A method of treating acute infectious diseases of the peripheral nervous system

 

(57) Abstract:

The method relates to medicine, namely to the treatment of acute CNS, and for the treatment of acute infectious diseases of the peripheral nervous system in children. To do this, hold the complex therapy. Additionally, depending on the form of the disease, duration of disease and severity is assigned instenon. In severe generalized and ascending forms of diphtheria polyneuropathy (DPNP) and polyradiculoneuritis (EOP) at the beginning of the disease the drug is administered in/drip from 1 to 2.0 ml of 1 time per day depending on age, for 5-10 days, followed by oral administration in doses of from 1/3 to 1 tablet 3 times a day for 2-6 weeks depending on the severity of neurological symptomatic. In neuritis of the facial nerve (NLN), polio (PM) and medium-heavy for DPNP and REC instenon in the acute period is entered in/m from 1 to 2.0 ml up to 5-10 times with a further oral administration in the period of restitution and recovery within 2-6 weeks. When polimaltozny diseases (TEP) and light during NLN, DPNP, REC - from the first days of the disease the drug is administered orally for 2-4 weeks in combination with electrophoresis instenon area parolee to accelerate the relief of musculoskeletal disorders and to improve the outcome.

The invention relates to the field of treatment of acute CNS, and in particular to methods of treatment OSPS in children, and can be used in clinical practice.

The relevance of the study ESPNS due to the increase of their frequency with 14% (1987 - 1991 ) to 30% (from 1992 to 1996) in recent years, due to epidemics of diphtheria, tick-borne and enteroviral infections (C. C. Ivanov et al., 1995; I. E. Korenberg, 1996; I. N. Martynenko, 1996).

OSPS include nosologically self infectious diseases such as polio (PM), poliomyelomalacia disease (TEP), polyneuropathy (PNP), polyradiculoneuritis (NRN), neuritis, which is caused by polititicheskiy lesions within a peripheral neurons, however, the unifying principle is the peripheral level of the CNS. Low awareness of clinicians about OSPS, late diagnosis and inadequate treatment leads to a prolonged, and in some cases lifelong disability as in PM), and often lethal outcomes (mortality in critically ill acute lesions PNS is 11.3% according to Popova L. M. , 1994).

Therefore, taking into account new knowledge about the pathogenesis of infectious diseases the I treatment of neurological disorders infectious Genesis is extremely necessary and timely.

In the light of modern knowledge OSPS should not be seen as a local lesion of peripheral nerves infectious agent, and as polycythemia disease of the nervous system, cerebral hemodynamics, and hence neurometabolism Central and peripheral areas, and in the acute period of neurons, mainly suffer from edema and ischemic disorders, relief which prevents further damage to the nerves that served as the basis for the application of instenon when ESPNS.

Instenon - vasoactive neurometabolic, combined preparation containing 3 active agent: geksobendin, etamivan, etofylline. Geksobendin - improves metabolism in the tissue of the brain and spinal cord, increasing their blood supply. Etamivan - regulates cerebral blood flow, and stimulates all cortical and autonomic functions. Etofillin - has a positive inotropic effect on the heart, causes the bronchi with bronchospasm and increases diuresis.

In the literature of recent years indicates high efficiency of application of instenon in acute violation of cerebral circulation, terminal States, encephalopathy R is="ptx2">

Known methods of treatment OSPS in children include the assignment in the acute period of the disease, antihistamines, salicylates, Dibazol, corticosteroids, and in the phase of stabilization and restitution - anticholinesterase agents, vitamins of group B, biogenic stimulators, in combination with complementary therapies (FT, exercise therapy, massage) (a Guide for physicians "Acute neuroinfections in children. - edited by A. P. Zinchenko, L., "Honey.", - 1986, - S. 230 - 233).

However, the above standard basic therapy does not take into account the form and severity of the disease, the pathogenic mechanisms of acute neurological disorders in ESPNS.

Closest to the proposed invention is a method of treatment of the affected peripheral nerves depending on the form of the disease (prototype Y. Y. Abelanski "Diseases of the peripheral nervous system. - A guide for physicians, M., 1989. - S. 248 - 267).

