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A state of visual analyzer according to the reverse color chees type pattern in case of patients with type 1 diabetes
to have antibody titers to galactocerebroside, and the amount ofwhich 2 times exceeds an adults’ usual amount of titers [7]. It’s already known that the level of antibody production to glutamate receptors is also dependent on the age. In some children those titers remain for a long time. It must be emphasized that increased titers of antybodies to galactocerebro-sides, which are contained in the myelin membranes and cells myelin-producing cells, and to glutamate receptors, which activate neurotransmitter nitrogen oxide production, having a direct toxic effect on oligodendrocytes, create background for the development of demyelinating process in the central nervous system. Debut of MS at the age of 10 years implies
a more favorable course of the disease, whereas the debut at the age of12-14 characterized by severe course with frequent exacerbations [8].
Summary: Thequestion about the prognosis of multiple sclerosis, which debut in childhood remains unsolved. There are a lot of cases of benign and malignant course of MS in children. Taking into consideration the difficulty of clinical diagnosis of MS in childhood, only complex approach using modern methods of examination allows making an early diagnosis and appropriate treatment, provide an important adherence which is essential to prevent progression of disease and deterioration of the patient.
References
1. Avtoreferat k. m. n. Shevchenko P. P., Rasprostranennostiklinicheskayaharakteristikarasseyannogoskleroza v Stavropols-komkrae - Novosibirsk, 1992.
2. Shevchenko P. P., Karpov S. M., Rzaeva O. A., Yanushkevich V E., Koneva A. V. Rasseyannyiyskleroz: etiopatogenez s poz-itsiisovremennoynauki. 2014; s 123-124. Uspehisovremennogoestestvoznaniya.
3. Pazhigova Z. B., Karpov S. M., Shevchenko P. P., Kashirin A. I. Kliniko- nevrologicheskayaharakteristikabolnyih s rasseyan-nyimsklerozom s uchetomtyazhestisostoyaniya. 2014; s 771-775. Fundamentalnyieissledovaniya.
4. Pazhigova Z. B., Karpov S. M., Shevchenko P. P., Burnusus N. I. Rasprostranennostrasseyannogoskleroza v mire (obzor-nayastatya). 2014; s 78-82. Mezhdunarodnyiyzhurnaleksperimentalnogoobrazovaniya.
5. Burnus N. I., Karpov S. M., Shevchenko P. P. Neyrotransmitteryi v patogenezerasseyannogoskleroza. 2012 s 20-21. Mezh-dunarodnyiyzhurnalprikladnyihifundamentalnyihissledovaniy.
6. Evtushenkoisoavt. S.K., 1998, Ruggieri et al., 1999., http://med-books.info.
7. Kuzenkova L. M. Rasseyannyiyskleroz u deteyipodrostkov. Po materialam XII kongressapediatrovRossii., http://health-ua.com
8. R. Ts. Bembeeva, S. V. Piliya, E. Yu. Volkova, I. NankinaRasseyannyiyskleroz u deteyhttp://www.lvrach.ru
9. Karpov S. M., Pazhigova Z. B., Karpova E. N. Visual evoked potentials in examining the visual analyzer in patients with multiple sclerosis. Neurology, Neurolopsychiatry, Psychosomatics, 2014, number 3, 27-31.
Frantseva Anastasia Petrovna, Karpov Sergey Mihailovich, Khatuaeva Aminat Aubekirovna, Stavropol Medical State University, Assistant of the Neurology Department E-mail: a-frantseva@rambler.ru
A state of visual analyzer according to the reverse color chees type pattern in case of patients with type 1 diabetes
Abstract: The visual analyzer with an evaluation of its functional state at the time of the pulse and the response of the cortical structures presented stimuli. Results of the study revealed that diabetes mellitus in the structures of the visual analyzer significantly (p <0,01) increased in the latent period of the colored stimulus, relative to the control group and the performance of black and white pattern.
Keywords: diabetes, evoked potentials, visual analyzer.
Introduction
Among the pathological conditions of the nervous system, resulting in diseases of the endocrine glands, a special place is occupied by neurological disorders in diabetes mellitus (DM) [1]. This is due not only to the prevalence of these disorders, but their severity, a significant influence on the
prognosis and quality of life. DM is one of the most common diseases in the world. According to experts, by 2025 the total number of people with diabetes will reach 324 million people [3; 7; 11]. Currently, in Russia, about 8 million people suffer from diabetes and the number is constantly growing. [11] Despite the fact that the proportion of type 1 diabetes from
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all forms of diabetes is not more than 10-15% [3], this form is the most important medical and social problem of public health, as this disease often occurs in childhood and adolescence, characterized by severity, early disability and often fatal consequences [1; 4; 11].
