A method of treating ischemic stroke brain

 

(57) Abstract:

The invention relates to neurology, neurosurgery, and is intended for the rehabilitation of patients with ischemic stroke in the early recovery period. Stimulation of the motor centers of the cerebral cortex provide a consistent impact first on the point motor area of the right hand, with the center of the magnetic coil is placed 3 cm to the left from the location of the electrode z, then the impact of exercise on the second point of the motor area of the left hand, with the placement of the center of the magnetic coil 3 cm to the right from the location of the electrode z and stimulation of these two points should be performed within 5 minutes of pulsed magnetic field value 1.5 to 3 Tesla, then impinges on the third point stimulation of the motor area of the lower limb with the placement of the center of the magnetic coil 4 cm frontline and 1 cm left from the location of the electrode z, and the fourth point stimulation of the motor area of the left lower extremity, with the center of the magnetic coil is placed 4 cm frontline and 1 cm to the right from the location of the electrode z and stimulation of these zones should be performed within 5 min of pulsed magnetic field of 2 to 4.5 Tesla. After stimulation dvigateli cervical thickening of the location of the center of the first coil over the spinous process of the C7 vertebra, and then the influence of the spinal lumbar thickening with the center of the coil over the spinous process of the L5 vertebra. The impact on the roots of the cervical thickening should be performed within 5 minutes of pulsed magnetic field of 1.5 - 3 Tesla, and the spinal lumbar thickening of the pulse magnetic field of 2 to 4.5 T for 5 minutes, then after a session of transcranial magnetic stimulation on the next day additionally carry out audiovisual stimulation (AVS) with a frequency of audiovisual signals between 8 Hz and smooth lifting up to 15 Hz and session duration 15 min, and in the presence of stimulation with 10 Hz with a gradual decrease to 5 Hz for 20 minutes. The course of treatment is 14 daily alternating sessions of transcranial magnetic stimulation and ABC. The threshold of stimulation for each patient at all points of stimulation is determined by increasing the stimulus intensity by 10%, since 30% of maximum power stimulation 5 T up to the point at which half of the stimuli causes of motor evoked potentials, and treatment is carried out subthreshold pulse, which is 10 - 20% below the threshold. The method reduces neurological deficits and to increase adaptive activity large. 2 C.p. f-crystals, 4 Il., table 4.

The invention relates to medicine, namely to capable of neurology, of neurosurgery.

Transcranial magnetic stimulation (TCMS) is used in neurology, however, its scope is limited primarily by the diagnosis of impaired conduction of the impulse through corticospinal tract. In our opinion, perhaps the use of transcranial magnetic stimulation as an auxiliary method of rehabilitation in the recovery period in patients with ischemic stroke. The magnetic field arising during the passage of current in the coil induces an electrical current in the brain and causes depolarization of neurons. The depth of penetration of the magnetic field with a maximum strength of stimulation 5 T, is 4-5 see TCMS has both excitatory and inhibitory effect on neurons of the brain. TCMS acts directly on the initial segment of the Central motor neuron and transsynaptically within the crust and outgoing calls volley of impulses acting on the motoneurons of the spinal cord with subsequent emergence of motor evoked potential. During random muscle contractions TCMS causes of motor evoked potential (IMP), and then the temporary suppression of muscle potentials period of silence (PM). PM occurs mainly due to synchronous C is CLASS="ptx2">

These effects of transcranial magnetic stimulation was crucial for selection as a secondary method of rehabilitation of patients with ischemic stroke in the recovery period. Repetitive magnetic stimulation is a noninvasive, painless and safe method to obtain the transient activation of the cortical substance of the person. During stimulation of motor areas of the hemisphere pulsed magnetic field can be activated not only the contralateral muscles, but also ipsilateral. Hemisphere of the brain unaffected by the disease process in ischemic infarcts of the brain is also involved in the management of ipsilateral muscles of the affected limbs. The correction mechanism of neurological deficit lies in the formation of the descending motor control pathways unaffected hemisphere over the activity of the ipsilateral motoneurons. Also shown activating effect of transcranial magnetic stimulation on the reticular formation and dopaminergic brain structures, which contributes to the activation of compensatory restoration processes in the Central nervous system.

