WO2018106152A1 - Méthode de régulation des fonctions viscérales du patient par stimulation non invasive de la moelle épinière - Google Patents

Méthode de régulation des fonctions viscérales du patient par stimulation non invasive de la moelle épinière Download PDF

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WO2018106152A1
WO2018106152A1 PCT/RU2017/095001 RU2017095001W WO2018106152A1 WO 2018106152 A1 WO2018106152 A1 WO 2018106152A1 RU 2017095001 W RU2017095001 W RU 2017095001W WO 2018106152 A1 WO2018106152 A1 WO 2018106152A1
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spinal cord
pulses
stimulation
electrodes
functions
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Russian (ru)
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Татьяна Ромульевна МОШОНКИНА
Арина Владимировна МИНЯЕВА
Сергей Александрович МОИСЕЕВ
Руслан Михайлович ГОРОДНИЧЕВ
Александр Алексеевич ГРИШИН
Юрий Петрович ГЕРАСИМЕНКО
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Общество с ограниченной ответственностью "Косима"
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents

Definitions

  • the invention relates to medicine, as well as to the physiology of humans and animals, in particular to the regulation of visceral functions in humans and animals by non-invasive stimulation of the spinal cord.
  • the method can be used for experimental studies.
  • Respiratory problems in spinal patients are, first of all, problems of the acute period of trauma (Baran Yu. V. et al. Injury of the spine and spinal cord: diagnosis and treatment // Ukrainian Medical Journal. - 2004. - N °. 1. - P. 39.) when the epidural electrical stimulation of the spinal cord is not yet carried out. But due to the close connection between the cardiovascular and respiratory systems, and also due to the fact that the innervation of the respiratory muscles is carried out at the level of C1-L1 segments of the spinal cord (Fishman A. P., Elias JA, Fishman JA, Grippi M. A., Senior RM, Pack A. Fishman's Pulmonary Diseases and Disorders. 2vol.set, 4th ed., McGraw-Hill, 2008, 2895 p), it can be assumed that by stimulating the spinal cord at this level, it is possible to influence respiration parameters .
  • Epidural electrical stimulation of the spinal cord affects the functioning of the gastrointestinal tract, in particular, it was shown that stimulation statistically significantly weakened the visceromotor reflex - contraction of the abdominal muscles in response to colorectal distension. This result was observed in anesthetized rats upon stimulation of L2-L3 segments with a frequency of 100 Hz (Qin C, Martinez M., Tang R. et al. Is Constant Current or Constant Voltage Spinal Cord Stimulation Superior for the Suppression of Nociceptive Visceral and Somatic Stimuli? A Rat Model // Neuromodulation. 2012. V. 15. P. 132) or with a frequency of 40 Hz (Tang R., Martinez M., Goodman-Keiser M. et al. Comparison of burst and tonic spinal cord stimulation on spinal neural processing in an animal model // Neuromodulation. 2014. V. 17. N ° 2. P. 143) for 20 minutes with a pulse duration of 0.3 ms and stimulus intensity of 90% of the motor threshold.
  • a known method of treating enuresis (RU2308302 C2, publ. 20.10.2007), which consistently conduct bilateral magnetic action on the paracentral lobes of the medial surface of the cerebral hemispheres.
  • infrared laser radiation is applied to the T12-L1-L2 segments of the spinal cord and suprapubic zone.
  • Epidural electrical stimulation of the S2-S4 segments of the spinal cord and segments S4-S5-C1 of the spine, electrical stimulation of the rectum and suprapubic zone are performed. Finish the procedure by exposure to infrared radiation on the visual analyzer.
  • the proposed method allows you to restore the balance of the processes of excitation and inhibition in the cerebral cortex, improve the functional state of the central, spinal structures of the brain and peripheral nerve structures responsible for voluntary urination, stimulate the sympathetic structures innervating the bladder.
  • bipolar stimulation is performed with electric pulses with a burst and pause duration of 2 s, with a burst filling frequency of 3000 Hz of the S2-S4 segments of the spinal cord and segments of the spine S4-S5-C1 with a weak sensation of the passage of electric current for 15 minutes.
