RU2344805C2 - Treatment method for peripheral nervous system diseases and injuries, their consequences, and consequences of spinal marrow blood circulation disorders and spinal injuries - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: cholinolytic medicine is injected. Over 10-30 minutes anticholinesterase medicine is injected to bioactive and motor points. Then segment reflexogenic zones are affected by electric impulses of 500 to 6100 V for 10-45 minutes. A course includes 10-40 sessions. Proserine can be used as anticholinesterase medicine. Metacine can be used as cholinolytic medicine.

EFFECT: target transport of anticholinesterase medicine to motor and bioactive points, reduced recovery time for damaged limb motion functions, simplified treatment method.

3 cl, 5 ex

Description

The invention relates to the field of medicine for the treatment of diseases, injuries of the peripheral nervous system, their consequences and the consequences of impaired spinal cerebral circulation and spinal injuries, in particular neuropathies, peripheral paralysis, through conservative therapy using a combination of medication and electrical stimulation.

There is a method of drug treatment of lesions of the peripheral nerves by the introduction of metacin sequentially subcutaneously and after a time interval of proserin according to the scheme. Doses of drugs and a temporary gap, the number of sessions is determined by the attending physician depending on the dynamics of the patient's recovery (1).

However, this method is ineffective in some forms of paresis and neuropathy with severe dysfunction.

A known method for the combined treatment of peripheral paresis and paralysis, including the administration of an anticholinesterase drug, in particular proserin, followed by electrical stimulation, according to which, depending on the location of the paresis or paralysis on the arm or leg, one bipolar electrode is fixed on the shoulder or thigh of the injured limb, and the second on the healthy limbs of the same name. The contacts of each electrode are located against each other on the extensor and flexion parts of the limbs. During combined neuromyostimulation, a series of pulses are applied to both electrodes simultaneously with the application of electrical irritation to the damaged nerve trunk. In addition, during electrical stimulation, the patient conducts active movements with a healthy limb. (3) This method is adopted as a prototype.

Part of the disadvantage of this method is its limited scope of treatment only for peripheral paralysis and paresis. In addition, the introduction of the drug by the generally accepted method has an indirect effect on the whole organism, therefore, when it enters the body, a significant part of it, more than 30%, is inactivated, which leads to an extension of the recovery time for impaired functions. The complication of the treatment process is also caused by the fact that during combined electrical stimulation, the patient must conduct additional active cyclic movements with a healthy limb to the accompaniment of an audio or light signal. However, with spinal injuries and the consequences of impaired spinal cerebral circulation, both limbs are paralyzed, which does not allow to fully implement the aforementioned method.

The basis of the present invention is the task of accelerating the recovery of "interested" peripheral nerves, plexuses, denervated muscles, impaired limb functions due to spinal injuries or impaired spinal cerebral circulation.

The problem is solved in that, using the combined effect of medication and reflexotherapy, in particular the use of cholinolytic and anticholinesterase drugs, as well as subsequent electrical stimulation, a distinctive feature is that after applying the cholinolytic drug, the anticholinesterase drug is introduced into biologically active and locomotor points with subsequent exposure to segmental reflexogenic zones by pulses of electric current high voltage. Proserine is used as an anticholinesterase drug, and metacin as a cholinolytic drug. The impact on segmental reflexogenic zones is carried out by pulses of electric current from 500 to 6100 V for 10-45 minutes, a course of 10 to 40 procedures, the number of which is determined by the dynamics of recovery.

Targeted delivery of an anticholinesterase drug to motor and biologically active points and subsequent effects on segmental reflexogenic zones, carried out in a programmed mode by electric current pulses from 500 to 6100 V for 10-45 min, courses from 10 to 40 procedures, allowed from two to five times to reduce the recovery time of impaired motor functions of the limbs.

The implementation of the method is as follows.

Given the pharmacokinetics of cholinolytic and anticholinesterase drugs, the severity of the pathological process, the physiological response of the body to their use, treatment is carried out in the following methodological sequence:

- we use a cholinolytic drug, in particular, metacin at a dose of 0.2 to 8 mg per dose, administered either orally or by injection;

- after 10-30 minutes, we inject an anticholinesterase injection into biologically active and motor points of the body, in particular, proserin in a dose of 0.5-1.5 mg, the doctor determines the formulation of biologically active and motor points;

- we apply pulses of high-voltage electric current from 500 to 6100 V to the interested segmental-reflexogenic zones using the POLITERAS apparatus according to the patent for utility model No. 45629, IPC A61N 39/00, for 10 to 45 minutes, course from 10 to 40 treatments. The number of treatment courses depending on the severity of the pathological process is set individually by the attending physician.

