The method of treatment diencephalic syndrome

 

(57) Abstract:

The invention relates to medicine and can find application in the treatment of Central autonomic disorders. In addition to drug therapy tranquilizers and symptomatic drugs to patients diencephalic syndrome conducting anode micropolarization ganglia solar plexus, referring to the constant electric current power 800-1000 µa for 35-45 min daily for 10-15 days. With 5-6 days of treatment, gradually reduce the amount of injected drugs to complete their withdrawal by the end of treatment. Such impacts if necessary, repeat not earlier than 2 months. The method allows to reduce the treatment time up to 2-2,5 weeks, reduce the amount of injected drugs and dosages to the complete abolition.

The invention relates to medicine, namely to neurology, and may find application in the treatment of Central autonomic disorders.

Diencephalic syndrome (hereinafter referred to as DS) is one of the most common types of neurological pathology. The most common form of DS, known as dystonia occurs in 31% of urban residents over the desposable. The consequences of DS in the form of cardiac and vascular cerebral accidents, severe endocrine pathology in more than 40% of cases lead to permanent disability. The incidence of DS detects a clear tendency to increase, especially in industrialized countries. A characteristic feature of this disease is expressed resistantly all available to date treatment methods.

DS is polietiologic disease with polymorphic symptomatology. The allocation of DS in independent clinical diagnostic form due to common pathogenetic mechanism, the core of which is persistent increased excitability diencephalic (hypothalamic) structures of the brain, leading to dysregulation of various visceral, neurohumoral and emotional functions.

At the present time to ensure that the BC conservative treatments such as drug therapy, physiotherapy, radiotherapy, diet and balneotherapy. Drug treatment is mainly symptomatic and is directed primarily to normalize disturbed by this form DS functions: circulation, digestion, vnutrenestey therapy DS through the introduction of drug benzodiazepine group (Relanium), which reduces the excitability of the neural substrate, in particular stem structures of the brain, as well as symptomatic means. This method is taken as a prototype (Wayne A. M., Solovieva, A. D., Kolosov O. A. Vegetative-vascular dystonia. - M.: Medicine, 1981, S. 276; Schaefer, D. Hypothalamic syndromes. - M.: Medicine, 1971, S. 340).

He is that sick DS is injected oral Relanium up to 10 mg per day, and as symptomatic therapy may be imposed, depending on the predominant symptoms, the following drugs:

1) vasodilator: Cinnarizine 25 mg 3 times per day, reverse 5 mg 3 times per day or other vasodilator;

2) hypotensive: clonidine 0.075-0.15 mg 2-3 times per day;

3) antispasmodics: no-Spa on 40-80 mg 1-2 times per day;

4) regulatory peristalsis: reglan 10-20 mg 1-2 times per day;

5) blockers: inderal for 10-40 mg 2-3 times a day, peroxan 15-30 mg 2-3 times per day;

6) antidepressants: amitriptyline 25 mg 2-3 times per day;

7) vitamins b, C;

8) electrolytes and trace elements: Panangin 1 tablet 3 times daily, potassium orotate 0.5-1 g 3 times per day;

9) antihistamines: suprastin 25 mg 1-2 RA is sick DS with this method of treatment are reduced by the parenteral administration of 0.5% solution Relanium at a dose of 4-6 ml

This method of treatment DS allows in most cases to achieve a positive effect in the improvement of the General condition of patients, weakening the main symptoms of the disease, and in some cases ischemia autonomic seizures and reduce the degree of their manifestation. In isolated cases may occur short remission duration of 1-2 months. Relapses are associated, generally, with the influence of exogenous factors (geomagnetic fluctuations, meteosensitivity, stress), and with the cessation of medication. With consistent use of individually prescribed medicines for diseases wave, periods of ill health of the patients can be associated with addiction to the drugs, forcing, or increase the dose up to the allowable limits, or jump to the use of drugs in its class. Terms of hospital stay in these patients from 5 weeks to 2-3 months, depending on the severity of the condition, outpatient treatment when this is done for life. The cure for the DS does not.

As you can see, the disadvantages of this method of drug therapy DS are:

1) indiscriminate, diff is idealny selection of therapy;

3) the need for constant, almost a lifetime, the medication;

4) possible side effects of potent drugs,

5) the possibility of addiction to specific drugs in the first place - to tranquilizers;

6) polipragmazie;

7) required the necessity of repeated inpatient treatment to modify the schema of drug therapy.

The application of other, known from the literature and permitted treatment methods DS (physiotherapy, balneotherapy, and Spa treatment, and so on) on the state of the ball is not significantly affected.

