Method for increasing optic functions in children with inborn optic nystagmus

FIELD: medicine, neuroophthalmology.

SUBSTANCE: it is necessary to register electroencephalogram (EEG) and at disorganized low-amplitude EEG, when amplitude of alpha-rhythm is below 30 mcV or is not detected at all it is necessary to prescribe nystenon per os per 1 tablet twice/d daily for 2 wk. In case of high-amplitude hypersynchronous EEG at amplitude of alpha-rhythm being 100 mcV and more one should prescribe glycin per 1 tablet 100 mg sublingually twice/d daily for 2 wk. Then comes video-training with the help of "Amblyocor-01" device for 2 wk along with simultaneous intake of earlier prescribed preparations. In case of disorganized low-amplitude EEG one should fulfill training in the mode of "relaxation", in case of high-amplitude hypersynchronous EEG - in the mode of "activation". The innovation enables to affect central departments of optic analyzer.

EFFECT: higher efficiency of correction.

2 ex

 

The invention relates to medicine, in particular neuro-ophthalmology is approved for treatment of children with congenital optic nystagmus.

Congenital optic nystagmus has a complex pathogenesis and, as a rule, is accompanied by a significant reduction of vision. The direct mechanism of vision loss in an optical nystagmus some authors consider amblyopia and recommend appropriate treatment (Proskurina O.V. Accommodative ability of the eye in patients with optic nystagmus and recovery capabilities: Dis.... Kida. the honey. Sciences. - M., 1994. - 178 C.).

Other authors point to the role of changes in cortical-subcortical relationships in the mechanism of vision loss in children with nystagmus (Shcherbakova E.M. State of visual functions in children with optic nystagmus with regard to neurophysiological features: Dis.... Kida. the honey. Sciences. - R., 2000. - 111 S.). In schools for visually impaired children with congenital optic nystagmus range from 20% to 40% in different regions of Russia (Avetisov AS System of measures to improve visual function in nystagmus. Methodical recommendations msri of eye diseases Helmholtz. - M., 1980. - 19 S.).

Given the medical and social importance of congenital optic nystagmus caused by reduced professional adaptation, quality of life of younger patients, the development of new ways Le is to be placed and improve vision in such patients, is an important task in neuro-ophthalmology.

Because children with congenital optic nystagmus is often determined astigmatism, the treating ophthalmologist these patients get on the principle of amblyopia treatment.

There is a method of treatment of amblyopia (RF Patent 2197199, - 2003. Bull. No. 3), the essence of which is medication (Cerebrolysin, agapurin, dicine, taufon) in the form of the introduction of these drugs through the catheter, continuous (up to 10 days)recorded in the tenon's space eyeball with simultaneous additional physiotherapeutic treatment: magnetic and light stimulation.

The disadvantage of this method is its invasiveness and complexity, as catheterization of the tenon space for a long time is a potential for the development of dangerous inflammatory complications in orbit.

Known method of correcting visual functions Tumanyan S.A. (RF Patent 2070011, - 1996. Bull. No. 32), which record the bioelectrical activity of both hemispheres of the brain at rest with eyes closed and during a session with open eyes, to determine the dominant frequencies in the band of the alpha rhythm, selecting them then upon presentation of the subject image, conducting auditory training with the modulation of the brightness of the image depending on these values the signals.

The disadvantage of this method is its low efficiency in the treatment of children with optic nystagmus, since the defeat of the Central section of the visual analyzer is not functional and organic causes of pathology.

There is a method of treatment of partial atrophy of the optic nerve (RF Patent 2192817, - 2002. Bull. No. 33) through consistent implementation of health interventions, including the pterygopalatine-orbital blockade, the session FMS and hyperoxaluria.

The disadvantage of this method is the impossibility of its realization in children, due to their lightly managed behavior.

