RESUMO
Stem cell transplantation has shown promising regenerative effects against neural injury, and photobiomodulation (PBM) can aid tissue recovery. This study aims to evaluate the therapeutic effect of human umbilical cord mesenchymal stem cells (hUCMSCs) and laser alone or combined on spinal cord injury (SCI). The animals were divided into SCI, hUCMSCs, laser treatment (LASER) and combination treatment (hUCMSCs + LASER) groups. Cell-enriched grafts of hUCMSCs (1 × 106 cells/ml) were injected at the site of antecedent trauma in SCI model rats. A 2 cm2 damaged area was irradiated with 630 nm laser at 100 mW/cm2 power for 20 min. Locomotion was evaluated using Basso-Beattie-Bresnahan (BBB) scores, and neurofilament repair were monitored by histological staining and diffusion tensor imaging (DTI). First, after SCI, the motor function of each group was restored with different degrees, the combination treatment significantly increased the BBB scores compared to either monotherapy. In addition, Nissl bodies were more numerous, and the nerve fibers were longer and thicker in the combination treatment group. Consistent with this, the in situ expression of NF-200 and glial fibrillary acidic protein in the damaged area was the highest in the combination treatment group. Finally, DTI showed that the combination therapy optimally improved neurofilament structure and arrangement. These results may show that the combination of PBM and hUCMSCs transplantation is a feasible strategy for reducing secondary damage and promoting functional recovery following SCI.
Assuntos
Células-Tronco Mesenquimais/fisiologia , Traumatismos da Medula Espinal/radioterapia , Traumatismos da Medula Espinal/terapia , Animais , Diferenciação Celular/efeitos da radiação , Células Cultivadas , Imagem de Tensor de Difusão/métodos , Humanos , Filamentos Intermediários/efeitos da radiação , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Transplante de Células-Tronco Mesenquimais/métodos , Atividade Motora/efeitos da radiação , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica/efeitos da radiação , Medula Espinal/efeitos da radiação , Cordão Umbilical/efeitos da radiaçãoRESUMO
The translation of new therapies for spinal cord injury to clinical trials can be facilitated with large animal models close in morpho-physiological scale to humans. Here, we report functional restoration and morphological reorganization after spinal contusion in pigs, following a combined treatment of locomotor training facilitated with epidural electrical stimulation (EES) and cell-mediated triple gene therapy with umbilical cord blood mononuclear cells overexpressing recombinant vascular endothelial growth factor, glial-derived neurotrophic factor, and neural cell adhesion molecule. Preliminary results obtained on a small sample of pigs 2 months after spinal contusion revealed the difference in post-traumatic spinal cord outcomes in control and treated animals. In treated pigs, motor performance was enabled by EES and the corresponding morpho-functional changes in hind limb skeletal muscles were accompanied by the reorganization of the glial cell, the reaction of stress cell, and synaptic proteins. Our data demonstrate effects of combined EES-facilitated motor training and cell-mediated triple gene therapy after spinal contusion in large animals, informing a background for further animal studies and clinical translation.
Assuntos
Terapia por Estimulação Elétrica , Fator Neurotrófico Derivado de Linhagem de Célula Glial/genética , Moléculas de Adesão de Célula Nervosa/genética , Traumatismos da Medula Espinal/terapia , Fator A de Crescimento do Endotélio Vascular/genética , Adenoviridae/genética , Animais , Terapia Baseada em Transplante de Células e Tecidos/métodos , Modelos Animais de Doenças , Espaço Epidural , Terapia Genética/métodos , Vetores Genéticos/uso terapêutico , Fator Neurotrófico Derivado de Linhagem de Célula Glial/uso terapêutico , Humanos , Atividade Motora/genética , Atividade Motora/fisiologia , Moléculas de Adesão de Célula Nervosa/uso terapêutico , Neuroglia/transplante , Recuperação de Função Fisiológica/genética , Recuperação de Função Fisiológica/efeitos da radiação , Medula Espinal/fisiopatologia , Medula Espinal/efeitos da radiação , Traumatismos da Medula Espinal/genética , Traumatismos da Medula Espinal/fisiopatologia , Suínos/genética , Fator A de Crescimento do Endotélio Vascular/uso terapêuticoAssuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Capecitabina/efeitos adversos , Carcinoma/secundário , Mielite/etiologia , Radiodermite/etiologia , Radioterapia Adjuvante/efeitos adversos , Neoplasias da Coluna Vertebral/secundário , Vértebras Torácicas , Antimetabólitos Antineoplásicos/uso terapêutico , Antineoplásicos Fitogênicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Capecitabina/uso terapêutico , Carcinoma/tratamento farmacológico , Carcinoma/radioterapia , Carcinoma/cirurgia , Terapia Combinada , Docetaxel/uso terapêutico , Substituição de Medicamentos , Feminino , Humanos , Oxigenoterapia Hiperbárica , Letrozol/uso terapêutico , Pessoa de Meia-Idade , Mielite/induzido quimicamente , Mielite/diagnóstico por imagem , Mielite/terapia , Miosite/diagnóstico por imagem , Miosite/etiologia , Prednisolona/uso terapêutico , Radiodermite/induzido quimicamente , Radiodermite/diagnóstico por imagem , Radiodermite/terapia , Medula Espinal/efeitos da radiação , Neoplasias da Coluna Vertebral/radioterapiaRESUMO
Neuropathic pain is characterized by an uncertain etiology and by a poor response to common therapies. The ineffectiveness and the frequent side effects of the drugs used to counteract neuropathic pain call for the discovery of new therapeutic strategies. Laser therapy proved to be effective for reducing pain sensitivity thus improving the quality of life. However, its application parameters and efficacy in chronic pain must be further analyzed. We investigated the pain relieving and protective effect of Photobiomodulation Therapy in a rat model of compressive mononeuropathy induced by Chronic Constriction Injury of the sciatic nerve (CCI). Laser (MLS-MiS) applications started 7 days after surgery and were performed ten times over a three week period showing a reduction in mechanical hypersensitivity and spontaneous pain that started from the first laser treatment until the end of the experiment. The ex vivo analysis highlighted the protective role of laser through the myelin sheath recovery in the sciatic nerve, inhibition of iNOS expression and enhancement of EAAT-2 levels in the spinal cord. In conclusion, this study supports laser treatment as a future therapeutic strategy in patients suffering from neuropathic pain induced by trauma.
Assuntos
Lasers , Terapia com Luz de Baixa Intensidade/métodos , Bainha de Mielina/efeitos da radiação , Neuralgia/radioterapia , Animais , Comportamento Animal , Transportador 2 de Aminoácido Excitatório/metabolismo , Hiperalgesia/complicações , Inflamação , Masculino , Proteína Básica da Mielina/metabolismo , Óxido Nítrico Sintase Tipo II/antagonistas & inibidores , Limiar da Dor , Pressão , Qualidade de Vida , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/lesões , Medula Espinal/efeitos da radiaçãoRESUMO
BACKGROUND: Multiple sclerosis (MS) is an autoimmune disease, for which the forms of treatment are medication and rehabilitation. However, in vitro and in vivo studies have demonstrated that photobiomodulation can be an effective treatment modality for inflammatory diseases, including MS. Photobiomodulation has a broad range of benefits, such as the avoidance of cell and tissue death, the stimulation of healing and injury repair, reductions in pain, edema and inflammation, cell proliferation, and even apoptosis. The outcomes of photobiomodulation include the regeneration of cells, the stimulation of the growth of Schwann cells, a reduction in spasticity, functional improvements, a reduction in nitric oxide levels, and the upregulation of the cytokine IL10, demonstrating that this therapeutic modality can offer neuroprotection. METHODS: A randomized, controlled, double-blind, clinical trial is proposed. The patients will be divided into 6 groups. Groups 1 and 2 will receive sham and active photobiomodulation in the sublingual region, respectively. Groups 3 and 4 will receive sham and active photobiomodulation along the spinal cord, respectively. Group 5 will receive placebo treatment with photobiomodulation on the skin in the region of the radial artery with a specific bracelet. Group 6 will be treated with photobiomodulation on the skin in the region of the radial artery. DISCUSSION: Treatment for MS is directed at the immune response and slowing the progression of the disease. This is one of the first clinical trials involving photobiomodulation in the sublingual region and along the spinal cord, which could help establish a promising new form of nonpharmacological treatment for autoimmune diseases. This is one of the first clinical trials with sublingual photobiomodulation and along the spinal cord that could help establish a new form of promising treatment of the disease associated with pharmacological treatment.
Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Esclerose Múltipla , Método Duplo-Cego , Humanos , Inflamação/imunologia , Monitorização Fisiológica/métodos , Soalho Bucal/efeitos da radiação , Esclerose Múltipla/imunologia , Esclerose Múltipla/terapia , Estresse Oxidativo/efeitos da radiação , Projetos de Pesquisa , Medula Espinal/efeitos da radiaçãoRESUMO
Although it is well known that migraine pain is enhanced by photic stimulation of the eye, the mechanisms underlying this response are not yet understood. Noxious stimulation to the dura is known to activate trigeminal spinal subnucleus caudalis and upper cervical spinal cord (Vc/C1) neurons, causing migraine pain. Intense photic stimulation to the eye is also known to activate certain Vc/C1 neurons, thus increasing migraine pain. In this study, we hypothesized that Vc/C1 neurons receiving noxious dural input would be further activated by intense photic stimulation, resulting in the enhancement of migraine pain. However, mechanisms underlying the interactions between dural and photic sensory information in Vc/C1 neurons is unknown. To evaluate the above hypothesis, we studied phosphorylated extracellular signal-regulated kinase (pERK) -immunoreactive (IR) cells in Vc/C1 in dural mustard oil (DMO)-administrated rats. The change in neuronal excitability of Vc/C1 nociceptive neurons receiving input from the dura in DMO rats was examined and tested if those neurons were modulated by intense flush light stimulation. There were many pERK-IR cells in the lateral portion of Vc/C1 after MO administration to the dura. Flashlight presentation to the eye in DMO rats caused an enhancement of ERK phosphorylation in Vc/C1 neurons and pERK-IR cells were significantly suppressed after intracisternal administration of MEK1 inhibitor PD98059. Dura-light sensitive (DL) neurons were recorded in the lateral portion of Vc/C1 and photic responses of DL neurons were significantly enhanced following dural MO administration. These findings indicate that DL Vc/C1 neurons in DMO rats intensified their responses to intense photic stimulation and that ERK phosphorylation in Vc/C1 neurons receiving noxious dural input increased with intense photic stimulation, suggesting that Vc/C1 nociceptive neurons are involved in the enhancement of dural nociception associated with intense light stimulation.
Assuntos
MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Luz , Transtornos de Enxaqueca/metabolismo , Neurônios/metabolismo , Medula Espinal/metabolismo , Núcleo Inferior Caudal do Nervo Trigêmeo/metabolismo , Animais , Masculino , Transtornos de Enxaqueca/patologia , Mostardeira , Nociceptores/metabolismo , Fosforilação , Estimulação Luminosa , Óleos de Plantas/farmacologia , Ratos Sprague-Dawley , Medula Espinal/patologia , Medula Espinal/efeitos da radiação , Núcleo Inferior Caudal do Nervo Trigêmeo/patologia , Núcleo Inferior Caudal do Nervo Trigêmeo/efeitos da radiaçãoRESUMO
BACKGROUND: The development of hypersensitivity following spinal cord injury can result in incurable persistent neuropathic pain. Our objective was to examine the effect of red light therapy on the development of hypersensitivity and sensorimotor function, as well as on microglia/macrophage subpopulations following spinal cord injury. METHODS: Wistar rats were treated (or sham treated) daily for 30 min with an LED red (670 nm) light source (35 mW/cm(2)), transcutaneously applied to the dorsal surface, following a mild T10 hemicontusion injury (or sham injury). The development of hypersensitivity was assessed and sensorimotor function established using locomotor recovery and electrophysiology of dorsal column pathways. Immunohistochemistry and TUNEL were performed to examine cellular changes in the spinal cord. RESULTS: We demonstrate that red light penetrates through the entire rat spinal cord and significantly reduces signs of hypersensitivity following a mild T10 hemicontusion spinal cord injury. This is accompanied with improved dorsal column pathway functional integrity and locomotor recovery. The functional improvements were preceded by a significant reduction of dying (TUNEL(+)) cells and activated microglia/macrophages (ED1(+)) in the spinal cord. The remaining activated microglia/macrophages were predominantly of the anti-inflammatory/wound-healing subpopulation (Arginase1(+)ED1(+)) which were expressed early, and up to sevenfold greater than that found in sham-treated animals. CONCLUSIONS: These findings demonstrate that a simple yet inexpensive treatment regime of red light reduces the development of hypersensitivity along with sensorimotor improvements following spinal cord injury and may therefore offer new hope for a currently treatment-resistant pain condition.