Vascular lesions are observed in all forms of diabetes. However, the effect of high levels of disabilities in type 1 diabetes comes from exactly microangiopathy, which lead to diabetic retinopathy (DR) [6; 8]. It is noted that diabetes is one of the first places to cause blindness and visual impairment in all age groups. The risk of blindness in patients with diabetes is 25 times higher than in people without diabetes [9; 11; 12]. In this regard, the study of the state of the entire path of the visual analyzer with type 1 diabetes is of particular importance.
The purpose of the study: to study the neurophysiological state of the visual analyzer pathways in patients with type 1 diabetes, according to the black-and-white or color stimulus.
Materials and methods
A comprehensive clinical and physical examination in 81 patients with type 1 diabetes mellitus (33 men, 48 women) diagnosed with type 1 diabetes who were treated at the Clinical Hospital №3 at the endocrinology department of Stavropol. The average age of the patients was 25,3 ± 4,5 years. The duration of the disease ranged from 1 year to 10 years, and averaged 7,1 ± 1,4 years.
Most of the patients studied were in a state of relative compensation of DM. Clinical state of the visual analyzer in patients studied in conjunction with an ophthalmologist. The criterion for the possibility of the study was the presence of type 1 diabetes with the initial stage of diabetic retinopathy or without marked changes in the fundus. Of the patients studied, persons with anisometropia, myopia greater than 1.0 diopters, astigmatism, amblyopia, exophoria, color anomalies, any other (except for diabetic retinopathy) eye diseases or injuries to anyone not previously held photo laser coagulation were excluded.
To evaluate the visual analyzer, neurophysiological studies were conducted on the device “Neuron-Spectrum-4 / EPM” produced by “Neurosoft” with computer processing, developed at the Academy of the Russian Federation, Ivanovo MTN. Studied the latent period (LP) and the amplitude of the response induced by visual potentials (CDW) on a reverse black and white (B&W), red-yellow (QOL) and green-black (AF), chess pattern (SHP). The advantage of this study is the most accurate selection in a graphical display of the main P100 wave, which corresponds to the activation of the 17th (primary visual cortex) and 18 (visual association cortex) field by Brodmann [2, 11]. The method allows to trace the nerve impulse along the optic fibers from the cells of the retina (rods and cones, dipolar and ganglion cells) further along the optic nerve, through the optic tract and the structure of the midbrain to the occipital lobe of the cerebral cortex [2], making it possible to quantify conduction velocity on the visual analyzer on black-and-white and color spectrum of visible light. The study was conducted according to standard procedure.
The active electrode was placed over the occipital region
in lead O2 O1 international scheme “10-20%” and the ground electrode in the frontal region (at Frz). Ipsilateral electrode was placed at Cz. The impedance at the electrodes is less than 5 ohms, the cell size is 49 ‘ Stimulation was carried out on alternate black and white and colored checkerboard pattern, alternating on the left and right eye in a darkened room with a pre-adaptation in the sitting position for one study. Evaluated the response components N75, P100 and N145 ms. Mainly emphasized the study of the main component and P100 wave amplitude N75-P100. All studies were conducted prior to the baseline treatment. Comparative analysis of the results was carried out with a group of 15 healthy subjects, a statistically homogeneous by sex and age.
All the patients were conducted clinical and laboratory examination, including determination of antibodies to myelin basic protein (MBP), which were determined by enzyme immunoassay analysis, using reagent kit developed by Yastrebova
N.E. and Benaiah N.P. (firm “Navi”, Moscow) [5].
For the analysis, the results were obtained by using the arithmetic mean values (M) and their errors (m), standard deviation (S). Significance of differences of mean values was evaluated using Student’s t test (t).
Results and discussion
Clinical examination in 18 (58.1%) patients were diagnosed as diabetic encephalopathy, which is a manifestation of the complaints were asthenic character: general weakness, fatigue, decreased performance, anxiety, emotional lability, impaired concentration, memory loss. In 67.7% of cases detected cephalgic syndrome. It should be noted that the headache often had the character of a compression compresses the type of “close headdress.”
