RU2008038C1 - Method for treating paresis of mimic muscles with damaged peripheral branches of facial nerve - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves fixing one electrode of implanted induction coil on surface of nerve trunk and the other one, in subcutaneous fat tissue. . Induction amplitude on inductor surface is 0.1-0.25 T, duration of front and rear induction frontages, 1 and 50 ms, pulse repetition period, 0.3 s, voltage on output leads of implanted coil, 1-5 V, pulse duration, 0.5 ms. First, magnetic field with alternating pulse polarity is applied to segmental structures of brain at a magnetic field induction of 0.25 T, duration of front and rear pulse frontages, 1 and 50 ms, pulse repetition period, 1.5 s. Electromagnetic stimulation is administered for 5 min daily and magnetic field is applied for 10 min alternatively to each region. Course of treatment is 5-8 procedures. EFFECT: faster restoration of function of mimic muscles and prevention of development of contractures of mimic muscles. 3 tbl

Description

 The invention relates to medicine, namely to maxillofacial surgery, and is intended to restore the function of facial muscles in case of damage to the peripheral branches of the facial nerve.

There is a method of treating facial neuritis and facial muscle contractures combined exposure to ultrasound and a sinusoidal modulated current [1]. At the same time, they act with ultrasound on the projection area of the upper cervical sympathetic nodes alternately on the right and left. Intensity - 0.2 W / cm ² , continuous mode, exposure duration - 5 min per field. The influence of a sinusoidal modulated current is carried out by installing the electrode 2 cm behind the angle of the lower jaw, and the second electrode is installed 2 cm above the first. Variable mode, type of work 1 (constant modulation), frequency 150 Hz, modulation depth 50%, 3-5 min per field. Type of work IY (alternation of packages), frequency 70 Hz, duration of frequency alternation for 3 s, modulation depth 50%, exposure duration 3-5 min per field. However, the use of this method is not possible in patients with damage to the peripheral branches of the facial nerve as a result of surgical intervention on large (usually parotid) salivary glands with lesions of the latter by tumors. It should also be noted the absence of a differentiated approach of stimulation by sinusoidal modulated currents, taking into account the varying degrees of trauma to the peripheral nerve trunks of the facial nerve.

 As a prototype, a method of rehabilitation of the function of facial muscles was chosen [2], which is carried out by their electrical stimulation, restorative drug therapy and electrophoresis.

 To do this, by means of electrodiagnostics, the location of the motor points of the paretic facial muscles and the parameters of electrical stimulation are clarified. From 40-60 minutes before the start of electrical stimulation, parenterally or orally, depending on the individual tolerance and effectiveness of the muscle relaxation action, 5 to 40 ml of a 20% sodium hydroxybutyrate solution is administered. In the places of projection of the motor points of the paretic muscles, active stimulating electrodes are fixed, the pads of which are moistened with a 10% solution of sodium oxybutyrate, after which the face is corrected by adhesive bandage tension. A bipolar technique is used, the second electrode is installed in the area of the projection of the exit of the facial nerve from the styloid opening. Then, electrophoresis is carried out for 5-10 minutes with a 10% solution of sodium oxybutyrate, after which, through the same electrodes, against the background of ongoing electrophoresis, an electro-stimulating effect is performed. The intensity of exposure to electrical stimulation is selected according to the nature of the induced contraction of paretic muscles.

 The disadvantage of this method is the impossibility of its use in the treatment of patients with trauma to the peripheral branches of the facial nerve regarding the removal of a tumor of the large salivary glands. A contraindication in this case is the use of electrophoresis [3, 4].

 In addition, in the early postoperative period, given the swelling and soft tissue infiltration in the area of surgical intervention, these electrodiagnostics may be inadequate. From these positions, it seems impossible to carry out facial symmetry correction with adhesive bandages. In addition, stimulation of directly paretic muscles requires higher exposure parameters than irritation of nerve trunks innervating these muscle structures.

