Method of selecting tactics of treating tension headache

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology, therapy, family medicine, and can be used for selection of tactics for treatment of tension headache. For this purpose level of peripheral heart vegetative balance is determined in patient by analysis of index of sympathetic-parasympathetic relationship (LF/HF) in spectral analysis of cardiac rhythm. If LF/HF index increases higher than 2.0 conv. units, psychotropic drugs are introduced into therapy for relief of anxiety and/or depression.

EFFECT: method ensures possibility to stratify patients, requiring introduction of psychotropic drugs, thus making it possible to optimise treatment and increase its efficiency due to account of individual peculiarities of heart vegetative balance.

3 tbl, 2 ex

 

The invention relates to medicine, namely neurology, internal medicine, family medicine, and concerns the choice of the optimal tactics of providing medical care to patients with tension-type headache and stratify groups of patients in prescribing psychotropic therapy, without the need to involve a psychiatrist or therapist.

Headache voltage (hereinafter referred to as TTH)as any pain, often accompanied by mental disorders such as anxiety and/or depression. Approximately 2/3 of ambulatory patients is significant pain (in this case the leader is a headache), 1/3 of the patients anxiety and depression and ¼ - their combination. Patients with pain often resort to medical care, analgesic use tools, have a long period of disability, limited social contacts, manifestations of anxiety, fear, depression, and high level mebolevich somatic symptoms that increase psychological distress. Depression and anxiety have an independent effect on the severity of the pain, its diffusion, functional limitations, the number of days of disability and quality of life. Psychopathology associated with headache, manifested polymorphic somatic disorders that has the greatest invalidity the existing impact and leads to disruption of vegetative cardioblate. It is established that depression is an independent risk factor for stroke, especially ischemic. The presence of moderate or severe depression is associated with an increased risk (1.2-4.5 times) development of coronary heart disease with increasing 2-2 .8 times the risk of developing heart failure, with increased risk of developing diabetes type 2 on 23-38%. The presence of anxiety disorders is associated with increased risk of coronary heart disease in 1.3-4 times. Similar negative impact of psychopathology due to dysfunction of the hypothalamic-pituitary-adrenal system with a high level of sympathetic activity (sympathicotonia), which causes irregular heartbeat; increased blood pressure; increased risk of thrombosis; myocardial ischemia; increase of level of cholesterol in the blood and a higher risk of atherosclerosis due to disturbed lipid metabolism (the content of free fatty acids and production of steroids increased utilization of glucose reduced). When psychopathology associated with pain, the human autonomic regulation significantly intensify and worsen the prognosis of both pain and psychopathology. Polymorphic autonomic symptoms of anxiety and depression determine the preference of patients to refer to psychiatrists and to racemosa practice, which interpret existing emotional disorders in patients with headache as a consequence of somatic diseases. As a result, the under-diagnostics of psychopathology commitment somatic diagnosis and ignoring comorbid mental disorders underlie inadequate treatment of patients with pain that contribute to chronic pain and psychopathology.

From the field of engineering known method of treating headache voltage, including transnasal electrical stimulation, wherein the stimulation is carried out in the breathing rhythm of the patient at the height of inspiration when current 10 µa, increasing the current strength every 5 min for 3-5 µa 20-25 µa for 15-20 minutes daily, 10-12 course (Russian Federation Patent for the invention №2170597).

However, ignoring the associated TTH psychopathology translates this way in the discharge of symptomatic therapy, the application of which in General does not cure the patient.

Also known is a method of treatment of chronic daily headache, described in the Patent of the Russian Federation for invention №2321387. Although this method involves the ingestion of psychotropic drugs, as well as symptomatic means in combination with psychotherapy, the author proposes to use the additional physiotherapeutic techniques, but without any of the systems what's recommendations sequence and duration of courses of therapy, which generally complicates the choice of treatment of patients with TTH in practice.

A prototype of the invention is selected there is a method of choice of treatment in patients with chronic tension-type headache, including the examination of the patient and the appointment of medical therapy (Filatova EVGENIY Headache voltage / Consultation-medium. Directory of outpatient physician. Tom 04, №4, 2005).

