RU2789004C1 - Method for increasing the level of consciousness of patients with prolonged impairment of consciousness after traumatic brain injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to anesthesiology and resuscitation, and can be used to increase the level of consciousness of patients with prolonged impairment of consciousness after a traumatic brain injury. An air mixture containing 30% xenon is inhaled once a day for 30 minutes for seven days.

EFFECT: method allows to increase the level of consciousness of patients due to inhalation of the air-xenon mixture, which has an anti-inflammatory effect.

1 cl, 3 tbl, 2 ex

Description

The invention relates to medicine, namely to medicine of critical conditions, resuscitation, anesthesiology and clinical pharmacology, and can be used for prolonged impairment of consciousness after a traumatic brain injury (TBI).

Relevance

The problem of long-term impairment of consciousness after TBI over time not only does not lose relevance, but also gradually comes to the fore. This is mainly due to an increase in the incidence of severe concomitant trauma, in the structure of which TBI occurs in about a third of cases. In turn, prolonged impairment of consciousness contributes to the development of secondary complications that significantly worsen the prognosis in this category of patients.

State of the art

In addition to high mortality, TBI is fraught with another danger - a long rehabilitation period and a high percentage of disability with the development of cognitive impairment. This is primarily due to the processes of neuroinflammation, the development of which, according to recent data, leads to a long-term impairment of consciousness.

Within the framework of modern ideas about the causes and pathogenesis of a long-term impairment of consciousness, the process of neuroinflammation is of the greatest interest [Corps KN, Roth TL, McGavern DB. Inflammation and neuroprotection in traumatic brain injury. JAMA Neurol. 2015; 72 (3): 355-62.]. If in the acute period primary injuries as a result of the injury itself predominate, then after a few days inflammatory processes begin to come to the fore, the development of which leads to undesirable consequences in the form of cognitive impairment and prolonged impairment of consciousness.

The search for a drug that can, if not prevent, then at least significantly minimize the consequences of TBI, has been going on for a long time. Understanding the root causes, as well as pathological cascades and main targets within neuroinflammation, suggested that the effects of the inhaled anesthetic xenon could potentially beneficially affect the recovery of this group of patients [Maze M, Laitio T. Neuroprotective Properties of Xenon. Mol Neurobiol. 2020; 57(1): 118-124. https://doi.org/10.1007/s12035-019-01761-z. PMID: 31758401; Licastro F, Hrelia S, Porcellini E, Malaguti M, Di Stefano C, Angeloni C, Carbone I, Simoncini L, Piperno R. Peripheral Inflammatory Markers and Antioxidant Response during the Post-Acute and Chronic Phase after Severe Traumatic Brain Injury. Front Neurol. 2016; 7:189. https://doi.org/10.3389/fneur.2016.00189. PMID: 27853449; PMCID: PMC5089971; McDonald SJ, Sun M, Agoston DV, Shultz SR. The effect of concomitant peripheral injury on traumatic brain injury pathobiology and outcome. J Neuroinflammation. 2016; 13(1): 90. https://doi.org/10.1186/s12974-016-0555-1. PMID: 27117191; PMCID: PMC4847339].

Organoprotection by inert gases is becoming the subject of more and more careful study [Stryapko N.V., Sazontova T.G., Potievskaya V.I., Khairullina A.A., Vdovina I.B., Kulikov A.N., Arkhipenko Yu.V. ., Molchanov I.V. Adaptive effect of repeated use of xenon. General resuscitation. 2014; 10(2):50-56. https://doi.org/10.15360/1813-9779-2014-2-50-56]. This is due, in part, to their intactness with respect to enzyme systems and excretion from the body in an unchanged state, which potentially facilitates their use in patients in extremely severe conditions. A 2019 research paper compared the neuroprotective potential of all inert gases in a model of ischemic brain injury. The highest potential was noted for xenon and argon, while the remaining gases (krypton, neon, and helium) did not have a significant effect on the severity of hypoxic damage [Koziakova M, Harris K, Edge CJ, Franks NP, White IL, Dickinson R. Noble gas neuroprotection: xenon and argon protect against hypoxic-ischaemic injury in rat hippocampus in vitro via distinct mechanisms. Br J Anaesth. 2019; 123(5): 601-609. https://doi.org/10.1016/j.bja.2019.07.010. PMID: 31470983; PMCID: PMC6871267.].

