WO2016013958A1

WO2016013958A1 - Method for treating patients with arterial pressure regulation system disorders

Info

Publication number: WO2016013958A1
Application number: PCT/RU2015/000383
Authority: WO
Inventors: Александр Александрович ГУРОВ; Владислав Валерьевич ИВАНОВ; Ирина Михайловна ЧЕРНЫШ
Original assignee: Общество с ограниченной ответственностью "ИНФЕРУМ"
Priority date: 2014-07-23
Filing date: 2015-06-22
Publication date: 2016-01-28
Also published as: RU2563389C1

Abstract

The invention relates to physiotherapy, electroacupuncture and cardiology and is intended for a course of treatment for hypertension and hypotension using transcutaneous electrical stimulation. To begin with, systolic and diastolic blood pressure are measured and the type of disorder is determined. Specific electrostimulation zones and parameters (pulse frequency and duration) are established according to different systolic and diastolic blood pressure readings.

Description

METHOD FOR TREATING PATIENTS WITH DISORDERS

ARTERIAL PRESSURE REGULATION SYSTEMS

FIELD OF TECHNOLOGY

The invention relates to medicine, namely to physio-, electroreflexotherapy and cardiology, is intended for the course treatment of hypertension and hypotension by percutaneous electrical stimulation and can be used in clinics, hospitals, dispensaries, sports complexes and in everyday conditions as an auxiliary or primary means of treating patients with circulatory system disorders.

BACKGROUND OF THE INVENTION

The growing interest in the method of reflexology is associated with the possibility of achieving effective results without the use of drugs in the correction of blood pressure or the possibility of a significant reduction in supporting pharmacological therapy in severe forms of diseases.

Methods of influencing biological active points (BAP) and biologically active zones (BAS) can be very diverse, from acupuncture to exposure to electromagnetic radiation, magnetic field and light.

A known method for the treatment of arterial hypertension, including multiple session transcutaneous exposure to low-intensity infrared laser radiation of the paravertebral areas at the level of SZ-C7 with a frequency of 100 Hz with setting the session duration individually according to the above formula (patent RU 2296594, 2007).

The known method, although it provides a decrease in blood pressure, however, requires an individual calculation of the duration of the sessions before treatment, which makes it difficult to widely use it. Besides Moreover, its use does not allow to increase blood pressure in case of hypotension.

There is a method of treating diseases, including arterial hypertension, by dynamic electrical stimulation, in which electrical stimulation determines the rate of change of the capacitive component of the impedance of the subelectrode region of the skin of a biological object and when the value of the rate of change of impedance is close to zero (time to reach the impedance plateau is from 15 seconds up to several minutes) withstand the time interval of stimulation for 3-5 minutes, after which the stimulation is stopped, while the course of treatment consists of 5-10 sessions per week nevne single procedures lasting 5-10 minutes (patent RU 2256762, 2005).

The specified method of electrical stimulation is intended for the treatment of a wide range of diseases, however, it is not effective enough for the targeted treatment of arterial hypertension. In some cases, depending on the selected parameters of the pulses, the effect is either only on systolic or only on diastolic blood pressure. In addition, in the case of low blood pressure, a regulatory effect is not provided.

The closest in technical essence is a method of treating arterial hypertension by dynamic electrical stimulation, including determining during the electrical stimulation the rate of change of the capacitive component of the impedance of the sub-electrode area of the skin of a biological object and subsequent electrical stimulation for a certain time interval after reaching a value of the rate of change of impedance close to zero, after which electrical stimulation is stopped, while subsequent conduct of electrical stimulation and is performed at a frequency of 9.1-9.3 Hz for a first time interval of 2-3 min, after which a pause is maintained during a second time interval of 2-5 seconds, and then carried by electrostimulation alternating pulses with a frequency of 75-79 Hz and 9.9-10.1 Hz with a frequency of 200-400 ms for a third time interval of 3-4 minutes, while dynamic electrical stimulation is performed on the biologically active point MC6 of the manual pericardial meridian (patent RU 2338564, 2008).

