Neuromodulation最新文献

{"title":"Challenging the Excitatory-Inhibitory Dichotomy Dogma of Intermittent Theta-Burst Stimulation and Continuous Theta-Burst Stimulation.","authors":"Molly S Hermiller","doi":"10.1016/j.neurom.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.06.011","url":null,"abstract":"","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review on the Current Landscape of Invasive Neuromodulation for Poststroke Motor Recovery: Mechanisms, Challenges, and Future Directions.","authors":"Ugur Kilic, Charlotte Smets, Zhengdao Deng, Alexandra Boogers, Myles Mc Laughlin, Philippe De Vloo, Derek D George, Bart Nuttin","doi":"10.1016/j.neurom.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.06.004","url":null,"abstract":"<p><strong>Objectives: </strong>Stroke is a leading cause of disability. Despite rehabilitation efforts, most survivors of stroke do not fully recover. Invasive neuromodulation has shown promise but has not yet become standard of care in poststroke rehabilitation. Given the inherent drawbacks of invasive modalities, a critical evaluation is warranted. This review examines invasive neuromodulation strategies for poststroke recovery, focusing on their mechanisms of action, clinical evidence, and technical challenges.</p><p><strong>Materials and methods: </strong>A structured search was conducted using PubMed for studies from 2000 to 2025, with the terms (\"Stroke\"[MeSH] OR \"Stroke Rehabilitation\"[MeSH]) and (\"Neurostimulation\" OR \"Invasive Electrical Stimulation\" OR \"Deep Brain Stimulation\" OR \"Epidural Stimulation\" OR \"Spinal Cord Stimulation\" OR \"Cortical Stimulation\" OR \"Cerebellar Stimulation\"). Only human studies were included. Moreover, clinical trials from ClinicalTrials.gov and the European Union Clinical Trials Register were cross-referenced, and preclinical studies underpinning selected clinical trials were integrated.</p><p><strong>Results: </strong>Vagal nerve stimulation has received Food and Drug Administration approval, whereas motor cortex stimulation, cerebellar stimulation, and spinal cord stimulation remain investigational. These methods aim to recruit residual motor networks and promote plasticity. However, narrow cohorts, variability in stroke location and timing, differences in rehabilitation intensity, and inconsistencies in outcome measures present significant challenges to achieving consistent and broadly applicable therapeutic outcomes across trials.</p><p><strong>Conclusions: </strong>Given the risks associated with invasive techniques, a deeper understanding of their mechanisms is essential to maximizing their therapeutic potential. Nevertheless, advances in electrode technology, adaptive stimulation, and multimodal approaches hold promise for optimizing the effectiveness of invasive neuromodulation and improving patient outcomes.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Blood Flow Responses to Extracranial Alternating Current Brain Stimulation in CVN Mouse Model of Alzheimer's Disease: A Pilot Study Determining Optimal Dose.","authors":"Simone Degan, Yu Feng, Carol Colton, Stephen Schmidt, Angel V Peterchev, Dennis A Turner","doi":"10.1016/j.neurom.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.06.002","url":null,"abstract":"<p><strong>Introduction: </strong>Insufficient metabolic supply in response to neural demand is a key mechanism of degeneration in Alzheimer's disease [AD]. However, extracranial alternating current [AC] stimulation can increase cerebral blood flow [CBF] and metabolic substrate supply to the brain. In this work, we investigate in an initial, pilot study the optimal dosage of extracranial AC brain stimulation appropriate for long-term treatment to retard degeneration in a mouse AD model [CVN].</p><p><strong>Materials and methods: </strong>We applied extracranial AC (0.5-2.0 mA; 10 Hz; 20-second bursts) to CVN and control C57Bl/6 mice while measuring CBF and intracerebral electric field in vivo in anesthetized animals, and behavioral responses in awake animals.</p><p><strong>Results: </strong>We found a significant, diffuse increase in cortical CBF (2.6% increase at 0.75 mA) and intracerebral electric field (6.36mV/mm gradient at 0.75 mA) in response to extracranial AC brain stimulation in both CVN and control mice. In awake, behaving mice, the optimal dose of stimulation was 0.75 mA (in 30-second bursts), causing no adverse behavioral effects.