Neurostimulation for lower motor neuron bowel syndrome due to incomplete lower motor neuron injury

神经刺激治疗因不完全下运动神经元损伤引起的下运动神经元肠综合征

• 批准号: 10368668
• 负责人: MATTHEW O FRASER
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10368668
• 关键词: Accidents; Acute; Aging; Anal canal; Animals; Behavior Therapy; Bladder; Caring; Catheters; Cauda Equina; Cerebrum; Chronic; Colon; Colorectal; Constipation; Contracts; Data; Defecation; Development; Devices; Diabetes Mellitus; Diet Modification; Disease; Distal; Dorsal; Elderly; Electric Stimulation; Electrodes; Ensure; Equus caballus; External anal sphincter structure; Fecal Incontinence; Feedback; Female; First lumbar vertebra; Frequencies; Functional disorder; Goals; Health; Hyperreflexia; Hyporeflexia; Implant; Incontinence; Injury; Interruption; Intestines; Isoflurane; Laminectomy; Lesion; Lower urinary tract; Manometry; Methods; Military Personnel; Modeling; Morbidity - disease rate; Motor Neurons; Multiple Sclerosis; Operative Surgical Procedures; Oral; Pathway interactions; Patients; Pelvis; Peripheral nerve injury; Pharmaceutical Preparations; Quality of life; Rattus; Rectum; Reflex action; Sacral spinal cord structure; Signal Transduction; Smooth Muscle; Sphincter; Spinal Cord; Spinal Injuries; Spinal cord injury; Spinal nerve root structure; Stroke; Symptoms; Syndrome; System; Testing; Therapeutic; Thinness; Time; Trauma; Urethane; Urethra; Valsalva Maneuver; Veterans; advanced disease; base; combat trauma; design; detrusor underactivity; effective therapy; experience; experimental study; falls; flexibility; iatrogenic injury; male; motor neuron injury; nerve injury; nerve transection; neural stimulation; rectal; rectum/anus; relating to nervous system; response; spinal reflex; spine bone structure; success; symptom treatment; young adult

Sacral or cauda equinal injury due to spinal trauma results in lower motor neuron injury neurogenic bowel disorder (LMNI-NBD). Due to decreased sacral parasympathetic propulsive control of the distal colonic smooth muscle and pudendal somatomotor control of the external anal sphincter, the storage and release function of the rectum and anus are disrupted. This results in a hypocontractile bowel and sphincter, which manifests as constipation and fecal incontinence, with increased frequency of defecation and incontinence, increased use of oral medications and dietary modifications directed toward bowel care, and increased time for defecation and use of the Valsalva maneuver when defecation is the goal. The constellation of symptoms, treatments and behavioral modifications with lack of effective treatments contribute dramatically to reduction in quality of life for patients with LMNI- NBD. We have recently demonstrated the ability to impose control of function in a parallel pelvic storage and release system, the lower urinary tract, under conditions of incomplete LMNI. Our model was that of unilateral preganglionic pelvic nerve transection, as might result from pelvic surgery or trauma. In this model of neurogenic underactive bladder with detrusor underactivity, we demonstrated on-demand voiding function using proximal outlet (urethra) neural stimulation, activating positive feedback signals for evacuation. As such mechanisms are known to exist within the anorectal control system, we hypothesize that this approach may also be employed to treat LMNI-NBD by local electrical stimulation of anal canal reflex pathways in patients with incomplete LMNI.

脊髓损伤致下运动神经元损伤致神经源性损伤 肠道疾病(LMNI-NBD)。由于骶骨远端副交感神经推进控制减弱 结肠平滑肌和阴部外括约肌的运动控制，存储 直肠和肛门的释放功能被破坏。这会导致肠道收缩减退， 括约肌，表现为便秘和大便失禁，频率增加 排便和大小便失禁，增加口服药物的使用和指导饮食调整 肠道护理，增加排便时间，并在下列情况下使用瓦尔萨尔瓦手法 排便是目标。症状、治疗和行为调整的星座 缺乏有效的治疗极大地降低了LMNI患者的生活质量- NBD。 我们最近已经证明了在平行的骨盆储存和治疗中施加功能控制的能力 在LMNI不完全的情况下，下尿路的释放系统。我们的模型是 单侧神经节前盆腔神经切断，可能是骨盆手术或创伤造成的。在这 神经源性逼尿肌活动不足模型的建立 利用近端出口(尿路)神经刺激的排尿功能，激活正反馈信号 用于疏散。由于这种机制已知存在于肛门直肠控制系统中，我们 假设此方法也可用于局部电刺激治疗LMNI-NBD 不完全性LMNI患者的肛管反射通路。