There is a method of combined use of electrical stimulation of the median nerve and FMS structures of the posterior cranial fossa in patients with toensing evoked potentials for 15 min in combination with transcranial magnetic stimulation in the projection of the posterior cranial fossa with indusia magnetic field of 0.2 - 0,3 T (Imranov R. F., Masherov E. C., Ceneviva C. D., Y. Vorobyev Century Combined application of electrical stimulation of the median nerve and FMS structures of the posterior cranial fossa in patients in a vegetative state. - Modern aspects electroneurostimulation and new technologies in neurosurgery and neurology. Collection of scientific papers. - Saratov - 1998 - S. 41 - 42.).

The disadvantage of this method is that the stimulation is carried out in nefiziologichnoe frequency range, FMS structures of the posterior cranial fossa acts on the mid-stem structure and does not affect disrupted functional connectivity of the nidus.

There is also known a method of pulsed magnetic treatment of patients with spondylogenic diseases of the nervous system, including effects on the area affected segments of the spinal cord and along the projection of the nerve, formed from komprimierung spinal roots, in which exposure is carried out using a round coil with a diameter of 10 cm with a magnetic field of 1 T and a pulse repetition rate of 40 pulses/min and exposure duration 10 min (Nikitin centuries, Skoromets T. A., Shumilina A. P., Endelave S. M. , Tumanova, N., E. the genetic diseases of the nervous system // the vertebral neurology - 1998 - N 1 - N-66 - 69.).

The disadvantage of this method is that the electrical stimulation is conducted according to the standard, undifferentiated method, without individual selection effects on peripheral motoneurons and effects on the Central motoneuron.

1. Closest to the claimed method is complex restorative treatment of patients with organic lesions of the nervous system traumatic lesions of the brain and peripheral nervous system and spondylogenic diseases of the nervous system) - multi-level magnetic and electrical stimulation of the affected motor analyzer developed in the Russian research neurosurgical Institute. A. L. Polenov and clinic of nervous diseases and neurosurgery, St. Petersburg state medical University. I. P. Pavlova Tyszkiewicz So, and Nikitina C. C. (1997). The method provides transcranial magnetic stimulation of the affected motor centers of the cerebral cortex pulsed magnetic field with the intensity of 2-2,5 T and a frequency of 0.1 - 0.25 Hz with duration of exposure 30 sec - 1 min, magnetic stimulation of the spinal cord magnetic Indus is tion is provided by electric stimulation of peripheral neuromuscular apparatus (Tyszkiewicz So G., Nikitin centuries Magnetic and electrical stimulation in the rehabilitation treatment of patients with organic lesions of the nervous system, Zh. neurol. and the psychiatrist.-1997.- N9 - C. 41 - 43.).

The disadvantage of the prototype is that the stimulation is fixed parameters influencing the electromagnetic field and there is no selection of the mode of stimulation, taking into account individual sensitivity threshold. The impact is only on the damaged structure that allows to include in the restore process only restorative mechanisms, and activation of compensatory mechanisms in the intact hemisphere is not provided. In addition, in this way there are no factors aimed at restoring normal afferention cortex, which greatly complicates the activation of sanogenetic mechanisms in case of insufficiency of cerebral circulation. Directed action of afferent stimuli in physiological range accelerates the recovery of the Central neuron, which is in the state namely parabiosis.

The present invention is to improve the effectiveness of treatment of ischemic strokes, creating an individual treatment regimen.

The novelty of the method:

1. Conducting alternating sessions of transcranial magnetic stimulation (TCMS) and audiovisual stimulation, can compensate for the deficiencies in the functioning of the musculoskeletal system in the physiological range, as transcranial magnetic stimulation of Central and peripheral motor motor creates a directional flow of efferent stimuli and ABC - directional flow of afferent stimuli in physio is the mind unlike the prototype, can influence not only on the mechanisms of restitution in the affected area of the Central motor motor, but also to include compensation mechanisms in the Central zone of the propulsion motor of the intact hemisphere of the cerebral cortex. The impact in the projection of the spinous processes of vertebrae C7 and L5 can further involve Central and peripheral motor neurons, creating an additional afferent flow to the Central motoneuron and additional efferent flow to the peripheral neuromuscular apparatus.

