A method of treating functional disorders of the central nervous system and device for its implementation

 

(57) Abstract:

The invention relates to medicine, specifically to neurology and clinical neurophysiology, and is intended for the treatment of functional disorders of the Central nervous system (CNS) by stabilizing the bioelectrical activity of the brain sensory signal. Preparing the patient for carrying out the method is also, as for the standard EEG examination. As sensors of the EEG signal, the EEG amplifier and stimulator uses a standard EEG equipment. The transformation of the EEG signal in digital form, performing digital signal processing and control of the stimulants provided hardware and software tools based on the PC and the microprocessor module digital signal processing, which is embedded in one of the empty slots PC as coprocessors fee. Interface module for communication with the external device 32 includes a line input analog EEG signal, and 4 is equivalent to the output lines control the operation of stimulants. EEG signal output from pre-amplifier EEG by means of a connecting cable is supplied on the input line interface module digital Oska with PC control software modes trigger stimulation device is ready for operation. The exchange of signaling and control information between the module digital signal processing and personal computer is carried out via the system interface of the PC. In the research process on the display of the EEG signal and the current settings trigger stimulation. Channel access parameter changes trigger the stimulation is carried out with the help of the mouse and special keys. The positive effect of the method lies in the possibility of sustainable changes in the functional state of the brain, which correlates with therapeutic effect. 2 S. and 1 C. p. F.-ly, 9 Il.

The invention relates to medicine, specifically to neurology and clinical neurophysiology, and is intended for the treatment of functional disorders of the Central nervous system (CNS) by stabilizing the bioelectrical activity of the brain sensory signal.

In terms of device the invention relates to medical technology, and specifically to systems with biological feedback, by which the regulation of the bioelectrical activity of the brain in a certain frequency range.

The known method [1] training brain activity using signals biofeedback. The way predoi patient. Signals from sensors on the individual channels are used for bandpass filters, the bandwidth of which is within the pre-defined sub-bands. The emitted signals are processed in the feedback signals and transmitted to the patient as a controlled light and sound stimuli inducyruya patient EEG activity of the brain within a given frequency spectrum. As a result it facilitates arbitrary regulation of the patient's own brain activity in a given frequency range.

The disadvantage of this method is the lack of objective criteria for choosing the path of adjustment by the patient's own brain activity.

Also known method [3] trigger stimulation. The method involves the use of special trigger schemes, in which the timing of external influence the dynamics of changes in rhythmic activity of the brain recorded in the selected area of the brain. The feedback signals at the output of the trigger circuit includes a light or audible stimulator synchronously with any selected phase of the rhythmic components of electroencephalographic (EEG) signal, or at any interval after it is positive, or negative, with a corresponding increase or decrease in evoked EEG response signal.

The disadvantage of this method is the subjective choice of the areas of the brain, with which the signal feedback, as this area is not always characterized by the highest frequency stability and the maximum intensity of a given rhythm.

This method is closest to the proposed to the technical essence and achieved results, and therefore chosen by the applicant as a prototype.

It is known device [2] reverse neuropathy for effects on bioelectric activity in a given frequency range. The device includes a sensor analog bioelectrical signal recorded on the patient's body in that place, where the generation of bioelectric signals on the desired frequency, the amplifier analog bioelectrical signal Converter analog bioelectrical signal in digital form, frequency selector, PC to digital signal processing, the display device of the signal processing results of the magnetic disk for recording and storing the signal information. In accordance with the application of the device, additionally can be what dostatkom this device is the use of only one lead bioelectric signal, in the case of the EEG signal does not automatically select an area of the brain, with which the signals of the feedback.

It is also known device [3] trigger stimulation, which includes EEG sensors fixed on the patient's head, EEG amplifier, trigger circuit, the input of which is fed the output signal of one channel EEG amplifier, stimulant, touch the output of which is directed at the patient. The transformation of the EEG signal at the input of the trigger circuit in the feedback signals controlling the operation of the stimulator, is performed by sequential passage of the signal through the circuit provides filtering, kvadratichnie, limitation and differencirovanie. The resulting signal initiates the integrating circuit, the pulses of which include a light or audible stimulator. In the trigger circuit provides a subtractive counter, which allows you to delay turning on the stimulator and direct incentives on any selected phase of the rhythmic components of the EEG signal, or at any interval after its occurrence.

