement of pathogenetic therapy is used by the appointment of a chondroprotector, in the presence of signs of a pronounced dysplastic process.

Distinctive features of the method:

- from the first days of physiotherapy, preparations containing organic magnesium salts in combination with pyridoxine are prescribed in average age dosages;

- after 7 days from the start of physiotherapy, the level of the Terminal terminal telopeptide of type 1 collagen is determined and, if its value drops below 1.5 mmol / l, oral administration of chondroitin sulfate is additionally prescribed at an average age dosage;

- the duration of drug therapy exceeds the duration of physiotherapy by one week.

The proposed method is illustrated by the following examples.

Example #1

An 8-year-old child with peripheral paresis of the left arm. History of trauma resulting from a traffic accident. Physiotherapy was prescribed for the area of the affected neuromuscular unit (SMT, according to a stimulating method: 2nd kind of work, non-rectified mode with a modulation frequency of 30 Hz, a modulation depth of 100%, a send-pause of 2-3 seconds from an apparatus of the "Amplipulse" type and muscle stimulation red LEDs from devices "Spektr", "Rainbow") lasting 10 days. From the first day of physiotherapy, "Magne B6" was additionally prescribed - 2 tablets 3 times a day for 17 days. On the 7th day, the level of the Terminal terminal telopeptide of type 1 collagen was determined, which amounted to 1.50 mmol/l. No additional appointments were made. A month later, electromyography was performed - a positive trend was revealed. The long-term prognosis is favorable.

Example #2

A 14-year-old child with peripheral paresis of the right hand. History of trauma resulting from a traffic accident. Physiotherapy was prescribed for the area of the affected neuromuscular unit (SMT, according to a stimulating method: 2nd kind of work, non-rectified mode with a modulation frequency of 30 Hz, a modulation depth of 100%, a send-pause of 2-3 seconds from an apparatus of the "Amplipulse" type and muscle stimulation red LEDs from devices "Spektr", "Rainbow", in combination with EHF-therapy on pain zones: duration of exposure - 10-15 minutes; procedures are carried out every other day 5 days), lasting 10 days. From the first day of physiotherapy, "Magne B 6" was additionally prescribed - 2 tablets 3 times a day for 17 days. On the 7th day, the level of the C-terminal terminal telopeptide of type 1 collagen was determined, which amounted to 1.34 mmol/l. Additionally appointed chondroitin sulfate 750 mg 2 times a day for 10 days. A month later, electromyography was performed - a positive trend was revealed. The long-term prognosis is favorable.

Example #3

A 9-year-old child with peripheral paresis of the left arm. History of trauma resulting from a traffic accident. Physiotherapy was prescribed for the area of the affected neuromuscular unit (SMT, according to a stimulating method: 2nd kind of work, non-rectified mode with a modulation frequency of 30 Hz, a modulation depth of 100%, a send-pause of 2-3 seconds from an apparatus of the "Amplipulse" type and muscle stimulation red LEDs from devices "Spektr", "Rainbow") lasting 10 days. No additional appointments were made - treatment according to the protocol. On the 7th day, the level of the C-terminal terminal telopeptide of type 1 collagen was determined, which amounted to 1.18 mmol/l. No additional appointments were made - treatment according to the protocol. A month later, electromyography was performed - the restoration of neuromuscular conduction did not occur. Recommended surgical intervention with intraoperative electromyography. During the operation, compression of the nerve trunk area by scar tissue was revealed. Further treatment is required. The long-term prognosis is not favorable.

Thus, under equal initial conditions (peripheral paresis of the hand caused by an accident), the additional prescription of drugs containing organic magnesium salts in combination with pyridoxine and with a pronounced dysplastic process, the appointment of chondroitin sulfate improved the results of treatment of children with peripheral paresis.

Claims (1)

A method for preventing the development of an unfavorable outcome in children with peripheral paresis, characterized by the fact that from the first days of physiotherapy, Magne B6 is prescribed in maximum age dosages, after 7 days from the start of physiotherapy, the level of C-terminal end telopeptide of type 1 collagen is determined and when its value decreases below 1.5 mmol / l is additionally prescribed oral intake of chondroitin sulfate in an average age dosage, the duration of drug therapy exceeds the duration of physiotherapy by one week.