3. Time and dose stimulation confirmed experimentally and are optimal. Applied subthreshold value of the pulse is a gentle and noninvasive, does not create discomfort for patients. The time of stimulation more than 5 minutes will result in changes in the functional state of the nerve centers and the change of the reaction, when the stimulation was less than 5 minutes you cannot create a sufficient focus of excitation in the cortex of the brain and this leads to slow recovery processes and increase the amount of necessary medical procedures.

4. Additional use of audiovisual stimulation osmesa dominant role in the mechanisms of generation of rhythm, resulting light stimuli cause the most pronounced changes in its electrical activity and metabolism. Intermittent photic stimulation with a smoothly changing frequency of outbreaks is a factor that provokes the mechanism of resonance activity of a number of fine-grained brain oscillators in the characteristic frequencies that are specific to different areas of the brain (Muhamedrakhimov R. J. Assessment of preferences and vegetative reactions in the perception of sound intensity // human Physiology. 1993 - Vol 19 - N 2 - N-45 - 52.; Galochkin Y. Dynamics, timing and effectiveness of purposeful motor acts on a conventional light signal // the Journal of higher nervous activity. - 1993 - vol.2 - S. 147 - 150; Fedotchev A. I., A. Bondar T. EEG of human response to intermittent light emission at different frequencies // Advances in physiological Sciences - 1990 - volume 21 - N 1 - N-97 - 109). When this occurs, the change in the functional status and other systems with the corresponding shift of metabolic processes, the change of regional cerebral blood flow in different brain areas. It is also known that bioelectric, neurochemical and vegetative reactions that occur when audio-visual stimulation of the brain depend on and the Sith from the level of the initial activity of the noradrenergic system. Its impact is addressed to the mechanisms forming the hyperpolarizing component of the complex bioelectric reaction (Kasabov, A., Makarova, I. I., bort, S. P. Spatial, bioelectrical and biochemical characteristics of early afferent response caudate nucleus on sound incentive // Physiological journal. I. M. Sechenov - 1994 - Volume 80 - N 3 - N-106 - 108.). It is proved that the resonance phenomena in the frequency range corresponding to the main EEG rhythms, occurs at the level of membranes, organs and systems, which are oscillatory processes (Markevich N.And., Selkov E. E. Mathematical model of resonant enhancement of external influences on the membrane. // Biophysics 1986. So 31. # 4. S. 662 - 666; Oknyansky L. G., N. Nikiforova.A., Nikolaeva A. N. On the role of oscillatory-wave processes in human // proc. Dokl. 15 th Congress of vsesojuz. Fiziol. Islands named I. P. Pavlova. So 2. Chisinau. 1987. S. 25 - 26). Any restructuring of the rhythm of nerve cells is accompanied by a corresponding shift of metabolism (Livanov, M. N. The rhythms of the electroencephalogram and their functional significance. // Ukr. the Supreme. nerve. the activities of the tis. 1984. So 34. # 4. C. 613 - 626. ). Data neurophysiological effects of rhythmic light and sound vibrations allow use which allows to compensate for the shortcomings of the afferent and efferent stimulation of the Central motor motor.

The invention is illustrated by drawings, where Fig. 1 shows the location of points on the motor centers of the cerebral cortex; Fig. 2 - the location of the motor centers of the spinal cord.

To solve this problem we use transcranial magnetic stimulator "Neuromag 011", manufactured by JSC "ZSMK" ITC "CORUM" , Novosibirsk, external coil diameter 14 cm, producing a maximum magnetic field of 5 T, the duration of about 100 μs.