The disadvantage of this device is defined in the trigger circuit of the switching impulse stimulator relative to the moment of passing through the zero potential line is J. EEG-activity and therefore, violated the exact ratio of stimulus and phase of the rhythmic components of the EEG signal in the sequence of sensor signals.

Another disadvantage of this device is the lack of automatic tracking area of the brain, with which the signals of the feedback.

This unit is closest to the proposed to the technical essence and the achieved results and, therefore, selected as a prototype.

An object of the invention is purposeful modification and stabilization of bioelectric brain activity reflecting the functional state of the Central nervous system that constitutes the basis of therapeutic effect.

At the technical task of the invention to provide an automatic block search is optimal for a given criterion, the check-in area of EEG signal, with which the signals of the feedback.

This object is achieved in that in the method the impact on the patient's sensory signal using the trigger stimulation is carried out from areas of the brain, which currently has the largest frequency stability and max is Atwater, the switch to digital signals, the digital computing unit selection criteria trigger zone, i.e. the zone of the brain from which the abstraction of bioelectric activity at the input of the trigger circuit. Trigger scheme to unify the forms of presents the EEG signal has a digital implementation. Digital EEG signal output from the analog-to-digital Converter is fed to the input of switch digital signals in the evaluation unit of selection criteria trigger zone. The input trigger circuit connected to the output of switch digital signals. According to the results of the calculation of the selection criteria trigger zone will control the state of switch digital signals so that the input of the trigger circuit is always connected to the area of the brain, which currently corresponds to a given criterion.

Collectively, the above features ensure the achievement of the technical objectives of the invention.

In Fig. 1 explains the calculation of the parameters of the EEG waves MNP; Fig. 2 - determination of the moment of stimulation in the trigger circuit of Fig. 3 presents a block diagram of the proposed device.

N-channel analog EEG signal reflecting physiological status is prologo Converter 4. Digital EEG signal output from the analog-to-digital Converter is supplied to the digital processing of the EEG signal, which implements the algorithms of N-channel switch digital signals 5, block 7 calculation criteria of selection of trigger points and trigger circuit 6. The interaction of digital blocks is accomplished by passing the samples of EEG signal parameters programming constructs 5, 6, 7. Digital EEG signal is transmitted to the input N-channel switch digital signals 5 and block 7 calculation criteria selection trigger zone. The state of switch digital signals 5 is determined by the results of the calculation of the selection criteria triggering area in unit 7. With the output switch digital signals 5 digital EEG signal from the selected areas of the brain are transmitted to the input of the trigger circuit 6. The pulse signals generated at the output of the trigger circuit 6 includes a stimulator 8, touch the output of which is directed at the patient 1.

Calculation of selection criteria trigger zone in the block 7 and the switching of switch digital signals 5 runs with a period of 1 s in the process impact on the patient touch signal. Each channel of the EEG signal in the block 7 is processed similarly. Assess the time T, maxF1isecand minF1isecthe maximum and minimum value of the frequency rhythmic activity 1 on the interval T. the Value of Cuin each channel is calculated by the formula:

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The trigger zone stimulation is selected as the maximum value of the criterion Cicalculated across all channels.

Thus, automatically tracking the area of the brain, which currently has the maximum value of the evaluation criterion EEG signal recorded leads.

The trigger circuit 6 carries out coordination of supply time testing effects with a particular phase of the rhythmic components of the EEG signal. The algorithm of functioning of the trigger circuit includes performing low-pass filtering of the input EEG signal in order to eliminate from the signal elements with a frequency above a given rhythm, the segmentation of the received signal is half-wave detection, EEG waves, formed by two adjacent half-wave, and the computation of their amplitude and time parameters, as shown in Fig. 1 for wave MNO. Amplitude max(A1, A2), Duration D1+D2, where A1 is the amplitude of the left half, A2 is the amplitude of the right gender and duration DLMNdetected EEG waves LMN (Fig. 2) are in a given range of amplitudes and frequencies, the time indicated by the point A is a fixed delay circuit 15 MS) starts the delay, adjustable in the range from 0 to 500 MS, after which the signal of the start of the stimulator. Introduction delay allows you to direct stimulus to any selected phase of the rhythmic components of EEG signals or at any interval after its occurrence.