A little later, in a large meta-analysis in 2021, previously available data were summarized and a conclusion was made about the unequivocal effectiveness of xenon in brain damage of various origins [Hollig A, Coburn M. Noble gases and neuroprotection: summary of current evidence. Curr Opin Anaesthesiol. 2021; 34(5): 603-606. https://doi.org/10.1097/ACO.0000000000001033. PMID: 34224430.] This work included a number of large experimental studies aimed at determining the mechanisms for implementing neuroprotection and possible patterns of use [Lavaur J, Lemaire M, Rure J, Le Nogue D, Hirsch EC, Michel PP. Neuroprotective and neurorestorative potential of xenon. Cell Death Dis. 2016; 7(4): e2182. https://doi.org/10.1038/cddis.2016.86. PMID: 27054337; PMCID: PMC4855665.; Fahlenkamp AV, Rossaint R, Coburn M. Neuroprotektion durch Edelgase: Neue Entwicklungen und Erkenntnisse [Neuroprotection by noble gases: New developments and insights]. Anaesthesist. 2015 Nov;64(11): 855-8. German. https://doi.org/:10.1007/s00101-015-0079-6. PMID: 26329914].

However, there is no previous work that has evaluated the effects of xenon exposure in patients with long-term impairment of consciousness.

There are several therapeutic agents and methods aimed at solving the problem of neuroprotection in TBI.

In particular, it is proposed to use xenon in cases where neurointoxication is caused by an excess of neurotransmitters. Xenon can reduce the release of neurotransmitters, primarily dopamine, which is caused, for example, by conditions of hypoxia, such as apoplexy or TBI (RU 2246949). This method includes inhalation of a gas mixture of oxygen, nitrogen and xenon (xenon content 5-30 vol.%) in the first hours after TBI (acute period). The use of the known method does not give the technical results of the proposed method, since a long-term impairment of consciousness after TBI is formed after coming out of a coma and persists for up to a year, which implies the absence of neurointoxication, which occurs only in the first hours after TBI.

There is a known method of increasing and accelerated recovery of working capacity, which is characterized by the fact that a person is exposed to gas mixtures based on xenon, which have the property of increasing the physical and psychological capabilities of a person during preparation for extreme loads and / or after extreme loads (US 2009258087). Exposure to these mixtures is carried out for several minutes before extreme loads by inhaling a gas mixture consisting of oxygen and / or air and at least one inert gas, mainly xenon, with an oxygen or air content of 20% to 98% and at least one inert gas with a content of 2% to 80%. Inhalation with a gaseous mixture is carried out until the onset of a state of euphoria, but not more than 20 minutes with or without interruptions.

The use of the known method does not give the technical results of the proposed method, since it involves the use of xenon in the preconditioning mode, before the onset of extreme events, it is applicable in healthy people and is not applicable in patients with prolonged impairment of consciousness after TBI.

Closest to the claimed method in terms of a combination of matching essential features is a method of xenon therapy for somatic diseases, including periodic inhalation of a mixture of oxygen with an inert gas xenon at a ratio of (50:50) - (30:70) vol. %, characterized in that each inhalation is carried out 2 times a day - in the morning and in the evening for 7-10 days, increasing the content of xenon in the mixture from the second or third day, while the duration of inhalation increases from 3-5 minutes in the first two days to 7-15 minutes on the next day (RU 2305565).

The use of the known method does not give the technical results of the claimed invention, since it involves the use of high oxygen concentrations up to 50 vol. %, which is inappropriate in patients with cerebral accidents and short exposures of xenon from 3-5 minutes in the first two days to 7-15 minutes in the next day and does not involve the treatment of patients with prolonged impairment of consciousness after TBI.

Disclosure of the essence of the invention

The claimed invention is aimed at solving the problem of increasing the level of consciousness of patients with prolonged impairment of consciousness after TBI by inhalation of an air-xenon mixture. The anti-inflammatory effects of xenon inhalation anesthetic, which have been repeatedly shown in previous studies, have the potential to beneficially affect the level of consciousness in these patients by targeting key links of neuroinflammation.

In a previous experimental study, the authors of the proposed method proved a distinct anti-inflammatory effect of this anesthetic, which consisted in increasing the ability of neutrophils to spontaneous apoptosis after modeling an inflammatory response [Grebenchikov O.A., Shabanov A.K., Nikolaev L.L., Shpichko A. I., Bratishchev I.V., Marchenko L.Yu., Khusainov Sh.Zh., Cherpakov R.A., Shpicko N.P. Influence of xenon on pro-inflammatory activation and apoptosis of human neutrophils in ex vivo conditions. Journal them. N.V. Sklifosovsky "Emergency medical care". 2021; 10(3): 511-520. https://doi.org/10.23934/2223-9022-2021-10-3-511-520].

