RU2352365C1 - Method of treatment of diencephalic syndrome of pubertal period - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine and is intended for treatment of a diencephalic syndrome of the pubertal period. Influences by the physical factor on area of the eyes, traditional medicinal therapy, massage, hypohigh-calorie diet are performed. Influence is carried out by intermittent giving of electromagnetic waves of an optical range with a wavelength from 400 to 760 nm and duration of impulse from 1 till 8 seconds. Before each procedure for selection of a wavelength of influence the patient is suggested to choose the most pleasant to him at present colour from a range of lengths of waves from 400 to 760 nm, with an exception of those colours which are contraindicative to it according to accompanying diseases and prevailing semiology in a picture of its disease. Other parametres of the procedure - smooth or sharp increase of the intensity of light exposure, brightness, presence of pauses between flashes and additional illumination of area of eyes are selected before each procedure individually depending on sensitivity of the visual analyser of the patient to light exposure and rhythm choices. Influence by one colour in a prone position is carried out within 8 minutes. Influence is performed daily in first half of day. The course consists of 10 procedures.

EFFECT: offered way provides the best psychoemotional shipping of procedures with children, absence of fear before influence on eyes, absence of contraindications at allergic reactions to medicinal preparations, individual approach to each patient.

2 ex, 5 tbl

Description

The invention relates to medicine, in particular to physiotherapy, pediatrics, endocrinology, and can be used to treat patients with hypothalamic syndrome of puberty.

It is known that among endocrine pathology during puberty, the hypothalamic syndrome of puberty (GSPP) is about 60%.

In the absence of correction, the pathological process progresses, persistent neuroendocrine disorders are formed, which reduce working capacity, leading to the development of hyperplastic processes in hormone-dependent organs and the formation of endocrine forms of infertility (Mirimanova R.P. The state of the reproductive system in hypothalamic syndrome of puberty in girls: Abstract. Dis .... Doctor of Medical Sciences. - Yerevan, 1986). What makes the problem of treatment of GSPP one of the most relevant in pediatric endocrinology.

The traditional treatment of HSPP is represented by drug therapy with nootropic, vasodilator, diuretic drugs and vitamins, however, the penetration of active drugs into the hypothalamic-pituitary region is difficult due to the blood-brain barrier, which leads to insufficient treatment with medications alone. As a result, drugs are used in combination with massage, hypocaloric diet and physiotherapy. (Gurkin Yu.A. Gynecology of adolescents. / Manual for doctors. - St. Petersburg: IFC "Foliant", 2000. - pp. 152-163).

A known physiotherapeutic method for treating patients with HSPP using a magnetic field, based on bitemporal exposure to a traveling alternating magnetic field with a frequency of movement of 1-12 Hz and induction on working surfaces of 10-30 mT. (RF patent №2248818 A method for the treatment of adolescents with hypothalamic syndrome of puberty. Bolotova N.V., Raigorodskaya N.Yu., Averyanov A.P., registered. 03/27/2005).

The disadvantage of this method is the very high cost of the apparatus for such therapy, which is economically unprofitable.

A known method of treating patients with GSPP with bitemporal inductothermy, based on exposure to the brain by eddy currents of ultrahigh frequency. (Kirgizova O.Yu., Mashanskaya A.V. Physiotherapeutic treatment of adolescent girls with hypothalamic dysfunction: Overview // Reproductive health of children and adolescents. - 2006. - No. 6. - P.61.).

The disadvantage of this method is the large number of contraindications and, in particular, intolerance to bitemporal inductothermia with traumatic injuries of the hypothalamus.

For the prototype, we took the closest to the proposed method for the treatment of GSPP with transorbital "superelectrophoresis" of aspirin, based on the introduction of 5% aspirin solution on dimethyl sulfoxide into the orbit using galvanic current (Physiotherapeutic methods for correcting disorders of the reproductive system of a teenage girl. Methodological recommendations. Edition. PPMI . - SPb. - 1996. - p. 18.).

