A method for the treatment of spastic krivoshei

 

(57) Abstract:

The invention relates to medicine. Can be used for the treatment of spastic Krivoshei. Realize the impact of needles on corporal acupuncture points. Effects combine with craniopuncture homolateral. In the course of 10 treatments. Within the first 5 treatments affect a second embodiment of the brake method. In the next 5 treatments affect a second embodiment of the excitation method.

The invention relates to medicine, namely, neurology, and can be used in the practice of the treatment of spastic Krivoshei (SC).

SC - idiopathic focal dystonia, in which the tonic and sudden involuntary movements of the neck muscles lead to periodic or constant deviation of the head and neck (A. J. Fox., 1989). Leading neurological syndrome in SC is characterized by distinct dynamics that is manifested in the phenomena of corrective gestures, inversions, rotations, remission, communication with the emotional and functional status, posture, locomotor stereotype (Orlova O. R., Moscow, 1989, "Clinical and physiological analysis of spastic Krivoshei", Diss. Kida. the honey. Sciences). In the pathogenesis of IC distinguish Central and peripheral run-sided organic lesions of the nigro-veins of the system and leads to changes in interhemispheric interaction and as a consequence, in violation of the functional state of nonspecific systems of the brain stem. Peripheral mechanisms represented by the asymmetry of the tone of the neck muscles.

There is a method of treatment of IC with acupuncture, described Tykocinski E. D. (fundamentals of acupuncture. - M.: Medicine, 1979), in which the impact is only on THE corporeal: Bai-Hui, Yes-GUI, Feng-Chi, kun-LUN and a local point in the field of hyperkinesis: Jian-Jin, Jian-Yu, FEI-Shu, Jian-waisha and point tonic and lullaby steps: zu-San-Li, qu Chi, show-San-Li, kao-Huang, xing-Jian, Le Tue, Hae-GU, treatment includes 14-16 procedures the time of exposure of the needle 30-40 minutes, This method has no effect on the Central mechanisms of pathogenesis, which is a disadvantage. The effectiveness of this technique by the author is not analyzed.

A prototype of the proposed method for the treatment of IC method of acupuncture is the technique of manual therapy and acupuncture, described Ivancheva, A. (Painful muscle seals (BMU). Ed. Kazan University, 1990) is a landmark treatment of patients with IC. Use THE corporeal in combination with auricular THE course consists of 10-12 procedures with follow-up treatment after 2-4 weeks to 3 months depending on the action is on the peripheral pathogenesis of, excluding the Central mechanism, which is a disadvantage. It is assumed phasing of treatment, i.e. the use of this technique RTI after adequate exposure of the Central mechanisms by the method of pharmacotherapy, which increases the duration of treatment (clinical effect with a good selection of adequate pharmacotherapy is manifested through 12-15 days from the start of treatment in terms of reducing tonic activity of the Central mechanisms). The use of this method of treatment is impractical with the ineffectiveness of pharmacotherapy. Acupuncture combined with techniques postisometric relaxation (PIR) and manual therapy in the full treatment for a long time (18-20 days, daily). Use the following TA: Tian-Ding, fu-Tu, Tian-Quan, Tian-Rong, Jian Wai Shu, Jian-Zhong-Shu, and others (Ivanchev, A. Painful muscle seals, Ed. Kazan University, 1990, S. 140-144) within 15-30 minutes a Positive effect is achieved within 25-35 days (50 days after start of treatment), during the year, the courses have to be repeated 3-4 times. However, 6 out of 38 patients were positive effects from the treatment, even after four courses of treatment, indicating the predominance in these cases, the Central mechanisms pathogenesi increase the effectiveness of treatment of IC.

The problem is solved simultaneous effects on the Central and peripheral mechanisms of pathogenesis of IC through a combination of craniopuncture impact on THE corporeal and painful muscle seals (BMU) in the concerned muscles.

The method is as follows.