This therapeutic result was realized by reducing the expression of adhesion molecules CD11b and CD66b on the surface of neutrophils. Also, after exposure to xenon in modeling TBI in vivo, a significant decrease in the activation of pro-inflammatory genes NF-kB1 and NF-kB2, responsible for the synthesis of cytokines and other molecules involved in inflammation, was proved [Filev AD, Silachev DN, Ryzhkov IA, Lapin KN, Babkina AS, Grebenchikov OA, Pisarev VM. Effect of Xenon Treatment on Gene Expression in Brain Tissue after Traumatic Brain Injury in Rats. Brain Sci. 2021; 11(7): 889. https://doi.org/10.3390/brainsci11070889. PMID: 34356124; PMCID: PMC8301933].

However, if regarding the beneficial effect of xenon in acute conditions, even if small, but still significant experience has been accumulated [Wilhelm S, Ma D, Maze M, Franks NP. Effects of xenon on in vitro and in vivo models of neuronal injury. Anesthesiology. 2002; 96(6): 1485-91. https://doi.org/10.1097/00000542-200206000-00031. PMID: 12170064.; David FIN, Leveille F, Chazalviel L, MacKenzie ET, Buisson A, Lemaire M, Abraini JH. Reduction of ischemic brain damage by nitrous oxide and xenon. JCereb Blood Flow Metab. 2003; 23(10): 1168-73. https://doi.org/10.1097/01.WCB.0000087342.31689.18. PMID: 14526227.; Alam A, Suen KC, Hana Z, Sanders RD, Maze M, Ma D. Neuroprotection and neurotoxicity in the developing brain: an update on the effects of dexmedetomidine and xenon. Neurotoxicol Teratol. 2017; 60:102-116. https://doi.org/10.1016/j.ntt.2017.01.001. Epub 2017 Jan 6. PMID: 28065636], it was not used for patients in a state of long-term impairment of consciousness.

Implementation of the invention

Based on the understanding of the complex effect of xenon on neuroprotection, the authors of the proposed method conducted a prospective randomized clinical study of the effect of xenon inhalation sedation on the level of consciousness in patients with post-coma long-term impairment of consciousness as a result of TBI.

Patients were randomized into 2 equal groups. In group I (control, n=15) - in addition to the standard treatment after TBI, each patient included in the study underwent 7 sessions of inhalation of an air-oxygen mixture with an O2 content _of at least 30 vol% for 30 minutes, 1 time per day. In group II (study, n=15), in addition to the standard treatment, each patient included in the study underwent inhalation of an air mixture containing 30 vol% xenon for 30 minutes, for seven days, once a day. Before and after the course of treatment (on the 7th day), patients were assessed using the CRS-R scale and the modified Ashworth scale.

The recruitment of patients into groups was carried out according to the inclusion and exclusion criteria.

Inclusion Criteria:

- men and women aged 18 to 65;

- patients with severe brain damage due to traumatic brain injury;

- level of consciousness: a vegetative state or a state of minimal consciousness;

- independent breathing;

- informed consent of the patient or his legal representative to participate in a scientific study.

Exclusion Criteria:

- presence of indications for emergency surgical intervention;

- the need for inotropic and vasopressor support, assessed on the VIS scale more than 10 points;

- aggravated allergic history;

- drug intolerance;

- The investigator may decide to terminate the patient's participation in the study early at any time if the patient's condition requires it.

To eliminate the preferences of the researchers, the recruitment into groups was carried out by the envelope method.

After the start of the study, 3 patients were excluded from the control group - in one case, emergency surgical treatment of gastrointestinal bleeding was required, in two cases, the need for mechanical ventilation. Three patients were also excluded from the main group: in two cases, inotropic support was required, in one case, the need for bypass surgery due to increased intracranial hypertension. The age composition and sex of patients included in the study are presented in Table 1.

For the procedure in both groups, a KTK-01 xenon therapeutic circuit (Akela-N, Russia) was used, equipped with an oxygen and xenon gas analyzer, as well as a xenon dispenser, which allows controlling both the current consumption and the total consumption. All patients included in the study were on their own breathing through a tracheostomy tube. Before the procedure, the patient's tracheostomy tube was sanitized and the cuff was inflated to further seal the respiratory circuit and minimize xenon loss during inhalation.

