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3EFFICIENCY OF TRANSCRANIAL MICROPOLARIZATION IN THE
REHABILITATION OF PATIENTS WITH ISCHEMIC STROKE
12
Ziyakhadjaeva Latofat Uchqunovna, Khamidova Nodira Abdujabbarovna
12
, Tashkent Pediatric Medical Institute,Department: of Neurology, Child Neurology and Medical
Genetics
https://doi.org/10.5281/zenodo.8372610
Abstract. A malfunction in the circulatory system of the brain associated with thromboembolism is called ischemic stroke. Blockage of an artery by a blood clot stops the flow of blood to the brain. Without nutrition, tissues soften, cell necrosis occurs, which ends with an organ infarction. Pathological changes in the arteries occur gradually. The impetus for apoplexy is the characteristics of the organism or unfavorable external conditions.
Transcranial micropolarization (TCMP) is a treatment method that allows stimulating and changing the functional state of various components of the central nervous system. During this procedure, a weak current is applied to the head area. The current parameters are in the range of tens or hundreds of microamps, which is much less than what is used in traditional physiotherapy. In addition, the direction of influence is ensured through the use of small areas of electrodes and their localization.
Residual effects after a stroke are detected in about % of patients, of which 50% have cognitive impairments that limit social adaptation, including work and self-service at home, even in the absence of significant motor impairments [5]. The most common are mild and moderate CI, in most cases amenable to correction and recovery with the timely appointment of appropriate therapy. Post-stroke cognitive impairment (PSCI) should be understood as any cognitive impairment that has a temporal relationship with stroke, i.e. are detected in the first 3 months after a stroke (early PUCI) or at a later date, but no later than 1 year after a stroke (late PUCI). The later cognitive impairments are detected after a stroke, the less clear their direct relationship with stroke becomes[9].
Keywords: ishemic stroke, rehabilitation, transcranial micropolarization, cerebral circulation, motor and cognitive disorders
Relevance: Movement disorders are the most frequent and severe consequences of cerebrovascular accident. The economic consequences of a stroke are extremely severe, as the resulting disorders lead to disability. Despite the obvious progress in the study of the pathogenesis of strokes, our understanding of the real compensatory mechanisms of the brain and their ability to restore affected functions remains insufficient. This creates difficulties in the development of modern, functional and restorative technologies, among which methods such as functional biofeedback, non-invasive electrical and magnetic stimulation, and transcranial micropolarization are of particular interest. Influencing the neurodynamic processes in the cerebral cortex, these methods contribute to the deployment of compensatory processes in the brain, significantly facilitate and speed up the rehabilitation process. Of great importance in drug therapy in patients who have had a stroke is neuroprotection, which can be carried out at any stage of medical care for patients with stroke [7,8,9]. Of particular interest are neuropeptides -due to their high efficiency, provided their low concentration in the body. The safest and most effective in stroke are neuropeptide drugs widely used in our country - neuroprotectors: Semax, Cerebrolysin, Cortexin [4,7]. According to the results of the ESCORT multicenter double-blind
study, the high efficacy and safety of a repeated course of Cortexin treatment in patients with hemispheric IS has been proven compared to a single course of this drug and placebo, which confirms the high therapeutic effect and rehabilitation potential of Cortexin[5,10].
Purpose of the study: To study the effectiveness of transcranial micropolarization in the rehabilitation of motor and cognitive impairments in patients with acute cerebrovascular accident.
Materials and methods of research: The work was carried out on the basis of the Neuromed clinic, City Clinical Hospital No. 7. Our study included 50 patients (24 women and 26 men) aged 50 to 74 who had had an ischemic stroke. The period of observation of patients was from 2018-2022. The main group included 25 patients with ischemic stroke who received transcranial micropolarization sessions along with standard pharmacotherapy. In the main group there were: 14 men, mean age - 67.1 ± 8.2 years; 11 women, mean age 65 ± 5.6 years. The comparison group included an equal number of patients who received only standard pharmacotherapy. In the comparison group, the following were examined: 12 men, mean age - 62.5 ± 6.5 years; 13 women, mean age 63.4 ± 6.9 years. The whole complex of measures was carried out in the early recovery period.
Patients with a neurological deficit greater than 25 points on the NIHSS stroke scale were excluded from the study; with the presence of severe and unstable somatic diseases (acute myocardial infarction, severe heart, kidney and liver failure); with clinically significant other neurological or psychiatric diseases; with established dementia, total aphasia, recurrent stroke, hemorrhagic stroke; as well as unwillingness to cooperate in the study.
