UA134136U - METHOD OF ASSESSMENT OF MOTOR ACTIVITY IN PATIENTS WITH DISEASED FOOT SYNDROME ON DIABETIC POLYNEUROPATY - Google Patents

Abstract

A method of assessing motor activity in patients with restless legs syndrome (CHN) on the background of diabetic polyneuropathy (DPN) involves performing actigraphy using a tibial accelerometer. When monitoring movements with a shin accelerator (eZ430-Chronos), an acceleration signal is selected at a frequency of 10 r / sec, which is digitally integrated to measure movement activity in the movement chart exported in a Microsoft Excel spreadsheet.

Description

A useful model belongs to medicine, namely neurology and endocrinology, and can be used to diagnose and determine the effectiveness of treatment of restless legs syndrome (RLS) in patients with diabetes mellitus complicated by diabetic polyneuropathy (DPN).

SNN or Willis-Ekbom syndrome is a sensorimotor disorder, which is characterized by a frequent irresistible desire to change the position of the limbs in order to relieve unpleasant sensations in them.

SNNs are classified into primary and secondary. Primary SNN usually appears in the first decade of life and is hereditary. Secondary CHF occurs in late life against the background of iron deficiency, kidney failure, pregnancy, polyneuropathies, hypothyroidism, etc.

IOaimiPetgv U, UMMipKeItapp U). Neziezz Ied5 zupagote: iradaiye op rayodepeziv. Sy Orip Rit May 2013:19(6):594-6001.

According to the International Research Group on SNN (2003), 4 main criteria are sufficient to establish a diagnosis: 1) the desire to move the limbs in combination with unpleasant sensations in them, which 2) occurs at rest and 3) usually in the evening or at night and 4) unpleasant sensations are relieved by movement. However, there are criteria that support the diagnosis, which include: a positive response to treatment with dopaminergic drugs, the presence of periodic limb movements (PRM) during sleep and a positive family history |Zutmoshakiv E,

Apuiapiakiv E, Giopiz S. VNeviev5 Ied5 zupagote: Iyegaishge hemiem. ZAO Ratio Mea. 9. 2010; 128y7123-26). In clinical practice, there are patients who have symptoms that correspond to the main criteria of SNF, in particular, patients with diabetic polyneuropathy, some of whom do not have a positive effect from drugs to relieve neuropathic pain.

Polysomnography (PSG) is the most common instrumental method of diagnosing SLE - a method of parallel registration of various physiological indicators during sleep, which allows you to assess the depth of sleep and its stages, as well as to determine the state of breathing, the amplitude of respiratory movements of the chest and abdominal walls, motor activity (body position, limb movements), blood oxygen saturation, presence of snoring, heart activity with video monitoring of a person's behavior during sleep.

It includes surface electromyography (EMG) - to study motor activity, electrooculography is used to record eye movements, electroencephalography - to measure and evaluate brain activity and its changes during motor activity, electrocardiogram

Zo - recording of heart rate and rhythm; nasal sensors for recording air flow; microphone - for recording snoring (MipKetap UM/, Keaiype 5, VaYidm/p SM, ei a. Roizuzotpodgarpis apa NneaiNgeiaied diaiiyu oi Ie sogteiaez oi geziyez5 Id zupagote ip She 5iveer Neapy Neatsy 5schau.

Zieer 2009;32:772-8|. This diagnostic complex is important and final in the diagnosis of sleep disorders and movement disorders, but the research is expensive and requires special diagnostic equipment, premises (sleep laboratory) and special skills, so it cannot be recommended for the general public of doctors.

A well-known way of diagnosing SVT, namely its severity, is the immobilization test (IT) using the EMG registration system. The purpose of this method is to identify motor symptoms of the disease. According to the standards, this examination is carried out in 1.5-2 hours. before sleep for 60 min. after immobilization to the patient, who must not move and not sleep. The EMG registration system consists of electrodes that remove muscle potentials, an amplifier of these signals, and a recording device. When recording EMG, bipolar lead with surface electrodes is used, they are fixed on the skin above the area of the motor point of the muscle (t. The large size and distance from the muscle tissue of the surface electrodes allows recording the total activity of the muscles, that is, the interference of the action potentials of many muscle fibers. Each contraction on the interference curve corresponding to dorsiflexion of the toes is considered as one PRK IMapsopi M, Sazetsa I, cSomopi M,

Sezpik E. Rgatirehoiye ip gez(ez5 Iedz zupdgote. Emaiitsayop ru ziddeviei ittobii2ainop ievi. 9.

