A method for predicting the course and outcome of hypoxic - ischemic lesions of the central nervous system in neonates with respiratory distress syndrome
(57) Abstract:The invention relates to medicine, namely to Pediatrics, and can be used to predict the course and outcome of the disease in children with respiratory distress syndrome. Spend electroencephalographic examination. Using computer analysis assess the quantitative characteristics of spectral indicators power Delta-rhythm and their spatial distribution. If from the first day of the intensive care unit the maximum spectral power observed in occipital and parietal areas, reaching respectively 119-160 µv2and 106-138 µv2and on days 2-3 power characteristics the Delta rhythm reliably prevail in the left hemisphere compared to the right, predicts favorable outcome of the disease. The method allows to prevent the development of possible neurological disorders in children and thereby improve the results of treatment of neonates with respiratory distress syndrome in hypoxic-ischemic lesions of the Central nervous system. 3 table. The invention relates to medicine, namely to Pediatrics, and can be used to predict the course and outcome of the disease is a syndrome (RDS).In recent years, thanks to the success of resuscitation and intensive therapy, many infants undergoing extreme States, has a chance to survive. However, mortality from a number of severe complications of the underlying disease remains high (Century. Century. would turn, 1989).A very common cause of respiratory disorders in the newborn, in addition to the pathology of the lungs themselves may be the malformations of the Central nervous system, cerebral or spinal birth trauma, as well as severe ischemic disorders of cerebral hemodynamics, often leading to ischemic stroke.Brain damage is one of the main reasons for admission of children in intensive care. The combination of hypoxic-ischemic brain injury with respiratory distress syndrome in newborns, regardless of the primary process in the lungs or Central nervous system, leads to a vicious circle, thereby increasing the hypoxic brain damage, and therefore the system evaluation methods the effectiveness of respiratory support should include the impact of these methods on the functional activity of the Central nervous system (G. Greisen, 1994).The development and introduction of methods of intensive therapy in neonatology practical CNS effects of using mechanical ventilation is often an easier task than restoring the functions of the CNS. From this perspective, the most urgent development of diagnostic methods, to adequately assess the severity of CNS lesions, the prognosis and the effectiveness of intensive therapy.Therefore, great interest in neonatology practice are methods of monitoring the condition of the newborn, especially non-invasive (K. Beck et al. 1977; R. D. Tallman et al., 1983), assessment of functional status of various organs and systems.To assess the condition of the Central nervous system in newborns, apply the following methods:
1. assessment of clinical neurological picture;
3. clinical and cytological examination of the cerebrospinal fluid during lumbar puncture;
4. x-ray methods (crangrape, angiography, pneumoencephalography);
7. transluminal skull;
8. ultrasound examination of the brain;
9. nuclear magnetic resonance (NMR) method of examination and computed tomography (CT);
10. electroencephalography.Clinical when misticheskuyu, than the actual position of the patient. In addition, the prevalence and variability of the brain leads to an abundance of possible combinations abnormal neurological symptoms. Clinical signs of damage to the brain stem, prognostically not reliable. As for pupillary reflexes, dilated pupils are not sufficiently constant characteristic of the subsequently detected irreversible defect of the brain. Under anoxic brain damage disappear and caloric reflexes, but this feature is unreliable as bilateral absence of Vestibulo-ocular reflex noted in transtentorial the infringement of a brain and bulk processes, as well as barbituric coma when this phenomenon is reversible (P. F. Pryor, 1969).One of the most accessible methods in everyday practice is ophthalmoscopy. Information about the diagnostic value of this study to identify and assess the extent of damage to the Central nervous system in neonates is controversial (A. I. elections., O. Century Dubela, 1987; O. Century Dubela, 1991; Sveeingsen, Eidal, 1988). The electroretinography also does not play a big role in assessing the severity of brain damage (Wilkus, 1971).Method rheoencephalography is visokoi frequency. Rheoencephalography allows you to judge the tone and elasticity of blood vessels of the brain, the amount of blood, the state of the vascular wall, reveals the asymmetry of blood in a vascular beds (H. H. information support, 1967; A. J. Mintz, M. A. Ronkin, 1967). However, standardized methods of analysis does not exist, leading remains a qualitative assessment of the data, which is subjective. Many authors studied the possibilities of evaluation of cerebral circulation, to determine whether any of its parameters have prognostic value. If the heart activity is satisfactory and swelling of the small brain, cerebral blood flow may be normal, i.e. it