In group I, inhalation with an oxygen-air mixture was carried out according to the following method: after connecting the patient to the xenon therapeutic circuit, five-minute denitrogenation was performed by inhalation with 100% oxygen until a stable oxygen concentration in the circuit was 95-97 vol.%. Thereafter, the O ₂ concentration was reduced to 30 vol % and the exhalation valve was closed, thereby making the circuit completely closed. Within 30 minutes, the patient was inhaled with an oxygen-air mixture while maintaining a constant concentration of O ₂ at 30% vol. During the procedure, ECG monitoring was performed in 3 leads with the calculation of heart rate and blood pressure by a non-invasive method, as well as plethysmography with pulse oximetry. After 30 minutes, the therapeutic circuit was disconnected and the procedure was completed.

In group II, denitrogenation was performed according to the same method, however, after it, immediately after the exhalation valve was closed, xenon was supplied to the circuit at a rate of 0.5–1 l/min until a concentration of 30 vol % was reached. Further, the specified concentration was maintained for 30 minutes with monitoring similar to the control group. After the end of the procedure, oxygen supply was started into the circuit at a rate of 3-5 l/min, and the exhalation valve was opened. Within 2-3 minutes, the concentration of xenon in the exhaled mixture was brought to 0 vol%, after which the patient was disconnected from the circuit.

Before and after the completion of the course, the following indicators were assessed:

The level of recovery after coma using the CRS-R scale (Coma Recovery Scale-Revised).

Statistical data analysis was performed using the Statistica 10 software package (StatSoft, Inc., USA). Descriptive statistics of quantitative traits are presented as medians and quartiles in Me (LQ; UQ) format. The study groups were compared using the Mann-Whitney U test and the Wilcoxon test. Differences were considered statistically significant at p<0.05.

Results:

The final evaluation included 12 patients from the control group and 12 patients from the study group. 3 patients from each group were excluded as a result of critical incidents not related to the nature of the therapy.

When assessing the level of recovery of consciousness in the control group, the authors did not receive significant (p>0.05) differences between the initial and final points (Table 2). The initial value was 8 [6; 10] points, final - 9 [7; 11] points. Data are presented by median and interquartile range.

In the study group on the 7th day there was a significant (p=0.021) increase in the level of consciousness in relation to the initial level. At the start of the study, the score was 9 [7; 10], and after the course of treatment - 15 [12; 17] (Table 3). Separately, it should be noted that with an intergroup comparison of the results on the 7th day, the level of consciousness in group II would be significantly (p = 0.038) higher than in the control group.

Conclusions: Inhalation of an air mixture containing 30 vol% xenon, according to the method proposed by the authors, made it possible to have a beneficial effect on the level of consciousness of patients after TBI.

Clinical examples

1. Patient A. Admitted to the FSCC RR on February 19, 2020.

From the anamnesis: she was injured as a result of an accident (a passenger car, a collision of 2 cars) on November 29, 2019, was taken to the emergency department of the City Clinical Hospital of the Emergency Department of Vladimir in an extremely serious condition, where she was examined by a traumatologist, surgeon, urologist, neurosurgeon ), a CT scan of the brain was performed on November 29, 2019, where an acute subdural hematoma was verified in the region of the right frontotemporal-parietal lobe with a maximum thickness of up to 13 mm. Minimal traumatic SAH. Small foci of contusion in the right fronto-parietal region. Chest CT scan dated 11/29/19: changes in S4 of the right lung, most likely corresponds to a post-inflammatory process in the stage of incomplete resolution. On November 29, 2019, the operation was performed: resection decompressive trepanation of the skull in the right fronto-parietal-temporal region, removal of an acute subdural hematoma of the right hemisphere localization. On December 17, 2019, she was transferred to the Design Bureau of the Design Bureau of Vladimir. The course of the disease was complicated by the addition of lower lobe pneumonia. On February 19, 2020, she was admitted to the FSCC RR to continue rehabilitation and therapeutic measures.

Diagnosis at admission: Main: Consequences of severe TBI dated 11/29/2019. Condition after surgical treatment: decompressive craniotomy with removal of acute subdural hematoma from 11/20/2020. vegetative state.

Companion: Lower tracheostomy from 29.11. 2019 Hyperplastic sinusitis. Chronic subatrophic nasopharyngitis. Angiopathy of the retina in both eyes.

