Method for the diagnosis of lesions of the facial nerve, cortical - nuclear path of the facial nerve and the first branch of the trigeminal nerve

 

(57) Abstract:

The invention relates to medicine, namely, neurology, and can be used in the diagnosis of lesions, dynamic monitoring of treatment effectiveness, expert assessment of disability and prognosis. Register components of the blink reflex, obtained by electric stimulation of the superciliary region and magnetic stimulation of motor cortex in the brains analyze the latency of the first component. With increasing latency the first component of the blink reflex during magnetic stimulation over an 18.4 MS and electric stimulation 15.2 MS diagnosed peripheral lesion of the facial nerve, when indicators of latency the first component of the blink reflex when electric stimulation (13,71,1) MS, and magnetic stimulation 19.9 MS diagnosed the lesion cortical-nuclear path of the facial nerve, while the performance of the latency of the first component of the blink reflex during magnetic stimulation (16,10,7) MS, and electric stimulation more than 15.3 MS diagnosed defeat the first branch of the trigeminal nerve. The method allows for the differential diagnosis of the disease and to raise it is Vano in the diagnosis of lesions of the actual facial nerve, cortical-nuclear path of the facial nerve and the first branch of the trigeminal nerve.

There is a method of assessment blink reflex in electroneuromyography using electrical stimulation (Badalyan L. O., I. Skvortsov A. Clinical electromyoneurography. -M. : Medicine, 1986. -S. 64-66., Zenkov L. R., Ronkin, M. A. Functional diagnosis of nervous diseases. -M.: Medicine, 1991. -N-579-580).

The disadvantage of this method is the lack of a selective approach to the assessment of afferent and efferent part of the blink reflex arc and the inability differential diagnosis of lesions of the facial nerve, cortical-nuclear path of the facial nerve and the defeat of the first branch of the trigeminal nerve.

The closest to the achieved result (prototype) is a method for the diagnosis of lesions of the trigeminal nerve, including the recording and analysis of somatosensory evoked potentials (ERPs) healthy and diseased hand, when the purpose of determining the level of destruction evoked potentials recorded on the stimulation of output I, II and III branches of the trigeminal nerve, analyze the components of the range 309 milliseconds (MS) and by reducing their amplitude by more than 15% in the response of one of the branches diagnose extratime of this method are the inability differential diagnosis of lesions of the facial nerve, cortical-nuclear path of the facial nerve and the defeat of the first branch of the trigeminal nerve. In addition, ERPs recorded with needle electrodes, i.e. invasive method for analysis of components using a large number of implementations (128-256), the intensity of each of which corresponds to 1.5-3 rapids initial feelings on the healthy side of the face, resulting in a longer research time.

The result of the claimed invention is the establishment of a lesion of the facial nerve, cortical-nuclear path of the facial nerve, the first branch trouncing nerve, establishing a dynamic control over the outcomes of the expert assessment of disability and prognosis.

A positive result of the claimed invention is achieved by the fact that in order to establish the location of the lesion in addition to providing electric stimulation of the superciliary region additionally produce magnetic stimulation of motor cortex and with increasing latency the first component of the blink reflex (PMCR) when magnetic stimulation over 18.4 MS and electric stimulation over 15.2 MS diagnosed peripheral lesion of the facial nerve on Stour the stimulation of more than 19.9 MS diagnosed the lesion cortical-nuclear path of the facial nerve. when indicators of latency PCMR when magnetic stimulation (16.1 0.7) MS, and electric stimulation more than 15.3 MS diagnosed defeat the first branch of the trigeminal nerve on the side of increasing latency.

The method is as follows.

The blink reflex study carried out in two stages: initially get blink reflex by electrical stimulation in the superciliary region, followed by magnetic stimulation of motor cortex. The recording electrodes for each side set in the same points for both types of stimulation. In Fig. 1 shows the General scheme of the blink reflex studies using complex equipment, including magnetic stimulator (1), for example MAGSTIM 200 Magstim company (England), electromyograph (EMG) (2), for example SAPPHIRE PREMIERE company Medelec (England). In addition, marked: the magnetic coil (3), the output of cutaneous biopolar electrode electromyography (4), surface ground electrode (5), mounted on the patient's skin in the wrist area, diverging electrodes (6), the potential difference which is applied to the input of the amplifier EMG.

Magnetic stimulator 1 is used in combination with 2 EMG. This requires semesan in time with the beginning of the scan EMG 2. Synchronization is achieved by connecting the trigger output (located on the rear panel of the magnetic stimulator 1) to the trigger input 2 EMG. Magnetic stimulator 1 generates the trigger signals of positive or negative polarity, pulse duration of 50 MS or 50 MS.

During the examination the patient should be in a relaxed waking state. To obtain the components of the blink reflex (Fig. 2) using electrical stimulation applied bipolar cutaneous electrode 7, which represent the two felt wick diameter 5-8 mm, mounted in a metal cage, enclosed in a plastic holder at a distance of 15 mm, moistened with isotonic sodium chloride. Skin irritation is applied in the superciliary region (1 branch of the trigeminal nerve) symmetrically on both sides of the face. Serves rectangular current pulses, following in the correct rhythm with a repetition rate of 2-3 CPS, duration 0.1 MS, current - 15 - 25 mA at sensitivity 100 mV. Era of the early components of the received response with electric and magnetic stimulation is 10-50 MS.

Registering shashechnye electrodes 8, filled with electrode gel, placed on the kr ptx2">

In response to electrolytic irritation there are two reflex response. The first one has a constant latent period (see tab. 1).