  • laser irradiation is carried out by low-intensity infrared waves with amplitude-frequency modulation with a frequency of up to 3 Hz and a modulation depth of up to 30 percent, energy up to 50 J, wavelength 960 nm; electrical stimulation of the sciatic-cavernous muscles is carried out by a bipolar pulse current with a weak tetanic contraction with a duration of a pack and a pause of 2 seconds with a filling frequency of a pack of 3000 Hz and bipolar electrical stimulation is carried out between segments S2-S4 of the spinal cord and S4-S5-C1 of the spine with infralow electric waves with frequency up to 3 Hz and amplitude up to 100 ⁇ A.
  • the laser exposure time for each area is 5 minutes, the exposure time with a pulsed current is 30 minutes, the exposure time with an infra-low current is 24 hours; the course of treatment is 15 days.
  • a known method of high density epidural stimulation to facilitate locomotion, posture, voluntary movements and to restore autonomous, sexual, vasomotor and cognitive functions after neurological disorders (WO2012094346 A2, publ. 12.07.2012), which consists in restoring locomotor and postural control, arbitrary control over body movements and / or autonomic (visceral) functions in people with damage to the spinal cord, brain or neurological diseases leading to movement disorders.
  • the method consists in stimulating the human spinal cord using epidural electrode arrays that are placed in the cervical, thoracic or lumbosacral spinal cord, using physical training to generate proprioceptive and / or supraspinal signals and, possibly, administering pharmacological drugs.
  • Electrodes are placed on the neck to stimulate the trunk of the spinal cord or cervical spinal cord, in the lower back to stimulate the lumbar, or sacral region of the spinal cord, or region T11 - T12 vertebrae.
  • Using the invention allows to restore motor functions lost due to spinal cord injury, cerebral ischemia, Parkinson’s disease, Alzheimer's disease, Huntington’s disease, etc.), consisting of standing, walking, voluntary movements, sitting, moving to a lying position, in grasping repulsive and attractive movements.
  • the closest analogue of the proposed method is a method of electrical surface stimulation in the back, affecting the autonomic nervous system (Kaur B. et a. Effect of surface spinal stimulation on autonomic nervous system in the patients with spinal cord injury // Archives of Medicine and Health Sciences. - 2014. - T. 2. - N °. 2. - C. 126.).
  • the technical problem is the impossibility of the controlled regulation of visceral functions humans and animals by non-invasive electrical effects on the spinal cord at the level of innervation of the corresponding organ or organs.
  • the technical result provided by the invention is the provision of regulation of visceral functions of humans and animals through non-invasive stimulation of the spinal cord at the level of innervation of the corresponding organ or organs.
  • the technical result is achieved due to the fact that at least one electrode is placed on the patient’s skin dorsally above the spinal cord segment at the level of innervation of the corresponding organ or organs, and two electrodes are located ventrally symmetrically with respect to the vertical axis of the patient’s body, then they are acted upon by a sequence of rectangular electric pulses through the indicated electrodes with a pulse amplitude of 10 - 150 mA, a pulse repetition rate of 0.2 - 100 Hz, a pulse duration of 0.5-1 ms.
  • visceral functions in this application refers to the physiological functions of the human and animal body, which are regulated by the visceral (autonomous) nervous system, namely the respiratory system, digestive system, thermoregulatory system, circulatory system, excretory system, etc. At the same time, one of the respiratory, digestive, excretory, sexual, cardiovascular functions, functions of the blood supply to the brain, and peripheral blood supply is chosen as visceral functions.
  • the selection of a combination of the amplitude of the pulses and the shape of the pulses is carried out individually by selecting parameters that do not cause pain in patients.
  • the choice of the amplitude of the pulses is carried out within 50-100% of the minimum amplitude of the pulses causing contraction of the skeletal muscles over the segment of the spinal cord at the level of innervation of the corresponding organ or organs to single unmodulated pulses of 0.5-1 ms duration or to a continuous sequence of monopolar unmodulated pulses with a frequency of 0.2- 1 Hz and a pulse duration of 0.5-1 ms.
  • the impact through these electrodes is carried out by a sequence of rectangular electric pulses, while the shape of the pulses can be selected from: monopolar unmodulated pulses, monopolar pulses modulated with a carrier frequency of 2-10 kHz, bipolar pulses of unmodulated pulses, bipolar pulses of a carrier frequency of 2-10 kHz pulses.
  • the electrodes are located between the spinous processes of the vertebrae in the region of the T6-L2 vertebrae and ventrally in the area of the ribs or crests of the ilium and are affected by a sequence of rectangular electric pulses through these electrodes with a frequency of 20-50 Hz.