The disadvantage of this method is the inability to carry out procedures for patients with allergic reactions to non-steroidal anti-inflammatory drugs, dimethyl sulfoxide and children with individual intolerance to direct current, which is quite common among patients with HSPP. In addition, the very process of applying wet pads to the eyes causes discomfort and fear in children in the first procedures.

The objective of the invention is to reduce discomfort during physiotherapy procedures, increase the effectiveness of treatment of patients with hypothalamic puberty syndrome with allergic reactions to NSAIDs, dimethyl sulfoxide and intolerance to galvanic current, increase the affordability of physiotherapeutic treatment, an individual approach to each patient.

To achieve this goal, we first proposed a method for treating the hypothalamic syndrome of the puberty period, including exposure to the eye area with a physical factor, traditional drug therapy, massage, a low-calorie diet, characterized in that the exposure is carried out by intermittent feeding of electromagnetic waves in the optical range with a wavelength of 400 to 760 nm and a pulse duration of 1 to 8 seconds, and before each procedure, to select the exposure wavelength, the patient is asked to choose the most appropriate the color that is currently clear to him from the wavelength range from 400 to 760 nm, with the exception of those colors that are contraindicated to him according to concomitant diseases and the prevailing symptoms in the picture of his disease, other parameters of the procedure - a smooth or sharp increase in light intensity, brightness, pauses between flashes and additional illumination of the eye area are also selected individually before each procedure, depending on the sensitivity of the patient’s visual analyzer to illumination and its rhythm preference, then the exposure is carried out with the same color in the supine position for 8 minutes, and the exposure is carried out daily in the morning, and the course is 10 procedures.

The advantage of this method over the prototype is the best psycho-emotional tolerance of the procedures for children, the absence of fear of eye exposure, the absence of contraindications for allergic reactions to non-steroidal anti-inflammatory drugs and dimethyl sulfoxide, an increase in the effectiveness of treatment in patients with intolerance to constant galvanic current, an individual approach to each patient.

An advantage over other analogue treatment methods is the low cost of equipment for treatment, the absence of contraindications for traumatic damage to the hypothalamus.

The range of electromagnetic waves that we offer is due to the fact that visible radiation through the visual analyzer can affect the suprachiasmal nuclei of the hypothalamus, which are sensitive to this particular spectrum of electromagnetic waves. The intermittent supply of electromagnetic waves by pulses lasting from 1 to 8 minutes is most physiological for the organ of vision, since it corresponds to the biorhythms of the visual analyzer, normally the more or less pronounced rhythmically repeated predominance of either the right or left monocular field of vision is characteristic, and the alternation of visual perceptions occurs at regular intervals, on average, after 1-8 seconds. (Rappoport, Ya.A. The phenomenon of competition of visual fields in normal conditions and in certain diseases of the brain. Ukr. Institute of Eye Diseases named after Grishman, 1982).

Individual selection of color, the rate of increase in the intensity of illumination, brightness, the presence of pauses between flashes and additional illumination of the eye area corresponds to the principle of individual treatment with physical factors (V.M. Bogolyubov, G.N. Ponomarenko. General physiotherapy: Textbook. - 3rd ed. , revised. - M., St. Petersburg: SLP, 1998.p.31-33). The lying position is considered one of the most optimal positions during physiotherapy procedures and allows the patient to relax as much as possible. The treatment time of 8 minutes is average for color therapy procedures. The number of procedures per course 10 was selected by us, taking into account the children's age of patients whose reactivity is higher compared to adult patients. More procedures per course is too stressful for the child’s body, fewer procedures, in our opinion, will not be enough to treat such a serious illness as GSPP. The morning hours were selected for treatment (the time of activity of the meridians of the “stomach” and “spleen-pancreas”). This approach provides restoration of the diurnal rhythm of lipolysis and liposynthesis processes, distorted during HSPP (TM Uglanova. The influence of reflexology on the dynamics of body weight loss and some indicators of the hormonal status of obese patients. Journal of Oriental Medicine, No. 1, 1993, pp. 64-72).

