Method for treatment of generalized tics disease

FIELD: medicine, psychiatry, neurology.

SUBSTANCE: method involves carrying out pharmacotherapeutic treatment for 20 days. Method involves treatment with mexidolum in the dose 150-200 mg per 24 h by intravenous drop route, diazepam in the dose 15-20 mg per 24 h by intramuscular route, immune correcting drug thymogenum in the dose 1 ml of 0.01% solution by intramuscular route, once per 24 h for the first 10 days and then five injections every other day by intramuscular route. Hyperbaric oxygenation under excessive pressure 0.8-1 atm at the rate compression and decompression 0.1 atm per a minute, isopression period for 40 min, 2 times per 24 h, is carried out with pharmacotherapy simultaneously. Invention provides rapid and stable reducing the main psychopathological symptoms: simple and complex motive tics and vocalism based on nonspecific complex normalizing effect on neurohomeostasis.

EFFECT: enhanced and valuable method of disease treatment.

1 ex

 

The invention relates to medicine, namely to psychiatry, and can be used in the treatment of patients with generalized disease ticks.

The disease is generalized ticks combines different kinds of ticks, on the one hand, and speech disturbances. Usually, therapy of this disease is limited to the use of antipsychotics with a symptomatic effect and cause a number of side effects (Buyanov MM System neuropsychiatric disorders in children and adolescents. A guide for physicians and speech therapists. Moscow, 2004). Clinical efficacy of haloperidol, a typical representative of this group, happy doubtful, because on the background of therapy with this drug was slightly reduced the severity of some symptoms, but overall regression was not observed. The duration of treatment is limited unwanted effects.

With this method of treatment is not considered the main pathogenetic mechanisms of disease: the neuroendocrine and immune dysfunction, ancelina hypoxia, impairment of protein, lipid, water and electrolyte exchange.

The technical result is rapid and complete reduction of major psychopathological symptoms: simple and complex motor tics and vocalisms due to nonspecific effects on naregamia the pelvis.

The invention consists in that within 20 days of conducting pharmacotherapy Mexidol in a dose of 150-200 mg per day intravenously, diazepam at a dose of 15-20 mg / day intramuscularly, immunocorrector timagenes 0,01% solution 1 ml intramuscularly 1 time per day for first 10 days, and then injection a day five injections. Simultaneously with pharmacotherapy within 20 days of conducting hyperbaric oxygenation pressure of 0.8 to 1 ATM at a speed of compression and decompression of 0.1 atmospheres per minute, the period of isopress 40 minutes, 2 times a day.

The method is as follows. From the first day of treatment, patients are assigned Mexidol intravenously in a daily dose of 150-200 mg, diazepam intramuscularly in a dose of 15-20 mg per day. Drugs administered for 20 days. Immunocorrector timogen 0.01% per 1 ml intramuscularly 1 time per day administered during the first 10 days daily, and then injection a day five injections. At the same time within 20 days patients spend hyperbaric oxygenation in single chambers BLX-3-01 (Scientific-production Association "LAD", Russia) with a gauge pressure of 0.8-1.0 atmosphere at a speed of compression and decompression of 0.1 atmospheres per minute, the period of isopress is 40 minutes. Sessions of hyperbaric oxygenation is carried out 2 times a day.

Clinical at the er. Patient P., 17 years old (case history No. 2736), entered in the Mordovian Republican psychiatric hospital of the city of Saransk 06.10.2005, in the direction of a psychiatrist, diagnosed with generalized Disease ticks. History: onset at age 6, when first appeared simple compulsive movements of the head, neck, shoulders, then musculoskeletal disorders were capturing the upper and lower limbs. Because of the emergence of complex motor tics - squats, jumping, touching others and vocalisms in the form of shouting certain words, phrases, Lal, - the child has become marginalized: they could not eat, to study in school. This clinic were followed for 11 years, against the background of repeated inpatient and outpatient treatment with neuroleptics.

Mental status at admission. Outwardly neat. Is oriented correctly in all views. During the conversation takes many simple and complex involuntary movements (tics). Squats and jumping on the spot, makes frequent blink movement, spits, nods, pumping its arms, touches others. Musculoskeletal disorders are accompanied by voice disorders in the form of barking, shouting some words. Because of the pronounced TIC seizures the patient is unable to hold a spoon, ISAT, tearing the paper. Due to hyperactivity with attention deficit expressed frustration education was conducted at home.

During the examination. General analysis of blood from 06.10.2005,: hemoglobin 129 g/l, ESR - 5 mm/h, the total number of leukocytes - 5,4×109/l, eosinophils - 5%, stab neutrophils - 6%, segmented neutrophils - 48%, lymphocytes - 38%, monocytes - 3%. Urinalysis - without a pathology.

The immunological dated 07.10.2005, T-lymphocytes and 68%, lymphocytes - 4%, immunoglobulin M - 56 mg %, immunoglobulin G - 670 mg %, immunoglobulin a - 42 mg %, the activity of neutrophil phagocytosis - 40%, T-helpers - 36%, T-suppressors - 0%, circulating immune complexes, large - $ 7, circulating immune complexes medium - $ 25, circulating immune complexes of small - $ 143, adhesion of neutrophils to 9%, nst-test - 2%index activation of neutrophils 0,07 USD, the load index is 6.8 cu, immunoregulatory index - 36. Conclusion: Immunopathological condition. Deficiency of humoral immunity (hypoinsulinemia class a and G), the weakening of the functional activity of neutrophils, inhibition of oxygendependent systems of neutrophils, the imbalance of T-subpopulations, increasing circulating immune complexes of different molecular weight, reduce tensions functioning of the immune system.