  • the electrodes are placed between the spinous processes of the vertebrae in the region of the T12-L2 vertebrae or in the coccyx and ventrally in the area of the crests of the ilium and act by a sequence of rectangular electric pulses through these electrodes with a frequency of 1-20 Hz.
  • the electrodes are located between the spinous processes of the vertebrae in the region of the T6-T12 vertebrae and ventrally in the region of the ribs and are affected by a sequence of rectangular electric pulses through these electrodes with a frequency of 30-50 Hz.
  • the location of the cathodes cutaneous in the central line of the spine between the spinous processes of the vertebrae allows you to directly stimulate the spinal cord.
  • the preliminary selection of the amplitude is connected with the fact that it is necessary to make sure that the electrodes are above the desired segment.
  • the pulse duration of ⁇ 1 ms was chosen to be the same as that used to cause movements during percutaneous stimulation of the spinal cord, so that the motor response to stimulation was predictable. Only with this arrangement of electrodes can the spinal cord be stimulated (Gerasimenko Y. et al. Transcutaneous electrical spinal cord stimulation in humans // Annals of physical and rehabilitation medicine. - 2015. - T. 58. - N °. 4. - C. 225-231.).
  • FIG. 1 shows a rehabilitation simulator providing forced leg movements.
  • FIG. 2 shows the position of the test subject in a supine position, with each test subject hanging on independent swing pendants.
  • FIG. 3-9 schematically show the results of experimental data, in particular, increase in lung ventilation, respiratory rate, decrease in tidal volume.
  • FIG. Figure 3 shows the change in lung ventilation during voluntary movement (black columns) and movement caused by percutaneous electrical stimulation of the spinal cord (white columns), relative to lung ventilation before this movement (rest) or after movement (recovery).
  • FIG. 4 shows a change in respiratory rate during voluntary movement and movement caused by percutaneous stimulation of the spinal cord. Designations as in FIG. 3.
  • FIG. 5 shows the change in tidal volume during voluntary movement and movement caused by percutaneous stimulation of the spinal cord. Designations as in FIG. 3.
  • FIG. Figure 6 shows the change in the duration of expiration during voluntary movement and movement caused by percutaneous stimulation of the spinal cord. Designations as in FIG. 3.
  • FIG. 7 shows the change in inspiration duration during voluntary movement and movement caused by percutaneous stimulation of the spinal cord. Designations as in FIG. 3.
  • FIG. Figure 8 shows the change in oxygen consumption during voluntary movement and movement caused by percutaneous stimulation of the spinal cord. Designations as in FIG. 3.
  • FIG. Figure 9 shows the change in the partial pressure of oxygen in the alveolar gas during voluntary movement and movement caused by percutaneous stimulation of the spinal cord. Designations as in FIG. 3.
  • the method of regulating the activity indicators of the respiratory, cardiovascular, gastrointestinal (digestive), excretory, reproductive systems, functions of the blood supply to the brain, peripheral blood supply is carried out by non-invasive stimulation of the spinal cord.
  • At the first stage at least one cathode is applied to the patient’s skin between the spinous processes of the vertebrae or in the coccyx above the segment of the spinal cord at the level of innervation of the corresponding organ or organs, and at least two anodes are ventrally symmetric with respect to the vertical axis of the patient’s body, for example, above right and left clavicles (along the clavicles), or symmetrically to the right and left above the ribs (along the ribs), or over the iliac crests to the right and left (along the ridges), or on the bends of the hip joints (along the bends )
  • the cathodes can be made round or rectangular in shape, with a size of at least 3 cm, but not more than 5 cm, and the anodes can be oval or rectangular, with a size of 5-10 cm along the long axis.
  • the electrodes are supplied with current in the form of monopolar or bipolar pulses of rectangular shape with a pulse duration of 0.5-1 ms with a frequency of 0.2-100 Hz, modulated or not modulated with a frequency of 2-10 kHz with a current amplitude of 10-250 mA.
  • the location of the electrodes, the frequency and amplitude of the pulses is selected depending on the desired effect on the visceral system.
  • the combination of the amplitude of the pulses and the shape of the pulses is carried out individually by selecting parameters that do not cause pain in patients.
  • the current amplitude is selected within 50-100% of the minimum amplitude of the pulses that cause skeletal muscle contractions over the spinal cord segment at the level of innervation of the corresponding organ or organs to single unmodulated pulses of 0.5-1 ms duration or to a continuous sequence of monopolar unmodulated pulses with a frequency of 0.2-1 Hz and a pulse duration of 0.5-1 ms.
