Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, Austria.
Research Unit of Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Graz, Austria.
J Neuroeng Rehabil. 2023 Apr 25;20(1):51. doi: 10.1186/s12984-023-01159-y.
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of disabilities resulting from cognitive and neurological deficits, as well as psychological disorders. Only recently, preclinical research on electrical stimulation methods as a potential treatment of TBI sequelae has gained more traction. However, the underlying mechanisms of the anticipated improvements induced by these methods are still not fully understood. It remains unclear in which stage after TBI they are best applied to optimize the therapeutic outcome, preferably with persisting effects. Studies with animal models address these questions and investigate beneficial long- and short-term changes mediated by these novel modalities. METHODS: In this review, we present the state-of-the-art in preclinical research on electrical stimulation methods used to treat TBI sequelae. We analyze publications on the most commonly used electrical stimulation methods, namely transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS) and vagus nerve stimulation (VNS), that aim to treat disabilities caused by TBI. We discuss applied stimulation parameters, such as the amplitude, frequency, and length of stimulation, as well as stimulation time frames, specifically the onset of stimulation, how often stimulation sessions were repeated and the total length of the treatment. These parameters are then analyzed in the context of injury severity, the disability under investigation and the stimulated location, and the resulting therapeutic effects are compared. We provide a comprehensive and critical review and discuss directions for future research. RESULTS AND CONCLUSION: We find that the parameters used in studies on each of these stimulation methods vary widely, making it difficult to draw direct comparisons between stimulation protocols and therapeutic outcome. Persisting beneficial effects and adverse consequences of electrical simulation are rarely investigated, leaving many questions about their suitability for clinical applications. Nevertheless, we conclude that the stimulation methods discussed here show promising results that could be further supported by additional research in this field.
背景:创伤性脑损伤(TBI)是导致认知和神经功能缺陷以及心理障碍的主要原因。直到最近,电刺激方法作为 TBI 后遗症的潜在治疗方法的临床前研究才受到更多关注。然而,这些方法预期改善的潜在机制仍不完全清楚。这些方法在 TBI 后哪个阶段应用效果最佳,以优化治疗效果,最好是具有持久效果,目前仍不清楚。动物模型研究解决了这些问题,并研究了这些新方法介导的有益的长期和短期变化。
方法:在这篇综述中,我们介绍了用于治疗 TBI 后遗症的电刺激方法的临床前研究现状。我们分析了关于最常用的电刺激方法的出版物,即经颅磁刺激(TMS)、经颅直流电刺激(tDCS)、深部脑刺激(DBS)和迷走神经刺激(VNS),这些方法旨在治疗 TBI 引起的残疾。我们讨论了应用的刺激参数,如刺激的幅度、频率和长度,以及刺激时间框架,特别是刺激的开始时间、刺激的重复频率以及治疗的总时间。然后,我们根据损伤严重程度、正在研究的残疾以及刺激的位置分析这些参数,并比较产生的治疗效果。我们提供了全面和批判性的综述,并讨论了未来研究的方向。
结果和结论:我们发现,这些刺激方法中的每一种方法的研究中使用的参数差异很大,使得很难在刺激方案和治疗效果之间进行直接比较。电模拟的持久有益效果和不良后果很少被研究,这使得它们是否适合临床应用存在许多问题。尽管如此,我们得出的结论是,这里讨论的刺激方法显示出有希望的结果,可以通过该领域的进一步研究来进一步支持。
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