Method of diagnosing malignancy of neuroepithelial tumours of iii ventricle by data of electroencephalographic examination

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to oncologic neurosurgery, neurology and functional diagnostics. Electroencephalographic (EEG) examination is carried out. Power of delta-range waves in parietal regions is estimated on EEG. In case of simultaneous increase of power in left parietal region above 80 mcV2 and in right region above 85 mcV2, malignant form of growth of neuroepithelial tumour of III ventricle is diagnosed.

EFFECT: method extends arsenal of means for diagnosing type of growth of neuroepithelial tumours of III brain ventricle.

1 tbl, 2 ex

 

The invention relates to medicine, namely to neurosurgery neurology and functional diagnostics.

Identifying signs of malignancy of brain tumors is essential for adequate treatment when first diagnosed tumors, and dynamic observation of patients with benign tumors in the timely correction of treatment.

There are several ways to diagnose malignant brain tumors neuroimaging methods. The described method for the diagnosis of malignant brain gliomas [Patent RU (11) 2308225 (13) C1. 17.05.2006] on the basis of estimates of the magnitude of perifocal edema, racemose component of the tumor based on average space MRI examination modes T1 with contrast enhancement and T2. When square perifocal edema more than the tumor area not less than 20%, racemose component of tumor - 40-70%, diagnose malignant astrocytic glioma series. If the area of swelling is smaller than the area of the tumor by at least 10% in the presence of tumor projection racemose component of any size, diagnosed malignant glioma oligodendroglial series. Limit the use of this method is its applicability only in the presence of perifocal edema that nabludaetsa is often significant when the size of the tumor.

A known method for the diagnosis of malignancy of brain tumors in the area of the third ventricle on the basis of MRI and endoscopic studies of [RU (11) 2237447 (13) C2. 24.05.2002] no arachnoidal cracks around the perimeter of the tumor. The disadvantage of this method is invasive nature of diagnostic procedures.

The described method for the diagnosis of malignancy glial tumors [Patent RU (11) 2375961 (13) C2. 20.12.2009] on the basis of single photon emission computed tomography. So, if you identify on tomoscintigraphy 1 hour after intravenous injection of the radiopharmaceutical hearth intensive pathological accumulation, which is re-examined after 4 hours, diagnosed with high tumor grade. The disadvantage of this method is invasive, the use of expensive reagents, duration.

Described markers of malignant growth of brain tumors in biological fluids. There is a method of diagnosing a malignant form of tumor growth [Patent RU (11) 2300104 (13) C] according to the cumulative percentage change in the intensity of chemiluminescence of blood plasma and content derived nitric oxide is relatively normal. One indicator suggests the presence of multiple cerebral metastases in patients with extras replyname malignant tumors and does not allow you to diagnose signs of malignancy in patients with neuroepithelial tumors of the third ventricle.

There is a patent of the Russian Federation [RU (11) 2258932 (13) C1. 04.10.2004] in the method for the diagnosis of malignant brain tumors on the basis of crystallographic studies of cerebrospinal fluid. When the concentration of protein in samples of cerebrospinal fluid from 0.50 g/l and above, with a predominance on the crystallographic pattern of crystals in the form of the oppressed dendrites diagnosed with a malignant brain tumor. The disadvantage of this method is its invasive nature, the inability to use the outpatient practice.

The bioelectrical activity of the brain (BEAM) in patients with malignant tumors varies largely due to gross violations of cortical-subcortical interaction [Zenkov LR, Ronkin M.A. Functional diagnosis of nervous diseases: Guide for physicians. - M.: Medpress-inform, 2004. - 488 C.]. The difficulty in diagnosing BEAM in patients with neuroepithelial tumors of the third ventricle caused by a variety of infiltration and involvement modulatory systems of the brain to electrogenic crust. It is therefore important to have a clear diagnostic EEG criteria of malignant forms of growth neuroepithelial tumors of the third ventricle. But immediately changes electrogenesis crust in malignant tumors of the third ventricle in the medical literature are not described.

