Roberts V L H, Patel N K, Tremaine W H
School of Veterinary Sciences, University of Bristol, Somerset, UK.
Institute of Neurosciences, Southmead Hospital, Bristol, UK.
Equine Vet J. 2016 Mar;48(2):201-4. doi: 10.1111/evj.12394. Epub 2015 Apr 8.
REASONS FOR PERFORMING STUDY: There are no consistently safe and effective methods for the treatment of trigeminal-mediated headshaking in horses. In affected horses, the trigeminal nerve is sensitised, appearing to result in neuropathic pain. Percutaneous electrical nerve stimulation (PENS) therapy is a minimally invasive neuromodulatory treatment used in people to manage neuropathic pain. OBJECTIVES: To determine whether PENS therapy is safe, tolerated and effective for the management of trigeminal-mediated headshaking in horses. STUDY DESIGN: Descriptive case series. METHODS: Seven horses diagnosed with trigeminal-mediated headshaking and currently showing clinical signs were studied. All procedures were carried out in sedated horses with a needle-prick sized area of skin desensitised with local anaesthetic to facilitate probe insertion. A disposable PENS probe was advanced subcutaneously adjacent to the nerve, rostral to the infraorbital foramen under ultrasonographic guidance. The nerve was stimulated for 25 min following a protocol of alternating frequencies and a perception threshold based on human clinical data. The probe was removed and the procedure repeated on the contralateral side. The protocol used comprised a series of 3 or 4 treatments, with treatments being repeated when signs of headshaking recurred. RESULTS: All horses tolerated the procedure well. Three horses developed a haematoma at the site on one occasion and 2 had increased clinical signs for up to 3 days following first treatment. Six horses demonstrated a positive response to their first treatment, returning to ridden work at the same level as prior to onset of headshaking, with 5 continuing to respond. Median remission time for first treatment was 3.8 days (range 0-8 days, n = 7), second treatment 2.5 weeks (0-8 weeks, n = 7), third treatment 15.5 weeks (0-24 weeks, n = 5) and fourth treatment 20 weeks (12-28 weeks ongoing, n = 2). CONCLUSIONS: Percutaneous electrical nerve stimulation therapy is a safe, well tolerated, minimally invasive, repeatable management option for trigeminal-mediated headshaking, with encouraging efficacy for amelioration of clinical signs in the short- to medium term.
开展本研究的原因：目前尚无始终安全有效的方法来治疗马匹三叉神经介导的晃头症。在患病马匹中，三叉神经会变得敏感，似乎会导致神经性疼痛。经皮电神经刺激（PENS）疗法是一种用于人类的微创神经调节治疗方法，用于管理神经性疼痛。 目的：确定PENS疗法对于治疗马匹三叉神经介导的晃头症是否安全、可耐受且有效。 研究设计：描述性病例系列。 方法：对7匹被诊断为三叉神经介导的晃头症且目前有临床症状的马匹进行研究。所有操作均在镇静的马匹身上进行，用局部麻醉剂使针头大小的皮肤区域脱敏，以方便探头插入。在超声引导下，将一次性PENS探头经皮下推进至神经附近，眶下孔前方。根据人类临床数据，按照频率交替和感知阈值的方案对神经进行25分钟的刺激。取出探头，在对侧重复该操作。所采用的方案包括一系列3或4次治疗，当晃头症状复发时重复治疗。 结果：所有马匹对该操作耐受性良好。3匹马在某一部位出现过一次血肿，2匹马在首次治疗后临床症状加重长达3天。6匹马对首次治疗有阳性反应，恢复到晃头症发作前的骑行水平，其中5匹马持续有反应。首次治疗的中位缓解时间为3.8天（范围0 - 8天，n = 7），第二次治疗为2.5周（0 - 8周，n = 7），第三次治疗为15.5周（0 - 24周，n = 5），第四次治疗为20周（12 - 28周持续，n = 2）。 结论：经皮电神经刺激疗法是一种安全、耐受性良好、微创、可重复的治疗三叉神经介导的晃头症的管理选择，在短期至中期改善临床症状方面疗效令人鼓舞。
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