EVALUATION OF THE EFFECTS OF ELECTRO-ACUPUNCTURE COMBINED WITH CEREBROLYSIN HYDRO-ACUPUNCTURE ON PEDIATRIC PATIENTS WITH POST-ACUTE VIRAL ENCEPHALITIS

Summary

Objectives: To evaluate the effects of electro-acupuncture combined with cerebrolysin hydro-acupuncture on pediatric patients with post-acute viral encephalitis at National Hospital of Acupuncture in 2023 and survey some unwanted effects of cerebrolysin hydro-acupuncture. Subjects: 60 pediatric patients diagnosed with post-acute viral encephalitis from 01 year old to under 16 years old, voluntarily participating in inpatient treatment at National Hospital of Acupuncture from April to December 2023. Methods: Prospective study, controlled intervention, comparison before and after treatment of pediatric patients. Results: The improvement in motor function of pediatric patients has progressed very well, accounting for 46.7% (GMFCS level decreased by 2 points); 23.3% had good progress (GMFCS level decreased by 1 point); no progress accounts for 30.0% (GMFCS level remains the same); No patient had any changes for the worse. During the research process, there was only one case of bleeding during hydro- acupuncture, accounting for 3.3%. Conclusion: The level of improvement in GMFCS motor function of pediatric patients with post-acute viral encephalitis after treatment is further improved. Symptoms of bleeding during the hydro-acupuncture process went away after being treated with dry cotton to stop the bleeding and there is nothing dangerous for pediatric patients.

I. INTRODUCE

Encephalitis is an inflammation of the brain parenchyma, manifested by focal or diffuse neurological and mental dysfunction. There are many causes of encephalitis, but the main cause is viruses. Viral encephalitis is often contracted in young children and leaves many serious sequelae for children such as movement disorders, language disorders, reduced intelligence,...[1], [2]. Viral encephalitis has become a top concern globally, especially in Asian countries including Vietnam because the disease often has a high mortality rate and severe neurological sequelae. Vietnam is located in Southeast Asia, an area that can be considered a hot spot for viral encephalitis, in which Japanese encephalitis is recognized as the leading cause of viral encephalitis throughout Asia. Asia with approximately 16,000 cases reported each year [3].

According to traditional medicine, encephalitis is classified as a disease of Wen disease. Encephalitis is a sequela of Wen's illness. The initial illness is often caused by external evil spirits. Encephalitis often occurs in the summer or late summer, so it is considered mild or mild. After passing the acute stage of the disease, the patient moves to the post-remedial sequelae stage, which is often caused by internal injuries [4]. Currently, there is no research evaluating the effects of electroacupuncture combined with cerebrolysin hydroacupuncture on pediatric patients with post-acute viral encephalitis at the National hospital of Acupuncture. Therefore, we conducted the study: "Evaluation of the effects of electro-acupuncture combined with cerebrolysin hydro-acupuncture on pediatric patients with post-acute viral encephalitis at National Hospital of Acupuncture in 2023".

II. RESEARCH SUBJECTS AND METHODS

2.1. Research subjects.

60 pediatric patients diagnosed with post-acute viral encephalitis from 01 year old to under 16 years old received inpatient treatment from April to December 2023 at the National Hospital of Acupuncture.

2.2. Research Methods

2.2.1. Research design: Prospective method, controlled intervention, comparison before and after treatment.

2.2.2. Sample size: Choose sample n=60

2.2.3. Procedure:

Pediatric patients studied were divided into two groups:

Research group of 30 pediatric patients (n) were treated with electroacupuncture every 30 minutes * 1 time/day * 40 days (20 consecutive days of treatment - T1, 5 days off and continue treatment for 20 days - T2), hydro-acupuncture Cerebrolysin 1 ml * 1 time/day * 40 days, Vincozyn 2ml * 1 time/day * 40 days, combined with acupressure massage 30 minutes/time * 1 time /day * 40 days;

The control group of 30 pediatric patients were treated with electro-acupuncture, Vincozyn 2ml * 1 time/day * 40 days, combined with acupressure massage 30 minutes/time * 1 time /day * 40 days;

The acupoint formula is applied [4]:

During treatment, change acupoints and position the patient to lie on his back or face to suit his physical condition.

2.2.4. Research indicators and how to determine research indicators: Research indicators were evaluated before the patient was treated (T­₀), 20 days after treatment (T₁), and 40 days after treatment (T₂) including: Level of motor paralysis according to the scale Rankin [5], gross motor function level according to the GMFCS scale [6]. Disease monitoring indicators of traditional medicine [4].

2.2.5. Data processing: Research data were processed using the SPSS 20.0 software program. The difference is statistically significant with p < 0.05.

