Method for the diagnosis of compensatory abilities of the brain in patients with post-stroke paralysis
(57) Abstract:The invention relates to medicine, namely to neurology. Record the electroencephalogram in the background of the formation of the conditioned reflex multiple combination of light and sound stimuli, while the sixth and twelfth combination replaces the isolated effect of light stimulation. Determine the correlation coefficient alpha oscillations of cortical areas of the brain. When reducing integrative correlation coefficient when light stimulation, the replacement of the sixth and twelfth combination, in identifying differences in the correlation coefficients of the temporal and occipital areas of the right and left hemispheres during light stimulation, replacement twelfth combination, and at low values of integrative correlation coefficient after repeated stimulation diagnose high compensatory potential of the brain. The method allows to increase the quality objective assessment of compensatory abilities of the brain. The invention relates to medicine and can be used in neurology.There is a method of assessing the functional state of the Central nervous system of man, which consists in the registration of electroencephalographic A. A. The method of estimation of the functional state of the Central nervous system and device for its implementation "Encephalitis"). While the subject is asked in the shortest possible time to establish the coincidence of the frequencies of light and sound stimuli at the expense of time on the job is not more than 30 seconds.The disadvantages of this method of assessing the functional state of the Central nervous system are the difficulty of carrying out research in patients with severe neurologic defects (post-stroke paralysis) and normally requires a single presentation of sensory stimuli, not allowing to trace system realignment neurodynamics.The closest solution is the method of monitoring the effectiveness of rehabilitation treatment of post-stroke patients, including electroencephalography at different stages of treatment and comparing the results of clinical and EEG studies (Belov, A. N., Troshin C. M. the Use of electroencephalography to monitor the effectiveness of rehabilitation treatment of post-stroke patients //Cauldron. the honey. log. - 1987. - So 68. - 35. - S. 385-386).The disadvantage of this method is otsustusi performance criteria functional recovery in patients after stroke with paralysis.The objective of the invention is to improve the quality objective assessment of compensatory abilities of the brain in patients with post-stroke paralysis on the dynamics of the formation of conditioned reflex alterations bioelectric activity of the brain during a single study.This object is achieved as follows. Patients after cerebral stroke before treatment during registration electroencephalogram form a conditioned reflex to a visual stimulus by multiple combinations of light and sound stimulation, as well as determine the coefficients of variation and the level of correlation of cortical areas in the alpha frequency oscillations.In the present study, 107 patients with post-stroke paralysis in one session was conducted by a combination of the light stimulus - flashes of light, a frequency of 10 Hz and a duration of 10 seconds with sound effects a frequency of 1000 Hz, the power of 3 dB and a duration of 5 seconds (Resonance EEG reactions in rhythmic photostimulation and changes in the functional status /A. I. Fedotchev, A. T. Bondar, A. A. Majewski, L. P. Akatova //Ukr. the Supreme. nervous activity. - 1996. , 46, 3. - S. 447-455; Fedotchev A. I. Analysis of resonant EEG>The photic stimulation was preceded by 5 seconds of noise stimulation and accompanied her for 5 seconds. The combination of stimuli in 5-second intervals repeatedly (12 times) was repeated.To estimate the speed of a conditioned reflex on the light signal of the sixth and twelfth combinations were replaced by isolated action of the light stimulus. Electroencephalography was performed according to standard methods in a background condition within 30 seconds, the recording continued during the light and sound stimuli, upon presentation of the first combination of stimuli, when the isolated action of light, the replacement of the sixth and twelfth combinations. After each photo session and noise stimulation were recorded electroencephalogram within 30 seconds. This determined the amount of alpha oscillations per second in eight standard leads (frontal, parietal, temporal, occipital right and left hemispheres: FdCdTdABOUTdFsCs, TsOs).It is known that the alpha rhythm is the most responsive to sensory stimulation and well reflects the functional state of cortical areas (Shestov I. A. et al. The dynamics of the dominant cha is.P. Pavlova. - 1996. , 46, 2. - S. 253-259). For an objective evaluation of systemic violations of neurodynamics defined indicators that reflect the relationship and interaction of components of a complex system in the formation of cerebral homeostasis.To characterize the functional state of the brain was determined by the number of alpha oscillations for each lead for each second. The study was