Up to the present time, the methods of the local conservative influence on solar ganglia with diencephalic syndrome has not been applied.

The technical result of the present invention is to reduce the length of stay in the hospital for 10-14 days, reducing the number of used drugs to 1-2 drugs and reducing their dosages 2-3 times, until their complete abolition.

This result is achieved by the fact that in addition to the described method of drug therapy in patients with DS is anodic micropolarization ganglia solar plexus through in the 5th-6th day gradually decreasing the amount of injected drugs to complete their withdrawal by the end of treatment, and this action, if necessary, be repeated not earlier than 2 months.

Being engaged for several years in the treatment of patients with focal lesions of the brain, we, along with surgical treatment and drug therapy, tried to apply and anodic polarization on the method of transcranial micropolarization - TCMP (Bogdanov O. Century and other RF Patent 2122443 from 01.07.1997), placing electrodes on the scalp in the areas of projection of acute lesions (Naryshkin, A. G., shelyakin A. M., Tyulkin O. N., Gorelik A. L. a Method for the treatment of acute focal brain lesions. RF patent 2188674 from 10.09.2002).

However, we observed high efficiency of such effects and no side effects. Attempts to apply this method for the treatment of DS is unknown to us.

Watching lately patient O., 50 years, about postaccording toxic Solarium with daily, stormy, autonomic crises and the lack of effect of drug therapy ganglioblokatorami, tranquilizers and antispasmodics, we tried to hold him anodic polarization Sunny the impact when TCMP.

After the fifth procedure unexpectedly found that within three days our patient was missing solar vegetative crises. This prompted us to extend the course of polarization of up to 10 treatments, which led to the regression of vegetative symptoms. This observation led us to the thought clinically to examine the state of the solar plexus ganglia in patients with DS, because most of them were observed similar symptoms. It was found that almost all patients BC is soreness solar points and highlights of objective clinical signs of autonomic nervous irritation varying degrees of severity.

Then we tried to apply a similar method for the treatment of patients BC, selecting empirically optimal exposure parameters. Depending on the particular situation and the severity of the pathological manifestations of the current ranged from 800 to 1000 μa, and the duration of one procedure - 35-45 minutes Criteria optimal DC power when exposed to solar ganglia and its duration was subjective feelings of sleepiness, discomfort under the electrodes.

When power DC m is an unpleasant sensation under the electrodes, accompanied by redness of the skin. When exposure time is less than 20 minutes typical changes have not had time to develop, and when extending the impact of more than 45 minutes in some patients reported discomfort in the form of heaviness in the head and in the epigastric region, feelings of anxiety, weakness.

As our experience, this method of exposure of the nerve of the solar plexus when DS can effectively arrest the autonomic seizures are significantly reduced, up to the complete abolition, the dose of medicines, and also to achieve a stable and long-term remission. Moreover, such a result can be obtained in 1-2 weeks, depending on the severity of the disease.

The nature and effectiveness of the method is illustrated by the following examples.

Example 1.

Patient M. , 1950 R., IB 4698/2001, received 10.09.2001 with the diagnosis of Cerebral arachnoiditis with diencephalic syndrome". Upon receipt of a complaint by intense headaches in parietotemporal departments, more to the right, constant, compressive in nature, the sense of disruption of heart rhythm, the constant feeling of abdominal discomfort, seizures, tachycardia, chills, chills and a feeling of tightening in anecdotiana pollakiuriya and diarrhea.

This deterioration within 6 months, the attacks have become daily, appeared anorexia, in connection with which the patient has lost 17 kg weight, and insomnia, the symptoms of depression.

From the anamnesis: similar symptoms with the age of 20, with the frequency of attacks up to two times per month, rheumatism, cerebral rheumatic vasculitis, small chorea in the pubertal period, blunt abdominal trauma without surgery at the age of 13 years, at the age of 36 years - spontaneously developed extreme pain in the lumbar-thoracic spine, forcing sick for 4 months to use crutches, without convincing objective violations. Annual depressive episodes. Observed by a physician with a diagnosis of coronary heart disease: atherosclerotic cardiosclerosis, paroxysmal tachyarrhythmia, urolithiasis, 2-sided nephroptosis 2-nd degree, concretions both kidneys.

Constantly gets Relanium to 20-25 mg per day, in the paroxysms in the form of injection, amitriptyline 25 mg 2 times a day, ranitidine 0.3 g 3 times per day, inderal 40 mg per day, parasol and but, silos at rises HELL, and potassium orotate and multivitamin complexes.