</p><p><strong>Conclusion: </strong>Scheduled (at fixed times) or demand-triggered (during dynamic metabolic need) bursts of extracranial brain stimulation could enhance CBF to improve brain metabolic supply. The goal of this potential AD treatment is to alleviate mismatches between neural metabolic demand and brain substrate supply, to prevent AD phenotypic disease progression. Based on these pilot data, 0.75 mA is an optimal stimulation treatment dose leading to an appreciable net change in CBF, at a moderate intracranial electrical field, while also indicating behavioral tolerability, now being implemented in a long-term treatment trial.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Competency-Based Approach to Functional Neurosurgery Training: Insights From the Surgical Autonomy Program.","authors":"Katrina Hon, Pranav Warman, Vishal Venkatraman, Alexander D Suarez, Margot Kelly-Hendrick, Samuel Teshome, Rajeev Dharmapurikar, Michael M Haglund, Shivanand P Lad","doi":"10.1016/j.neurom.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.06.010","url":null,"abstract":"<p><strong>Background: </strong>The Accreditation Council for Graduate Medical Education (ACGME) relies on case minimums as a standard competency indicator, set by expert opinion rather than individual resident performance. We used the Surgical Autonomy Program, a validated method of competency-based resident evaluation, to track autonomy progression across residency and compare the reported number of cases it took residents to reach autonomy with the case minimums set by the ACGME.</p><p><strong>Materials and methods: </strong>Data from neurosurgery residents across 14 institutions on five functional procedures (deep brain stimulation [DBS], internal pulse generator implantation [IPG], percutaneous spinal cord stimulator placement [SCS], epilepsy vagal nerve stimulation [VNS], and epilepsy stereo electroencephalography [SEEG]) were analyzed. Surgical autonomy was measured using a four-point Teach, Advise, Guide, Solo scale (TAGS), a modified version of the Zwisch scale in which \"T\" represents the lowest and \"S\" the highest level of independence. These scores were tracked over time to create learning curves delineating autonomy progression. The number of cases required to achieve competency for the first and second time were determined and compared with ACGME case minimums. Results were analyzed with descriptive statistics.</p><p><strong>Results: </strong>On average, residents showed advanced competency, defined as scoring among the top two TAGS scores, approximately postgraduate year (PGY) 3 for DBS, VNS, and SCS cases, and approximately PGY-2 for IPG and SEEG cases. Median case volumes for achieving competency (first time, second time) were DBS 16, 16 (ACGME minimum [min.] ten); IPG 12, 13 (min. ten); SCS 14, 16 (min. ten); VNS 6, 12 (min. ten); SEEG five, seven (min. ten). Individual variance in competency levels and rate of progression was observed.</p><p><strong>Conclusion: </strong>Although DBS, IPG, and SCS procedures required more cases to reach competency than ACGME standards suggest, VNS and SEEG required fewer, indicating that case complexity and learning curves vary significantly across subspecialties. A competency-based approach, recognizing individual progression, could enhance surgical training efficacy and improve assessment of surgical autonomy on graduation. Future studies should explore the long-term outcomes of competency-based training to validate these findings further.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonimplantable Peripheral Electrical Stimulation for Management of Chronic Pelvic Pain: An Umbrella Review.","authors":"Fateme Tahmasbi, Alireza Rahimi-Mamaghani, Farzin Soleimanzadeh, Salar Ghaderi, Reza Aletaha, Hanieh Salehi-Pourmehr, Omid Sedigh, Mohsen Mohammad-Rahimi","doi":"10.1016/j.neurom.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.05.009","url":null,"abstract":"<p><strong>Background: </strong>Chronic pelvic pain (CPP) is a complex and debilitating condition that significantly affects quality of life. Peripheral electrical stimulation (PES) has gained attention as a noninvasive or minimally invasive therapeutic and rehabilitative approach. However, its overall efficacy remains uncertain.</p><p><strong>Objectives: </strong>This study aimed to synthesize current evidence on the effectiveness and safety of PES modalities for CPP management.