 In addition, it is known that one of the most frequently observed complications during surgery on the large salivary glands is paresis of facial muscles. In some cases, paresis is caused by the course of the operation itself and is inevitable during the preparation of the facial nerve. The causes of paresis of facial muscles are a mechanical nerve injury during surgery, a violation of blood supply due to the intersection of blood vessels, a forced limitation of normal facial functions in connection with an operating injury, and compression of the nerve trunks with exudate [5]. Trauma to the peripheral branches of the facial nerve is quite common in osteosynthesis of bone fragments of the maxillofacial region, operations for occlusal correction, etc. [6]. Attention is focused on patients with pathology of large (in particular, parotid) salivary glands. This is due to the fact that the anatomically peripheral branches of the facial nerve pass through the parotid salivary gland and, when intervening in the latter, are inevitably traumatized [5]. In addition, there is a significant number of patients with lesions of the glands by tumors, which sharply limits the possible range of use of preformed physical factors (ultrasound, SMT, electrophoresis, etc.).

 The aim of the invention is to reduce the time of treatment and rehabilitation measures in patients with postoperative paresis of the facial muscles through the use of two therapeutic factors, namely magnetotherapy and electromagnetic stimulation of the peripheral branches of the facial nerve.

 This goal is achieved by the fact that intraoperatively verify the peripheral branches of the facial nerve from the sensory nerve trunks of the trigeminal system, after which the most damaged facial nerve trunks are identified, using the apparatus for electrodiagnostics. An inductor is then implanted, one electrode of which is fixed directly to the most damaged nerve trunk of the facial nerve, and the second in the subcutaneous adipose tissue, and then they are transcutaneously remotely exposed to the area of the inductor by a pulsed magnetic field. The induction amplitude on the surface of the inductor is from 0.1 T to 0.25 T, the duration of the leading and trailing edges of the induction pulse is 1 ms and 50 ms, respectively, the pulse repetition period is selected in the range from 0.3 to 1.5 s. The voltage at the terminals of the implanted inductor has an amplitude, the value of which depends on the distance to the inductor, from 1 to 5 V for a pulse duration of 0.5 ms. In addition, they preliminarily act on the segmental structures of the brain with a magnetic field symmetrically on both sides (right and left), positioning the magnetic field source in the parietal region from the sides in turns.

 Electromagnetic stimulation is carried out daily for 3-5 minutes, visually controlling the degree of reduction of the facial muscles, and a magnetic field is applied for 10 minutes in each area. The course of treatment is 5-8 procedures.

 To implement the proposed method using the following devices.

 The apparatus for electrodiagnostics is a pulse generator with a duration of 1-2 ms, a frequency of 1-2 Hz, an amplitude adjustable from 0 to 6 V, with a current limit of 50-200 μA. One electrode of the generator is fixed in the regional section of the surgical wound, the second, made in the form of a probe, is used to verify nerve trunks.

A device for magnetic and electromagnetic stimulation contains a receiver and a radiator: the receiver is an inductor with leads having a contact surface of at least 10 mm ² (the coil housing and the non-working surface of the leads are covered with sealed polyamide insulation); the source of the pulsed magnetic field in the form of an electromagnet with a central ferromagnetic rod - hub is equipped with a distance regulator from the end face of the electromagnet to the plane of the inductor, made in the form of a cylinder, blind on one side, having a threaded joint with the housing in which the electromagnet is placed, and the current pulse generator has an amplitude and the duration of the rise and fall fronts of the current within the pulse.

 The proposed method is as follows. Surgery (removal of neoplasm of the large salivary glands, osteosynthesis of bone fragments, osteotomy for occlusion correction, etc.) is performed under general anesthesia. Considering it inappropriate to dwell on the techniques for performing these operations, since they are detailed in the educational and scientific literature [3, 5, 6]. The operation under anesthesia is caused, in addition to the volume and trauma of the intervention, by the fact that local anesthesia causes tissue infiltration with an anesthetic, which changes the conductivity of the facial nerve and, therefore, makes it impossible to adequately identify the nerve trunks. Verification of the peripheral branches of the facial nerve from the sensory trigeminal nerve trunks with the subsequent determination of the most injured branches of the facial nerve is carried out in agreement with the anesthesiologist, in particular, by the end of the action of muscle relaxants used in endotracheal anesthesia. Apply the probe of the apparatus for electrodiagnostics to the nerve trunk in the operating wound (against the background of hemostasis), while setting a voltage of 1-3 V. Touching the nerve trunk of the facial nerve causes a reduction in the innervated facial muscle or muscle group. Alternately apply a probe to each nerve trunk of the facial nerve and assess the severity of muscle contraction of the facial muscles. It should be noted that the above surgical interventions are not accompanied by a violation of the anatomical integrity of the facial nerve. A nerve trunk or a group of nerve trunks of the facial nerve is determined, upon irritation of which by a voltage of 3V there is a barely noticeable reduction in the facial muscles or none. Then, an inductor is inserted into the surgical wound and one electrode is fixed on the damaged nerve trunk, the second in the subcutaneous fatty tissue. Options are possible, in particular, in the presence of two or more equally damaged nerve trunks. In this case, the first electrode is fixed proximally, i.e., closer or directly to the main trunk of the facial nerve when the last leaves the styloid opening (to the point of division into peripheral branches). Through the central hole in the inductance coil, a ligature (lavsan thread) is carried out, which is removed from the surgical wound into the mechnoid gap, taking into account the diameter of the inductance coil (0.5 cm), the latter should be less than the distance between the seams. The surgical wound is sutured in layers. The ends of the ligature are fixed on the skin of the face with an adhesive bandage.

