Northwestern University, Evanston, IL, USA; E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Spain.
Cala Health Inc, Burlingame, CA, USA.
J Neurol Sci. 2022 Apr 15;435:120195. doi: 10.1016/j.jns.2022.120195. Epub 2022 Feb 19.
Pathological tremor in patients with essential tremor and Parkinsons disease is typically treated using medication or neurosurgical interventions. There is a widely recognized need for new treatments that avoid the side effects of current medications and do not carry the risks of surgical interventions. Building on decades of research and engineering development, non-invasive electrical stimulation of peripheral nerves has emerged as a safe and effective strategy for reducing pathologic tremor in essential tremor. This review surveys the peripheral electrical stimulation (PES) literature and summarizes effectiveness, safety, clinical translatability, and hypothesized tremor-reduction mechanisms of various PES approaches. The review also proposes guidelines for assessing tremor in the context of evaluating new therapies that combine the strengths of clinician assessments, patient evaluations, and novel motion sensing technology. The review concludes with a summary of future directions for PES, including expanding clinical access for patients with Parkinson's disease and leveraging large, at-home datasets to learn more about tremor physiology and treatment effect that will better characterize the state of tremor management and accelerate discovery of new therapies. Growing evidence suggests that non-invasive electrical stimulation of afferent neural pathways provides a viable new option for management of pathological tremor, with one specific PES therapy cleared for prescription and home use, suggesting that PES be considered along with medication and neurosurgical interventions for treatment of tremor. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
特发性震颤和帕金森病患者的病理性震颤通常采用药物或神经外科干预治疗。人们普遍认识到需要新的治疗方法，以避免现有药物的副作用，且不具有手术干预的风险。基于数十年的研究和工程开发，外周神经的非侵入性电刺激已成为一种安全有效的策略，可以减少特发性震颤中的病理性震颤。这篇综述调查了外周电刺激（PES）的文献，并总结了各种 PES 方法的有效性、安全性、临床可转化性和假设的震颤缓解机制。该综述还提出了评估新疗法的震颤评估指南，这些新疗法结合了临床医生评估、患者评估和新型运动感应技术的优势。该综述最后总结了 PES 的未来发展方向，包括为帕金森病患者扩大临床应用，并利用大型家庭数据集更多地了解震颤生理学和治疗效果，从而更好地描述震颤管理的现状，并加速新疗法的发现。越来越多的证据表明，感觉神经通路的非侵入性电刺激为病理性震颤的治疗提供了一种可行的新选择，一种特定的 PES 疗法已获准处方和家庭使用，这表明 PES 应与药物和神经外科干预一起考虑用于治疗震颤。本文是由 Daniel D. Truong、Mark Hallett 和 Aasef Shaikh 编辑的特刊“Tremor”的一部分。