  • the shape of the pulses (bipolar or monopolar, modulated or non-modulated, modulated with a frequency of 2-10 kHz) is selected. It is known that to reduce the pain of any electrical stimulation, the pulse duration is reduced to 0.5 ms or less.
  • Monopolar impulses are more powerful than bipolar impulses, but also more painful. Monopolar impulses require a lower current intensity in order to achieve the same effect.
  • Frequencies less than 0.5 Hz are used to invoke reflex responses of various organs; at high frequencies, the responses will overlap or influence the previous one on the next one, i.e. these frequencies are needed to perform a diagnostic function.
  • the response function to modulated low-frequency impulses in particular, the contraction of skeletal muscles over a segment of the spinal cord at the level of innervation of the corresponding organ or organs, is blurred. Therefore to call reflex The answer is to increase the current amplitude. Stable reflex responses cause only unmodulated monopolar impulses.
  • Unmodulated monopolar impulses were previously used to induce motor responses during spinal cord stimulation of paralyzed spinal patients during stimulation below the injury site, they have no sensitivity there, spinal neural networks “sleep” many years after the injury (Noninvasive Reactivation of Motor Descending Control after Paralysis. Gerasimenko YP1, 2,3, Lu DC4.5, Modaber M4.5, Zdunowski S1, Gad P1, Sayenko DG1, Morikawa E4.5, Haakana P4.5, Ferguson AR6, Roy RR1 .7, Edgerton VR1, 4.7. J Neurophysiol. 2016 Jul 1; 1 16 (1): 98-105. Doi: 10.1 152 / jn.00146.2016. Epub 2016 Apr 13.).
  • the cathode is placed above the T2-TK vertebrae, and the anodes above the lower ribs, using a current frequency of 30-50 Hz, bipolar or monopolar modulated pulses and current amplitudes within 50-100% of the minimum pulse amplitude causing contraction of skeletal muscles over a segment of the spinal cord at the level of innervation of the corresponding organs.
  • the cathode is placed above the T11-L2 vertebrae, and the anodes are above the iliac bones, a current frequency of 30-50 Hz, bipolar or monopolar modulated pulses with a current amplitude equal to or in the range of 50-100% of the minimum the amplitudes of the impulses causing skeletal muscle contractions above the spinal cord segment at the level of innervation of the corresponding organs.
  • the cathode is located in the cathode
  • C1-C3 vertebrae, and the anodes above the clavicle use a current frequency of 50 Hz, bipolar or monopolar modulated pulses, the amplitude of which is in the range of 50-100% of the minimum amplitude of the pulses causing contraction of the skeletal muscles over the spinal cord segment at the level of innervation of the corresponding organ.
  • the cathode is placed in the region of the L3-S1 vertebrae, and the anode is placed in the folds of the hip joint, a current frequency of 0.2-3 Hz, bipolar or monopolar modulated pulses, the amplitude of which is used is in the range of 50-100% of the minimum amplitude of the pulses causing contraction of skeletal muscles over a segment of the spinal cord at the level of innervation of the corresponding organ.
  • the cathode is placed between the spinous processes of the vertebrae in the T6-T12 region of the vertebrae, and the anodes are ventrally in the region of the ribs and act by a sequence of rectangular electric pulses through these electrodes with a frequency of 30-50 Hz.
  • the exposure duration is from 1 minute to 60 minutes. Stimulation can be done in courses.
  • Percutaneous spinal cord stimulation may be accompanied by mechanotherapy.
  • Percutaneous spinal cord stimulation may be accompanied by pharmacotherapy.
  • Example 1 The effect of percutaneous electrical stimulation of the spinal cord on the characteristics of external respiration.
  • the study was conducted on a healthy male volunteer. During the research, the test subject was placed in a rehabilitation simulator (BIOKIN, manufacturer of Kosima LLC), which provides forced leg movements in a walking rhythm, as well as in another mode, allowing the test subject to make walking movements on his own. During the study, the subject was in a reclining position (Fig. 1).
  • a rehabilitation simulator BIOS, manufacturer of Kosima LLC
  • a 5-channel stimulator Biostim-5 manufactured by Biostim-5 (manufacturer Kosima LLC) was used.