 On the first day after the operation, the source of the magnetic field in the parietal region is alternately left and right. The exposure time of 10 min per field, the induction amplitude on the surface of the inductor is 0.25 T, the duration of the leading and trailing edges of the pulse is 1 ms and 50 ms, respectively, the repetition period is 1.5 s. Then, the magnetic field source is located in the projection of the inductor, while the magnetic field source is at a certain distance from the inductance coil in the range of 0.5-1.5 cm, which is sufficient to reduce facial muscles. The induction amplitude on the surface of the inductor ranges from 0.1 to 0.25 T, the duration of the leading and trailing edges of the pulse is 1 ms and 50 ms, respectively, the pulse repetition period is 0.3 ms. The voltage at the terminals of the implanted inductor has an amplitude, the value of which depends on the distance to the inductor (from 1 to 5 V), the pulse duration is 0.5 ms. Correcting the distance from the inductor to the inductor, visually control the "soft" contractions of the facial muscles, excluding excessive; the latter are accompanied by mild soreness. The exposure time from 3 to 5 minutes

 Thus, the distinctive features in comparison with the prototype include the following.

 1. In the proposed method, two therapeutic factors are used, namely, a pulsed magnetic field that affects the structures of the brain, including the nuclear apparatus of the facial nerve, as well as a pulsed magnetic field and an induced electric field in the form of an EMF arising in the inductor with the passage of a magnetic field pulse during stimulation of the peripheral branches of the facial nerve.

 2. Carry out selective stimulation of damaged nerve trunks, rather than paretic facial muscles, identifying the most injured, and in the presence of several equally affected trunks, the stimulation site is chosen proximal to the site of division of the main nerve trunk of the facial nerve into peripheral branches.

3. Individually train the facial muscles through stimulation of the nerve structures, focusing on the motor reaction, which is important given:
- varying degrees of damage to peripheral nerve trunks;
- various severity of postoperative stenosis of soft tissues of the face;
- individual sensitivity of the patient to this preformed physical factor.

 4. The impact is carried out both on the nuclear apparatus of the facial nerve and on the peripheral section.

The proposed method is the method of choice in patients with postoperative paresis of facial muscles, operated on for tumors of the large salivary glands and allows:
1. To restore the functional state of the central and peripheral structures of the facial nerve in the optimum early terms, which contributes to the complete restoration of the movements of the facial muscles, eliminating the effects of paresis.

 2. To reduce soft tissue swelling in the early postoperative period during dosed training of facial muscles due to electromagnetic stimulation of the peripheral branches of the facial nerve, which is due to the improvement of regional blood circulation and which, in turn, reduces the likelihood of developing inflammatory complications in the surgical wound.

 3. To reduce pain, improve the general condition and, thereby, reduce the need of patients for analgesic correction.

 4. To avoid overstretching of the muscle fibers of the facial muscles due to individually selected dosage stimulation of the peripheral nerve trunks, which is provided by visual control.

 5. Ensure good tolerance of the physical factors used.

 The listed therapeutic effects help to reduce the number of postoperative complications and reduce the length of stay of patients in hospital treatment.

 Justification for the use of these physical factors and the sequence of manipulations.