When choosing drug therapy in the treatment of headache voltage at the specified method are guided, first of all, the frequency of pain:

- if the pain is rare (up to 10 days per month), one-shot techniques analgesic funds

- if the pain is frequent (more than 10 days in a month, but less than 20), in which the leading role played by anxiety disorder, it is recommended to assign the anxiety, and the presence of muscle tension muscle relaxant. While a significant proportion of patients whose anxiety can be combined with depression do not receive antidepressants

- chronic pain (pain more than 20 times per month) in the basis of chronicity is depression, which determines the prescription of antidepressants.

However, the administration of psychotropic therapy is only possible when identifying anxiety, depression or mixed anxiety-depressive disorders that clinically which can only be done by a psychiatrist or specialist, skilled in identifying psychopathology. Therefore, in most cases, General practitioners suggested the use of specific questionnaires or scales, allowing to detect anxiety and/or depression.

Thus, despite the high relevance of the above methods, the doctor at the outpatient reception does not have the practical possibility of their application, as well as special training for skills on the application and interpretation of the results. Drugs affecting the pain associated psychopathology, appointed an ad hoc and unsystematic. As a consequence, the effectiveness of therapeutic interventions for headache voltage is low and unpredictable; frequent complications of drug therapy, manifested decompensation of headaches in the form of transformation in chronic daily pain.

The task of the invention is to increase the effectiveness of treatment of headache voltage by taking into account individual peculiarities of vegetative cardioblate.

Patients with TTH further define the level of peripheral autonomic cardioblate by index research simpato-parasympathetic relations (LF/HF) in spectral analysis of heart rhythm, and with increasing index of more than 2.0 services. units in therapy are introduced psychotropic drugs for edema Tr is wage and/or depression highly associated with peripheral autonomic disorders in patients with tension-type headache.

The study of heart rate variability in present time is recognized as an objective method for instrumental evaluation of vegetative cardioblate. Index score simpato-parasympathetic relations in patients with headache and comorbid psychopathology allows to judge about the failure of peripheral mechanisms of autonomic regulation, increase the activity of the sympatho-adrenal activity, which in turn indicates a high risk of developing psychosomatic illness and death.

Technical result achieved when the task is to optimize treatment and to increase its effectiveness in patients with tension-type headache, decrease of the incidence of risk of chronic TTH and adverse outcomes, the ability to stratify patients requiring the administration of psychotropic therapy.

The technical result is achieved through the implementation of the method of treatment of headache voltage, including the examination of the patient and the appointment of medical therapy, characterized in that in a patient with tension-type headache is determined by the level of peripheral autonomic cardioblate by researching the Oia index simpato-parasympathetic relations (LF/HF) in spectral analysis of heart rhythm, with increasing index of more than 2.0 services. units in therapy are introduced psychotropic drugs to relieve anxiety and/or depression.

To confirm a positive performance were investigated in terms of the Department of pathology of the autonomic nervous system SIC GBOU VPO First MGMU them. I.M. Sechenov. The study included 215 patients with headaches voltage. The average age of the patients was 37,8±11.6 years, among observed patients was 170 women and 45 men. The diagnosis of headache voltage were formulated in accordance with generally accepted criteria of ICD-10 and ICBG II and confirmed by clinical neurological and instrumental examination, including data analysis of CT/MRI. The presence of concomitant pain psychopathology was determined clinically (based on the criteria of the emotional-affective disorders according to ICD 10) and using self-assessment tests Beck (definition of level of depression), test of spielberger (definition of level of anxiety). The presence or absence of autonomic disorders associated with psychopathology was assessed by the "Questionnaire for signs of autonomic dysfunction. Preservation or violation of vegetative cardioblate was determined by the index simpato-parasympathetic relations (LF/HF) using spectral analysis of heart rhythm.

The results of IP the surveys showed that:

1) the higher the index LF/HF, the more pronounced autonomic dysfunction (correlation coefficient r=0,54);

2) in patients with TTH "Index LF/HF" more than 2.0 units, indicating that sympathicotonia and objectively reflects the presence of vegetative cardiodilatin (OSH 8,95 [4,06; 19,99] (table 1). The observed imbalance in patients with tension-type headache is highly associated with anxiety and depression (OSH 14,9 [7,2; 31,3] (Tables 2 and 3))that determines whether to assign specific psychotropic therapy.

