Method for treating patients for parkinsonism

FIELD: medicine.

SUBSTANCE: method involves applying thermomagnetic self-excitation inductance treatment of 1.2-2 Tesla units in subcortical nuclei projection with effective frequencies detected from increased amplitude of somatosensory and motor invoked potential and dophamine level growth in blood or liquor, reduced basic rhythm disorganization on electroencephalogram before and after applying thermomagnetic self-excitation inductance treatment. Synchronized median nerve electrostimulation with rectangular pulses is concurrently carried out with current intensity equal to 12-18 A and pulse duration of 0.1-0.l3 ms in trains of 3-5 s duration and 6-10 s long pauses with pulse succession frequency equal to 50 Hz daily during 15-30 min. The total treatment course is 10-20 days long.

EFFECT: enhanced effectiveness of treatment.

 

The invention relates to medicine, namely, neurology and neurosurgery, and can be used for the treatment of parkinsonism and Parkinson's syndrome, caused by various factors.

There is a method of treatment of speech disorders by exposure to a pulsed magnetic field on the intracranial part of the caudal group of cranial nerves in the posterior cranial fossa, and the electric pulses on the peripheral part of the nerve in the neck. The intensity of the pulsed magnetic field of 1.5-2.0 Tesla. At the same time conduct electrical stimulation rectangular pulses with amperage 12-20 mA, pulse duration of 0.1-0.3 MS. The duration of exposure of 20 minutes. This impact exercise daily for 10-15 days, repeating it if necessary within 1-1 .5 months (patent No. 2197297).

However, this method has significant drawbacks. Magnetic stimulation and electrical stimulation is carried out without regard to the frequency characteristics of bioelectric activity of the brain, which, in turn, can lead to reduced performance impact, and also lead to various complications.

The closest that we have chosen as a prototype, is a method of treatment of patients in coma and vegetative state, including the effects of synchronized magnetic field, sees the school and the electrical stimulation is the most effective frequencies, defined on the basis of registration and analysis of bioelectric activity of the brain, characterized in that the use of a pulsed magnetic field of 1.2 to 2 T in the projection of the brain stem, while conducting visual stimulation is important for the patient paintings for 5-10 s and electrical stimulation of the median nerve rectangular pulses at an amperage of 12-18 mA and pulse duration of 0.1-0.3 MS, a frequency of 5-15 Hz, daily for 2-8 hours, 10-20 sessions per course of treatment (patent No. 2197294).

However, this method has drawbacks. Stimulation with induction of 1.2-2 T is in the trunk, and not in the projection of subcortical nuclei (that is most affected in Parkinson's disease), and the electrical stimulation is performed with a low frequency (15 Hz).

The objective of the invention is to increase the effectiveness of treatment of patients suffering from Parkinson's disease and Parkinson's syndrome.

The task is achieved by using a coil creates a magnetic field in the projection of subcortical nuclei, and the frequency of the pulsed fields are selected according to the optimal reactions of the bioelectrical activity of the brain, and the maximum induction of a magnetic field provide in the range of 1.2-2 T, while conducting electrical stimulation of the median nerve rectangular pulses at an amperage of 12-18 mA long is almostly pulse of 0.1-0.3 MS, series 3-5 seconds of stimulation and pause 6-10 seconds at a frequency of the pulse 50 Hz, daily for 15-30 minutes, 10-20 sessions per course of treatment.

The authors have carried out the necessary experimental work to determine the characteristics of transcranial magnetic stimulation (TMS) and electrical stimulation (ES) of the median nerve.

Currently, all forms of parkinsonism are commonly subdivided into three main groups:

1) Parkinson's disease (idiopathica form);

2) symptomatic parkinsonism: toxic, antipsychotic, cardiovascular, infectious, traumatic, neoplastic;

3) “Parkinson plus” is a group of degenerative diseases, the clinical picture which meets parkinsonism.

In parkinsonism develop complex abnormalities in neurotransmitter systems of the brain. The role of “triggering”factor certainly plays degeneration igralni neurons, which is followed by a drop of the contents in the brain of dopamine (Golubev V.L. Levin YA, Wayne A. M. Disease Parkinson and Parkinson's disease. M, 2000, page 416).

Transcranial magnetic stimulation is widely used for research and treatment of lesions of the nervous system (patents: No. EN 2100037, №2134131, №2128485, №2194477), and can also affect different neurotransmitter systems, including dopaminergic (Imranov Russia, having got Tran is cranial magnetic stimulation. M: Allan, 2002, page 164). Therapeutic electrical stimulation of different parts of the nervous system is also widely used in the world (Tsuhokawa T., Yamamoto T., Katayama Y. Deep brain stimulation in persistent vegetative state; follow-up results and criteria for selaction of candidates. Brain Inj., v.4, pp. 315-327, 1990; Kazuyoshi F., Mitsuhiro O., Daisuke N. Spinal cord stimulation for vegetative state. The society for treatment of coma, v.3, pp.91-95, 1994; Cooper J.B., J.A. Jane, Alves W.M., Cooper E.B. Right median nerve electrical stimulation hasten awakening from coma. Brain Inj., v.13, pp.261-267, 1999; Kompaneets E.B. Neurophysiological fundamentals improve and restore the function of the sensory systems. Thesis...Prof. Biol. Sciences in the form of a scientific report. - M., 1992, 90 C.).