Most Liskin analog is the way to diagnose tumors of the diencephalic region [Zhavoronkova L.A. Features of interhemispheric interaction in patients with tumors of the area of the third ventricle before and after surgery, including partial cutting of the corpus callosum. In the book: Right-handed-left-handed. Interhemispheric asymmetry of the electrical activity of the human brain. Moscow, Nauka, 2006, p.131-134]. According to this method, to determine the changes BEAM according to the results of frequency and spectral coherence analysis. Changes in the electroencephalogram (EEG) of patients were considered primarily in connection with more or less impact on the visual hillock or the hypothalamus for example mainly extracerebral tumors basal cerebral localization (pituitary adenomas, craniopharyngioma, suprasellar meningiomas) and less-neuroepithelial tumors of the third ventricle. Despite the high relevance of this method has a significant disadvantage in that due to the lack of simultaneous comparative analysis of anomalistic spectrum by different types of tumors of the third ventricle was not possible to identify differential diagnostic EEG pattern in malignant forms of growth of these tumors.

The problem solved by the invention is the development of a method for the diagnosis of the nature of the growth neuroepithelial tumors of the third ventricle.

Achievable technical result is dia the suspects malignancy in patients with neuroepithelial tumors of the third ventricle by detecting the EEG pattern, with high sensitivity and specificity (table 1).

Table 1.
EEG pattern in malignant tumors of the third ventricle.
Option tumorEEG patternCharacteristic EEG pattern and its 95% confidence intervals
The risk ratioSensitivitySpecificity
Neuroepithelial tumors of the third ventricle+dP3 & + dP4 (d3>80 MKV, d4>85 mcV)2,21 (1,37-3,57)0,52 (0,39 -0,66)0,76 (0,6 -0,84)

In the name of the EEG patterns of the "+" sign indicates a significant high value relative to the norms of power, d - Delta sub-band, R - standard notation parietal derivations; even digit following the designation of the area belongs to the right hemisphere, odd numbers to the left.

Listed in table 1 lower threshold values obtained from the results of calculation of capacity on many (210) segments of the EEG in 42 patients with malignant neuroepithelial the diversified tumors of the third ventricle.

A statistically significant increase in capacity on the Delta rhythm in the right and left parietal regions reflects the gain of the synchronizing reticulo-cortical influences due to infiltration and activation of structures in the limbic-reticular complex with the weakening of the activity of cortical structures in patients with malignant forms of neuroepithelial tumors of the third ventricle.

To solve the tasks were analysed data anomalistic spectrum of EEG spectral indicators 121 patients with neuroepithelial tumors of the third ventricle: a benign (80 people) and malignant (41).

Conducted clinical and electroencephalographic study entry standard EEG. Nosological variants of tumors was determined according to x-ray examinations (CT, MRI), protocols, surgical interventions and morphological data.

The method is as follows.

Numerical values of EEG indicators receive the usual way: record biopotentials patients on the international arrangement "10-20%", according to the recommendations of the International Federation of clinical neurophysiology [http://eeg-online.ru/standards/rec_mtr_acns.htm] on a standard electroencephalograph, perform the fast Fourier transform, and then calculate the frequency power spectra and coherent the spine.

Performance indicators evaluated according to standard leads, and coherent - for all pairs of leads throughout the physiological range (0.5 to 30) Hz and four standard ranges. The obtained values of EEG indicators discretizing and lead to three values (above normal and below normal) on the results of testing statistical hypotheses concerning the relationship of the median of the corresponding EEG indicators of patients and healthy subjects non-parametric test of Mann-Whitney. The significance level is equal to 0.05. The results of the testing code prefixes names indicators "+"if the value is significantly above the "norm" and "-"if below. Indicators with values, not significantly different from the "norm"will not be considered. The algorithm spectral analysis will verify using the software package MatLab 7.

