新型内固定材料的生物学特性及临床应用★

摘要：检索Pubmed数据库、中国期刊全文数据库及万方数据库1991-01/2007-12期间文献33篇，总结新型内固定材料聚乳酸及镍钛记忆合金的生物学特性及临床应用特点。文献显示新型内固定材料聚乳酸及镍钛记忆合金因其良好的生物学特性已广泛应用于临床；而形状记忆合金具有优异的记忆效应和超弹性性能、优良的生物相容性、低的生物退行性变性,且弹性模量与人体骨头相近，临床已在管径较小的管状骨及髌骨骨折中作为首选；聚乳酸及其复合材料内固定物，几乎没有毒性作用，亦不需再次手术取出，适用在松质骨骨折的治疗中；生物降解可吸收和形状记忆合金骨折内固定物存在一些并发症, 需要进一步的深入观察和研究。     

不同种类植入物置入内固定治疗髋臼横行骨折的理论及其应用

目的：通过检索PubMed、中国科技期刊数据库等就髋臼横行骨折不同内固定材料研究的现状和进展做一综述。 资料来源：由调查员进行检索。中文资料检索时间为1990/2009,英文资料检索时间为1980/2009。检索数据库包括PubMed数据库及中国科技期刊数据库。英文检索词为“acetabular/acetabulum,fracture,plate/plates,screw/screws,cable”。中文检索词为”髋臼,骨折,内固定,钢板,螺钉,钢丝/张力带”。 资料选择：纳入标准为髋臼横行骨折手术时机、内固定方法的基础研究、临床研究、综述和病例报道。排除重复及内容、数据不完整的文章。 结局评价指标：纳入35篇文献,其中综述3篇,基础研究8篇,临床研究24篇。 结果：目前切开复位内固定是髋臼横行骨折的标准治疗方法,其治疗的目标在于髋臼的解剖复位和坚强内固定,从而使早期活动成为可能。重建钢板具有强度大、韧性好、固定牢固、组织相容性好的特点,是目前公认的标准内固定材料。但是,近几年国内外不少学者采用锁定钢板、可吸收螺钉、记忆合金骑缝钉、髋臼记忆内固定系统等内固定取得较好的临床效果。 结论：髋臼横行骨折的内固定材料类型较多,目前公认的内固定材料是重建钢板,在实际的手术操作当中,可以灵活的结合使用螺钉,达到更加有效的固定。     

镍钛形态记忆合金环抱器与重建钢板置入内固定治疗尺桡骨中段骨折的比较

背景：重建钢板螺钉内固定的松动、钢板段裂是影响骨折愈合的最常见的原因。镍钛形态记忆合金环抱器由于具有优良的力学特性、生物相容性和低生物蜕变性使其在骨折内固定方面显示出极大的优越性。 目的：比较镍钛形态记忆合金环抱器内固定与重建钢板内固定治疗有移位或粉碎性尺桡骨中段骨折的临床效果。 方法：选择兰州大学附属第一医院骨科2004-04/2009-03收治的尺桡骨中段骨折患者56例,镍钛形态记忆合金环抱器内固定组26例,重建钢板内固定组30例。所有患者分别在内固定后第1,2,4,6,12个月随访,采用Anderson标准进行前臂功能优良率评定。 结果与结论：与重建钢板相比,镍钛形态记忆合金环抱器内固定治疗有移位或粉碎性尺桡骨中段骨折操作简单、手术时间短、术中出血量少、切口小(P < 0.05),适应证广,内固定后前臂功能恢复优良率高,可早期进行功能锻炼。两组住院时间、内固定取出时间、内固定后骨折愈合率差异无显著性意义。提示记忆合金环抱器内固定治疗有移位或粉碎性尺桡骨中段骨折的疗效优于重建加压钢板。     

运用锁定加压接骨板内固定置入系统治疗骨折的临床新进展

目的：就近年来锁定加压接骨板在桡骨远端、肱骨近端、胫骨及其他部位的骨折治疗进展进行归纳总结。 资料来源：检索人为第一作者,检索文献时限为1992-06/2009-05,检索数据库为PubMed数据库(http://www. ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm)。中文检索词为锁定加压接骨板,骨折,治疗,综述;英文检索词为LCP,Fracture,Therapy,Review。 资料选择：纳入标准：①运用锁定加压接骨板内固定系统行骨折内固定手术病例。②运用锁定加压接骨板内固定系统行骨折内固定手术的临床研究进展。排除重复研究。 结局评价指标：计算机初检到127篇文献,阅读标题和摘要进行初筛,排除研究目的与本文无关的文献51篇,内容重复性研究35篇,保留41篇文献进一步分析,包括综述、评述、论著及临床报道文章。 结果：近几年锁定加压接骨板内固定系统已经关泛用于全身各处骨折内固定,并且治疗效果明显优于普通加压固定内固定系统,它依托微创接骨板固定技术,具有创伤小、操作简单、内固定牢靠,在某种程度上替代了外固定架,而且稳定性大于外固定架并兼顾了骨折解剖复位的特点。但对于下肢干部骨折,临床仍然首选髓内钉固定,目前这方面文献较少,希望以后加强这几方面的对比研究。 结论：锁定加压接骨板作为国际内固定协会理论下产生的新技术,由机械力学转向生物力学角度,提倡“弹性固定”,减少创伤,促进骨痂形成做出了令人鼓舞的贡献。     

