The method of diagnostics of the functional state of the afferent pathways of the spinal cord

 

(57) Abstract:

Relates to medicine, namely, neurology, and can be used in the diagnosis of lesions of the afferent systems of the spinal cord, dynamic monitoring of treatment effectiveness, expert assessment of disability and prognosis. Perform magnetic stimulation of the spine at two points and record the blink reflex. Calculate the speed of propagation of an excitation between these points. When lowering the speed to 42,11 9.9 m/s diagnose violation of the functional state of the afferent pathways of the spinal cord demilitarised type on the side of the speed reduction. The method allows to set the localization of lesions. 3 Il., table 2.

The invention relates to medicine, namely, neurology, and can be used in the diagnosis of lesions of the afferent systems of the spinal cord, for example, in patients with multiple sclerosis.

There is a method of evaluation of the functional status of the pyramidal tract through stimulation of Central and peripheral nervous system magnetic field of high power (A. T. Barker et al. // Lancet. - 1985. - Vol.l. - P. 1106-1107).

The disadvantage of this method is the lack of and the achieved result (prototype) is a method of diagnosis of the functional state of the afferent systems of the spinal cord, performed by sequential electrical stimulation of the rectangular pulses (0.5 MS, 100 - 300 V) of the radial nerve at the wrist and peroneal in the popliteal fossa with simultaneous recording electromyography blink reflex. The speed of propagation of excitation was calculated by dividing the distance between the spinous processes of D12-C7 vertebrae on the difference of latent periods evoked potentials in the circular muscle of the eye (Judelson Y. B. About method invocations, and the clinical value of EMG blink reflex. In the book: Vascular diseases of the nervous system. New methods of diagnosis in neurology. Smolensk, 1980, S. 133-135).

The disadvantages of this method are the large power (100-300 C) and duration (0.5 MS) electrical stimulation. Significant destruction of places of stimulation from the site of the spinal cord, which determine the velocity of propagation of excitation, leads to errors in determining the speed. The main advantage of magnetic stimulation compared with electrical stimulation is easy and painless impacts on deep-lying and therefore inaccessible by other means of the nerves. In addition, there is no damage to the skin, and Nakane lesion afferent systems of the spinal cord, in particular sadashivaiah a multimodal system, establishing a dynamic control over the outcomes of the expert assessment of disability and prognosis.

A positive result of the invention is achieved by the fact that in order to establish the location of the lesion produce magnetic stimulation (MS) of the spinal cord in the region of the vertebrae CVI-CVII and LII-LIV (see tab. 1) determine the velocity of propagation of the excitation ratio of the distance between the center of the coil during stimulation at two points to the difference of latent period of the late component of the blink reflex and by reducing the velocity of propagation of excitation in this section to 42.1 9.9 m/s diagnosed with impaired conduction of excitation along the afferent pathways of the spinal cord demyelinating type on the side of the speed reduction.

The method is as follows.

Alternately stimulate the spinal cord and simultaneously record electromyography of the blink reflex. The blink reflex study carried out in two stages: initially get blink reflex in MS spinal cord in the region of the vertebrae CVI - CVII, followed by MS spinal cord in the region of the vertebrae CLASS="ptx2">

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 surface of the ground electrode 4 mounted on the patient's skin in the wrist area, the discharge electrode 5, the potential difference which is applied to the input of the amplifier EMG 2.

Magnetic stimulator 1 is used in combination with 2 EMG. For this purpose it is necessary to synchronize EMG 2 and magnetic stimulator 1 so that the pulse from the stimulator 1 is aligned 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 study, the patient must be in a relaxed waking state in the sitting position.

Registering shashechnye electrodes 6 (Fig. 2) filled v gel, have ndoh sides of the face.

The patient applied magnetic irritation in the spine by using the induction coil 3, for example high-power coil 90 mm, with the following characteristics of the magnetic field: surface coil of 2.0 Tesla (T) max, at a distance of 1 m from the coil of 0.2 MT max. 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 1 percentage (%) 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 spinal cord. The rate of spread of excitation along the afferent pathways of the spinal cord in healthy and patients with multiple sclerosis are presented in table. 2. Patients with a diagnosis of multiple sclerosis was detected a significant reduction of the velocity of propagation of excitation. Therefore, by reducing the velocity of the pits of the spinal cord demyelinating type on the side of the speed reduction.

Example. Patient S. 49 years. The history N 137248. Directed with a diagnosis of multiple sclerosis. The clinic was dominated by sensory and motor disturbances from the side extremities, retro-bulbar optic neuritis.

Conducted magnetic stimulation of the spine at the stated procedure. Received marked reduction in the velocity of propagation of excitation along the afferent pathways of the spinal cord on the right 76.6%, left by 63.9% (in comparison with the arithmetic mean healthy). In this case, diagnose demyelinizing defeat the afferent pathways of the spinal cord (table. 1).

For the first time by the claimed method it is possible to delineate the lesion of the afferent and efferent (pyramidal) tracts of the spinal cord that ensures proper and accurate diagnosis and allows you to choose differential treatment for patients with this pathology.

The method enables to estimate the degree of the damage, to monitor the effectiveness of treatment, to form an objective idea about the prognosis of the disease.

The inventive method can be used in neurological hospitals, rehabilitation and aftercare, specialissima diseases of the nervous system.

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

The method of diagnostics of the functional state of the afferent pathways of the spinal cord, including the blink reflex study, characterized in that, to establish the location of the lesion, register blink reflex during magnetic stimulation of the spine at two points and by reducing the velocity of propagation of excitation in this area to 42,19,9 m/s diagnosed with impaired conduction of excitation along the afferent pathways of the spinal cord demyelinizing type on the side of the speed reduction.

 

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3 ex

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