The method is as follows: previously conducted clinical neurology and clinical examination of the patient, establishes and clarifies the diagnosis of cerebrovascular disease. Acute violation of cerebral circulation in ischemic type, the recovery period. The patient is located in a chair, patients with severe neurologic deficit is lying on the couch. The patient is superimposed ground cutaneous electrode made in the form of the cuff, completely covering the area of the lower third of the right forearm, a pre-skin in the lower third of the right forearm treated 70% ethanol for degreasing. Lateral cutaneous standard electri. The skin is also treated 70% ethanol for degreasing. All patients performed a multilevel electromagnetic stimulation. The first level is transcranial magnetic stimulation (TCMS) affected motor centers of the cerebral cortex. The first point stimulation is a motor area of the right hand, the center of the magnetic coil is placed 3 cm lies lateral (left) the location of the electrode Cz according to the international system "10-20" (Jasper, 1958). The second point stimulation is a motor area of the left hand, the center of the magnetic coil is placed 3 cm lies lateral (right) the location of the electrode Cz (Fig. 3). Stimulation of each point is held for 5 min pulsed magnetic field value 1.5 to 3 Tesla. Motor evoked potentials (GWP) are captured on screen, dual channel electromyograph "Medelec MS V" firm NEUROSTAR. The third point stimulation is a motor area of the right lower limb, the center of the magnetic coil is placed 4 cm frontline and 1 cm lies lateral (left) location of the electrode Cz. The fourth point stimulation is a motor area of the left lower extremity, the center of the magnetic coil is placed 4 cm frontline and 1 cm lies lateral (right). the DOI zone is carried out for 5 min pulsed magnetic field 2 - 4, 5 T, respectively. The threshold of stimulation is defined on each side by increasing the stimulus intensity by 10%, since 30% of maximum output of the stimulator 5 Tesla. Threshold count level at which half of the stimuli causes of motor evoked potentials (GWP) from studies of one person. Is used for the treatment of subthreshold pulse (10 - 20% below the threshold), individually tailored for each person. The second level of electromagnetic stimulation of the spinal cord, while the fifth point of stimulation - the center of the coil is located above the spinous process of the C7 vertebra. We stimulate the roots of the cervical thickening of the previously selected sub-threshold pulse value 1.5 to 3 Tesla for 5 minutes Then carried stimulation of the roots of the lumbar thickening, the sixth point stimulation of the center coil is located above the spinous process of the L5 vertebra (Fig. 4). Stimulation is previously selected sub-threshold pulse value 2 to 4.5 T for 5 minutes After the session TCMS patients are encouraged to stay in the house for 30 - 60 minutes

After a session of transcranial magnetic stimulation, the next day, is audiovisual stimulation device "Vojager Galaxy, by Tetha Technologies, USA"is conducted as follows: the patient is located in a chair, patients with severe neurologic deficit is lying on the couch. All patients previously conducted EEG mapping to study the state of the bioelectrical activity of the brain. On the basis of EEG data mode is selected impact. When there is a predominance of slow activity and violations of the zonal distribution of the alpha rhythm is proposed recovery mode alpha activity: frequency of audiovisual signals starts at 8 Hz and gradually rises to a frequency of 15 Hz, the duration of the session 15 minutes If irritation proposed mode with theta activity: frequency of audiovisual signals starts with 10 Hz and falls to the frequency of 5 Hz, the duration of the session 20 minutes

The course of treatment is 14 daily sessions, and sessions of transcranial magnetic stimulation and ABC alternate.

The treated group of patients (10 people) with ischemic stroke in the recovery period. Options magnetic stimulation used in the treatment table. 1.

Compliance with the proposed method the criterion of "novelty" is confirmed by the application of patients in the recovery period of ischemic stroke in complex restorative treatment combination of transcranial electromagnetically current in the brain, causing depolarization of neurons in order to restore conduction of impulses in corticospinal tract and audiovisual stimulation, compensating the lack of afferent flow through artificial rhythmic stimulation to restore physiological zonal distribution of bioelectric activity of the brain.

Thus, in the State research center of health of miners treated this way 10 patients with ischemic stroke brain. The results obtained indicate that the method reduces neurological deficits and to increase adaptive activity of patients. Dynamic observation after 6 and 12 months showed that the application of this method of treatment can reduce morbidity of patients and to improve the quality of life of patients after ischemic stroke. The method is effective, painless, safe, non-invasive, affordable and easy to use.

