Neuromodulation最新文献

{"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}

{"title":"Auricular Allodynia is Associated With Worse Outcomes in Children With Functional Abdominal Pain Disorders Using Neurostimulation","authors":"Neha R. Santucci MD, MBBS ,&nbsp;Umber Waheed MD ,&nbsp;Jesse Li BS ,&nbsp;Sherief Mansi MD ,&nbsp;Kahleb Graham MD ,&nbsp;Jennifer Hardy MSc ,&nbsp;Megan M. Miller PhD ,&nbsp;Rashmi Sahay MD, MS ,&nbsp;Khalil El-Chammas MD","doi":"10.1016/j.neurom.2025.02.011","DOIUrl":"10.1016/j.neurom.2025.02.011","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Percutaneous electrical nerve field stimulation (PENFS) is a minimally invasive, nonpharmacologic approach to treat children with functional abdominal pain disorders (FAPD). Allodynia refers to pain from a stimulus that does not usually provoke pain. We aimed to characterize auricular allodynia during PENFS and associate it with outcomes.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective cohort study reviewing charts of patients who underwent PENFS for an FAPD. We included demographic data, medical history, and validated questionnaire responses. Allodynia was noted through physician notes of localized ear pain, soreness, or tenderness. Baseline clinical scores and PENFS outcomes were compared in patients with and without allodynia.</div></div><div><h3>Results</h3><div>Of 219 patients with FAPD (mean age 16.2 ± 2.7 years), 79% were female, and 87% were Caucasian; 28% of patients experienced allodynia with no significant demographic differences. The most common gastrointestinal symptoms were abdominal pain (100%) and nausea (70%), and the most common FAPD diagnoses included irritable bowel syndrome (58%) and functional dyspepsia (54%). Of the 93 total visits with allodynia, 44% of the visits had patients report allodynia once and 34% twice. Common interventions included placing &lt;four of the usual leads (19%) and early device removal (10%). Patients with allodynia had significantly greater Abdominal Pain Index, pain catastrophizing, Functional Disability Inventory, and insomnia scores (<em>p</em> &lt; 0.05) at treatment completion than did those without allodynia.</div></div><div><h3>Conclusion</h3><div>Allodynia in patients with FAPD who underwent PENFS had worse clinical outcomes. Excitation thresholds of rapidly conducting Aβ fibers in the ear are lower than those of nociceptive slowly conducting Aδ and C fibers. Patients with allodynia may require adjustment of nerve fiber stimulation to improve outcomes.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 840-846"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037620","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":"Ultra-High Frequency Spinal Nerve Neuromodulation for Improving Bladder Continence: Implications for Overactive Bladder Management","authors":"Bor-Shing Lin PhD ,&nbsp;Nurida Khasanah MD ,&nbsp;Chun-Ying Cai BS ,&nbsp;Chun-Wei Wu PhD ,&nbsp;Kuo-Hsiang Lu MS ,&nbsp;Wei-Tso Lin PhD ,&nbsp;Chih-Wei Peng PhD","doi":"10.1016/j.neurom.2024.09.476","DOIUrl":"10.1016/j.neurom.2024.09.476","url":null,"abstract":"<div><h3>Objective</h3><div>Ultrahigh frequencies (UHF) have been shown to selectively suppress the sensory pathway with a rapid onset and prolonged effect compared with low frequencies. Few studies have explored the feasibility of UHF electrical stimulation in treating overactive bladder. This study aimed to investigate whether bladder overactivity could be inhibited by UHF stimulation at the L6 nerve root.</div></div><div><h3>Materials and Methods</h3><div>Female Sprague-Dawley rats (<em>n</em> = 12) were divided into two groups: sham and UHF groups. Bladder overactivity was induced by continuous intravesical infusion of 0.5% acetic acid (AA). UHF L6 nerve root stimulation (500 kHz, 20 mA for 5 minutes) was applied to the rats in the UHF group. To investigate the effects of the treatment, intravesical pressure was recorded by cystometrography during continuous transvesical infusion, with volume threshold (VT) and intercontraction interval (ICI) used to conduct the investigation.</div></div><div><h3>Results</h3><div>Bladder overactivity was successfully developed in all rats with a significant decrease of median VT and ICI to 83.7% and 86.4%, respectively. UHF stimulation of the L6 nerve root was able to counteract the AA effect by significantly increasing median VT and ICI to 220% and 36.1%, respectively; these effects persisted for ≥two hours. There was a significant difference in the effects of UHF electrical stimulation between the sham and UHF groups (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>This preliminary study provides evidence for UHF stimulation of the L6 spinal nerve root, analogous to the sacral nerve root in humans, as a potential alternative neuromodulation technique to suppress bladder overactivity.