Our proposed method has been clinically tested on the basis of the endocrinology department of the regional children's clinical hospital in Astrakhan in the period from 2004 to 2006. Under our supervision, there were 50 adolescents with a diagnosis of GSPP. The average age of adolescents was 14.5 years. All of them received medical treatment, including nootropic drugs and dehydration therapy, massage, hypocaloric diet, in addition, visual pulsed color therapy was included in the treatment complex. All patients showed good tolerability of the procedures.

After treatment, patients receiving color therapy noted the disappearance or decrease: irritability (88%), tearfulness (89)%, sleep disturbances (85%), fatigue (92%), headaches (98%), dizziness (88%) ), visceral pain (77%), palm hyperhidrosis (85%), normalization of high blood pressure (95%), reduction of overweight (67%), blanching of striae (77%), normalization of menstrual function (33%).

To assess well-being, activity and mood, the SAN test was performed. Anxiety was assessed using the Spielberger test. Schulte's test was used to assess the ability to concentrate.

Based on the results of the Schulte test, in patients after the treatment we proposed, a significant (p <0.01) decrease in the average number search time from 38.6 to 37.5 seconds was observed, which indicates an increase in the concentration of attention.

According to the Spilberger test, after treatment according to our scheme, reactive and personal anxiety significantly decreased (p <0.05) from 24 to 19 points and from 41 to 37 points, respectively.

According to the SAN test, in patients receiving color therapy according to the scheme we proposed, there was a significant positive dynamics in well-being, activity and mood. The results of this test are presented in table No. 1.

In the framework of clinical and laboratory studies, patients underwent rheoencephalography (REG) before and after treatment. Assessment of cerebral circulation was carried out on two leads - occipitoid-mastoidal, characterizing blood flow in the pool of vertebro-basilar arteries and frontomastoidal lead, reflecting hemodynamics in the pool of internal carotid arteries.

Under the influence of complex treatment, there was a significant (P <0.05) normalization of the rheographic index characterizing the blood supply to the brain. At the same time, a decrease in increased blood supply in the pool of vertebro-basilar arteries and an increase in reduced blood flow in the pool of internal carotid arteries were observed.

Also, in all the leads, a reliable (P <0.05-0.01) normalization of both increased and decreased peripheral resistance of the vessels of the microvasculature was observed.

In addition, complex treatment reliably led to the normalization of the dicrotic and diastolic indices characterizing the state of the tone of arterioles, venules, veins, and venous outflow as a whole. Moreover, the changes were more pronounced in the basin of the internal carotid artery.

Below, as an example, the results of testing this method in two patients from the study group are given.

Example 1. Patient S. va Z.M. 17 years. Case history No. 2689. She was treated in the endocrinology department of the regional children's clinical hospital in Astrakhan from 02/02/05. until 08.17.05.

Upon admission, she complained of frequent headaches, irritability, tearfulness, palm hyperhidrosis, cramps in the muscles of the extremities, periodic pain in the heart, stretch marks on the skin of the thighs and mammary glands.

From the anamnesis it is known that the patient suffers from headaches for a long time, after a concussion received in 1990. In 2002, she dramatically gained weight, striae appeared, the menstrual cycle was disrupted. In January 2002, she underwent inpatient treatment in the above department, with unstable improvement.

Objectively upon admission: height 170 cm, weight 61 kg. General condition of moderate severity. The skin is clean, swarthy. On the skin of the thighs and mammary glands are white stretch marks. The development of subcutaneous fat is moderate, the distribution is uniform. Peripheral lymph nodes are not enlarged. Vesicular breathing in the lungs, no wheezing, NPV 18. Heart sounds are loud, rhythmic. HELL 95/65 mm Hg Pulse 60 per minute. The abdomen is soft, painless, not swollen. The liver and spleen are not palpable. The kidneys are not palpable, Pasternatsky’s symptom is negative.

The studies carried out in the hospital - a general blood test, a general urinalysis, a biochemical blood test, an ultrasound of the pelvic organs - without deviations from the norm. Based on the patient’s complaints, medical history, objective and laboratory tests, a diagnosis was made - hypothalamic syndrome of puberty.

Additional tests were carried out - the Luscher test, which determines the psycho-emotional state, the Luria test, which characterizes the state of memory, the Schulte test, which assesses the speed of search-orientational gaze movements and attention, the Spielberger test, which assesses personal and reactive anxiety, and rheoencephalography.

