RU2157261C2 - Method for treating abstinence syndrome in narcomaniac patients - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out transcranial electric stimulation using pulsating current of 5 Hz and 5-9 V voltage during 1 min per electrode position. The treatment course is 2-6 procedures long. The electrodes are placed in three positions. The first one is front - back of the head position, the second one is front - back head surface area at the nose bridge level, the third one is bitemporal position above the upper part of the auricular concha. EFFECT: enhanced effectiveness of treatment; direct action upon patient brain.

Description

 The invention relates to medicine, namely to addiction medicine, psychiatry and pediatrics, and can be used to alleviate withdrawal symptoms in drug addicts.

 Various methods are known for treating withdrawal symptoms (AS). Most of them are based on the principle of symptomatic treatment with a combination of psychopharmacological drugs [1]. Recently, the possibility of alleviating AS by selective action of highly specific antagonists and agonists on the corresponding mediator receptors, cholecystokinin antagonists, enkephalinase inhibitors, and opiate receptor antagonists has been shown [2,3]. However, almost all methods of pharmacotherapy of AS are associated with the manifestation of side effects. An alternative approach to the treatment of AS, aimed at changing pathological homeostasis in the body, is extracorporeal detoxification, realized, for example, by plasmapheresis, hemosorption or cerebrospinal fluid absorption [4-6].

 The most modern and closest method of the same purpose to the claimed invention according to the combination of features and accepted as a prototype is hemocarboperfusion [5]. This invasive method is the detoxification of the blood of drug addicts on carbon sorbents of the SKN type along the venous-venous circuit at a speed of 90-120 ml / min with a total perfusion volume of 1.5-2 circulating blood volumes. Time intervals and their number are determined in each case by the dynamics of the disease. Its disadvantages, as well as plasmapheresis [4,5], are invasiveness and manifestation of exacerbation and aggravation of AS after the first and second procedures, especially the occurrence of painful and extremely painful pains in various areas of the body, causing patients to constantly move. In addition, the method requires mandatory medical reinforcement.

 The invention is aimed at creating a non-invasive method for the treatment of AS, which allows you to directly affect the patient’s brain, changing the pathological homeostasis that has developed in it and correcting the psychopathological manifestations of AS. It is assumed that the effect on the brain over time should be short and the treatment procedure itself should not be felt by the patient, since the peculiarity of patients with AS is tension, anxiety, irritability. The manifestation of the effect should be quick or immediate.

 The essence of the invention lies in the use of targeted effects on the central nervous system for the treatment of opium AS through short-term electrical stimulation with a weak low-frequency current.

 The claimed method differs from the prototype in that it carries out targeted transcranial electrical stimulation with a pulse current of 5 Hz at a voltage of 5-9 V, the exposure time is 1 minute at the position of the electrodes, the treatment course is 2-6 procedures.

 Non-invasive methods for the analysis of blood circulation and metabolism of the whole brain of drug addicts showed that AS for different drugs is associated with a change in the functional activity of various areas of the brain [7-9]. Therefore, the strategy of alleviating AS for different drugs should be differentiated and ideal would be one that would allow one to target the effect on a certain area, exert influence on different mediator systems within it and change its connections with other areas of the brain. A convenient tool for this effect is targeted transcranial electrical stimulation (MES) of the brain.

 A feature of the proposed MES is the impact of a weak low-frequency current on certain areas of the brain by arranging the electrodes in appropriate positions on the head. The huge difference in electrical resistance between the cellular elements of the brain and the intercellular fluid in it involves the flow of a weak current during MES through the intercellular fluid and disturbance of mainly small molecules, for example, inorganic ions, monoamine or purine mediators, amino acids, peptides or their fragments, which should entail changes, on the one hand, the environment of cells (in particular neurons and receptors on their surface) and their functional state, and, on the other hand, volumetric transmission of the brain, providing integrative mechanisms of the brain [10]. This is confirmed by the systemic psychotropic effect achieved using the proposed method. The psychotropic effect of MES in drug addicts is composed primarily of anxiolytic, antidepressant, hypnotic and sedative effects, apparently due to the involvement of different mediator systems and is not limited to changes in the reinforcement system, if only because the frontal lobes are largely involved share.

