Neuromodulation最新文献

{"title":"German National Guidelines for Epidural Spinal Cord Stimulation for the Treatment of Chronic Pain.","authors":"Jan Vesper, Juliane Weski, Phillip J Slotty","doi":"10.1016/j.neurom.2025.03.070","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.03.070","url":null,"abstract":"<p><strong>Introduction: </strong>Epidural spinal cord stimulation (SCS) or dorsal root ganglion stimulation (DRG-S) is a neuromodulatory, reversible interventional procedure for patients with pain who cannot be adequately treated with conservative and less invasive means. This review provides the recently updated German recommendations for SCS and DRG-S, followed by a standardized diagnostic and therapeutic procedure.</p><p><strong>Objective: </strong>The purpose of this work is to present the current evidence-based results of SCS, including DRG-S, for various neuropathic and nonneuropathic pain conditions. Moreover, it aims to optimize the treatment of patients with chronic pain for whom neuromodulation can be a component in the treatment concept of multimodal pain therapy.</p><p><strong>Materials and methods: </strong>A systematic literature search was conducted based on a Cochrane analysis, followed by search strategies in the common data bases (PubMed, Medline, and Embase). The relevant literature was reviewed and discussed within working groups. Finally, evaluation of evidence and identification of recommendations was performed by members of the guideline commission comprising representatives of relevant medical societies in Germany.</p><p><strong>Results: </strong>The first German guideline on SCS was published in April 2013. Any guideline has only limited validity (eg, in Germany, guidelines are valid for a maximum of five years). Owing to the numerous publications in this field, an update had become mandatory. On the basis of literature from 2013 to 2018, indications were newly identified or reevaluated. In addition, new methods were discussed, and predictors for treatment success were defined as part of the psychologic assessment.</p><p><strong>Conclusion: </strong>Neuromodulation, especially SCS, is based on the systematic study of treatment data. Real-world data are indispensable. Particularly in the current situation, in which fundamental questions about the value of SCS are being publicly discussed, sometimes in nonscientific media, it is essential to publish systematic guidelines, on both a national and international level.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028863","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":"From Short-Term Relief to Long-Term Management: A Meta-Analysis of Temporary Spinal Cord Stimulation and Pulsed Radiofrequency in Postherpetic Neuralgia.","authors":"Abdallah Abbas, Haneen Sabet, Mohamed El-Moslemani, Dina Essam Abo-Elnour, Shereen Mohamed Olama, Mahmoud G A Saleh, Hoda Awad, Ahmed M Raslan","doi":"10.1016/j.neurom.2025.03.076","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.03.076","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to conduct a meta-analysis comparing the efficacy of temporary (ie, without implantable pulse generator) spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) in managing postherpetic neuralgia (PHN).</p><p><strong>Materials and methods: </strong>A systematic review was performed using Scopus, PubMed, Cochrane CENTRAL, Web of Science, and Embase databases through January 1, 2025, targeting randomized controlled trials (RCTs) comparing SCS and PRF in PHN management. Two independent reviewers undertook screening, extracted data, and assessed risk of bias using the Cochrane Risk-of-Bias 2.0 tool. The meta-analysis used Review Manager 5.4 to assess pain intensity, treatment success, medication reduction, and quality of life. Subgroup analyses were performed based on the follow-up duration.</p><p><strong>Results: </strong>Four RCTs involving 125 patients with SCS and 136 with PRF were analyzed. SCS significantly reduced pain intensity after one month (mean difference [MD]: -0.98, 95% CI: -1.77, -0.19), three months (MD: -1.34, 95% CI: -2.59, -0.09), and six months (MD: -1.27, 95% CI: -2.30, -0.23). Treatment success (>50% pain reduction) favored SCS at three months (risk difference: 0.37, 95% CI: 0.10, 0.63) and beyond. SCS significantly reduced pregabalin use at three (MD: -27.88 mg, 95% CI: -39.12, -16.64) and 12 months. Quality-of-life improvements in SCS were significant for 36-Item Short Form Health Survey bodily pain and physical role domains from six months onward.</p><p><strong>Conclusion: </strong>SCS outperformed PRF in mid- and long-term outcomes for PHN, including pain reduction, treatment success, and quality-of-life improvements. PRF remains a viable short-term alternative to SCS. Further research should focus on the cost-effectiveness, safety, and long-term efficacy of this approach.