Molsberger Albrecht, McCaig Colin D
Department of Orthopedics, Ruhr-University Bochum, Bochum, Germany.
Clinic for Orthopedics and Pain Treatment, Düsseldorf, Germany.
Med Devices (Auckl). 2018 Jun 14;11:205-214. doi: 10.2147/MDER.S163368. eCollection 2018.
There is a high medical need to improve the effectiveness of the treatment of pain and traumatic soft tissue injuries. In this context, electrostimulating devices have been used with only sporadic success. There is also much evidence of endogenous electrical signals that play key roles in regulating the development and regeneration of many tissues. Transepithelial potential gradients are one source of the direct current (DC) electrical signals that stimulate and guide the migration of inflammatory cells, epithelial cells, fibroblasts and mesenchymal stem cells to achieve effective wound healing. Up to now, this electrophysiological knowledge has not been adequately translated into a clinical treatment. Here, we present a mobile, handheld electroceutical smart device based on a microcontroller, an analog front end and a battery, which generates DC electric fields (EFs), mimicking and modulating the patient's own physiological electrical signals. The electrical stimulation is applied to percutaneous metal probes, which are located close to the inflamed or injured tissue of the patient. The treatment can be used in an ambulatory or stationary environment. It shows unexpectedly, highly effective treatment for certain severe neurological pain conditions, as well as traumatic soft tissue injuries (muscle/ligament ruptures, joint sprains). Without EF intervention, these conditions, respectively, are either virtually incurable or take several months to heal. We present three cases - severe chronic cluster headache, acute massive muscle rupture of the rectus femoris and an acute ankle sprain with a ruptured anterior talofibular ligament - to demonstrate clinical effectiveness and discuss the fundamental differences between mimicking DC simulation and conventional transcutaneous electric nerve stimulation (TENS) or TENS-like implanted devices as used for peripheral nerve cord, spinal cord or dorsal root stimulation.
提高疼痛和创伤性软组织损伤的治疗效果具有很高的医学需求。在此背景下,电刺激设备的使用仅取得了零星的成功。也有许多证据表明内源性电信号在调节许多组织的发育和再生中起关键作用。跨上皮电位梯度是直流电(DC)电信号的一个来源,它刺激并引导炎症细胞、上皮细胞、成纤维细胞和间充质干细胞迁移,以实现有效的伤口愈合。到目前为止,这种电生理知识尚未充分转化为临床治疗方法。在此,我们展示一种基于微控制器、模拟前端和电池的便携式手持电治疗智能设备,它能产生直流电场(EFs),模仿并调节患者自身的生理电信号。电刺激通过经皮金属探针施加,这些探针靠近患者发炎或受伤的组织。该治疗可在门诊或固定环境中使用。它对某些严重的神经疼痛病症以及创伤性软组织损伤(肌肉/韧带断裂、关节扭伤)显示出意想不到的高效治疗效果。在没有直流电场干预的情况下,这些病症要么几乎无法治愈,要么需要数月才能愈合。我们展示三个病例——严重慢性丛集性头痛、股直肌急性大面积肌肉断裂以及伴有距腓前韧带断裂的急性踝关节扭伤——以证明临床疗效,并讨论模仿直流模拟与用于外周神经索、脊髓或背根刺激的传统经皮电神经刺激(TENS)或类似TENS的植入设备之间的根本差异。