As a basic therapy, she received nootropic drugs, antioxidants, gastroprotectors, drugs for the treatment of spasticity.

03/05/2020. started a course of inhalation of an air mixture containing 30% xenon for 30 minutes. In neurological status 03/05/2020: Level of consciousness: minimum consciousness "minus". The eyes are closed during examination. Opens in response to a painful stimulus, periodically - spontaneously. It fixes the gaze, monitors the inspection, localizes the sound, monitors the mirror.

CRS scale - 10 b (2-3-2-1-0-2).

The position of the patient in bed is passive in the given position. He reacts to a painful stimulus with a grimace, flexion of the limbs (posotonic reaction). He does not perceive the addressed speech. There is no private speech. There is no articulation. Doesn't follow instructions.

There are no meningeal signs.

Eye fissures D=S. The range of motion of the eyeballs is not limited. Pupils - D=S, rounded. Direct pupillary response to light was preserved, friendly pupillary response to light was preserved. The oculocephalic reflex is preserved. The movements of the lower jaw are not limited. The corneal reflex is preserved. The face is symmetrical at rest. The pharyngeal reflex is reduced. Tongue in the mouth along the midline, does not lead beyond the line of the teeth. Reflexes of oral automatism: proboscis.

Muscles are developed correctly, hypotrophic. Fasciculations and myokymia are not determined, there are no clonuses. Muscle strength: it is not possible to reliably determine due to limited contact with the patient. Saved active movements in the right leg. Passive movements in the limbs are limited due to increased muscle tone: flexor installation of the hands and feet. Muscle tone increased according to the spastic type: in the right hand 4 points, in the left hand 3 points, in the right leg 3 points, in the left leg 4 points. according to the modified Ashworth spasticity scale. There are no hyperkinesias. Tendon and periosteal reflexes are equal, high. Pathological reflexes: Babinsky from 2 sides. Sensitive sphere - it is impossible to reliably assess due to limited contact with the patient. The functions of the pelvic organs are not controlled.

After 7 procedures of inhalation of an air mixture containing 30% xenon, the patient showed positive dynamics in the neurological status.

Neurological status 03/16/2020: Level of consciousness: syndrome of reintegration of consciousness (exit from the state of minimal consciousness). The eyes are open on examination. The gaze fixes, follows the inspection, differentiates objects. CRS scale - 22 b (4-5-6-2-2-3).

The position of the patient in bed is passive in the given position. He perceives the addressed speech correctly, somewhat slowly. There is no own speech (the presence of TST). Tries to articulate. Performs available instructions. Answers questions correctly (with a nod of the head, blinking, minimal articulation).

There are no meningeal signs.

Eye fissures D=S. The range of motion of the eyeballs is not limited. Pupils - D=S, rounded. Direct pupillary response to light was preserved, friendly pupillary response to light was preserved. The oculocephalic reflex is preserved. The movements of the lower jaw are not limited. The corneal reflex is preserved. The face is symmetrical at rest. The pharyngeal reflex is reduced. Tongue in the midline. Reflexes of oral automatism: proboscis.

Muscles are developed correctly, hypotrophic. Fasciculations and myokymia are not determined, there are no clonuses. Muscle strength: it is not possible to reliably determine due to limited contact with the patient. Saved active movements in the right leg. Passive movements in the limbs are limited due to increased muscle tone: flexor installation of the hands and feet. Muscle tone is increased according to the spastic type: in the right hand 4 points, in the left hand 3 points, in the right leg 2 points, in the left leg 3 points. according to the modified Ashworth spasticity scale. There are no hyperkinesias. Tendon and periosteal reflexes are equal, high. Pathological reflexes: Babinsky from 2 sides. The functions of the pelvic organs are not controlled.

Dynamics in comparison with the previous examination - the level of consciousness has increased (syndrome of reintegration of consciousness). Improved communication with the patient (answers yes-no questions by blinking, tries to articulate, follows available instructions).

2. Patient P. Admitted to the FSCC RR on December 27, 2020.

From the anamnesis: on October 16, 2019, she got into an accident, was hit by a car, the ambulance crew delivered her to the Ramenskaya Central District Hospital, where CT scan of the brain revealed subdural hematomas in the right occipital and left frontal areas, subarachnoid hemorrhage, ventricular hemorrhage. On 10/17/19, she was transferred to the NII SP im. N.V. Sklifosovsky. On October 18, 2019, the operation was performed: decompressive craniotomy, removal of a subdural hematoma in the right frontotemporal-parietal region with a volume of 59 cm3. The postoperative period proceeded without complications. On December 27, 2019, she was transferred to the FSCC RR to continue rehabilitation activities.

