Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
Indiana University School of Medicine, Indianapolis, IN, USA.
J Neurosci Methods. 2020 Apr 15;336:108631. doi: 10.1016/j.jneumeth.2020.108631. Epub 2020 Feb 20.
Gastric electrical stimulation (GES) can be a life-changing, device-based treatment option for drug-resistant nausea and vomiting associated with diabetic or idiopathic gastroparesis (GP). Despite over two decades of clinical use, the mechanism of action remains unclear. We hypothesize a vagal mechanism.
Here, we describe a noninvasive method to investigate vagal nerve involvement in GES therapy in 66 human subjects through the compound nerve action potential (CNAP).
Of the 66 subjects, 28 had diabetic GP, 35 had idiopathic GP, and 3 had postsurgical GP. Stimulus charge per pulse did not predict treatment efficacy, but did predict a significant increase in total symptom score in type 1 diabetics as GES stimulus charge per pulse increased (p < 0.01), representing a notable side effect and providing a method to identify it. In contrast, the number of significant left and right vagal fiber responses that were recorded directly related to patient symptom improvement. Increased vagal responses correlated with significant decreases in total symptom score (p < 0.05).
COMPARISON WITH EXISTING METHOD(S): We have developed transcutaneous recording of cervical vagal activity that is synchronized with GES in conscious human subjects, along with methods of discriminating the activity of different nerve fiber groups with respect to conduction speed and treatment response.
Cutaneous vagal CNAP analysis is a useful technique to unmask relationships among GES parameters, vagal recruitment, efficacy and side-effect management. Our results suggest that CNAP-guided GES optimization will provide the most benefit to patients with idiopathic and type 1 diabetic gastroparesis.
胃电刺激（GES）可以为糖尿病或特发性胃轻瘫（GP）相关的耐药性恶心和呕吐患者提供一种改变生活的基于设备的治疗选择。尽管已经临床应用了二十多年，但作用机制仍不清楚。我们假设一种迷走神经机制。
在这里，我们通过复合神经动作电位（CNAP）描述了一种非侵入性方法，以研究 66 名人类受试者中 GES 治疗中迷走神经的参与情况。
在 66 名受试者中，28 名患有糖尿病性 GP，35 名患有特发性 GP，3 名患有术后 GP。每个脉冲的刺激电荷量并不能预测治疗效果，但与每个脉冲的 GES 刺激电荷量增加呈正相关（p<0.01），这代表了一个显著的副作用，并提供了一种识别它的方法。相比之下，记录到的左侧和右侧迷走纤维反应的数量与患者症状的改善直接相关。迷走神经反应增加与总症状评分的显著降低相关（p<0.05）。
我们已经开发出一种在清醒的人类受试者中同步进行经皮记录颈迷走神经活动的方法，以及一种用于区分不同神经纤维组的活动与传导速度和治疗反应的方法。
皮肤迷走神经 CNAP 分析是一种有用的技术，可以揭示 GES 参数、迷走神经募集、疗效和副作用管理之间的关系。我们的结果表明，CNAP 引导的 GES 优化将为特发性和 1 型糖尿病性胃轻瘫患者提供最大的益处。