The implementation of the method is illustrated by the following examples.

Patient P., 23 years old, athlete, master of sports in Greco-Roman wrestling.

He complained of a decrease in strength in his right hand, fatigue with little physical exertion in his hand (1.5 kg a dumbbell can lift with his right hand no more than 3 times), a decrease in muscle mass of the right shoulder and shoulder girdle.

In the anamnesis: 1.5 years ago, during a wrestling competition, he was injured while hitting a rug with his shoulder. He was treated on an outpatient basis. The pain syndrome was stopped, but weakness and inability to make active movements with the right hand persisted.

During the examination: paresis of the proximal arm with involvement of the deltoid muscle, biceps, supraspinatus and infraspinatus muscles, suprascapular and anterior dentate muscles is noted. Lost biceps reflex, reduced carporadial reflex, hypoesthesia on the outer surface of the shoulder and forearm in the area of the roots of S-5 and S-6, that is, lesions of the upper trunk of the brachial plexus on the right, Duchenne-Erb paralysis. Significant changes in neuro-myographic research are also noted.

The patient underwent a course of treatment of 35 procedures of the claimed method. There is a visible increase in the muscle mass of the atrophied muscles, a significant increase in strength in the right hand (the patient can lift a weight of 16 kg up to 20 times in a row), a significant improvement in neuromyographic indicators is noted.

Patient I., 46 years old, process engineer. He complained of drooping of the left hand, inability to make extensor movements of the hand and fingers, impaired sensitivity in the forearm and hand, decreased strength in the hand.

From the anamnesis: 2 years ago after an accident, he received a radius fracture in a typical place with displacement of fragments, osteometallosynthesis was performed, the fracture was consolidated, and the hand function was fully implemented. After 1 year, the metalwork was removed, after which it became impossible to make extensor movements with the brush and fingers of the left hand. He was treated on an inpatient and outpatient basis for 4 months; he did not notice any visible results.

On examination: the left hand hangs, the abduction of the thumb of the left hand cannot be performed, the triceps reflex is absent, the carporadial reflex is reduced, hyposthesia is noted on the dorsal surface of the shoulder, forearm, hand, thumb and forefinger, the musculoskeletal sensation does not suffer. Deterioration of neuro-myographic indicators is noted.

Diagnosis: post-traumatic neuropathy of the left radial nerve.

The patient underwent a treatment course of the claimed method, consisting of 45 procedures. A significant improvement in the patient's condition is noted: the movement of the thumb of the left hand in full, the hand holds in a horizontal position (does not hang), the strength in the hand has increased, sensitivity has been restored, neuro-myographic indicators have improved.

Patient D., 35 years old, nurse. She complained of lacrimation from the left eye, inability to close the left eye, choking when eating liquid food, drooping of the left cheek. Outpatient treatment for facial neuritis on the left was performed for 1.5 months. Notes a slight improvement in well-being.

On examination: Bell symptom - when you try to close your eye, it moves up; Hvostek symptom. It can not wrinkle the forehead, there is smoothness of the left nasolabial fold, slight deviation of the tongue to the right, hyperosthesia of the skin surface of the face on the left.

The patient underwent a course of treatment of 30 procedures of the claimed method.

Significant improvement is noted. Symptoms of Bell and Hvostek are absent.

Active movements of facial muscles of the face appeared on the left, nasolabial folds are symmetrical, can wrinkle the forehead, folds are symmetrical, the tongue is in the midline, sensitivity is restored.

Patient M., 47 years old, driver. He complained of constant pain in the lower back, in the pelvic area, right leg, inability to rely on the right leg, weakness in the right leg, inability to move independently, is moved with crutches.

In 2003, he got into an accident, was hospitalized with a diagnosis of head injury, a pelvic fracture with displacement of fragments. Operated. During a neuromyographic study, lesions were identified at the level of the anterior horns L-4, L-5, S-1 of the spinal cord on the right, post-traumatic lumbosacral plexopathy with impaired right lower limb function was established. He was subsequently treated inpatiently in clinics in St. Petersburg, Rostov-on-Don for 2 years. However, no improvement in health was noted.