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973476","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":"Kilohertz High-Frequency Electrical Stimulation Effectively Mitigates Hyperalgesia in Mice With Neuropathic Pain Through Regulation of the Calcium/Calmodulin-Dependent Protein Kinase II/N-Methyl-D-Aspartate 2B Signaling Pathway.","authors":"Kexin Fang, Xiaorong Ouyang, Wen Cheng, Bin Yu","doi":"10.1016/j.neurom.2025.03.071","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.03.071","url":null,"abstract":"<p><strong>Objectives: </strong>Kilohertz high-frequency electrical stimulation (KHES), an avant-garde neuromodulation strategy, is progressively emerging in the field of neuropathic pain management, showing its unique therapeutic potential. This study delves into the mechanisms by which KHES exerts therapeutic effects on neuropathic pain induced by chronic constriction injury (CCI) in mice through modulation of the calcium/calmodulin-dependent protein kinase II (CaMKII)/N-methyl-D-aspartate receptor 2B (NMDAR2B) signaling pathway.</p><p><strong>Materials and methods: </strong>In this study, mice were randomly assigned to groups and received intrathecal injections of CaMKII activator BayK8644, CaMKII inhibitor KN93, and N-methyl-D-aspartate (NMDA). Subsequently, mice underwent a week-long KHES treatment, with each session lasting 30 minutes. The impact of KHES on mechanical allodynia and thermal hyperalgesia in mice was assessed through paw withdrawal threshold and thermal withdrawal latency measurements, respectively. In addition, anxiety and depressive-like behaviors in mice were evaluated using pole climbing, open field, and forced swim tests. Quantitative reverse transcription polymerase chain reaction, Western blot, and immunofluorescence techniques were used to detect the expression levels of CaMKII, phosphorylated CaMKII (p-CaMKII), and NMDAR2B in the spinal cord.</p><p><strong>Results: </strong>Results indicated that KHES not only significantly reduced mechanical allodynia in CCI mice, with a sustained analgesic effect lasting up to six hours, but also somewhat alleviated anxiety and depressive-like symptoms. KHES inhibited the expression of p-CaMKII and NMDAR2B in the spinal cord. This inhibitory effect was reversed in the presence of BayK8644 and NMDA, suggesting that activation of CaMKII and NMDAR2B may contribute to the maintenance of neuropathic pain. Conversely, KN93 enhanced the analgesic effect of KHES by reducing mechanical allodynia and downregulating p-CaMKII and NMDAR2B expression, further confirming the significance of the CaMKII/NMDAR2B signaling pathway in KHES-mediated neuropathic pain relief.</p><p><strong>Conclusion: </strong>This study not only unveils the potential therapeutic value of KHES in treating neuropathic pain induced by CCI in mice but also provides insights into its molecular mechanisms of action through inhibition of the CaMKII/NMDAR2B signaling pathway.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002847","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":"10-kHz High-Frequency Spinal Cord Stimulation Significantly Reduces Proinflammatory Cytokines and Distinct Populations of T Lymphocytes in Patients With Persistent Spinal Pain Syndrome Type 2.","authors":"Stefanie S Kogias, Jayden A O'Brien, Rebecca V Robertson, Allan Peng, Fernando A Tinoco-Mendoza, Alister Ramachandran, Luke A Henderson, Paul J Austin","doi":"10.1016/j.neurom.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.02.010","url":null,"abstract":"<p><strong>Objectives: </strong>Persistent spinal pain syndrome type 2 (PSPS-T2) is a chronic mixed nociceptive and neuropathic pain condition that results after lumbar spinal surgery. PSPS-T2 is a highly treatment-resistant condition with less than half of patients receiving adequate pain relief from conventional medications. 10-kHz high-frequency (HF) spinal cord stimulation (SCS) is a highly effective therapy for treatment-resistant PSPS-T2 that can often provide a >50% reduction in pain. This study aimed to systematically investigate the peripheral immune environment in PSPS-T2 compared with that in healthy controls, before assessing the immune effects of 10-kHZ SCS in PSPS-T2.</p><p><strong>Materials and methods: </strong>This study used high-parameter mass cytometry and a multiplex cytokine assay to characterize the peripheral immune environment in healthy controls (n = 16) compared with patients with PSPS-T2 before (n = 16) and after seven to ten days of HF SCS treatment (n = 12).