Diagnostic technique for electrophysiological immaturity of newborn's brain

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neonatology and neurology. During a 300-second slow sleep recording, transitory patterns are recovered on the EEG: frontal sharp waves of an average duration of 0.13 seconds, spike acute waves of an average duration of 0.045 seconds, high-amplitude PTӨ-waves of an average duration of 0.1 seconds, STOP-wave patterns of an average duration of 0.1 seconds. Indices (K) are calculated for each pattern in percentage, as a relation of the number of patterns of 300 seconds multiplied by its average duration to the recording duration (300 seconds). If K of the most patterns determined is less than 1, a physiologic norm is diagnosed; K falling within the range of 1-2 shows a moderate neurophysiologic immaturity; and if K is more than 2, major disturbances of the electrobiologic brain activity are stated.

EFFECT: method enables assessing the electrobiologic brain maturity of newborns of different gestational age that is ensured by determining and considering the transitory age-related patterns in the EEG.

4 dwg, 3 ex

 

The invention relates to medicine, in particular for neurology and neonatology, and can be used for diagnostic electrophysiological immaturity brain of newborns.

A known method for the diagnosis of electrophysiological brain activity in infants by determining the characteristics of the transient pattern of electroencephalogram (EEG) slow vysokovoltnyh waves sawtooth form, localized in the temporal leads, registered in the fast stage of sleep. This method is determined by the duration of one pattern and the frequency of its registration in one minute recording stage REM sleep [Pear P. L., La Fleur B. J., S. Reigle C., Rich A-S. et. al. // Saw tooth wave density analysis during REM sleep in normal volunteers. // Sleep Medicine 2002; V3, 153, p255-258].

The disadvantage of this method is its low information content, since the duration of REM sleep in premature infants depends on the gestational age of the patient under examination, the number of transitive patterns in stage REM sleep significantly less than in the stage of slow wave sleep. In addition, the definition of only one transient pattern does not fully reflect the physiological immaturity of the brain. Another disadvantage of this method is that it defines the pattern rarely occurs in newborn EEG.

There is a method of determining characteristics the specifications specifications total spontaneous brain activity in infants by analyzing the frequencies and shapes of the main EEG rhythms in the stage of slow wave sleep (alpha, beta, theta and Delta rhythms) [Tolonen M, PalvaJ. M., Andersson, S., Vanhatalo S. // Development of the spontaneous activity transients and ongoing cortical activity in human preterm babies. // Neuroscience 2007;30;145(3):991-1006].

The disadvantage of this method is the lack of a definition of those transient EEG patterns, newborns, which reflect the degree of neurophysiological immaturity.

Closest to the claimed is a method of determining characteristics of the transient pattern of EEG acute frontal waves recorded during stage REM sleep. The method is quantitative counting only one, but frequent in newborns pattern (acute frontal waves) EEG for the entire duration of REM sleep [Ana Chrystina Crippa, Carlos Eduardo Sivado, Luciano de Paola, Rosana H. Scolaetal.// Analysis of Frontal Sharp Transients in 32 Neonatal Polysomnography in Healthy Fullterm Newborns.// Arq Neuropsiquiatr 2007;65(2-A):222-227].

The disadvantage of this method, selected as a prototype, is that the definition of transient pattern is carried out in stage REM sleep, the duration of which depends on the gestational age of the newborn child. In addition, it is known that the number of transitive patterns in stage REM sleep in normal less than in the stage of slow wave sleep, therefore, the probability of reception of transient patterns in the stage of slow wave sleep higher than in fast.

Another disadvantage of the prototype is that opredelyaytes the characteristics only of individual EEG patterns, that makes it difficult to determine the physiological maturity and thus reduces the diagnostic capability of the method.

The present invention is the advanced diagnostic capabilities of the method.

The technical result of the invention is achieved in that in the method for the diagnosis of electrophysiological immaturity brain of newborns using quantitative characteristics of transient age-dependent patterns, namely, that calculate transient pattern in the write period of sleep for a certain period of epoch EEG, within 300 seconds of recording slow wave sleep distinguish transitory patterns: frontal sharp waves average duration of 0.13 seconds, spike-sharp waves average duration of 0.045 seconds, high-amplitude PTΘ-wave average duration of 0.1 second, the pattern of STOP-wave average duration of 0.1 seconds; determine the index (K) for each selected transient pattern EEG premature baby by the formula:

where N is the number of the designated pattern for 300 seconds;

Y - the average duration of the defined pattern;

τ is the duration of a recording, equal to 300 seconds

and when the value To most defined transient patterns of less than 1 diagnose the physiological norm, when Velicina most defined transient patterns in the interval 1-2 diagnosed with moderate neuro-physiological immaturity, and when the value To most defined transient patterns more than 2 diagnose gross violations of electrobiological activity of the brain.