The patient analyze the clinical picture of IC (Orlova O. R. Clinical and physiological analysis of spastic Krivoshei, Diss. on saisc.the degree of Cand. the honey. Sciences. Moscow 1989), the severity of dystonia on scales (N. Masur Extrapyramidal-motorische syndrome. 1995), rotation, dynamic hyperkinesias, tone and texture of the muscles of the neck, the diameter of m. sternocleidomastoideus from two sides. Treatment includes 10 sessions daily, with a break after the fifth procedure for 2 days. Use a combination of the second brake option and the second option of the exciting methods (Tareeva D. M., 1980). The time of exposure of the needle 5-30 minutes

The first 5 procedures include the impact on THE corporeal from one side of the body for 10-30 min a second embodiment of the brake method: Feng-Chi, WAN-su, Tien-Yu, Tian-Zhu, Xia, Liang, Wen-Liu, Tian-Jun, and 3rd treatments sachetana, homolateral with craniotomy 3 (Klimenko, L. M. Acupuncture points specific zones of influence. - M.: Prometheus, 1990).

Points are used restorative actions symmetrically from two sides for 5-10 min (he-GU, zu-San-Li, Le-Tue, Yang Ling Quan) (Pichel J. C., Shapiro, M. I., Shapiro, I. I. Anatomic-clinical Atlas of acupuncture) 4 times for the course in any order.

For each procedure by palpation examine the tone and texture of the neck muscles (m. trapezius m.splenius, m.sternocleido - mastoideus, m.levator scapulae and others ). If there BMU, pain produce puncture this area for 20 minutes

Use is selected based on the results of pulse diagnosis (szewczyk, S. N. Suji shopping street-Chimsur acupuncture points of wrists, 1993; Gabaa luvsan, Traditional and modern aspects of Eastern reflexology, M.: Nauka, 1992, S. 211-226) individual in each case.

Influence carry out regular acupuncture needles, to enhance the effect, it is recommended to use gold and silver needle.

Example 1. Patient H., 39, janitor by trade.

Diagnosis: the focal form of muscular dystonia, spastic torticollis. The duration of disease 10 months. The pose of the head: turn to the right at a 90 degree angle, tilt to the right shoulder A muscles : m. sternocleidomastoideus sinistra, m.splenius dextra, m.trapezius dextra, m.levator scapulae dextra. Palpation was determined BMU in m.trapezius dextra, m.splenius dextra. The intensity of pain according to the visual analogue scale (VAS) was 8 points (max = 10 points). The diameter of participating in the rotation of the sternocleidomastoid muscle 4.5cm, opposite 2 see Noted the impossibility of willpower to keep his head upright. When paraclinical examination of data on focal brain lesion no.

By the above method conducted 10 sessions of acupuncture daily with a break after the fifth procedure for 2 days.

In the first 5 treatments effect on one side of the body a second embodiment of the brake method for 20 min TA: Feng-Chi, WAN-su, Tien-Yu, Tian-Zhu, Xia, Liang, and 3rd treatments sachetana, homolateral with craniotomy 3.

The next 5 procedures included the impact on the other side of the body the second excitation method for 5 min in the same ONE, but with the third homolateral with craniotomy 3.

During the first, third, seventh, ninth procedures of puncturevine bracing THE symmetrically within 10 min and BMU in m.trapezius m.splenius second option irritant effect.

According to the results of pooling the min, the second option irritant effect.

Clinical improvement has been demonstrated for 3 procedure as reduction of pain intensity up to 3 points on 6-8 procedure in the form of lower tone participating in the sternocleidomastoid muscle, the decrease in the degree of rotation and tilt up to 5-10 degrees. The opportunity arose willpower to keep his head upright.

After treatment the severity of dystonia in the points made by Tsui 3 points, Fahn 8 points, social activity was 95%, diameter participating in the rotation of the sternocleidomastoid muscle was 3 see the Position of the head: slight rotation to the right at an angle of 5-10 degrees, which does not limit physical activity, the patient started to work.

Example 2. Patient S., 17 years old, student.

Diagnosis: the focal form of muscular dystonia, spastic torticollis. Disease duration of 2 years. The pose of the head: rotation to the left by 5 degrees, muscular-tonic and myofascial syndrome in m.trapezius on both sides, the asymmetry of tone m.sternocleidomastoudeus with a predominance of right, the diameter of the sternocleidomastoid muscle on the right 2.5 cm, left-2 cm, the Intensity of the pain in YOUR=9 points. The severity of dystonia in points by Tsui 5 points, Fahn 15 points, social activity is 95%. When steam is todoke conducted 10 sessions of acupuncture in the same sequence.