Table No. 1
Contingency table of characteristics "Index LF/HF" and "Autonomic dysfunction"
Autonomic dysfunctionAutonomic dysfunctionAmount
No
LF/HF<=2,13038168
LI/IF>2,0133447
The sum of columns 14372215
X2=40,76cc=lp=0,0000

Table No. 2
Contingency table of characteristics "Autonomic dysfunction and Anxiety and/or Depression.
Autonomic dysfunction
No
Autonomic dysfunction
Amount
Anxiety and/or Depression No452460
(Anxiety and/or Depression Is20159155
The sum of columns56159215
χ2=75,21SS=1p=0,0000

Table No. 3
Comparison of Index LF/HF in patients with tension-type headache depending on the presence of anxiety and/or depression (Me (LQ;UQ)).
IndexAnxiety and/or Depression noAnxiety and/or Depression isValues of p
LF/HF, usled1,6 (0,9;1,8)2,6 (2,1;3,8)0,000000#
# - significant difference between the compared groups of patients (p<0,05) (comparison was carried out using non-parametric statistics using the U criterion Mann-Whitney)
Note: given that the distribution is not normal, in the assessment of the indicators used the median and the interquartile scale (weighted 25% and 75% percentiles).

Thus, identification of patients with tension-type headache violated simpato-parasympathetic balance on the periphery of the system reflects the negative impact of psychopathology. The use of psychotropic therapy, and first of all the antidepressants will affect the complicated mechanisms of frequency and chronicity of headache, among which the leading position is occupied alarming and epressive disorders. Applying the proposed method to stratify patients in the group requiring the administration of psychotropic therapy. Adequate appointment last increases the efficiency of treatment of patients with headaches voltage and decreases the incidence of chronicity. The method is characterized by high information content and objectification identify groups of patients with concomitant anxiety and/or depression at the outpatient reception without the use of additional evaluative or without the involvement of specialists, and at the present level of equipping of clinics of the Russian Federation and ease of implementation.

The proposed method is as follows. At the primary treatment of a patient with tension-type headache he takes the standard clinical neurological and paraclinical examination. In addition, determine vegetative cardinals using index simpato-parasympathetic relations LF/HF on the spectrum of heart rhythm. Recording of heart rate with subsequent spectral analysis is carried out for diagnostic medical equipment, equipped with software for recording and analysis of heart rate variability. Currently this hardware diagnostic complexes include "Health Centres", as well as the functional diagnosing medical diagnostic Uch is ideny of the Russian Federation. For this state of relaxed wakefulness after 10-15 minutes of rest in supine position produce 5-minute recording of heart rate. The dimension of the index is carried out in automatic mode. Normal index is in the range from 0 to 2.0 used, increasing determine segmental (peripheral) sympathicotonia, indicating a significant negative disturbances in vegetative cardioblate associated with anxiety and/or depression.

Distinctive features of the method are simplicity, ease of implementation and high informativity outpatient General medical admission. After determining the value of the index LF/HF in patients with tension-type headache solve the issue of inclusion in the medical complex psychotropic drugs normalizing the status of the hypothalamic-pituitary-adrenal axis, thereby reducing peripheral sympathicotonia. The increase of the index LF/HF more than 2.0 usled shows a patient with tension-type headache autonomic cardiochiles, which is highly associated with anxiety and/or depression. Adequate therapy level of anxiety and/or depression prevents chronicity of headache tension.

Clinical examples

Example No. 1.

The patient MS 33 years, serving addressed in the Department of pathology of the autonomic nervous with the system SIC PMGA them. Sechenov with complaints of frequent tightening head pain, fatigue and emotional lability.

From the anamnesis: chronic diseases of internal organs denies. This is the first call for medical help. Constantly undergo regular medical examinations. Menstrual function is not broken, pregnancy, childbirth was not. Social status - not married, is a senior accountant in a major foreign company.

During the inspection. Background mood reduced. Somatic disorders are not identified. Observed S-shaped scoliosis, a longitudinal platypodia, diffuse painful muscle tension in the head, neck, chest, and blotchy redness on the neck, face and chest, increased sweating of palms and feet, a symptom of Huasteca II degree. After 3 minutes of hyperventilation, there was an increase neuromuscular excitability (a symptom of Huasteca III degree in combination with paresthesia in the feet).

Was established clinical diagnosis of "stress Headaches, astheno-neurotic syndrome".

In the analysis of heart rate index LF/HF ratio was 4.2 used that reflects sympathicotonia. This defined the purpose of the antidepressant paroxetine duration of 6 months. At the control examination after 8 weeks, the patient's headaches are concerned, the mood has improved, I became calmer, index LF/HF is left 2,9 used, testified to the positive dynamics of the treatment. Examination after 4 months of therapy showed persistence of therapeutic effect, the index LF/HF ratio was 1.2 usled

Example No. 2.