The choice of time period for determining the indices of transient patterns equal to 300 seconds, due to the relatively short duration of the stage of slow wave sleep in newborn infants (duration is on average about 10 minutes), rapid change her stage REM sleep, which comes the awakening of the patient. The duration of EEG recordings in 300 seconds is sufficient for the registration of transient patterns and fully reflects the characteristics of electrobiological activity of the brain of the patient. Therefore, improving the efficiency of the diagnosis.

Another distinctive feature of the proposed method is the measurement of transient EEG patterns, that allows you to create a quantitative description of each transient EEG pattern and to estimate the percentage of this pattern of EEG recordings, which reflects the degree of the physiological immaturity of the brain.

The method is as follows. The analysis of all transient EEG patterns.

Known average duration of each defined pattern of EEG recordings:

- average length of frontal sharp waves is 0.13 seconds;

- average permanent the ability spike and sharp waves is 0.045 seconds;

- the average duration RT-wave is 0.1 seconds;

- the average duration of the STOP-waves is 0.1 seconds.

Knowledge of the average duration of each transient pattern allows you to make calculations and to determine the percentage of this pattern in the EEG recordings.

In Fig.1 presents a plot of EEG recordings newborn registration frontal sharp waves.

In Fig.2 presents a plot of EEG recordings newborn registration pattern STOP (in the left occipital derivations).

In Fig.3 presents a plot of EEG recordings newborn registration pattern of the complex Delta-brushes, clearly defined in the right occipital leads and registration of multiple sporadic patterns of adhesions sharp waves.

In Fig.4 presents a plot of EEG recordings newborn registration pattern of high-amplitude RC in the temporal leads right hemisphere.

A study carried out in a period of slow sleep of a newborn is subject to mandatory standard conditions of EEG recordings, including: standard speed resolution / size of 30 mm/sec; sensitivity channels - 10 µv; recording time 60 minutes; recording be performed without the use of filters; the age of the subject in a premature infant to adjust with age, full-term newborn is 38-42 weeks. Check with the standing dream, wakefulness is carried out according to two criteria: surveillance for rapid movement of the eyeballs and the determination of changes in EEG activity in the form of high-amplitude slow waves.

For registration of EEG in the examined newborns should use a 13-electrode system, checkoway electrodes, mounted in a plastic frame. Use the international system of electrode placement in the neonatal modification (10-20) with the use of video monitoring of the patient and the use of mono - and bipolar leads. Indexes transient patterns determine the time interval of 300 seconds of EEG recordings in the stage of slow wave sleep.

Example 1. Patient B. (history No. 23740, D. R. 19.11.10) - premature girl, gestational age 34 weeks, he entered the Department of ORIT newborn SPb GPA on the 2nd day of life.

Diagnosis to conduct EEG research: hypoxic-ischemic brain damage in the first degree, early recovery period, the outer substitution hydrocephalus, demyelinization, motor disorders. In post-conceptual age 38 weeks performed EEG with video and the implementation of the method for the diagnosis of electrophysiologically immaturity brain of newborns using quantitative characteristics of transient age-dependent patterns and op is adelene their index in the period, equal to 300 seconds of EEG recordings in the stage of slow wave sleep.

The results of EEG studies:

During wakefulness is logged continuous activity, is dominated by Delta activity with a frequency of 2-3 Hz and amplitude up to 60 µv, theta activity in the form of groups of waves with a frequency of 4-5 Hz and amplitude up to 55 mV.

During slow sleep is logged dashed curve (tracealternant). Perspicacia intervals of depression rhythm is about 6 seconds. Interhemispheric synchronic is 85%.

Indexes transient patterns are: frontal sharp waves and 1.7%; RT - 2%; STOP - 1,66%, spike-waves - of 0.48%.

Conclusion according to the results of EEG: changes in the bioelectrical activity of the brain, moderate neuro-physiological immaturity (given that the values of the indexes of most transient patterns were in the range of 1-2 values).

The final diagnosis using EEG results: hypoxic-ischemic brain damage in the first degree, early recovery period, the outer substitution hydrocephalus, demyelinization, reasonable neurophysiological immaturity, motor disorders, the risk of developing moderate delay of psychomotor development.

Example 2. Patient L. (history No. 1230, D. R. 26.11.10) - a premature boy, gestational age 28/29 weeks, he entered the Department of ORI the newborn SPb GPA on the 3rd day of life.

Diagnosis to conduct EEG research: hypoxic-ischemic brain damage is severe, early recovery period, mixed substitution hydrocephalus, periventricular leucomalacia (stage cysts), hypoplasia of the corpus callosum, demyelinization, motor disorders (spastic tetraparesis), symptomatic epilepsy.

In post-conceptual age 40 weeks performed EEG with video recording and analysis the EEG results from the implementation of the method for the diagnosis of electrophysiologically immaturity brain of newborns using quantitative characteristics of transient age-dependent patterns and determine their index in the time interval of 300 seconds of EEG recordings in the stage of slow wave sleep.