Distal symmetric polyneuropathy met in 28 (90.3%) patients. Thus the patients were affected by tingling, numbness, coldness of feet and rarely brushes or burning sensation, pain in the extremities, which is often amplified at night or at rest. The patients showed a reduction of pain, temperature or vibration sensitivity of the type “socks” and “gloves”, reduced reflexes, tone, in some cases moderate motor impairment. Hypaesthesia gradually spread from the distal portions of the legs and arms to the proximal. In 11 (35.5%) patients had depressive changes of varying severity as a consequence of the disease. In all cases, the patients reported a syndrome of vegetative dystonia in the form of diffuse dermographism, diffuse hyperhidrosis, acrocyanosis. In 3 cases, the patients reported the development of presyncope. In 5 (16.1%) cases, the patient developed vegetative trophic disorders in the form of arthropathy manifesting progressive deformity of the ankle and foot joints as a result of defeat of autonomic fibers.
To clarify, the extent of damage of the peripheral nervous system and in particular the visual analyzer were used indicators of evoked potentials. For this, we used the method of visual EP brain, allowing it to objectively assess the state of the conduction system of the visual analyzer of the retina to the cortex. Functional state of visual-neural pathways in patients
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A state of visual analyzer according to the reverse color chees type pattern in case of patients with type 1 diabetes
with type 1 diabetes was investigated by VIZ alternated on a chess pattern. VEP are electrical signals generated neurons in the brain in response to a pulsed-light stimulation of photoreceptors of the eye. We investigated the degree of impair-
ment of the optical paths of conduction in patients with type 1 diabetes without diabetic retinopathy (DR).
Conducted neurophysiological examination revealed several patterns. The results are shown in Table 1.
Table 1. - CDW dynamics of quantitative indicators in patients with type 1 diabetes on a black and white checkerboard pattern (M±m)
Period СД 1 Type (n=36) Before treatment Controlled Group(n=15)
Latency period (ms ) N75 76,1±2,81 72,1±2,09
Р100 109,3±2,78 103,1±1,72
N145 164,2±2,49 151,3±2,22
Amplitude (mV ) P100 4,3±1,63 8,1±1,21
Note.* - Significant differences ( r<0,05 ) - the control group.
After analyzing the results of the VEP on black-white Silk Significant changes in P100 wave were not found. Results of P100 wave was found that in patients with type 1 diabetes the study indicate that the elongation LP P100 wave was ob-
observed a moderate increase in the PL right and left, which served in 87.1% of cases. Graphically, this is shown in Figure 1.
amounted 109,3+2,78 ms (control group 103,1+1,72 ms).
Fig. 1. Indicators of VEP components on a black and white WS relative to the control group (in ms).
Another important patterns at SGP on BW Silk was a reduction of the wave amplitude N75-P100, where the amplitude component analysis allowed the note split wave crest in a third of cases. For the patients who examined wave amplitude N75-P100 amounted 4,3±1,63 mV., Indicating a state of “depression,” the response of visual neurons.
The greatest research interest is the analysis of the results obtained in the colored checkerboard pattern alternated. In the second trial, the color red (with wavelength range 625740 nm) was substituted with a yellow color (with the wavelength range 565-590 nm). The studies revealed significant
changes both in terms of LP and amplitude response. This is shown graphically in Figure 2. It has been found that red-yellow WS (box 49 ‘) showed (r<0,01) a significant increase in PL P100 wave in all the samples relative to the control group and the right and left was 143.2 ±3,38 ms (control 109,8±2,87 ms). Credible (r<0,01) changes in terms of the LP were identified late EP components. Since PL wave N145 was 185,2±3,97 ms (control 149,4±2,79 ms). We noted that only three (11.5%) cases PL P100 wave was slightly above test results, however, exceeding the value of the control group.
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Section 3. Medical science
■ patients with diabities control group
185,2
N 75 P100 N145
Fig. 2. Indicators of VEP components on a red-yellow reversible WS relative to the control group (in ms).
Analysis of the wave amplitude N75-P100 showed on red-yellow Silk shows that patients with type 1 diabetes as well noted significant ( p<0,05 ) decrease in the amplitude response to a stimulus that was 2,2±1,79 uV .
Results for green and black reversible WS where pulsed effect was sent to the mono color mode only visible light on
the system of cells (cone ) (Green - wavelength range 500565 nm). According to this test PEL on the green there was a significant (p<0,05 ) increase in PL, which is to a wavelength P100 - 139,3±3,78 (control group 107,3±2,82 ms). Indicators LP wave N145 just had significant changes. The results are shown in Figure 3.
Fig. 3. Indicators of VEP components to green - black reversible WS relative to the control group (in ms).