conducted in the initial state, on the background photo and noise stimulation and subsequent 30-second segment of EEG.In accordance with theory P. K. Anokhin (1971) reflex closes on polymodal neurons of the brain, and when forming a temporary connection, the effect of generalization is followed by a decrease in the number of neurons involved in the implementation of the conditioned reflex. Correlation relationships of the various structures of the brain is an expression of the system state, including various brain structures in a single system (Zavialov A. C. the Ratio of body functions /Experimental. and clinical and physiological aspects. - M.: Medicine, 1930. - 159 C. ), so we calculated the correlation coefficients between the second fluctuations in the amount of alpha oscillations in each of the zones in the second. For the evaluation of SPO is the oscillations.The analysis of these indicators (frequency of alpha oscillations, coefficients of variation and multilateral correlation) was performed before treatment and after treatment in patients with severe, moderate improvement and no improvement of sensorimotor functions.Found the following pattern: the higher the integral (cumulative) indicator of the level of correlation of the investigated areas, the lower the effectiveness of the treatment. A high level of correlation indicates excessive generalization of the brain's response to the presentation of conditional signal that indicates a "wasteful" the mechanisms of cross-system integration. Studies in the dynamics is carried out for the search criteria, allowing to predict the outcome of rehabilitation.Method of assessment the compensatory capacity of the brain is carried out as follows. Patients after cerebral stroke, conduct clinical and electroencephalographic study before and after a course of rehabilitation treatment using pharmacokineti, massage, electrical stimulation of muscles, therapeutic exercises. The EEG recording equipment according to the standard technique in its original condition within 30 seconds the toe and twelfth combination, and within 30 seconds after each exposure. Calculate the amount of alpha oscillations per second for each abstraction, coefficients of variation, coefficient of mutual and multilateral correlation of frequency fluctuations in the amount of alpha waves, the integral of the correlation coefficient for each of the studied areas.The obtained data were compared with the results of a study of electroencephalograms 20 healthy subjects. A comparative analysis of data obtained before and after treatment of patients, divided into three groups: significant improvement after treatment, a moderate improvement and no improvement.The study established the following facts. In the initial condition of patients in all leads was observed a decrease of the alpha rhythm and the increase in its variability in comparison with healthy subjects. Draws the attention of another pattern: in 75% of cases hemispheric differences in the variability of the alpha rhythm in patients were significantly greater than in healthy.Average values of the variability of alpha activity in patients ranged from 14,81,2% to 8,21,0%, and in healthy individuals from 10,80,5% to 7,01,2%. Therefore, the ability of the brain of the camera is significantly weakened. The increased variability of the alpha-rhythm and the weakening of the level of correlation of the zones patients indicates deterioration homeostatic mechanism that supports the average level of the functional state of each zone and the cerebral hemispheres as a whole. That correlation alpha activity in patients weaker than in healthy, shows this fact: the value of the coefficients of pair correlation 0,4 more healthy met more often (in 35,70,1%) than in patients (25,00,1%, P<0,01). The average frequency of alpha oscillations, coefficients of variability, correlation coefficients in the initial state was taken as 100%.In healthy individuals at the first presentation of the light stimulus, the average number of alpha oscillations per second decreased (8,40,3%, P<0.01), and slightly decreased values of coefficients of variation (average 7,20,1%, P<0.01) and significantly increased the level of correlation of the investigated zones with each other, especially the right and left temporal areas (159%).Patients post-stroke paralysis was observed sharp (39,00,5%, P<0.01) decrease of alpha activity especially in four areas Cs, Ts, Tdand Osand a more pronounced increase is, the particularly FdCdand Odwhile the integral indicator of a correlation of the zones exceeded that of the background condition of 170%.Analysis of the indicators of a correlation of cortical areas on the frequency characteristics of the alpha rhythm during the first six combinations of light and sound stimuli showed that the level of correlation of cortical areas remains high in healthy subjects and patients (160 and 170%). This is the stage of generalization emerging conditioned reflex reaction to a light stimulus.After eleven combinations of photo - and noise stimulation in healthy subjects, the integral indicator of a correlation of the zones was reduced by 19% in comparison with the background condition and