Trigeminal nerve stimulation: a current state-of-the-art review.
Trigeminal nerve stimulation: a current state-of-the-art review.
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三叉神经刺激：当前最先进的回顾。
DOI：
10.1186/s42234-023-00128-z
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发表时间：
2023-12-13
影响因子：
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通讯作者：
Li, Chunyan
中科院分区：
文献类型：
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作者：
Powell, Keren;Lin, Kanheng;Tambo, Willians;Saavedra, Andrea Palomo;Sciubba, Daniel;Al Abed, Yousef;Li, Chunyan
近50年前，首次观察到三叉神经刺激（TNS）对脑血流的影响。这一暗示直接导致了进一步的研究和TNS作为治疗干预的成功。TNS具有与关键脑和脑干区域的独特连接，已观察到其调节脑血管舒张、脑代谢、脑自动调节、脑和全身炎症以及自主神经系统。独特的作用范围使其成为主要的治疗方式，并导致其在慢性疾病如偏头痛，长期意识障碍和抑郁症中的临床应用。本文旨在对TNS的研究及其更广泛的治疗潜力进行全面概述。出于本综述的目的，检索了PubMed和Google Scholar从开始到2023年8月28日的数据，共识别出89项临床和临床前相关研究。TNS利用血管活性神经肽的释放、神经传递的调节和对自主神经系统的直接作用来产生一套强大的多靶点治疗效果。虽然TNS已在临床上应用于慢性病理条件，这些强大的影响，最近显示出巨大的潜力，在一些急性/创伤性病理。然而，仍然有关键的机制和方法学知识的差距，以解决TNS在更广泛的临床环境中的可行的治疗选择。这些包括双峰或矛盾的影响和机制，关于其在急性/创伤条件下的安全性的问题，更有选择性的刺激方法的发展，以避免潜在的适应不良的影响，以及其连接到潜水反射，三叉神经介导的保护性内源性反射。这些问题的解决可以克服目前的局限性，并允许TNS在治疗上应用于无数的病理学，因此它现在正处于成为突破性治疗方式的边缘。
Nearly 5 decades ago, the effect of trigeminal nerve stimulation (TNS) on cerebral blood flow was observed for the first time. This implication directly led to further investigations and TNS’ success as a therapeutic intervention. Possessing unique connections with key brain and brainstem regions, TNS has been observed to modulate cerebral vasodilation, brain metabolism, cerebral autoregulation, cerebral and systemic inflammation, and the autonomic nervous system. The unique range of effects make it a prime therapeutic modality and have led to its clinical usage in chronic conditions such as migraine, prolonged disorders of consciousness, and depression. This review aims to present a comprehensive overview of TNS research and its broader therapeutic potentialities. For the purpose of this review, PubMed and Google Scholar were searched from inception to August 28, 2023 to identify a total of 89 relevant studies, both clinical and pre-clinical. TNS harnesses the release of vasoactive neuropeptides, modulation of neurotransmission, and direct action upon the autonomic nervous system to generate a suite of powerful multitarget therapeutic effects. While TNS has been applied clinically to chronic pathological conditions, these powerful effects have recently shown great potential in a number of acute/traumatic pathologies. However, there are still key mechanistic and methodologic knowledge gaps to be solved to make TNS a viable therapeutic option in wider clinical settings. These include bimodal or paradoxical effects and mechanisms, questions regarding its safety in acute/traumatic conditions, the development of more selective stimulation methods to avoid potential maladaptive effects, and its connection to the diving reflex, a trigeminally-mediated protective endogenous reflex. The address of these questions could overcome the current limitations and allow TNS to be applied therapeutically to an innumerable number of pathologies, such that it now stands at the precipice of becoming a ground-breaking therapeutic modality.