Hausmann Janet, Sweeney-Reed Catherine M, Sobieray Uwe, Matzke Mike, Heinze Hans-Jochen, Voges Jürgen, Buentjen Lars
Department of Neurology, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
J Neuroeng Rehabil. 2015 Nov 14;12:100. doi: 10.1186/s12984-015-0096-3.
Gait dysfunction due to lower limb central paralysis, frequently involving drop foot, is a common cause of disability in multiple sclerosis and has been treated with transcutaneous functional electrical stimulation (FES). We provide here the first report of 4-channel semi-implantable FES of the peroneal nerve which has been successfully used for rehabilitation in patients following stroke.
FES was implemented via a 4-channel semi-implantable closed-loop system (ActiGait(®), ©Ottobock), generating dorsiflexion in drop foot. Walking distance, gait symmetry (temporospatial gait analyses, Vicon Motion Systems(®)), gait velocity (10 m walking test) and quality of life (SF-36 questionnaire) were measured to evaluate the therapeutic benefit of this system in two patients with progressive MS.
Walking distance increased from 517 to 1884 m in Patient 1 and from 52 to 506 m in Patient 2. Gait velocity did not change significantly in Patient 1 and increased from 0.6 to 0.8 m/s in Patient 2. Maximum deviations of center of mass from the midline to each side changed significantly after 3 months of stimulation compared to baseline, decreasing from 15 to 12 mm in Patient 1 and from 47 to 37 mm in Patient 2. Both patients experienced reduced pain and fatigue and benefits to quality of life. Adverse events did not occur during the observation period.
We conclude that implantable 4-channel FES systems are not only feasible but present a promising new alternative for treating central drop foot in MS patients.
下肢中枢性瘫痪导致的步态功能障碍，常伴有足下垂，是多发性硬化症中常见的致残原因，以往采用经皮功能性电刺激（FES）进行治疗。我们在此首次报告了4通道半植入式腓总神经FES，该技术已成功用于中风患者的康复治疗。
通过4通道半植入式闭环系统（ActiGait®，奥托博克公司）实施FES，以产生足背屈。测量步行距离、步态对称性（时空步态分析，Vicon Motion Systems®）、步态速度（10米步行测试）和生活质量（SF-36问卷），以评估该系统对两名进行性多发性硬化症患者的治疗效果。
患者1的步行距离从517米增加到1884米，患者2从52米增加到506米。患者1的步态速度无显著变化，患者2从0.6米/秒增加到0.8米/秒。与基线相比，刺激3个月后，质心从身体中线向两侧的最大偏移量有显著变化，患者1从15毫米降至12毫米，患者2从47毫米降至37毫米。两名患者均疼痛减轻、疲劳缓解，生活质量得到改善。观察期内未发生不良事件。
我们得出结论，植入式4通道FES系统不仅可行，而且为治疗多发性硬化症患者的中枢性足下垂提供了一种有前景的新选择。