 It is known that the use of magnetic fields for therapeutic purposes leads to a wide range of therapeutic effects. So when exposed to the brain of an electromagnetic field (EMF), both positive changes from the peripheral blood were noted (a decrease in fibrinogen content, an increase in fibrinolytic activity, a decrease in cholesterol, etc.), and an increase in blood supply to the cerebral vessels, an increase in inflow to the brain, an improvement venous outflow. According to rheoencephalography and electroencephalography, a decrease in slow-wave activity, a decrease in the tonic tension of the vascular wall, and an increase in the alpha index were noted [8]. Similar effects were noted in works on the treatment of vascular diseases of the brain of an atherosclerotic nature using MP [9]. In diseases of the peripheral nervous system, there is evidence of an improvement in nonspecific resistance and an increase in the body's defenses under the influence of MP [10], in particular in patients with neurological syndromes [11]. The positive effect of MP on the processes of reparative regeneration, its ability to enhance metabolic processes is known [12]. In particular, published data on the successful use of pulsating MP in the treatment of trophic ulcers and wound healing [13].

 Thus, the feasibility of exposure to the brain with a pulsed magnetic field in the proposed method is due to improved blood supply, normalization of the functional state of the segmental structures of the brain, including the nuclear apparatus of the facial nerve. The use of the operating mode with inversion of polarity from period to period is justified by the fact that an ordered flow of afferent impulse from the peripheral part of the facial nerve is created, which also leads to an increase in the lability of the central nerve formations. Dosed contractions of facial muscles, controlled visually, are due to the optimal regime of electromagnetic stimulation of the peripheral nerve trunks of the facial nerve. There is an opportunity for selective stimulation of both the most damaged nerve trunk and a group of nerve trunks, which optimizes the processes of rehabilitation of the function of facial muscles.

 Regional blood supply to the facial muscles in the area of surgical intervention (in the area of innervation of damaged peripheral nerve trunks of the facial nerve) was judged on the basis of rheography data, which was carried out according to the traditional method [14]. The following data were recorded: rheographic index (RI), peripheral vascular resistance index (IPA), diastolic index (CI).

 Rheographic parameters in patients with postoperative paresis of facial muscles from the affected side: n = 12, where n is the number of patients, p <0.05, are given in table. 1.

 The dynamics of trophic processes (oxygen exchange conditions) were evaluated according to polarography [14].

 The following data were recorded: volumetric blood flow velocity (RNS).

 Polarographic parameters in patients (n = 12) with postoperative paresis of facial muscles from the affected side (p <0.05) are given in Table. 2.

The functional state of the peripheral nerve trunks of the facial nerve was evaluated by the results of electroneuromyography (ENMG) [15]
The following electroneuromyography data were recorded: early component (PK) and late component (PC) of the threshold, latent period, and duration.

 The electroneuromyographic parameters of the blinking reflex during stimulation of the infraorbital nerve in patients (n = 12) with postoperative paresis of the facial muscles from the affected side (p <0.05) are shown in Table. 3.

 Thus, the conducted functional studies indicate a steady (p <0.05) tendency (on the tenth day after surgery when using the proposed method of treatment) to normalize the regional blood supply of trophic processes in paretic facial muscles, which is consistent with electromyographic parameters confirming the restoration of the functional state peripheral nerve trunk of the facial nerve.

 The essence of this method is illustrated by the following clinical examples.

 PRI me R 1. Patient K., 42 years old, medical history N 6115/3.

 Diagnosis: mixed tumor of the right parotid salivary gland.