Then the patient applied magnetic stimulation in the area of the motor cortex using an induction coil, for example high-power coil 90 mm, with the following characteristics of the magnetic field: surface coil 2.0 Tesla (T)max.at a distance of 1 m from the coil 0.2 MTmax. Switching characteristics: rise time 100 μs, the duration is 1 MS.

The power level of the output signal is visualized on the display magnetic stimulator in percent (%) of the maximum possible. After turning on the device in the network display shows 30% of the output power. The regulator magnetic stimulator is used to change the output power, which constitutes 30% of maximum until a response is received. To obtain the blink reflex enough magnetic pulse 40 - 60% of maximum power output.

In Fig. 3 given the design of the study blink reflex irritation of the motor cortex. Efferent part of the blink reflex, obtained by electrical stimulation, is a common and blink reflex, emulatie (the first branch of the trigeminal nerve) (ST segment) and cortical-nuclear path of the facial nerve during magnetic stimulation (AB) are different in the two types of stimulation.

In response to stimulation of the motor cortex arise as electric stimulation, two reflex response. The first one has a constant latent period table. 2.

With the defeat of the facial nerve was observed the increase of latency PCMR received electric and magnetic stimulation to (16.1 0.9) MS (15.2 - 1.0 MS) and (18.8 0.4) MS (18.4 - 19.2 MS), respectively. Therefore, when increasing the latency PCMR when electrical stimulation over 15.2 and magnetic stimulation over 18.4 MS diagnose a lesion of the facial nerve on the side of increasing the latency table. 3.

With the defeat of cortical-nuclear path of the facial nerve was observed the increase of latency PCMR only when magnetic stimulation before (31.2 11.3) MS (19.9 - 42.5 MS). Therefore, when the indicators of latency PCMR caused by magnetic stimulation over 19.9 m on the background of the satisfactory performance of latency PCMR caused by electric stimulation (13.7 1.1 MS), diagnose the lesion cortical-nuclear path of the facial nerve table. 3.

With the defeat of the first branch of the trigeminal nerve registering an increase of latency PCMR received electric stimulation to (19.3 4.0) MS (15.3 - 23.3 MS) on the background of satisfactory values latency PCMR, Polo encourage more 145.3 MS on the background of satisfactory latency PCMR when magnetic stimulation diagnosed the lesion of the nerve branch of the trigeminal nerve on the side of increasing the latency table.3.

Clinical examples (see following text).

Example 1. Patient S. 38 years. The history N 23. Directed with a diagnosis of a lesion of the right facial nerve.

Caused skin irritation in the symmetric parts of the face in the superciliary region, then held by magnetic stimulation of the motor cortex according to the described method.

Analysis of latency of the responses received showed that electric and magnetic stimulation increased latency PCMR right respectively 19.6% (16.5 MS) and 18.1% (18.9 MS). In this case, diagnosed the lesion of the right facial nerve (see tab. 4).

Example 2. Patient N. 41. The history N 245. Directed with a diagnosis of multiple sclerosis to clarify the involvement in the pathological process of the facial nerve.

Caused skin irritation in the symmetric parts of the face (brow area), then held by magnetic stimulation of the motor cortex according to the described method.

The analysis of the components of the blink reflex showed that magnetic stimulation increased latency PCMR right to 98.8% (31.8 MS), left - 9.8% (18.0 MS). In this case, diagnose the lesion cortical-nuclear path of the right facial nerve priemyselna diagnosed with neuropathy of the trigeminal and facial nerve on the left.

Caused skin irritation in the symmetric parts of the face in the superciliary region and magnetic stimulation of the motor cortex according to the described method.

The analysis of the components of the blink reflex showed that electrical stimulation increased latency PCMR left by 59.6% (21.7 MS). This latency PCMR electrical stimulation to the right and latency PCMR magnetic stimulation satisfactory. In this case, diagnose the defeat of the first branch of the trigeminal nerve on the left (see tab.6).

For the first time by the claimed method it is possible to delineate the lesion of the facial nerve, cortical-yadernogo path of the facial nerve and the first branch of the trigeminal nerve, which provides a correct and accurate diagnosis and allows you to choose differential treatment for patients with this pathology.

First it is shown that the blink reflex can be called not only by the electrical stimulation of the superciliary region, and magnetic stimulation of the motor cortex.

The inventive method can be used in neurological hospitals, rehabilitation and aftercare, specialized units (e.g., neurophysiological laboratory) the VI of the trigeminal nerve, demyelination diseases of the nervous system.

The method is easy to use and saves time neurophysiological studies.

Method for the diagnosis of lesions of the facial nerve, cortical-nuclear path of the facial nerve and the first branch of the trigeminal nerve, including the blink reflex study by electric stimulation, characterized in that it further register blink reflex during magnetic stimulation of motor cortex and with increasing latency the first component of the blink reflex during magnetic stimulation over an 18.4 MS and electric stimulation 15.2 MS diagnosed peripheral lesion of the facial nerve; when indicators of latency the first component of the blink reflex when electric stimulation (13,7 1,1) MS, and magnetic stimulation 19.9 MS diagnosed the lesion cortical-nuclear path of the facial nerve. when indicators latency of the first component of the blink reflex during magnetic stimulation (16,1 0,7) MS, and electric stimulation more than 15.3 MS diagnosed defeat the first branch of the trigeminal nerve.

 

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3 ex

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