</p><p><strong>Results: </strong>Compared with healthy controls, there was a significant increase in proinflammatory signaling through nuclear factor-κB, p38 mitogen-activated protein kinase, and signal transducer and activator of transcription 3 pathways in natural killer (NK), CD4⁺ \"terminally differentiated effector memory cells re-expressing CD45RA\" (TEMRA), central memory CD8⁺, and \"effector-like\" CD8⁺ T lymphocyte populations in PSPS-T2. Seven to ten days of HF SCS treatment led to significant pain relief in 75% of patients with PSPS-T2, improved psychologic measures, and induced multiple antiinflammatory effects, including a reduction in the abundance of central memory CD4⁺ T helper 17 (T_H17) lymphocytes and natural killer T (NKT) cell populations, that were correlated with pain relief. Furthermore, the expression of granzyme B, a major cytotoxic effector molecule, was reduced in the CD8⁺ T lymphocyte compartment. These changes in immune cell number and function were associated with a significant reduction in plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, interferon (IFN)-α, IFN-γ, and IFN-λ1, and a greater reduction in tumor necrosis factor-α plasma levels in those patients with greatest pain relief, representing an antiinflammatory shift.</p><p><strong>Conclusions: </strong>These changes suggest that PSPS-T2 is a chronic inflammatory condition characterized by cytotoxic and exhausted immune cell populations. The resolution of this inflammation by distinct immune cell populations induced by SCS may contribute to pain relief, and specific populations, such as T_H17 and NKT cells, may represent useful biomarkers of treatment effectiveness.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995504","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, Umber Waheed, Jesse Li, Sherief Mansi, Kahleb Graham, Jennifer Hardy, Megan M Miller, Rashmi Sahay, Khalil El-Chammas","doi":"10.1016/j.neurom.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.02.011","url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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 <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 (p < 0.05) at treatment completion than did those without allodynia.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","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":"Management and Cost of Spinal Cord Stimulator Explants due to Infection.","authors":"Jonathan Royds","doi":"10.1016/j.neurom.2025.03.069","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.03.069","url":null,"abstract":"<p><strong>Objectives: </strong>Explants due to infected spinal cord stimulation (SCS) devices are a significant concern, leading to complex care needs and high costs. This study aimed to evaluate the cost of explant and subsequent management in patients in cases of device infection.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed data over eight years (2014-2022) at a UK neuromodulation center. Cases of explant due to infection were identified from a departmental data base. Data were collected from electronic clinical care records. Patient admission costs were retrieved from the accounting services using cost pool groups. Electrical neuromodulation equipment costs were obtained from National Health Service England data bases specific to each manufacturer.</p><p><strong>Results: </strong>Among 215 explants, 23 were attributed to infection, with 22 of 23 involving the implantable pulse generator. A total of 16 of 23 cases (70%) met the criteria for deep surgical site infection, whereas seven cases occurred after 90 days. Microbiological cultures confirmed infections in nine of 23 cases (39%). In five cases, explant was performed owing to pus observed around the hardware during revision surgery that grew no bacteria after culture. The median time to explant due to infection was 42 days [29-356]. The median cost of explant and follow-up care was £16,957 [£5,243-£26,823], with higher costs observed when reimplantation was attempted (£26,172 [£18,753-£37,427]). Reimplantation of the neuromodulation device was attempted in 13 of 23 patients (57%). Successful reimplant was limited and achieved in only eight of 13 cases (62%). The median time to reimplantation was 193 days [181-658] postexplant, and the reinfection rate in those who were reimplanted was 30%. Ultimately, a successful reimplant was achieved in 35% of patients (eight of 23) after explant due to suspected infection.</p><p><strong>Conclusion: </strong>The findings emphasize the need for preventive strategies to mitigate infection risk and reduce costs. Improved understanding of infection management may ultimately help reduce the clinical and economic burden of SCS infections. Attempts to reestablish the therapy need careful consideration and counseling of patients.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001803","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":"Electrical Nerve Stimulation Induces Synaptic Plasticity in the Brain and the Spinal Cord: A Systematic Review.","authors":"Patricia Beltrá, Nuria Viudes-Sarrión, María José Giner, Emilio Tomás-Muñoz, Laura Pérez-Cervera, Rodrigo Martín-San Agustín, Francisco Javier Ortega, Raúl Valdesuso, Luis Suso-Martí, Alexander Binshtok, Miguel Delicado-Miralles, Enrique Velasco","doi":"10.1016/j.neurom.