The known method, although it provides a decrease in blood pressure (BP), however, uses the same algorithm for all types of hypertension and does not take into account the features in cases of isolated systolic and diastolic hypertension, which require additional correction modes. The specified method is not intended for use in case of low blood pressure - with hypotension. Another disadvantage of this method is the dependence of determining the time interval of stimulation not only on the reaction of the autonomic nervous system, but also on the level of perspiration, which, as you know, also depends on the temperature and humidity of the environment (Gurov A.A., Budnikov Yu.F. , Koroleva M.V. et al. Experimental studies of the characteristics of surface impedance during percutaneous electrical stimulation. // Electrostimulation -2002. / Proceedings of the scientific-practical conference (March 27-28, 2002). - M .: RAMS. - 2002. - S.1 18-123). (Chernysh I.M., Gurov A.A., Vasilenko AM New principles of electro-puncture diagnostics. The Bioreper method. // Reflexology. - 2006. - N ° 2 (10). - P.38-43.), Which reduces the significance of the above method for determining the time interval of stimulation in order to obtain a clinical effect with a minimum dosage. In this method, the dependence of the time interval of stimulation on external factors may introduce an error in determining the interval of stimulation. For example, at the same level of blood pressure in a patient, the stimulation interval in hot weather will be shorter than in cold weather due to increased sweating, which will lead to premature termination of stimulation. The opposite picture can be observed when determining the time interval in the cold the weather. In addition, the uncertainty of the time interval for stimulation of the MC6 zone with prolonged intervals can lead to an overdose consisting in a decrease in systolic pressure by 15-20 mm Hg. (Materials of the international symposium "Dynamic electrostimulating therapy. Evolution continues", Yekaterinburg. - 2004. P.91), which can be manifested by a vegetative reaction in the form of dizziness and nausea.

In addition, the set of frequencies used in the prototype is limited, which reduces the effectiveness of therapy, since it covers only part of the regulatory mechanisms from among the possible (Samokhin A.V., Gotovskiy Yu.V. Practical electropuncture according to the method of R. Voll.-M .: Imedis, 1 1997.-C671).

Moreover, there is no possibility of choosing a treatment regimen depending on the type of violation of blood pressure: hyper- or hypotension, as well as its severity. SUMMARY OF THE INVENTION

The basis of the invention is the task of more complete coverage of existing options for violations of the regulation system of blood pressure, increasing the effectiveness of treatment while increasing the safety of therapy.

The technical result from the use of the proposed method is to increase the effectiveness of treatment by expanding regulatory mechanisms while improving the safety of therapy, taking into account the direction of the pathology and its severity.

The inventive method of treating patients with impaired regulation of blood pressure (BP), including electrical stimulation by pulses in the area of the acupuncture point (TA), while measuring systolic blood pressure (SBP) and diastolic blood pressure (DBP), determine the type of violation and depending on the type violations determine the zone and parameters of electrical stimulation: with high blood pressure in the range of values of GARDEN 120-179 mmHg. stimulation is carried out in the area of the MC6 point by bursts of pulses with frequencies of 9.1-9.3 Hz, 9.4-9.6 Hz, 75-79 Hz and 9.9-10.1 Hz with a frequency of 200-400 ms, 75-79 Hz , 190-210 Hz, while with the values of the GARDEN of 120-139 mm Hg use pulses with a duration of 23-27 μs and a duration of a burst of pulses of 3-4 minutes, with hypertension of the first degree SAD 140-159 mm Hg - pulses with a duration of 28-32 μs and a pulse train duration of 4-5 minutes, with second-degree hypertension, SAD 160-179 mm Hg - pulses with a duration of 33 -37 μs and the duration of each packet of pulses 5-6 minutes; with isolated systolic hypertension and SBP values of more than 140 mm Hg and DBP less than 90 mm Hg stimulation is carried out in the area of the MC6 point by bursts of pulses with frequencies of 3.2-3.4 Hz, 9.1-9.3 Hz, 75-79 Hz, a pulse duration of 28-32 μs and a pulse train duration of 4-5 minutes, with diastolic hypertension and the difference in the values of SBP and DBP is less than 15-20 mm Hg, stimulation is carried out in the area of the MC6 point by bursts of pulses with frequencies of 9.1-9.3 Hz, 9.4-9.6 Hz, 75-79 Hz pulse duration 28-32 μs and a pulse train duration of 4-5 minutes; with hypotension and SBP values less than 100 mm Hg stimulation is carried out in the area of the TR5 point by bursts of pulses with frequencies of 5.9-6.1 Hz, 75-79 Hz with amplitude modulation with a frequency of 4-5 Hz, 135-145 Hz with amplitude modulation with a frequency of 4-5 Hz, with pulse duration 28-32 μs and a pulse train duration of 2-4 minutes.

