Soghoyan Gurgen, Biktimirov Artur R, Piliugin Nikita S, Matvienko Yury, Kaplan Alexander Y, Sintsov Mikhail Y, Lebedev Mikhail A
Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia.
Laboratory of Experimental and Translational Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.
Front Neurosci. 2024 Nov 25;18:1466684. doi: 10.3389/fnins.2024.1466684. eCollection 2024.
Limb amputation results in such devastating consequences as loss of motor and sensory functions and phantom limb pain (PLP). Neurostimulation-based approaches have been developed to treat this condition, which provide artificial somatosensory feedback such as peripheral nerve stimulation (PNS), spinal cord stimulation (SCS), and transcutaneous electrical nerve stimulation (TENS). Yet, the effectiveness of different neurostimulation methods has been rarely tested in the same participants. Meanwhile, such tests would help to select the most effective method or a combination of methods and could contribute to the development of multisensory limb prostheses. In this study, two transhumeral amputees were implanted with stimulating electrodes placed in the medial nerve and over the spinal cord epidurally. PNS and SCS were tested in each participant as approaches to enable tactile and proprioceptive sensations and suppress PLP. Both PNS and SCS induced sensation in different parts of the phantom hand, which correlated with cortical responses detected with electroencephalographic (EEG) recordings. The sensations produced by PNS more often felt natural compared to those produced by SCS. Еvoked response potentials (ERPs) were more lateralized and adapted faster for PNS compared to SCS. In the tasks performed with the bionic hand, neurostimulation-induced sensations enabled discrimination of object size. As the participants practiced with neurostimulation, they improved on the object-size discrimination task and their sensations became more natural. А combination of PNS and TENS enabled sensations that utilized both tactile and proprioceptive information. This combination was effective to convey the perception of object softness. In addition to enabling sensations, neurostimulation led to a decrease in PLP.
https://clinicaltrials.gov/, identifier, #NCT05650931.
肢体截肢会导致运动和感觉功能丧失以及幻肢痛（PLP）等毁灭性后果。已经开发出基于神经刺激的方法来治疗这种疾病，这些方法提供人工体感反馈，如外周神经刺激（PNS）、脊髓刺激（SCS）和经皮电神经刺激（TENS）。然而，不同神经刺激方法的有效性很少在同一参与者身上进行测试。同时，这样的测试将有助于选择最有效的方法或方法组合，并有助于多感官肢体假肢的开发。在这项研究中，两名经肱骨截肢者被植入了放置在内侧神经和硬膜外脊髓上的刺激电极。在每个参与者身上测试了PNS和SCS，作为产生触觉和本体感觉以及抑制PLP的方法。PNS和SCS都在幻手的不同部位诱发了感觉，这与脑电图（EEG）记录检测到的皮层反应相关。与SCS产生的感觉相比，PNS产生的感觉更常让人感觉自然。与SCS相比，PNS诱发的反应电位（ERP）更偏向一侧且适应更快。在使用仿生手执行的任务中，神经刺激诱发的感觉能够区分物体大小。随着参与者对神经刺激的练习，他们在物体大小辨别任务上有所改善，并且他们的感觉变得更加自然。PNS和TENS的组合能够产生利用触觉和本体感觉信息的感觉。这种组合有效地传达了物体柔软度的感知。除了产生感觉外，神经刺激还导致PLP减少。
