RU2325146C1 - Method of rehabilitation of multiple sclerosis patients with disordered motor function - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: method consists of intramascular injection of cerebrolysin, nootropyl, vitamins B12 and B6, and cocarboxylase. Cerebrolysin is injected intramuscularly at T16, T20, T21 and twin points PC52. Nootropyl is injected intramuscularly at T12, T13, T14 and twin points GI15. Vitamin B12 is injected intramuscularly at T16 and twin points F5, V60. Vitamin B6 is injected intramuscularly at PC75 and twin points PN105, PN106. Cocarboxylase is injected projective to the piriform muscle. Preparations are injected daily during 10 days.

EFFECT: longer remission period.

1 ex, 2 tbl

Description

The invention relates to medicine, namely to neurology, and can be used for the rehabilitation of impaired motor functions (gait, balance and motor coordination), which are the most disabling factor in patients with multiple sclerosis (PC), severely limiting the patient's ability to move and self-care, in clinical and outpatient practice of neurological departments.

From literary sources it is known that prevalence rates of PCs tend to increase and, according to various estimates, there are about 3 million patients in the world (approximately 1: 1000 of the population). Over the past 70 years, the incidence has increased 5 times (especially at a young age of 20-40 years), and more often women are sick (Schmidt T.E., Yakhno N.N. Multiple sclerosis. M: Medicine, 2003. P.10 ) According to WHO, the number of patients is currently increasing by approximately 105 thousand people per year (Modern aspects of the pathogenesis and treatment of multiple sclerosis. Saratov. Publishing house of SSMU. 2000. C 3). The elimination of a significant number of able-bodied people from active life, the additional costs of diagnosis, treatment, rehabilitation and social assistance make the problem of PC morbidity socially and economically significant.

A known method of treating patients with PC by using glucocorticoid hormones (methylprednisolone, dexamethasone, etc.), the purpose of which is to limit the inflammatory process and the degree of destruction of myelin, i.e. improve the condition of patients at the time of exacerbation, reduce its duration and, possibly, prevent the development of persistent neurological consequences.

The disadvantages of this method include the fact that glucocorticoids only reduce the severity and duration of exacerbation, but do not have a beneficial effect on the course of the disease in the future (Thompson AJ, Kennard C, Swash M. et al. Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS. Neurology 1989, v. 39, p. 969-971). The expected inhibition of the pathological process does not occur (according to a number of information sources, the maximum time for preservation of the Romberg posture by patients after the course of treatment ranges from 3 to 5 seconds), in addition, there is a steroid dependence - the course of the disease worsens after canceling treatment with glucocorticoids, and the patient suffers from numerous side effects - osteoporosis, peptic ulcer, hypertension, obesity, immunodeficiency, increased susceptibility to infections. The frequency of side effects of drugs of this type ranges from 30 to 68% (Egorova L.I. Treatment with glucocorticoids and ACTH. Ed.2-M., “Medicine”, 1972).

As a prototype, a method using metabolic therapy that promotes the regeneration of the affected tissue and maintains the balance of immunoregulation (Gusev E.I., Demina T.L., Boyko A.N. Multiple sclerosis. M., 1997. S. 344) was selected. The essence of metabolic therapy is the use of a complex of drugs (cerebrolysin, nootropil, B vitamins and others in a dose of 1 ml of each drug daily), which contribute to the restoration of nerve impulses that activate and normalize the functioning of the central and peripheral nervous system, as well as improve overall metabolism substances in the body, injected intramuscularly into the upper outer quadrant of the buttock. The use of metabolic therapy prevents exacerbation of the PC or reduces its severity and to some extent affects the improvement of the patient's motor functions.

The disadvantages of this method include the fact that in some cases, metabolic therapy does not always contribute to a visible improvement in the general condition of the patient; restoration of impaired motor functions, as a rule, is insignificant and is observed mainly in the early stages of PC. Slightly improves stability in the Romberg position (from 5 to 10 seconds). Therefore, the effect on the course of the disease of drugs introduced intramuscularly into the upper outer quadrant of the buttocks by the prototype method is insignificant and does not allow to achieve the necessary therapeutic result. The low effect of the courses of therapy necessitates an increase in the frequency of their repetition (3-4 times a year) and an increase in the total dose of drugs, which can lead to an increase in the workload on the liver, and increases the possibility of sensitization of the body. There is evidence of the use of acupuncture in patients with PC for the purpose of rehabilitation, but the effectiveness of such treatment is negligible (Gusev E.I., Demina T.L., Boyko A.N. Multiple sclerosis. M., 1997. S.365).

