In the treatment of drug-refractory epilepsy in children, surgical treatment has a good clinical effect. However, for children whose surgical site is difficult to determine and who cannot undergo resectional surgery, neuromodulation techniques are one of the treatments that can be considered. At present, new neuromodulation technologies in children mainly include transcutaneous vagus nerve stimulation (transcutaneous auricular vagus nerve stimulation, ta-VNS), deep brain stimulation (deep brain stimulation, DBS), reactive nerve stimulation (responsive neurostimulation, RNS), transcranial magnetic stimulation (transcranial magnetic stimulation, TMS), transcranial direct current stimulation (transcranial direct current stimulation, TDCS) and transcranial alternating current stimulation (transcranial alternating current stimulation, TACS). This article briefly discussed the clinical efficacy and safety of various currently available neuromodulation technologies, so as to provide a reference for the rational selection and application of neuromodulation technologies, and improve the clinical efficacy and quality of life of children with drug-refractory epilepsy.
Objective To systematically review the effect of percutaneous acupoint electrical stimulation (TEAS) on heart rate variability (HRV). Methods The PubMed, Embase, Ovid MEDLINE, Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of percutaneous acupoint electrical stimulation on heart rate variability from inception to February 28, 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 14 RCTs involving 719 patients were included. The results of meta-analysis showed that SDNN (MD=12.95, 95%CI 9.18 to 16.72, P<0.01), RMSSD (MD=1.81, 95%CI 0.10 to 3.53, P=0.04), pNN50 (MD=1.75, 95%CI 1.02 to 2.48, P<0.01), HF (SMD=0.27, 95%CI 0.01 to 0.52, P=0.04), LF/HF (MD=−0.07, 95%CI −0.12 to −0.03, P<0.01), ln-LF (MD=0.63, 95%CI 0.25 to 1.01, P<0.01), ln-HF (MD=1.05, 95%CI 0.60 to 1.49, P<0.01), mean RR (MD=−11.86, 95%CI −21.77 to −1.96, P=0.02), and HR (SMD=−0.43, 95%CI −0.66 to −0.20, P<0.01) all showed improvement compared with the control group. However, there were no significant differences between the two groups in LF (SMD=0.15, 95%CI −0.10 to 0.40, P=0.23), LF norm (SMD=0.24, 95%CI −0.10 to 0.58, P=0.16) or HF norm (SMD=0.25, 95%CI −0.47 to 0.97, P=0.5). TEAS on PC6: SDNN, pNN50, HF, LF/HF, LF norm, HF norm, ln-LF, ln-HF, and HR all showed improvement compared with the control group. However, there were no significant differences between the two groups in RMSSD, LF, or RR interval. Conclusion This study supports the improvement of heart rate variability by transcutaneous acupoint electrical stimulation and PC6 acupoint selection. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo explore the best nursing regimen for patients with severe Tardive dyskinesia (TD) after deep brain stimulation (DBS). MethodsTo analyze the clinical nursing data of 7 patients with TD treated by DBS in our department from January 2018 to August 2019, preoperative assessment of the patient's condition, dyskinesia care, psychological care, preoperative preparation, preoperative guidance, etc. General nursing, observation and nursing of complications, psychological nursing, safety management and rehabilitation training of limb function were carried out after operation discharge to discharge guidance, daily life guidance, DBS device-related education and other post-discharge continuous care to help patients improve quality of life. The changes of TD symptoms were assessed with the abnormal involuntary movement scale -LRB-AIMS, the nursing effect was assessed with the psychiatric nursing observation sc-Nosiee (NOSIE) , and the self-care ability was assessed with the ability of daily livin-ADL- scale (ADL). ResultsAll of the 7 TD patients recovered well after operation, without complications caused by improper nursing, and the TD symptoms were relieved. The AIMS and NOSIE scores were significantly lower at 1 month, 3 months and 1 year after operation than those before operation (P<0.05). The ADL scores were significantly higher than those before operation (P<0.05). ConclusionIn order to treat TD patients with DBS operation, we should pay attention to the pertinent nursing in perioperative period and the continuous nursing after discharge, it is of great significance to relieve the symptoms of involuntary movement, improve the mental state and improve the self-care ability of patients with TD.