In this sample on the green wave amplitude N75-P100 was significantly reduced. According to the studied patients wave amplitude N75- P100 amounted 3,21±2,14 mV . The study results suggest that the decrease in the amplitude of the response on the results of CDW in different light wavelength range associated with reduced impulse flow along the fibers of the visual analyzer and the consequent decrease in the number of neurons that activate the response of the bark on the presented stimuli. Taking into account the obtained results, we believe that the increase in the PL on the visual analyzer in patients with type 1 diabetes is the result of processes of de-myelination. In this context, to clarify these particular mechanisms, we performed immunological studies related to the specification of the concentration of antibodies Ig G to myelin basic protein, as a manifestation of chronic immunological reaction. During the study of 19 patients with type 1 diabetes was found that the concentration levels of IgG antibodies to MBP in patients with diabetes was significantly (p <0,001)
higher than the control group and put together amounted the treatment group as 188,6 ± 4,1 g / ml . (Control group 50,1 ± 2,12 g / ml) . It should be noted that raising of antibodies to MBP was detected in all cases.
Conclusion
Thus, the neurophysiological and immunological results indicate that the type 1 diabetes demyelination processes occur in the structures of the visual analyzer, which help to reduce the conductivity of the “flow” of visual momentum in cortical structures of the visual analyzer. These changes lead to a decrease in the response of cortical reaction presenting stimulus mainly in the visible color spectrum of visible light. The study results in the early stages of type 1 diabetes to identify the pathology of the visual analyzer, before the appearance of clinically significant symptoms. This method can be used in the diagnosis of early manifestations of the pathology of the visual analyzer in the cases when patients are diagnosed with type 1 diabetes.
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Contemporary approaches to the trigeminal neuralgia therapeutic management
References:
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7. Shustov S.B, Baranov V.L, Halima Y.S. / Clinical Endocrinology . - M .: Publishing House LTD . “Medical inf. Agency", 2012 - 632 p.
8. Frantseva A.P, Karpov S.M, Belyakov N.A, Sedakov L.V, Frantseva V.O, Ciechanowski L.V, Shevchenko P.P State of the visual analyzer using the drug “ Tiogamma “ in diabetes mellitus type 1.//Fundamental research. - 2013 , - №5 (Part 1)
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9. Huang, C., Lu, C., Chang, H - W., Tsai, N., Chang, W. Brainstem Auditory Evoked Potentials Study in Patients with Diabetes Mellitus // Acta Neurologica Taiwanica. - Vol. 19 № 1. - March 2010. - Р. 33 - 40.
10. Karpov S.M., Gerasimova M.M. Evoked potential in diagnostic of craniocerbral trauma in children. // European Journal of Neurology. - 2006. - Т. 13. - С. 1343.
11. The Eurodiam IDDM. Complications study group (1994). Microvascular and acute complications in insulindependent diabetes mellitus: the Eurodiab IDDM complications study // Diabetologia. - 1994. - Vol. 37. - P. 278 - 285.
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Khatuaeva Aminat Aubekirovna, Stavropol State Medical University, postgraduate student, department of Neurology Karpov Sergey Mihailovich, Stavropol State Medical University, professor, doctor of medical sciences, department of Neurology Frantseva Anastasia Petrovna, Stavropol State Medical University, postgraduate student E-mail: khatuaeva@yandex.ru
Contemporary approaches to the trigeminal neuralgia therapeutic management
Abstract: Trigeminal neuralgia is one of the most widespread cases of prosopalgia characterized by a high intensiveness ofpain attacks as well as by an exclusive resistance to different therapeutic methods. [2, 39-41; 3, 326-329]. Specific paroxysmal character of pain attacks in trigeminal neuralgia defines its therapy techniques. The first medication which gave a significant effect in the therapy of trigeminal neuralgia was Dilantin. Blom in 1973 was the first who used anticonvulsants for pain management (Finlepsin, Carbamazepine).
Keywords: Trigeminal neuralgia, paroxysmal pain, treatment, anticonvulsants.
Purpose ofresearch: to analyze contemporary methods of the trigeminal neuralgia treatment.
Materials and methods: analyze of contemporary literature concerning the basic approaches to the trigeminal neuralgia treatment.
Results of research: Specific paroxysmal character of pain attacks in trigeminal neuralgia defines its therapy techniques. The first medication which gave a significant effect in the therapy of trigeminal neuralgia was Dilantin. Positive results were achieved by a combination of Dilantin with Am-
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