We first proposed a method for the rehabilitation of PC patients with impaired motor functions by intramuscular injection of a number of drugs directly into biologically active points used for acupuncture in traditional oriental medicine for paresis and paralysis, cerebral and peripheral blood circulation disorders (Ivanov V.I. Traditional medicine. Military publishing house. M., 1991). The clinical implementation of this method has a pronounced positive effect in case of impaired movement functions, since injections of drugs are carried out directly to the points on the projection of the muscles involved in the movement act, as well as in areas associated with activation of cerebral circulation.

The scheme of the use of drugs in the clinical manifestations of PC, expressed in spastic paresis, impaired sensory function of the limbs, unsteady gait, heaviness in the legs, dizziness, is an injection of drugs:

- cerebrolysin at the points of PC52 paired, T16, T20, T21 - 0.2 ml each,

- nootropil to the points GI15 paired, T12, T13, T14 - 0.2 ml each,

- vitamin B 12 at points F5, V60 paired, T16 - 0.2 ml each,

- Vitamin B6 to the points PN105, PN106 paired, PC75 - 0.2 ml each.

The choice of biologically active points in the implementation of the rehabilitation scheme for PC patients with impaired motor functions was carried out by analogy with a reflexology course for cerebral and peripheral blood supply disorders, paresis and muscle paralysis, dizziness (Samosyuk I.Z., Lysenyuk V.P. Acupuncture. Encyclopedia. Ukrainian Encyclopedia named after MP Bazhan (Kiev), publishing house ACT - Press. Moscow, 1994. Russian language. S.27-174). Drugs are administered in therapeutic doses (1 ml), distributing each drug in the five points above.

The proposed rehabilitation method was used in patients aged 20 to 50 years old with a diagnosis of multiple sclerosis, cerebrospinal form, secondary progressive course, spastic lower paraparesis, cerebellar cider. The diagnosis in all cases was made taking into account the clinical picture and using NMR-T examination of the head, while foci of demyelination of various sizes were revealed on the tomograms of all patients in the substance of the brain. The course of rehabilitation measures with the severity of motor disorders according to the international scale for assessing the severity of the condition in patients with an indicator of 4-4.5 points included 10 sessions. Each session, in turn, consisted of daily injections of drugs injected into biologically active points according to the scheme given above. During the courses and in the intervals between them, physical therapy sessions were held individually with an emphasis on restoring the performance of weakened paretic muscles, taking into account the degree of their atrophy in each patient.

The comparison group consisted of 20 patients with PC, comparable by sex, age, clinical and morphological patterns of the course of the disease, treated with drugs using the prototype method, the rehabilitation group - according to the proposed method with a similar diagnosis of the disease - from 23 patients. The averaged values of the values of the temporary criteria for the symptomatology of the condition of patients with PC when comparing the methods of the prototype and the proposed are given in table 1.

The results of comparing the changes in symptoms after the treatment measures showed a positive effect in both groups, but in the second group, in which rehabilitation was carried out using the pharmacopuncture method, as can be seen from the data in Table 1, gait unsteadiness decreased earlier (by about 2 times), muscle strength increased, dizziness decreased, muscle spasticity decreased. In the same rehabilitation group, a more stable remission of the disease was noted (during the year compared to 6 months in the comparison group achieved using the prototype method), social adaptation more fully passed.

Table 1. Symptoms Metabolic therapy according to the prototype method Pharmacopuncture metabolic therapy Unsteadiness gait 7-9 day 3-5 day Muscle strength 7-9 day 3-5 day Dizziness 8-10 day 5-7 day Muscle spasticity reduction 8-10 day 5-7 day

We first found that the additional injection of cocarboxylase into the projection region of the piriformis muscle significantly increases the efficiency of rehabilitation of patients with PC using pharmacopuncture. A comparison of the dynamics of the restoration of the patient’s physical condition after a course of injections into biologically active points and into the region of the projections of the piriformis muscles according to the criterion of the onset of improvement is given in Table 2.

