A method for the treatment of acute focal brain lesions

 

(57) Abstract:

The invention relates to medicine, and is intended for the treatment of acute lesions of the brain. On the projection zones of focal lesions in the first days after their occurrence is influenced by direct current power 100-500 μa and duration 30-40 minutes, within 10-15 days. Reologicheskie drugs administered during and within 5-10 days after exposure to DC. As rheological use drugs pentoxifylline. The effect of direct current passes through 3-6 lead electrode area of 400-600 mm2each. The method allows to increase the effectiveness of treatment of acute focal brain lesions. 2 C.p. f-crystals.

The invention relates to medicine, namely to neurosurgery and neurology, and may find application in the treatment of lesions crush zone of the brain and intracerebral haematomas traumatic etiology, as well as ischemic and hemorrhagic strokes.

Craniocerebral trauma (CCT) is one of the most common types of injuries, the frequency is 36-40% of all types of injuries. In recent decades, increases the frequency and severity of brain damage. In Moscow to CMT is more likely to occur in age from 20 to 50 years, i.e. in the period of maximal work capacity, 1.5 times more often in men than in women. Men are more serious injuries and 3 times higher mortality. Consequences of brain injury, especially heavy, reduce the working capacity of the affected and cause disability. Such complications in severe traumatic brain injury occur in 50-100% of victims. The overall mortality in traumatic brain injury is 4-5%, with serious injury - 68-70%. Intracerebral hematomas in traumatic brain injury occur up to 25-30% of cases.

In recent years the increase worldwide in the number of patients with acute disorders of cerebral circulation is mainly due to the increased frequency of ischemic stroke. According to the available statistics, the frequency of cerebrovascular disorders is 2.3 cases per 1000 population. Hemorrhage in the brain are much less common than ischemic stroke. The last is about 3/4 of violations of cerebral circulation. However, mortality due to bleeding in the brain is significantly higher than in patients with ischemic stroke. The number of deaths from haemorrhage accounts for 2/3 of the total number of deaths from cerebrovascular disease. Nabludaetsa is krovoobrasheniya are aged 40-50 years, about 13% of patients younger than 40 years. Mortality in the conservative treatment of hemorrhagic stroke reaches 70-85%, surgical reduced to 28-39%. thus, as can be seen from the above data, the problem of acute focal brain lesions (OOPHM) is one of the most serious health problem.

At the present time for the treatment OOPHM used surgical and conservative treatment methods.

Surgical methods of treatment of acute focal lesions in brain injury and stroke shown in the case of compression of the brain and dislocation of his trunk. The operation is in the evacuation of hematoma or brain detritus and is for health reasons, as in the earlier period from the moment of the catastrophe. In this case, the operation is no alternative method of treatment. It is believed that previously removing the source of hemorrhage, even do not pose an immediate threat to life, lead to more rapid and more complete recovery of impaired functions. However, as with any surgery, surgical treatment OOPHM does not exclude the risk of anesthetic and surgical aggression. Surgical treatment should be considered as an extreme measure and easy the possibility of conservative treatment. In ischaemic stroke operation aimed at restoring patency of cerebral vessels, or calculated on its resume method for creating different types of anastomoses are effective only in the first minutes after a stroke and in the absence of significant neurological deficit. As a rule, patients with ischemic stroke received in neurosurgical hospital in the period when this kind of surgical intervention are already hopeless.

The primary method of treatment OOPHM in the acute period is a medical therapy. The General scheme used for all kinds of OOPHM (traumatic lesions, hemorrhagic and ischemic strokes), the so-called undifferentiated treatment includes:

1) vasoactive therapy;

2) therapy aimed at improving the rheological properties of blood;

3) dehydration therapy;

4) metabolic therapy;

5) cerebroprotective treatment.

The main disadvantage of all these treatments is the diffuse nature of their actions and a number of side effects.

So, vasoactive funds act diffuse to the blood vessels of the entire body is neither. Such action often is the cause of the syndrome "victimize".

Drugs, improves blood rheology, have side effects. So, aspirin has ulcerogenic action, reopolyglykin, contributing to fluid retention in the body, is considered to be contraindicated in brain swelling, etc. however, this group of medicines without causing syndrome victimize that are essential for the optimization of cerebral circulation in the "transition" of sharp focus.

The feasibility of dehydration therapy is obvious, However, to date, the question of its efficiency in the use of modern diuretics discussed. Side-effects in their application include hypovolemia, often accompanied by unwanted decrease of systemic blood pressure and increased blood viscosity. Use as a tissue anti money glucorticoid hormones also carries a range of side effects, the main of which is the inhibition of function of the adrenal glands and expressed ulcerogenic action.

