Neuromodulation最新文献

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.

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.