经颅电刺激用于深脑刺激的研究进展

经颅电刺激（TES）是一种无创、经济、耐受性好的神经调控技术。但是,传统TES为全脑性刺激,且刺激电流较小,无法满足临床治疗中对深部脑区的有效聚焦刺激的需求。随着TES技术临床应用的不断深入,研究人员不断探索出新的刺激方法来提高刺激聚焦性、刺激强度和刺激深度,尤其是以高精度经颅电刺激、时间干涉刺激为代表的多电极刺激研究已展开。本文回顾了近年来TES的优化方案,并进一步分析了现有刺激方法的特点和局限,以期为相关临床应用提供借鉴和参考,并为后续研究提供指导。此外,本文还对TES未来发展趋势进行了展望,并提出了可能用于深脑刺激的TES优化方向,以期能为后续研究和应用提供新的思路。     

听觉刺激器的研制

作者介绍一种用微机听觉诱发电位刺激器。该刺激器可以产生“喀呖”声，具有十二档刺激频率，四档刺激脉冲宽度，刺激强度最大１３２分贝，并具白噪声屏蔽。     

盆神经刺激器的研制

本文介绍了一种部分植入式盆神经刺激器，它主要由体外脉冲发射装置与体内感应接收器和刺激电极组成。文中描述该刺激器的电路设计原理及动物实验结果。     

硬膜外脊髓电刺激仪的研制

临床实验证实硬脊膜外脊髓电刺激(ESCS)与减重步态疗法(PWBT)相结合,能明显提高患者脊髓损伤康复后的行走能力,对运动能量代谢产生显著影响,但相应的神经与生理机制目前尚不清楚.本研究开发研制一种小型低功耗的先进ESCS刺激仪,为ESCS机理的实验研究提供所需的刺激模式.基于印刷电路板工艺,采用聚酰亚胺对银电极触点进行绝缘封装,改进电极的设计.进行ESCS刺激仪性能的动物实验验证,改变电压幅值、频率和波宽等刺激参数,观察实验猫肌肉的抽搐情况.实验结果表明:所研制的小型低功耗ESCS刺激器能提供所需的多通道多模式刺激信号,电池供电和低功耗设计可提供使用安全性,ESCS电极满足柔韧性和生物兼容性要求,可为ESCS和PWBT组合疗法的机理研究提供先进实验手段.     

脑深部电刺激,跨颅磁刺激及迷走神经电刺激对神经精神病的治疗作用

美国Andrews BJ.(2003年5月)指出,在过去的十年间,通过神经调制作用和神经保护作用,业已开展了三种对神经、精神疾病的新一代疗法。 一、脑深部电刺激(deep brain stimulation,DBS)是一种神经外科手术疗法,刺激器是如同起搏器样的装置,或者将刺激电极植入基底神经核区,或背侧丘脑,或底丘脑核区,以高频电刺激打断神经、精神病疾病的异常神经活动。McIntyre CC和Thakor NV.(2002)指出,     

电刺激与磁刺激运动诱发电位的比较研究

在２２名正常成人志愿者的上下肢比较电与磁两种经皮运动皮层、脊髓刺激法所引出之运动诱发电位（ＭＥＰ）的差异。结果表明，电刺激诱发成功率为１００％，磁刺激在下肢肌诱发成功率为０％～１４．３％（皮层刺激）和０％～４２．９％（脊髓刺激）；电刺激ＭＥＰ波幅比磁刺激高２．４７～４１倍（平均１１．３倍）；电刺激ＭＥＰ潜时比磁刺激平均短２．７８ｍｓ（皮层刺激）和１．３４ｍｓ（脊髓刺激）。作者认为，易引出高大而可靠的ＭＥＰ的电刺激方法值得临床推广应用，而磁刺激法则应加强基础和方法学研究。     