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science was performed to identify systematic reviews and meta-analyses evaluating nonimplantable PES modalities, including transcutaneous electrical nerve stimulation (TENS), percutaneous tibial nerve stimulation (PTNS), and intravaginal electrical stimulation (IVES). Study selection, data extraction, and methodologic quality assessment were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of included reviews.</p><p><strong>Results: </strong>A total of 15 systematic reviews were included, covering a range of PES modalities for CPP conditions such as vulvodynia, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), bladder pain syndrome, interstitial cystitis, and endometriosis-associated pelvic pain. Among the interventions, TENS and PTNS showed the most consistent evidence of pain reduction, particularly in CP/CPPS. IVES indicated potential benefits for dyspareunia and pelvic floor dysfunction, whereas the evidence for pudendal nerve stimulation remained limited. Most PES modalities were well-tolerated, with tolerable adverse events. However, the quality of evidence was generally low, with only two high-quality systematic reviews identified.</p><p><strong>Conclusions: </strong>PES, particularly TENS and PTNS, appears to be a promising treatment for CPP, offering noninvasive pain relief with minimal adverse effects. However, the heterogeneity in study populations, treatment protocols, and outcome measures limits the certainty of conclusions. Future research should prioritize high-quality randomized controlled trials, standardized treatment protocols, and comparative effectiveness studies to refine clinical recommendations.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Transcutaneous Trigeminal Nerve Stimulation and Transcutaneous Auricular Vagal Nerve Stimulation on the Biomarker Response to Stress.","authors":"Brandon M Roberts, Katelyn M Conn, Audrey Hildebrandt, K Riley Connor, Emily Lange, Alyssa V Geddis, Andrea Taylor, Nicole Ekon, Kristin J Heaton, Caitlin Ridgewell, William H Neumeier","doi":"10.1016/j.neurom.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.05.008","url":null,"abstract":"<p><strong>Background: </strong>Transcutaneous trigeminal nerve stimulation (tTNS) and transcutaneous auricular vagal nerve stimulation (tVNS) are neurostimulation methods that have recently gained attention for their potential to modify the response to stress. However, current understanding of the effects of tVNS and tTNS on autonomic nervous system (ANS) activity in healthy individuals is limited. Therefore, this study compared the effect of tTNS and tVNS on the biochemical markers of ANS activity after an acute stress test in a cohort of young healthy adults.</p><p><strong>Materials and methods: </strong>Participants aged 18 to 45 years were randomized to tTNS, tVNS, or sham stimulation conditions. Participants received 20 minutes of neurostimulation/sham and then completed the Trier Social Stress Test (TSST). Cortisol, sulfated dehydroepiandrosterone (DHEA-s), insulin-like growth factor-1 (IGF-I), prolactin, norepinephrine (NE), γ-aminobutyric acid (GABA), and brain-derived neurotrophic factor were measured prestimulation and then again 0, 15, 30, and 60 minutes after TSST.</p><p><strong>Results: </strong>The TSST induced a stress response by increasing levels of cortisol, DHEA-s, prolactin, IGF-I, and NE relative to baseline. Neither tTNS nor tVNS caused significant changes in stress biomarker concentrations compared with sham, except for norepinephrine (NE). NE levels were significantly higher in participants receiving tTNS than in those receiving tVNS at both 15 minutes (p < 0.01) and 30 minutes (p < 0.02) after the TSST. In addition, NE was elevated in the tTNS group compared with sham at 15 minutes after stress (p < 0.01).</p><p><strong>Conclusion: </strong>In this study, although tVNS and tTNS did not appear to influence biochemical markers of stress generally, tTNS was uniquely associated with elevations in NE. These findings provide evidence that tTNS may influence arousal under conditions of stress.