In the specified method in the Arsenal of therapeutic agents include drug therapy using different routes of administration; orally, parenterally, by using physiotherapeutic procedures, neuritis recommended I/m injection of hydrocortisone in combination with local its introduction by electropo the purpose dehydrating means and vitamins. When Poland as infectious, infectious-allergic and toxic, courses of treatment with injections of ATP, vitamins of the B complex, angioprotectors, such as complain, nikoshpana, nikoverin. In the period of rehabilitation is used electrophoresis Dimedrol, platifillina, ultrasound in pulsed mode.

However, the disadvantage of this method is that almost all medications (3 to 5) in the acute period of the disease entered/m without taking into account the severity and child day receives up to 3 to 5 injections; and we know that/m injection, in addition to the stress factor, further prolonging the disease, increase the risk of paralysis: paralysis, primarily affects the limb, which is in/m injection. In addition, the authors point to the importance of this method of treatment is corticosteroids, and long-term use of them leads to immunosuppressive state and the formation of a protracted and sometimes chronic. The purpose of the above vascular drugs leads, on the one hand, to the improvement of microcirculation, and on the other, given their mechanism of action, contributes to the difficulty of venous outflow (nikoverin, nikoshpana) that affects the regression neurology treatment ESPNS children by carrying out the treatment, characterized in that depending on the form of the disease, duration of disease and severity is assigned instenon: severe generalized and ascending forms and REC at the beginning of the disease the drug is administered in/drip slowly from 1 to 2.0 ml of 1 time per day (in physiological solution or 5% glucose) depending on age, for 5 to 10 days followed by oral administration in doses of from 1/3 to 1 pill 3 times a day for 2 to 6 weeks depending on the severity of neurological symptoms; when NLM, PM and medium-heavy for DPNP and REC instenon in the acute period is entered in/m from 1 to 2.0 ml up to 5 - 10 times with a further oral administration in the period of restitution and recovery within 2 to 6 weeks; fire protection and lightweight for NLN, DPNP, REC - from the first days of the disease the drug is administered orally in 2 to 4 weeks in combination with electrophoresis instenon on the area affected segments with subsequent cottage in the convalescence period in the presence of residual phenomena.

In the specified way etiological factor is relevant only in the early stages of the disease, but in this initial period for full recovery of nerve functions already assigned to the drug (imism, on the vegetative and painful symptoms, to accelerate the regeneration of dead fibers, restoring their conductivity.

The inventive method of treatment can be demonstrated by the following examples.

Example 1.

Andrew A. , age 12, history N 1535. Diagnosis: infectious-allergic encephalomyelopathy, severe.

Ill 04.03.96. Appeared naturalnie effects: cough, runny nose. T to 37.4. Diagnosis: acute respiratory infections. With 04.03.96 on 11.03.96 were outpatients, treatment is symptomatic. 12.03.96 in 10 hours was noted weakness in the legs, numbness of hands and feet, nasalized speech speech and difficulty swallowing, and the same day, 17 hours in a very difficult position was hospitalized at the Institute of children's infections in the intensive care unit. The condition worsened, uploaded, restless, there was a growing weakness in the extremities, nasalized speech, appeared aphonia, dysphagia, difficulty swallowing water. Language paretic rejected right, limiting the mobility of the soft palate. Diplopia, paresis VI pairs with 2 sides, tetraparesis, more to the right, mainly in the distal hand to 1 point) and legs (up to 2 points), areflexia. "Chest excursion enough, but worse on the right, the tension of the abdominal wall is weakened abdominal reflexes on the x functions, the child was transferred 13.03.96 on a ventilator initiated the introduction of spirits at the rate of 15 mg/kg per day, hormones dose of 3 mg/kg of body weight, dopamine at a dose of 1.2 g/kg/min, held 5 sessions of plasmapheresis (13.03.96 - N 2, 15.03.96, 16.03.96, 19.03.96). On the background of therapy to 20.03.96 regained consciousness, began to swallow the food, trying to wiggle your toes, came the cough reflex. However, spontaneous breathing was absent, expressed paralysis of the arms and legs, vegetative symptoms, pain. 22.03.96 removed from a ventilator, hormones, zovirax, depmin cancelled and added to therapy instenon, which was introduced in/drip 2.0 ml per day in 100 ml of physiologic saline N 10. 25.03.96 marked a distinct regression of neurological symptoms: disappearance of strabismus, decreased hypersalivation, appeared sphenopalatine reflex, increased movement in her legs began to tighten his legs slightly to keep them), wiggling fingers. 26.03.96 pain disappeared, the language in the midline, there were attempts to eat on her own, had a voice. 29.03.96 - eat himself, swallows good, not poderjivaetsya, the soft palate is movable. 01.04.96 holds the legs in a bent position, increased muscle strength and feet to 4 points, began to raise their hands to the horizontal level, worse on the left. Continued introduction of instenon 1 pill 3 times a day. 10.04.96 - W fully, appeared tendon reflexes in the hands. The child was discharged home from the recovery, spent in hospital 46 hospital days.