MeshgoIodu 2003; 250:1494-5). However, this method does not evaluate the nocturnal manifestations of INF and is short-lived and therefore cannot be the only way to establish a diagnosis and be used to evaluate the effectiveness of INF treatment.

It is advisable to use ambulatory portable diagnostic devices that can provide information on motor activity both during wakefulness and during sleep over a long period of time. The advantages of the method are simplicity, minimization of "laboratory" effects that can disturb the quality of the patient's sleep, long-term recording, and the possibility of conducting examinations even for young children or patients with dementia, when it is not possible to use other examination methods. The convenience of the examination is that it can be carried out outside the laboratory and even at home.

The essence of the method is to monitor the movements of the lower limbs using a leg accelerometer (e2430-Spgopo5). The device is attached to the patient's leg (if the patient does not indicate which leg bothers more, it is installed on the dominant right) and is covered with a cuff to prevent damage during sleep. The device monitor contains a piezoelectric sensor for recording physical movement. The acceleration signal produced by body movement is sampled 10 times per second and digitally integrated to measure motor activity. This activity is converted into numerical data, accumulated for each time epoch and stored in the device's memory. The data contained in the memory of the device are integrated into the movement graph during certain time intervals (qualitative changes) or they are exported to the table of Mysgozoiia Ehsei, where "0" means the absence of motor activity, and a numerical value other than "0" indicates for the presence of traffic in a certain period of time. This method is more convenient for counting the number of limb movements.

Despite the fact that the device perceives movement every 6 ms, the recording interval (displayed on a graph or in a table) is 2 s, since movements registered along different axes during this time period are considered one movement act or one PRK.

Some literature sources present data on the feasibility of using portable actigraphs on both limbs at the same time in order to obtain more accurate information on the number of leg movements during sleep. However, these claims have been refuted due to the fact that the use of two actigraphs simultaneously detects almost twice as many movements as a single device. All this happens due to the fact that motor activity in both legs may not occur simultaneously, but sequentially, that is, one limb begins to move, followed by another; accordingly, both actigraphs regard it as separate motor acts due to the mismatch in time (the time interval is usually 2 s), but in fact it is one motor act with the beginning in one leg and a gradual transition to the other. Therefore, it is more informative to use one device on the dominant leg.

The basis of a useful model is the task of evaluating the effectiveness of treatment of patients with SNN on the background of DPN.

The task is solved by the fact that, according to a useful model, when monitoring movements with the ankle accelerometer (e2430-Spgopo5), the acceleration signal is sampled at a frequency of 10 r/second and digitally integrated to measure motor activity in the movement graph exported to the Misgoboy Ekhsei table. This makes it possible to monitor the effectiveness of the prescribed treatment and to carry out a clearer differential diagnosis of ENT and DPN, taking into account the presence of unpleasant sensations that occur during sleep in ENT, as well as in patients with DPN, with

Because of which drugs for suppressing neuropathic pain are ineffective and can mask the symptoms

SN.

The use of the method of quantitative assessment of subjective manifestations of SNN, which is claimed, is illustrated by graphs, where: fig. 1 - actigraphy of patient M. (medical card of an inpatient

Mo 35216) before treatment. The diagram shows motor activity from 23:53:46 to 06:15:26; fig. 2 -

Actigraphy of patient M. (medical card of inpatient Mo 35216) after treatment. The diagram shows motor activity from 23:40:28 to 06:05:10; fig. C - Actigraphy of a practically healthy person N., 46 years old.

An example of a specific implementation of the method.

