Sequential transcranial electrical stimulation in patients with dyscirculatory encephalopathy associated with post-COVID syndrome

Abstract

BACKGROUND: The primary hypothesis for the use of sequential transcranial electrical stimulation therapy in the rehabilitation of patients with dyscirculatory encephalopathy associated with post-COVID syndrome is the potential synergistic effect on the central nervous system. Specifically, the method combines brain micropolarization — involving neocortex neurons and diencephalic brain stimulation — affecting limbic system structures. This synergy is expected to improve connections between cortical and subcortical structures, as well as neurohumoral regulation.

AIM: To study the effectiveness of complex medical rehabilitation involving sequential transcranial electrical stimulation therapy in patients with dyscirculatory encephalopathy associated with post-COVID syndrome.

MATERIALS AND METHODS: An open, prospective, randomized comparative study included 142 patients with dyscirculatory encephalopathy: 79 female (55.6%) and 63 male (44.4%) patients, aged 59 (45–69] years. The average disease duration was 8.4 years, with a period after coronavirus infection of 3.6 months. After randomization, patients in Group 1 (comparison group 1, n=48) received brain micropolarization; Group 2 (comparison group 2, n=46) received diencephalic brain stimulation; and Group 3 (main group, n=48) received both therapies sequentially. Treatment outcomes were evaluated based on changes in clinical symptoms over time and a battery of neuropsychological tests.

RESULTS: In Group 3, which received sequential transcranial electrical stimulation therapy, all symptoms of dyscirculatory encephalopathy showed a significant improvement (1.2–1.6 times) compared to baseline (p <0.05–0.001). For brain micropolarization alone (Group 1), there was an average reduction in the severity of symptoms such as cranialgia, memory and attention deficits, irritability, and sleep disturbances by 1.2–1.4 times. In Group 2, diencephalic brain stimulation resulted in an improvement in tinnitus, fatigue, work productivity, and dizziness by 1.3–1.4 times. In the main group, there was an overall alleviation of all psychophysiological issues (1.1–2.0 times; p <0.05–0.01); in comparison groups 1 and 2, improvement was 1.1–1.5 times and 1.2–1.8 times, respectively.

CONCLUSION: Medical rehabilitation using a combined approach (sequential application of brain micropolarization and diencephalic brain stimulation) alongside pharmacological support in patients with dyscirculatory encephalopathy associated with post-COVID syndrome is shown to be the most effective due to the pronounced neurotropic effect of the physical factors involved, allowing for the correction of a whole range of neurological, neuropsychological, and motor disorders.

Keywords

dyscirculatory encephalopathy / post-COVID syndrome / transcranial electrical stimulation / medical rehabilitation

References

[1] Trusova NA, Levina NO, Levin OS. Encephalopathy--Letzte wiese domestic angioneurology. Sovremennaya terapiya v psikhiatrii i nevrologii. 2016;(2):11–17. EDN: VZDITD

[2] Трусова Н.А., Левина Н.О., Левин О.С. Дисциркуляторная энцефалопатия ― letzte wiese отечественной ангионеврологии // Современная терапия в психиатрии и неврологии. 2016. № 2. С. 11–17. EDN: VZDITD

[3] Parfenov VA. Dyscirculatory encephalopathy and vascular cognitive disorders. Moscow: IMA-PRESS; 2017. 128 р. (In Russ.)

[4] Парфенов В.А. Дисциркуляторная энцефалопатия и сосудистые когнитивные расстройства. Москва: ИМА-ПРЕСС, 2017. 128 с.

[5] Vizilo TL, Arefieva EG. Improving the effectiveness of pharmacotherapy in comorbid patients with chronic cerebral ischemia on an outpatient basis. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov journal of neurology and psychiatry. 2023;123(3):51–55. EDN: JRKCTU doi: 10.17116/jnevro202312303151

[6] Визило Т.Л., Арефьева Е.Г. Повышение эффективности фармакотерапии у коморбидных пациентов с хронической ишемией головного мозга в амбулаторных условиях // Журнал неврологии и психиатрии им. С.С. Корсакова. 2023. Т. 123, № 3. С. 51–55. EDN: JRKCTU doi: 10.17116/jnevro202312303151

[7] Dag U, Chaglayan M, Onchul H, et al. Mask-associated dry eye syndrome in healthcare professionals as a new complication caused by prolonged use of masks during the COVID-19 pandemic. Ophthalmic Epidemiol. 2023;30(1):1–6. doi: 10.1080/09286586.2022.2053549

[8] Dag U., Chaglayan M., Onchul H., et al. Mask-associated dry eye syndrome in healthcare professionals as a new complication caused by prolonged use of masks during the COVID-19 pandemic // Ophthalmic Epidemiol. 2023. Vol. 30, N 1. P. 1–6. doi: 10.1080/09286586.2022.2053549

[9] Mao L, Jin Н, Wang М, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683–690. doi: 10.1001/jamaneurol.2020.1127