The inventive method is applicable for the following violations of blood pressure regulation systems:

1. with high blood pressure, i.e. in the range of systolic blood pressure values of 120-139 mm Hg;

2. with hypertension of the 1st degree, i.e. in the range of systolic blood pressure values 140-159 mm Hg;

3. with hypertension of the 2nd degree, i.e. in the range of systolic blood pressure values of 160-179 mm Hg; 4. with isolated systolic hypertension, i.e. with a systolic blood pressure value greater than or equal to 140 mmHg and diastolic blood pressure less than 90 mm Hg;

5. with diastolic hypertension, i.e. with a difference between systolic and diastolic blood pressures of less than 15-20 mm Hg;

6. with hypotension, i.e. with systolic blood pressure values less than 100 mmHg

Depending on the type of violation, an acupuncture point is selected in the MC6 zone (for violations indicated under the above numbers 1 to 5) or in the TR5 zone (for hypotension, i.e. for the violation indicated under number 6). The hypertension exposure zone was the MC6 acupuncture point of the manual pericardial meridian, which is located on the palmar surface of the forearm two tsun (transverse fingers of the patient) above the proximal wrist fold. The acupuncture point TR5, which is located on the dorsal surface of the forearm, above the proximal wrist fold of the joint by two tsuns (transverse fingers), was chosen as the zone of exposure for hypotension. The acupuncture point TR5 has a pronounced regulatory effect on the cardiovascular system, the nature of the action is very close to MC6, but, unlike it, has not a sedative, but a mild tonic effect. It has a stabilizing effect on vascular tone during atmospheric pressure fluctuations. It is used for headaches, vegetative-vascular dystonia with fluctuations in blood pressure. The choice of the point of influence is determined by the convenience of use for the patient, the ability to use in various conditions - at work, at home, as self-help and in emergency cases, as well as with course treatment.

The pathogenesis of hypertension is a violation of the baroreceptor relationships in the chain: large arteries - centers of the brain - sympathetic nerves - resistive vessels - capacitive vessels - heart, as well as activation of the renal endocrine circuit. The inventive method of exposure consists in determining blood pressure and classifying the type of disorder. Depending on the type of blood pressure disorders, specific frequencies are set for the formation of packets of stimulating impulses from them, aimed at correcting the pathological state of organs and systems involved in pathogenesis. The specific frequencies of stimulating impulses of influence are known per se (Samokhin A.V., Gotovskiy Yu.V. Practical electro-puncture according to the method of R. Voll.-M.: Imedis, 1997.-S671). For example, atherosclerotic vascular damage - 3.3 Hz, kidney damage - 9.2 Hz, endocrine disorders - 9.45 Hz and 9.5 Hz, vascular brain damage - 9.5 Hz, etc. Stimulation with a frequency of 77 Hz with frequency modulation, as well as 200 Hz, reduces the stress index and, accordingly, the tone of the sympathetic nervous system, which, in turn, leads to a decrease in blood pressure. According to the claimed method, the number of bursts of pulses corresponds to the number of selected frequencies.

The duration of the pulses in the packet is determined depending on the severity of the pathology, taking into account the fact that with a less pronounced degree less power is required, and therefore a shorter duration, since the pulse duration is equivalent to the power of the effect. At the same time, the power used should not exceed a comfortable level of sensations, since a high level of power can cause stress, which in itself can lead to an increase in blood pressure.

The duration of the pack is set similarly to the above approaches. The maximum and minimum durations of the pack were established by the dynamics of the voltage index values of regulatory systems by the method of assessing heart rate variability (PM Baevsky, A.P. Berseneva. Introduction to prenosological diagnostics.-M.: Slovo, 2008.-С220; PM Baevsky, O. I. Kirilov, SZ Kletskin Mathematical analysis of changes in heart rate under stress.-M.: Nauka, 1984.-C221). The approach to determining the duration of the pack is due to the fact that at a minimum duration it should be a positive clinical effect was obtained, and at maximum there should be no increase in the stress index.