Measure the power in the parietal areas in the Delta range and check the fairness of the comparisons. When the power in the left parietal region above 80 µv2and right above 85 µv2conclude malignant form neuroepithelial tumors of the third ventricle.

The method provides an opportunity to objectively differentiated evaluation of malignancy in patients with neuroepithelial tumors of the third ventricle on the basis of quantitative EEG analysis that allows the use of E. what about in outpatient practice, and for optimizing treatment strategies for dynamic observation of patients with benign neuroepithelial tumors of the third ventricle in the neurosurgical and expert practice.

Example 1.

Patient E., age 17. Anaplastic astrocytoma III ventricle and visual hillocks.

Within a few months - severe General weakness, vision problems, persistent headache without nausea and vomiting. When CT and brain MRI revealed a tumor of the third ventricle (likely glioma).

During examination: decreased vision, to hundredths, reduced reaction of pupils to light, field of view changed by bitemporally type with concentric narrowing of the visual field and impaired Central vision, color does not distinguish between (perimetry), convergence is weakened. The fundus of the eye: OD = optic nerve pink, swollen, prominenet in the vitreous body, arteries narrowed veins moderately full - stagnant optic nerve head. OS = the optic nerve pink, borders edema, viewed the temporal half, veins moderately full, arteries narrowed - stagnant optic nerve head. Astasia, severe drowsiness, fatigue, increased tendon reflexes.

When EEG study revealed a statistically significant high power Delta-range in the left and right parietal regions (127 MKV and 110 MKV), h who testified about the malignant nature of the tumor growth.

The patient carried out the removal of a tumor of the third ventricle transcallosal access. A tumor, which completely blocked the moderately stretched hole Monroe. Already in this area was noticeable expressed infiltration by tumor ependyma edges magentacolored holes, and the same infiltration was observed in the cavity of the 3rd ventricle on the whole surface of its contact with sprouted ependymal. The tumor tissue is gray-yellow, fleshy and with an abundance of abnormal blood vessels at the edges, in the center - yellow-gray necrotic mass. At the mouth of the water also had a significant infiltration by the tumor of its walls and roof and the choroid plexus of the third ventricle. Biopsy - astrocytoma with signs of malignancy.

Thus, these EEG studies on the likely malignant nature of the tumor growth were confirmed by histological studies.

Example 2.

B-e z, 30 L. Diagnosis: anaplastic ependymoma of the third ventricle.

Within 8 months of concern moderate headache, tremor of the fingers, drowsiness, seizures, headaches with nausea and vomiting, episodes of severe weakness in the legs. During an MRI examination of the brain revealed a tumor of the third ventricle occlusive hydrocephalus.

Upon entering the background hypertension-hydrocephalic symptoms (occlusive headaches, Estonie disks of optic nerves), the patient revealed diencephalic deficiency (fixation amnesia, drowsiness, cataplectic condition), the secondary stem symptoms (absence of pupillary reactions to light, 2-sided symptom Babinski).

For EEG study showed signs of malignancy of the tumor: a statistically significant high power Delta-range in the left and right parietal regions (130 MKV and 115 MKV).

The patient carried out the removal of a tumor of the third ventricle transcallosal access. The tumor was infiltrative adjacent wall of the optic tubercles, more right, was distributed in the posterior divisions of the third ventricle in the anterior sections of the tumor reached holes Monroe. Biopsy - anaplastic ependymoma.

Thus, morphological examination of biopsy material confirmed the data of EEG research on the likely malignant character growth neuroepithelial tumors of the third ventricle.

Method for diagnosis of malignancy neuroepithelial tumors of the third ventricle according to electroencephalographic studies, including electroencephalographic (EEG) studies, characterized in that on EEG appreciate the power of the Delta band in the parietal areas and at higher capacities - left above 80 MKV and right above 85 MKV, diagnose malignant growth neuroepithelial tumors of the third ventricle.



 

Same patents:

FIELD: medicine.