Metabolic (nootropics) therapy for all its seeming "butabi. the ti stimulators of metabolic processes of the first cell during the so-called "metabolic storm" may have the opposite effect.

Cerebroprotective therapy involves the use of antihypoxants and calcium channel blockers. The first is sodium oxybutyrate. When using it, you may experience agitation and seizures, hypokalemia. The most powerful preparations of the second group is now considered to be nimotop. This drug has a significant hypotensive in the treatment OOPHM.

Thus, current methods of medical treatment OOPHM have significant shortcomings and accompanied by a number of side effects that require additional correction.

There is a method of medical treatment OOPHM (Charles C. A. Therapy for neurological diseases - M.: Medicine, 1987-512).

It is the use of different vasoactive drugs, drugs, ulucami rheological properties of blood, dehydrogenase drugs, improve the metabolism of the brain, cerebroprotective funds. Thus dehydrating and cerebroprotective drugs primeste 2 months. This method allows to achieve compensation and certain regression of neurological deficit. However, it is characterized by long duration of treatment and, as practice shows, after such treatment in patients for life remain persistent residual symptoms, leading to lifelong disability. Suffice it to say that only 1% of patients after ischemic stroke, recovered to such an extent that the return to their professional activities.

The closest method to the proposed method is the treatment of acute focal brain lesions, consisting in the use of electrical stimulation pulse current brain and the introduction rheological drugs (EN 2157259 C2 from 10.10.2000). However, in the way there is no impact on areas of projection of focal lesions. In addition, the impact is alternating current that does not give adequate therapeutic effect in the treatment of this disease.

The technical result of the present invention is to reduce the duration of treatment and significantly reduce the amount of medication therapy.

This result is achieved by the fact that at the same time 30-40 minutes and the influence of exercise daily for 5-15 days then drug therapy continue for another 5-10 days. As medicines are prescribed medications that improve blood rheology (pentoxifylline), and the effect of direct current exercise superimposed on the scalp 3-6 lead electrodes, the area of 400-600 sq. mm each.

Because, as was said above, known methods of conservative treatment is not effective enough, the search for new therapeutic options for this pathology is constantly ongoing.

The present invention concerns the development of a new approach to the treatment of this severe pathology.

In medical practice there is a method of transcranial micropolarization brain (TCMP). It is used to treat a number of chronic diseases of the Central nervous system, accompanied by motor disorders (BOGACHOV O. C., shelyakin A. M., Transfiguration, I. treatment of neuropsychiatric diseases involving movement disorders. RF patent 2122443 from 01.07.1997,: Pinchuk D. Y. Clinical and physiological study aimed transcranial micropolarization in children with dysontogenetic pathology of the CNS, author's abstract on competition of a scientific degree of doctor M. N. St. Petersburg, 1997 the brain by this method watched its high efficiency and, most importantly, the absence of any side effects.

Up to the present time, the methods of the local conservative impact on acute lesion of brain damage was not primenenii. Moreover, various physical therapy methods for local effects on the brain, it is absolutely contraindicated in the acute period of cerebral accidents. For example, in acute focal brain lesions absolutely contraindicated effect on the brain by an alternating current, and magnetic radiation and galvanic (direct) current Ushakov A. A. guidance on the practical physiotherapy): "ARMY", 1996). The application of an alternating magnetic field, decimeter waves, electropolymerization UHF currents is possible and feasible with a small stroke no earlier than 4 to 5 weeks, in severe form in 6-7 weeks (Reference physiotherapy. Edited by Prof. Century, one. M,"Medicine" 1992).

The reason for first use TCMP in this category of patients was the following case.

In the hospital admitted a heavy elderly patients. When the survey was diagnosed with cerebral vascular accident on hemorrhagic t the left hemisphere of the brain. The volume of intracerebral hematoma MRI brain (CTG) was 90-100 ml, offset median structures from left to right at 8 mm. it was revealed severe cerebral symptoms, the clinic compression of the left hemisphere brain hematoma and signs of dislocation syndrome. The patient was shown to surgical treatment. However, the relatives of the patient, despite the seriousness of the situation, from the operation refused. Knowing from experience that patients while conducting the standard conservative therapy are doomed, we decided to hold him TCMP, and it turned out that the patient already after the second procedure regained consciousness, after 5 treatments according to the CTG showed a significant decrease in the perifocal compartment that is clinically consistent with the regression of cerebral and dislocations symptoms. Just spent 15 procedures. After 3 weeks it was noted signs of recovery of neurological deficit (regression of aphasia and the emergence of movements in the right limbs). After 6 weeks with the assistance sits down, gets up from the bed, regressing saved in the dynamics of right-sided hemiparesis, complete regression of sensory aphasia, a partial regression of the motor is t itself. According to CTG signs of resorption of the hematoma, the reduction of the hematoma in the volume of 50-60 ml, hematoma isodense, perifocal compartment is missing offset median structures no. Was discharged after 35 days on an outpatient aftercare.

