Effects of Translumbosacral Neuromodulation Therapy on Gut and Brain Interactions and Anorectal Neuropathy in Fecal Incontinence: A Randomized Study.
Effects of Translumbosacral Neuromodulation Therapy on Gut and Brain Interactions and Anorectal Neuropathy in Fecal Incontinence: A Randomized Study.
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DOI：
10.1111/ner.13485
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Hamdy S
中科院分区：
文献类型：
--
作者：
Rao SSC;Yan Y;Xiang X;Sharma A;Ayyala D;Hamdy S
经腰骶神经调节疗法(TNT)可改善大便失禁(FI)的症状，但其作用机制尚不清楚。我们验证了这样的假设，即一个或多个频率的TNT将通过调节肠道和脑轴的上行和/或下行信号通路以及肛门直肠感觉运动功能来显着改善FI的潜在病理生理学。我们评估了FI受试者在电刺激肛门直肠后的传入肛门-直肠皮质诱发电位(CEP)，经颅磁刺激和腰椎磁刺激后的传出皮质-肛门直肠和臀部-肛门直肠运动诱发电位(MEP)，以及每周6次TNT治疗前后的肛门直肠测压，随机分为1 Hz、5 Hz和15 Hz重复磁刺激。比较神经生理学、肛门直肠感觉运动功能和症状，以检查机制的影响。共同的主要措施是无皮质CEP、皮质-肛门MEP和腰骶部-肛门MEP。基线和治疗后数据比较采用Wilcoxon符号等级检验，三个频率之间的变化比较采用单因素方差分析。33名FI患者参与了研究。TNT后，1赫兹组的传入肛门诱发电位潜伏期较基线(p=0.0029)、5赫兹或15赫兹组(p=0.032)显著缩短。皮质-肛门MEP在三组中均无变化。与基线相比，1赫兹、15赫兹和5赫兹时，双侧腰肛门和骶管MEP潜伏期显著缩短，但无统计学差异。与其他两组相比，1赫兹组的肛门挤压括约肌压力(p<；0.005)和最大耐受量(p<；0.019)显著增加，FI反应率(p<；0.04)也较高。在1 Hz组中，MEP反应与FI反应显著相关(p=0.006)。TNT可显著改善传入大脑皮层信号、传出的腰、肛门神经病变和肛门直肠感觉运动功能。这些神经生物学效应在1赫兹频率下最为显著。TNT通过改变潜在的病理生理学，可能是通过神经调节来改善FI。
Translumbosacral neuromodulation therapy (TNT) improves symptoms of fecal incontinence (FI), but its mechanism of action is unknown. We tested the hypothesis that TNT at one or more frequency will significantly improve underlying pathophysiology of FI through modulation of ascending and/or descending signaling pathways in the gut and brain axis and anorectal sensorimotor function. We assessed afferent anorectal-cortical evoked potentials (CEP) following electrical stimulation of anorectum, efferent cortico-anorectal and lumbo-anorectal and sacro-anorectal motor evoked potentials (MEP) after transcranial and lumbosacral magnetic stimulations, and anorectal manometry before and after six weekly TNT sessions in FI subjects, randomized to 1 Hz, 5 Hz or 15 Hz repetitive magnetic stimulations. Neurophysiology, anorectal sensorimotor function and symptoms were compared to examine mechanistic effects. Co-primary measures were ano-cortical CEPs, cortico-anal MEPs and lumbosacral-anal MEPs. Baseline and post-treatment data were compared with Wilcoxon signed-rank test and changes between the three frequencies with one-way ANOVA. Thirty-three FI patients participated. After TNT, the afferent anal CEP latencies significantly decreased in the 1 Hz group compared to baseline (p=0.0029) and 5 Hz or 15 Hz groups (p=0.032). Cortico-anal MEPs were unchanged in all three groups. Bilateral lumbo-anal and sacro-anal MEP latencies significantly decreased with 1 Hz, lumbo-anal with 15 Hz and sacro-anal with 5 Hz compared to baseline, but without group differences. The 1 Hz group showed significant increase in anal squeeze sphincter pressure (p<0.005) and maximum tolerable volume (p<0.019) and demonstrated higher FI responder rate (p<0.04) compared to the other two groups. The MEP responders were significantly correlated with FI responders (p=0.006) in 1 Hz group. TNT significantly improves afferent ano-cortical signaling, efferent lumbo-anal and sacro-anal neuropathy and anorectal sensorimotor function. These neurobiologic effects were most prominent with 1 Hz frequency. TNT improves FI by modifying the underlying pathophysiology possibly through neuromodulation.
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影响因子：
3.7
作者：
Leung, Felix W.;Rao, Satish S. C.
通讯作者：
Rao, Satish S. C.
影响因子：
3.4
作者：
Mundet L;Rofes L;Ortega O;Cabib C;Clavé P
通讯作者：
Clavé P
影响因子：
3.5
作者：
Harris, M. L.;Singh, S.;Hamdy, S.
通讯作者：
Hamdy, S.
影响因子：
29.4
作者：
Rao, Satish S. C.;Bharucha, Adil E.;Wald, Arnold
通讯作者：
Wald, Arnold
影响因子：
7.7
作者：
Perera T;George MS;Grammer G;Janicak PG;Pascual-Leone A;Wirecki TS
通讯作者：
Wirecki TS