Table 2. Symptoms Pharmacopuncture metabolic therapy Pharmacopuncture metabolic therapy with the additional introduction of cocarboxylase to the piriformis projection region Unsteadiness gait 3-5 day 2-4 day Muscle strength 3-5 day 2-4 day Dizziness 5-7 day 5-7 day Reduced muscle spasticity 5-7 day 4-6 day

EXAMPLE. Patient S. 34 years.

She complained of shakiness of the gait, dragging of the right leg, severe general weakness, tension in the lower back, heaviness in the legs, the ability to walk only within the apartment, along the street - several meters with outside help and with great difficulty. She got sick 14 years ago after suffering an ARI. Objectively: the consciousness is clear, the left nasolabial fold is smoothed out, the movements of the eyeballs are in full, the finely spread nystagmus is at rest and when looking to the side, when looking upwards - with the rotator component, there is no diplopia, swallowing is not impaired. Muscle strength in the hands is reduced to 4 points, in the legs to 3 points. Active movements in the lower extremities are limited in all joints. Reflexes from the arms and legs are high, with the expansion of reflexogenic zones, S> D, positive symptoms of Babinsky and Rossolimo on both sides, a positive analogue of Rossolimo's symptom on both hands. Muscle tone in the limbs is elevated according to the pyramidal type, more in the legs and on the right. There are no violations of sensitivity. In the Romberg position, the patient is unstable, the maximum posture preservation time is no more than 3 seconds. Data of visual registration of NMR-T of the head: in the substance of the brain (paraventricular zone) in both hemispheres foci d = 5-6 mm. The picture of the demyelinating process.

Diagnosis: multiple sclerosis, cerebrospinal form, secondary progressive course, spastic tetraparesis, cerebellar syndrome. The patient underwent a rehabilitation course according to the proposed method of metabolic therapy to biologically active points lasting 10 days.

Pharmacopuncture of cerebrolysin was carried out by injection into the points of PC52 paired, T16, T20, T21 - 0.2 ml each,

- nootropil to the points GI15 paired, T12, T13, T14 - 0.2 ml each,

- vitamin B 12 at points F5, V60 paired, T16 - 0.2 ml each,

- Vitamin B6 to the points PN105, PN106 paired, PC75 - 0.2 ml each,

- cocarboxylases in the area of projections of the piriformis muscles.

Improving walking and other motor functions appeared after 2 days and was continuous throughout the entire rehabilitation period. Shakiness in walking decreased, spasticity of paretic muscles, increased walking distance and strength of leg muscles, increased the range of opportunities for homework, increased social adaptation. Increased stability in the Romberg position (up to 20 seconds). In the future, the condition for maintaining the stability of the condition was the periodic conduct of repeated rehabilitation courses and exercise therapy.

The application of the proposed method involves the use of courses for 10 days of a complex of drugs that have virtually no adverse effects on the body, the introduction of which at biologically active points and in the area of projections of the piriformis muscles gives a much more pronounced effect than the use of a treatment regimen according to the prototype method. This allows you to increase the efficiency of rehabilitation of patients with PC, achieve stable remission, socially adapt the patient, reduce the possibility of disability at a young age, limit the use of glucocorticoid hormones, cytostatics and other drugs that have significant side effects while reducing the economic cost of treatment.

Claims (1)

A method of rehabilitation of patients with multiple sclerosis with impaired motor function, including intramuscular administration of cerebrolysin, nootropil, vitamins B12, B6, cocarboxylase, characterized in that cerebrolysin is administered at points T16, T20, T21 and paired points of PC52, butotropil is administered at points T12, T13 , T14 and to GI15 paired points, vitamin B12 is introduced to T16 point and to F5, V60 paired points, vitamin B6 is introduced to PC75 point and to PN105, PN106 paired points, cocarboxylase is introduced into the piriformis projection area, daily for 10 days.