On examination, some up to 110 per minute with frequent PVCs, HELL 130/80 mm, vesicular breathing, the abdomen is soft, painful in all departments, with deep palpation - unbearable pain in solar spots, with perverted pupillary reaction, against which at the time of inspection has evolved reduced autonomic seizure with fever, tremor, redness of the skin of the upper body. Severe pain when moving palpation of the large arteries, more to the right. The vegetation index of irritation on Markelov - 3. Neurologically: transient, poorly expressed anisocoria right, deep reflexes somewhat strengthened right, coordenadoria sample with light intentsionnogo tremor predominant on the left.

Blood tests, urine - without features.

ECG signs of left ventricular hypertrophy.

Ophthalmologist: myopia small degree.

CT scan abdomen - without pathological changes.

Electroencephalogram: expressed cerebral changes in diffuse-organic type with signs of deep stem dysfunction mainly diencephalic level.

On the basis of the clinical examination were diagnosed: "Diencephalic syndrome toxic-metabolic etiology with vegetariana to the following treatment:

1) Relanium - 20 mg per day;

2) inderal 40 mg per day;

3) peroxan - 30 mg 2 times a day;

4) Cavinton - 5 mg 3 times a day;

5) Panangin - 2 tablets 2 times a day.

On the background of this therapy for three days, the patient has slightly decreased headaches, but the rest of the symptoms remained, autonomic seizures were observed daily. Then she was offered a course anodic polarization ganglia solar plexus. The current strength was 800 μa, the current increases, the patient appeared a burning sensation under the electrodes, decreasing the irritability and anxiety. If the procedure lasts longer than 45 minutes it was weakness and drowsiness, the effect in the form of a feeling of total comfort and relaxation came in the 30th minute of the action. After the third procedure, the patient stopped the seizures, and the fifth - pain and discomfort completely regressed. From this point the patient independently stopped taking any medicines, first of all tranquilizers. Upon completion of the course of the 10 procedures, complaints, neurological and somatic symptoms completely disappeared, the patient was discharged after hospital 15 days. Two me complaints. Ambulatory patient underwent repeated course anode of micropolarization. Subsequent she is in remission at the moment.

Thus, the application of the anode micropolarization on the projection area of solar ganglia allowed not only for the first time and in full to alleviate chronic patient, but also to eliminate the dependence on drugs.

Example 2.

Patient I. , 1926, R., IB 1012/2002, received 18.02.2002, observed by us (A. G. Naryshkin) for more than 20 years. Complains of frequent, when ill - daily attacks in the form of intense burning-pressure-headache, pollakiuria accompanied pulling pains in the left half of the abdomen, lift the HELL up to 250 / 120g mm, melanopogon symptoms, cold and numbness in the extremities. The duration of the attack is usually 2-3 hours, stopped by the introduction of from 2 to 6 ml Relanium intramuscularly.

History: malaria, tuberculosis bronchogenic, frequent stressful situations, strumectomy at 7 years of age, rubella with neurological complications of suppurative appendicitis complicated by peritonitis, dysentery, tonzillogenna syndrome. Since 1978, began to disturb the attacks of burning pain in the left abdomen, and in 1980 - for the first time is 1984 in the clinic IEM USSR chosen complex therapy, including gangleronum and Relanium, against which the frequency of attacks decreased in 2 times. In subsequent continued to use this scheme, independently adjusting the doses. Addressed in connection with the frequent attacks after discontinuation of the drug gangleronum.

Admission: skin pale yellowish, dry, reduced turgor, expressed pastos legs, elements of alopecia. A slight shake of the head and hands alone. Sharp pain on palpation of the upper, middle, lower solar points, edges of crests of the iliac bones. Pain when moving palpation of the vessels of the upper and lower extremities up to a. tibialis on the feet and a. radialis on wrists, also tenderness to palpation a. temporalis on both sides, more on the left. Emotionally unstable, whining.

Ophthalmologist: incipient cataract, atherosclerosis of the retina.

Therapist: chronic bronchitis, pneumosclerosis, emphysema, respiratory failure 0-1 degree, hypothyroidism, coronary heart disease: atherosclerotic cardiosclerosis, circulatory insufficiency of 1-2 degrees.

Radiography of the spine: common involutive osteochondrosis, Shinnai fiber is not revealed. Atherosclerosis of the abdominal aorta.

ECG: migration supraventricular pacemaker, incomplete blockade of the right bundle branch, the deviation of the electrical axis to the left, left ventricular hypertrophy, impaired repolarization.

EEG: prominent diffuse changes of bioelectric activity with signs of deep stem dysfunction.

Based on the data of the anamnesis and clinical evaluation confirmed the diagnosis: "Diencephalic syndrome of infectious and metabolic dysfunction with autonomic seizures".