There is a method of restoring vision in optic nerve atrophy, retinal diseases and amblyopia (RF Patent 2102046, - 1998. Bull. No. 2), the essence of which lies in the 2-stage electrical stimulation of the optic nerve, when the first stage is the "shakedown" of the stimulation is carried out in quasilocal mode 5 sessions, and at the second stage 5 sessions with a frequency of 9-10 Hz.

The disadvantage of this method is its lack of effectiveness in children with congenital optic nystagmus, as electrostimulation only improves the transmission of nerve impulses along the conduction paths of the visual analyzer, and in children with nystagmus in the main pathology is observed in the Central division of the visual analyzer and d is I improve visual functions require medical interventions to improve metabolic processes and increase the functional activity of the cerebral cortex.

There is a method of treatment of patients with partial atrophy of the optic nerve (RF Patent 2124875, - 1999. Bull. No. 2), the essence of which lies in the combination of percutaneous periorbital stimulation with the introduction of intramuscular drugs: gangleronum and after 20-40 min - galantamine within 10 days.

The disadvantages of this method include the invasiveness of the method, because intramuscular injections of 2 daily cause negative attitudes toward treatment and make it impossible to carry out the treatment in full.

There is a method of treatment of amblyopia (RF Patent 2080845, - 1997. Bull. №2) with the use of device "Ambliokor-01", which is used in the treatment of nystagmus. Physiological basis of amblyopia treatment on the device "Ambliokor-01" is the normalization of processes of reception and processing of visual information at the level of the flat zone of the visual cortex, which is determined by the changes of bioelectric activity of the cortical-subcortical sections of the visual analyzer in a given direction. The device provides automatic registration of EEG with the definition of its amplitude envelope control of the subject image on the monitor screen: the image appears or disappears considering the magnitude of the threshold signal and a given mode of treatment. In patients with amblyopia on the background of myopia, blizaro the CSOs and mixed astigmatism treatment is carried out in the mode of "relaxation", and in patients with amblyopia in the background of hyperopia, hyperopic astigmatism and apachi treatment in mode "activation". The disadvantages of this method include the lack of consideration of the original EEG, which has several species in children with nystagmus, treatment regimen exhibited depending on the type of refraction and low efficiency in the normalization of cortical-subcortical interactions, which significantly disrupted in congenital optic nystagmus in children.

Closest to the claimed method and taken for the prototype is a method of treatment of congenital optic nystagmus proposed Proskurina O.V. "Accommodative ability of the eye in patients with optic nystagmus and recovery capabilities": author.... Kida. the honey. Sciences. - M., 1994. - P.3-20, because it is aimed at improvement of visual functions in children with congenital optic nystagmus, by improving accommodative ability of the eye by spectacle correction, training exercises, laser radiation.

The disadvantage of this method is the focus on improving the health of the accommodative apparatus of the eye, while in children with optic nystagmus in the most affected cortical Department of visual analyzer.

It should be noted that we have for several years conducted a study neurophysiol the policy mechanisms in the pathogenesis of optic nystagmus in children (Heidrich, Amirbekov. The role of neurophysiological mechanisms in the pathogenesis of optic nystagmus // Vestnik of ophthalmology. - 2002. No. 6. P.19-21). The results oftalmohirurgicheskih studies have shown that the main mechanism in the reduction of vision is not amblyopia, and pathology of the Central section of the visual analyzer in children and adolescents with an optical eye. This conclusion was confirmed by the following factors:

1) in children with nystagmus with low visual acuity is recorded 2 species EEG: hypersynchronous EEG with high irregular alpha-rhythm and the high-amplitude slow waves and disorganized EEG with low irregular alpha-rhythm and the predominance of slow waves - Delta and theta. Both EEG confirm the presence of immature bark, its low bioelectric activity dominated activity diencephalic region when the hypersynchronous EEG;

2) reduction of the frequency-contrast characteristics in the upper spatial frequencies;

3) psycho-pedagogical examination special tests adapted to different age children showed that children with optic nystagmus in 69.6% of the surveyed reduced intelligence.