was equal to 140% (P<0,05), which reflects the concentration of the conditioned-reflex reaction and minimize it.Patients post-stroke paralysis integral indicator of a correlation of the zones after eleven combinations of stimuli remained on the same high numbers, indicating that the redundant process of generalization, preventing the concentration of the conditioned reflex.To assess the compensatory capacity of the brain EEG showing the th scale where a score of 0 corresponds to plegia, and 5 is the norm. The subgroup of patients with significant improvement consisted of patients with an increase scoring at 3-4 points after treatment. Moderate improvement was characterized by a higher points score 1-2 points. In the subgroup of patients without positive dynamics of changes in scoring occurred.The study of the frequency values of alpha oscillations, coefficients of variation and correlation before and after treatment revealed the following regularities. In patients with significant improvement has been slight fluctuations in the frequency of the alpha rhythm (from 5 to 8%, P<0.05), and patients of the other two subgroups fluctuations in the frequency of alpha waves was 10-22% (P<0,01). Therefore, patients with the worst outcomes homeostatic mechanisms do not provide adequate stability of the functional state of the brain.The values of correlation coefficients in patients with significant and moderate improvement fluctuated within narrow limits 21-65% (P<0,04), while in patients without improvement of the performance of the correlation coefficients varied more significantly (95-107%, P<0,02).In patients with significant and moderate improvement coefficients correlatio when light stimulation, superseding twelfth combination significantly decreased (26.5+7,2%, P<0,05). In the subgroup of patients without improvement of the correlation coefficients decreased only 16,02,3% (the difference is significant, P<0,02). This fact testifies to the early formation stage of concentration of the conditioned-reflex response of the brain to use conditional stimulus (light) in patients of the first two subgroups. Thus, shifts in levels of correlation of the studied areas are most associated with the indicators of the functional status and the effectiveness of treatment.Patients with better treatment outcomes (high compensatory abilities of the brain) correlation of electrical activity in cortical areas during the formation of the conditioned reflex is greatly reduced when multiple light and sound stimulation. Patients with worse outcomes (low compensatory abilities of the brain) level correlation ArcCatalog sensory stimulation.Celebrated another pattern: if the values of the correlation coefficients of the right parietal and occipital areas during photostimulation (instead of the twelfth combination) more than the left, in comparison with the background research and is smaller than the left, in comparison with the first combination for 15 or 60%, the forecast recovery of sensorimotor function in patients with high. If the level of correlation of the parietal and occipital areas of the right hemisphere during light stimulation, superseding twelfth combination differs from the index of the left hemisphere at 30%, the positive dynamics in the treatment outcome is not observed. With the increase of the integral of the correlation coefficient and its variation, redundancy shifts in the level of correlation of the zones in the formation of the conditioned reflex in one study increases the severity of neurological deficit and worsen the results of the treatment.Thus, this method allows you to objectively assess compensatory potential of the brain in patients with post-stroke paralysis, quantify the factors affecting the outcome of rehabilitation. The method also allows to process one study electroencephalo treatment for maximum effect, which points to its simplicity and availability. The calculation of the integral of the correlation coefficient between the second oscillation in the frequency of alpha waves in each of the zones is a quantitative indicator of the readiness of the brain to the formation of a conditioned reflex relations, compensation of impaired functions in patients after suffering a stroke. Method for the diagnosis of compensatory abilities of the brain in patients with post-stroke paralysis, including registration electroencephalogram (EEG) in terms of bringing light and sound stimuli and determining the frequency alfacleaner, characterized in that the EEG recorded on the background of the formation of the conditioned reflex multiple combination of light and sound stimuli, while the sixth and twelfth combination replaces the isolated effect of light stimulation, determine the correlation coefficient alfacleaner cortical areas of the brain and decreasing integrative correlation coefficient when light stimulation, the replacement of the sixth and twelfth combination, in identifying differences in the correlation coefficients of the temporal and occipital areas of the right and left hemispheres during light stimulation, replacement twelfth oceanaut high compensatory potential of the brain.
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