Example 1

Patient M., aged 52, was admitted to the neurology ward 31.08.98 with complaints expressed dizziness, inability to stand and walk because of weakness, General weakness.

The history of the disease. Illness is s when swallowing liquid food. The next day feeling worse: could not swallow solid food and could not move because of the pronounced dizziness and unsteadiness when walking. Was treated in the neurology Department at the place of residence. After treatment dizziness decreased, swallows yourself liquid and pasty food, but remains expressed ataxia, can't walk, moves on a wheelchair.

Objective status. A proper physique, satisfactory power. The skin is clean. The vesicular breathing. The rhythmic heart sounds, pulse rate of 72 per minute, HELL 150/85 mm RT. Art. Abdominal palpation soft, painless.

Neurological status. Clear consciousness. Palpebral fissure, pupils D=S, the movement of the eyeballs in full, horizontal melcorazmashisty nystagmus, a more pronounced when looking to the left, upset convergence. Flattened nasolabial fold to the right, the tongue in the midline. Moderately pronounced hypotonia of the muscles of the limbs. Tendon reflexes D > S. Pathological stop signs on the right. Muscle strength in the right and left extremities D=S=5 points. Active movement in the limbs in full. Sensitive disorders no. Cortaccia: the patient moves to a wheelchair due to severe unsteadiness when walking, can't stand. In the Romberg falls to the right.

Diagnosis. Cerebrovascular disease. Acute violation of cerebral circulation in ischemic type in the vertebro-basilar pool, early recovery period. Bulbar syndrome, vestibulotoxicity syndrome. Atherosclerosis of cerebral vessels.

Symptomatic hypertension.

The survey was conducted.

Common blood test, General urine analysis showed no pathology

Biochemical analysis of blood - cholesterol 6,27 mmol/l, LDL 99,4.E., triglycerides 3.65 mmol/l

ECG - moderate metabolic and degenerative changes in the myocardium.

USDG extracranial vessels - signs hindered perfusion in the vertebro-basilar pool.

EEG alpha activity V 8-9 Hz And up to 30 µv, reduced activity, distorted beta activity, combined with theta activity And up to 25 µv, zonal distribution is correct, the index of approx 40%. Reaction activation clear, palenie it is activated. Beta activity is diffuse And up to 15 µv, with elements of the beta rhythm, V 21-24 Hz And up to 30 mV. Theta activity is diffuse And up to 25 mV. BSR alpha-band on the background EEG, HV - unit alpha-theta range. Conclusion: cerebral manifestation is haunted by neurodynamics (Fig. 1).

Ophthalmologist - angiosclerosis retinal vessels 2 tbsp.

Computed tomography of the brain - hearth hypotensives density in the vertebro-basilar pool.

Treatment was conducted according to the standard technique (Actovegin 80 mg intravenous infusion of physiological solution, nootropil 10,0 intravenous nicotinic acid 1% intramuscular injection scheme, vitamin B6 5% to 4.0 intramuscularly, Enap 5 mg 2 times a day under the supervision of AD, aspirin 0.25 per lunch), therapeutic exercise.

In addition to the described treatment held 14 sessions of transcranial magnetic stimulation (TCMS) and audio-visual stimulation (AVS).