In connection with the stated purpose of the proposed method is an improvement of visual functions in children with congenital optic nystagmus.

The objective is achieved by Thu the original EEG recording EEG and taking into account the amplitude of the alpha rhythm of the EEG prescribed medication: if you have a disorganized low-amplitude EEG, when the amplitude of the alpha rhythm below 30 µv or not is determined, assign instenon 1 tablet 2 times daily for 2 weeks, and the registration of high-amplitude hypersynchronous EEG with the amplitude of the alpha rhythm 100 µv and above prescribed glycine and 1 tablet of 100 mg under the tongue 2 times a day every day for 2 weeks, followed by a video training with the help of the device "Ambliokor-01" within 2 weeks, while continuing to adopt the previously prescribed medications, disorganized low-amplitude EEG training is carried out in the mode of "relaxation", when high-amplitude EEG hypersynchronous - in the "activation".

Choice of drugs due to their pharmacological action. The drug instenon contains etamivan 50 mg, hexobendine dihydrochloride 20 mg, etofylline - 60 mg of the Combination of components provides an activating effect on the limbic and reticular formation of the brain stem that leads to the adequate functioning of the neural components of the cortex and subcortical-stem structures, mainly due to etamivan.

Geksobendin, which is part of the drug, improves cerebral blood flow, stimulates neuronal metabolism, restores synaptic connection. It is very important that no so-called syndrome victimize observed when assigning draganaturnic drugs.

Etofillin stimulates subcortical education centers vegetative regulation (Register of medicines of Russia. -Doctor. M, - 1999. - S). In children with optic nystagmus in combination with disorganized low-amplitude EEG instenon causes the activation state of the crust.

The drug glycine is a nonessential amino acid, a Central mediator of the braking action, improves metabolic processes in the tissues of the brain, improves mental performance (the Register of medicines of Russia. - Doctor. M, - 1999. - S). In children with optic nystagmus in combination with hypersynchronous EEG glycine induces a state of relaxation of the crust.

The method is as follows.

Children with optic nystagmus originally recorded EEG the EEG with a digital definition of the amplitude of the alpha rhythm, which is prescribed medication and choose the treatment regimen on the device "Ambliokor-01". When disorganized low-amplitude EEG designate instenon per os no 1 tablet 2 times a day for 2 weeks, but when high-amplitude hypersynchronous EEG - glycine under the tongue 1 tablet of 100 mg 2 times a day for 2 weeks, followed by a video training with the help of the device "Ambliokor-01" within 2 weeks, while continuing to adopt the previously prescribed medications. The patient is in front of the monitor screen is, which demonstrates video, adapted to the perception of age respectively, intellect and emotional condition of the child. At the same time on the instrument "Ambliokor-01" is logged integral (envelope) of the EEG over the projection of the visual cortex, which goes to the computer where it is analyzed by a special program. When low-amplitude disorganized EEG choose the mode "relaxation", when high-amplitude hypersynchronous EEG - mode "activation". Supplied with a threshold device, the signal includes, if the magnitude of the envelope EEG above the threshold when operating in the mode of "relaxation", the screen also happens if the envelope EEG below the threshold when operating in mode "activation". Daily monitoring within 2 weeks, it promotes the development of the conditioned reflex, aimed at changing the bioenergetics of the cerebral cortex in a given direction, which is normal ongoing differentiated drug therapy aimed at strengthening disorganized when low-amplitude EEG and relaxation at high amplitude hypersynchronous EEG.

The developed method is well tolerated by children with optic nystagmus, is of interest to treatment, has a General and positive visual impact.

Substantially the m distinguishing feature of the claimed method is to conduct medical pathogenetically substantiated treatment in combination with videotraining effect on the cerebral cortex device Ambliokor-01", allowing to improve visual function in children with optic nystagmus. The choice of therapeutic mode on the device "Ambliokor-01" have been determined by us, not by type of refraction, and the amplitude of the EEG monitored patient.