In the first 5 treatments the impact of a second embodiment of the brake method for 30 min at TA: Feng-Chi, Tien-Yu, Tian-Zhu, WAN-GU, Wen-Liu, Xia-lien, and 3rd treatments sachetana, homolateral with craniotomy 3.

The next 5 treatments included exposure to second exciting method over 6 minutes and the same with THE other side of the body and, starting with the 3rd procedure sachetana, homolateral with craniotomy 3.

During 2, 4, 8, 9 procedures were puncticollis BMU in m.trapezius m.levator scapulae, and THE Tien-Chi, San-Yin-Jiao, Li GOU within 10 min (according to the results of pulse diagnosis) the second option irritant effect.

It should be noted that the procedure is not carried out during menstruation.

After treatment, the severity of dystonia in the points made by Tsui = 3 points, Fahn = 2 points, social activity was 100%.

Pain in the neck muscles began to appear sporadically, the intensity of the pain in YOUR amounted to 1-2 points. To detect the rotation was not possible. The tone of the sternocleidomastoid muscle without asymmetry, the diameter was 2 see

Example 3. Patient B., aged 47, engineer.

Diagnosis: the focal form of muscular dystonia, spastic torticollis. Disease duration of 12 months. Pose groviaioai failed. The severity of dystonia in points by Tsui 19 points, Fahn 42 points, social activity was 25%. Tense muscles: m.trspezius S>D, m.splenius, m.sternocleidomastoideus sinistra. Palpation was determined BMU in these muscles, the diameter of m.sternocleidomastoideus left 4 cm, right 3 see the pain on YOUR totaled 6 points. When clinical examination data for focal brain lesion no.

By the above method conducted 10 sessions of acupuncture in the same sequence, the same ONE for 10 minutes (in the first 5 procedures a second embodiment of the braking effect) and within 5 min (in the next 5 treatments the second stimulating effect), was used symmetric craniotomy 3 3 through 5 and 8 through 10 of the procedure.

During 3, 7, 9, 10 treatments were puncticollis symmetrically THE restorative action of a second embodiment of the irritant effect for 5 min, and xing-Jian, Zhi-bian, kun-LUN (on the results of pulse diagnosis) within 30 minutes

5 procedure began to show positive results in reduction in tone in m.sternocleidomastoideus sinistra, its diameter was 3.2 cm, gone pain (VAS=0). Back tilt angle decreased to 15 degrees to 10 procedure. The severity of dystonia was on Tsu treatment effect was observed lasting improvement in subjective and objective condition of all patients at 30-80% from baseline.

If this were eliminated such characteristic of patients with complaints, as the presence of pain, the inability to hold head upright, rarely had to use corrective gestures (QL - special techniques to reduce Krivoshei), significantly improved mood and social adaptation of patients.

In some cases, it was able to reduce the dose previously long-term medication (trihexyphenidyl, baclofen, clonazepam), which significantly reduces the severity of side effects.

Thus, the proposed method of acupuncture using craniopuncture effective for all types of IC is available, does not cause side effects, at the same time affects the Central and peripheral mechanisms of pathogenesis that leads to sustained improvement.

The use of the proposed method in medical practice can reduce treatment time and reduce the dose previously long-accepted pharmacological preparations, to increase the efficiency of treatment of patients with spastic Krivoshey.

This method can be used in some cases as the primary, and in combination with other methods as a landmark comprehensive treatment.

The method of treatment with the different themes, the impacts on the corporeal acupuncture points combined with craniopuncture, and influence carry out a course of 10 treatments, daily, with a break after 5 procedur for 2 days, the first 5 procedures exposure is carried out for 10 to 30 minutes a second embodiment of the braking method with one side of the body corporeal acupuncture points, and starting with 3 treatments sachetana, homolateral with craniopuncture, in the next 5 procedures are conducted in effect for 5 - 10 min a second embodiment of the excitation method from the other side of the body corporeal acupuncture points, and starting with 3 treatments, sachetana, homolateral with craniopuncture.

 

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