All patients underwent a study of somatic and neurological status using generally accepted scales [26-28]. To assess the effectiveness of the studied drug, a complex of neuropsychological tests was also used (MMSE short mental status assessment scale, 10-word memorization test, Montreal Cognitive Assessment Scale (MoCA-test) on days 1-7 after a stroke (visit 0), then after 3 ( visit 1), 6 (visit 2), 9 (visit 3) and 12 months (visit 4). Throughout the study, patients were monitored for vital functions (blood pressure, electrocardiography) and laboratory parameters (hemoglobin, red blood cell count, creatinine, bilirubin, glucose, hepatic transaminases, protein, coagulogram) to assess adverse events and side effects.
Research results: An analysis of the subjective symptoms of patients showed the prevalence of complaints of general weakness and weakness in the limbs (96% and 94%, respectively). Also, very often patients complained of dizziness (94%), increased blood pressure (86%) and headaches (82%). The next most common were speech disorders, which were more common in the main group (80%) than in the comparison group. 54% of patients complained of sensory disturbances. 6% of the patients examined by us had visual disturbances. Next, we analyzed the focal clinical symptoms in patients. All cases of ischemic stroke noted in our observations occurred in the carotid pool.
Muscle strength in the paretic limbs in the main group averaged 2.16±0.98 points and corresponded to paresis. The severity of paresis in the comparison group was slightly lower than in the main group and averaged 1.96±0.93 points. We assessed the severity of paresis after the procedures, and the muscle and severity of paresis in the main group decreased by almost 2 times and amounted to 1.16 ± 0.74 points, while in the comparison group the difference after treatment decreased by 0.5 points and amounted to 1 .46±0.65 points.
We examined the severity of spasticity in the examined patients according to the Ashworth scale. The analysis included the results of the assessment of spasticity only on the affected limbs. In both evaluated groups, muscle tone initially ranged from 1 to 4 points on the Ashworth scale. In the main group, this indicator was slightly higher and averaged 2.68±1.1 points, while in the comparison group the
average score was 2.24±1.04. The implementation of therapeutic measures made it possible to reduce spasticity compared to the outcome, however, the most significant improvement occurred in the main group, where spasticity decreased from 2.68±1.1 points to 1.4±1.5 points, i.e. almost 2 times, while in the comparison group, after therapy, this figure decreased to 1.78±0.9.
To assess the functional features of motor disorders of the upper limb, as well as to restore the level of daily functioning in the main and comparative groups of patients, a modified Fugle-MeyerAssessment scale was used.
After the therapeutic measures taken, in all patients, to one degree or another, there was an improvement in the motor function of the affected upper limb. However, patients of the main group showed a significant improvement in comparison with the comparative group.
When assessing patients on the Fugle-MeyerAssessment scale, improvements were noted in both groups, but there was a significant difference between the main and comparative groups. In the main group, these changes occurred due to an increase in the volume of active movements in the proximal arm. There was also a statistically significant change in the volume of passive movements in the hand. At the same time, only an increase in the volume of passive movements was significant in the comparison group. Initially, in the main group, the score on the FMA scale was slightly lower (31.08±2.9 points) than in the comparison group (34.57±3.5). However, after transcranial micropolarization, in the main group this indicator increased by 10 points and amounted to 41.6±3.8 points, while in the comparison group, the increase was by 3 points and amounted to 37.44±3.8 points. In the main group, the severity of walking disorders was higher (4.36±2.05 points) than in the comparison group (4.04±1.5). After transcranial micropolarization, the degree of gait dysfunction in the main group decreased by 2 points and amounted to 2.32±1.07 points, while in the comparison group, the improvement was only 1.16 points and amounted to 2.88±1.3 points .
Conclusions:
1. The therapy in the group of patients receiving, in addition to standard therapy, transcranial micropolarization, the indicated regression of cognitive impairment was statistically significantly more pronounced.
2. Transcranial micropolarization is a highly effective additional treatment for patients with ischemic stroke, which is reflected, in particular, in a significant acceleration of the regression of motor disorders.
3. After the therapeutic measures taken, in all patients, to one degree or another, there was an improvement in the motor function of the affected upper limb. However, patients of the main group showed a significant improvement in comparison with the comparative group.
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