Thus, the course of treatment method TCMP not only allowed to save the patient life, but also to avoid surgical intervention and to provide a quick signicant recovery of neurological deficits. We received such severe pathology unexpectedly quick and good results encouraged us to further explore the possibilities of this method in other patients with OOPHM. When conducting TCMP empirically, we have chosen the optimal exposure parameters DC and the timing of its application, depending on the situation and severity of pathology current was 100 to 500 microamps, and the duration of the session no more than 40 minutes. Criteria for optimal power used DC was sleepiness and positive dynamics in the EEG. If amperage is less than 100 microamps these changes were not observed. With increasing current strength of more than 500 microamps and the duration of exposure more than 40 minutes in patients placed In our opinion, the proposed method of treatment allows to quickly arrest the symptoms of swelling, to stabilize the lesion and significantly reduce the severity of residual neurological deficit. Moreover, this result was achieved by us for 2-4 weeks depending on severity.

The essence of the method is illustrated by the following examples.

Example 1.

Patient C. 1937 R., history 766 entered the unit, the hospital 11.02.2001 was diagnosed with cerebrovascular disease, acute violation of cerebral blood flow in ischemic type in vertebrobasilar basin, heart attack right half Valieva bridge.

At admission the patient was determined, dysarthria, left-side hemiparesis, cerebellar ataxia, horizontal nystagm when looking to the left. The patient was unable to walk due to hemiparesis and ataxia, could hardly helped himself. On computed tomography of the brain (CTG) from 11.02. identified hypodensity area size 1,h,9x1,0 cm in the right half Valieva bridge. Right half of the SE ventricle and pavement tanks crushed. It was decided to hold the course TCMP 11.02. the first transcranial micropolarization (TCMP) of the lesion brain the cathode back on level craniovertebral joint. Current 400 microamps. At lower values of current the patient was missing characterized by drowsiness and positive changes on EEG, and at large - amplified headache and appeared discomfort under the anodes. Procedure duration is 40 minutes. Just spent 10 sessions TCMP. In parallel with the TCMP received oral pentoxifylline 200 mg 3 times a day to improve the rheological properties of blood, and which lasted for 9 days after a course TCMP before discharge of the patient.

The next day after the first session noted the positive dynamics in the form of reducing the severity of focal disturbances, increased strength in the left extremities, decreased ataxia. The patient was discharged 2.03. 2001 19 days. At discharge: satisfactory condition, fully regressed left geminates, ataxia, nystagmus. Walking without support, not swaying, maintains itself in full, retained elements of dysarthria. According to CTG area of ischemia but disappeared signs of embarrassment 1U ventricle and the pavement of the tank, indicating the disappearance of the zone of perifocal edema.

Thus, bolinao TCMP nearly complete regression of neurological symptoms in the course of 19 days. According to the report of the Department for the year 2000, the average hospital bed day for patients with stem ischemic stroke was 31.3 day.

Example 2.

Patient B. , 1936, R., history of 1277. Received unit in the hospital 23 12.03.2001, After examination, he was: cerebrovascular disease, hypertension III, hemorrhagic stroke, parishiltononenightin hemorrhage with mixed hematoma in the deep sections of the right hemisphere of the brain.

Pain in acute 12.03.2001 g, when suddenly time has led to a weakness in the left extremities, more in his hand, fell. When entering a serious condition in mind, the stun is 1 degree, complains of significant headache. There is a smoothness of the left nasolabial folds, dysarthria, hemiparesis left with a decrease in strength up to 3 points. Unable to walk due to weakness in the left leg On the CTG from 12.03.2001, the lateral sections of the right lenticular nucleus and adjacent areas of the outer capsule revealed a hematoma 3,h,2x3,0, with a distinct area of swelling around it, with signs of compression of the right lateral ventricle. It was decided to carry out treatment method TCMP. 13.03.2001, was held the first session. The electrodes maclachlani lines, respectively, the area of projection of the hearth, and the cathode in the region of the opposite mastoid. The current strength was 300 microamps, the duration of the session 30 minutes. The current smaller values did not cause characterized by drowsiness and a lack of positive changes in EEG, the increase of the current was accompanied by discomfort in the area of location of anodes, similar sensations appeared in the continuation of the session on the current 300 µa after 30 minutes. Just spent 10 sessions. parallel carried out pharmacological therapy: pentoxifylline 200 mg 3 times a day. The effect appeared the next day. was a decrease cephalgic syndrome, improvement of health, reduction of weakness in the left extremities, speech has improved. When CTG in dynamics from 23.03.2001, - reducing the size of the hematoma to 2,h,h,6 cm, no perifocal zone compartment, no signs of compression of the right lateral ventricle. On completion of the course TCMP received tentatively in the same doses for 10 days. discharged 2.04.2001, 20 days. In the statement, the condition is satisfactory. Complete regression of cerebral and focal neurological symptoms. The patient walks a lot, maintains itself in full. According to CTG from 30.03.2001, in the area of the former th with hemorrhagic stroke and formation of intracerebral hematomas and signs of compression of the right hemisphere of the brain on the background TCMP has been able to achieve significant results in just 20 days. According to the annual report of the Department for 2000, the average period of treatment of patients with hemorrhagic stroke was 36.2 days.