The timing of the start of the stimulator relative to the point A (EEG wave LMN) or B (EEG wave MNP, AMNPthe wave amplitude MNP, DMNP- wave duration MNP) detects the trigger stimulation.

Digital switch 5, the computing unit selection criteria trigger zone 7 and the trigger circuit 6 is implemented in the system based on the PC and is specially designed microprocessor module digital signal processing, embedded in one of the empty slots of the PC. The architecture of the microprocessor module, which contains two signal TMS320C25 processor, optimized to provide the required quality of control modes trigger stimulation and evaluation of controlled parameters of the EEG signal.

The mouth of the preliminary calculations completed and if you want the generated control signal.

The method is as follows. As sensors of the EEG signal, the EEG amplifier and stimulator uses a standard EEG equipment. The transformation of the EEG signal in digital form, performing digital signal processing and control of the stimulants provided hardware and software tools, developed in accordance with the implemented device, a method for the treatment of functional disorders of the Central nervous system. The hardware includes PC and microprocessor module digital signal processing, which is embedded in one of the empty slots PC as coprocessors fee. Interface module for communication with the external device 32 includes a line input analog EEG signal, and 4 is equivalent to the output lines control the operation of stimulants. EEG signal output from pre-amplifier EEG by means of a connecting cable is supplied on the input line interface module digital signal processing. The output line interface connected to the sockets external triggering stimulants.

After starting with the PC control program modes trigger stimulation device the TCI signals and the PC is carried out via the system interface of the PC. In the research process, the display shows the EEG signal and the current settings trigger stimulation. Access to channels change settings trigger stimulation is carried out with the help of the mouse and special keys.

Preparing the patient for the study is conducted as well as for standard EEG examination. The patient is in a separate darkened room, sitting in a relaxed and comfortable position in the chair. On the head using a special helmet mounted 16 EEG electrodes (Fp2, F4, C4, P4, O2, Fp1, F3, C3, P3, O1, F8, T4, T6, F7, T3, T5), located above the main cortical areas. Switching unipolar electrodes reference electrodes (A1, A2), is mounted on the left and the right ear lobe. The grounding electrode is installed in any area of the head. Flash lamp with energy flash 0.3 j and a duration of 50 μs is located in the midline at a distance of 25-30 cm from the patient's eye.

Before the study explained to the patient safety research, and instructed to sit in a relaxed posture, silently, with his eyes closed, not to make swallowing movements and eye movements. After a three-minute adaptation and validation calibration is I EEG recorded during one minute. Then turn trigger the stimulator mode auto search channel stimulation by selecting "Start the TFS" on the display screen of the PC with the help of the mouse.

During the triggering of stimulation is controlled by the nature and rate of occurrence of changes in the EEG. When signs of normalization of the EEG (stabilization of the alpha rhythm, the elimination of inter-hemispheric asymmetry) trigger the stimulation stops. While maintaining normalized EEG within three minutes after the termination of the trigger stimulation, the results of the procedure are regarded as sustainable changes in the functional state of the Central nervous system. The total duration of the study should not exceed 30 minutes

Example 1. Patient P. 45 years, and/b 8198. Complaints gradually progressive rotation of the head to the right for 5 years. Objective: torsional rotation of the head to the right, decreasing lying in a dream, when you touch the right hand to the chin, worse standing, under emotional stress. Hypertonicity and hypertrophy of the left Sterno sternocleidomastoid muscle. Signs of focal lesions of the Central nervous system no. The results of standard laboratory tests within normal limits.

Diamante to an EEG-study was conducted so that as explained above. In the background EEG (Fig. 4) found gross hemispheric asymmetry is dominated by acute low-amplitude alpha rhythm in the right hemisphere and high-frequency activity in the beta range in the left hemisphere. The nature of hemispheric asymmetry correlates with the direction of rotation of the head to the right. Task of the method was the elimination of the pathological hemispheric asymmetry with the ability to restore normal posture of the head.