The method is as follows:

Patient with parkinsonism register bioelectric activity of the brain - the electroencephalogram (EEG), (VIZ), somatosensory evoked potentials (ERPs)caused by motor potentials (GWP), determine the level of dopamine in the blood or cerebrospinal fluid) before and after TMS with different frequencies from 1 to 15 Hz (diagnostic TMS). Registration takes place on 18-channel electroencephalograph Nihon Koden "EEG-4217 (Japan) and neurocranial "Viking IVP" by Nicolet (USA). On the basis of spectral and coherence analysis of EEG amplitude and latency of the main components of ERPs, VMP find the optimum amplitude and frequency of TMS, which is an increase in the amplitude of the ERPs and VMP, reduction in EEG major disruption of the rhythm and increase the level of dopamine in the blood or cerebrospinal fluid). After selection of the amplitude-time characteristics of the effects and no side effects to the patient is assigned a treatment stimulation therapy.

Stimulation is carried out as follows: the patient lies on a couch in light-, sound-proof Cabinet with a fixed inductor's magnetic field at the intersection of the middle line of the head and the line connecting external auditory passages, the magnetic field of 1.2-2 T. Transcranial magnetic simulation carried out by magnetostimulation “MS-1” firm “Neurosoft” (Ivanovo, Russia)connected through an external input from a personal computer, which allows using the software for this magnetostimulation, to adjust the frequency and duration of the pulse magnetic field. Induction of the magnetic field corresponds to 100% of motor threshold (TMS, causing movement in the contralateral upper limb stimulation of the motor cortex) and over 1.2 T, pulse duration 0.3 MS, the frequency of 1-15 Hz (individually customized for each patient), the coil diameter of 80-120 mm with proceeds from this physical basis for the formation of excitation. At the same time conduct electrical stimulation of the median nerve rectangular pulses at an amperage of 12-18 mA and pulse duration of 0.1-0.3 MS, a series of 3-5 seconds of stimulation and pauses the th 6-10 seconds at a frequency of the pulse 50 Hz, daily for 15-30 minutes, 10-20 sessions per course of treatment. Stimulation spend every day for 15-30 minutes, within 10-20 days.

The results can be illustrated by the following clinical example:

Patient S., aged 44 years, was in outpatient treatment with a diagnosis of Parkinson's disease (idiopathic form). The first symptoms appeared 3 years ago, in the form of General fatigue, stiffness of movement, a small tremor in hands after exercise. In the last year has increased, clinical manifestations of disease (patient requiring assistance in everyday life). According to neurological examination, MRI, neurophysiological and biochemical examination confirms the diagnosis (in two medical institutions). The patient is recommended to take levodopa by increasing the scheme, however, the patient has a marked adverse effects on the drug. The patient was registered EEG, ERPs, VMP, determining the level of dopamine in TMS with different frequencies and identified on the basis of the analysis of the data obtained, the optimal frequency of stimulation: TMS - 7,4 Hz.

The patient had 10 sessions, TMS, with the induction of a magnetic field of 1.4 T and VMP. The duration of each stimulation was 20 minutes a day.

After the treatment notes:

1. The patient in those which begins 3 months of follow-up after stimulation alone eats dress up, stands up, walks down the street.

2. The patient does not take levodopa.

3. Positive dynamics in the EEG and EP - reducing disruption basic rhythms, increasing the amplitude of the ERPs, VMP, reducing motor thresholds in TMS.

4. Decrease depression, improve sleep.

Using the proposed method allows to obtain the following positive effects:

1. Allows you to slow down and reduce regenye and shaking clinical manifestations of Parkinson's disease or Parkinson's syndrome.

2. Improve sleep and reduce depression.

3. To ensure the effectiveness of the treatment in the absence of positive results in the treatment drugs.

4. To slow down or stop the process of apoptosis in subcortical nuclei.

The proposed method of treatment can be used for treating Parkinson's disease, and Parkinson's disease.

Treatment of parkinsonism, including transcranial magnetic stimulation (TMS), characterized in that exercise influence TMS induction of 1.2-2 T in the projection of subcortical nuclei, effective frequency, defined on the basis of increasing the amplitude of somatosensory and motor evoked potentials and increase the level of dopamine in the blood or cerebrospinal fluid, decrease in EEG disorganization cos the main rhythms before and after TMS, and at the same time spend synchronized electrical stimulation of the median nerve rectangular pulses at an amperage of 12-18 mA and pulse duration of 0.1-0.3 MS, a series of 3-5 s and pause 6-10 with a pulse frequency of 50 Hz, daily for 15-30 min, 10-20 sessions per course of treatment.



 

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