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ĐẶT VẤN ĐỀ MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY PHAM NGOC THUY STUDYING THE EFFECTS OF ACUPUNCTURE IN RESTORING PSYCHOMOTOR FUNCTIONS IN PEDIATRIC PATIENTS AF[.]

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY PHAM NGOC THUY STUDYING THE EFFECTS OF ACUPUNCTURE IN RESTORING PSYCHOMOTOR FUNCTIONS IN PEDIATRIC PATIENTS AFTER HERPES SIMPLEX VIRUS ENCEPHALITIS Major Code : Traditional medicine : 9720113 SUMMARY OF THESIS OF DOCTOR OF PHILOSOPHY IN MEDICINE HA NOI – 2022 THE WORK HAS BEEN COMPLETED AT HANOI MEDICAL UNIVERSITY Supervisor: Dr DANG MINH HANG Assoc.Prof.Dr NGUYEN VAN THANG Opponent 1: Assoc.Prof.Dr Ta Van Binh Opponent 2: Assoc.Prof.Dr Pham Quoc Binh Opponent 3: Dr Cao Vu Hung The thesis will be defended at Board of Examiners of Hanoi Medical University At: 14:00 Date: 10/ 09 / 2022 The thesis can be found at: National library of Vietnam Library of Hanoi Medical University INTRODUCTION THESIS The urgency of the subject In Vietnam, the most common viral cause of encephalitis today is still caused by the Japanese virus, although it has decreased significantly compared to about two decades ago thanks to vaccination right after birth Herpes simplex virus has become the second leading etiological group after Japanese encephalitis B according to Pham Nhat An and coworker Encephalitis caused by external herpes simplex virus has the same characteristics of brain parenchyma as other types of encephalitis, but is often more severe due to brain parenchyma necrosis or local bleeding, leaving irreversible sequelae Before there was no treatment for acyclovir, the mortality rate was 70% and only 2.5% of the survivors recovered normal neurological function, The rest of the patients mostly had motor sequelae and mental illness such as acute encephalitis in general Traditional medicine to restore motor function often uses acupuncture such as acupuncture, ear acupuncture, electro-acupuncture, hydro-acupuncture, and massage, which has confirmed the therapeutic effect on the sequelae of the disease The acupuncture regimen of the Pediatric Department of the Central Hospital of Traditional Medicine has been established for the treatment of psycho-motor rehabilitation for children after acute encephalitis Therefore, it is very necessary to study the effects of acupuncture in the rehabilitation of mind-motor function in pediatric patients after acute encephalitis caused by Herpes simplex virus With the desire to improve the quality of life for children, help them integrate into the community, return to normal life soon, and reduce the burden of caring for the family and society is an urgent matter We conduct this research with the following objectives: Describe some clinical characteristics according to traditional medicine in pediatric patients after acute encephalitis caused by Herpes simplex virus Evaluation of the effect of acupuncture in rehabilitation of mind-motor function in pediatric patients after acute encephalitis under years old caused by Herpes simplex virus Identify a number of factors affecting the results of treatment New contributions of the thesis Encephalitis caused by herpes simplex virus is one of the dangerous diseases, causing serious brain damage, mortality and sequelae rates are still quite high With the desire to minimize functional deficiencies for pediatric patients with sequelae after acute herpes simplex virus encephalitis and to improve the effectiveness of rehabilitation, to reintegrate children into normal life as soon as possible burden on the family and society, we conducted a study: The effect of acupuncture in the rehabilitation of psychomotor function in pediatric patients after acute herpes simplex virus encephalitis With an open clinical trial research method with two research groups, 53 pediatric patients received acupuncture in combination with the background regimen and 50 patients performed only recovery according to the background regimen Research results show that acupuncture has a role and confirms the ability to restore movement and mind after six weeks of treatment This result also helps clinicians to have new options in rehabilitation care in pediatric patients with sequelae after acute viral encephalitis in general and herpes simplex virus in particular This is the first research topic in Vietnam and the world Hao acupuncture has the effect of restoring motor paralysis according to the Henry scale in pediatric patients with sequelae of acute encephalitis caused by Herpes simplex virus (p0,05 Note: The corresponding neurological disorders are as follows: 0- No disorder 1- Mildly disordered 2- Moderately disturbed 3Severely disturbed Remarks: The improvement of movement disorder symptoms in each group, before and after six weeks of treatment was statistically