On admission: the tumor node 3.5 to 4.0 cm in the thickness of the right parotid chewing region, limited displacement. There are no symptoms of facial nerve damage. The diagnosis was confirmed by cytological examination 05/24/1991, the operation (under anesthesia), right-sided subtotal resection of the parotid salivary gland. After removal of the neoplasm against the background of hemostasis, the peripheral nerve trunks of the trigeminal system from the facial nerve trunks were verified. These manipulations were performed against the background of the end of the action of muscle relaxants. In this case, an apparatus for electrodiagnostics was used. Touching the active electrode to the peripheral nerve trunk of the facial nerve at a voltage of 3 V caused a different reaction of the facial muscles (from barely noticeable to pronounced). Then, in turn, a probe was applied to the nerve trunks of the facial nerve and the reaction of facial muscles was evaluated. In this case, the least bursting reaction of the facial muscles was noted during stimulation of one of the branches of the facial nerve. The inductor was implanted, one of the electrodes of the latter being fixed to the damaged nerve trunk, and the other to the subcutaneous fat. The surgical wound is sutured in layers. The lavsan thread, drawn through the central hole in the inductor, is brought out through the mechnoid gap, and is fixed on the skin with an adhesive bandage. On the day after surgery, moderate ligation of the soft tissues of the parotid chewing region on the right, paresis of the facial muscles, in particular, loosening of the eyelids on the right, and a decrease in the amplitude of movement of the facial muscles during blinking and wrinkling of the nose, were noted. Damage to the peripheral nerve trunks of the facial nerve was judged on the basis of the listed clinical data and according to the results of functional studies. With electroneuromyography of the blinking reflex and stimulation of the 1st branch of the trigeminal nerve, changes were noted, which amounted to:
threshold: RK = 19.4
PC = 18.8
Latent Period: RK = 9.9
PC = 35.1
Duration: RK = 8.9
PC = 28.4
Significant changes in the data of reagraphy were noted:
RI = 0.42
IPS = 96.7
CI = 52.3
and polarography: SOK = 21.6
Thus, electroneuromyographic indicators indicated a change in the functional state of the peripheral facial nerve. Res - and polarographic data showed a violation of microcirculation and oxygen saturation of tissues in paretic facial muscles.

 On the first day after surgery, the patient underwent a session of magnetic and electromagnetic stimulation. A magnetic field source was placed alternately on the right and left in the parietal region. The induction amplitude on the inductor surface is 0.25 T, the duration of the leading and trailing edges of the pulse is 1 ms, and the pulse repetition period is 1.5 s. Polarity inversion mode from period to period. The exposure time for each field is 10 minutes. Then the source of the magnetic field was located at a distance of 1 cm from the projection on the face skin of the inductance coil, which caused "soft" contractions of the facial muscles in the area of paretic affected muscle structures. The induction amplitude was 0.18 T, the duration of the leading and trailing edges of the pulse was 1 ms and 30 ms, respectively, and the pulse repetition period was 0.3 ms. The exposure time is 5 minutes

 Conducting 5 sessions with the specified parameters. After this, a significant improvement was noted, in particular, the phenomena of paresis of the facial muscles were stopped, the full range of movements of the facial muscles was practically restored.

Electroneuromyoraphic indicators returned to normal:
threshold: RK = 17.4
PC = 17.1
latent period: RK = 9.8
PC = 34.1
Duration: RK = 8.7
PC = 27.2
rheographic: RI = 0,053
IPR = 88.4
CI = 52.7
and polarographic: SOC = 24.16 ± 0.7
PRI me R 2. Patient S., 58 years old, medical history N 3783/3.

 Diagnosis: cylindroma (adenocystic carcinoma) of the right parotid salivary gland.

 On admission: a tumor of 3.0 by 4.0 cm in the thickness of the right parotid gland. Painless, limited displacement. There is a slight paresis of facial muscles on the right. With pharyngoscopy, a swelling of the lateral pharyngeal wall was noted. The diagnosis is cytologically confirmed.

03/27/1991, the operation under general anesthesia - right-sided subtotal resection of the parotid gland (with a tumor). The peripheral nerve trunks of the facial nerve were verified. During electrodiagnostics, it was established that the groups of nerve trunks of the facial nerve in the lower third of the face are most injured. An inductor was implanted, with one electrode fixed proximal to the division site of the indicated group of nerve trunks from the main trunk of the facial nerve. The second electrode is fixed in subcutaneous fat. The lavsan thread is brought out through the intershock gap. On the first day after the operation, moderate swelling of the soft tissues in the area of surgical intervention, the phenomena of paresis of facial muscles were noted. In particular, the omission of the lower lip on the right, difficulties in inflating the cheeks on the right, the decrease in the amplitude of facial muscles with a smile on the right, the inability to curl the lips "into a tube." Significant changes were noted in the indicators of the blinking reflex of the circular muscle of the eye during stimulation of the 1st branch of the trigeminal nerve during electroneuromyography:
threshold: RK = 19.3
PC = 18.4
latent period: RK = 9.9
PC = 34.7
Duration: RK = 8.8
PC = 28.5
rheography: RI = 0.42
IPS = 94.75
CI = 50.8
polarography: SOK = 21.5
Clinical and functional research methods showed damage to the peripheral branches of the facial nerve and a change in regional blood flow in the parotid-masticatory region. Conducted 8 daily sessions. Parameters of magnetic stimulation of segmental brain structures similar to the first observation. When stimulating the peripheral nerve trunks of the facial nerve, the magnetic field source was located at a distance of 0.5 cm from the inductor. The induction amplitude on the surface of the inductor is 0.25 T, the remaining parameters are similar to those described in the first example.