is sensible to examine the ratio of blood flow to the brain and consumption of oxygen in order to avoid false-positive results.The disadvantage of electromyography, taking into account the fact that in the last time for registration of potentials taken away from the muscles that are primarily used needle electrodes, is the difficulty of installation of the electrodes and execution of goal-directed movements in newborn infants. EMG helps to differentiate muscle weakness caused by damage to the CNS from weakness caused by damage to nignog the social survey (R. T. Leshner, W. W. Campbell, 1988). In addition, for some diseases there is no characteristic potentials, deviations are not specific to the nature of this disease, which significantly reduces the accuracy of diagnosis.Transluminal produced by the lamp, placed in a closed cartridge and gives the light in one direction. The lamp is placed on the baby's skull in several places and appreciate the nature and size of the glow. Healthy child around the light source is visible transparent ring thickness of 0.5-1 see If the width of the luminous ring, it may have a pathological character, giving valuable information about intracranial pathology in newborns and infants. The disadvantage of this method is ambiguous interpretation of the result, since the degree of the glow depends on the strength of the light source, the ambient light, which is the study of the age of the child, the content of pigment in the skin of the child, the adaptation of a physician. That is, the method is extremely subjective.Fairly affordable method for diagnosing intracranial hemorrhage is the clinical and cytological examination of the cerebrospinal fluid during lumbar puncture. However, his absolute diagnostiki - and subdural hemorrhage, hemorrhagic strokes in the area hemispher brain and subcortical structures do not give change cerebrospinal fluid. In addition, the obvious disadvantage of this method is its invasiveness.Crangrape in newborns, especially in the acute period, in the detection of minimal signs of divergence of cranial sutures has no clear diagnostic advantages in comparison with clinical signs, palpation. In newborns with a light increase in intracranial pressure without divergence of cranial sutures crangrape gives reference data for diagnosis (Y. A. Yakunin, E. I. Yampolskaya, S. L. Kipnis, I. M. Sysoev, 1979). Angiography is performed in children under General anesthesia, neurosurgical hospital, i.e., this method is invasive, traumatic and extremely difficult, dangerous its complications in the form of occurrence of hematoma in the area of the puncture. In addition, angiography in early childhood often does not allow you to diagnose a number of pathological conditions. Pneumoencephalography in children under the age of 3 months reveals more extensive changes than might be assumed on the basis of clinical data (E. M. Yampolskaya, 1971), however, this method also vysokotrave on the body of a newborn baby.Using one-dimensional echoencephalography (Ahaah) for the differentiation of perinatal lesions of the CNS hypoxic and traumatic Genesis does not always give reliable results, since Ahoah does not allow you to diagnose intracranial hemorrhage when events expressed generalized swelling of the brain and noinformation localization of hemorrhage in the posterior cranial fossa with the symmetric location of subarachnoid and intraventricular hemorrhage (G. S. Melnikov, 1981).With regard to sectoral Ahoah (neurosonography - the people's Assembly), it is a simple, safe method with success to identify periventricular hemorrhage, in the early stages to determine their size, distribution, and evolution. But first, the people's Assembly uninformative if you suspect another topico intracranial hemorrhages - subdural, subarachnoid localization, hemorrhages in the deep structure of the brain (N.I. Myznikova, L. I. Voronin, 1984; M. C. Bear et al., 1986; Tarby, Volpe, 1982; Bozynski et al., 1990; Toma et al., 1990). This ultrasonic technique also does not reflect the functional state of the nervous tissue.Assessment of cerebral hemodynamics using Doppler e is draconic postischemic hemorrhages and provided preliminary investigation.Recently developed nuclear magnetic resonance (NMR) method of examination and computed tomography (CT), which has undoubtedly high diagnostic value (L. A. Nikulin, 1992; Suhonen - Polvi et al., 1988; Campodonico et al., 1989, Koeda et al., 1990). However, the introduction of these highly sensitive techniques in everyday clinical practice cannot be called a wide, due to the high cost of equipment, inability surveys severe neonatal (in particular, patients on mechanical ventilation), and given the insecurity for the patient in CT (R-radiation) - which excludes the dynamic monitoring of newborns.Electroencephalography - method study of brain-based recording of electric potentials. EEG is a complex oscillatory electrical process that can be registered at the location of the electrodes on the brain or on the surface of the scalp, and is the result of electrical summation and filtering of elementary processes in the neurons of the brain.In recent years, has increased the interest of both domestic and foreign researchers to electroencephalographic (EEG)-diagnosis