The use of transcutaneous electric stimulation in patients with partial optic nerve atrophy due to chiasmo-sellar region tumors

Purpose - to increase functional results of treatment of partial optic nerve atrophy in patients after surgical procedure for chaismo-sellar region neoplasm by improvement and realization of a new approach to impulse electrical stimulation of visual analyzer. Material and methods. A clinical case of patient’s visual rehabilitation after surgical procedure for chiasmo-sellar region tumor and visual function impairments due to this disease are presented. Preoperatively, evident visual function impairments were present. We observed visual acuity decrease of the right eye (RE) up to 0.09 (no correction possible), in her left eye (LE) up to 0.01 (no correction possible); visual fields limits sum in 8 meridians made up 183º in RE and 100º in LE, electrophysiological indices (electric sensitivity threshold was 480 mkA in RE, 580 in LE, electric liability was 28 Hz in RE, 26 Hz in LE) and visual evoked potentials were tested. No visual acuity restoration was observed postoperatively. Brain tractography was fulfilled in order to visualize the orientation and the integrity of conduction pathways. A treatment course of transcutaneous impulse electric stimulation of the visual analyzer was fulfilled for residual vision stabilization and possible visual function increase. We used software complex sets ESOM-KOMET, ESOM-MASTER (“Neuron”, Russia) applying an improved method. We increased the number of sessions from 10 to 20 using the individual microprocessor-based set ESOM- Micro (“Neuron”, Russia) with the option of setting up a personal program of treatment for each eye separately. Results. Considerable positive changes of visual functions in this patient were obtained after the whole course of prescribed treatment (20 sessions) was finished. At the beginning of treatment, visual acuity of the right eye increased from 0.09 to 0.9-1.0 (correction with -2.0 Dptr.); of the left eye from 0.01 to 0.3 eccentrically (correction with -1.5 Dptr.). Limits of visual fields in 8 meridians broadened from 185º to 230º in the right eye and from 100º to 110º in the left eye. Electrophysiological indices improved so as the electric sensitivity threshold of the right eye decreased from 480 mkA to 240 mkA, the left eye threshold changed from 580 to 420 mkA. Stabilization of electric liability figures was marked, it made up 28 Hz in the right eye and 26 Hz in the left eye. When investigating visual evoked potentials (in dynamics) in both eyes latency reduced from 105 to 100 msec., the amplitude increased from 9.2 to 11.9 mV, evidencing the activation of functionally depressive neural elements. Conclusion. The use of improved approach to impulse electric stimulation of visual analyzer elements is the instrument to visual acuity increase, visual fields broadening and electrophysiological indices improvement. The possibility to make an individual treatment program with setting it up on the equipment for personal use allows reducing the time of in-patient stay in the hospital and guarantees the succession of treatment therapy ful- fillment for this category of patients.

partial optic nerve atrophy, chiasmo-sellar region tumor, electric stimulation, rehabilitation