School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Nat Rev Neurol. 2024 May;20(5):259-268. doi: 10.1038/s41582-024-00953-z. Epub 2024 Apr 3.
Neurostimulation, the use of electrical stimulation to modulate the activity of the nervous system, is now commonly used for the treatment of chronic pain, movement disorders and epilepsy. Many neurostimulation techniques have now shown promise for the treatment of physical impairments in people with stroke. In 2021, vagus nerve stimulation was approved by the FDA as an adjunct to intensive rehabilitation therapy for the treatment of chronic upper extremity deficits after ischaemic stroke. In 2024, pharyngeal electrical stimulation was conditionally approved by the UK National Institute for Health and Care Excellence for neurogenic dysphagia in people with stroke who have a tracheostomy. Many other approaches have also been tested in pivotal device trials and a number of approaches are in early-phase study. Typically, neurostimulation techniques aim to increase neuroplasticity in response to training and rehabilitation, although the putative mechanisms of action differ and are not fully understood. Neurostimulation techniques offer a number of practical advantages for use after stroke, such as precise dosing and timing, but can be invasive and costly to implement. This Review focuses on neurostimulation techniques that are now in clinical use or that have reached the stage of pivotal trials and show considerable promise for the treatment of post-stroke impairments.
神经刺激，即利用电刺激来调节神经系统的活动，目前常用于治疗慢性疼痛、运动障碍和癫痫。许多神经刺激技术现已显示出在治疗中风患者身体功能障碍方面的潜力。2021 年，迷走神经刺激被美国食品和药物管理局（FDA）批准作为缺血性中风后慢性上肢功能障碍强化康复治疗的辅助手段。2024 年，英国国家卫生与保健优化研究所（NICE）有条件批准了经口咽电刺激用于治疗中风后行气管切开术的患者的神经性吞咽困难。许多其他方法也已在关键性设备试验中进行了测试，还有一些方法处于早期研究阶段。通常，神经刺激技术旨在增加对训练和康复的神经可塑性，尽管其潜在作用机制不同，尚未完全了解。神经刺激技术在中风后使用具有许多实际优势，例如精确的剂量和时间控制，但实施起来具有侵入性且成本高昂。本综述重点介绍了目前已在临床应用或已进入关键性试验阶段、在治疗中风后功能障碍方面显示出巨大潜力的神经刺激技术。