Hvora M., born in 1966. was on inpatient treatment in the endocrinology department

of the Ivano-Frankivsk Regional Clinical Hospital with a diagnosis of type 2 diabetes mellitus, of moderate severity, stage of subcompensation (medical card of an inpatient Mo 35216). During hospitalization, complaints of restlessness and unpleasant sensations in the legs in the form of burning, tingling, "crawling ants", tingling, which occurred mainly during rest and before sleep. When walking, rubbing the limbs, the condition improved somewhat. According to the neurological examination, the patient had hypoesthesia of surface (temperature, pain, tactile) and vibration sensitivities, symmetrical reduction of knee and absence of Achilles reflexes, vegetative disorders, such as dryness of the skin of the feet, hyperkeratosis. The strength in the limbs is preserved. When conducting

EMG diagnosed damage to the peripheral nerves of the lower extremities mainly by axonal type. Based on the data of subjective and objective signs and paraclinical research methods, DPN of the PA stage was established. Standard treatment of DPN (correction of glycemia, dyslipidemia, c-lipoic acid, benfotiamine) and gabapentin with dose titration starting from 0.6 g to 2.4 g per day for 14 days was prescribed. According to the patient, the condition improved slightly - unpleasant sensations and restlessness in the legs continued to bother her mainly in the evening and at night; the condition improved with movement. Taking into account the patient's complaints, the lack of effect from the use of gabapentin, the diagnosis of NN was suspected and confirmed with the help of 4 main diagnostic criteria. During IT, 16 PRKs were detected within an hour, which corresponds to the mildest degree of SNN. When interviewing the patient according to the SNN-6 scale, which includes the results of answers about sleep satisfaction, the severity of symptoms of the disease before sleep, at night, during the day at rest and during active activity, it was established that the satisfaction of sleep corresponded to 9 points, the severity of symptoms before sleep 60 was 7 points, at night - 7 points, during the day during active activity - Z points, during the day during rest - 5 points, daytime sleepiness corresponded to 8 points. The average score of the scale was 6.5 points, which corresponded to a moderate effect of the symptoms of the disease on the functioning of the patient. Pramipexole was prescribed at a dose of 0.25 mg per day at bedtime for 10 days. During repeated IIA, 5 PRKs were found, which corresponds to the data of practically healthy people (P3O0). However, the patient continued to complain of poor sleep, unpleasant sensations in the legs and excessive motor activity at night, the need to walk at night in order to alleviate the condition. The average score of the SNN-6 scale improved slightly and amounted to 5.9 points due to the reduction of symptoms at bedtime and during the day, although the severity of symptoms at night corresponded to 8 points. The patient underwent actigraphy and revealed excessive motor activity, which was significantly different from the PZO data (Figs. 1, 3). The dose of pramipexole was increased to 0.75 mg per day at night for 10 days. According to the patient, the condition has improved significantly - restlessness and unpleasant sensations in the limbs have decreased, sleep has significantly improved, and daytime sleepiness has decreased. There was a decrease in all indicators of the SNnNN-b scale (satisfaction with sleep - C points, severity of symptoms before sleep - C points, at night - 2 points, during the day during rest - 1 point, during the day during active activity - 0 points, daytime sleepiness - 2 points ).

After conducting repeated actigraphy, data were obtained that were almost indistinguishable from PZO (Fig. 2). so

The PI was not helpful for evaluating the effectiveness of treatment of patients with SNF, but the performed actigraphy, which takes into account the night symptoms of the disease, helps to better monitor the patient's condition and prescribe adequate effective therapy of patients with SNF against the background of DPN.

Claims (1)

USEFUL MODEL FORMULA A method of assessing motor activity in patients with restless legs syndrome (RLS) against the background of diabetic polyneuropathy (DPN), which includes actigraphy using a leg accelerometer, which differs in that when monitoring movements with a leg accelerometer (e7430-Spgopo5), an acceleration signal sampled at a frequency of 10 r./second, which is digitally integrated to measure motor activity in the movement graph exported to the table of Misgozoia Ehsei. shcha: Ban v a BE 6 ee ni ni ni ni NI NE Cori, ENN EN eV ENN I OUR xx AVNE AND IN NECNI ESHNU ERA. 1: MO: YOU'RE LIKE ME; shi IZ BIV IN v. Finn; and BIB NE SCHI NINA YAN | | ENN V NI SENYK NE VIN BE KON EV V: Pa EV V 15 NEZHAA NI AEN KU shi p Be shay N eE EENAEEE YE NEVE NN COMPLETE MU: ZEM 0 Fig. 1 Fig. 2 Fig. WITH