of CNS lesions in Novo is 1986; Wilson, Stoiner, 1986; F. Gutierrer et al., 1989; Protapet al., 1989; G. Greisen, 1994), which is probably due to the introduction of computer processing techniques EEG, P. F. Pryor (1978), Connell et al. (1988), G. Greisen (1994) recommended that EEG monitoring as an informative indicator of newborns from high-risk groups; according to their data, according to various nosologies, the relative predictive value of EEG and ultrasound examination (sonography) is similar, and in some cases changes in EEG was preceded by that of ultrasound. In addition, ultrasound, answering the question of morphological damage, allows to judge about the expected violation of the functions only indirectly (including topics and prevalence of lesions). EEG directly reflects the functional state of the brain at the same time giving information about the expected localization of the damage.An important aspect is the analysis and interpretation of EEG. The use of computer technology and mathematical methods of analysis allows to considerably speed up the processing of large arrays of EEG data (for example, when conducting EEG monitoring), to select informative features for assessing the severity of the pathological process, to assess the functional changes of the brain in various"ptx2">Computerization of processing EEG increased efficiency studies of patients with focal lesions of the brain (Boldyrev, 1978; Rusyn et al., 1987, 1988); epilepsy (Lopes da Silva et. al., 1975, 1977; Isaksson et al., 1981; Ktonas, 1983); traumatic brain injury, cerebral stroke (P. Pryor, 1979, Tolonen, 1981, 1984; Zhirmunsky, 1989).In the last 15-20 years the focus of electrophysiology aimed at studying electrical processes in different brain States. A special place is occupied by the study of such pathological conditions as coma or pre-comatose state, seizures, i.e., situations requiring urgent intervention. Sometimes neurological disorders arise suddenly, rapidly developing so rapidly, requiring emergency care. Treatment in these cases should be planned in such a way as to maintain vital functions and at the same time continue neurological examination. All this makes the solution to the problem of neonatal intensive care on a scientific basis is extremely urgent, and EEG is often the only evidence of the organic nature of the pathological process underlying the appearance of various neurological disorders.The essence of the method is that when the study children were in the EEG using an 8-channel system with constant contact single-pole electrodes, topographic maps were obtained according to the study of amplitude -,-,- and-rhythm, the correlation between the amplitudes of the waves, periodograms, power EEG and analysis transition probabilities rhythm (analysis of forty-Baksheevo). In children with depression of the Central nervous system revealed a marked increase-rhythm in both temporal lobes and the lower-rhythm (13-17 Hz) in the left temporal region compared to the right. In children with focal symptoms noted a decrease in the amplitude-2-rhythm (18-30 Hz) in the temporal and occipital lobes and increased activity in potentially intact areas. Analysis of forty-Baksheevo demonstrated a marked reduction in the number of transitions of rhythm in areas of potential damage.In the proposed method we are talking about diagnostic EEG signs of some neurological symptoms in the perinatal brain damage; no prognostic criteria of the disease, in addition, a detailed analysis that includes all spectral until the wait for those assessment of the severity of the Central nervous system in children in extreme States require physician quick decisions and immediate intervention.These drawbacks electroencephalographic method of screening newborns with perinatal brain damage can be eliminated in the invention.The objective of the invention: development of reliable and available for use in real-time method for the assessment of prognosis and outcomes of hypoxic-ischemic brain damage in newborns in extreme conditions.The problem is solved in that with the help of EEG analysis with computer processing to determine the spectral indices of power-rhythm, spatial distribution and, if the first day of the intensive care unit the maximum spectral power observed in occipital and parietal areas, and on days 2-3 power characteristics-rhythm reliably prevail in the left hemisphere compared to the right, predicts favorable outcome of the disease.As the main method of mathematical analysis of EEG elected spectral, allowing you to get more information about the frequency composition p is reflecting the presence of the entire set of rhythms;
2. mutual complex spectra, carrying the information on mutual relations of the two processes and their phase relationships.Spectral analysis allows you to:
1. To analyze more subtle structure frequency components, and to compare the frequency characteristics in different parts of the brain (frequency asymmetry), to obtain the calculated values of power, power indices, the dominant and the weighted average of the frequencies in all leads. With this purpose in software uses the fast Fourier transform. Data are represented as histograms and graphs, where X axis is frequency and the Y - axis of their power, as well as in the form of tables, taking into account the zonal distribution of basic rhythms, their percentage by regions, average and dominant frequency. Diagnostic criteria are differences of peak power and frequency in the two hemispheres (Pfurtscheller G., 1986).2. To compare the frequency characteristics in different parts of the brain, differences in the symmetric lobes of the brain (frequency asymmetry), front and rear areas of the brain.3. To analyze the degree of mastering rhythm.4. To obtain the calculated values of power, power indices, dominioni allows us to observe the dynamics of change in spatial performance immediately upon registration of EEG and during subsequent processing to determine the presence of foci of pathological activity, beginning localization and path outbreaks and discharges polymorphic and epileptiform activity.EEG is of particular importance in the examination of children with perinatal pathology, allowing objectively without resorting to invasive methods of examination, to assess the state of the brain, to a certain extent predict the outcome of acute period of the disease, and the ability to restore normal functioning of the brain.Detailed description of the method and examples of its specific implementation.Studies conducted at admission (day 1), at 2-3-day and then in the dynamics.1. The study includes dynamic and monitor monitoring using information medical EEG system Analyzer electrical activity of the brain topographic mapping "Encephalan 131-01", version 4.3 M ("Medic LTD", Taganrog), implemented on the computer IBM PC/AT. Used 12 monopolar derivations with reference electrodes on the earlobes scheme: frontal (F3, F4, F7, F8), temporal (T5, T6), Central (C3, C4), parietal (P3, P4), and occipital (O1, O2). Program each study includes:
1.1. Recording EEG in a state of relative rest (spontaneous EEG) with the x2">1.2. Spectral analysis, including the use of filtering data rhythms.1.3. Analysis of the phenomena of paroxysmal activity (PA) with spatial localization.1.4. Topographic mapping in the current time.The operability of the invention is evidenced by the following specific examples.Example 1. Child B s, history 49/3290, born 09.06.96 from the first adverse pregnancy (placental insufficiency, preeclampsia second half of pregnancy), childbirth urgent. Body weight at birth 3900,, estimation on Apgar scale 6-7 points. He enrolled in the intensive care unit 19.06.96 diagnosed with perinatal hypoxic traumatic encephalopathy, acute, severe, CNS depression syndrome. Conducted intensive respiratory therapy. For EEG examination on the first day, -, -, - and-the activity is not localized, amplitude up to 59, 33, 111 and 73 µv, respectively, the spectral power -,-,- and-rhythms was 12, 5, 127 and 32 µv2accordingly, the indicators of asymmetry of the spectral power is not expressed (7%, 1%, 9% and 8% in the rhythm). Power fluctuation range in all departments crust high; the highest in the occipital and tempeh frontal and Central derivations. In the dynamics on the 2-3rd day there was an increase of performance indicators compared with research conducted on the eve of the spatial distribution of power characteristics-activity has not changed. Increased rates of power asymmetry (60%- rhythm in the left temporal region). 04.07.96 on EEG spectral power -,-,- and-rhythms was 24, 10, 388 and 64 µv2accordingly, the indicators of asymmetry of the spectral power in the rhythm - 55% in the left temporal region, marked by short bursts of sharp waves with a predominance in the left anterior-temporal leads, power indicators - and-rhythm prevail in occipital leads
< / BR>04.07.96 the child was transferred to the neonatal care unit in satisfactory condition,
Example 2. Child-Yang, history 72/4295, born 23.08.96 from the third pregnancy (two megabit), polyhydramnios, urgent delivery at 40 weeks (caesarean section). Body weight at birth 3300,, estimation on Apgar scale 5-6 points. He enrolled in the intensive care unit 26.08.96 diagnosed with perinatal hypoxic-traumatic encephalopathy, acute, severe, symptoms of CNS depression, respiratory distress syndrome, pneumonia, atelectasis of the lungs. Transferred to the PE the public, marked hemispheric asymmetry in the rhythm in the frontal area with right-sided lateralization of up to 34%, the spectral power of the rhythms were 1, 4, 59 and 10 µv2accordingly, the indicators of asymmetry of the spectral power - 43%- rhythm). It was noted episodes of generalized bursts of slow waves. In the dynamics on the 2-3rd day EEG acquired a "flat" character with short episodes of generalized pathological waves, the marked increase in the amplitude characteristics of waves up to 114 µv and, consequently, increase the power of slow waves, indicators power asymmetry decreased to subthreshold. Performance indicators other rhythms decreased. In the dynamics noted further progressive increase in the power of the waves by reducing the amplitude of other rhythms, reduce "paroxizmalnoe". At the time of death, 31.08.96 marked generalized decrease in performance, with a simultaneous increase of the asymmetry of the spectral power in the rhythm (62%), "poor" pattern density spectral power.Surveyed 66 full-term newborns aged 0 to 42 days, with a body mass of from 2800 to 5000 g, with gestation