During a neurological examination: atrophy of the muscles of the buttock, thigh, calf muscle on the right, the inability to tear the heel off the couch while lying on your back, straighten the right leg in the knee joint. Lying on his stomach, he can’t straighten his right leg in the hip joint, he can’t take his leg back, active movements in the foot are disturbed. The knee and Achilles reflexes on the right are absent. Hyposthesia is noted on the outer-posterior surface of the right thigh, lower leg and on the outer surface of the right foot and fingers. The joint-muscle feeling is saved. Moves with crutches without resting on his right leg.

The patient underwent 3 courses of the claimed method (70 procedures). The dynamics are positive. Notes a significant improvement in his condition. Movements in the right leg are active, in full. An increase in muscle mass and muscle turgor in the right leg is noted. The pain syndrome is stopped. There was a force in the right leg, walking, leaning on the right leg. He walks around the house on his own, uses a cane when walking long distances. There is a significant improvement in neuromyographic indicators, in particular an increase in STI (impulse conduction velocity).

Patient O., 47 years old. He complained of lack of movement in the lower extremities, numbness of the lower extremities, inability to move independently, urinary and fecal incontinence. From the anamnesis: in January 2002, he was treated in a hospital for fever and cough. On the 7th day of treatment, waking up, I found that the sheet under it was wet with the smell of urine and feces, but I couldn’t get up on my own, there was completely no movement in the legs. He was urgently transferred to the neurosurgical department of the regional hospital. During the examination it was established: Epidural abscess in the region of the L-3 vertebra, acute violation of the spinal cerebral circulation, complicated by lower flaccid paraparesis and impaired function of the pelvic organs. A laminectomy of the L-3 vertebra was made, the purulent focus was sanitized. Within 2.5 months I was at the station. treatment in the neuro-surgical department of the MOB. On computed tomography revealed: swelling of the dural sac, impaired course of the horse tail fibers (fused with purulent process), as well as significant pronounced violations in neuro-myographic research. Discharged for further treatment by a neurologist at the place of residence without visible changes.

He contacted the NPC 4 months after surgical treatment. On examination: the phenomenon of lower paraparesis, atrophy of the muscles of the lower extremities, hypesthesia, impaired joint-muscle feeling to the knee joints, inclusive on both sides, impaired function of the pelvic organs (spontaneous urination and defecation), uses diapers.

The patient underwent 6 courses of the claimed method (30 procedures in 1 month, 180 procedures in total). After 3 courses, there were active movements in the fingers and feet, the patient began to move independently with crutches, leaning on both legs. Neuro-myographic indicators improved, the function of the pelvic organs improved. After treatment, the patient independently, without auxiliary means, moves around the apartment, independently serves himself, controls urination and defecation, walks without diapers, in ordinary underwear, however, a decrease in tactile sensitivity in the lower extremities. Atrophied muscles significantly increased in volume, their turgor improved, and strength in the extremities was 4 points. When walking, a step is noted. For long distances, he uses a cane when walking. In repeated CT studies, there is no compression of the dural sac, the course of the cauda equina is free, without features, neuromyographic indicators with significant positive dynamics.

Information sources

1. Auth. testimonial. USSR No. 1147400, A61K 31/00, 1981 (analog).

2. Auth. testimonial. USSR No. 1183121, A61N 1/36, 1982 (prototype).

3. B.C. Lobzin, V. B. Laskov, N. M. Zhulev. Nerve injury. Voronezh, Voronezh University Press, 1989, pp. 174-175, 176-177.

Claims (3)

1. A method of treating paralysis, paresis or neuropathy due to diseases or injuries of the peripheral nervous system, comprising administering an anticholinesterase drug and conducting electrical stimulation, characterized in that the cholinolytic drug is additionally administered, and after 10-30 minutes the anticholinesterase drug is administered into biologically active and locomotor points with subsequent exposure to segmental reflexogenic zones by pulses of electric current from 500 to 6100 V for 10-45 minutes with a course of 10 to 40 procedures. 2. The method according to claim 1, characterized in that proserin is used as an anticholinesterase drug. 3. The method according to claim 1, characterized in that metacin is used as a cholinolytic drug.