The patient is O.K. 52 years old, came with complaints of frequent (20-22 times a month) diffuse headaches compressive character in the second half of the workday or after emotional stress, moderate intensity (intensity on the visual analogue scale was 6-7 points). Headache was accompanied by a feeling of palpitations, pain in the heart area, numbness in the hands and feet, impaired respiratory type "coma" in the throat or a feeling of lack of air. Headaches are not accompanied by nausea, photo - or phonophobia not increased from the usual activity of the patient. Headaches decreased after administration of analgesics in combination with muscle relaxants and sedatives (for example, analgin But with spay and Valocordin). Also, the patient complained of decreased mood, according to the patient was closed, tearful, tired quickly, appeared sleep disorders in the form of difficulties falling asleep and early morning awakenings, poor endurance stifling rooms, appeared recurrent pain in the heart area.

From the anamnesis: ill 9 years ago, when amid the prolonged emotional stress (Aswad husband) disturbed sleep and arose periodic diffuse pressure headaches. Were outpatients nootropic, vascular and vitamin preparations with a positive effect. Noted improvement in health in the spring and summer, during the holidays. About a year ago on the background of dismissal and menopause headaches become frequent and higher intensity. In the usual regimens were included 1-2-month courses of benzodiazepines or antidepressants of the SSRI class, but this does not contribute to the improvement of the patient's condition: against this background, pains in the heart and feelings of breathlessness. According to the patient at the beginning of antidepressant treatment took place 7-10 day deterioration which led to the cancellation of the treatment.

The history of life. From previous diseases indicates gastritis. Directed by the district neurologist in the Department of pathology of the autonomic nervous system for examination and treatment.

When inspecting the condition is satisfactory. Background mood reduced. Somatic disorders are not identified. In neurological status meningeal signs. From cranial nerves revealed no pathology. Appearances no. Muscle tone is not changed. Tendon reflexes moderately reduced D=S, pathological signs. The Romberg test is negative, the coordination is not violated. Sensitive disorders are not identified. Sharply illness is Jenny and tense on palpation of the temporal, chewing, trapezoidal belt and the neck muscles without an accent hand, major and minor pectoral muscles, with emphasis on the left and without the presence of trigger points. When evaluating the autonomic nervous system observed an increased neuromuscular excitability (a symptom of Huasteca III degree), persistent pink dermographism, lability heart rhythm, generalized sweating, frequent sighing, uneven depth and rate of breathing, decreased mood.

Paraclinical examination. Consultation of the ophthalmologist, physician, ECG, USDG brachiocephalic vessels, radiography of the skull, cervical and thoracic spine severe pathology it is not revealed. In the study of cardioblate index simpato-parasympathetic relations LF/HF 3.8 usled

Was diagnosed with Chronic headaches voltage with the voltage of the neck muscles, scalawag aponeurosis and chest. Psychovegetative syndrome. Treatment:

- tolperisone 150 mg 3 times a day for 10 days

- DULOXETINE 60 mg 1 capsule in the evening for 6 months.

At the control examination after 8 weeks the complaint does not claim that the pain has stopped. Index value LF/HF decreased to 3.0 used When re-check in 4 months index LF/HF ratio was 2.3 usled Decided to continue therapy with DULOXETINE for 6 months as a preventive treatment given the historical data on psychotropic drug use by the patient, as well as recommended swimming 2-3 times a week, especially during the period from September to June each year.

The selection method of treatment of headache voltage, including the examination of the patient and the appointment of medical therapy, characterized in that in a patient with tension-type headache is determined by the level of peripheral autonomic cardioblate by index research simpato-parasympathetic relations (LF/HF) in spectral analysis of heart rhythm, and with increasing index of more than 2.0 services. units in therapy administered psychotropic drugs to relieve anxiety and/or depression.