不同植入材料治疗陈旧性腕舟骨骨折

摘要 目的：对不同植入材料治疗腕舟骨骨折的方法和进展进行归纳总结。 方法：第一作者应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm),在标题和摘要中以“陈旧性,腕舟骨,治疗”或“Carpal bone,fracture ununited”为检索词进行检索。选择文章与检索关键词材料学特点、生物相容性及其应用效果相关,同一领域文献则选择近期发表或发表在权威杂志文章。共纳入25篇文献。 结果：早期的临床工作中应用石膏管型固定腕关节来治疗,由于固定范围较大,时间较长,且固定效果欠佳,所以术后腕关节活动度的恢复会受到一定的影响,后来采用带有血液供应的骨瓣、骨膜移植技术治疗腕舟骨陈旧性不愈合,并加用克氏针、herbert钉、空心螺钉等内固定材料,取得了较为满意的疗效;随着生物技术的发展,在前人工作的基础上,含有骨形态发生蛋白的骨材料开始应用于临床,取得了令人满意的疗效。 结论：目前治疗腕舟骨骨折的各种带血管蒂的骨瓣移植术式均可取得较为满意的疗效;应用骨形态发生蛋白/纤维蛋白复合物辅助治疗可取得更加的疗效,可应用于临床,远期使用骨膜包绕肌腱-松质骨匀浆复合体替代舟骨可作为未来的一个治疗方向。 关键词：腕舟骨;骨折不愈合;植入材料;骨瓣;内固定材料 doi:10.3969/j.issn.1673-8225.2010.21.025     

气管支气管内支架材料的评价

摘要 目的：评价各种气管支气管支架材料的性能和应用，寻找更加安全有效的气管内支架材料。 方法：以“人工气管，气管支架，生物材料”为中文关键词，“trachus，bronchus，stent”为英文关键词，由第一作者应用计算机检索Pubmed 数据库(http://www.ncbi.nlm.nih.gov/PubMed)及维普数据库(http://www.cqvip.com/) 1995-01/ 2008-10有关气管支架生物材料的文献，排除重复研究或Meta分析类文章。以18篇文献为主重点讨论了气管支气管支架材料的种类及其性能。 结果：经检索共查到相关文献50余篇，经阅读标题、摘要、全文后筛选纳入18篇文献进行评价。其中英文文献16篇，中文文献2篇。各种材料的气管支架均有其特点，不能完全否定任何一种材质的支架。文献显示目前国内应用最多的为镍钛记忆合金支架，它已被广泛应用于各类原因所致的气管狭窄治疗中，可以被径向拉长，此时直径变细，便于装入导管。释放后又可以自动回复至原直径，顺应性良好，可置于气管各个部位，很好地缓解了气短症状，从而减轻患者的痛苦。 结论：人工气管支架近年来发展迅速，金属类支架更是得到了蓬勃的发展。其中镍钛记忆合金支架是目前较为理想的支架材料，它既安全可靠，操作方便又价格适宜，已被广泛地应用于各类气管狭窄的治疗中。     

镍钛形状记忆合金的生物相容性及其在骨科的应用

背景：尽管镍钛合金在骨科的应用已有长足的进展,但由于其具有潜在的细胞、组织及器官毒性,在临床应用仍受到很大的限制。 目的：通过阐述镍钛形状记忆合金在骨科的应用情况、存在的问题及针对这些问题现有的解决方法,为该材料在重建外科领域的安全应用提供理论支持。 方法：应用计算机检索Springer全文数据库及中国CNKI期刊数据库。中英文资料检索时间均为2003/2010。分次输入检索词检索文献,所有英文检索词为“nickel-titanium shape memory alloy (NiTi-SMA); corrosion; biocompatibility; modifications; reconstruction”。所有中文检索词为“镍钛合金;腐蚀性;生物相容性;改性;骨科”。纳入与镍钛合金的临床应用、腐蚀性、生物相容性及其远期应用挑战等相关的文献。排除相关度不大和重复性文章。 结果与结论：镍钛合金以其良好的形状记忆性和超弹性在医学上具有特殊的应用价值。但由于从镍钛合金中释放的镍具有细胞毒性,使提高镍钛合金的抗腐蚀性显得尤为重要。对镍钛合金进行改性是目前该领域研究的重点及以后的研究方向。 关键词：镍钛合金;腐蚀性;生物相容性;改性;骨科 doi:10.3969/j.issn.1673-8225.2010.25.046     