The results of EEG studies:

During wakefulness is logged continuous activity, is dominated by Delta activity with a frequency of 3 Hz and amplitude up to 60 µv, theta activity in the form of groups of waves with a frequency of 4-5 Hz and amplitude up to 40 µv, irregular. Epileptiform activity is not logged.

During slow sleep is logged pattern dashed curve (tracealternant). Perspicacia intervals of depression rhythm is about 5 seconds. Interhemispheric synchronic outbreaks is 80%.

Indexes transient patterns accounted for the pose: frontal sharp waves - 2,38%; Θ - 2,33%; STOP - 8,66%, spike-waves - of 1.23%.

Conclusion according to the results of the EEG: a gross violation electrobiological activity of the brain, severe neuro-physiological immaturity (most index transient patterns exceeded the value of 2).

The final diagnosis using EEG results: hypoxic-ischemic brain damage is severe, early recovery period, mixed substitution hydrocephalus, periventricular leucomalacia (stage cysts), hypoplasia of the corpus callosum, demyelinization, motor disorders (spastic tetraparesis), symptomatic epilepsy, severe neuro-physiological immaturity, the risk of formation of a coarse delay of psychomotor development.

Example 3. Patient A. (history No. 2739, D. R. 28.04.11) - premature girl, gestational age of 35 weeks, he entered the Department of ORIT newborn SPb GPA on the 4th day of life.

Diagnosis to conduct EEG research: post-hypoxic brain damage is mild, early recovery period, external hydrocephalus in substitution type, motor disorders of mild severity. In post-conceptual age 38/39 weeks performed EEG with video recording and analysis the EEG results from the implementation of the method for the diagnosis of power is ideologicheskoi immaturity brain of newborns using quantitative characteristics of transient age-dependent patterns and determine their index in the period, equal to 300 seconds of EEG recordings in the stage of slow wave sleep.

The results of EEG studies:

During wakefulness is logged continuous activity, is dominated by Delta activity with a frequency of 3-4 Hz and amplitude up to 40 µv, theta activity in the form of groups of waves with a frequency of 4-5 Hz and amplitude up to 40 µv, fairly regular. Epileptiform activity is not logged.

During slow sleep is logged pattern dashed curve (trace alternant). Perspicacia intervals of depression rhythm is 3-5 seconds. Interhemispheric synchronic outbreaks is 80%.

Indexes transient patterns are: frontal sharp waves - 1,03%; RT - 1%; STOP - 0,66%, spike-waves - 0,76%.

Conclusion according to the results of EEG: neurophysiological maturity corresponds to the age norm (index values of most transient patterns within the unit).

The final diagnosis using EEG results: post-hypoxic brain damage is mild, early recovery period, external hydrocephalus in substitution type, motor disorders of mild severity, neurophysiological maturity corresponds to the post-conceptual age.

The proposed method allows for a universal approach to the quantitative assessment of the characteristics of all transient patterns of e is G a stage of slow wave sleep, that gives the opportunity to assess the degree of maturity electrobiological maturing brain of newborns of different gestational age to assess the degree and level of functional changes in the Central nervous system, which, in turn, gives the possibility to predict the likely neurological complications caused by immaturity of the child and related to the immaturity of pathological conditions of the Central nervous system, and external adverse factors.

This method allows you to identify possible cerebral disorders and to develop new approaches in the treatment of brain pathology in newborns of different gestational age. In addition, the inventive method allows to assess the adaptive capacity of the brain of a newborn child when his damage in terms of practical medicine.

Method for the diagnosis of electrophysiological immaturity brain of newborns using quantitative characteristics of transient age-awesime patterns, namely, that calculate transient pattern in the write period of sleep for a certain period of epoch EEG, characterized in that during the 300 seconds of recording slow wave sleep distinguish transitory patterns: frontal sharp waves average long is inetu of 0.13 seconds spike-sharp waves average duration of 0.045 seconds, high-amplitude RC-wave average duration of 0.1 second, the pattern of STOP waves average duration of 0.1 seconds; determine the index (K) for each selected transient pattern of EEG premature baby by the formula:

where
N is the number of the designated pattern for 300 seconds;
Y - the average duration of the defined pattern;
τ is the duration of a recording, equal to 300 seconds,
and when the value To most defined transient patterns of less than 1 diagnose the physiological norm, when the value To most defined transient patterns in the interval 1-2 diagnosed with moderate neuro-physiological immaturity, and when the value To most defined transient patterns more than 2 diagnose gross violations of electrobiological activity of the brain.



 

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2 ex

FIELD: medicine.

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2 ex

FIELD: medicine.

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11 tbl, 5 ex

FIELD: medicine.

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3 dwg, 4 tbl, 2 ex

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2 dwg

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2 tbl, 2 ex

FIELD: medicine.

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4 tbl, 4 ex

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2 tbl, 2 ex

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4 dwg, 1 ex

FIELD: medicine.

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1 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.

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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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