The method was carried out as follows: the patient comfortably in a chair. The patient superimposed ground cutaneous electrode made in the form of the cuff, completely covering the area of the lower third of the right forearm, a pre-skin in the lower third of the right forearm was treated with 70% ethanol for degreasing. Discharge standard cutaneous electrodes for registration of motor evoked potentials superimposed on m. abductor digiti minimi (m ADM) on the right and left hand. The skin also amrabat emulate. The first level was a transcranial magnetic stimulation (TCMS) affected motor centers of the cerebral cortex. The first point of stimulation was the motor area of the right hand, the center of the magnetic coil was placed 3 cm lies lateral (left) the location of the electrode Cz according to the international system "10-20" (Jasper, 1958). The second point of stimulation was the motor area of the left hand, the center of the magnetic coil was placed 3 cm lies lateral (right) the location of the electrode Cz right hemisphere. Stimulation of each point was performed for 5 min pulsed magnetic field value of 2.5 T. Motor evoked potentials (GWP) were recorded on screen, dual channel electromyograph "Medelec MS V" firm NEUROSTAR. The third point of stimulation was the motor area of the right lower limb, the center of the magnetic coil was placed 4 cm frontline and 1 cm lies lateral (left) location of the electrode Cz. The fourth point of stimulation was the motor area of the left lower extremity, the center of the magnetic coil was placed 4 cm frontline and 1 cm lies lateral (right) the location of the electrode Cz. The discharge electrodes superimposed on m. extensor digitorum brevis (M. EDB) bilateral. Stimulation of each zone was carried out for 5 min impartial 10%, since 30% of maximum output of the stimulator 5 Tesla. The threshold is counted in the level at which half of the stimuli were generated profit center. Were used for treatment of subthreshold pulse (10-20% below the threshold), selected individually. The second level of electromagnetic stimulation of the spinal cord, while the fifth point of stimulation - the center of the coil was placed over the spinous process of the C7 vertebra. Conducted stimulation of the cervical roots thickening of the previously selected sub-threshold pulse of 2.5 T for 5 minutes Then conducted stimulation of the roots of the lumbar thickening, while the sixth point stimulation center of the coil was placed over the spinous process of the L5 vertebra. Stimulation was performed previously selected a subthreshold pulse of 3.5 T for 5 minutes After the session TCMS patient rested in the chamber for 30-60 min.

After a session of transcranial magnetic stimulation, the next day, was held audiovisual stimulation device "Vojager Galaxy, by Tetha Technologies, USA" individually selected mode with the aim of afferent stimulation of the cerebral cortex. The method was carried out as follows: the patient is located in a chair. Based on the EEG data were selected mode of exposure. The presence of irritation aetsa to frequency 5 Hz, each session lasts 20 minutes

In addition to the described treatment held 14 sessions of transcranial magnetic stimulation (TCMS) and audio-visual stimulation (AVS). The stimulation sessions were followed: first session - TCMS, second session - ABC, etc.

After 2 sessions interleaved transcranial magnetic stimulation and visual stimulation of the patient noted a decrease dizziness and General weakness. After 4 sessions of stimulation decreased the severity of static and dynamic ataxia. Dynamics of muscle evoked potential (IMP) with m. abductor digiti minimi and m. exstensor digitorum brevis are presented in table. 3.

At the end of treatment showed a positive dynamics in the form of a significant reduction in static and dynamic ataxia - the patient can stand and walk.

EEG after the end of treatment positive dynamics. More index alpha activity, single stem digits, only the alpha range (see Fig. 1).

Example 2

Patient N. , 1932 R. was admitted to the neurology ward 27.05.98 with complaints of weakness in the right arm and leg, difficulty speaking, headache.

The history of the disease. Ill 16.04.98, when nahodilsa hospitalized in the neurology Department at the place of residence, where conducted medical treatment according to the usual method of treatment of ischemic stroke (Cavinton intravenous drip, nootropil intravenous nicotinic acid intramuscularly, vitamins, anti-hypertensive drugs), massage right limbs and physiotherapy. No significant improvement is noted.

Objective status. The patient lies in bed, unable to turn within the bed. Skin pale, dry. HELL 190/100 mm RT. senior HR 68 minutes Right physique, satisfactory power. The skin is clean, in the lungs vesicular breathing, wheezing no. Heart sounds clear and rhythmic. The abdomen is soft, palpation painless.

Neurological status. Palpebral fissure D < S, the movement of the eyeballs in full, no nystagmus, upset convergence. Pupils D=S, the average expression of aliveness, D=S. Arcus senilis. Right flattened nasolabial fold. Symptom lashes on the right. Deviation of the tongue to the right. Muscle strength in the right hand - 0 points, right foot - 0 points. Active movement in the right limbs are missing. Tendon reflexes D > S in the right limbs increased tone in spastic type, pathological signs on the right. Hemipepsis the prognosis. Cerebrovascular disease. Acute violation of cerebral circulation in ischemic type in the basin of the middle cerebral artery on the left, early recovery period. Right-sided hemiplegia. Elements of motor aphasia. Atherosclerosis of cerebral vessels. Hypertension 3 tbsp., decompensation.

