A method of evaluating the effectiveness of therapy idebenone cognitive impairment
(57) Abstract:The invention relates to medicine, namely to psychiatry. Electroencephalographic study carried out before and after psychodiagnostic load for the mental playback charged the standard set of visual stimuli from 12 graphic figures and 16 words. Determine the index of the reactivity of the alpha rhythm spectrometric method and when it is increased at least 20% compared to baseline diagnosed with a positive outcome. The method allows to increase the precision of estimates of treatment by obtaining objective data. table 2., 3 Il. The invention relates to medicine, namely to psychiatry.Idebenone refers to drugs nootropic action. On chemical structure is a derivative of benzoquinone: 6-(10-hydroxybenzyl)-2,3-dimethoxy-5-methyl-1,4-benzoquinone. Is a stimulator of the synthesis of NGF, neuropeptide receptors which are located on the cholinergic Terminalia in cortex and hippocampi (In kN.: Radar-2001, M., 2000, S. 340).There is a method of assessing the effectiveness of enhancement through psychological tests before and after a single dose of the drug registration electroencephalo patients with acute disorders of cerebral circulation // In the book. In : proceedings of the Symposium "Clinical significance of drug nootropil". M., 1976, S. 99-105).The disadvantage of this method is the low accuracy of the study due to lack of consideration of individual functional state of the Central nervous system (CNS) at the time of the study, which largely determines the results of psychological testing.There is a method of assessing the effects of nootropic drugs on the bioelectrical activity of the brain - for example, drug piracetam. The evaluation was conducted on the change in the spectral power of the frequency bands of the EEG, including alpha-rhythm, before and after treatment (L. N. Stolyarova, A. S. Kadykov. The use of piracetam in the treatment of patients with residual effects of cerebral circulation. // In the book: Proceedings of the Symposium "Clinical use of the drug nootropil". M., 1976, S. 128-133).The disadvantage of this method is the low diagnostic accuracy in the absence of consideration of clinical manifestations and actions of the drug on cognitive function, because the change of clinical and EEG indicators are not always synchronous.The technical result of the proposed solution is to increase precision">This result is achieved by the fact that the EEG recording is carried out before and after psychodiagnostic load with the presentation of a standard set of visual stimuli from 12 graphic figures and 16 words, determine the reactivity index of the alpha rhythm spectrometric method and when it is increased at least 20% compared to baseline before treatment diagnosed positive outcome.Follows from the known level of the fact that the change in the index of reactivity of alpha-rhythm at least 20% compared to baseline levels can serve as an objective criterion for evaluating the effectiveness of treatment idebenone cognitive impairment.The method is as follows.Before treatment idebenone patients suffering from organic diseases of the Central nervous system with cognitive impairment, carry out background record EEG. Then the patient is conducted psychodiagnostic load with the presentation of a standard set of visual stimuli of 16 words and 12 graphic shapes - see figures 1, 2 (In Russian). : Atlas for research deviations of mental activity. Edited by Professor I. A. Polishchuk. Kiev, Health, 1968).During mental play these visual stimuli make powtorki. The difference between these indicators is the index of the reactivity of the alpha rhythm to the test. After a course of therapy with idebenone to 90 mg per day for 30-45 days EEG study with the use of psychodiagnostic load with a repeat measurement of the reactivity index of the alpha rhythm after treatment. Then conduct a comparison of the reactivity index of the alpha rhythm before and after treatment with idebenone and increasing at least 20% compared to baseline diagnosed with a positive outcome.The invention is illustrated by example.Example. Patient M. , 1947, R., DS: Residual effects of organic lesions of the Central nervous system traumatic Genesis with cognitive impairment. Has been examined in clinical Advisory Department of the Moscow research Institute of psychiatry of the Russian Federation Ministry of health 11.09.2000, Complaints about memory loss, impaired concentration, low mood, fatigue. In 1999 - the closed craniocerebral injury with brief loss of consciousness in the accident.Before treatment patients received background recording EEG. Then brought psychodiagnostic load, consisting of a standard set of visual stimuli: 16 words and 12 graphic shapes, see Fig is divided index alpha rhythm spectrometric method in the occipital and parietal regions of the right and left hemispheres before and after psychodiagnostic load.The results are shown in table 1.The reactivity index of the alpha rhythm, which is determined by the difference between the metric of spectral power of the alpha rhythm when playing graphic shapes, words and indicator background spectral power of the alpha rhythm, respectively 13 and 14.Patients received a course therapy idebenone at a dose of 90 mg per day for 45 days. After treatment, the patient noted improvement in memory, increased efficiency, has become more concentrated when doing intellectual work. Repeated EEG study before and after psychodiagnostic load with the presentation of a standard set of visual stimuli of 16 words and 12 graphic shapes - see figures 1, 3 (to exclude the possibility of training after the first test).The results are shown in table 2.The reactivity index of the alpha rhythm was 15.8 and 16.8 up 21.5% and 20% respectively higher than the original index of the reactivity of the alpha rhythm.Thus, the increase of the reactivity index of the alpha rhythm after therapy idebenone by 20% compared to baseline in the patient corresponded to a positive clinical outcome.The decree is treated with idebenone. The coincidence of the results of clinical and EEG studies occurred in 29 patients and 97% of cases (p<0,01).A method of evaluating the effectiveness of treatment idebenone cognitive impairment by conducting clinical psychological and electroencephalographic studies index definition of the alpha rhythm before and after treatment, characterized in that the electroencephalographic study conducted before and after psychodiagnostic load for the mental playback charged the standard set of visual stimuli from 12 graphic figures and 16 words, determine the reactivity index of the alpha rhythm spectrometric method and when it is increased at least 20% compared to baseline diagnosed with a positive outcome.
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