As proof of the effectiveness of the proposed method here is 2 examples.

Example 1. Child M 5 years (East. bol. 20345/05).

Observed with a diagnosis of Congenital optic nystagmus, partial atrophy of the optic nerves, complex gipermetropicheskim astigmatism in both eyes. Parents report the child block, a quick visual fatigue, memory loss. The boy observed at the neuropathologist. Diagnosis: the Instability of the cervical spine, disorders of cerebral circulation. In 3 years appointed as eyeglass correction. Repeatedly conducted courses pleoptic treatment. Visual function within 2 years on the same level.

At the time of inspection:

Vis OD=0,1sph+2,0D cyl+2,0D ax 90°=0,2

Vis OS=0,09sph+2,5D cyl+2,0D ax 90°=0,15

OU - Horizontal sredneimportnye pendulum-like movement. Anterior segment without features, transparent optical medium. The nature of binocular vision. The fundus of the eye - the optic nerve disc pale, solid color, border, clear, macular shaft-reflex saved, the vessels are normal.

EEG amplitude of the alpha rhythm 21 µv, alpha activity is irregular, zonal differences of shla the ENES, focus maximum electrical activity is not detected, recorded slow waves.

SWCP - peak amplitude of the P100- 10-8 µv latent period 136-140 milliseconds.

In connection with low-amplitude EEG child's assigned - instenon per os no 1 tablet inside 2 times a day every day for 2 weeks, followed by a session on the device "Ambliokor-01" within 2 weeks, while the child continued to adopt the previously prescribed medication. The selected video "Tom and Jerry", "relaxation". The child explained that the image sometimes will be switched off, which means less attention. The sessions were conducted daily in both eyes for 20 minutes. After treatment, the visual acuity improved both the original and correction:

Vis OD=0,2sph+2,0D cyl+2,0D ax 90°=0,4

Vis OS=0,15sph+2,5D cyl+2,0D ax 90°=0,3

The parameters of the EEG amplitude of the alpha rhythm 38-40 µv, maximum focus of electrical activity in the occipital region.

SWCP - peak amplitude P100- 14 µv, the latent period of 110 MS.

Conclusion: a comprehensive treatment within 1 month helped to improve the original and corrected visual acuity in 2 times, to normalize the parameters SVKP and EEG. Parents report more active the child's behavior, improve memory, interest in movies, books, etc. Three months achieved visual acuity is preserved. Recommended to repeat the ing the course of treatment after 5-6 months.

Example 2. Child D. 8 years (the East. bol. 21267/05). Observed with a diagnosis of Congenital optic nystagmus, partial atrophy of the optic nerves, complex inverse hyperopic astigmatism in both eyes. Consists on the account at the neuropathologist. Diagnosis: MMD, asthenoneurotic syndrome. Vegetative-vascular dystonia. Parents report the child increased anxiety, irritability, rapid visual fatigue. With 4 years is spectacle correction, twice a year conducted courses pleoptic treatment, visual function has not changed. At the time of inspection:

Vis OD=0,15sph+1,0D cyl+2,5D ax 180°=0,2

Vis OS=0,2sph+1,0D cyl+2,0D ax 180°=0,2

OU - Horizontal sredneimportnye pendulum-like movement. Anterior segment without features, transparent optical medium. The nature of binocular vision. The fundus of the eye - the optic nerve disc pale, especially the temporal half, boundaries clear, macular shaft-reflex saved artery evenly narrowed veins expanded.

EEG alpha activity increased, irregular, the amplitude of the alpha rhythm 100-120 mV, the maximum focus of electrical activity is determined in the Central zone, registered high-amplitude slow waves.

SWCP - peak amplitude of the P100- 10-12 µv latent period 130-140 MS.