The basis of the pathogenesis of hypotension are impaired neurohumoral apparatus that regulates vascular tone. Hypotension may be a symptom of acute vascular failure. In case of hypotension, stimulation regimes should be tonic (A.N. Razumov, A.M. Vasilenko, I.P. Bobrovnitsky, .Yu. Cheremkhin, I.M. Chernysh, A.A. Gurov. Dynamic electrical neurostimulation. Study guide. - M.-EKB. Tokmas-Press, 2008.-С139). Such modes include those with amplitude modulation of high frequencies - 77 and 140 Hz - lower - frequency 4 + 5 Hz, which increases the centralization of the regulation of vegetative tone and causes an increase in the stress index, thereby causing an increase in both systolic and diastolic blood pressure. Stimulation of the TR5 zone using a frequency of 6 Hz has a similar effect.

With high blood pressure, electrical stimulation is performed on the MC6 acupuncture point. Set 6 packs of pulses with frequencies of 9.1 + 9.3 Hz, 9.4 + 9.6 Hz, 75 + 79 Hz and 9.9 - ^ - 10.1 Hz with a frequency of 200 + 400 ms, 75 + 79 Hz, 190 +210 Hz, set the duration of the stimulation pulses to 23 + 27 μs and the duration of the pulse train 3-M-minutes.

With hypertension of the 1st degree, the method is carried out similarly to the above, while the duration of the stimulation pulses is set to 28 + 32 μs and the duration of the pulse train 4 + 5 minutes.

With hypertension of the 2nd degree, the method is carried out similarly to the above, while the duration of the stimulation pulses is set; 33 + 37 μs and the duration of each burst of pulses are 5 + 6 minutes.

With isolated systolic hypertension, electrical stimulation is performed according to the acupuncture point MS6. Set 3 packs of pulses with frequencies 3.2 + 3.4 Hz, 9.1 + 9.3 Hz, 75 + 79 Hz, in this case, the duration of the stimulation pulses is set at 28-32 μs, and the duration of the burst of pulses is 4- ^ 5 minutes.

With diastolic hypertension, electrical stimulation is carried out according to the acupuncture point MS6. Set 3 bursts of pulses with frequencies of 9, H9.3 Hz, 9.4- ^ 9.6 Hz, 75- ^ 79 Hz, while the duration of the stimulation pulses is set to 28-32 μs, and the duration of the burst of pulses is 4 ^ -5 minutes.

In case of hypotension, 3 packets of pulses with frequencies of 5.9 ^ -6.1 Hz, 75 ^ 79 Hz with amplitude modulation of 4 ^ 5 Hz, 135-445 Hz with amplitude modulation with a frequency of 4-5 ^ 5 Hz are set, while the duration of stimulation pulses set 28 ^ -32 μs, and the duration of the pulse train 2 ^ -4 minutes. Electrical stimulation is performed at the acupuncture point TR5.

Using the proposed method allows to ensure the overall effect of pressure changes, to expand indications for medical use for various ?: types of circulatory system disorders.

BEST MODES FOR CARRYING OUT THE INVENTION

The inventive method is illustrated by the following examples of specific performance.

Example 1

Patient M., 38 years old. A history of periodic increases in blood pressure not exceeding 139/89 mm Hg Of the concomitant diseases there are: chronic gastritis, duodenitis, ICD, chronic abacterial prostatitis.

Correction of high blood pressure. The course of treatment consisted of 10 sessions. Sessions were held every other day.

For electrical stimulation, a DiaDENS-Cardio type apparatus was used. The electrodes of the device with a special clamp are mounted on the acupuncture point MC6. Electrical stimulation at the acupuncture point MS6 was performed. Set 6 packs of pulses with frequencies of 9.1-9.3 Hz, 9.4-9.6 Hz, 75-79 Hz and 9.9-10.1 Hz with a frequency of 200-400 ms, 75-79 Hz, 190-210 Hz, the duration of the stimulation pulses was 23-27 μs and the duration of the pulse train was 3-4 minutes.

As a result of the treatment, blood pressure (BP) stabilized at 120/80, 130/85 mm Hg. The follow-up history was traced for 3 months.

Example 2

Patient G., 58 years old. History - periodic increase in blood pressure to 140/90, 152/95 mm Hg, accompanied by headaches and discomfort in the heart. Among concomitant diseases are the initial manifestations of cerebrovascular insufficiency, coronary heart disease, chronic gastro-duodenitis, ICD, and chronic prostatitis.