Transcranial magneto-acoustic electrical stimulation (TMAES) is a novel method of brain nerve regulation and research, which uses induction current generated by the coupling of ultrasound and magnetic field to regulate neural electrical activity in different brain regions. As the second special envoy of nerve signal, calcium plays a key role in nerve signal transmission. In order to investigate the effect of TMAES on prefrontal cortex electrical activity, 15 mice were divided into control group, ultrasound stimulation (TUS) group and TMAES group. The TMAES group received 2.6 W/cm2 and 0.3 T of magnetic induction intensity, the TUS group received only ultrasound stimulation, and the control group received no ultrasound and magnetic field for one week. The calcium ion concentration in the prefrontal cortex of mice was recorded in real time by optical fiber photometric detection technology. The new object recognition experiment was conducted to compare the behavioral differences and the time-frequency distribution of calcium signal in each group. The results showed that the mean value of calcium transient signal in the TMAES group was (4.84 ± 0.11)% within 10 s after the stimulation, which was higher than that in the TUS group (4.40 ± 0.10)% and the control group (4.22 ± 0.08)%, and the waveform of calcium transient signal was slower, suggesting that calcium metabolism was faster. The main energy band of the TMAES group was 0−20 Hz, that of the TUS group was 0−12 Hz and that of the control group was 0−8 Hz. The cognitive index was 0.71 in the TMAES group, 0.63 in the TUS group, and 0.58 in the control group, indicating that both ultrasonic and magneto-acoustic stimulation could improve the cognitive ability of mice, but the effect of the TMAES group was better than that of the TUS group. These results suggest that TMAES can change the calcium homeostasis of prefrontal cortex nerve clusters, regulate the discharge activity of prefrontal nerve clusters, and promote cognitive function. The results of this study provide data support and reference for further exploration of the deep neural mechanism of TMAES.
In order to solve the problems of insufficient stimulation channels and lack of stimulation effect feedback in the current electrical stimulation system, a functional array electrode electrical stimulation system with surface electromyography (sEMG) feedback was designed in this paper. Firstly, the effectiveness of the system was verified through in vitro and human experiments. Then it was confirmed that there were differences in the number of amperage needed to achieve the same stimulation stage among individuals, and the number of amperage required by men was generally less than that of women. Finally, it was verified that the current required for square wave stimulation was smaller than that for differential wave stimulation if the same stimulation stage was reached. This system combined the array electrode and sEMG feedback to improve the accuracy of electrical stimulation and performed the whole process recording of feedback sEMG signal in the process of electrical stimulation, and the electrical stimulation parameters could change with the change of the sEMG signal. The electrical stimulation system and sEMG feedback worked together to form a closed-loop electrical stimulation working system, so as to improve the efficiency of electrical stimulation rehabilitation treatment. In conclusion, the functional array electrode electrical stimulation system with sEMG feedback developed in this paper has the advantages of simple operation, small size and low power consumption, which lays a foundation for the introduction of electrical stimulation rehabilitation treatment equipment into the family, and also provides certain reference for the development of similar products in the future.
OBJECTIVE: To study the influence of the electric stimulation of denervated muscle atrophy. METHODS: Sixteen SD rats were made the model of denervated skeletal muscle in two lower limbs by cutting off the sciatic nerve and femoral nerve. The right gastrocnemius muscle was stimulated with JNR-II nerve amp; muscle recovery instrument by skin as the experimental side and the left was not treated as the control side. The muscle histology, ultrastructure, fibrillation potential amplitude, Na(+)-K(+)-ATPase and Ca(2+)-ATPase activities were observed 2 weeks and 4 weeks after operation. RESULTS: Electric stimulation could protect mitochondria and sarcoplasmic reticulum from the degeneration. The reduction rates of muscle cell diameter and cross section in the experimental side were slower significantly than those in control side. There was no influence on fibrillation potential amplitude in the both sides after electric stimulation. The reduction rates of Na(+)-K(+)-ATPase activity in the experimental side were slower 15.59% and 27.38% respectively than those in the control side. The reduction rates of Ca(2+)-ATPase activity in the experimental side were slower 4.83% and 21.64% respectively than those in the control side. CONCLUSION: The electric stimulation can protect muscle histology, electrophysiology and enzymic histochemistry of denervated skeletal muscle from the degeneration. The electric stimulation is an effective method to prevent and treat muscle atrophy.