Hormonal status from 07.10.2005,: ti is eutrophy hormone - 0,13 IU-IU/ml, T4free - 8,35 pmol/l, antibodies to thyroglobulin is not found, the cortisol - 300,34 nmol/L.

Blood biochemistry. The increase of total lipids, total cholesterol, β-LDL, atherogenic index, increasing the concentration of malondialdehyde activity of aminotransferases in the blood plasma, the decrease in the concentration of potassium ions without compensatory growth in the concentration of sodium.

Diagnosis: the Disease is generalized ticks.

Treatment:

1. Sol. Mexidoli 5% - 3 ml (150 mg)

Sol. Natrii Chloridi 0,9% - 400 ml

Intravenous drip 2 times a day for 20 days.

2. Sol. Diazepami 0,5% - 3 ml (15 mg)

Intramuscular injection, 2 times a day for 20 days

3. Sol. Thymogeni 0,01% - 1 ml

Intramuscularly 1 time per day for 10 days, then every other day number 5.

4. Hyperbaric oxygenation with a gauge pressure of 0.8-1.0 atmospheres, at a speed of compression and decompression of 0.1 atmospheres per minute, the period of isopress - 40 minutes, 2 times a day for 20 days.

On a background of treatment:

Positive dynamics was observed with 5 days of therapy, when some degenerate complex involuntary movements - squats, jumping from complex ticks preserved only touching others, simple tics and vocalism remained. To 10, and more for up to 15 days of treatment decreased the frequency of blink movements, spitting, to vcov head. Voice disorders in the form of barking, shouting some words are rare (2-3 times daily). Twitching hands became less pronounced, allowing the patient to independently take liquid foods and do not put, have the opportunity to write. By the 20th day of therapy vocalism, complex motor tics are degenerate completely. Simple musculoskeletal disorders in the form of turns of the head, shoulders twitching, tremors, involuntary movements of the limbs were extremely rare, mild and appeared only when excited. Reduction of motor and vocal tics had a positive impact on the emotional and volitional spheres of mental activity of the patient. The patient began to actively communicate with others, to build a real future plans.

During the examination. General analysis of blood from 27.10.2005 St,: hemoglobin - 135 g/l, ESR - 4 mm/h, the total number of leukocytes - 5,7×109/l, eosinophils - 3%, stab neutrophils - 2%, segmented neutrophils - 54%, lymphocytes - 38%, monocytes - 3%. Urinalysis - without a pathology.

The immunological from 27.10.2005 St, T-lymphocytes - 70%, lymphocytes 10%, the immunoglobulin class M - 70 mg %, immunoglobulin G -1000 mg %, immunoglobulin A - 105 mg %, the activity of neutrophil phagocytosis - 62%, T-helpers - 54%, T-suppressor - 12%of circulating immune complexes large - 0$, circulate the s immune complexes medium - 10 USD, circulating immune complexes of small - $ 52, adhesion of neutrophils to 45%, nst-test - 10%, the index of the activation of neutrophils to 0.15 USD, the load index is 2.1 cu, immunoregulatory index of 4.2. Conclusion: In comparison with immunological dated 07.10.2005, there is a positive trend: normalized number of immunoglobulin G, recovered the functional activity of neutrophils, activated oxygendependent system of neutrophils, decreased circulating immune complexes, system metrics - load index and immunoregulatory index correspond to the norm. Still hypoinsulinemia class And, despite considerable improvement in this index.

Hormonal status from 27.10.2005 St,: thyroid-stimulating hormone - 2,14 IU-IU/ml, T4free - 18,35 pmol/l, antibodies to thyroglobulin is not found, the cortisol - 550,34 nmol/L.

Blood biochemistry. Normalization of metabolic parameters is parallel to the major reduction of psychopathological symptoms. Normalized indicators electrolyte metabolism, possibly due to increased oxidative phosphorylation in mitochondria and providing calcium pumps required for operation of metabolic energy. Normal amount of albumin in the plasma, which helps to prevent possible fluid overload CL is current and prevents the destruction of mitochondria and other cellular structures.

28.10.05, the patient was discharged.

Mental state at the time of discharge. Outwardly neat. Is oriented correctly in all views. Complex involuntary movements and vocalisms not observed. During the conversation makes a single rare twitching head, hands. The patient writes, involuntary movements during eating is not observed.

The effect of the treatment is positive. Consult 3 months.

30.01.2006, during examination: impulsive twitching of the muscles of the shoulder girdle, arms - not observed. Within 3 months of complex motor tics and vocalism was not renewed. During the day are sporadic simple tick in the form of head turns, nods. The child was adapted in school, increased attention span.

Thus, in this clinical example, through the use of regimens with the inclusion of an antioxidant, anxiolytic, immunocorrector and hyperbaric oxygen therapy has achieved the expressed clinical effect and to obtain the stable and long-term remission.

The combination of pathogenic action allows for an effective and safe therapy of generalized disease ticks.

Method for the treatment of generalized disease ticks, namely, that within 20 days of conducting the pharmacotherapy of mexy is I at a dose of 150-200 mg / day intravenous drip, diazepam at a dose of 15-20 mg / day intramuscularly, immunocorrector timagenes with 0.01%solution of 1 ml intramuscularly 1 time per day for first 10 days, and then injection a day five injections, along with pharmacotherapy within 20 days of conducting hyperbaric oxygenation pressure of 0.8 to 1 ATM at a speed of compression and decompression of 0.1 atmospheres per minute, the period of isopress 40 min, 2 times per day.



 

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