Thus, the use of instenon in the treatment of polyradiculoneuritis contributes to a favorable course and improves their outcomes.

Example 2.

Patient Karina L., age 9, history N 3254. Diagnosis: Primary: combined diphtheria (throat, nose, throat), toxic II - III degree.

Companion: chronic pyelonephritis.

Complications: 1. Infection-toxic nephrosis.

2. Myocarditis early period.

3. Cranioleuca polyneuropathy.

Pain in acute 05.06.96, T to 39.6, sore throat, raids in the shed. The doctor did not cause, symptomatic treatment. 06.06.96 T to 38,6, swelling of the neck, difficulty swallowing, hoarseness. 07.06.96 raids increased, fever up to 39, aphonia and a girl in a very severe condition in 15 hours enrolled in the intensive care unit of NEEDY. Pronounced symptoms of intoxication, neck swelling until the middle of the clavicle with the transition back to back until the middle of the blades. In the mouth swelling of surrounding tissue, plaque on both tonsils dense, not detachable from the transfer to the cheeks, soft palate and uvula. Tachycardia to what tivolitryne serum diphtheria immunoglobulin, hormone at a dose of 5 mg/kg of body weight, held 2 sessions of hemosorption. However, in the ICU raids in the shed was growing and swelling increased and at 1 a.m. was observed respiratory disorders, in connection with which the child transferred on a ventilator again double-entered using anti-diphtheria serum, repeated sessions of hemosorption, is symptomatic and detoxification therapy. The condition is stabilized, clear consciousness and 11.06.96 girl removed from a ventilator and is breathing on their own. However 11.06.96 appear early complications such as myocarditis, nephrosis and craniovertebral polyneuropathy. Marked paresis of convergence and accommodation, reduced mobility of the soft palate and Palatine reflex when drinking poderjivaetsya, reflexes disappear from his hands. Hormones are canceled to therapy is added instenon 1 pill 3 times a day. 17.06.96 occasionally poderjivaetsya, deep reflexes of the hands and feet of moderate vividness, the accommodation is slightly reduced, the convergence in norm. 25.06.96 swallows well, not poderjivaetsya, accommodation with no specifics, no paresis, myocarditis significant improvement. 04.07.96 from the nervous system without pathology, from the heart without clinically characteristics and ECG signs the certificate is with recommendations to continue taking instenon for 2 weeks and subsequent attendance at the consultation appointment. Spent in hospital 27 hospital days.

This example suggests that, probably, diphtheria early appointment of instenon in sufficient doses, prevents the development of severe neurological complications, which speeds up the recovery of patients.

Example 3.