The fact that the therapeutic effect in patients with opium AS is directly related to MES follows from several facts:
1. After the first or second procedure, almost all patients noted “internal calm” and “relaxation”, improved mood, the disappearance of anxiety and unpleasant thoughts associated with the inability to stop taking drugs, the weakening influx of thoughts about them and the emergence of confidence that they will cope with severe withdrawal symptoms manifestations. Most patients after MES showed improvement and normalization of sleep. The effect of the procedure lasted 24-36 hours, after which the patients became more restless. Repeating the MES procedure restored patient peace (see "Example 1").

 2. In some patients to whom electrostimulation was prescribed late from the onset of the disease, one basic drug therapy did not stop psychopathological manifestations and only the addition of its electrostimulation led to a significant change in their condition.

3. AS can be stopped without drug therapy using MES (see "Example 2")
4. In the group of control patients there was no rapid relief of psychopathological manifestations
The method is as follows. For its implementation, any physiotherapeutic device permitted by the Russian Ministry of Health can be used that generates a weak low-frequency current. In our medical practice, we used a laboratory electrostimulator "ESL-2" and an adapted electrode system, acting with a unipolar pulse current of 5 Hz at a voltage of 5-9 V; pulse duration (rectangular shape) - 100 ms. The total duration of the MES procedure was 3-5 minutes, i.e. an average of 1 minute. for each position of the pair of electrodes, with each half of the pulses being allocated half this time.

 The choice of positions of the electrodes on the head is intended to affect both the limbic and paralymbic systems of the brain, and the monoaminergic (especially dopaminergic) neurons of the midbrain and bridge, that is, the areas of the brain that are most activated when the drug enters the body and excretes it. The first position for the electrodes is the forehead and the occipital region, the second position is the forehead and the area on the back of the head on the same horizontal as the bridge of the nose. In the third position, the electrodes are mounted bitemporally over the upper part of the auricles.

 Electrodes for electrical stimulation are made of high-quality stainless steel and are disks with a diameter of 14 mm, fixed on an elastic strip of fabric with Velcro ends. To cover the entire surface of the forehead, a graphitized fabric with an active area of 3 cm x 16 cm is used as an electrode. Pads of 10-layer flannel fabric moistened with tap water are used as electrode spacers. This system of electrodes allows, with an appropriate choice of their positions, to perform electrical stimulation transcranially in almost any direction.

 To perform the procedure, the patient is sitting on a chair. Sequential fixation of pairs of electrodes on the head and electrical stimulation through them is transferred by the patient without anxiety and tension. The duration of electrical stimulation for each position of the electrodes is not more than 1 minute. The procedure does not cause pain or other unpleasant sensations in the patient. At the place of application of the electrodes after the procedure, there is sometimes a slight reddening that disappears after a few minutes. The course of treatment is from 2 to 6 procedures, 2-3 procedures per week.

 Of any of the 23 opium AS patients examined, no complications after electrical stimulation were noted.

 We give examples of extracts from the medical history.

 Example 1

 Patient P., 20 years old, / medical history N 1342 / entered on a personal initiative in the 2nd department of the Territorial Medical Association for Psychiatry N 2 of St. Petersburg on May 28, 1998 regarding the treatment of opium addiction. He has been using drugs for 9 months. The last month he took daily injections of heroin, one "check" per day. The last injection was made two days ago. In the past I tried to stop on my own, but I could not stand it for more than two weeks. I was not treated by a narcologist. In September 1997, he suffered a concussion.