Assuntos
Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/radioterapia , Terapia com Luz de Baixa Intensidade/métodos , Neuralgia/etiologia , Neuralgia/radioterapia , Traumatismos da Medula Espinal/complicações , Animais , Antígenos CD/metabolismo , Peso Corporal/efeitos da radiação , Cor , Modelos Animais de Doenças , Ectodisplasinas/metabolismo , Lateralidade Funcional/efeitos da radiação , Locomoção/efeitos da radiação , Macrófagos/efeitos da radiação , Masculino , Microglia/efeitos da radiação , Condução Nervosa/efeitos da radiação , Limiar da Dor/efeitos da radiação , Ratos , Ratos Wistar , Medula Espinal/efeitos da radiaçãoRESUMO
The effects of laser polarization on the efficacy of near-infrared low-level laser therapy for spinal cord injury (SCI) are presented. Rat spinal cords were injured with a weight-drop device, and the lesion sites were directly irradiated with a linearly polarized 808-nm diode laser positioned either perpendicular or parallel to the spine immediately after the injury and daily for five consecutive days. Functional recovery was assessed daily by an open-field test. Regardless of the polarization direction, functional scores of SCI rats that were treated with the 808-nm laser irradiation were significantly higher than those of SCI alone group (Group 1) from day 5 after injury. The locomotive function of SCI rats irradiated parallel to the spinal column (Group 3) was significantly improved from day 10 after injury, compared to SCI rats treated with the linear polarization perpendicular to the spinal column (Group 2). There were no significant differences in ATP contents in the injured tissue among the three groups. We speculate that the higher efficacy with parallel irradiation is attributable to the deeper light penetration into tissue with anisotropic scattering.
Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Traumatismos da Medula Espinal/terapia , Medula Espinal/patologia , Medula Espinal/efeitos da radiação , Trifosfato de Adenosina/análise , Trifosfato de Adenosina/metabolismo , Análise de Variância , Animais , Feminino , Ratos , Ratos Sprague-Dawley , Índices de Gravidade do TraumaRESUMO
BACKGROUND: Experimental autoimmune encephalomyelitis (EAE) is the most commonly studied animal model of multiple sclerosis (MS), a chronic autoimmune demyelinating disorder of the central nervous system. Immunomodulatory and immunosuppressive therapies currently approved for the treatment of MS slow disease progression, but do not prevent it. A growing body of evidence suggests additional mechanisms contribute to disease progression. We previously demonstrated the amelioration of myelin oligodendrocyte glycoprotein (MOG)-induced EAE in C57BL/6 mice by 670 nm light-induced photobiomodulation, mediated in part by immune modulation. Numerous other studies demonstrate that near-infrared/far red light is therapeutically active through modulation of nitrosoxidative stress. As nitric oxide has been reported to play diverse roles in EAE/MS, and recent studies suggest that axonal loss and progression of disability in MS is mediated by nitrosoxidative stress, we investigated the effect of 670 nm light treatment on nitrosative stress in MOG-induced EAE. METHODOLOGY: Cell culture experiments demonstrated that 670 nm light-mediated photobiomodulation attenuated antigen-specific nitric oxide production by heterogenous lymphocyte populations isolated from MOG immunized mice. Experiments in the EAE model demonstrated down-regulation of inducible nitric oxide synthase (iNOS) gene expression in the spinal cords of mice with EAE over the course of disease, compared to sham treated animals. Animals receiving 670 nm light treatment also exhibited up-regulation of the Bcl-2 anti-apoptosis gene, an increased Bcl-2:Bax ratio, and reduced apoptosis within the spinal cord of animals over the course of disease. 670 nm light therapy failed to ameliorate MOG-induced EAE in mice deficient in iNOS, confirming a role for remediation of nitrosative stress in the amelioration of MOG-induced EAE by 670 nm mediated photobiomodulation. CONCLUSIONS: These data indicate that 670 nm light therapy protects against nitrosative stress and apoptosis within the central nervous system, contributing to the clinical effect of 670 nm light therapy previously noted in the EAE model.