镍钛合金表面改性后生物相容性及其持续动力压应力对骨折愈合的影响

背景：许多研究均特别强调镍离子在镍钛形状记忆合金腐蚀过程中的溶解作用,而这些离子可能对人体造成潜在的危害。应用各种表面处理措施可提高镍钛合金内植入材料的抗腐蚀能力。在现代医学的研究中,非常有必要对表面修饰后镍钛合金的特征进行分析。 目的：观察表面改性及未改性的弹性镍钛合金内固定材料对骨折愈合的影响。同时设置髓内钉内固定材料做对照,比较弹性内固定材料在持续应压力下对骨折愈合的影响。 设计、时间及地点：随机对照动物实验,于2004-09/2005-03在兰州大学第二医院骨科研究所组织工程实验室完成。 材料：类金刚石镀膜镍钛合金环抱器和非镀膜镍钛合金环抱器(4H8-40型)由兰州西脉记忆合金股份有限公司提供,髓内针(ZQY-01型 2X150)由天津市金兴达实业有限公司提供。 方法：选择清洁级4~6月龄的青紫兰兔30只,按随机数字表法分为3组,类金刚石镀膜镍钛合金环抱器组、非镀膜镍钛合金环抱器组、髓内针内固定组,每组10只。每只兔1%戊巴比妥钠(25 mg/kg)麻醉后行股外侧切口,制成股骨中段横断骨折模型,分别用上述材料固定。 主要观察指标：4周后取骨折局部骨痂,检测单位骨痂中无机物含量及碱性磷酸酶、骨钙素及肿瘤坏死因子的表达。并取局部肌肉组织、肝组织及脑组织测定镍离子含量。 结果：①类金刚石镀膜镍钛合金环抱器组、非镀膜镍钛合金环抱器组骨痂中无机物含量,碱性磷酸酶、骨钙素及肿瘤坏死因子的表达均高于髓内针内固定组(P < 0.05)。②类金刚石镀膜镍钛合金环抱器组和髓内针内固定组肝、脑、骨折周围肌肉组织内镍离子的含量低于非镀膜镍钛合金环抱器组(P < 0.05)。 结论：弹性内固定明显促进骨折愈合,类金刚石镀膜镍钛合金环抱器的组织相容性优于非镀膜镍钛合金环抱器。 关键词：镍钛形状记忆合金;镀膜;骨折;组织相容性     

椎弓根螺钉在胸腰椎骨折置入内固定治疗中的应用及其生物相容性

目的：阐述椎弓根螺钉在胸腰椎骨折内固定治疗中的应用进展,并评价其生物相容性。 方法：第一作者应用计算机检索PubMed(1989/2009)数据库,检索关键词“Pedicle screws,thoracolumbar,fractures,biocompatibility”,限定语言种类为English;同时检索CNKI(1989/2009)数据库,检索关键词“椎弓根螺钉,胸腰椎,骨折,生物相容性”,限定语言种类为中文。共检索到57篇文章,按纳入和排除标准对文献进行筛选,最终纳入31篇文章。 结果：后路椎弓根螺钉内固定系统是治疗胸腰椎骨折的有效方法,但内固定后易发生椎弓根螺钉断裂。联合椎弓根螺钉系统和向伤椎空腔内置入自体骨或人工材料,可以有效减少置入物的松动、断裂等并发症,但价格昂贵。内固定时充分植骨,骨折愈合后适时取出置入物能有效的防止脊柱内固定器的断裂。不锈钢材料的椎弓根螺钉强度较大,但组织相容性差。钛类内固定材料的生物相容性较好,但其刚度较小,容易断裂。 结论：椎弓根螺钉内固定系统是治疗胸腰椎骨折的最有效手段。各种椎弓根螺钉的生物相容性均有待提高,钛类椎弓根螺钉组织相容性较好,其刚度需要提高,不锈钢材料椎弓根螺钉刚度较好,但其生物相容性较差。     

外固定支架-行损伤控制性治疗在创伤骨科修复中的应用

背景：严重多发性骨折或粉碎骨折合并多发创伤的危重患者难以承受复杂大手术,对此类患者利用外固定支架行损伤控制性手术治疗修复骨科创伤已在临床上逐步开展。 目的：通过查阅大量相关文献并进行分析总结,概述利用外固定支架行损伤控制性手术治疗用于创伤骨科修复的必要性、适用范围、实施步骤、优点及应用效果,并对其应用前景做出展望。 方法： 以damage control,external fixator,fracture,trauma,rehabilitation为检索词,检索PubMed数据库(1990/2009-12);以损伤控制,外固定支架,骨折,创伤,修复为检索词,检索CNKI数据库(1995/2009-12)。文献检索语种限制为英文和中文。纳入应用外固定支架行损伤控制性手术治疗修复骨折创伤的内容,文献类型包括综述和临床研究;排除动物实验、重复研究及内容与研究目的不相符的文献。 结果与结论：计算机初检得到289篇文献,对资料进行分析,根据上述筛选标准,排除动物实验、重复研究及内容与研究目的不符的文献共130篇,剩余159篇文献以近10年发表的为主抽取,最终保留25篇文献做进一步分析。通过对文献的复习可知,针对严重多发性骨折或粉碎骨折合并多发创伤的危重患者的骨折修复,合理应用外固定支架行损伤控制性手术治疗,可明显提高其生存率,经临床验证是一种安全有效的治疗方法。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.