 

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7 cl, 1 tbl, 3 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to medicine. What is described is an adhesive composition containing donepezil and a stabiliser. The stabiliser containing one or more compounds specified in a group consisting of ascorbic acid, metal salt or ester of such, isoascorbic acid or metal salt of such, ethylene-diamine-tetraacetic acid or metal salt of such, cysteine, acetylcysteine, 2-mercaptobenzimidazole, 3(2)-tert-butyl-4-hydroxyanisol, 2,6-di-tert-butyl-4-methylphenol, tetrakis[3-(3',5'-di-tert-butyl-4'-hydroxyphenyl)]propionate pentaerythrite, 3-mercapto-1,2-propanediol, tocopherol acetate, rutin, quercetin, hydroquinone, metal salt of hydroxymethansulphinic acid, metabisulphite metal salts, sulphite metal salt and thiosulphate metal salts; it is added to a layer of a pressure sensitive adhesive applied on at least one side of the substrate.

EFFECT: prepared high reliable and stable adhesive composition which inhibits formation of donepezil-related compounds in the layer of the pressure sensitive adhesive.

14 cl, 4 tbl

FIELD: chemistry.

SUBSTANCE: invention relates to novel compounds of formula (I)

, where: n equals 0, 1, 2; G denotes CH2, CHR3; R1 denotes H, C1-C6-alkyl, C3-C6-alkenyl, -CH2Ph; R2, R3, R4 independently denote H, CH3, -CH2F, -CHF2, CF3; A denotes 1,4-Ph, 1,3-Ph, which can be optionally substituted with 1-4 substitutes selected from halogen, C1-C4-alkyl, C1-C4alkoxy, fluorinated C1-C4-alkyl and fluorinated C1-C4alkoxy; E denotes NR5, where R5 denotes H, C1-C3-alkyl; Ar denotes a radical of formula

and

where: Ra denotes halogen, C1-C6-alkyl, fluorinated C1-C6-alkyl, C1-C6-alkoxy, fluorinated C1-C6-alkoxy, phenyl sulphonyl, CN, -NR6R7, where R6 and R7, together with an N atom, form a 5- or 6-member saturated ring or denotes a 5-member saturated or unsaturated aromatic or non-aromatic heterocyclic ring containing, as ring members, 1, 2 or 3 heteroatoms selected from N, O and S, and where the heterocyclic ring can carry 1, 2 or 3 substitutes selected from halogen and C1-C6-alkyl, or denotes a 6-member saturated heterocyclic ring containing, as ring members, one N and one O atom; Rb and Rc independently denote H, halogen, CH3, OCH3, CH2F, OCH2F, CHF2, OCHF2, CF3, OCF3, CH2CH2F, OCH2CH2F, CH2CHF2, OCH2CHF2, CH2CF3 or OCH2CF3; Rd denotes Ra or a 5- or 6-member heteroaromatic ring containing, as ring members, 1, 2 or 3 heteroatoms selected from N, O and S, and where the heteroaromatic ring can carry 1 substitute selected from C1-C6-alkyl and C1-C6-alkylthio; Re denotes H or is defined as Ra; Rf is defined as Ra; k equals 0, 1, 2, 3; j equals 0, 1, 2, 3, 4; provided that Ra does not denote F, CH2F, CHF2, CF3, OCF3, if A denotes 1,4-Ph, Ar denotes a radical of formula (A) and Rb and Rc denote H, halogen; except compounds, where R1 denotes propyl, G denotes CH2, n equals 1, A denotes 1,4- Ph, E denotes NH, Ar denotes a radical of formula (F) and Rd denotes halogen, C1-C6-alkyl, C2-C6-alkenyl or a 5-member heteroaromatic ring; and physiologically acceptable acid addition salts thereof.

EFFECT: compounds exhibit 5HT6 receptor simulating activity, which allows for their use in a pharmaceutical composition.

25 cl, 6 tbl, 107 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to neurology and hepatology. Multi-level neurodynamic analysis of cardiorhythmograms is registered and realised by means of rhythmocardiograph and hardware and software complex "Omega-C". Determined are indices, reflecting: "A" - association of all, but mainly peripheral rhythmic processes, "B1" - degree of equilibration of sympathetic and parasympathetic effects on sinus node of heart, "C1" - state of central subcortical regulation, "D1" - state of central cortical regulation. Diagnostics index (YHE-L) is calculated in patients with chronic liver diseases by formula: YHE-L= -1.5 + 0.003*A + 0.013*B1 + 0.006*C1 + 0.053*D1. If YHE-L value is from -0.47 to 0.49, hepatic encephalopathy of latent stage in patients with chronic liver diseases is determined.

EFFECT: method makes it possible to increase reliability of diagnostics of hepatic encephalopathy of latent stage.

8 tbl, 2 ex

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