 Mental condition. Oriented correctly. Complains of weakness, pain in muscles, joints, dizziness, lower back pain, runny nose, lacrimation. The mood is reduced, depressed. He talks in a quiet voice, the answers are monosyllables, his voice is inexpressive. Anxious, fears worsening of his condition, annoyingly interested in treatment methods and drugs, asks to appoint a tram. On the day of receipt and subsequently twice a week, MES was produced. On the first day, with persistent withdrawal symptoms, he noted "internal calm", "relaxation", was not annoying with the appointment of additional drugs. At night the dream is sensitive, superficial. On the second day, he was calm during the day, noted the disappearance of anxiety, the appearance of inner confidence that he would cope with severe withdrawal feelings. Later, after the procedures, MES felt an improvement in mood, inner peace, some drowsiness and slept during the day. These phenomena persisted for 24-36 hours, after which the patient became restless, intrusively interested in the terms of discharge, the ability to call, etc. After the procedure, calm was restored and the patient noted the onset of "enlightenment". He sleeps well at night, his appetite is preserved. Expresses a sober attitude. There are no socially dangerous and suicidal tendencies, the mood is even. Blood pressure 120/70 mm Hg. Somatoneurological condition: from the internal organs there is no pathology. Viral hepatitis C without exacerbation. Blood and urine analysis without pathology.

 Treatment: clofellin, amitriptyline and symptomatic drugs. It is written out independently.

 Example 2

 Patient Z., 21 years old, / medical history N 1464 /, was admitted on June 10, 1998, was discharged on June 17, 1998. Diagnosis: opium addiction, withdrawal syndrome.

 He applied independently to the 2nd department of the Territorial Medical Association for Psychiatry N 2 of St. Petersburg on June 10, 1998 regarding the treatment of opium addiction. He has been using drugs for 3.5 years. He smoked anasha, then switched to intravenous administration of solutions from poppy straws, which he prepared himself. In recent months, he switched to heroin use. I did the injections myself. He was treated five times in psychiatric hospitals, remission no more than 2 months. During periods of remission, he was inactive, made no attempts to find a job, continued communication with friends of drug addicts. He was last discharged from our hospital on January 14, 1998. After discharge, he immediately resumed anesthesia. He uses heroin at a dose of 0.1 g per day. He injected daily.

 Mental condition. It is oriented correctly, contact is available, the mood is reduced. He admitted that he made the last injection of heroin before coming to the hospital. Complains of a lowered mood, anxious, somewhat tense. He expresses concern that he will never be able to give up drugs, is afraid of the upcoming “withdrawal,” asks for more relanium, sodium oxybutyrate. On the day of hospitalization, the MES procedure was performed, which was repeated on June 11, 13 and 15. On the first day, he noted the disappearance of anxiety and tension, the disappearance of unpleasant thoughts associated with the inability to stop taking drugs, noted the onset of mild drowsiness, an improvement in mood. I received Relanium at night in a dose of 4 ml / m. He remained calm, orderly, did not find importunity with requests for the appointment of additional medicines, did not express complaints about the phenomena of withdrawal. He slept enough at night. In the future, still calm, orderly, without depressive disorders. I was interested in the extract. After discharge, he intends to leave for the cottage to do household work. Expresses an attitude to stop drug use. It is written out independently with the recommendation of observation by a narcologist at the place of residence.

 The psychotropic effect induced by MES is apparently not due to the specifics of functional brain disorders in opium addiction, since it was also pronounced in a patient with alcoholic AS and manifestations of anxiety, depression and suicidal intent, which noted the immediate onset of “enlightenment” after the first procedure and connected in the future the increase in the improvement of his condition with MES.

 The possibilities of using MES are not limited only to nuclear power plants. Apparently, it could be effective in other mental illnesses, for the treatment of which electroconvulsive therapy is actively used. The latter, as you know, causes the death of part of the brain cells. This drawback is deprived of MES.

 The claimed method is simple, does not require sophisticated equipment and can be used in the complex treatment of patients both in the acute period and in the process of remission.

Literature
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Claims (1)

 A method of treating opiate withdrawal syndrome with transcranial electrical stimulation, characterized in that they are stimulated with rectangular pulses of 100 ms duration, a frequency of 5 Hz in the direction of 5 - 9 V, exposure time of 1 min to one position of the electrodes, a course of treatment of 2 to 6 procedures, placing the electrodes sequentially in three positions, namely: the first is the forehead-nape, the second is the forehead-region on the back of the head at the bridge of the nose, and the third is the bitemporal position above the upper part of the auricles.