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.02.008","url":null,"abstract":"<p><strong>Objectives: </strong>This review aimed to compile the literature on synaptic plasticity induced by electrical nerve stimulation (ENS) in nociceptive and somatosensory circuits within the central nervous system, with a particular focus on its effects on both the brain and spinal cord. Understanding the mechanisms underlying synaptic changes, enhances our comprehension of how ENS contributes to both pain relief and the development of experimental pain models.</p><p><strong>Materials and methods: </strong>We conducted a systematic search of PubMed, Scopus, PEDro, SciELO, and Cochrane databases, adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and evaluated the quality of evidence using SYRCLE's risk of bias tool. The inclusion criteria were application of ENS to peripheral nerves, reporting of a detailed methodology, providing direct physiological measurements of synaptic activity (eg, field potentials or intracellular recordings), and publication in English or Spanish. From 8094 results, 85 studies met the inclusion criteria.</p><p><strong>Results: </strong>ENS was found to induce synaptic potentiation in 70 studies, depression in 7, and both effects in 8. These outcomes were determined by specific stimulation parameters and individual characteristics, with distinct molecular mechanisms involved in each case. Notably, most research focused on long-term potentiation in nociceptive pathways to create experimental pain models, with most studies conducted in the spinal cord. Few studies explored the link between ENS-induced synaptic plasticity and its analgesic effects or the role of plasticity in supraspinal brain regions, suggesting promising areas for future research.</p><p><strong>Conclusions: </strong>ENS-induced synaptic plasticity presents a valuable opportunity for both pain management and the development of experimental pain models. Further research is needed to explore the connections between plasticity, analgesia, and higher brain regions.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803760","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":"Meta-analysis of Randomized Controlled Trials on the Efficacy of Sacral Neuromodulation in Chronic Constipation.","authors":"Sameh Hany Emile, Justin Dourado, Anjelli Wignakumar, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Marylise Boutros, Steven D Wexner","doi":"10.1016/j.neurom.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.03.001","url":null,"abstract":"<p><strong>Objectives: </strong>The present systematic review aimed to assess the outcome of sacral neuromodulation (SNM) in adult patients with chronic constipation.</p><p><strong>Materials and methods: </strong>A systematic review of randomized controlled trials (RCTs) that assessed the efficacy of SNM in chronic constipation was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline. PubMed, Scopus, and Web of Science were screened from their inception through March 2024. The primary outcome was improvement in constipation and quality of life (QoL), and the secondary outcome was adverse events after treatment. The risk of bias and certainty of evidence were assessed by the risk of bias 2 tool and Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>Five RCTs incorporating 187 patients (93.6% female) with a median age of 42.5 years were included; 154 patients underwent SNM whereas 86 patients were crossed over to sham stimulation, and 33 received conservative treatment, amounting to a control group of 119 patients. The odds of relief of constipation after SNM were similar to those in the control group in the random-effect model (odds ratio [OR]: 1.92, 95% CI: 0.68-5.42, p = 0.217). The median percentage of reduction in the Cleveland Clinic Florida/Wexner Constipation Score was 27.9% in the SNM group vs 18.4% in the control group. No significant differences were observed in QoL. Both groups had similar odds of adverse events (OR: 2.22, 95% CI: 0.19-25.53, p = 0.521).</p><p><strong>Conclusion: </strong>Although a relatively safe treatment, SNM was not associated with any tangible improvements in either constipation or QoL.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803766","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":"Computational Optimization of Spinal Cord Stimulation for Dorsal Horn Interneuron Polarization.","authors":"Adantchede Louis Zannou, Mojtaba Belali Koochesfahani, Gabriel Gaugain, Denys Nikolayev, Marc Russo, Marom Bikson","doi":"10.1016/j.neurom.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.01.015","url":null,"abstract":"<p><strong>Objectives: </strong>The proposed mechanisms of spinal cord stimulation (SCS) follow the polarization of dorsal column axons; however, the development of subparesthesia SCS has encouraged the consideration of different targets. Given their relative proximity to the stimulation electrodes and their role in pain processing (eg, synaptic processing and gate control theory), spinal cord dorsal horn interneurons may be attractive stimulation targets.