In the department, against the background of drug therapy with piracetam, vitamin B1, visual impulse therapy was prescribed according to the scheme we proposed.

The exposure was carried out by intermittent supply of electromagnetic waves in the optical range with a wavelength of 400 to 760 nm and a pulse duration of 2 to 8 seconds. Before each procedure, for the selection of the exposure wavelength, the patient was offered to choose the color most pleasing to her at the moment from the wavelength range from 400 to 760 nm. Other parameters of the procedure - brightness, the presence of pauses between flashes and additional highlighting of the eye area were also selected before each procedure, depending on the sensitivity of the patient’s visual analyzer to the light and its rhythm preference. Only one color was used during one procedure. The procedure was carried out in a prone position, daily in the morning, for 8 minutes. In total, the patient received 10 procedures. The portability of the procedures was good. The scheme of the procedures is presented in table No. 2.

After treatment, headaches and dizziness disappeared, hyperhidrosis of the palms decreased, tearfulness and irritability disappeared, muscle cramps were not observed, there was no pain in the heart, striae were barely noticeable. Body weight decreased by 1 kg.

According to the SAN test, after treatment, the patient's state of health improved (from 6 to 6.5 points) and mood (from 4.9 to 6.2 points), her activity increased (from 6.0 to 6.8 points).

According to the Spielberger test, reactive and personal anxiety decreased as a result of treatment (from 18 to 11 points and from 35 to 33, respectively).

According to the Luscher test, after the therapy we proposed, the level of the average total deviation decreased from 19 to 14 points, which indicates an improvement in the psychoemotional state.

After the complex treatment, the average time for finding numbers on Schulte tables decreased, which indicates an increase in the patient's attention (from 49 to 44 s).

According to the Luria test, the average number of memorized words increased, which indicates an improvement in memory (from 8.0 to 8.2).

The REG data presented in table No. 3 indicate that under the influence of the treatment we proposed, the patient returned to normal blood circulation in the vertebral artery pool (BPA), as well as a decrease in increased peripheral resistance in the basin of the internal carotid artery (BSA). In addition, the vascular tone of the microvasculature in both basins on the right improved slightly and the venous outflow in BPA returned to normal.

Thus, this example illustrates the positive effect of color therapy as part of complex treatment on the state of cerebral circulation, well-being, activity, mood, attention and memory, as evidenced by the results of rheoencephalography and tests of SAN, Schulte and Luria. The use of color therapy has allowed to reduce the level of reactive and personal anxiety and clinical manifestations of the disease.

Example 2. Patient A-va M.S. 15 years. Medical history No. 2358. She was treated in the endocrinology department of the regional children's clinical hospital in Astrakhan from 07.20.06. on 08/07/05.

Complaints at admission: periodic (1-2 times a week) headaches, dizziness, increased blood pressure to 130/90 mm Hg, emotional lability, tearfulness, irritability, hyperhidrosis of the palms and feet, increased fatigue, insomnia, and coma burning in the throat, pain in the chest, stretch marks on the skin.

From the anamnesis it is known that growth rates have intensified since 2002, but the weight remained stable, striae appeared six months ago, blood pressure increased, headaches and the rest of the above complaints began to disturb. A month before entering this department, she was treated in the gynecology department of the regional children's hospital in Astrakhan with a diagnosis of juvenile bleeding, subacute bilateral oophoritis. In addition, the patient suffers from chronic tonsillitis, chronic pyelonephritis in remission, and superficial gastritis. Among the diseases noted chickenpox, rubella.

Objectively upon admission: height 173 cm, weight 64 kg. General condition of moderate severity. Marked skin with areas of hyperkeratosis and small acne is noted. On the skin of the lower back - white stretch marks. The development of subcutaneous fat is moderate, the distribution is uniform. Peripheral lymph nodes are not enlarged. In the lungs, vesicular breathing, no wheezing, NPV 16 per minute. Heart sounds are clear, rhythmic. HELL 129/69 mm Hg Pulse 88 per minute. The abdomen is painful in the epigastric region. The liver and spleen are not palpable. The kidneys are not palpable, Pasternatsky’s symptom is negative.