periods of more than 38 weeks. The majority of the surveyed children (61,4 %) children received vagelos condition, with pronounced signs of respiratory distress and neurological disorders, cardiovascular disorders; the majority of children and 68% had been admitted to the intensive care unit on a ventilator.All children RDS combined with lesions of the nervous system: in 36 children (54.5 per cent) on the stage of the maternity hospital was diagnosed with perinatal hypoxic-traumatic encephalopathy, and in 32 children (48,5%) - asphyxia.All of the studied infants were divided into 2 groups: 1 - the survivors (28 children) and 2 deaths (38 children).The research results are processed by methods of descriptive statistics using arithmetic average (M), the mean square error (m), student test (t) and the degree of reliability of differences (P). Statistical treatment was carried out using startpaket "Microstat" on the computer IBM PC/AT. Statenames helped to identify the most significant features of the power components of the EEG rhythms and their distribution by regions of the cortex, as well as the variability amplitudes, different in different parts of the brain and changing in the process of dynamic observation of patients depending on the disease, and showed that the most prognostically C is the bottom of tables 1-3, where the average value of the power-activity in the 1st and 2nd groups and their variability, in the 1st group on the first day of research capacity fluctuation range in all departments crust high; the highest in the occipital and parietal leads. The variability amplitudes, according to the average standard deviations are small. In the 2nd group indicators power-band in all areas of the cortex (except skull) significantly less (p>0,001), spatial capacity values are distributed with a predominance of frontal derivations, and to the right. The variability amplitudes in the 2nd group is slightly higher.In 2-3 days the spatial distribution of power characteristics-activity dominated in the occipital areas in the 1st group is stored, and in the 2nd group cardinality indicators-rhythm fully represented in the Central leads, maintained right-sided lateralization. Variability ranges compared to the first day grew and dominated in the 1st group. Performance indicators reliably prevail now in the 2nd group (p>0,001).In the 1st group on the eve of the statement of the spectral distribution of power indices in the range remains the same (is cliche in the spectral power distribution of indicators across the cortex in a range not mentioned. In General, performance indicators slow rhythms predominate in the 2nd group. Variability in the 1st group on the eve of the statement somewhat smaller, in the 2nd group, in contrast, are growing.As for average power (MCP), the 1st day was statistically significant predominance of MCP-rhythm in the 1-St group compared with the 2nd. In dynamics has been a considerable increase in MCP, but later in the 1st group as the stabilisation of the power characteristics of the rhythm was not significantly changed, and in the 2nd group as weight status performance indicators declined. Draws attention to the significant prevalence of indicators of power-rhythm 2-3 days in leads with the left hemisphere in the 1-St group compared with the 2-nd (p>0,001), where, in contrast, is not only not observed significant differences in this indicator in the hemispheres, but also as weight status, the difference in the spatial distribution of power indicators-rhythm is becoming less pronounced.The accuracy of the proposed method is to 87.6%.As seen from the above examples, the inventive method is simpler and more efficient in comparison with the known and compared with routine visual unctionally condition of the Central nervous system in real time and over time.2. Thanks to computer programs easy to use.3. Preliminary analysis of only one of the rhythms, the most significantly different in a number of other characteristics, does not require a long time and does not cause difficulties in interpretation.4. Can serve as a criterion of adequacy of therapy.5. Allows early to predict the course of the disease and to correct, if possible, the tactics of conducting the patient and his treatment.6. Can be used in maternity hospitals, intensive care units and the departments of pathology of newborns, without requiring special conditions and without interfering with the provision of remedial measures.The inventive method will allow us to predict the degree of damage, the functional state of the CNS, the course and outcome of the disease in newborns with hypoxic-ischemic and traumatic brain injury and RDS and thereby reduce the development of complications. A method for predicting the course and outcome of hypoxic-ischemic lesions of the Central nervous system in neonates with respiratory distress syndrome, including electroencephalographic study, characterized in that jenstvennoe distribution and if from the first day of the intensive care unit the maximum spectral power observed in occipital and parietal areas, reaching respectively 119-160 µv2and 106-138 µv2and on days 2-3 power characteristics-rhythm reliably prevail in the left hemisphere compared to the right, predicts favorable outcome of the disease.