</p><p><strong>Materials and methods: </strong>We developed a computational modeling pipeline termed \"quasiuniform-mirror assumption\" and applied it to predict polarization of dorsal horn interneuron cell types (islet type, central type, stellate/radial, vertical-like) to SCS. The quasiuniform-mirror assumption allows the prediction of the peak and directional axes of dendrite polarization for each cell type and location in the dorsal horn, in addition to the impact of the stimulation pulse width and electrode configuration.</p><p><strong>Results: </strong>For long pulses, the peak polarization per milliampere of SCS with a spaced bipolar configuration was islet type 3.5mV, central type 1.3mV, stellate/radial 1.4mV, and vertical-like 1.6mV. For stellate/radial, the peak dendrite polarization was dorsal-ventral, and for islet-type, the peak dendrite polarization was in the rostral-caudal axis. For islet type and central type cells, peak dendrite polarization was between stimulation electrodes, whereas for stellate/radial and vertical-like cells, peak dendrite polarization was under the stimulation electrodes. The impact of the pulse width depends on the membrane time constants. Assuming a 1-millisecond time constant, for a 1-millisecond or 100-μs pulse width, the peak dendrite polarization decreases (from direct current values) by approximately 33% and approximately 88%, respectively. Increasing the interelectrode distance beyond approximately 3 cm did not significantly increase the peak polarization but expanded the region of interneuron polarization.</p><p><strong>Conclusions: </strong>Predicted maximum polarization of islet-cells in the superficial dorsal horn at locations between electrodes is 4.6mV for 2 mA, 1-millisecond pulse SCS. A polarization of a few millivolts is sufficient to modulate synaptic processing through subthreshold mechanisms. Our simulations provide support for SCS approaches optimized to modulate the dendrites of dorsal horn neurons.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780723","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":"Effects of Ultrasound-Guided Percutaneous Neuromodulation on Shoulder Muscle Strength in CrossFit Athletes: A Pilot Randomized Controlled Trial.","authors":"Romina Sangiacomo, Fermín Valera-Garrido, Francisco Minaya-Muñoz, Alberto Carcasona-Otal, Pablo Herrero, Diego Lapuente-Hernández","doi":"10.1016/j.neurom.2025.03.072","DOIUrl":"10.1016/j.neurom.2025.03.072","url":null,"abstract":"<p><strong>Background: </strong>CrossFit integrates diverse functional movements to optimize overall fitness, with muscle strength training being a core component. Ultrasound-guided percutaneous neuromodulation (US-guided PNM) has emerged as a potential adjunct to enhance muscle strength gains; however, its efficacy in the upper limb in healthy individuals remains unexplored.</p><p><strong>Objective: </strong>This study evaluated the efficacy of two US-guided PNM protocols (three sessions and one session) targeting the axillary and suprascapular nerves in improving shoulder muscle strength in healthy CrossFit athletes.</p><p><strong>Materials and methods: </strong>A pilot, randomized, controlled, single-blind clinical trial was conducted with 39 healthy CrossFit athletes randomly allocated to one of three groups: control (G1, no intervention), one session of US-guided PNM (G2), or three sessions of US-guided PNM (G3). Shoulder muscle strength was assessed using a hand-held dynamometer to measure external and internal rotation muscle strength at various shoulder positions before each treatment session (days 1, 7, and 14) and one week after the last session (day 21). Moreover, the one-repetition maximum (1RM) shoulder press exercise was evaluated on day 1 and day 21.</p><p><strong>Results: </strong>No statistically significant differences were observed among groups for any outcome. However, the within-group analysis indicated statistically significant improvements over time in the treated limbs of intervention groups (G2 and G3), whereas no statistically significant changes were observed in the control (G1) or the untreated limbs of G2 and G3. The improvements were more consistent for shoulder strength measured in the neutral position than at 90° abduction.</p><p><strong>Conclusions: </strong>Although US-guided PNM did not yield significantly greater improvements than did the control group, both one and three sessions targeting the axillary and suprascapular nerves enhanced rotational shoulder muscle strength in treated limbs and 1RM shoulder press performance. These findings should be interpreted with caution, and further investigation is warranted, particularly in populations with lower baseline strength and in exploring varied application parameters to optimize efficacy.</p><p><strong>Clinical trial registration: </strong>The Clinicaltrials.gov registration number for the study is NCT06529770.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780726","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}