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EFFECT: method extends arsenal of means for predicting development of complications in early postoperative period in patients with different anatomical-topographical versions of tumours of basal-diencephalic localisation.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to oncologic neurosurgery, neurology and functional diagnostics. Electroencephalographic (EEG) examination is performed. Coherent connections of brain regions, intensity of EEG rhythms in alpha-, beta- and theta- ranges are determined. Taking into account obtained EEG data and in dependence with localisation of tumour position in basal-diencephalic region, degree of functional activity disorder is determined.

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1 tbl, 3 ex

FIELD: medicine.

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2 tbl, 4 ex

FIELD: physics.

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2 cl, 11 dwg

FIELD: medicine.

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1 dwg, 3 ex

FIELD: medicine.

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1 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology and psychiatry. Electroencephalogram (EEG) is registered at the background of hyperventilation on orthostatic table first in horizontal position, then, after turning the table on 60-70 degrees and bringing the examined person in orthostatic position. Registration of EEG is carried out in patient within 1 hour after sleepless night. Turning of orthostatic table is performed during 3-5 seconds. Examined person is brought into orthostatic position for 10 minutes and hyperventilation in orthostatic position is performed for 3 minutes. If signs of orthostatic blood circulation disorder are absent and epileptoform patterns are present, epileptoform activity is diagnosed.

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2 ex

FIELD: medicine.

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4 ex

FIELD: medicine.

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3 dwg, 1 ex

FIELD: medicine.

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1 tbl, 3 ex

FIELD: medicine, neurology, psychopathology, neurosurgery, neurophysiology, experimental neurobiology.

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5 dwg, 1 ex, 1 tbl

FIELD: medicine, neurology.

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EFFECT: higher reliability of prediction.

2 ex, 1 tbl

FIELD: medicine; medical engineering.

SUBSTANCE: method involves doing multi-channel recording of electroencephalogram and carrying out functional tests. Recording and storing rheoencephalograms is carried out additionally with multi-channel recording of electroencephalogram synchronously and in real time mode in carotid and vertebral arteries. Electroencephalograms and rheoencephalograms are visualized in single window with single time axis. Functional brain state is evaluated from synchronous changes of electroencephalograms, rheoencephalograms and electrocardiograms in response to functional test. The device has electrode unit 1 for recording bioelectric brain activity signals, electrode unit 2 for recording electric cardiac activity signals, current and potential electrode unit 3 for recording rheosignals, leads commutator 4, current rheosignal oscillator 5, synchronous rheosignal detector 6, multi-channel bioelectric brain activity signals amplifier 7, electrophysiological signal amplifier 8, demultiplexer 9, multi-channel rheosignal amplifier 10, multi-channel analog-to-digital converter 11, micro-computer 12 having galvanically isolated input/output port and personal computer 13 of standard configuration.

EFFECT: enhanced effectiveness of differential diagnosis-making.