Patient Glory X, , 1 year, history N 3144. Diagnosis: Poliomielitnoj disease, flaccid paresis of the left leg on malicious.com type, enterovirus nature (seeding from the feces of ECHO - 20). Ill 22.05.96, 2 times pasty stool, the body temperature is 37.2. 26.05.96 vomiting 2 times, T in the norm. 27.03.96 appeared limp on the left leg, and in the evening did not get up on the leg. 28.05.96 entered the clinic of the CNS in the state of moderate severity, limping on the left leg, podvolakivaet it recorvery in the knee joint, rotating the first four foot outwards. Objectively draws attention paresis of the left leg with a decrease in muscle tone plastic and DINAMIChESKOE, more proximal extremities, high tendon reflexes in the legs S > D, expressed radicular syndrome, the diagnosis is not in doubt. The child was assigned diacarb and instenon 1/2 tablets 2 times a day and electrophoresis was performed on the lumbar region with instenon N 6. Due nasatelevision diseases. 03.06.96 being satisfactory, the pain disappeared, the child ceased to limp, continued entrelace S > D. 14.06.96 tendon reflexes moderate vividness S = D, continued slight decrease muscle tone in the left leg and the patient was discharged home from the recovery. Recommended to take instenon outpatient for 2 weeks and subsequent clinical examination, held in hospital 16 hospital days.

This observation, combined application of instenon promotes fast relief of musculoskeletal disorders, which prevents the development of persistent residual effects.

A comparative analysis of current OSPS in the group of children who are not treated (group I) and treated (group II) instenon, revealed a significant decrease (from 22.7 to 1.9 days. to 8.6 0,21 Nam. respectively) the duration of the autonomic and sensory (from 33.5 to 1.4 days. to 9.0 with 0.1 DN) violations, flaccid paresis (2,4 45 days. to 18.8 1,2 DN. respectively). The duration of hospital stay was reduced by almost 2 times (68,5 3,2 Nam. to 36.8 2,3-ordinator. respectively.

When studying the impact of instanton on the level and dynamics of diphtheria toxin in the composition of the CEC, TNF - a and IG a and E, it was found that its use leads to a significant reduction in cruie its products at, highly specific to diesel fuel and the elimination of the last of the organism, thereby providing a protective effect on the development of DPNP. The level of TNF - and IL E in the blood drops from 869 to 7.4 PG/ml and 126 to 9.1 PG/ml and with 253,8 9.4 g/l to 35.8 2.2 g/l, respectively, and therefore decrease their damaging effect on neurons. Increasing the concentration of IG in 2 times (from 1.15 to 0.2 to 1.9 0.3 g/l) in the first week of the disease leads to a reduction in the duration of the raids on the tonsils, and hence the total dose stimulate toxin that reduces the likelihood of developing neurological complications in the future.

When Doppler and thermal monitoring during therapy instenon found that by the end of the first week of treatment was observed recovery rate of peripheral blood flow and thermal performance, which demonstrates the positive impact of the drug on systemic hemodynamics.

The use of this method of treatment in the clinic of macroinverte NEEDY SPb has improved the course and outcomes of OSPS in children: the number of recovered without residual effects at discharge was 87% no comparison with 59% in the comparison group, the stay of patients in hospital is reduced on average by 10 to 32 days, that is.

The proposed method can be recommended and applied in infectious and neurological hospitals in the treatment of ESPNS children that will improve their outcomes and significantly shorten the stay of patients in hospital.

A method of treating acute infectious diseases of the peripheral nervous system (OSPS) in children by conducting comprehensive therapy, characterized in that depending on the form of the disease, duration of disease and severity is assigned instenon: severe generalized and ascending forms of diphtheria polyneuropathy (DPNP) and polyradiculoneuritis (EOP) at the beginning of the disease the drug is administered in/drip from 1 to 2.0 ml of 1 time per day depending on age, within 5 to 10 days followed by oral administration in doses of from 1/3 to 1 pill 3 times a day for 2 to 6 weeks depending on the severity of neurological symtomatic; neuritis of the facial nerve (NLP), polio (PM) and medium-heavy for DPNP and REC instenon in the acute period is entered in/m from 1 to 2.0 ml up to 5 - 10 times with a further oral administration in the period of restitution and recovery within 2 to 6 weeks; if polimaltozny diseases (TEP) and mild course, NLP, DPNP, REC - from the first days of Bo is the R segments with subsequent cottage in the convalescence period in the presence of residual phenomena.

 

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