significant, with p < 0.05 The improvement of neurological symptoms between the two groups was not statistically significant, p>0.05 3.3.3 Treatment results according to the type of traditional medicine After treatment, the symptoms tended to decrease in both disease groups: The negative body, the number of children with symptoms of dry mouth and throat, apple defecation (< times/week) red or pink face, relatively dry skin, fever, low urination, dark yellow, colored fingerprints purple…reduced statistically significant with p < 0.05 The number of children with symptoms of insomnia, crying and screaming, sharp pulse, etc decreased with statistical significance with p < 0.05 Control group: In the form of yin disease, after treatment, symptoms of dry mouth and throat, apple defecation (< times/week), fever ≤ 380C, relatively dry skin, less urination tends to decrease, however the difference difference was not statistically significant with p > 0.05 In the form of syphilis, the symptoms almost did not improve, the symptoms of dry mouth and throat, relatively dry skin, bad breath, fever ≤ 380C decreased, but the difference was not significant Statistical significance with p > 0.05 * Change the degree of Henry's paralysis according to the disease type of Traditional Medicine After six weeks of treatment, the new improvement in both groups was statistically significant with p < 0.05 The study group had 16.7% of children recovered from motor paralysis, the improvement of motor paralysis was better than the control group, the difference was statistically significant with p < 0.05 * Developmental index in the gross motor area after treatment in diseases of Traditional Medicine In the gross motor area, after weeks of treatment, the improvement in both groups was statistically significant with p < 0.05 The study group had better gross motor improvement than the control group, the difference was statistically significant with p0.05 However, the difference between the two groups was not statistically significant, with p > 0.05 * Development index in the individual - social area after treatment in diseases of Traditional Medicine The socio-personal development index after treatment in the negative-negative form of each group tends to be higher than that in the negative-negative form, p < 0.05 In the negative form, the development index of the study group tended to be higher than that of the control group, but the difference was not statistically significant, with p > 0.05 The index of social personal development after treatment of the study group tended to be higher than that of the control group, but the difference was not statistically significant, with p > 0.05 3.3.2.1 Evaluation of treatment results by changes in muscle tone according to the modified Ashworth scale * Changes in muscle tone according to modified Ashworth scale of groups After six weeks of treatment, in both groups, dystonia decreased much compared to before treatment, with statistical significance (with p < 0.05) In the study group, there were no patients with severe hypertonia, 11.3% of patients with muscle tone returned to normal In the control group, there were patients with increased muscle tone, the affected limb was very stiff and difficult to stretch, none of the children had any increase in muscle tone The level of score reduction in the study group was higher than that in the control group after four weeks of treatment, but there was no statistical significance with p > 0.05; But after six weeks of treatment the difference was statistically significant with p < 0.05 3.3.2.2 The results of treatment for psychomotor disorders according to the Denver II test * Growth index in gross motor area after treatment according to Denver II test of two groups The rate of children with severe retardation was only 3.8% in the study group and 4% in the control group The rate of children with mild retardation was highest in the two study groups at 71.7%, the control group with moderate delay was the highest at 60% In the study group, 11.3% of the pediatric patients returned to normal, while the control group had no children After six weeks of treatment, the study group had better gross motor improvement than the control group, the difference was statistically significant with p < 0.05 * Developmental index change in fine motor areas after treatment according to Denver II test After six weeks of treatment, the subtle motor improvement in each group changed to statistical significance (p < 0.05) After treatment, the research group left 3.8% of children with severe growth retardation, returning to normal by 11.3% In the control group, there were 4% children with severe growth retardation, none of them returned to normal After six weeks of treatment, the study group had better fine motor improvement than the control group, the