Neuromodulation最新文献

Background: Herpes zoster infection involving the ophthalmic branch of the trigeminal nerve may lead to the development of ophthalmic herpetic-related neuralgia. Pharmacologic treatment of ophthalmic herpetic-related neuralgia often exhibits suboptimal clinical outcomes. However, limited reports suggest the use of Gasserian ganglion (GG) stimulation or supraorbital nerve stimulation (SON) through the foramen ovale to treat ophthalmic herpetic-related neuralgia. This study aims to investigate the efficacy and safety profile of peripheral nerve stimulation (PNS), including GG stimulation and SON stimulation, in the management of ophthalmic herpetic-related neuralgia.

Materials and methods: We retrospectively analyzed 40 patients who were diagnosed with ophthalmic herpetic-related neuralgia and treated with GG stimulation or SON in the pain department of the Fourth Affiliated Hospital of Harbin Medical University from January 2021 to June 2024. The primary outcomes were obtained through electronic medical records and follow-ups, and they included the visual analog scale (VAS) score, treatment efficacy rate, analgesic drugs dose/type, Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). Additionally, treatment-related adverse reactions were recorded.

Results: The preoperative VAS score of patients was 8.6 ± 1.0. Both GG and SON stimulation revealed ideal therapeutic outcomes, with no statistically significant difference in pain relief between the two patient groups. This metric was reduced from the first week postoperatively. By the end of the 24 weeks postoperatively, the VAS decreased to 2.3 ± 1.8. Furthermore, there was a decrease in the amount of analgesic medication used by the patients. Approximately 55% of the patients completely discontinued the use of analgesic medications. After treatment, the sleep quality and emotional status of the patients were significantly improved. The PSQI score at week 24 postoperatively was 5.0 ± 3.0, whereas the SAS score was 31.1 ± 5.9, and the SDS score was 29.5 ± 6.0. Two of the 40 patients exhibited no response to the treatment, and no serious adverse events were observed in the entire cohort.

Conclusion: PNS targeting the GG and SON is a safe and effective therapeutic approach for the management of ophthalmic herpetic-related neuralgia. Overall, PNS is a reliable treatment modality for herpetic-related neuralgia after trigeminal herpes infection.

Clinical trial registration: This study has been reviewed and approved by the Chinese Clinical Trial Registry (Registration number: ChiCTR2400089429) and has undergone ethical review and approval by the Medical Ethics Committee of The Fourth Affiliated Hospital of Harbin Medical University, with approval number 2024-Ethical Review-79.

Background: Gastric electrical stimulation (GES) has been shown to relieve symptoms in children with gastroparesis (GP). Currently, trials with temporary gastric stimulation (tGES) guide selection for permanent implantation; however, there remain several nonresponders and early failures requiring early device explant. This study reports our experience with patient selection with "blinding" during their tGES trial.

Materials and methods: A cohort study was conducted in patients aged four to 26 years who underwent blinded (B) and nonblinded (NB) tGES for GP from January 2014 to April 2022. B cases began the trial as either ON or OFF and then crossed over. Gastroparesis Cardinal Symptom Index (GCSI), nutritional intake, and permanent stimulator implant outcomes were measured and compared between the groups using Fisher exact test.

Results: A total of 84 patients underwent tGES, of whom 57 were NB and 27 B. Of the NB, 55 (96.5%) had improved GCSI, of whom 49 (86%) underwent permanent implantation. In the B group, 14 (51.9%) showed improvement when ON and worsened when OFF (concordant), whereas the others had either discordant or no response to the ON/OFF phase; 12 of 27 B cases (44.4%) were implanted. Early failures were noted in one of 12 B vs nine of 49 in NB cases (p = 0.67).

Conclusions: Overall, GES remains an effective therapy for severe GP in children and adolescents. Blinded tGES trials appeared to allow improved patient selection for those with concordant responses with lower implant rates and fewer early failures. Long-term outcomes of patients who were blinded and received a permanent implant need to be further studied.

Introduction: Chorea-acanthocytosis (ChAc) is a rare autosomal recessive neurodegenerative disorder characterized by progressive movement disorders. Deep brain stimulation (DBS) targeting the globus pallidus internus has shown efficacy in managing ChAc. However, evidence regarding subthalamic nucleus (STN) DBS remains limited, with only two cases previously reported from our center.