FIELD: medicine, neurology, psychopathology, neurosurgery, neurophysiology, experimental neurobiology.
SUBSTANCE: one should simultaneously register electroencephalogram (EEG) to detect the level of constant potential (LCP). At LCP negativization and increased EEG power one should detect depolarizational activation of neurons and enhanced metabolism. At LCP negativization and decreased EEG power - depolarized inhibition of neurons and metabolism suppression. At LCP positivation and increased EEG power - either repolarized or hyperpolarized activation of neurons and enhanced metabolism. At LCP positivation and decreased EEG power - hyperpolarized suppression of neurons and decreased metabolism of nervous tissue. The method enables to correctly detect therapeutic tactics due to simultaneous LCP and EEG registration that enables to differentiate transition from one functional and metabolic state into another.
EFFECT: higher accuracy of diagnostics.
5 dwg, 1 ex, 1 tbl
FIELD: medicine, neurology.
SUBSTANCE: one should establish neurological status, bioelectric cerebral activity, availability of perinatal and ORL pathology in patients, establish their gradations and numerical values followed by calculation of prognostic coefficients F1 and F2 by the following formulas: F1=-31,42+1,49·a1-2,44·a2+0,2·а3+1,63·a4+0,62·а5+3,75·a6+1,8·а7-3,23·a8-0,8·а9-1,32·а10+3,26·а11+8,92·a12-2,0·a13+3,88·а14+1,79·a15+0,83·a16-2,78·a17; F2=-27,58+1,43·a1+3,31·а2+0,08·а3+3,05·а4-0,27·а5+2,69·а6+3,11·а7-6,47·a8-6,55·a9+1,99·а10+5,25·а11+7,07·a12-0,47·a13+0,13·a14+4,04·a15-1,0·a16-1,14·а17, correspondingly, where a1 - patient's age, a2 - studying either at the hospital or polyclinic, a3 - duration of stationary treatment (in days), a4 - unconscious period, a5 - terms of hospitalization since the moment of light close craniocerebral trauma, a6 - smoking, a7 - alcohol misuse, a8 - arterial hypertension, a9 - amnesia, a10 - close craniocerebral trauma in anamnesis, a11 - psychoemotional tension, a12 - meteolability, a13 - cervical osteochondrosis, a14 - ORL pathology, a15 - availability of perinatal trauma in anamnesis with pronounced hypertension-hydrocephalic syndrome, a16 - availability of paroxysmal activity, a17 - availability and manifestation value of dysfunction of diencephalic structures. At F1 ≥ F2 on should predict the development of remote aftereffects in young people due to evaluating premorbid background of a patients at the moment of trauma.
EFFECT: higher reliability of prediction.
2 ex, 1 tbl
FIELD: medicine; medical engineering.
SUBSTANCE: method involves doing multi-channel recording of electroencephalogram and carrying out functional tests. Recording and storing rheoencephalograms is carried out additionally with multi-channel recording of electroencephalogram synchronously and in real time mode in carotid and vertebral arteries. Electroencephalograms and rheoencephalograms are visualized in single window with single time axis. Functional brain state is evaluated from synchronous changes of electroencephalograms, rheoencephalograms and electrocardiograms in response to functional test. The device has electrode unit 1 for recording bioelectric brain activity signals, electrode unit 2 for recording electric cardiac activity signals, current and potential electrode unit 3 for recording rheosignals, leads commutator 4, current rheosignal oscillator 5, synchronous rheosignal detector 6, multi-channel bioelectric brain activity signals amplifier 7, electrophysiological signal amplifier 8, demultiplexer 9, multi-channel rheosignal amplifier 10, multi-channel analog-to-digital converter 11, micro-computer 12 having galvanically isolated input/output port and personal computer 13 of standard configuration.
EFFECT: enhanced effectiveness of differential diagnosis-making.