脑电仿生电刺激治疗小儿抽动症的应用

目的 采用CVFT-028M仁和脑电仿生电刺激仪,治疗小儿抽动症46例,效果显著.方法 采用CVFT-028M仁和脑电仿生电刺激仪,将一次性电极片黏贴与双耳后乳突处或耳道平行的突出区域,仪器主输出线的一对夹持器分别与两侧电极纽扣相连,用松紧绑带或网状弹力帽将电极辅助固定.治疗选用模式4、标准方式、频率181%、强度从65%开始,可逐渐增大,到小儿能耐受为止,90%以下为儿童安全范围.对于年龄较大且耐受性强的孩子,可选择自设频率范围,但不能低于150%.强度也是从小到大,逐渐增强,到能耐受为止.每次30min,15次为一疗程.结果 一般治疗7d左右见效,10d左右症状明显减轻,32例15d(一个疗程)治愈,14例好转,只有2例做3个疗程好转,44例痊愈.而后随访无复发.结论 脑电仿生电刺激仪治疗小儿抽动症,疗效好,无创伤,无副作用,操作简便,是值得推广的项目.     

电刺激在脑瘫治疗中的应用

脑性瘫痪是中国人群疾病谱中最主要的致残因素之一,近年来的发病率呈显著上升趋势。经过40多年的研究表明,电刺激疗法能成功地恢复脑瘫患者的部分运动功能,且具有无创、操作简便、适应症广等优点,它是现代康复工程领域很有应用前景的一项新技术。本文综述了当前应用于电刺激治疗脑性瘫痪的两类电刺激即神经肌肉电刺激（NMES）和阈值电刺激（TES）的治疗原理、临床疗效、适应症及并发症等,并介绍了与之相关的治疗技术和研究进展。     

神经电生理监测在听神经瘤手术中的应用

目的:探讨术中神经电生理监测在听神经瘤手术中的应用及意义。方法:26例听神经瘤患者,在神经电生理监测下行听神经瘤切除术,将其临床资料进行回顾性分析。结果:26例病人中20例完全切除肿瘤,6例大部切除肿瘤。术后随访6个月,患者面瘫均有不同程度改善。所有患者均未遗留明显后组颅神经及脑干损害表现。结论:在听神经瘤切除术中行神经电生理监测可较好地保护面、听神经的功能,提高听神经瘤全切率,减少术后并发症的发生。     

刺激大鼠坐骨神经向中端对胃酸分泌的影响

研究了电刺激大鼠坐骨神经向中端前、后胃酸分泌量的变化.食道插管向胃内输入生理盐水,十二指肠插管收集灌流液,0.005 mol/L NaOH滴定,比较电刺激大鼠坐骨神经向中端前、后胃酸分泌量的变化.结果表明：电刺激坐骨神经向中端后胃酸的分泌量明显减少（从刺激前的6.18 μmol/15 min减少到刺激后的4.45 μmol/15 min,P＜0.01）.说明坐骨神经传入纤维的兴奋可抑制胃酸的分泌.     

Comparison of three methods of electrical stimulation for converting skeletal muscle to a fatigue resistant power source suitable for cardiac assistance

Twelve dogs were sorted into 3 equal groups, and thein-situ right latissimus dorsi muscle of each dog was stimulated via its motor nerve for a period of 6 weeks. The resulting isotonic contractions were used to pump fluid in an implanted, 2-chambered, compressible pouch system. Three methods of electrical stimulation were used: (a) continuous 2 sec⁻¹ single pulses that caused muscle twitching, (b) a 250 msec train of pulses (36 sec⁻¹) that caused tetanic muscle contractions and was repeated every 2 sec for 15 min followed by a 15 min period of rest, and (c) alternating 15 min periods of the above 2 stimulation methods to cause alternating twitch and tetanic contractions. The 2 sec⁻¹ twitch stimulation and the combined twitch/tetanic stimulation methods resulted in a 100% conversion to fatigue-resistant fibers within 6 weeks. Standardized muscle function tests were performed weekly. With the twitch stimulation (Method 1), the time to fatigue increased from 9 to 116 min (p<0.001), but fluid pumping ability of the muscle decreased substantially from 0.25 to 0.14 liters min⁻¹ (p<0.05). With the intermittent tetanic stimulation (Method 2), the fatigue resistance increased only slightly from 7 to 11 minutes (p=NS), and pumping ability was unchanged. With the combined (twitch-tetanic) stimulation (Method 3), the time to fatigue increased from 9 to 107 min (p<0.001), and the pumping ability did not significantly change from 0.20 to 0.22 liters min⁻¹ (p=NS). These results suggest that a combined electrical stimulation method which produces both twitches and tetanic contractions can achieve rapid fiber conversion and increased fatigue resistance without loss of muscle strength.     