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burst Stimulation Evokes Increased Bladder and Urethral Pressure in Patients With Sacral Neuromodulation, Indicating Potential Activation of the Autonomic Nervous System: A Pilot Study","authors":"Perla Douven PhD ,&nbsp;Sam Tilborghs MD ,&nbsp;Sigrid van de Borne MPT ,&nbsp;Gommert A. van Koeveringe MD, PhD ,&nbsp;Stefan de Wachter MD, PhD","doi":"10.1016/j.neurom.2024.06.502","DOIUrl":"10.1016/j.neurom.2024.06.502","url":null,"abstract":"<div><h3>Objectives</h3><div>Currently, sacral neuromodulation (SNM) outcomes are often suboptimal, and changing stimulation parameters might improve SNM efficacy. Burst stimulation mimics physiological burst firing of the nervous system and might therefore benefit patients treated with SNM. The purpose of the present pilot study was to evaluate the effect of various Burst SNM paradigms on bladder and urethral pressure in patients with overactive bladder (OAB) or nonobstructive urinary retention (NOUR).</div></div><div><h3>Materials and Methods</h3><div>The bladder was filled to 50% of its capacity under general anesthesia in six patients with an implanted sacral lead for SNM purposes. Bladder pressure, and mid- and proximal urethral pressure were measured using conventional (Con-) SNM and various Burst SNM paradigms (10-20-40 Hz interburst frequency) with increasing amplitudes up to 5 mA for Con-SNM and 4 mA for Burst SNM.</div></div><div><h3>Results</h3><div>Burst SNM caused a substantial increase in both bladder and urethral pressure. In contrast, Con-SNM caused a milder increase in urethral pressure, and only one patient showed a modest increase in bladder pressure. Furthermore, the pressure increase was higher in the proximal urethra than in the midurethra using Burst-SNM, whereas Con-SNM caused comparable increases in proximal and midurethra pressure.</div></div><div><h3>Conclusions</h3><div>Burst SNM induces bladder contraction compared with Con-SNM and induces higher pressure increases in bladder and proximal urethra than does Con-SNM in patients with OAB or NOUR, indicating a higher degree of autonomic nervous system stimulation. The observed responses could not be fully explained by the total charge of the Burst SNM paradigms, which suggests the importance of individual Burst SNM parameters, such as frequency and amplitude. Future studies should assess the feasibility and efficacy of Burst SNM in awake patients.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 858-864"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jeffrey Ardell, PhD (December 20, 1952–February 12, 2025)","authors":"Robert D. Foreman PhD ,&nbsp;Siamak Salavatian MEng, PhD","doi":"10.1016/j.neurom.2025.04.009","DOIUrl":"10.1016/j.neurom.2025.04.009","url":null,"abstract":"","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 713-714"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Sacral Neuromodulation Prevented Detrusor Overactivity in Rats With Spinal Cord Injury","authors":"Linchen Lv MD ,&nbsp;Wenxian Li MD ,&nbsp;Dongyue Guo MD ,&nbsp;Benkang Shi PhD ,&nbsp;Yan Li PhD","doi":"10.1016/j.neurom.2024.05.008","DOIUrl":"10.1016/j.neurom.2024.05.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;Sacral neuromodulation&lt;span&gt;&lt;span&gt; (SNM) has been shown to alleviate bladder dysfunction in patients with &lt;/span&gt;overactive bladder and nonobstructive &lt;/span&gt;&lt;/span&gt;urinary retention. However, the therapeutic effect and mechanism of SNM in &lt;/span&gt;neurogenic bladder dysfunction are still not fully understood. Using a rat model of &lt;/span&gt;spinal cord injury&lt;span&gt; (SCI), this study aims to investigate the therapeutic effect of early SNM in the bladder-areflexia phase on neurogenic bladder dysfunction and evaluate its possible mechanism.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;Basic physiological parameters such as body/bladder weight, blood pressure, and electrocardiogram results were measured to evaluate the safety of SNM. Enzyme-linked immunosorbent assays and quantitative real-time polymerase chain reaction were used to examine the expression of proinflammatory factors. Hematoxylin and &lt;/span&gt;eosin&lt;span&gt; and Masson’s trichrome &lt;/span&gt;&lt;/span&gt;staining&lt;span&gt;&lt;span&gt;&lt;span&gt; were used to observe morphological changes, and cystometry was used to evaluate &lt;/span&gt;urodynamic changes after SNM treatment. &lt;/span&gt;Western blotting&lt;span&gt;&lt;span&gt; and immunofluorescence staining were used to measure the levels of &lt;/span&gt;transient receptor potential vanilloid 1&lt;span&gt;&lt;span&gt;&lt;span&gt; (TRPV1) and calcitonin gene-related peptide (CGRP) in the L6-S1 &lt;/span&gt;dorsal root ganglia&lt;span&gt; (DRGs) and bladder. &lt;/span&gt;&lt;/span&gt;Capsaicin desensitization was used to investigate whether inhibiting TRPV1 could prevent detrusor overactivity in SCI rats.