Objectives and methods: We analyzed seven consecutive patients with ChAc who underwent STN DBS at Ruijin Hospital (2010-2024). Motor symptoms were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and the Unified Huntington's Disease Rating Scale (UHDRS). Quality of life was measured with the 36-Item Short Form Survey (SF-36). Examinations occurred at baseline, early follow-up (EFU,

Results: STN DBS provided significant improvements in chorea symptoms, with 72.7% reduction in UHDRS at EFU (p = 0.0033) and 52.8% at FFU (p = 0.0067). Dystonic symptoms showed marked improvement, with BFMDRS movement scores decreasing by 71.7% at EFU (p = 0.0023) and 48.4% at FFU (p = 0.0198). Significant improvements in BFMDRS mouth subscores were observed at both EFU and FFU compared with baseline (p = 0.0058 and p = 0.0060, respectively). SF-36 showed significant improvements across six domains (physical function, body pain, social function, general health, vitality, and mental health) at both follow-ups (EFU: p < 0.0001; FFU: p = 0.0005). No serious device-related adverse events occurred.

Conclusions: STN DBS is a safe and effective treatment for ChAc, providing sustained relief of motor symptoms. Nevertheless, partial recovery in motor scores may reflect disease progression. Overall, these findings support the STN as a viable therapeutic target for the management of ChAc.

Introduction: Peripheral nerve stimulation (PNS) delivered for 60 days has emerged as a promising short-term neuromodulation therapy for chronic pain, with early outcomes showing favorable results. However, the ability to predict which patients will sustain long-term benefit remains limited, given existing predictive models have not fully integrated psychosocial and behavioral factors that are increasingly recognized as key modulators of response in chronic pain management. To address this gap, we aimed to identify psychosocial predictors of sustained pain relief at 12 months after 60-day PNS and develop clinically relevant nomograms to guide patient selection and prognostication.

Materials and methods: This prospective, multisite observational cohort study enrolled 110 patients who underwent temporary PNS therapy for chronic trunk and/or limb pain. Baseline assessments included demographics, clinical characteristics, and validated psychosocial instruments including the Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, Oswestry Disability Index, and Physical Activity Vital Sign. The primary outcome was ≥50% pain reduction at 12 months. Predictors were evaluated using univariate logistic regression, and two nomograms were developed: one incorporating core clinical features and another integrating psychosocial factors. Model performance was assessed using the area under the curve (AUC), internal validation with 1000 bootstrapped samples, and penalized regression through Least Absolute Shrinkage and Selection Operator.

Results: A total of 110 participants completed follow-up. Initial 60-day response (odds ratio [OR] 11.09), high physical activity (OR 7.71), and high pain self-efficacy (OR 6.67) were strong positive predictors, whereas pain catastrophizing, insomnia, anxiety, and high baseline disability predicted nonresponse. The clinical nomogram achieved excellent discrimination (AUC = 0.91), whereas the psychosocial-enhanced model showed robust performance (AUC = 0.97). Adverse events were rare and mild, and supplemental treatments were more common in nonresponders.

Conclusion: Treatment response at 60 days, functional capacity, and psychosocial context meaningfully influence long-term outcomes after temporary PNS. The resulting nomogram models show promise for supporting individualized patient selection and hypothesis generation in future predictive neuromodulation research. However, these findings should be considered preliminary pending external validation in independent cohorts.

Introduction: Spinal cord stimulation (SCS) provides significant relief for patients with chronic pain; however, many approaches have limitations in programming complexity, personalization, and long-term efficacy. Traditional open-loop systems require manual programming and fail to adapt to patient-specific anatomical or physiological changes over time. In response, closed-loop SCS systems have emerged, offering real-time modulation based on biomarkers such as position and evoked compound action potentials (ECAPs). However, these systems still largely fail to integrate subjective aspects of pain alongside objective neural biomarkers.

Objectives: The purpose of this scoping review is to evaluate the control signals and algorithms used by closed-loop SCS devices and identify directions for improving their efficacy.

Materials and methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, the PubMed, SCOPUS, and Web of Science data bases were queried on December 14, 2024. Peer-reviewed studies written in English related to closed-loop SCS were included. The inclusion criteria were 1) SCS therapy for chronic pain, and 2) real-time modulation of stimulation parameters. The exclusion criteria included review studies, book chapters, conference proceedings, small animal studies, or works unrelated to chronic pain. Initially, 688 unique articles were identified. After screening by two independent reviewers, 28 articles met all the established criteria, encompassing 19 unique studies.

Results: Three studies investigated subjective states, such as rating of pain, mood, and paresthesias; seven used objective features, including position and movement, and nine studies incorporated ECAP characteristics as a control signal. To our knowledge, no existing model has fully integrated both subjective and biophysical markers to inform closed-loop stimulation parameters.

Conclusions: A closed-loop SCS algorithm that incorporates subjective and objective features may hold potential to improve quality of life in patients with chronic pain. Combining these approaches in a temporally resolved manner, for example, integrating patient reports with continuous electrophysiologic information using a state space mathematical model, could allow more optimized and patient-specific SCS programming.

Background: Older individuals are at high risk for herpetic-related neuralgia, and aging significantly increases the likelihood of postherpetic neuralgia (PHN). Although spinal cord stimulation has shown promise in treating chronic intractable neuralgia, the comparative efficacy of tonic and burst stimulation modes in treating herpetic neuralgia through short-term spinal cord stimulation (st-SCS) remains unclear. In addition, the optimization of procedural strategies has rarely been reported.