difference was statistically significant with p < 0.05 * Change in development index in language area after treatment according to Denver II test After six weeks of treatment, the language disorder in each group improved significantly compared to before treatment, but there was no statistical significance, p>0.05 The severity of language disorders in both groups remained high The rate of children who got rid of language disorders in the study group was 11.3% higher than in the control group compared to 0% However, the difference between the two groups was not statistically significant with p > 0.05 * Change in development index in the individual - social area after treatment according to Denver II test After six weeks of treatment, the development index in the individual - social area in each new group changed statistically significantly (p < 0.05) The number of pediatric patients in the study group with mild delay accounted for the highest rate of 54.7%, with 11.3% of children returning to normal development In the control group, the rate of severe delay was 12%, moderate delay accounted for the highest rate of 64%, no patients returned to normal The difference between the two groups after treatment was also statistically significant with p < 0.05 3.3.4 Monitor unwanted effects in treatment * Clinical undesirable effects Comments: During the weeks of treatment with acupuncture, all the pediatric patients did not experience any unwanted effects such as needles, infection at the injection site, broken needles during acupuncture Only bleeding at the injection site was observed in two children in the control group (3.8%), each child only experienced once when the needle was removed during the procedure 3.3.5 Evaluation of general clinical results after treatment After six weeks, the research group had 11.3% cured, 77.4% mild sequelae, most of the children still had mild and moderate sequelae in the control group, 70% severe sequelae, the difference between after treatment compared to with pre-treatment had statistical significance with p < 0.05 The difference between the two groups after treatment was statistically significant with p < 0.05 3.4 RESULTS INDENTIFIED SOME RELATED FACTORS 3.4.1 A number of factors related to treatment results reduce the degree of paralysis according to Henry * Factors related to the results of treatment to reduce paralysis on the Henry scale In general, the older the patient is, the longer the duration of the disease, the need to feed through the nasogastric tube, the child being malnourished and in the form of schizophrenia, according to traditional medicine, are the limiting factors Limiting the research group's acupuncture results in the rehabilitation of motor paralysis, there is statistical significance p < 0.05 The difference between before and after treatment was statistically significant with p < 0.05 3.4.2 Relationship between brain damage on magnetic resonance imaging and the change of paralysis according to Henry scale * The relationship between brain damage localization on magnetic resonance and the change of paralysis according to Henry scale The number of brain lesions is very diverse, from one to many locations in the same pediatric patient The location of lesions on the magnetic resonance of these children is most common in the temporal lobe (one or two sides) Research group 44/53, accounting for the highest rate 83% After six weeks, pediatric patients with temporal lobe injuries recovered from paralysis more slowly than with injuries to other areas The difference after treatment was not statistically significant with p > 0.05 *Relation between the number of brain injury sites in a pediatric patient according to magnetic resonance and the change of paralysis according to the Henry scale The location of the lesion on the brain of each patient is diverse The most common is a two-site lesion, 47.2% At least three lesions were involved, with three children (10%) having grade IV paralysis After treatment, the less number of damaged sites, the better the recovery of motor paralysis The best paralysis recovery is in children with brain damage in only one location, with seven patients of this type at the time of admission, after treatment, six patients recovered from paralysis * Distribution of paralysis degree in research subjects according to brain injury location on MRI at the time before and after treatment Comment: Before treatment, there were children with grade I paralysis and children with grade II paralysis After treatment, there was patient with grade I paralysis, and patients recovered from paralysis Before treatment, there were children with grade II and 22 children with grade III After treatment, there were 25 children from grade III to grade I Injury to areas, no patients recovered from paralysis Statistical value p