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: 10623142
• 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/10623142
• 关键词: Accidents; Acute; Aging; Anal canal; Anesthesia procedures; Animals; Behavior Therapy; Bladder; Caring; Catheters; Cauda Equina; Cerebral cortex; Chronic; Colon; Colorectal; Constipation; Contracts; Data; Defecation; Development; Devices; Diabetes Mellitus; Diet Modification; Disease; Distal; Dorsal; Elderly; Electric Stimulation; Electrodes; Ensure; Experimental Designs; 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; Relaxation; 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; combat trauma; detrusor underactivity; effective therapy; experience; falls; flexibility; iatrogenic injury; male; motor neuron injury; nerve injury; nerve transection; neural; neural stimulation; rectal; rectum/anus; response; spinal reflex; spine bone structure; success; 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.

脊柱创伤导致的骶骨或马尾损伤导致神经源性下运动神经元损伤 肠道疾病（LMNI-NBD）。由于骶骨副交感神经对远端的推进控制减少， 结肠平滑肌和阴部体运动控制肛门外括约肌，储存 直肠和肛门的排泄功能被破坏。这导致肠收缩功能减退， 括约肌，表现为便秘和大便失禁， 排便和失禁，增加使用口服药物和饮食调整， 肠道护理，增加排便时间和使用瓦尔萨尔瓦动作， 排便是目标。症状，治疗和行为改变的星座， 缺乏有效治疗显著降低了LMNI患者的生活质量， NBD。 我们最近已经证明了在平行的骨盆存储中施加功能控制的能力， 释放系统，下尿路，在不完全LMNI的条件下。我们的模式是 单侧节前盆腔神经切断，可能由盆腔手术或创伤引起。在这 模型的神经源性膀胱活动不足与逼尿肌活动不足，我们证明了按需 使用近端出口（尿道）神经刺激的排尿功能，激活正反馈信号 疏散。由于已知这些机制存在于肛门直肠控制系统中，我们 假设该方法也可用于通过局部电刺激治疗LMNI-NBD 肛管反射通路在不完全LMNI患者中的作用。