III. RESULTS

3.1. Changes in clinical symptoms according to modern medicine

Table 1. Changes in clinical symptoms according to modern medicine

Comment: The improvement in clinical symptoms in each group, before and after treatment, was statistically different, with p < 0.05. Among them, dystonia and extrapyramidal disorders had significant differences after treatment between the study group and the control group.

3.2. Changes in clinical symptoms according to traditional medicine

Table 2. Changes in clinical symptoms according to traditional medicine

Comment: The improvement in clinical symptoms according to traditional medicine in each group, before and after treatment, was statistically different, with p < 0.05. In particular, many symptoms improved for the better.

3.3. Change in the level of motor paralysis according to the Rankin scale

Table 3. Change in the level of motor paralysis between the two groups

Comment: After treatment, the difference in paralysis compared to before treatment is statistically significant with p < 0.05. In the research group, 16.7% of pediatric patients recovered from paralysis, and in the control group, 3.3% of pediatric patients recovered from paralysis. The average motor paralysis shift of the study group from 4.1 ± 0.62 to 2.3 ± 1.49, the control group from 4.5 ± 0.63 to 2.9 ± 1.57. The difference between before treatment and after treatment of the two groups is statistically significant with p < 0.05. The difference between the two groups in the average paralysis displacement after treatment was statistically significant with p < 0.05.

3.4. Change in the level of gross motor function between the two groups

Table 4. Change in the level of gross motor function between the two groups

Comment: After treatment, the difference in the level of gross motor function compared to before treatment is statistically significant with p < 0.05. The research group had 6.7% of pediatric patients at level I, the control group had 3.3% of pediatric patients at level I. The average shift in gross motor function level of the research group was from 4.2 ± 0.55 to 2.9 ± 1.14, control group from 4.1 ± 0.53 to 3.3 ± 1.15. The difference between before treatment and after treatment of the two groups is statistically significant with p < 0.05. The difference between the two groups in the average gross motor function level shift after treatment was statistically significant with p < 0.05.

3.5. GMFCS score change

Table 5. Change in GMFCS scores between the two groups

Table 6. Evaluate the progress of gross motor function GMFCS

between the two groups after treatment

Comment: After treatment, the research group made very good progress, 46.7% of pediatric patients improved very well (GMFCS level decreased by 2 points); 23.3% of pediatric patients improved well (GMFCS level decreased by 1 point); 30.0% of pediatric patients did not improve (GMFCS level remained the same); No patient had any changes for the worse. In the control group, 26.7% of pediatric patients improved very well (GMFCS level decreased by 2 points); 16.7% of pediatric patients improved well (GMFCS level decreased by 1 point); 56.6% of pediatric patients did not improve (GMFCS level remained the same); No patient had any changes for the worse. The level of gross motor function improvement of the study group was greater than that of the control group, with statistical significance p < 0.05.

3.6. Unwanted effects and mechanical effects in treatment

Table 7. Unwanted effects and mechanical effects

Comment: During the treatment period, all pediatric patients have not encountered any unwanted side effects such as anaphylaxis, infection at the hydro-acupuncture point, or needle breakage during acupuncture. Only bleeding at the puncture site occurred in 1 pediatric patient in the control group (3.3%)

IV. DISCUSS

4.1. Changes in clinical symptoms according to modern medicine

            After acute encephalitis, pediatric patients with viral encephalitis leave behind many clinical disorders.

            Consciousness disorders: All of the studied pediatric patients had moderate to severe consciousness disorders, no patient had normal consciousness. The proportion of pediatric patients with severe level of consciousness disorder is "awake, not aware". Research group 73.3%, control group 76.7% (table 3.1). Compared with previous Japanese encephalitis studies, this result is lower. In the study of Dang Minh Hang (2003), a combination of acupuncture and traditional acupressure massage restored motor function for 60 pediatric patients with sequelae of Japanese encephalitis after the acute stage, at the National Hospital of Traditional Medicine also has a high rate of consciousness disorders of 98.4% [7]. With a few of other research projects, Nguyen Thi Tu Anh (2001), researching at the National Hospital of Acupuncture, used electro-acupuncture to restore movement for 116 children with Japanese encephalitis after the acute stage (only 61 ,2% have the disease for less than 30 days) this rate is 68.1% [8]. According to Nguyen Thi Thanh Van (2001), a survey of 75 pediatric patients with Japanese encephalitis, the sequelae stage was 60.8%.

            Pediatric patients at the beginning of treatment all had consciousness disorders, of which severe consciousness disorders accounted for the majority. After treatment, the study group improved better than the control group, specifically 26.7% of pediatric patients with severe mental disorders in the study group, 33.3% of the control group. Children who were awake and familiar with the study group accounted for 46.7%, and the control group accounted for 43.4%.

