Brief post-surgical electrical stimulation accelerates axon regeneration and muscle reinnervation without affecting the functional measures in carpal tunnel syndrome patients
Brief post-surgical electrical stimulation accelerates axon regeneration and muscle reinnervation without affecting the functional measures in carpal tunnel syndrome patients
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DOI：
10.1016/j.expneurol.2009.09.020
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发表时间：
2010-05-01
影响因子：
5.3
通讯作者：
Chan, K. Ming
中科院分区：
文献类型：
--
作者：
Gordon, Tessa;Amirjani, Nasim;Chan, K. Ming
电刺激损伤的周围神经可加速实验动物的轴突再生。然而，这种干预的临床适用性从未在人类受试者中进行过调查。这项先导性研究的目的是确定ES对腕管正中神经受压患者术后轴突再生的影响，这些患者导致明显的运动性轴突丢失。一项随机对照试验为ES诱导人类患者轴突再生的加速提供了原理证据。刺激组行心包隧道松解术(CTRS)，在手术减压部位正中神经近端放置不锈钢电极丝，即刻进行1 h 20 Hz双极电刺激。每隔一段时间对受试者进行为期一年的跟踪调查。轴突再生通过运动单位数估计(MUNE)和感觉神经和运动神经传导研究进行量化。使用普渡钉板测试、Semmes Weinstein单丝和Levine的自我评估问卷评估功能恢复情况。刺激组术后6~8个月有明显的轴突再生，MUNE由基线时的150+/-62MU增加到290+/-140(平均+/-SD)运动单位(P0.2)。终末运动潜伏期在刺激组显著延长，而对照组未见明显延长(p>；0.1)。刺激组的感觉神经传导值改善明显早于对照组。其他结果测量结果显示，两组患者的情况都有显著改善。我们的结论是，短暂的低频ES加速了人类轴突的再生和靶神经的再支配。(C)2009 Elsevier Inc.保留所有权利。
Electrical stimulation (ES) of injured peripheral nerves accelerates axonal regeneration in laboratory animals. However, clinical applicability of this intervention has never been investigated in human subjects. The aim of this pilot study was to determine the effect of ES on axonal regeneration after surgery in patients with median nerve compression in the carpal tunnel causing marked motor axonal loss. A randomized control trial was conducted to provide proof of principle for ES-induced acceleration of axon regeneration in human patients. Carpel tunnel release surgery (CTRS) was performed and in the stimulation group of patients, stainless steel electrode wires placed alongside the median nerve proximal to the surgical decompression site for immediate 1 h 20 Hz bipolar ES. Subjects were followed for a year at regular intervals. Axonal regeneration was quantified using motor unit number estimation (MUNE) and sensory and motor nerve conduction studies. Purdue Pegboard Test, Semmes Weinstein Monofilaments, and Levine's Self-Assessment Questionnaire were used to assess functional recovery. The stimulation group had significant axonal regeneration 6-8 months after the CTRS when the MUNE increased to 290 +/- 140 (mean +/- SD) motor units (MU) from 150 +/- 62 MU at baseline (p0.2). Terminal motor latency significantly accelerated in the stimulation group but not the control group (p>0.1). Sensory nerve conduction values significantly improved in the stimulation group earlier than the controls. Other outcome measures showed a significant improvement in both patient groups. We conclude that brief low frequency ES accelerates axonal regeneration and target reinnervation in humans. (C) 2009 Elsevier Inc. All rights reserved.