An emerging method to noninvasively measure and identify vagal response markers to enable bioelectronic control of gastroparesis symptoms with gastric electrical stimulation.
An emerging method to noninvasively measure and identify vagal response markers to enable bioelectronic control of gastroparesis symptoms with gastric electrical stimulation.
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DOI：
10.1016/j.jneumeth.2020.108631
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发表时间：
2020-04-15
影响因子：
3
通讯作者：
Nowak TV
中科院分区：
文献类型：
--
作者：
Ward MP;Gupta A;Wo JM;Rajwa B;Furness JB;Powley TL;Nowak TV
胃电刺激（GES）可以是一种改变生活的基于器械的治疗选择，用于治疗与糖尿病或特发性胃轻瘫（GP）相关的耐药性恶心和呕吐。尽管临床使用了二十多年，但其作用机制仍不清楚。我们假设存在迷走神经机制。在这里，我们描述了一种非侵入性的方法来调查迷走神经参与GES治疗66人受试者通过复合神经动作电位（CNAP）。在66名受试者中，28名患有糖尿病GP，35名患有特发性GP，3名患有手术后GP。每脉冲刺激电荷不能预测治疗效果，但可以预测1型糖尿病患者的总症状评分随着GES刺激电荷的增加而显著增加（p < 0.01），这代表了一种显著的副作用，并提供了一种识别方法。迷走神经反应增加与总症状评分显著降低相关（p < 0.05）。我们已经开发了颈部迷走神经活动的经皮记录，该记录与清醒人类受试者的GES同步，沿着的是区分不同神经纤维组的活动的方法，这些神经纤维组的活动与传导速度和治疗反应有关。皮肤迷走神经CNAP分析是揭示GES参数、迷走神经募集、疗效和副作用管理之间关系的有用技术。我们的研究结果表明，CNAP指导的GES优化将为特发性和1型糖尿病胃轻瘫患者提供最大的获益。
Gastric electrical stimulation (GES) can be a life-changing, device-based treatment option for drug-resistant nausea and vomiting associated with diabetic or idiopathic gastroparesis (GP). Despite over two decades of clinical use, the mechanism of action remains unclear. We hypothesize a vagal mechanism. Here, we describe a noninvasive method to investigate vagal nerve involvement in GES therapy in 66 human subjects through the compound nerve action potential (CNAP). Of the 66 subjects, 28 had diabetic GP, 35 had idiopathic GP, and 3 had postsurgical GP. Stimulus charge per pulse did not predict treatment efficacy, but did predict a significant increase in total symptom score in type 1 diabetics as GES stimulus charge per pulse increased (p < 0.01), representing a notable side effect and providing a method to identify it. In contrast, the number of significant left and right vagal fiber responses that were recorded directly related to patient symptom improvement. Increased vagal responses correlated with significant decreases in total symptom score (p < 0.05). We have developed transcutaneous recording of cervical vagal activity that is synchronized with GES in conscious human subjects, along with methods of discriminating the activity of different nerve fiber groups with respect to conduction speed and treatment response. Cutaneous vagal CNAP analysis is a useful technique to unmask relationships among GES parameters, vagal recruitment, efficacy and side-effect management. Our results suggest that CNAP-guided GES optimization will provide the most benefit to patients with idiopathic and type 1 diabetic gastroparesis.
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