Su Xin, Simenson Heather A, Paralikar Kunal, Orser Heather D
Medtronic, Inc., Restorative Therapies Group, Research & Core Technology, Minneapolis, MN, USA.
Medtronic, Inc., Physiological Research Laboratories, Minneapolis, MN, USA.
Neuromodulation. 2017 Dec;20(8):787-792. doi: 10.1111/ner.12640. Epub 2017 Aug 7.
The present study compared the effectiveness of patterned frequency of spinal nerve stimulation (SNS) with continuous, fixed-frequency nerve stimulation in an animal model of the bladder reflex contraction (BRC).
In anesthetized female rats, wire electrodes were placed under each of the L6 spinal nerve to produce bilateral SNS. A cannula was placed into the bladder via the urethra, and the urethra was ligated to ensure an isovolumetric bladder.
Using motor threshold intensity, continuous stimulation at fixed frequencies of 4 Hz (n = 5) and 10 Hz (n = 7) decreased the frequency of BRC of 71 ± 24% (mean, SEM) and 85 ± 18% of controls, respectively (vs. no stimulation, n = 10, p < 0.05, two-way analysis of variance [ANOVA]). Fixed-frequency stimulation at 0.01, 0.1, 1, 40, and 100 Hz, did not demonstrate a trend change on BRC. When stimulation frequency is delivered with a 4-6 pulse/burst pattern every 1-100 sec, neuromodulation has demonstrated a trend toward effectiveness, with a four-pulse 40 Hz burst stimulation per second showing the most difference, reducing the BRC frequency of 74 ± 8% of control (n = 8, p < 0.05, two-way ANOVA). However, it is not more effective than continuous neuromodulation at a fixed frequency of 4 Hz or 10 Hz at BRC inhibition.
Burst stimulations may inhibit bladder contractions; however, they are not more effective than continuous neuromodulation. Without further knowledge regarding mechanisms and potential benefit of burst stimulation on bladder control in patients with neuropathological conditions, applications should utilize continuous fixed 10 Hz stimulation for maximal clinical outcomes.
本研究在膀胱反射性收缩（BRC）动物模型中比较了脊髓神经刺激（SNS）的模式频率与连续、固定频率神经刺激的有效性。
在麻醉的雌性大鼠中，将线电极置于L6每条脊神经下方以产生双侧SNS。通过尿道将套管插入膀胱，并结扎尿道以确保膀胱等容。
使用运动阈值强度，以4Hz（n = 5）和10Hz（n = 7）的固定频率连续刺激分别使BRC频率降低了对照组的71±24%（均值，标准误）和85±18%（与无刺激相比，n = 10，p < 0.05，双向方差分析[ANOVA]）。0.01、0.1、1、40和100Hz的固定频率刺激未显示出对BRC的趋势变化。当以每秒4 - 6个脉冲/阵发模式每1 - 100秒给予刺激频率时，神经调节已显示出有效性趋势，每秒4个脉冲的40Hz阵发刺激差异最大，使BRC频率降低了对照组的74±8%（n = 8，p < 0.05，双向ANOVA）。然而，在抑制BRC方面，它并不比4Hz或10Hz的固定频率连续神经调节更有效。
阵发刺激可能抑制膀胱收缩；然而，它们并不比连续神经调节更有效。在没有进一步了解阵发刺激对神经病理状况患者膀胱控制的机制和潜在益处的情况下，应用应采用连续固定的10Hz刺激以获得最大临床效果。