Investigations carried out in the hospital: biochemical blood test, ECG, blood coagulation test, M-ECHO, without deviations from the norm. According to a general blood test, mild hypochromic anemia was detected. In the general analysis of urine, a large number of epithelial cells are determined. On the roentgenogram of the skull bones in the lateral projection, the entrance to the Turkish saddle is closed due to the enlarged anterior sphenoid processes, an increase in the finger-shaped impressions is noted. On a radiograph of the hands in a direct projection, the bone age corresponds to the passport age.

Based on the patient’s complaints, medical history, objective and laboratory tests, a diagnosis was made - hypothalamic syndrome of puberty.

Additional tests were carried out - the Schulte test, which assesses the speed of search-and-orientation movements of the gaze and attention, the Spielberger test, which assesses personal and reactive anxiety, rheoencephalography.

In the department, against the background of drug therapy with piracetam and vinpocetine, visual impulse therapy treatment was prescribed according to the scheme we proposed.

The exposure was carried out by intermittent supply of electromagnetic waves in the optical range with a wavelength of 400 to 575 nm and a pulse duration of 1 to 3 seconds. Before each procedure, to select the exposure wavelength, the patient was offered to choose the color most pleasing to her at the moment from the wavelength range from 575 to 760 nm, the red color being excluded from the choice, which is contraindicated at the increased pressure that was observed in this patient. Other parameters of the procedure - a smooth or sharp increase in the intensity of illumination, brightness, the presence of pauses between flashes and additional illumination of the eye area were also selected before each procedure depending on the sensitivity of the patient’s visual analyzer to illumination and its rhythm preference. For one procedure, one color was used. The procedure was carried out in a prone position, daily in the morning, for 8 minutes. In total, the patient received 10 procedures. The procedures were well tolerated. The scheme of our procedures is presented in table No. 4.

After treatment, headaches and dizziness decreased, hyperhidrosis of the palms decreased, blood pressure decreased, tearfulness, irritability and increased fatigue disappeared, sleep was improved, burning sensations and sensations of “coma” in the throat became less frequent.

According to the SAN test, after treatment, the patient's state of health improved (from 5.9 to 6.1 points) and mood (from 4.9 to 5.4 points), her activity increased (from 4.8 to 6.4 points).

According to the Spielberger test, reactive and personal anxiety decreased as a result of treatment (from 29 to 15 points and from 45 to 23, respectively).

After the complex treatment, the average time for finding numbers on Schulte tables decreased, which indicates an increase in the patient's attention (from 41.4 s to 41.2 s).

The REG data reflected in table No. 5 indicate that under the influence of the treatment we proposed, the patient returned to normal pulse blood pressure in both pools. In the basin of the internal carotid artery (BSA), the vascular tone of the microvasculature improved and peripheral resistance indices normalized. In addition, venous outflow normalized in both basins.

Thus, under the influence of color therapy, the patient improved cerebral circulation, decreased blood pressure, decreased clinical manifestations of autonomic and psychoemotional disorders, improved memory and well-being.

Based on the data obtained and the examples cited, it can be argued that complex treatment, including basic therapy and color therapy, significantly reduces the clinical manifestations of the disease and improves the functional state of the central nervous system, which is manifested by an improvement in mood and well-being, increased activity and concentration of attention, and a decrease in the level of reactive anxiety .

It can also be said that the treatment complex that we proposed has mainly a normalizing effect on the indicators of cerebral circulation both at the level of the main arteries and veins, and at the level of the microvasculature, which is of no small importance for the treatment of functional disorders of the hypothalamic-pituitary region.

This allows us to argue that our proposed method improves the effectiveness of treatment of patients with hypothalamic syndrome of the puberty, does not lead to allergization of the body, which allows it to be prescribed to patients with a burdened allergic history. The procedures are well tolerated by patients and do not cause discomfort due to an individual approach to each patient. In addition, the cost of equipment for carrying out these procedures is small, which makes this method of treatment affordable and cost-effective for hospitals.