Example 3.

Patient M., 1939, R., history 2236. Delivered by ambulance in critical condition 4.04.2001, 1 hour 15 minutes Diagnosis: closed craniocerebral injury. Brain contusion severe. Intracerebral hematoma of the right parieto-occipital region. Subarachnoid hemorrhage. Alcohol intoxication. Alcoholic disease.

The circumstances of the injury is not known, taken from the street where he was found unconscious.

Admission: state of the heavy, deep stunning, incoherent speech, is not available to contact, disoriented, left-side hemiparesis about 3 points. Can't get out of the cart. Astasia - Abaza, cachexia. Dinamico, unable to turn over in bed. On CTG conducted 04.2001, revealed massive traumatic intracerebral hematoma in the basal regions of the right temporal-occipital brain areas. Hematoma volume is about 70 ml Hematoma surrounded by a zone of perifocal edema. There are signs of compression and dislocation of the ventricular system. Decided course TCMP.

the Noah area in the occipital region, respectively, the area of projection of the hematoma, 2 of the cathode - level craniovertebral the junction of the rear and on the left mastoid. Current - 100 microamps, the duration of the session in 40 minutes. When this current observed was the appearance of positive changes on the EEG, while increasing the current strength of the patient have any motor anxiety. The next day the clear consciousness, comes into contact, but disoriented, more active, independently changes the body position in bed. Just spent 10 sessions. Concurrently received medical therapy: a pentoxifylline dose of 200 mg 3 times a day. On day 7 I started to get out of bed, and began to walk to the toilet, quite well-versed in the Department, but quickly tired and exhausted, shaky gait. According to CTG from 12.04.2001, the zone of perifocal edema in the area of the hematoma is missing, the size of the hematoma without changes, the detected decrease in radiographic density hematoma disappeared signs of mass effect. After completion of the course TCMP took pentoxifyllin within 10 days. Discharged 25.04.2001, after 21 days, in satisfactory condition, active, saved asthenic manifestations moderately expressed intellective itself in full.

According to CTG from 23.04.2001, notes: "resorption" of the hematoma, and in its place remains small size hypodensity area, no signs of mass effect.

In this case draws attention to the fact early activation of the patient with the restoration of the level of consciousness and wakefulness and rapid regression of mental disorders, which allowed us to avoid a number of serious complications specific to this category of patients, primarily as it follows from our experience, alcoholic delirium and, secondly, congestive pneumatic automation. As a rule, the period of stay of such patients in the hospital last for 2-3 months, if they don't die from complications. According to the report on the work of the Department in 2000, the average hospital bed day for this group of patients was 43.1 day.

Only method TCMP treated 20 patients: 5 with hemorrhagic stroke, 6 with ischemic stroke, 4 patients with lesions of razmozjenia brain and 5 patients with traumatic intracerebral hematomas. All patients had been achieved constant positive result. The treatment allows you to avoid surgical treatment, to reduce the treatment time and significantly reduce the appearance nevrologicheskogo the treatment time is 10-20 days allows you to achieve rapid and significant regression of neurological and psychological deficits, the method significantly reduces the amount and timing of medication. Patients take only medications that improve blood rheology, and while conventional conservative therapy includes vasoactive, dehydration, nootropic, cerebroprotective medicines and improving the rheological properties of blood.

The method developed was tested in the neurosurgical Department of the city hospital 23, , St. Petersburg.

1. A method for the treatment of acute focal brain lesions by electrostimulation of the brain and the introduction rheological drugs, characterized in that the projection zones of focal lesions in the first days after their occurrence is influenced by direct current power 100-500 μa and duration 30-40 minutes, within 10-15 days, and rheological drugs administered during and within 5-10 days after exposure to DC.

2. The method according to p. 1, characterized in that the rheological use drugs pentoxifylline.

3. The method according to p. 1, characterized in that h is

 

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