11 cl, 6 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves recording multichannel electroencephalogram, electrocardiogram record and carrying out functional test and computer analysis of electrophysiological signals synchronously with multichannel record of electroencephalogram and electrocardiogram in real time mode. Superslow brain activity is recorded, carotid and spinal artery pools rheoelectroencephalogram is recorded and photopletysmogram of fingers and/or toes is built and subelectrode resistance of electrodes for recording bioelectrical cerebral activity is measured. Physiological values of bioelectrical cerebral activity are calculated and visualized in integrated cardiac cycle time scale as absolute and relative values of alpha-activity, pathological slow wave activity in delta and theta wave bandwidth. Cerebral metabolism activity dynamics level values are calculated and visualized at constant potential level. Heart beat rate is determined from electrocardiogram, pulsating blood-filling of cerebral blood vessels are determined from rheological indices data. Peripheral blood vessel resistance level, peripheral blood vessel tonus are determined as peripheral photoplethysmogram pulsation amplitude, large blood vessel tonus is determined from pulse wave propagation time data beginning from Q-tooth signal of electrocardiogram to the beginning of systolic wave of peripheral photoplethysmogram. Postcapillary venular blood vessels tonus is determined from constant photoplethysmogram component. Functional brain state is determined from dynamic changes of physiological values before during and after the functional test. Device for evaluating functional brain state has in series connected multichannel analog-to-digital converter, microcomputer having galvanically isolated input/output ports and PC of standard configuration and electrode unit for reading bioelectric cerebral activity signals connected to multichannel bioelectric cerebral activity signals amplifier. Current and potential electrode unit for recording rheosignals, multichannel rheosignals amplifier, current rheosignals generator and synchronous rheosignals detector are available. The device additionally has two-frequency high precision current generator, master input of which is connected to microcomputer. The first output group is connected to working electrodes and the second one is connected to reference electrodes of electrode unit for reading bioelectrical cerebral activity signals. Lead switch is available with its first input group being connected to potential electrodes of current and potential electrodes unit for recording rheosignals. The second group of inputs is connected to outputs of current rheosignals oscillator. The first group of outputs is connected to current electrodes of current and potential electrodes unit for recording rheosignals. The second group of outputs is connected to inputs of synchronous detector of rheosignals. Demultiplexer input is connected to output of synchronous detector of rheosignals and its outputs are connected to multichannel rheosignals amplifier inputs. Outputs of multichannel bioelectrical cerebral activity signals amplifier, multichannel rheosignals amplifier and electrophysiological signal amplifier are connected to corresponding inputs of multichannel analog-to-digital converter. Microcomputer outputs are connected to control input of lead switch, control input of multichannel demultiplexer, control input of multichannel analog-to-digital converter and synchronization inputs of current rheosignals oscillator and synchronous detector of rheosignals. To measure subelectrode resistance, a signal from narrow bandwidth current generator of frequency f1 exceeding the upper frequency fup of signals under recording is supplied. A signal from narrow bandwidth current generator of frequency f2≠ f1>fup is supplied to reference electrode. Voltages are selected and measured at output of each amplifier with frequencies of f1, f2 - Uf1 and Uf2 using narrow bandwidth filtering. Subelectrode resistance of each working electrode is determined from formula Zj=Ujf1 :(Jf1xKj), where Zj is the subelectrode resistance of j-th electrode, Ujf1 is the voltage at output from j-th amplifier with frequency of f1, Kj is the amplification coefficient of the j-th amplifier. Subelectrode resistance of reference electrode is determined from formula ZA=Ujf2 :(Jf2xKj), where ZA is the subelectrode resistance of reference electrode, Ujf2 is the voltage at output from j-th amplifier with frequency of f2, Jf2 is the voltage of narrow bandwidth current oscillator with frequency of f2.

EFFECT: wide range of functional applications.

15 cl, 10 dwg

FIELD: medicine, psychiatry.

SUBSTANCE: one should conduct EEG-testing to detect total value of the indices of spectral power or percentage spectral power of delta- and teta-rhythms due to spectrometric technique in frontal, parietal, central and temporal areas both before and during emotional-negative loading when visual emotionally negative stimuli are presented followed by their imaginary reproduction. In case of higher indices to visual stimuli being above 15% against the background one should diagnose epilepsy. The method enables to increase the number of diagnostic means, increase accuracy and objectivity in predicting epilepsy with polymorphic paroxysms at dissociation of clinical and EEG-values.

EFFECT: higher efficiency of diagnostics.

1 ex, 1 tbl

FIELD: medicine, neurophysiology.

SUBSTANCE: one should carry out EEG survey to detect spectrometrically the index of full range if alpha-rhythm both before and after therapy. Moreover, power index of full range of alpha-rhythm and the index of 9-10 Hz-strip's spectral power should be detected in occipital cerebral areas. One should calculate the value of the ratio of the index of 9-10 Hz-strip's spectral power to the index of full range of alpha-rhythm and at the increase of this value by 20% against the background it is possible to evaluate positive result of therapy. The method increases the number of diagnostic means applied in evaluating therapeutic efficiency in the field of neurophysiology.

EFFECT: higher efficiency of evaluation.