He underwent treatment for arterial hypertension, which consisted of 15 sessions. Sessions were held every other day. For electrical stimulation, a DiaDENS-ardio type apparatus was used. The electrodes of the device with a special clamp are mounted on the acupuncture point MC6. The treatment method was carried out by analogy with example 1, while the duration of the stimulation pulses was set in the range from 28-32 μs, and the duration of the bursts of pulses was 4-5 minutes.

After treatment, blood pressure did not exceed 140/90 mm Hg. Follow-up is tracked for 2 months. For a more pronounced therapeutic effect, a second course of treatment is recommended after 2-3 months.

Example 3

Patient K., 74 years old. A history of frequent increases in blood pressure in excess of 160/100 mmHg, most pronounced in the evening time (up to 175/95, 177/98 mm Hg) and accompanied by weakness, dizziness, heart palpitations. Of the concomitant diseases there are: CVB, chronic cerebrovascular insufficiency, coronary heart disease, chronic cholecystitis, chronic duodenitis, chronic cystitis.

She underwent treatment for arterial hypertension, which consisted of 17 sessions. Sessions were held daily.

For electrical stimulation, a DiaDENS-ardio type apparatus was used. The electrodes of the device with a special clamp are mounted on the acupuncture point MC6. The treatment method was carried out by analogy with example 1, while the duration of stimulation pulses was set in the range from 33 ^ -37 μs, and the duration of the pack was 5- ^ 6 minutes.

As a result of the treatment, the level of blood pressure did not exceed 160/100 mm Hg. Follow-up is tracked for 1.5 months. To obtain a more pronounced and lasting therapeutic effect, a repeated course of treatment after 1 month is recommended.

Example 4

Patient K., 84 years old. History: periodic increases in blood pressure, mainly systolic, usually up to 150/70 mm Hg, 160/75 mm Hg, accompanied by occipital headache, nausea, dizziness, and tingling in the heart.

Of the concomitant diseases, there are: CVB in the presence of hypertension, cerebral atherosclerosis, chronic cerebrovascular insufficiency, II stage, IHD, ICD, chronic calculous cholecystitis, history of duodenal ulcer, chronic urethritis, chronic prostatitis, and prostate adenoma.

He underwent treatment for isolated systolic hypertension, which consisted of 15 sessions. Sessions were held every other day.

For electrical stimulation, a DiaDENS-Cardio type apparatus was used. The electrodes of the device are mounted on a point using a special clamp Acupuncture MC6. Then 3 bursts of pulses with frequencies of 3.2- ^ 3.4 Hz, 9, H9.3 Hz, 75 ^ -79 Hz were set, while the duration of stimulation pulses was set to 28 - ^ - 32 μs, and the duration of the burst of pulses was 4 ^ - 5 minutes.

After the treatment, blood pressure was established on the numbers not exceeding the “working” blood pressure - 140/70 mm Hg. Follow-up history tracked for 1 month. At the same time, it was recommended that repeated courses of treatment be taken as a preventive measure once a month during the first half of the year.

Example 5

Patient G, 54 years old. In the anamnesis - periodic increases in diastolic pressure with normal systolic numbers (up to 120/100 mm Hg, 130/1 15 mm Hg), which are an accidental finding when measuring blood pressure and do not appear in complaints. Among concomitant diseases are hormone-dependent bronchial asthma, chronic pyelonephritis, chronic cystitis, chronic gastritis, chronic atonic colitis.

She underwent treatment for isolated diastolic hypertension, which consisted of 15 sessions. Sessions were held every other day.

For electrical stimulation, a DiaDENS-ardio type apparatus was used. The electrodes of the device with a special clamp are mounted on the acupuncture point MC6. Then 3 bursts of pulses with frequencies of 9.1- ^ 9.3 Hz, 9.4- ^ 9.6 Hz, 75- ^ 79 Hz were set, while the duration of stimulation pulses was set to 28-32 μs, and the duration of the burst of pulses was 4 ^ -5 minutes.

As a result of the treatment, increases in diastolic pressure occurred much less frequently and did not exceed 120/100 mm Hg. The follow-up history was traced for a month. For a more pronounced therapeutic effect, repeated courses of treatment are recommended. Example 6

Patient M., 57 years old. In the anamnesis - periodic episodes of weakness, dizziness, accompanied by low blood pressure = 80/50 mm Hg, occasionally - fainting with a decrease in blood pressure to a level of 70/40 mm Hg. Among concomitant diseases - chronic bronchitis, chronic cholecystitis, chronic spastic colitis, ICD.