11 cl, 6 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: method involves recording multichannel electroencephalogram, electrocardiogram record and carrying out functional test and computer analysis of electrophysiological signals synchronously with multichannel record of electroencephalogram and electrocardiogram in real time mode. Superslow brain activity is recorded, carotid and spinal artery pools rheoelectroencephalogram is recorded and photopletysmogram of fingers and/or toes is built and subelectrode resistance of electrodes for recording bioelectrical cerebral activity is measured. Physiological values of bioelectrical cerebral activity are calculated and visualized in integrated cardiac cycle time scale as absolute and relative values of alpha-activity, pathological slow wave activity in delta and theta wave bandwidth. Cerebral metabolism activity dynamics level values are calculated and visualized at constant potential level. Heart beat rate is determined from electrocardiogram, pulsating blood-filling of cerebral blood vessels are determined from rheological indices data. Peripheral blood vessel resistance level, peripheral blood vessel tonus are determined as peripheral photoplethysmogram pulsation amplitude, large blood vessel tonus is determined from pulse wave propagation time data beginning from Q-tooth signal of electrocardiogram to the beginning of systolic wave of peripheral photoplethysmogram. Postcapillary venular blood vessels tonus is determined from constant photoplethysmogram component. Functional brain state is determined from dynamic changes of physiological values before during and after the functional test. Device for evaluating functional brain state has in series connected multichannel analog-to-digital converter, microcomputer having galvanically isolated input/output ports and PC of standard configuration and electrode unit for reading bioelectric cerebral activity signals connected to multichannel bioelectric cerebral activity signals amplifier. Current and potential electrode unit for recording rheosignals, multichannel rheosignals amplifier, current rheosignals generator and synchronous rheosignals detector are available. The device additionally has two-frequency high precision current generator, master input of which is connected to microcomputer. The first output group is connected to working electrodes and the second one is connected to reference electrodes of electrode unit for reading bioelectrical cerebral activity signals. Lead switch is available with its first input group being connected to potential electrodes of current and potential electrodes unit for recording rheosignals. The second group of inputs is connected to outputs of current rheosignals oscillator. The first group of outputs is connected to current electrodes of current and potential electrodes unit for recording rheosignals. The second group of outputs is connected to inputs of synchronous detector of rheosignals. Demultiplexer input is connected to output of synchronous detector of rheosignals and its outputs are connected to multichannel rheosignals amplifier inputs. Outputs of multichannel bioelectrical cerebral activity signals amplifier, multichannel rheosignals amplifier and electrophysiological signal amplifier are connected to corresponding inputs of multichannel analog-to-digital converter. Microcomputer outputs are connected to control input of lead switch, control input of multichannel demultiplexer, control input of multichannel analog-to-digital converter and synchronization inputs of current rheosignals oscillator and synchronous detector of rheosignals. To measure subelectrode resistance, a signal from narrow bandwidth current generator of frequency f1 exceeding the upper frequency fup of signals under recording is supplied. A signal from narrow bandwidth current generator of frequency f2≠ f1>fup is supplied to reference electrode. Voltages are selected and measured at output of each amplifier with frequencies of f1, f2 - Uf1 and Uf2 using narrow bandwidth filtering. Subelectrode resistance of each working electrode is determined from formula Zj=Ujf1 :(Jf1xKj), where Zj is the subelectrode resistance of j-th electrode, Ujf1 is the voltage at output from j-th amplifier with frequency of f1, Kj is the amplification coefficient of the j-th amplifier. Subelectrode resistance of reference electrode is determined from formula ZA=Ujf2 :(Jf2xKj), where ZA is the subelectrode resistance of reference electrode, Ujf2 is the voltage at output from j-th amplifier with frequency of f2, Jf2 is the voltage of narrow bandwidth current oscillator with frequency of f2.
EFFECT: wide range of functional applications.
15 cl, 10 dwg
FIELD: medicine, psychiatry.
SUBSTANCE: one should conduct EEG-testing to detect total value of the indices of spectral power or percentage spectral power of delta- and teta-rhythms due to spectrometric technique in frontal, parietal, central and temporal areas both before and during emotional-negative loading when visual emotionally negative stimuli are presented followed by their imaginary reproduction. In case of higher indices to visual stimuli being above 15% against the background one should diagnose epilepsy. The method enables to increase the number of diagnostic means, increase accuracy and objectivity in predicting epilepsy with polymorphic paroxysms at dissociation of clinical and EEG-values.
EFFECT: higher efficiency of diagnostics.
1 ex, 1 tbl
FIELD: medicine, neurophysiology.