Hypothesis: The Humoral Immune Response to Oral Bacteria Provides a Stimulus for the Development of Rheumatoid Arthritis

Rheumatoid arthritis (RA) and adult periodontitis share common pathogenetic mechanisms and immunologic and pathological findings. One oral pathogen strongly implicated in the pathogenesis of periodontal disease, Porphyromonas gingivalis, possesses a unique microbial enzyme, peptidylarginine deiminase (PAD), the human equivalent of which has been identified as a susceptibility factor for RA. We suggest that individuals predisposed to periodontal infection are exposed to antigens generated by PAD, with deiminated fibrin as a likely candidate, which become systemic immunogens and lead to intraarticular inflammation. PAD engendered antigens lead to production of rheumatoid factor-containing immune complexes and provoke local inflammation, both in gingiva and synovium via Fc and C5a receptors.     

Development of biomarkers for multiple sclerosis as a neurodegenerative disorder

Multiple sclerosis (MS) is the most common neurological disorder leading to permanent disability in young adults in the developed world. While traditionally conceived as an autoimmune inflammatory disease it is becoming increasingly evident that axonal and neuronal degeneration occur, at least partly independent of inflammation, and already at the earliest stages of the disease. In addition, it is the progressive neurodegeneration which determines the amount of accumulating clinical disability. Therefore, MS should be considered as a neurodegenerative disorder. Development of disease-modifying drugs to treat MS is currently highly dynamic. Already, several drugs have shown short-term efficacy to delay progression of clinical disability, but the ultimate aim is to halt disease progression. In this context, the development of sensitive, reliable and valid biomarkers to measure neurodegeneration is an indispensible need to facilitate successful informative clinical trials. While no such biomarker is currently fully established, several promising candidate biomarkers obtained with multimodal techniques, including cerebrospinal fluid and serum analysis, neuroimaging and neurophysiology, are presently developed and evaluated. This paper compiles an up-to-date critical review of the available knowledge of candidate biomarkers of neurodegenerative processes in MS.     

The generation of rat dorsal root ganglion cell lines to identify the target of KW-7158, a novel treatment for overactive bladder

KW-7158 is a drug candidate for the treatment of overactive bladder. Although pharmacological studies have suggested that it suppresses afferent nerve conduction, its molecular target is unknown. We herein report the establishment of dorsal root ganglion (DRG) cell lines useful for identification of the target of this compound. First, we confirmed that the target exists in rat primary DRG by [³H]KW-7158 binding. To establish DRG cell lines, we used DRG from transgenic rats harboring the temperature-sensitive large T-antigen. The immortalized cells were initially screened for their expression of neuronal markers, and 72 positive clones were obtained (designated as TRD cells). Next, in order to select TRD cells expressing the target of KW-7158, we measured the binding affinity and amount of the binding sites present in each clone. Most clones expressed two binding sites, one with low affinity and one with high affinity. Differential binding of KW-7158 derivatives to each site revealed that the high affinity site is pharmacologically relevant. Therefore, we successfully identified “TRD-10” which express the largest amount of the high affinity site. These cell lines will therefore be useful tools to identify the target of KW-7158.