Objectives: This study aims to compare the efficacy of tonic and burst stimulation in treating herpetic neuralgia and establish a "321 strategy" for facilitating rapid recovery and preventing PHN.

Materials and methods: From January 2023 to June 2024, 94 patients (31 with acute herpetic neuralgia, 46 with subacute herpetic neuralgia, and 17 with PHN) whose pharmacologic and interventional treatments failed underwent st-SCS therapy with tonic or burst stimulation for 14 days. The visual analog scale (VAS) score and Pittsburgh Sleep Quality Index score were recorded at various intervals.

Results: No significant differences were found between the tonic and burst stimulation modes in reducing the VAS score for acute herpetic neuralgia, subacute herpetic neuralgia, or PHN (p > 0.05). At the six-month follow-up, st-SCS effectively reduced the incidence of PHN, with significant pain relief in most patients.

Conclusions: The 321 strategy under both stimulation modes can effectively alleviate herpetic neuralgia, promote rapid recovery, and reduce PHN incidence, indicating its potential as a promising therapeutic approach for herpetic neuralgia.

Introduction: Improving working memory (WM) is crucial for navigating current information-rich environments. Transcutaneous auricular vagus nerve stimulation (taVNS) shows promise for enhancing cognition, although its impact on WM varies significantly with stimulation parameters.

Materials and methods: Eighty participants were randomized into one of four stimulation groups: Sham (no stimulation), 5 Hz (30 seconds ON/OFF), 25 Hz (30 seconds ON/OFF), or 40-Hz-Burst (40-Hz-B; 5 seconds ON/OFF). Each group received a 30-minute session of their assigned taVNS protocol. After stimulation, WM was evaluated using a three-back task. Concurrent electroencephalography was recorded during the task to analyze event-related potentials (P3b a subcomponent of the P300) and oscillatory activity, specifically, theta event-related synchronization (ERS) and alpha event-related desynchronization (ERD).

Results: Significant WM enhancement was observed after a single 40-Hz-B taVNS session, with three-back task performance showing improved accuracy and reaction times. These behavioral gains were accompanied by consistent neural changes, including increased P3b amplitudes, elevated theta ERS, and enhanced alpha ERD.

Conclusions: The observed results suggest that 40-Hz-B taVNS synchronizes activity in fundamental neuromodulatory systems supporting attention and inhibitory control. Such synchronization promotes superior WM performance by optimizing neural resource utilization and strengthening interference suppression.

Clinical trial registration: The Chinese Clinical Trial Registry (http://www.chictr.org.cn/) number for the study is ChiCTR2300078459.

Background: Lennox-Gastaut syndrome (LGS) is a highly drug-resistant epileptic encephalopathy. The high seizure burden in LGS contributes to substantial morbidity, reduced quality of life, and increased mortality, underscoring the need for alternative therapeutic strategies such as invasive neuromodulation.

Objectives: We aimed to synthesize the efficacy and safety of invasive neuromodulation-vagus-nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS)-for seizure control in LGS.

Materials and methods: We performed a systematic review and meta-analysis (International Prospective Register of Systematic Reviews, CRD420251088693). PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to November 2025. Studies enrolling individuals of any age with LGS who underwent VNS, DBS, or RNS were eligible; mixed-etiology studies were retained if individual patient data permitted LGS-specific extraction. Two reviewers screened records and extracted summary data. The primary outcomes were the proportion crossing predefined thresholds (0%-25%, <50%, ≥50%, ≥70%, and ≥90% seizure reduction). Adverse events were summarized descriptively.

Results: From 1058 records, 71 studies (47 VNS [1618 patients], 16 DBS [110 patients], and eight RNS [37 patients]) involving 1765 patients met the inclusion criteria. Overall, 55.76% (95% CI 48.39-62.88) experienced a ≥50% seizure reduction. DBS yielded the highest responder rate (78.50%; 65.48-87.55), followed by RNS (53.57%; 35.44-70.80) and VNS (48.72%; 41.04-56.46). Only 18.64% (12.05-27.69) reached a ≥90% reduction, and seizure freedom was rare. Age-band subgroup analyses showed no efficacy difference between pediatric, adult, and mixed-age cohorts (interaction p > 0.1). Adverse events were modality-specific yet predominantly mild and manageable; infections occurred in <5% of cases. Risk of bias was serious or critical in most observational studies; overall Grading of Recommendations Assessment, Development and Evaluation certainty was very low.

Conclusions: Invasive neuromodulation can provide meaningful seizure reduction for LGS, with DBS showing the most favorable efficacy signal, but the evidence is low. Head-to-head randomized trials are required to confirm relative effectiveness and optimize target selection.