SUBSTANCE: one should carry out EEG survey to detect spectrometrically the index of full range if alpha-rhythm both before and after therapy. Moreover, power index of full range of alpha-rhythm and the index of 9-10 Hz-strip's spectral power should be detected in occipital cerebral areas. One should calculate the value of the ratio of the index of 9-10 Hz-strip's spectral power to the index of full range of alpha-rhythm and at the increase of this value by 20% against the background it is possible to evaluate positive result of therapy. The method increases the number of diagnostic means applied in evaluating therapeutic efficiency in the field of neurophysiology.
EFFECT: higher efficiency of evaluation.
FIELD: medicine, neurology.
SUBSTANCE: method involves carrying out the standard vascular and nootropic therapy. Diazepam is administrated under EEG control with the infusion rate that is calculated by the following formula: y = 0.0015x - 0.025 wherein y is the rate of diazepam administration, mg/h; x is an average EEG amplitude, mcV. Method provides enhancing the effectiveness of treatment of patients. Invention can be used for treatment of patients in critical severe period of ischemic insult.
EFFECT: enhanced effectiveness of treatment.
2 tbl, 1 dwg, 1 ex
SUBSTANCE: method involves selecting signals showing patient consciousness level and following evoked auditory potentials as responses to repeating acoustic stimuli, applying autoregression model with exogenous input signal and calculating AAI index showing anesthesia depth next to it.
EFFECT: quick tracing of unconscious to conscious state and vice versa; high accuracy of measurements.
9 cl, 3 dwg
FIELD: medicine; experimental and medicinal physiology.
SUBSTANCE: device can be used for controlling changes in functional condition of central nervous system. Device has receiving electrodes, unit for reading electroencephalograms out, analog-to-digital converter and inductor. Low noise amplifier, narrow band filter linear array which can be program-tuned, sample and store unit, online memory, microcontroller provided with controlled permanent storage, liquid-crystal indicator provided with external control unit are introduced into device additionally. Receiving electrodes are fastened to top part of patient's head. Outputs of electrodes are connected with narrow band filters linear array through electroencephalograph. Output of linear array is connected with input of input unit which has output connected with input of analog-to-digital converter. First bus of analog-to-digital converter is connected with online storage. Recording/reading bus of microcontroller is connected with control input of input unit and its starting bus is connected with address input of online storage. Third control bus is connected with narrow band filters linear array. Second control bus is connected with liquid-crystal indicator. Output bus is connected with inductor. External control (keyboard) of first control bus is connected with microcontroller. Output of online storage is connected with data input of microcontroller through 12-digit second data bus. Efficiency of influence is improved due to getting specific directed influence being based onto general technological transparency of processing of human brain's signals and strictly specific influence based on the condition of better stimulation.
EFFECT: increased efficiency.
3 cl, 1 dwg, 1 tbl
FIELD: medicine, neurology, professional pathology.
SUBSTANCE: one should carry out either biochemical blood testing and electroencephalography or SMIL test, or ultrasound dopplerography of the main cranial arteries, rheoencephalography (REG) to detect the volume of cerebral circulation and hypercapnic loading and their digital values. Then it is necessary to calculate diagnostic coefficients F by the following formulas: Fb/e=6.3-0.16·a1+0.12·a2-1·a3+0.2·a4, or FSMIL=9.6+0.16·a5-0.11·a6-0.14·a7+0.07·a8, or Fhem=48.6-0.04·a9+0.15·a10+13.7·a11-0.02·a12+24.7·a13, where Fb/e -diagnostic coefficient for biochemical blood testings and EEG; FSMIL - diagnostic coefficient for SMIL test; Fhem - diagnostic coefficient for hemodynamic testing; 6.3; 9.6 and 48.6 - constants; a1 - the level of vitamin C in blood; a2 - δ-index by EEG; a3 - atherogenicity index; a4 - the level of α-proteides in blood; a5 - scale 3 value by SMIL; a6 - scale K value by SMIL; a7 - scale 5 value by SMIL; a8 - scale 7 value by SMIL; a9 - the level of volumetric cerebral circulation; a10 - the value of linear circulatory rate along total carotid artery, a11 - the value of resistive index along total carotid artery; a12 - the value for the tonicity of cerebral vessels at carrying out hypercapnic sampling by REG; a13 - the value for the intensity of cerebral circulation in frontal-mastoid deviation by REG. At F value being above the constant one should diagnose toxic encephalopathy, at F value being below the constant - discirculatory encephalopathy due to applying informative values.
EFFECT: higher accuracy of diagnostics.
6 ex, 1 tbl