1 ex

FIELD: medicine, neurology.

SUBSTANCE: method involves carrying out the standard vascular and nootropic therapy. Diazepam is administrated under EEG control with the infusion rate that is calculated by the following formula: y = 0.0015x - 0.025 wherein y is the rate of diazepam administration, mg/h; x is an average EEG amplitude, mcV. Method provides enhancing the effectiveness of treatment of patients. Invention can be used for treatment of patients in critical severe period of ischemic insult.

EFFECT: enhanced effectiveness of treatment.

2 tbl, 1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: method involves selecting signals showing patient consciousness level and following evoked auditory potentials as responses to repeating acoustic stimuli, applying autoregression model with exogenous input signal and calculating AAI index showing anesthesia depth next to it.

EFFECT: quick tracing of unconscious to conscious state and vice versa; high accuracy of measurements.

9 cl, 3 dwg

FIELD: medicine; experimental and medicinal physiology.

SUBSTANCE: device can be used for controlling changes in functional condition of central nervous system. Device has receiving electrodes, unit for reading electroencephalograms out, analog-to-digital converter and inductor. Low noise amplifier, narrow band filter linear array which can be program-tuned, sample and store unit, online memory, microcontroller provided with controlled permanent storage, liquid-crystal indicator provided with external control unit are introduced into device additionally. Receiving electrodes are fastened to top part of patient's head. Outputs of electrodes are connected with narrow band filters linear array through electroencephalograph. Output of linear array is connected with input of input unit which has output connected with input of analog-to-digital converter. First bus of analog-to-digital converter is connected with online storage. Recording/reading bus of microcontroller is connected with control input of input unit and its starting bus is connected with address input of online storage. Third control bus is connected with narrow band filters linear array. Second control bus is connected with liquid-crystal indicator. Output bus is connected with inductor. External control (keyboard) of first control bus is connected with microcontroller. Output of online storage is connected with data input of microcontroller through 12-digit second data bus. Efficiency of influence is improved due to getting specific directed influence being based onto general technological transparency of processing of human brain's signals and strictly specific influence based on the condition of better stimulation.

EFFECT: increased efficiency.

3 cl, 1 dwg, 1 tbl

FIELD: medicine, neurology, professional pathology.

SUBSTANCE: one should carry out either biochemical blood testing and electroencephalography or SMIL test, or ultrasound dopplerography of the main cranial arteries, rheoencephalography (REG) to detect the volume of cerebral circulation and hypercapnic loading and their digital values. Then it is necessary to calculate diagnostic coefficients F by the following formulas: Fb/e=6.3-0.16·a1+0.12·a2-1·a3+0.2·a4, or FSMIL=9.6+0.16·a5-0.11·a6-0.14·a7+0.07·a8, or Fhem=48.6-0.04·a9+0.15·a10+13.7·a11-0.02·a12+24.7·a13, where Fb/e -diagnostic coefficient for biochemical blood testings and EEG; FSMIL - diagnostic coefficient for SMIL test; Fhem - diagnostic coefficient for hemodynamic testing; 6.3; 9.6 and 48.6 - constants; a1 - the level of vitamin C in blood; a2 - δ-index by EEG; a3 - atherogenicity index; a4 - the level of α-proteides in blood; a5 - scale 3 value by SMIL; a6 - scale K value by SMIL; a7 - scale 5 value by SMIL; a8 - scale 7 value by SMIL; a9 - the level of volumetric cerebral circulation; a10 - the value of linear circulatory rate along total carotid artery, a11 - the value of resistive index along total carotid artery; a12 - the value for the tonicity of cerebral vessels at carrying out hypercapnic sampling by REG; a13 - the value for the intensity of cerebral circulation in frontal-mastoid deviation by REG. At F value being above the constant one should diagnose toxic encephalopathy, at F value being below the constant - discirculatory encephalopathy due to applying informative values.

EFFECT: higher accuracy of diagnostics.

6 ex, 1 tbl

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