At admission, the level of consciousness was assessed as a vegetative state.

Diagnosis at admission:

Main: Consequences of a closed TBI on October 16, 2019, multiple brain contusions: small-focal contusion of the left temporal lobe (4.6 cm ³ ), frontal lobe (0.3 cm ³ and 0.3 cm ³ ), acute subdural hematoma of the frontal - temporo-parietal-occipital region 59 cm ³ , traumatic SAH, intraventricular hemorrhage 3.5 cm ³ . Decompressive craniotomy, removal of a subdural hematoma in the right frontal-temporal-parietal region 59 cm3 from ^10/18/2019

Complication: Bilateral lower lobe pneumonia. Mucopurulent tracheobronchitis. Acute catarrhal pansinusitis, bilateral tubo-otitis.

Concomitant: Arterial hypertension 1 degree, risk 4, HK1.

As a basic therapy, she received nootropic drugs, antihypertensives, antibiotic therapy, mucolytics, gastroprotectors

On February 17, 2020, a course of inhalation of an air mixture containing 30% xenon was started for 30 minutes.

In the neurological status on February 17, 2020: The level of consciousness is a vegetative state. The eyes are open on examination. The gaze is not fixed. CRS-R scale - 5 b. (1-1-1-0-0-2). Reacts to pain stimulus by minimal flexion of the left arm. He does not perceive the addressed speech. There is no private speech. Doesn't articulate. Doesn't follow instructions. There are no meningeal signs. The palpebral fissures are equal. The pupils are equal. Photoreactions are saved. The oculocephalic reflex is preserved. Movement of the lower jaw - lockjaw. The corneal reflex is preserved. The pharyngeal reflex is reduced.

Muscles are developed correctly, hypotrophic. Fasciculations and myokymia are not determined, there are no clonuses. Muscle strength: it is not possible to reliably determine muscle strength in points due to limited contact with the patient. The muscle tone in the extremities is increased according to the spastic type. According to the modified Ashworth spasticity scale on the left up to 3 points, on the right in the arm up to 2 points, in the right leg up to 4 points. The right leg was bent at the knee joint due to spasticity. Tendon and periosteal reflexes S>D. There are no pathological reflexes. Sensitive sphere - it is impossible to reliably assess due to limited contact with the patient. The functions of the pelvic organs are not controlled.

After 7 procedures of inhalation of an air mixture containing 30% xenon, the patient showed positive dynamics in the neurological status.

Neurological status 03/05/2020: Level of consciousness - minimum consciousness "plus". The eyes are open on examination. The gaze is fixed. CRS-R scale - 18 b. (4-4-4-2-1-3). The position of the patient in bed is passive in the given position. An attempt to localize pain on a painful stimulus.

Addressed speech is not perceived in full. Follows simple instructions: opens eyes on command, answers simple questions by blinking. Own speech is absent, there were attempts of articulation.

There are no meningeal signs.

The palpebral fissures are equal. The pupils are equal. Photoreactions are saved. The oculocephalic reflex is preserved. Lower jaw movements - trismus, opens the mouth on command. The corneal reflex is preserved. The pharyngeal reflex is reduced.

Muscles are developed correctly, hypotrophic. Fasciculations and myokymia are not determined, there are no clonuses. Muscle strength: it is not possible to reliably determine muscle strength in points due to limited contact with the patient, active movements in the right hand are preserved. The muscle tone in the extremities is increased according to the spastic type. According to the modified Ashworth spasticity scale: in the right hand 1 point, in the left hand 2 points, in the right leg 4 points, in the left leg 3 points. The right leg was bent at the knee joint due to spasticity. Tendon and periosteal reflexes S>D. Pathological reflexes: Babinsky on the right. Sensitive sphere - it is impossible to reliably assess due to limited contact with the patient. The functions of the pelvic organs are not controlled.

After a course of inhalation of an air mixture containing 30 vol% xenon, a positive trend was observed - an increase in the level of consciousness to a minimum consciousness "plus", she began to follow simple instructions, answers simple questions by blinking.

Claims (1)

A method for increasing the level of consciousness of patients with prolonged impairment of consciousness after a traumatic brain injury, including inhalation of a gas mixture containing xenon inert gas, characterized in that an air mixture containing 30% xenon is inhaled once a day for 30 minutes for seven days.