Neuromodulation最新文献

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Differential Gamma Responses to Transcutaneous Auricular Vagus Nerve Stimulation Revealed by Human Intracranial Recordings. 经皮耳迷走神经刺激对人颅内记录的差异反应。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-01-02 DOI: 10.1016/j.neurom.2025.11.013

Kara M Donovan, Gansheng Tan, Jon T Willie, Peter Brunner, Eric C Leuthardt

Objectives: Vagus nerve stimulation (VNS), along with noninvasive transcutaneous auricular VNS (taVNS), has been the focus of considerable research across numerous indications. However, although invasive VNS literature has explored ways stimulation amplitude influences both physiologic and behavioral outcomes, there is a less robust understanding of taVNS parameter-specific effects on central nervous system activity. The focus of this study was to better understand neurophysiologic responses to multiple taVNS intensities to inform future taVNS work with therapeutic applications.

Materials and methods: We recorded stereotactic electroencephalography signals from ten patients (six male) with intractable epilepsy (N = 8 included for analysis, four male) while they underwent both active and sham taVNS. Both active and sham stimulation conditions were administered at 30-Hz frequency, 250-μs pulse width, 30-second train with 1-second intertrain interval, for a total duration of 1 minute. Active taVNS amplitudes included 0.5, 1.0, and 1.5 mA whereas sham taVNS was administered at 1.5 mA. High gamma power between 95 and 170 Hz was quantified as the primary indicator of local activity.

Results: High gamma activity was amplitude-dependent, with different taVNS amplitudes producing distinct effects. Active taVNS at 1.0- and 1.5-mA amplitudes caused increased high gamma activity. Furthermore, the increases in high gamma in the orbitofrontal cortex and insula were maintained for significantly greater durations during 1.5-mA active taVNS than during sham. In addition, 0.5-mA stimulation led to moderate suppression of high gamma in certain regions, although further research is needed to investigate brain responses to subthreshold stimulation.

Conclusions: taVNS administered at 1.5-mA amplitude can elicit a sustained high gamma response throughout the course of stimulation in key brain areas implicated in the vagal afferent pathway. Our findings underscore the importance of parameter selection in taVNS protocols given different amplitudes can produce varied effects on brain activity.

目的：迷走神经刺激（VNS），以及无创经皮耳VNS (taVNS)，已经成为众多适应症中大量研究的焦点。然而，尽管有创VNS文献已经探讨了刺激幅度影响生理和行为结果的方式，但对taVNS参数特异性对中枢神经系统活动的影响的了解尚不充分。本研究的重点是更好地了解对多重taVNS强度的神经生理反应，为未来taVNS的治疗应用提供信息。材料和方法：我们记录了10例顽固性癫痫患者（6名男性）（N = 8, 4名男性）在接受主动和假taVNS时的立体定向脑电图信号。主动刺激和假性刺激均以30 hz频率、250 μs脉宽、30秒单次刺激、1秒间歇刺激和1分钟刺激。活性taVNS的振幅包括0.5、1.0和1.5 mA，而假taVNS的振幅为1.5 mA。在95和170赫兹之间的高伽马功率被量化为局部活动的主要指标。结果：高γ活动具有幅值依赖性，不同的taVNS幅值产生不同的效果。1.0 ma和1.5 ma振幅的激活taVNS导致高γ活动增加。此外，在1.5 ma活动taVNS期间，眶额叶皮层和脑岛的高伽马持续时间明显长于假手术期间。此外，0.5 ma刺激导致某些区域的高伽马中度抑制，尽管需要进一步研究大脑对阈下刺激的反应。结论：在1.5 ma振幅的taVNS刺激过程中，与迷走神经传入通路相关的关键脑区可引起持续的高γ反应。我们的研究结果强调了在taVNS协议中参数选择的重要性，因为不同的振幅可以对大脑活动产生不同的影响。

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引用次数: 0

Lateral Epidural Stimulation to Decrease Glucose Levels: A Preliminary Preclinical Study 外侧硬膜外刺激降低血糖水平：初步临床前研究。

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation

Pub Date : 2026-01-01 DOI: 10.1016/j.neurom.2025.08.409

Adam Sokal MD, PhD , Pawel Chodakowski MD , Alicja Bogusz MSc , Piotr Bogus MSc , Mike Eggen PhD , Abhijt Bhattacharya MSc , Lilian Kornet PhD

Background

Medical therapy in patients with type 2 diabetes (T2D) often has side effects and poor tolerance. Therefore, a device-based therapy may be more desirable.

Objective

We investigated whether increased dorsal root nerve activity by lateral epidural stimulation (LES) around T9–T10 indirectly decreases glucose levels.

Materials and Methods

In this animal study, it was first tested whether LES at various vertebra levels influences insulin secretion and subsequent glucose blood level. After finding the optimal stimulation site, glucose tolerance tests were performed to study the effect of LES on glucose and insulin before and during these tests. C-peptide was used as a surrogate for insulin.

Results

The optimal location of the electrode pairs to have the greatest effect on C-peptide was location T9–T10. Given the effect on glucose was not present in a euglycemic state, a hyperglycemic state was induced using an intravenous glucose tolerance (IVGT) test provoking a change in C-peptide (n = 6). The increase in C-peptide during the first 90 minutes of the IVGT test was greater during LES than during no stimulation (p = 0.024, two-sided paired t-test). The glucose decay time constant was more negative during LES than during no stimulation; that is, glucose was eliminated faster from the bloodstream (p = 0.045, two-sided paired t-test).

Conclusion

LES therapy seems to be a promising therapy to be used in patients who are noncompliant and have T2D or those having side effects with conventional medications, to affect insulin secretion and subsequently glucose blood level when in a hyperglycemic state.

背景：2型糖尿病（T2D）患者的药物治疗通常有副作用且耐受性差。因此，基于装置的治疗可能更可取。目的：研究外侧硬膜外刺激（LES）在T9-T10周围增加背根神经活动是否间接降低血糖水平。材料和方法：在动物实验中，我们首先测试了不同椎体水平的LES是否影响胰岛素分泌和随后的血糖水平。找到最佳刺激部位后，进行糖耐量试验，研究LES在试验前和试验中对葡萄糖和胰岛素的影响。c肽被用作胰岛素的替代物。结果：对c肽影响最大的电极对位置为T9-T10。考虑到在正常血糖状态下对葡萄糖的影响不存在，使用静脉葡萄糖耐量（IVGT）试验诱导高血糖状态，引起c肽的变化（n = 6）。在IVGT试验的前90分钟内，LES期间c肽的增加大于无刺激时（p = 0.024，双侧配对t检验）。LES时葡萄糖衰减时间常数比无刺激时更负；也就是说，葡萄糖从血液中消除得更快（p = 0.045，双侧配对t检验）。结论：LES治疗可能是一种很有前景的治疗方法，可用于不依从性T2D患者或常规药物有副作用的患者，在高血糖状态下影响胰岛素分泌和随后的血糖水平。

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