Treatment scheme, similar to that described in example 1, with the addition of aminophylline to 15 mg 3 times a day, clonidine 0,075 mg / day and L-thyroxine, which the patient takes regularly. Additionally, the patient was offered a course of polarization of solar ganglia with exposure parameters, similar to those described in example 1.

On the 4th day of hospital stay and after two sessions micropolarization paroxysms ceased and was never recovered. After 6 treatments significantly improved overall health, increased emotional background, the vegetative signs of irritation were reduced to index - 1 Markelov. From that moment started Passepartout. With 8 days of treatment the patient had not taken any drugs, except for L-thyroxine. A total of 12 sessions. Discharged from the hospital on the 18th day. After discharge and to this day feels good, the only attack in the reduced form was observed in August 2002

Example 3.

Patient M., 53 years old, invalid of the 2nd group was treated as an outpatient, physician recommendations, in June 2002, complaining of constant fatigue and chronic fatigue, frequent polymorphic headaches with dizziness and nausea, sleep disorders, a variety of dyspeptic disorders, frequent ascents AD with a picture of hypertensive crises (from 2 to 6 times per month), stopping only ambulances, allergic reactions in the form of urticaria, rhinitis, bronchial asthma with frequent attacks of breathlessness accompanied by fever, paresthesia, cold and numbness in the extremities. Constantly takes Relanium (diazepam) 5 mg up to 4 times a day, various anti-allergic and anti-hypertensive drugs.

Suffering from a real disease with 26 years of age, when they moved gipertoksicheskaya form of the flu. The disease is progredient-progressive. Repeatedly examined and angelina asthma, coronary heart disease: atherosclerotic cardiosclerosis, hypertension 2 tbsp., gall-stone disease, chronic pancreatitis, chronic enterocolitis. The last seven years has the 2nd group of disability.

History: measles, scarlet fever, dysentery, youth frequent tonsillitis, tonsillectomy, dystonia, twice a concussion, there is also a chronic stressful situation in the family: son suffers from mental illness.

On examination: skin is pale, moist, pasty, pronounced red dermographism. Muffled heart sounds, HELL -150/90, lungs breathing hard. The abdomen is soft, painful in all departments. There has been a sharp pain in solar points, the index of autonomic nervous irritation - 3 Markelov.

EEG: a pronounced stem dysfunction, with prevalence at the level of the diencephalic region, lowering the threshold of convulsive readiness.

Ambulatory patient, the course anode of micropolarization ganglia solar plexus with the force of a current of 1000 μa, because at a lower amperage wasn't the typical effect of drowsiness and relaxation. Procedure duration was 35 minutes, as the effects observed with the fifth procedure, asthma attacks stopped, the AD is established on the numbers 130/80 mm From this moment abolished Relanium started a gradual reduction of the dose of clonidine conventional scheme (to avoid withdrawal syndrome). Altogether there were 12 treatments. Upon completion of the course marked regression of pain and discomfort, allergies, improve emotional state, restoring night's sleep, stabilization HELL on figures 125/80 mm medications completely stopped.

In the future, after a two-month remission was noted partial resumption of the old symptoms in the reduced form, the patient again began to take Relanium - 1-2 tablets per week. Currently undergoing a second course of micropolarization.

To date, the proposed method were treated 6 patients with a diagnosis of Diencephalic syndrome": 4 women and 2 men. Age from 26 to 73 years, disease duration from 5 to 33 years. All patients noted marked and persistent improvement of health, the positive dynamics of clinical and laboratory tests. Four of them have completely stopped taking the medication, two moved from permanent to episodic taking tranquilizers when rare and blurred her disability 2-th group, returned to work. The number of courses ranged from 1 to 3, the timing of the current remission from 2 to 8 months. Available observations, therefore, indicate a high efficiency of the proposed method in comparison with other known methods has several advantages:

1) significantly reduces the treatment time up to 2-2,5 weeks, while the time of treatment of patients BC otherwise constitute from 5 to 6 weeks.

2) reduces the amount of injected drugs to 1-2 drugs and reduces their dosage, up to the complete abolition, while conventional drug therapy includes a large (up to 5-7 drugs for the individual patient), the number of drugs and often allows for increased dosages.

The method is developed and has been clinically tested in the neurosurgical Department of the City hospital 23 St. Petersburg.

The method of treatment diencephalic syndrome by tranquilizers and symptomatic drugs, characterized in that it further conducting anode micropolarization ganglia solar plexus, influencing them permanent electraspan reduce the amount of injected drugs to complete their withdrawal by the end of treatment, and such impacts if necessary, repeat not earlier than 2 months.

 

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FIELD: medicine.

SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

3 cl, 3 dwg

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