SU1212417A1 - Method of diagnosis of amyotropic lateral sclerosis - Google Patents

Description

The invention relates to the field of medicine, namely, neurology, and can be used for the diagnosis of amyotrophic sclerosis (ALS).

The aim of the invention is to improve the accuracy of the diagnosis of UAS to 194.5% of cases.

The method is carried out as follows. :. - “M

60-65 manganese chloride, after ijero on th () with mt Sephadex G-75, placed in a price column, are added to a 1.0-V | ,, ml spinal cord fluid. It is centrifuged for 1-2 minutes at 3000 rpm, the eluate is removed, the column with Sephadex is washed twice with a solution of potassium chloride (240-290 µmol), followed by centrifugation; 40-50 µmol of arginine and 50-55 µmol glycine are added to the eluate ) buffer pH 9.4-9.6, a sample with a volume of 2.0-2.2 ml is incubated for 40-60 minutes at 36-40 ° C, proteins are precipitated, the amount of urea in the supernatant is determined (using standard kits from LAKHEMA, Czechoslovakia) and with an increase in its content in the range from 0.023 mmol to 0.302 mmol, they diagnose amyotrophic lateral sclerosis.

Example 1. Patient J., 67 years old. He complained of general weakness, weight loss, difficulty walking because of weakness in his legs.

Two and a half years ago, I began to notice weakness of the muscles of the back, then of the legs, and after 6 months in the hands. There were twitches in different muscle groups. About a year ago there was a popping when eating, some breathing difficulties, the tone of the voice changed. Against the background of general weight loss, the other muscles of the legs and arms, the shoulder and pelvic muscles, are significant.

Neurological status. Sometimes gagging when eating, hoarseness, palate curtain is weak. Enhanced mandibular reflex. Strength in legs is reduced to degree I-2 points, in hands - to 2-3 points. Common fasciculations. Muscle hypotonia. Achilles reflexes are absent, knee - quickened. High periosteal reflexes. Moves with difficulty with a cane. When walking steppazh.

EMG: Damage to the cells of the anterior horns of the spinal cord. Urinary serum acid 8.4 mg% (with a rate of 2.5-8.0 mg%). The increase in the amount of urea of the cerebrospinal fluid by the proposed method was 0.302 mmol, i.e. the upper limit of the range of values obtained in patients with ALS.

In this case, the diagnosis of lateral amyotrophic sclerosis was not in doubt. This was confirmed by the study of liquor by the proposed method. At the same time, the use for the purpose of paraclinical diagnostics of a known method turned out to be

unsuitable - the amount of uric acid in the blood serum was not only not reduced, but even slightly exceeded the norm.

The indicated amount of urea in the liquor (0.302 mmol) was maximum; no figures higher than this in the experimental or control groups were obtained.

Example 2. Patient A. 41 g. Received complaints of weakness in the legs, weight loss of the leg muscles, twitching of the muscles of the arms and legs. Ill for about 2 years when convulsive contractions in the muscles appeared. A few months later, he noted weight loss of the legs, then the lower third of the thighs, weakness in the legs. A year later, widespread twitching in the muscles of the legs and arms appeared, it became difficult to walk. The weakness gradually increased, the last months walking with the help of crutches.

Neurological status; small-razma-0 shisty horizontal nystagmus. Pronounced lower paraparesis with oppression of tendon reflexes, muscular hypotension. Bilateral pathological signs Babinsky, Rossolimo. Significant hypotrophy of the muscles of the feet, lower legs to a lesser extent - 5 hips. Almost stop paws. Common fasciculations of the muscles of the arms and legs. Walking with crutches.

Electromyographic study (EMG) revealed damage to the cells of the anterior horns of the spinal cord primarily at the lumbosacral level and signs of increased excitability of motoneurons at the cervical level.

Diagnosis: Amyotrophic lateral sclerosis, in lumbosacral form.

In the study of the cerebrospinal fluid by the proposed method, an increase in the amount of urea to 0.023 mmol, i.e., a value within the range characteristic of ALS (lower limit).

In the control group in patients suffering from other diseases of the nervous system, often similar in clinical picture with ALS, an increase in the amount of urea in the CSF treated with the proposed method was not noted, except for a few cases where the value was below 0.023 mmol.

Example 3. Patient B., 36 years old. He entered with a diagnosis of amyotrophic lateral sclerosis.

Complaints of weakness in the proximal arms and legs, general weakness, weight loss of the muscles of the shoulder, the sa, hands.

I got sick a year ago, when weakness in my legs began to appear. Then noted weakness in the proximal arms. In addition, pain in the calf-5 leg muscles, shoulder muscles and body was disturbed. Muscular hypotrophy appeared. The weakness slowly but steadily increased, the last months moving with help.

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Neurological status. Walking is difficult (duck-walk), moves with support. Strength in the proximal muscle groups of the arms and legs is reduced to 2-3 points. Hypotrophy of the muscles of the shoulder and pelvic sa, scapulae, proximal leg and arm sections. Muscle hypotonia. The reflexes from the hands on the right, the knee, Achilles do not cause, on the left hand - sharply reduced.

After monitoring the patient, the initial diagnosis was questioned.

EMG - a study revealed some decrease in the speed of impulses in the proximal part of the arms: shortening and decrease in the potentials of the motor units, pronounced polyphase activity in the deltoid muscles.

The study of electrical excitability pointed to the primary muscular process.

In the study of the cerebrospinal fluid by the proposed method, an increase in the amount of urea to 0.008 mmol, that is, a value lying outside the limits specified for ALS, was established.

In the study of biopsy of the thigh muscles, dystrophic changes of a part of the muscle fibers were revealed with simultaneous growth of connective tissue.

On the basis of all the obtained data, the final diagnosis (clinical) was made: polymyositis, pseudo-myopathic form of the subacute course.

Claims (1)

A METHOD FOR DIAGNOSTIC OF LATERAL AMYOTROPHIC SCLEROSIS by biochemical examination of a biological fluid, characterized in that, in order to increase the accuracy of the method, the cerebrospinal fluid is examined, and a solution of manganese chloride is added to it, the resulting mixture is applied to Sephadex G-75, eluted with a solution of chloride potassium, arginine is added to the eluate in a buffer solution at pH 9.4–9.6, then the mixture is incubated at physiological temperature for 40–60 min, proteins are precipitated, and the amount of urea, and when its content is in the range of 0.023-0.302 mmol, amyotrophic e sclerosis is diagnosed. ® SU, „. 1212417>