When holding the trigger photostimulation (Fig. 5) automatic search areas of the brain, which at the moment was characterized by the highest frequency stability and the maximum index of the alpha rhythm during 3 min fixed hemispheric asymmetry due to the rise of internal EEG synchronization of the alpha rhythm in the left hemisphere. This effect persisted during the following 5 min of EEG registration and clinically manifested by a decrease in the degree of rotation of the head and hold the head upright.

This example illustrates sustainable change in the functional state of the CNS when the trigger photostimulation, which became the basis of therapeutic effect.

Example 2. Patient K., 46 years, the beats chills, lower mood, fatigue and impaired sleep. Objective: signs of autonomic dysfunction on the background of neurotic disorders alarming nature. Signs of focal lesions of the Central nervous system no. The results of standard laboratory tests within normal limits.

Diagnosis: Syndrome of a vegetative dystonia in the form of vegetative crises, lipoliticeski States, cephalgy psychogenic origin.

Patient preparation for EEG-study was carried out as described above. During registration, the background EEG patient experienced anxiety and a state of near vegetative crisis. On the background EEG (Fig. 6) registered low-amplitude "flat" EEG with paroxysmal discharges theta rhythm 6 Nr. /s and an amplitude of 15 mV, bilateral hypersynchronous, generalized by conosco. Picture EEG characteristic of dysfunction of the median non-specific brain systems dominated trophotropic influences.

When holding the trigger stimulation (Fig. 7) automatic search areas of the brain, which at the moment was characterized by the highest frequency stability and the maximum index of the alpha rhythm during 1 minute appeared dominance verkasalo stable trigger effect of photostimulation dominated fusiform alpha rhythm, bilateral hypersynchronous, immediately after the termination of the trigger photostimulation. In Fig. 9 shows a stable trigger effect of photostimulation in 3 min after the termination of the trigger photostimulation.

This example illustrates the elimination of the pathological paroxysmal activity midline structures of the brain and stabilization of the alpha rhythm in both hemispheres. This effect trigger photostimulation correlated with the disappearance of the symptoms of autonomic crisis.

The advantage of the proposed method in comparison with the prototype is:

precise synchronization of stimulation in any selected phase of the rhythmic components of the EEG signal;

automatic search trigger zone, which currently has the largest frequency stability and the maximum index of the specified rhythm.

The positive effect of the proposed method lies in the possibility of sustainable changes in the functional state of the brain, which correlates with therapeutic effect.

The proposed device has the following advantages compared with prototype:

the definition in the trigger circuit of the device of the moment of submission of the stimulus the components of the EEG signal in the sequence of sensor signals, as in this case, the monitored parameter is the phase of oscillations of the potential parameter, the least subject to possible distortion;

automatically tracking the area of the brain, which serves feedback signals in accordance with the specified search criteria, which gives the device properties of the medical device.

The proposed device was developed and tested in the clinic of nervous diseases, St. Petersburg State medical Academy on 36 patients with various disorders of the nervous activity.

1. A method of treating functional disorders of the Central nervous system, including the registration of the bioelectrical activity of the brain, it is converted into sensory feedback signals using trigger stimulation and their impact on the patient, characterized in that the exposure process with a period of 1 to define an area of the brain, which currently has the largest frequency stability and the maximum index of the specified rhythm, and use activity in this zone for further conversion and stimulation.

2. Device for the treatment of functional disorders of t the th signal, the analog amplifier electroencephalographical signal, and a trigger circuit, a stimulant, a touch signal which is directed at the patient, characterized in that between the amplifier output and the input of the trigger circuit is enabled multi-channel analog-to-digital Converter, coupled to the switch to digital signals, and a computing unit of selection criteria trigger zone, the output of which is connected to the control input of the switch.

3. The device according to p. 2, characterized in that the computing unit selection criteria trigger zone implements ratio

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where Iti, Ftiassessment of the index of the specified rate and its average frequency in the i - abstraction over a period of time T; max F1iwithand min F1iwithestimates of the maximum and minimum values of the frequency of a given rhythm 1 on the interval T;

N the number of leads,

the maximum value of the criterion Cidefines the current trigger zone stimulation.

 

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