[10] Mao L., Jin Н., Wang М., et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China // JAMA Neurol. 2020. Vol. 77, N 6. P. 683–690. doi: 10.1001/jamaneurol.2020.1127

[11] Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18–22. doi: 10.1016/j.bbi.2020.03.031

[12] Wu Y., Xu X., Chen Z., et al. Nervous system involvement after infection with COVID-19 and other coronaviruses // Brain Behav Immun. 2020. Vol. 87. P. 18–22. doi: 10.1016/j.bbi.2020.03.031

[13] Ceban F, Ling S, Lui LM, et al. Fatigue and cognitive impairment in post-COVID-19 syndrome: A systematic review and meta-analysis. Brain Behav Immun. 2022;101:93–135. doi: 10.1016/j.bbi.2021.12.020

[14] Ceban F., Ling S., Lui L.M., et al. Fatigue and cognitive impairment in post-COVID-19 syndrome: A systematic review and meta-analysis // Brain Behav Immun. 2022. Vol. 101. P. 93–135. doi: 10.1016/j.bbi.2021.12.020

[15] Bogolepova AN, Vasenina EE, Gomzyakova NA, et al. Clinical guidelines for cognitive disorders in elderly and older patients. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov journal of neurology and psychiatry. 2021;121(10-3):6–137. EDN: MPUDYF doi: 10.17116/jnevro20211211036

[16] Боголепова А.Н., Васенина Е.Е., Гомзякова Н.А., и др. Клинические рекомендации «Когнитивные расстройства у пациентов пожилого и старческого возраста» // Журнал неврологии и психиатрии им. С.С. Корсакова. 2021. Т. 121, № 10-3. С. 6–137. EDN: MPUDYF doi: 10.17116/jnevro20211211036

[17] Temporary guidelines of the Ministry of Health of the Russian Federation «Medical rehabilitation for the new coronavirus infection (COVID-19)», edition 2 dated 07/31/2020. (In Russ.) Available from: https://normativ.kontur.ru/document?moduleId=1&documentId=367585&cwi=11464. Accessed: 15.02.2024.

[18] Временные методические рекомендации Министерства здравоохранения Российской Федерации «Медицинская реабилитация при новой коронавирусной инфекции (COVID-19)», версия 2 от 31.07.2020. Режим доступа: https://normativ.kontur.ru/document?moduleId=1&documentId=367585&cwi=11464. Дата обращения: 15.02.2024.

[19] Fedorov AA, Ladygin DA, Matveev AV, Gulyaev VYu. Dynamics of neuropsychological parameters under the influence of comprehensive medical rehabilitation in patients with discirculatory encephalopathy after a new coronavirus infection. Resort Medicine. 2022;(3):108–113. EDN: UCMKXE doi: 10.51871/2304-0343_2022_3_108

[20] Федоров А.А., Ладыгин Д.А., Матвеев А.В., Гуляев В.Ю. Динамика нейропсихологических показателей под влиянием комплексной медицинской реабилитации у больных с дисциркуляторной энцефалопатией, переболевших новой коронавирусной инфекцией // Курортная медицина. 2022. № 3. С. 108–113. EDN: UCMKXE doi: 10.51871/2304-0343_2022_3_108

[21] Sakai T, Hoshino C, Hirao M, et al. Rehabilitation of patients with post-COVID-19 syndrome: A narrative review. Prog Rehabil Med. 2023;8:20230017. doi: 10.2490/prm.20230017

[22] Sakai T., Hoshino C., Hirao M., et al. Rehabilitation of patients with post-COVID-19 syndrome: A narrative review // Prog Rehabil Med. 2023. Vol. 8. P. 20230017. doi: 10.2490/prm.20230017

[23] Pouliopoulou DV, Macdermid JC, Saunders E, et al. Rehabilitation interventions for physical capacity and quality of life in adults with post-COVID-19 condition: A systematic review and meta-analysis. JAMA Netw Open. 2023;6(9):e2333838. doi: 10.1001/jamanetworkopen.2023.33838

[24] Pouliopoulou D.V., Macdermid J.C., Saunders E., et al. Rehabilitation interventions for physical capacity and quality of life in adults with post-COVID-19 condition: A systematic review and meta-analysis // JAMA Netw Open. 2023. Vol. 6, N 9. P. e2333838. doi: 10.1001/jamanetworkopen.2023.33838

[25] Kayumov SF, Klocheva EG, Pirogova SV, Shiman LG. Use of the combined physiotherapy methods in complex treatment of patients with dyscirculatory encephalopathy stages I and II on the background of arterial hypertension. Vestnik Sankt-Peterburgskoi gosudarstvennoi meditsinskoi akademii im. I.I. Mechnikova. 2009;(2):208–212. EDN: NSJYJL

[26] Каюмов С.Ф., Клочева Е.Г., Пирогова С.В., Шиман Л.Г. Применение комбинированных методов физиотерапии в комплексном лечении больных дисциркуляторной энцефалопатией I и II стадии на фоне артериальной гипертензии // Вестник Санкт-Петербургской государственной медицинской академии им. И.И. Мечникова. 2009. № 2. С. 208–212. EDN: NSJYJL