She underwent treatment for arterial hypotension, which consisted of 12 sessions. Sessions were held every other day.

For electrical stimulation, a DiaDENS-Cardio type apparatus was used. The electrodes of the device with a special clamp are mounted on the acupuncture point TR5. Then 3 bursts of pulses with frequencies of 5.9 ^ -6.1 Hz, 75 ^ 79 Hz with amplitude modulation with a frequency of 4-5 ^ Hz, 135 ^ -145 Hz with amplitude modulation with a frequency of 4-5 ^ 5 Hz were installed, while the duration of the stimulation pulses is set to 28-32 μs, and the duration of the burst of pulses 2 - ^ - 4 minutes.

As a result of the treatment, blood pressure stabilized at 90/60, 1 10/70 mm Hg. in quite satisfactory condition. Episodes of weakness and dizziness after treatment did not recur. The follow-up history was traced for 3 months. INDUSTRIAL APPLICABILITY

Using the proposed method allows more fully cover the existing options for violation of blood pressure, including isolated systolic hypertension, diastolic hypertension and hypotension. The application of the proposed method allows to increase the efficiency in the course of treatment, due to the integrated approach to the treatment of the disease with the involvement of additional pathogenetic mechanisms of regulation of various disorders of the cardiovascular system due to the wide selection of frequencies of specific action on the interested "target organs". For example, atherosclerotic vascular lesion - 3.3 Hz, lesion kidneys - 9.2 Hz, endocrine disorders - 9.45 Hz and 9.5 Hz, vascular lesions of the brain - 9.5 Hz. Improving the safety of therapy is achieved through the use of fixed time intervals of exposure, the duration of which depends on various options for violations of blood pressure, severity and eliminates an overdose of therapeutic effect. In addition, an increase in safety is due to a decrease in the drug load on the body.

Thus, as can be seen from the data presented, the claimed method is effective for treating various options for blood pressure disorders, contributes to the achievement of a sustainable therapeutic effect, ensuring high safety of therapy, given the direction of the pathology and its severity.

Claims

Claim

A method of treating patients with impaired blood pressure regulation (BP) systems, including electrical stimulation with pulses in the area of an acupuncture point, characterized in that systolic blood pressure (SBP) and diastolic blood pressure (DBP) are measured, the type of disorder is determined, and depending on the type of violation, it is determined zone and parameters of electrical stimulation: with increased blood pressure in the range of values of the GARDEN of 120-179 mm Hg stimulation is carried out in the area of the MC6 point by bursts of pulses with frequencies of 9.1-9.3 Hz, 9.4-9.6 Hz, 75-79 Hz and 9.9-10.1 Hz with a frequency of 200-400 ms, 75-79 Hz , 190-210 Hz, while with the values of the GARDEN of 120-139 mm Hg use pulses with a duration of 23-27 μs and a duration of a burst of pulses of 3-4 minutes, with hypertension of the first degree SAD 140-159 mm Hg - pulses with a duration of 28-32 μs and a pulse train duration of 4-5 minutes, with second-degree hypertension, SAD 160-179 mm Hg - pulses with a duration of 33 -37 μs and the duration of each packet of pulses 5-6 minutes; with isolated systolic hypertension and SBP values of more than 140 mm Hg and DBP less than 90 mm Hg stimulation is carried out in the area of the MC6 point by bursts of pulses with frequencies of 3.2-3.4 Hz, 9.1-9.3 Hz, 75-79 Hz, a pulse duration of 28-32 μs and a pulse train duration of 4-5 minutes, with diastolic hypertension and the difference in the values of SBP and DBP is less than 15-20 mm Hg, stimulation is carried out in the area of the MC6 point by bursts of pulses with frequencies of 9.1-9.3 Hz, 9.4-9.6 Hz, 75-79 Hz pulse duration 28-32 μs and a pulse train duration of 4-5 minutes; with hypotension and SBP values less than 100 mm Hg stimulation is carried out in the area of the TR5 point by bursts of pulses with frequencies of 5.9-6.1 Hz, 75-79 Hz with amplitude modulation with a frequency of 4-5 Hz, 135-145 Hz with amplitude modulation with a frequency of 4-5 Hz, with pulse duration 28-32 μs and a pulse train duration of 2-4 minutes.