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 796-802"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584036","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":"Frequency-Specific Effects of Noninvasive Median Nerve Stimulation on Gastric Slow Wave Activity in Humans","authors":"Elliot Thomas Hendry BSc ,&nbsp;Joseph Gonzales Balfe BSc ,&nbsp;Peng Du PhD ,&nbsp;Yusuf Ozgur Cakmak MD, PhD","doi":"10.1016/j.neurom.2023.12.005","DOIUrl":"10.1016/j.neurom.2023.12.005","url":null,"abstract":"<div><h3>Objectives</h3><div>The present study explored the effects of different frequencies of noninvasive median nerve stimulation (nMNS) on two autonomic responses: gastric slow waves under water-loading condition and heart rate variability (HRV). To the best of our knowledge, this is the first study to document the effects of different frequencies of nMNS on gastric slow waves (GSW) in humans under 5-minute water-loading condition.</div></div><div><h3>Materials and Methods</h3><div>Twenty healthy adult participants were fitted with a noninvasive body-surface gastric mapping, electrocardiogram (ECG), and a transcutaneous electrical nerve stimulation device and administered with four different nMNS frequencies (placebo-0 Hz, 40 Hz, 120 Hz, and 200 Hz) on four separate counterbalanced days. After the baseline and stimulation periods, a 5-minute water-load test was applied, and a post–water-load period also is recorded for ECG and GSW activity. Time-domain HRV parameters are analyzed with repeated-measures one-way analysis of variance (ANOVA) and a post hoc Tukey multiple comparison test. Parameters that failed normality tests underwent a Freidman test with a post hoc Dunn multiple comparison test. GSW data are analyzed with repeated-measures mixed-effects ANOVA.</div></div><div><h3>Results</h3><div>In empty stomach (baseline vs stimulation), only the 40-Hz frequency statistically significantly (<em>p</em> = 0.0129) increased GSW amplitude in comparison with its own baseline. In full (distended) stomach, 40-Hz and 200-Hz stimulations showed a statistically significant difference (post hoc multiple comparison adjusted, <em>p</em> = 0.0016 and <em>p</em> = 0.0183, respectively) in the Gastric Rhythm Index in comparison with the change obtained by placebo stimulation (baseline vs poststimulation periods); 120-Hz nMNS showed a statistically significant difference (<em>p</em> = 0.0300) in the stress index in comparison with the decrease observed in the placebo group. However, 120-Hz nMNS did not induce a statistically significant change in gastric electrical activity compared to placebo stimulation. The nMNS did not follow the linear “dose-response” relationship between nMNS frequency and gastric/HRV parameters.</div></div><div><h3>Conclusions</h3><div>The 40-Hz and 200-Hz nMNS frequencies showed the most promising results in response to gastric distension, in addition to 40 Hz for an empty stomach. Further research is essential to explore the potential therapeutic effects of these frequencies on gastric diseases such as gastroparesis, gastroesophageal reflux disease, and functional dyspepsia that can be used in wrist wearables.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 775-786"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094395","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":"Motor Response Matters: Lead Placement and Urologic Efficacy Linked in Sacral Neuromodulation","authors":"Sam Tilborghs MD ,&nbsp;Tim Brits MD ,&nbsp;Sigrid van de Borne MSc ,&nbsp;Donald Vaganée MD ,&nbsp;Stefan de Wachter MD, PhD","doi":"10.1016/j.neurom.2024.08.001","DOIUrl":"10.1016/j.neurom.2024.08.001","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to characterize the pelvic floor muscles (PFM) motor response provoked during sacral neuromodulation (SNM) lead placement, determining its utility in improving therapy delivery.</div></div><div><h3>Materials and Methods</h3><div>A prospective pilot study (January 2018–September 2021) was performed including patients with overactive bladder or nonobstructive urinary retention—a very homogeneous group without any medical history interfering with bladder function—who underwent SNM. An external pulse generator was connected for three weeks. Success was defined as ≥50% improvement.</div><div>PFM electromyography was recorded using a multiple array probe.</div><div>Differences in electrical PFM motor response (peak-to-peak amplitude, area under the curve [AUC] or latency) among different electrical stimulation levels up to 10V (and the clinically relevant intensities up to 3V) and different parts (four sides, three depths) of the pelvic floor were modeled using linear mixed model analysis (LMM).