  • the cathodes were placed percutaneously in the central line of the spine between the spinous processes of the vertebrae Th12-L1 and L1-L2.
  • As electrodes round electrodes with a diameter of 2.5 cm with an adhesive layer (Syrtenty®) were used.
  • a pair of oval electrodes 5 * 10 cm2 in size with an adhesive layer (Syrtenty®) were used as anodes; they were placed cutaneously in the abdomen, above the iliac bones on the right and left. Anodes were interconnected.
  • Spinal cord stimulation was carried out by unipolar modulated pulses with a frequency of 30 Hz, a modulation frequency of 5 kHz, and a pulse duration of 1 ms.
  • the current intensity was selected for each of the two levels of stimulation until the contraction of the muscles of the lower extremities, the amplitude of the current was 50-70 mA.
  • stage II the test subject was breathing through a disposable mouthpiece.
  • the parameters were recorded in the test mode "SVC".
  • SVC test mode
  • the lung capacity (EVC, l) inspiratory reserve volume (IRV, l), expiratory reserve volume (ERV, l), tidal volume (V T , l) and capacity were determined inspiration (1C, l).
  • stage III the subject also breathed through a disposable mouthpiece. Parameters were recorded in the "FVC" test mode.
  • the forced vital capacity of the lungs FVC, l
  • the peak expiratory flow PEF, l / s
  • expiratory flows at expiration of 75% 50% and 25% of the forced vital capacity were determined lungs (MEF 75%, MEF 50%, MEF 35%, l / s), forced expiratory volume in 1 sec (FEV1, l), forced expiratory time (FET100%, sec).
  • Stage I the study of the effect of percutaneous electrical stimulation of the spinal cord on spontaneous ventilation of the lungs, included 5 series. Between series, the test subject lay for at least 5 minutes in the simulator-bed at rest to exclude the influence of previous influences on the results of subsequent series.
  • Ill stage the study of the effect of percutaneous electrical stimulation of the spinal cord on the performance of the respiratory muscles and the resistance of the airways to the air flow included 3 series.
  • percutaneous stimulation of the spinal cord causes significant changes in both ventilation of the lungs and gas and energy metabolism. If electrical stimulation of the spinal cord at the level of the vertebrae Th12-L1 is accompanied by an increase in lung ventilation, oxygen consumption and the level of general energy exchange, then simultaneous stimulation at the levels of the Th12-L1 and L1-L2 vertebrae causes a decrease in lung ventilation, oxygen consumption and energy exchange.
  • percutaneous stimulation of the spinal cord against the background of performing arbitrary walking movements causes some changes both in ventilation of the lungs and in gas and energy metabolism.
  • the fact that the cancellation of electrical stimulation, while continuing to perform movements, causes a decrease in respiratory rate, oxygen consumption and the level of general energy exchange can indicate the presence of stimulated energy consumers, which may be auxiliary respiratory muscles.
  • percutaneous electrical stimulation of the spinal cord against the background of passive walking movements causes certain changes in lung ventilation, gas and energy metabolism.
  • the fact that the cancellation of electrical stimulation, while continuing to carry out passive movements, causes a decrease in the respiratory rate, primarily due to lengthening of the expiration, may indicate the activating effect of the applied stimulation on the expiratory muscles.
  • both voluntary walking movements and percutaneous electrical stimulation of the spinal cord have unidirectional effects on the main volumes and capacities of the lungs, reducing the reserve volume of expiration.
  • the fact that this effect is compensated by an increase in the reserve inspiration during voluntary movements, but does not occur when stimulation is compensated, can be explained by the cyclical nature of the voluntary movements, when the maximum inspiration occurs at the time of the minimum tension of the expiratory muscles of the abdomen and does not interfere with inspiration, while activation stimulates expiratory The musculature is permanent and inhibits expiration.
  • the peak velocity of the expiratory flow during stimulation was higher than the peak expiratory flow recorded not only at rest, but also when performing arbitrary walking movements (Table 6). This can be explained by the fact that during stimulation, at the initial moment of forced expiration, there is a synchronous contraction of a larger number of expiratory muscle groups than at rest and when performing walking movements.
  • the instantaneous speed of the expiratory flow after exhalation of 25% of the forced expiratory volume during stimulation was lower than the value of the same parameter in the condition of physical rest, but higher than under the conditions of performing walking movements. It is likely that during stimulation in the first phase of forced expiration, it is additionally reduced less than when walking, muscle groups that realize, at rest, the second phase of forced expiration.