Due to the high amplitude of the hypersynchronous EEG child assigned glycine 1 tablet 100 mg the od of the tongue 2 times a day every day for 2 weeks, then began the session on the device "Ambliokor-01" within 2 weeks, while the child continued to adopt the previously prescribed medication. Selected the movie "Winnie the Pooh"mode "activation". The child explained that occasionally the image on the monitor will disappear, which means less attention. The sessions were conducted daily in both eyes for 20 minutes After treatment, the visual acuity improved both the original and correction:

Vis OD=0,25sph+1,0D cyl+2,5D ax 180°=0,4

Vis OS=0,3sph+1,0D cyl+2,0D ax 180°=0,5

The parameters of the EEG alpha activity with regular frequency of 10 Hz, the amplitude of the alpha rhythm 60-64 µv, maximum focus of electrical activity recorded in the occipital region.

SWCP - peak amplitude of the P100- 14-16 µv latent period 100-105 milliseconds.

Conclusion: a comprehensive treatment within 1 month helped to improve the original and corrected visual acuity in 1,5 - 2 times, to normalize the parameters SVKP and EEG. Parents report that the child has become more diligent, attentive, calm. Three months achieved visual acuity is preserved. It is recommended to repeat the course of treatment after 5-6 months.

Thus, the claimed method of improving visual functions in children with optic nystagmus, taking into account features of the original EEG and its correct medication, you can use the training at prospect is drill "Ambliokor-01" not just to improve visual function, but to improve cortical-subcortical relationships, to ensure the activation state of the crust under disorganized EEG and the state of relaxation when hypersynchronous EEG, increase mental abilities and behavioral adaptation to a child with optic nystagmus, which in General can be defined as the improvement of life of such patients.

A method of improving visual function in children with congenital optic nystagmus, including training effect, characterized in that recorded the electroencephalogram and disorganized low-amplitude EEG, when the amplitude of the alpha rhythm below 30 µv or not is determined, assign instenon per os 1 tablet 2 times daily for 2 weeks, but when high-amplitude hypersynchronous EEG with the amplitude of the alpha rhythm 100 µv and above prescribed glycine and 1 tablet of 100 mg under the tongue 2 times a day every day for 2 weeks, followed by a video training with the help of the device "Ambliokor-01" within 2 weeks, while continuing to adopt the previously prescribed medications, disorganized low-amplitude EEG training is carried out in the mode of "relaxation", when high-amplitude hypersynchronous EEG - mode "activation".



 

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The invention relates to the field of medicine, can be used in the treatment of allergic diseases and autoimmune diseases and relates to pharmaceutical compositions intended for use as an inhibitor of Th2-differentiation, comprising the compound of formula (I)

The invention relates to the field of Bioorganic chemistry, namely to new biologically active substances and methods of production thereof

The invention relates to the use of formulations of 2,4-amyl-metacresol (or 2,4-DHB alcohol (2,4-DCB alcohol)) and amylmetacresol (or AMC (AMC) for the treatment or prevention of viral infections of Human Immunodeficiency Virus (HIV, HIV)

The invention relates to medicine, mainly for abdominal surgery

FIELD: medical engineering.

SUBSTANCE: device has means for acting upon object under study, means for recording responses having transducers connected to computer via signal input/output unit, photorecorder unit having programmed control mechanism and frame marker unit having in series connected control desk, frame marker, superposed responses photorecorder, programming unit and switchboard connected to control desk, means for acting upon object, means for recording responses and computer. Photorecorder programming unit has cam mechanism, the switchboard has relay circuits, the frame marker unit has means for recording treatment protocol and means for recording current events being tape drive with transparent tape coupled with tape drive with exposed film. The means for recording responses have magnetic tape recorder connected to control desk and transducers via switchboard. Tape recorder signal input is connected to microphone for recording vocal data describing current experiment condition and testee data.

EFFECT: enhanced effectiveness in recording biopotentials and creating feedback links among testees; wide range of functional applications.

2 cl, 6 dwg

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