The survey was conducted.

Common blood test, General urine analysis showed no pathology.

Biochemical analysis of blood - cholesterol 4.4 mmol/l, LDL 109, 9.E., triglycerides 2, 23 mmol/L.

ECG signs of left ventricular hypertrophy with systolic overload.

Fundus examination - hypertension-atherosclerotic angiopathy of the retina.

Computed tomography of the brain - Encephalopathy atherosclerotic type focus hypodensity in the basin of the middle cerebral artery on the left.

USDG extracranial vessels expressed the difficulty of the processes of cerebral perfusion in the arteries of both pools.

EEG throughout the record registered the following pathological phenomena: sustainable asymmetry in the temporal areas of the left dominant theta activity And up to 60 µv, single Delta waves; sustainable and activation; on the right is clear, the left - weakened; BSR theta, alpha theta range, with emphasis on the left hemisphere. Conclusion: the focus of pathological activity localized in the left hemisphere, in the temporal region, with secondary effects on the parietal region. Cerebral manifestations expressed, organic, with signs of interest in the oral sections of the trunk, with emphasis on the left, compensated for neurodynamics (see Fig. 2).

Treatment was conducted according to the standard technique (reverse 4,0 intravenous infusion of physiological solution, piracetam 20% - 10,0 intravenous nicotinic acid 1% intramuscular injection scheme, vitamin B6 5% to 4.0 intramuscularly, Enap 10 mg 2 times a day under the supervision of AD, diacarb 25 mg in the morning for 3 days, asparkam 1 tablet 3 times a day, aspirin 0.25 per lunch), massage right limbs and physiotherapy.

In addition to the described treatment held 14 sessions of transcranial magnetic stimulation (TCMS) and audio-visual stimulation (AVS).

The method was carried out as follows: the patient comfortably in a chair. The patient superimposed ground cutaneous electrode, made in the form of a cuff, completely covering the area of the lower third of the right prepl the m ethanol for degreasing. Discharge standard cutaneous electrodes for registration of motor evoked potentials superimposed on m. abductor digiti minimi (m ADM) on the right and left hand. The skin was also treated with 70% ethanol for degreasing. Conducted multi-level electromagnetic stimulation. The first level was a transcranial magnetic stimulation (TCMS) affected motor centers of the cerebral cortex. The first point of stimulation was the motor area of the right hand, the center of the magnetic coil was placed 3 cm lies lateral (left) the location of the electrode Cz according to the international system "10-20" (Jasper, 1958). The second point of stimulation was the motor area of the left hand, the center of the magnetic coil was placed on the 3 see lies lateral (right) the location of the electrode Cz. Stimulation of each point was performed for 5 min pulsed magnetic field value at 3.0 Tesla. Motor evoked potentials (GWP) were recorded on screen, dual channel electromyograph "Medelec MS V" firm NEUROSTAR. The third point of stimulation was the motor area of the right lower limb, the center of the magnetic coil was placed 4 cm frontline and 1 cm lies lateral (left) location of the electrode Cz. The fourth point stimulation ausralia (right) the location of the electrode Cz. The discharge electrodes superimposed on m. extensor digitorum brevis (M. EDB) bilateral. Stimulation of each zone was carried out for 5 min pulsed magnetic field of 4.5 T. The threshold stimulation was defined on each side by increasing the stimulus intensity by 10%, since 30% of maximum output of the stimulator 5 Tesla. The threshold is counted in the level at which half of the stimuli were generated profit center. Were used for treatment of subthreshold pulse (10-20% below the threshold), selected individually. The second level of electromagnetic stimulation of the spinal cord, while the fifth point of stimulation - the center of the coil was placed over the spinous process of the C7 vertebra. Conducted stimulation of the cervical roots thickening of the previously selected sub-threshold pulse at 3.0 T for 5 minutes Then conducted stimulation of the roots of the lumbar thickening, while the sixth point stimulation center of the coil was placed over the spinous process of the L5 vertebra. Stimulation was performed previously selected subthreshold pulse of 4.5 T for 5 minutes After the session TCMS patient rested in the chamber for 30-60 min.