 Conducted 8 sessions. There was a disappearance of the phenomena of paresis of the facial muscles, the range of movements of the facial muscles was practically restored.

Electroneuromyography data:
RK threshold = 17.3
PC = 17.00
latent period: RK = 9.8
PC = 33.8
Duration: RK = 8.7
PC = 27.1
rheography: RI = 0,054
IPS = 86.58
CI = 52.7
polarography: SOK = 24.10 ± 0.05
This indicates the normalization of the functional state of the peripheral nerve trunks of the facial nerve. (56) 1. USSR Copyright Certificate N 902757, cl. A 61 N 1/32, 1982.

 2. Copyright certificate of the USSR N 735259, cl. A 61 N 1/36, 1980.

 3. Paches A. I. Tumors of the head and neck. M.: Medicine, 1983, p. 415.

 4. Paches A. I. Treatment of tumors of the parotid salivary gland. M.: Medicine, 1968, p. 208.

 5. Solntsev A. M. and Kolesov V. S. Surgery of the salivary glands. Kiev: Health, 1979.

 6. Clinical operative maxillofacial surgery. Ed. Alexandrova N.M., L.: Medicine, 1985, p. 448.

 7. General oncology. A guide for doctors. Ed. Nachpalkova N.P. L.: Medicine, 1989. 648.

 8. Millere L. A. and Detlav I. E. Use of magnetotherapy in patients with the consequences of cerebrovascular accident. Problems of technology in medicine. Tr. All-Union Scientific + Technical. conf. Taganrog, Taganrog honey. Institute, 1980, p. 148-149.

 9. Magnetotherapy and electrical stimulation, as methods of rehabilitation of post-stroke disorders. Gilinskaya N. Yu., Poemny F.A., Olesov G.V. et al. - News of medical equipment. : Issue. 4, M., VNII MP, 1979, p. 67, 68.

 10. Medvedovsky N. P., Myshelova K. P. and Savchenko A. G., Influence of the low-frequency magnetic field on the immunological reactivity of patients with degenerative diseases of the joints and spine. "Problems of technology in medicine", Tr. All-Union scientific -tech. conf. - Taganrog, Taganrog honey. Institute, 1980, p. 213-215.

 11. Borisov I. A. Efficiency and ways to optimize the magnetotherapy of diseases of the peripheral nervous system. Peripheral nervous system. Vol. 5. Minsk: Science and Technology, 1982, p. 193-196, p. 26.

 12. Magnetotherapy for fractures of the lower jaw. Mikhailova R.I. et al. "Dentistry", 1982, N 2, p. 41, 42.

 13. Copyright certificate of the USSR N 1219097, cl. A 61 N 1/42, 1990.

 14. Prokhonchukov A.A. et al. Functional diagnostics in dental practice. M.: 1981.

 15. Badalyan N. O. and Skvortsov I. A. Clinical electroneuromyography. M.: 1986, p. 368.

Claims (1)

 METHOD FOR TREATING MIMIC MUSCULAR PAREASES AT PERIPHERAL FACES OF THE FACE NERVE by electrical stimulation, characterized in that they carry out dosed remote electromagnetic stimulation of the peripheral branches of the facial nerve by implantation of the inductance coil, one of them being placed on the other tissue’s fatty electrode to the area of the inductor by a pulsed magnetic field with alternating polarity of the pulses, with magnetic induction I on the surface of the inductor 0.1 - 0.25 T, the leading and trailing edges of the induction pulse of 1 ms and 50 ms, respectively, the pulse repetition period of 0.3 s, the voltage at the terminals of the implanted coil 1 - 5 V, the pulse duration of 0.5 ms, and previously acted upon by a pulsed magnetic field with alternating polarity of pulses on the segmental structures of the brain with a magnetic field induction of 0.25 T, the duration of the leading and trailing edges of the induction pulse 1 ms and 50 ms, respectively, with a pulse repetition period of 1.5 s, sessions are carried out daily for 5-8 days, exposure time with electromagnetic stimulation 5 minutes, when exposed to a pulsed magnetic field of 10 minutes for two fields in turn.

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