            Language disorders: All of the pediatric patients studied had language disorders of various levels, the majority of which were aphasia and muttering with unvoiced sounds, this rate was 73.3% in the research group, 73.3% in the study group control 76.7%. This characteristic of language disorder is found in most pediatric patients and appears early from the onset stage. Children often have difficulty speaking or are unable to speak. These are signs suggesting that the pediatric patient may have damage to the language area, causing signs of poor fluency, disordered use of word sounds, poor repetition and impaired understanding of words, resulting in the inability to speak. Even though he was sick before, he lived on his own and spoke well. After treatment, the proportion of children who were able to say single words was 63.3% in the study group and 53.3% in the control group. Other disorders such as swallowing disorders, circular muscle disorders, autonomic nervous disorders, muscle dystonia, and extrapyramidal disorders have all achieved positive results after treatment. After treatment, 53.3% of the study group had mild dystonia and 43.4% of the control group. Mild extrapyramidal disorders, 46.6% in the study group, 40.0% in the control group (table 3.1). The improvement in clinical symptoms in each group, before and after treatment, was statistically different, with p < 0.05. Among them, dystonia and extrapyramidal disorders had significant differences after treatment between the study group and the control group.

4.2. Changes in clinical symptoms according to traditional medicine

            Acupuncture according to modern medicine enhances local circulation and nutrition for paralyzed muscle areas. Enhance the body's ability to self-recover damaged areas. According to traditional medicine, with local acupuncture points, acupuncture has the effect of opening the meridians, helping the body's blood and energy circulate along the meridians to nourish the damaged area and the body. With acupuncture points all over the body, acupuncture helps regulate yin and yang, supporting the ability to restore damaged energy. After treatment, clinical symptoms improved compared to before treatment.

            Before treatment, all pediatric patients had moderate and severe disorders of consciousness, mainly severe disorders, no patients had mild disorders of consciousness or no disorders of consciousness. After treatment, there has been a decrease in the number of pediatric patients with consciousness disorders at this level. According to traditional medicine, encephalitis is caused by evil heat entering the body, going through the stages of protection, qi, nutrition, and blood, seriously damaging the yin and blood. Prolonged heat entering the blood causes the fluid to be lost and condensed, causing phlegm to form. Phlegm confuses the heart, leading to coma and speechlessness. Heat can enter the heart, block the heart, causing coma and confusion.

            All pediatric patients in the study had body temperature disorders. After treatment, only 13.3% of pediatric patients had body temperature disorders. Traditional medical theory believes that a child's constitution is "pure yang and no yin". According to modern medicine, in children, the process of energy metabolism for growth and development is always strong, releasing a lot of heat. Therefore, children are inherently hotter than other people. In addition, after the acute stage of encephalitis, although the patient no longer has a high fever, he is still in a state of fever, body temperature is usually below 38.50C. When the body is hot, the physiological response is sweating. But in children with sequelae of encephalitis, this excretion is often disturbed in an increased direction. Because of the changes in the autonomic nervous system, the patient's symptoms of increased sweating are even more intense.

            The improvement in clinical symptoms according to traditional medicine in the study group and control group, before and after treatment, was statistically different, with p < 0.05 (table 3.2). In particular, many symptoms improved for the better.

4.3. Change in the levels of motor paralysis

Before treatment, all pediatric patients had motor paralysis to varying levels. The study group had the highest rate of motor paralysis of level IV and V at 86.7%, the control group had 80.0%. After treatment, there were still 2 patients with grade V motor paralysis (rate 3.3%) in the study group (table 3.3). After treatment, the difference in paralysis compared to before treatment was statistically significant with p < 0.05. In the research group, 16.7% of pediatric patients recovered from paralysis, and in the control group, 3.3% of pediatric patients recovered from paralysis. The average motor paralysis shift of the study group from 4.1 ± 0.62 to 2.3 ± 1.49, the control group from 4.5 ± 0.63 to 2.9 ± 1.57. The difference between before treatment and after treatment of the two groups is statistically significant with p < 0.05. The difference between the two groups in the average paralysis displacement after treatment was statistically significant with p < 0.05.

As stated above, encephalitis caused by heat entering the body damages fluid, disrupts blood circulation, and affects the nutrition of muscle fascia, causing sequelae of motor paralysis. When treating, it is necessary to activate the blood and clear the meridians. To clear the meridian and treat movement disorders, we use a number of acupuncture points on the Yangming meridian. According to the theory of traditional medicine, Duong Minh is a meridians with many qi and many blood. When the blood is stimulated, the qi and blood will circulate well, helping to treat paralysis. In addition, we add Giap Tich acupoints in the neck and waist area. This is the exit site of the brachial plexus and lumbosacral plexus roots. Pinching it will stimulate the mobility of the limbs.

