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.

 

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