</div></div><div><h3>Results</h3><div>The study population comprised 26 women (overall success 81%). With increasing improvement in voiding diary data, higher peak-to-peak amplitudes and AUC were seen for up to 10V stimulation intensities (LMM: <em>p</em> value 0.0046 and 0.0043, respectively) and up to 3V stimulation intensities (LMM: <em>p</em> value 0.0261 and 0.0416, respectively). Subanalysis of the different parts of the PFM showed all different sides (first corrected <em>p</em> value &lt; 0.0125) and depths (first corrected <em>p</em> value &lt; 0.0167) presented with statistically significant differences in favor of those with higher percentage improvement for the 10V and 3V analyses, with only two exceptions: peak-to-peak amplitude at the posterior layer at the clinically relevant stimulation intensities (LMM: <em>p</em> value: 0.0752) and AUC at the posterior layer for the stimulation intensities on 10V (LMM: <em>p</em> value: 0.0557). No statistically significant differences were found for the overall mean peak-to-peak amplitude and AUC based on dichotomous outcome (responders vs nonresponders).</div></div><div><h3>Conclusions</h3><div>Intraoperative PFM electromyography obtained during lead placement aids in more accurate targeting of the lead to the nerve. To our knowledge, this is the first study to correlate tined lead placement based on electrodiagnostic testing and outcome in SNM. It has been proved to be a reliable measurement tool, serving as a physiological biomarker of treatment response during the test phase. A strong motor response can make the surgeon confident that the correct position of the lead has been established for maximal benefit.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 865-872"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470837","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":"Symptom Assessment of Candidates for Sacral Neuromodulation Therapy With Urologic and Colorectal Conditions: Time for a Holistic Approach? Results and Findings From a Prospective Single-Center Study","authors":"Lynn Ghijselings MD ,&nbsp;Irina Verbakel MD ,&nbsp;George Bou Kheir MD ,&nbsp;Dirk Van de Putte MD ,&nbsp;François Hervé MD, PhD ,&nbsp;An-Sofie Goessaert MD, PhD ,&nbsp;Kim Pauwaert MD ,&nbsp;Dimitri Beeckman PhD ,&nbsp;Melissa Ooms MD ,&nbsp;Karel Everaert MD, PhD","doi":"10.1016/j.neurom.2024.04.009","DOIUrl":"10.1016/j.neurom.2024.04.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Sacral neuromodulation<span> (SNM) has evolved as a therapeutic intervention for various pelvic floor dysfunctions. However, the traditional approach primarily assesses discipline-specific symptoms, potentially overlooking holistic symptom improvement. We aimed to investigate whether a more comprehensive evaluation of pelvic floor symptoms enhances the assessment of SNM’s test phase.</span></div></div><div><h3>Material and Methods</h3><div><span><span>A prospective single-center trial (Optimization of Lower Urinary Tract Symptoms study) assessed SNM efficacy from March 2018 to December 2021 in patients from the </span>urology department (UD) and </span>colorectal surgery<span> department (CRD) with a follow-up of 12 months. Objective and subjective outcomes were examined using diaries and patient-reported outcome measures. Statistical analyses were conducted to determine predictive factors for treatment success, expressed by the patient global impression of change. SPSS 29.0 was used.</span></div></div><div><h3>Results</h3><div><span>A total of 85 participants were included, displaying concomitant pelvic floor symptoms. After the first phase, significant improvements on all pelvic floor domains questionnaires were seen for both patients from UD and those from CRD. Although improvements were observed in bladder and bowel diaries, the traditional criteria for success (≥50% improvement in diary variables) did not consistently correlate with the patients' global impression of change. The absolute reductions in bother sum scores from multiple domains were significant predictors for the patients' global impression of change, outperforming discipline-specific assessments. Patients from UD benefit from both a urologic and </span>pelvic pain symptom evaluation, and those from CRD, from both a urologic and bowel symptom evaluation.</div></div><div><h3>Conclusions</h3><div>SNM shows positive effects across various pelvic floor domains, even beyond the primary intended indication of implantation. The rather rigid approach of patient selection of discipline-specific symptoms alone can be questioned. A more comprehensive evaluation encompassing various pelvic floor symptoms with the emphasis on subjective outcome measures could enhance SNM’s efficacy assessment during the test phase.</div></div><div><h3>Clinical Trial Registration</h3><div>The <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> registration number for the study is NCT05313984.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 847-857"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284330","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}