  • the instantaneous expiratory flow rate after exhalation of 75% of the forced expiratory volume during stimulation was greater than at rest and under the condition of performing arbitrary walking movements.
  • the volume of forced exhalation in the first second when performing arbitrary walking movements remained practically unchanged relative to the states of rest and voluntary walking.
  • Example 2 The effect of percutaneous stimulation of the spinal cord, causing a locomotor response, on the characteristics of external respiration and on general energy exchange.
  • transdermal stimulation of the spinal cord in the T11-L2 region of the vertebrae causes a motor reaction and can be used to rehabilitate motor functions. It is not known that transdermal stimulation of the spinal cord can be used to regulate respiration and metabolism.
  • the purpose of the study is to show that the reaction of the respiratory system to spinal cord stimulation is not a reaction to the movements that spinal cord stimulation causes, that spinal cord stimulation not only causes locomotor movements, but also changes the parameters of respiration and general metabolism.
  • Example 2 The study was conducted with 10 healthy male volunteers. The parameters of lung ventilation and gas exchange were recorded using a Cosmed Quark CPET metabolograph, described in more detail in Example 1.
  • the BiokinES-5 electric stimulator manufactured by Kosima LLC
  • the method features are the same as described in Example 1.
  • the subjects were in a supine position. In order to facilitate the execution of movements, each leg of the subjects was hung on independent swing swings (Fig. 2).
  • the parameters of ventilation and gas exchange were recorded for 1 minute in the initial state of rest, 2 minutes during transcutaneous electrical stimulation of the spinal cord by means of electrodes located above the thoracic vertebrae T1 1 - T12 with a current of 30-150 mA at a frequency of 30 Hz in order to cause spontaneous walking movements, 1 minute in the recovery process.
  • the walking movements caused by stimulation are accompanied by a smaller (P ⁇ 0.05) increase in oxygen consumption than randomly reproduced movements (P ⁇ 0.01) (Fig. 8).
  • P ⁇ 0.05 increase in oxygen consumption than randomly reproduced movements
  • P ⁇ 0.01 randomly reproduced movements
  • the partial pressure of oxygen in the alveolar gas increases slightly with evoked movements, and decreases with arbitrary movements (P ⁇ 0.01) (Fig. 9).

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Abstract

L'invention concerne le domaine de la médecine et de physiologie de l'humain ou des animaux et notamment la régulation des fonctions viscérales chez l'homme et les animaux par une stimulation de la moelle épinière non invasive. La méthode est caractérisée en ce que l'on dispose au moins une cathode sur la peau du patient dorsalement au-dessus d'un segment de la moelle épinières au niveau de l'innervation de l'organe (ou des organe) correspondant(s), et l'on dispose deux anodes sur la peau de manière ventral et symétrique par rapport à l'axe vertical du corps du patient ; on applique une séquence d'impulsions électriques rectangulaires via les électrodes en question avec un amplitude d'impulsions de 10 - 150 mA, une fréquence du train d'impulsions de 0,2 - 100 Hz, et une durée d'impulsions de 0,5-1 ms. En tant que fonctions viscérales on choisit une des fonctions suivantes: respiratoire, digestive, excrétrice, sexuelle, cardiovasculaire, d'irrigation sanguine du cerveau ou de circulation sanguine périphérique. La sélection d'une combinaison d'amplitude et de forme d'impulsions s'effectue de manière individuelle par le choix de paramètres qui ne provoquent pas de sensations maladives chez les patients. La sélection d'amplitude des impulsions s'effectue dans l'intervalle de 50-100 % par rapport à l'amplitude minimale des impulsions provoquant des contractions des muscles squelettiques au-dessus du segment de la moelle épinière ères au niveau de l'innervation de l'organe (ou des organe) correspondant(s), les impulsions se présentant comme des impulsions isolées non modulées de 0.5-1 ms ou comme une séquence ininterrompue d'impulsions monopolaires non modulées avec une fréquence de 0,2-1 Hz et une durée d'impulsions de 0.5-1 ms. L'utilisation de l'invention permet de réguler les fonctions viscérales de façon non invasive.
PCT/RU2017/095001 2016-12-08 2017-11-07 Méthode de régulation des fonctions viscérales du patient par stimulation non invasive de la moelle épinière WO2018106152A1 (fr)

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