[27] Borzunova YuM, Fedorov AA. Combined physiobalneotherapy of vibration disease associated with dyscirculatory encephalopathy in the miners. Voprosy kurortologii, fizioterapii i lechebnoi fizicheskoi kultury = Problems of balneology, physiotherapy and exercise therapy. 2012;89(5):16–19. EDN: PUGVJD

[28] Борзунова Ю.М., Федоров А.А. Комплексная физиобальнеотерапия вибрационной болезни, ассоциированной с дисциркуляторной энцефалопатией, у шахтеров // Вопросы курортологии, физиотерапии и лечебной физкультуры. 2012. Т. 89, № 5. С. 16–19. EDN: PUGVJD

[29] Moroz EV, Antonyuk MV, Zakharycheva TA. The effectiveness of non-drug methods of rehabilitation of patients with stage III dyscirculatory encephalopathy. Modern Problems of Science and Education. 2022;(2):113–121. EDN: ZDLVNV doi: 10.17513/spno.29624

[30] Мороз Е.В., Антонюк М.В., Захарычева Т.А. Эффективность немедикаментозных методов реабилитации пациентов с дисциркуляторной энцефалопатией III стадии // Современные проблемы науки и образования. 2022. № 2. С. 113–121. EDN: ZDLVNV doi: 10.17513/spno.29624

[31] Sanatorium-resort treatment. National guide. Ed. by A.N. Razumov, V.I. Starodubov, G.N. Ponomarenko. Moscow: GEOTAR-Media; 2021. 752 р. (In Russ.)

[32] Санаторно-курортное лечение: национальное руководство / под ред. А.Н. Разумова, В.И. Стародубова, Г.Н. Пономаренко. Москва: ГЭОТАР-Медиа, 2021. 752 с.

[33] Physical and rehabilitation medicine. National guide. Ed. by G.N. Ponomarenko. 2nd ed., revised and updated. Moscow: GEOTAR-Media; 2023. 912 p. (In Russ.)

[34] Физическая и реабилитационная медицина: национальное руководство / под ред. Г.Н. Пономаренко. 2-е изд., перераб. и доп. Москва: ГЭОТАР-Медиа, 2023. 912 с.

[35] Patent RUS № RU2371213 С1. Application 2008125642/14 from 26.06.2008. Bogolyubov VM, Khostikoyeva ZS. Method of restorative treatment of patients after brain stroke. (In Russ.) Available from: https://yandex.ru/patents/doc/RU2371213C1_20091027?ysclid=m2rkq258z379051483. Accessed: 15.02.2024.

[36] Патент РФ на изобретение № RU2371213 С1. Заявка 2008125642/14 от 26.06.2008. Боголюбов В.М., Хостикоева З.С. Способ восстановительного лечения больных после инсульта головного мозга. Режим доступа: https://yandex.ru/patents/doc/RU2371213C1_20091027?ysclid=m2rkq258z379051483. Дата обращения: 15.02.2024.

[37] Sevostyanova EV, Nikolaev YA, Polyakov VY, et al. Effectiveness of transcerebral pulse electrotherapy and chloride sodium baths in the treatment of patients with gastroesophageal reflux disease, combined with dyslipidemia. Int J Applied Basic Res. 2017;5(1):80–84. EDN: YNWCAD

[38] Севостьянова Е.В., Николаев Ю.А., Поляков В.Я., и др. Эффективность применения трансцеребральной импульсной электротерапии и хлоридных натриевых ванн в лечении больных гастроэзофагеальной рефлюксной болезнью, сочетанной с дислипидемией // Международный журнал прикладных и фундаментальных исследований. 2017. Т. 5, № 1. С. 80–84. EDN: YNWCAD

[39] Shekelle P, Cook I, Miake-Lye IM, et al. The effectiveness and risks of cranial electrical stimulation for the treatment of pain, depression, anxiety, PTSD, and insomnia: A systematic review. Washington (DC): Department of Veterans Affairs (US); 2018.

[40] Shekelle P., Cook I., Miake-Lye I.M., et al. The effectiveness and risks of cranial electrical stimulation for the treatment of pain, depression, anxiety, PTSD, and insomnia: A systematic review. Washington (DC): Department of Veterans Affairs (US), 2018.

[41] Price L, Briley J, Haltiwanger S, Hitching R. A meta-analysis of cranial electrotherapy stimulation in the treatment of depression. J Psychiatr Res. 2021;135:119–134. EDN: SZIYFV doi: 10.1016/j.jpsychires.2020.12.043

[42] Price L., Briley J., Haltiwanger S., Hitching R. A meta-analysis of cranial electrotherapy stimulation in the treatment of depression // J Psychiatr Res. 2021. Vol. 135. P. 119–134. EDN: SZIYFV doi: 10.1016/j.jpsychires.2020.12.043

RIGHTS & PERMISSIONS

Eco-Vector