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Early SNM did not affect the body/bladder weight, heart rate, blood pressure, or the expression of proinflammatory cytokines (PGE2, IL-1, IL-2, IL-6, TGF-β, or TNF-α) in the bladders of SCI rats. Morphologically, early SNM prevented urothelial edema (&lt;/span&gt;&lt;em&gt;p&lt;/em&gt;&lt;span&gt; = 0.0248) but did not influence collagen/smooth muscle in the bladder. Compared with untreated rats with SCI, the rats treated with SNM exhibited increased bladder capacity (&lt;/span&gt;&lt;em&gt;p&lt;/em&gt;&lt;span&gt; = 0.0132) and voiding efficiency (&lt;/span&gt;&lt;em&gt;p&lt;/em&gt; = 0.0179), and decreased nonvoiding contraction (NVC) frequency (&lt;em&gt;p&lt;/em&gt; = 0.0240). The maximum pressure, basal pressure, postvoid residual, and NVC amplitude did not change significantly. After the SNM treatment, the expression of TRPV1 in the bladder and CGRP in L6-S1 DRGs weredecreased (L6, &lt;em&gt;p&lt;/em&gt; = 0.0160; S1, &lt;em&gt;p&lt;/em&gt; = 0.0024) in SCI rats. In capsaicin-desensitized SCI rats, urodynamic results showed an increase in bladder capacity (&lt;em&gt;p&lt;/em&gt; = 0.0116) and voiding efficiency (&lt;em&gt;p&lt;/em&gt; = 0.0048), and diminished NVC frequency (&lt;em&gt;p&lt;/em&gt; = 0.0116), while other parameters did not change significantly.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Early SNM prevented urothelial edema morphologically and detrusor overactivity in SCI rats. Inhibition of TRPV1 in the bladder and DRGs m","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 746-756"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous Neuromodulation Promotes Functional Regeneration of the External Urethral Sphincter Neural Circuitry in Two Models of Nerve Lesion in Female Rats","authors":"Ricardo Juárez PhD ,&nbsp;José Luis Palacios PhD ,&nbsp;Yolanda Cruz PhD","doi":"10.1016/j.neurom.2025.02.009","DOIUrl":"10.1016/j.neurom.2025.02.009","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigated the effect of transcutaneous electrical stimulation of the dorsal nerve of the clitoris (DNC-TENS) on the functional recovery of the neural circuitry of the external urethral sphincter (EUS) neural circuitry in two models of childbirth trauma in rats: vaginal distension (VD) and injury of the motor branch of the pudendal nerve (MBPN).</div></div><div><h3>Materials and Methods</h3><div>In total, 42 Wistar adult female rats were used. Rats underwent sham VD (SH-VD), VD with sham DNC-TENS (VD SH-TENS) or VD with DNC-TENS, bilateral crush of MBPN crush injury (MBPNC) with sham DNC-TENS, or MBPNC with DNC-TENS. Stimulation was delivered to the dorsal region of the clitoral sheath, immediately and on days 2 and 4 after VD or MBPNC. The outcome parameters were EUS electromyograms (EMGs, amplitude and frequency) and cystometrograms (CMGs). Animals were evaluated at seven and 14 days after VD or SH-VD and at day 9 after the nerve crush.</div></div><div><h3>Results</h3><div>In SH-VD animals, the EUS EMG activity increased concurrently with bladder contraction. Tonic and bursting responses also were observed. VD significantly impaired EUS and CMG characteristics in the first week postlesion; in the VD SH-TENS group, the bursting EMG response was abolished; the amplitude of tonic activity decreased (<em>p</em> &lt; 0.0001), and the duration of bladder contraction decreased. DNC-TENS facilitated recovery of bursting and tonic EUS EMG activity after VD (<em>p</em> &lt; 0.0001). As with VD, MBPNC abolished EUS bursting activity and decreased (∼80%) tonic activity. TENS significantly improved EMG and CMG parameters.</div></div><div><h3>Conclusions</h3><div>VD and MBPNC significantly impair EUS EMG activity. DNC-TENS facilitates functional recovery of the EUS neural circuitry by promoting neuroregeneration and increases bladder compliance. Further studies are required to determine whether DNC-TENS is an effective noninvasive neuromodulation therapy to alleviate or prevent symptoms of stress urinary incontinence associated with childbirth trauma in women.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 757-766"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}