After a session of transcranial magnetic stimulation, the next day, was held audiovisual stimulation device "Vojager Galaxy, by Tetha Tec is estalella as follows: the patient is located in a chair. Based on the EEG data were selected mode of exposure. The predominance of slow activity and violations of the zonal distribution of the alpha rhythm has determined the choice of the mode of recovery of alpha-activity: frequency of audiovisual signals starts at 8 Hz and gradually rises to a frequency of 15 Hz, the duration of the session is 15 minutes

The course of treatment was 14 daily sessions, and sessions of transcranial magnetic stimulation and ABC were followed: first session - TCMS, second session - ABC, etc.

After the 6th session interleaved transcranial magnetic stimulation and visual stimulation appeared active movement in his right hand. After 7 stimulation session received muscle evoked potential (IMP) with m. abductor digiti minimi and appeared active movement of the right leg. After 9 stimulation session received profit center with m. exstensor digitorum brevis.

At the end of treatment showed a positive trend - the patient turns around and sits up in bed, produces the active movement of the right extremities. Muscle strength in the right hand - 3 points, in the right foot - 2 points. Dynamics of muscle evoked potential (IMP) with m. abductor digiti minimi and m. exstensor digitorum brevis are presented in table. 4.

EEG after treatment - dynamics positively the realizations in stem categories on the left hemisphere (see Fig. 2)

1. A method of treating ischemic stroke brain by transcranial magnetic stimulation (TCMS) motor centers of the cerebral cortex and the spinal cord, characterized in that the stimulation of the motor centers of the cerebral cortex provide a consistent impact first on the point motor area of the right hand, with the center of the magnetic coil have left from the location of the electrode Cz 3 cm, then the impact of exercise on the second point of the motor area of the left hand, with the placement of the center of the magnetic coil to the right from the location of the electrode Cz 3 cm and the stimulation of these two points should be performed within 5 min pulsed magnetic field value 1.5 to 3 Tesla, and then impinges on the third point stimulation of the motor area of the right lower limb with the placement of the center of the magnetic coil 4 cm frontline and 1 cm to the left from the location of the electrode Cz and the fourth point stimulation of the motor area of the left lower extremity, thus, the center of the magnetic coil is placed 4 cm frontline and 1 cm to the right from the location of the electrode Cz and stimulation of these zones should be performed within 5 min of pulsed magnetic field of 2 to 4.5 T, after stimulation gligoroski cervical thickening of the location of the center of the first coil over the spinous process of the C7 vertebra, and then the influence of the spinal lumbar thickening with the center of the coil over the spinous process of the vertebra L5, and the impact on the roots of the cervical thickening carried out for 5 min pulsed magnetic field of 1.5 - 3 Tesla, and the spinal lumbar thickening of the pulsed magnetic field of 2 to 4.5 T for 5 min, and then after a session of transcranial magnetic stimulation on the next day additionally carry out audiovisual stimulation (AVS) with a frequency of audiovisual signals between 8 Hz and smooth lifting up to 15 Hz and session duration 15 min, and in the presence of stimulation with 10 Hz with a gradual decrease to 5 Hz for 20 minutes

2. The method according to p. 1, characterized in that the treatment is 14 daily sessions of transcranial magnetic stimulation and ABC.

3. The method according to PP.1 and 2, characterized in that the threshold of stimulation for each patient at all points of stimulation is determined by increasing the stimulus intensity by 10%, since 30% of maximum power stimulation 5 T up to the point at which half of the stimuli causes of motor evoked potentials, and treatment is carried out subthreshold pulse, which is 10 - 20% below the threshold.

 

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The invention relates to medicine, namely to ophthalmology, and can also be used in traumatology, otolaryngology, Nephrology, in the treatment of atrophy hearing aid

The invention relates to Oncology

The invention relates to pediatric neuropathology and physiotherapy

The invention relates to methods and devices for processing of various substances, including water magnetic field to give them various antibacterial and regenerating properties

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

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