Table number 1 The effect of visual pulsed color therapy as part of a comprehensive treatment on well-being, activity, mood (according to the SAN test). Feeling well Activity Mood before treatment after treatment before treatment after treatment before treatment after treatment M 4.91 ± 0.18 5.83 ± 0.13 4.28 ± 0.17 5.09 ± 0.16 5.18 ± 0.19 5.97 ± 0.13 R p <0.001 p <0.001 p <0.001

Table number 2 The scheme of the treatment of the patient S-howl Z.M. 17 years. Case history No. 2689. procedure number wavelength, nm color time min pulse duration, sec. backlight pause smooth feed one 480-510 blue 8 four * 2 510-575 green 8 7 * 3 575-585 yellow 8 5 * four 450-480 blue 8 8 * 5 480-510 blue 8 four * 6 620-760 red 8 3 * * 7 585-620 Orange 8 3 * * 8 480-510 blue 8 5 * * 9 510-575 green 8 four * * 10 620-760 red 8 2 * *

Table number 3 Patient rheoencephalography C-howling Z.M. 17 years. Case history No. 2689. Abduction BSA BPA Side On right Left On right Left Rheoencephalogram indicator Before treatment After treatment Before treatment After treatment Before treatment After treatment Before treatment After treatment Reographic Index 0,203 0.114 0.159 0.152 0.116 0.1 0,077 0.174 Peripheral resistance 90.2 59.2 86.5 55 63.8 48 83.1 47.8 Dicrotic index 54.1 46.1 41 43.3 54,4 36.3 26,4 31.1 Diastolic index 68,2 66 61.2 64.8 76.5 71.3 61.1 58.8 Venous outflow index 24.4 16.7 23 13.1 31.6 19 12.7 7.7

Table number 4 The treatment regimen for the patient A-howling M.S. 15 years. Case history No. 2358 procedure number wavelength, nm color Time min pulse duration, sec. backlight pause smooth feed one 480-510 turquoise 8 3 * 2 510-575 green 8 3 * * 3 480-510 turquoise 8 3 * * four 480-510 turquoise 8 one * 5 480-510 turquoise 8 one * 6 480-510 turquoise 8 one * 7 480-510 turquoise 8 one * 8 400-450 Violet 8 one * * 9 450-480 blue 8 one * * * 10 450-480 blue 8 one *

Table number 5 The indicators of rheoencephalography of the patient A-howling M.S. 15 years. Case history No. 2358 Abduction BSA BPA Side On right Left On right Left Rheoencephalogram indicator Before treatment After treatment Before treatment After treatment Before treatment After treatment Before treatment After treatment Geographic index 0.121 0.17 0.85 0.186 0,094 0.159 0.118 0,097 Peripheral resistance 52 80.9 101.9 74.6 61.7 66,4 77.3 66.9 Dicrotic index 42.1 71,4 88.7 65.8 52.6 57.9 64.9 61.8 Diastolic index 59.9 71,4 88.7 65.8 68.5 72.7 64.9 78.9 Venous outflow index 19.8 28.7 35.5 22.7 32.9 29th 8.7 25,4

Claims (1)

A method of treating the hypothalamic syndrome of puberty, including exposure to a physical area on the eye area, traditional drug therapy, massage, a low-calorie diet, characterized in that the exposure is carried out by intermittent supply of electromagnetic waves in the optical range with a wavelength of 400 to 760 nm and a pulse duration of 1 up to 8 s, and before each procedure, for the selection of the exposure wavelength, the patient is asked to choose the color most pleasing to him at the moment from the wavelength range from 400 to 76 0 nm, with the exception of those colors that are contraindicated to him according to concomitant diseases and the prevailing symptoms in the picture of his disease, other parameters of the procedure - a smooth or sharp increase in light intensity, brightness, the presence of pauses between flashes and additional highlighting of the eye area are also individually selected before each procedure depending on the sensitivity of the patient’s visual analyzer to illumination and its rhythm preference, then the exposure is carried out in one color in the supine position for 8 minutes, and the effect is carried out daily in the morning, and the course is 10 procedures.