4.4. Change in the level of gross motor function between the two groups

            The GMFCS scale has been widely used in most countries since 2006 as a specific tool in assessing the level of gross motor development of children according to age and the results of rehabilitation intervention in each stage. . In this study, we used the GMFCS scale to evaluate the gross motor function level of pediatric patients. After treatment, the difference in gross motor function level compared to before treatment was statistically significant with p < 0.05. The research group had 6.7% of pediatric patients at level I, the control group had 3.3% of pediatric patients at level I. The average shift in gross motor function level of the research group was from 4.2 ± 0.55 to 2.9 ± 1.14, control group from 4.1 ± 0.53 to 3.3 ± 1.15. The difference between before treatment and after treatment of the two groups is statistically significant with p < 0.05. The difference between the two groups in the average gross motor function level shift after treatment was statistically significant with p < 0.05 (table 3.4).

4.5. Change in GMFCS score and assessment of treatment results

            After treatment, the research group made very good progress, with 46.7% of pediatric patients making very good progress (GMFCS level decreased by 2 points); 23.3% of pediatric patients improved well (GMFCS level decreased by 1 point); 30.0% of pediatric patients did not improve (GMFCS level remained the same); No patient had any changes for the worse. In the control group, 26.7% of pediatric patients improved very well (GMFCS level decreased by 2 points); 16.7% of pediatric patients improved well (GMFCS level decreased by 1 point); 56.6% of pediatric patients did not improve (GMFCS level remained the same); No patient had any changes for the worse. The level of gross motor function improvement of the study group was greater than that of the control group, with statistical significance p < 0.05 (table 3.5 and table 3.6).

4.6. Unwanted effects and mechanical effects in treatment

            Hydro-acupuncture is a treatment method of traditional medicine in which the physician directly applies medicine to the acupuncture point. In Traditional Medicine, Hydro-acupuncture is highly appreciated for its effectiveness in treating many diseases. This method not only helps quickly reduce disease symptoms but also quickly overcomes the cause of the disease thanks to the skillful combination of Eastern and Western medicine, affecting the right acupuncture points for treatment, making the treatment effective and fast. increase more.

            Within the scope of this study, with the research subjects being pediatric patients aged from 1 to under 16 years old, we are interested in unwanted effects that may be encountered clinically such as anaphylactic shock, bleeding. At the hydro-acupuncture site, swelling, pain, infection and needle breakage occur during hydro-acupuncture. In addition, other adverse mechanical effects remain to be monitored. Bleeding often occurs because the patient is afraid and struggles during hydro-acupuncture. To limit and prevent this effect, the physician must have a clear explanation for the patient and encourage the patient before performing the procedure. Most of the pediatric patients in the study had consciousness disorders of varying degrees, so explaining this encouragement was difficult. However, during the process of performing hydro-acupuncture according to the research process, we have not encountered any cases of anaphylactic shock, infection, or broken needles during hydro-acupuncture.

            The cause of bleeding is often due to the child not cooperating, damaging the blood vessels under the skin in the acupoint area. To prevent this effect, the physician who performs the procedure must be very careful, fully perform the acupuncture process, and have good anatomical knowledge of the acupoints. During the implementation of the project, there was only one case of bleeding during hydro-acupuncture, accounting for 3.3%. But after the hemostatic treatment with dry sterile cotton was successful, there was no danger to the patient.

V. CONCLUSION

Through research on 60 pediatric patients with post-acute viral encephalitis treated with electro-acupuncture combined with hydro-acupuncture and acupressure massage from April to December 2023, we came to the following conclusion:

- After treatment in the research group: improvement in motor function progressed very well, accounting for 46.7% of pediatric patients making very good progress (GMFCS level decreased by 2 points); Pediatric patients made good progress, accounting for 23.3% (GMFCS level decreased by 1 point); Pediatric patients who do not improve account for 30.0% (GMFCS level remains the same); No patient had any worsening changes, with statistical significance p < 0.05. General assessment when the patient was discharged from the hospital: The study group had better results than the control group.

- Unwanted effects of cerebrolysin hydro-acupuncture method: During the procedure, there was only one case of bleeding during hydro-acupuncture, accounting for 3.3%. The bleeding symptoms stopped after being treated with dry cotton and there is no danger to the child.

Keyword

Hydro-acupuncture,Viral encephalitis,National Hospital of Acupuncture