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.
SUBSTANCE: method involves carrying out intraoperative neural motor evoked potential monitoring. Spinal nerve stimulation is carried out with rectangular pulses of 0.2 ms duration, frequency of 4.1 Hz, intensity of 10-25 mA and distance between electrodes equal to 4 mm. Neural motor evoked potentials are recorded in popliteal space in sciatic nerve projection area. Peak No 1 latent period being longer than 21 ms, pulse conduction dysfunction is diagnosed in spinal nerve motor fibers.
EFFECT: high accuracy of diagnosis.
5 dwg, 3 tbl
SUBSTANCE: method involves carrying out acoustic monoaural stimulation with frequency of 8-12 Hz and recording cerebral auditory evoked stem potentials. Changes are detected when comparing to reference value in norm. No significant changes in cerebral auditory evoked stem potentials being found, additional stimulation is carried out with frequency of 30-100 Hz. Auditory evoked stem potentials are recorded. Significant changes being found when compared to norm, functional brainstem disorders are diagnosed.
EFFECT: high accuracy of early stage diagnosis.
FIELD: medicine, neurosurgery, neurology.
SUBSTANCE: one should study wink reflex to detect the lesion of oral departments in tegmentum of brain stem bridge and caudal departments of brain stem being counterlateral against vestibular schwannoma, moreover, it is necessary to study stem induced potentials. By the data obtained one should determine diagnostic coefficient that characterizes the degree of ischemic lesion of brain stem by the following formula: I=4.47+2.08φ1-2.18φ2-2.43α1+2.26α3+0.53α5, where φ1, φ2- patient's values at lesions of caudal departments of brain stem and oral departments of tegmentum of brain stem bridge are accepted to be equal to 1, and in case of no lesion - to -1; α1, α3, α5 - the values of latent periods I, III, V in peaks of acoustic stem induced potentials are accepted to be equal to -1 in case of correspondence to standard; and at any deviation against the standard - equal to 1 and at obtaining I=5±0.5 one should diagnose high-degree ischemic lesion of brain stem, at values of I=1±0.2 - average-degree ischemic lesion of brain stem; at I=0.5±0.1 - light-degree brain stem ischemia, at negative I values ischemic lesion of brain stem is inconsiderable. The innovation enables to increase significance of diagnostics due to combined analysis of factors that characterize ischemic lesion of brain stem.
EFFECT: higher accuracy of diagnostics.
SUBSTANCE: method involves carrying out electroencephalography and cognitive evoked potentials examination on showing binaural acoustic stimulation with 50 ms long pulses which intensity is of 80 dB with 2 s long pauses between stimuli, significant tone frequency equal to 2000 Hz, insignificant one equal to 1000 Hz when shown in pseudo random order. Three series of averaging are recorded with significant tone being repeated 26 times in each of them. The testee counts the significant tones in mind within the second and third series. N2, P3 peak latency and P3 peak amplitude are determined in the first (A1) and in the second (A2) averaging series. Habituation is calculated as A2/A1*100 and A coefficient as ratio of habituation P3 peak amplitude and P3 amplitude of the first averaging series. P3 peak latency being increased when compared to normal reference value in combination with dominated slow electroencephalography activity, severe uremic encephalopathy is to be diagnosed. Habituation P3 peak amplitude growing higher than 100%, P3 peak latency being normal and A coefficient not exceeding 12.31% mcV in combination with electroencephalogram beta-rhythm dominated by frequency below 25 Hz spread allover the whole convex with distinct rhythm mastering response to rhythmic photostimulation in broad frequency bandwidth taking place, mild uremic encephalopathy severity degree is to be diagnosed. Coefficient A value exceeding 12.31% mcV, P3 peak latency being normal in combination with high distant oscillation synchronization, low frequency alpha-rhythm being recorded, zonal amplitude differences being smoothed and theta-waves outbursts being available in frontal central leads, moderate uremic encephalopathy severity degree is to be diagnosed.
EFFECT: high diagnosis reliability.
2 cl, 8 tbl
FIELD: medicine, resuscitation.
SUBSTANCE: intensive therapy should be carried out, moreover, it is necessary to register somatosensor evoked potentials (SSEP), measure inter-peak interval N13-N18 at spinal lesions at C1-C2 level, N11-N13 at lesion at C1-C6 level and N22-C30 at lesions at C7-L3 level. Then one should calculate average arterial pressure (APav) and prescribe pressure-regulating medicinal preparations. Then comes control SSEP registration and at decreased values of inter-peak intervals one should change the preparation applied and its dosage, at constant level of inter-peak intervals - the dosage should be increased, and at increased values of intervals - one should intensify therapy due to increasing the dosage or substituting the preparation applied. SSEP values should be evaluated after changing the dosage of the preparation applied and in dynamics of investigation on the 3d, 5th and 9th d and, also, in case of deterioration of patient's health state. It has been provided due to applying a high-sensitive value that reflects the state of spinal cord.
EFFECT: higher efficiency of prophylaxis.
FIELD: medicine, anesthesiology, neurosurgery.
SUBSTANCE: at resecting a basal meningioma due to applying Nd-YAG-laser of 45-55 W power one should register acoustic stem evoked potentials at the stage of operation after premedication and at the stage of meningioma's resection. At altering amplitude-temporal parameters of their components at the stage of resection against the stage of premedication in combination with bradycardia being 48-52 strokes per min for 15 min with tendency to hypertension one should predict unfavourable result of operation. The method widens the number of ways for predicting the result of operation in case of removing cerebral basal tumors.
EFFECT: higher accuracy of prediction.