This paper aims to explore the effect of electrical stimulation of triboelectric nanogenerators (TENGs) on the osteogenic and other biological behaviors of mouse embryonic osteoblast precursor cells (MC3T3-E1 cells) on titanium surfaces. First, an origami-type TENG was fabricated, and its electrical output performance was tested. The optimal current of the generator and the feasibility of the experiment were verified by the CCK-8 assay and scratch assay. At the optimal current, the osteogenic conditions of the cells in each group were determined by quantitative analysis of the total protein content, alkaline phosphatase (ALP) activity, and alizarin red staining (ARS) on the titanium surface. Finally, the adhesion and spreading of cells on the titanium surface after electrical stimulation were observed. The results showed that the TENG had good electrical output performance, with an open-circuit voltage of 65 V and a short-circuit current of 42 μA. Compared with the rest of the current, a current strength of 30 μA significantly improved cell proliferation and migration, osteogenesis, and adhesion and spreading capabilities. The above results confirm the safety and operability of TENG in biomedical applications, laying the foundation for future TENG applications in reducing the time of bone integration around titanium implants after surgery.
In order to enhance the therapeutic effectiveness of peripheral nerve injury, intraoperative extrab electrical stimulation was used in peripheral nerve surgery. In 16 cases of incomplete peripheral rnerve injuries or poorly regeneratedn erves, continuous intraoperative electrophysiological monitoring was used for guidance of neurolysis. Meanwhile, extrastong electrical stimulation was applied. The latency and amplitude before and after electrical stimulation were recorded and the extent of improrement was compared. In all cases, the latency and amplitude were improved after neurolysis and electrical stimulation. Clinical follow-up also showed that the function of corresponding innorvated muscle was improved. Continuous intraoperative extrab electrical stimulation could be used as an practical measure to increase the effectiveness of peripheral nerve treatment.
We studied the influence of electrode array parameters on temperature distribution to the retina during the use of retinal prosthesis in order to avoid thermal damage to retina caused by long-term electrical stimulation. Based on real epiretinal prosthesis, a three-dimensional model of electrical stimulation for retina with 4×4 microelectrode array had been established using the finite element software (COMSOL Multiphysics). The steady-state temperature field of electrical stimulation of the retina was calculated, and the effects of the electrode parameters such as the distance between the electrode contacts, the materials and area of the electrode contact on temperature field were considered. The maximum increase in the retina steady temperature was about 0.004℃ with practical stimulation current. When the distance between the electrode contacts was changed from 130 μm to 520 μm, the temperature was reduced by about 0.006℃. When the contact radius was doubled from 130 μm to 260 μm, the temperature decrease was about 0.005℃. It was shown that there were little temperature changes in the retina with a 4×4 epiretinal microelectrode array, reflecting the safety of electrical stimulation. It was also shown that the maximum temperature in the retina decreased with increasing the distance between the electrode contacts, as well as increasing the area of electrode contact. However, the change of the maximum temperature was very small when the distance became larger than the diameter of electrode contact. There was no significant difference in the effects of temperature increase among the different electrode materials. Rational selection of the distance between the electrode contacts and their area in electrode design can reduce the temperature rise induced by electrical stimulation.
Existing neuroregulatory techniques can achieve precise stimulation of the whole brain or cortex, but high-focus deep brain stimulation has been a technical bottleneck in this field. In this paper, based on the theory of negative permeability emerged in recent years, a simulation model of magnetic replicator is established to study the distribution of the induced electric field in the deep brain and explore the possibility of deep focusing, which is compared with the traditional magnetic stimulation method. Simulation results show that a single magnetic replicator realized remote magnetic source. Under the condition of the same position and compared with the traditional method of stimulating, the former generated smaller induced electric field which sharply reduced with distance. By superposition of the magnetic field replicator, the induced electric field intensity could be increased and the focus could be improved, reducing the number of peripheral wires while guaranteeing good focus. The magnetic replicator model established in this paper provides a new idea for precise deep brain stimulation, which can be combined with neuroregulatory techniques in the future to lay a foundation for clinical application.