Assuntos
Encefalomielite Autoimune Experimental/terapia , Raios Infravermelhos/uso terapêutico , Estresse Fisiológico/efeitos da radiação , Animais , Apoptose/efeitos da radiação , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/metabolismo , Feminino , Regulação Enzimológica da Expressão Gênica/efeitos da radiação , Camundongos , Camundongos Endogâmicos C57BL , Glicoproteína Mielina-Oligodendrócito/imunologia , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo II/genética , Óxido Nítrico Sintase Tipo II/metabolismo , Fragmentos de Peptídeos/imunologia , Fototerapia , Medula Espinal/enzimologia , Medula Espinal/patologia , Medula Espinal/efeitos da radiaçãoAssuntos
Magnetoterapia/métodos , Paralisia/fisiopatologia , Paralisia/terapia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Vias Eferentes/fisiopatologia , Campos Eletromagnéticos , Humanos , Plasticidade Neuronal/fisiologia , Plasticidade Neuronal/efeitos da radiação , Medula Espinal/fisiopatologia , Medula Espinal/efeitos da radiação , Resultado do TratamentoRESUMO
Paralysis is a major consequence of spinal cord injury (SCI). After cervical SCI, respiratory deficits can result through interruption of descending presynaptic inputs to respiratory motor neurons in the spinal cord. Expression of channelrhodopsin-2 (ChR2) and photostimulation in neurons affects neuronal excitability and produces action potentials without any kind of presynaptic inputs. We hypothesized that after transducing spinal neurons in and around the phrenic motor pool to express ChR2, photostimulation would restore respiratory motor function in cervical SCI adult animals. Here we show that light activation of ChR2-expressing animals was sufficient to bring about recovery of respiratory diaphragmatic motor activity. Furthermore, robust rhythmic activity persisted long after photostimulation had ceased. This recovery was accomplished through a form of respiratory plasticity and spinal adaptation which is NMDA receptor dependent. These data suggest a novel, minimally invasive therapeutic avenue to exercise denervated circuitry and/or restore motor function after SCI.
Assuntos
Células do Corno Anterior/efeitos da radiação , Fototerapia/métodos , Respiração/efeitos da radiação , Insuficiência Respiratória/terapia , Traumatismos da Medula Espinal/terapia , Animais , Células do Corno Anterior/metabolismo , Células do Corno Anterior/fisiopatologia , Diafragma/inervação , Diafragma/fisiologia , Modelos Animais de Doenças , Feminino , Vias Neurais/metabolismo , Vias Neurais/fisiopatologia , Vias Neurais/efeitos da radiação , Plasticidade Neuronal/fisiologia , Plasticidade Neuronal/efeitos da radiação , Paralisia/metabolismo , Paralisia/fisiopatologia , Paralisia/terapia , Periodicidade , Ratos , Ratos Sprague-Dawley , Receptores de N-Metil-D-Aspartato/metabolismo , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Rodopsina/metabolismo , Rodopsina/efeitos da radiação , Medula Espinal/metabolismo , Medula Espinal/fisiopatologia , Medula Espinal/efeitos da radiação , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Resultado do TratamentoRESUMO
The objective of the study was to determine whether physical exercise combined with epidural spinal cord magnetic stimulation could improve recovery after injury of the spinal cord. Spinal cord lesioning in mice resulted in reduced locomotor function and negatively affected the muscle strength tested in vitro. Acrobatic exercise attenuated the behavioral effects of spinal cord injury. The exposure to magnetic fields facilitated further this improvement. The progress in behavioral recovery was correlated with reduced muscle degeneration and enhanced muscle contraction. The acrobatic exercise combined with stimulation with magnetic fields significantly facilitates behavioral recovery and muscle physiology in mice following spinal cord injury.
Assuntos
Terapia por Exercício/métodos , Magnetoterapia/métodos , Condicionamento Físico Animal/métodos , Recuperação de Função Fisiológica/efeitos da radiação , Traumatismos da Medula Espinal/terapia , Medula Espinal/efeitos da radiação , Animais , Modelos Animais de Doenças , Feminino , Camundongos , Atividade Motora/fisiologia , Atividade Motora/efeitos da radiação , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Debilidade Muscular/terapia , Atrofia Muscular/etiologia , Atrofia Muscular/fisiopatologia , Atrofia Muscular/terapia , Paralisia/etiologia , Paralisia/fisiopatologia , Paralisia/terapia , Recuperação de Função Fisiológica/fisiologia , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/fisiopatologiaRESUMO
OBJECTIVE: This is the first case describing an episode of acute renal failure occurring during a spinal cord stimulation trial. CLINICAL PRESENTATION: A 48-year-old male with a history of hypertension and 3 prior failed spine surgeries underwent a trial of spinal cord stimulation for uncontrolled bilateral lower extremity neuropathic pain. Two days after the placement of the percutaneous stimulator lead the patient returned complaining of 3 syncopal episodes. He was found to be hypotensive and in acute renal failure with a creatinine of 8.1 and a BUN of 83. INTERVENTION: The stimulator lead was immediately removed. The patient was admitted to the intensive care unit and responded promptly to rehydration and placement of a urinary catheter. His renal and urological work-ups revealed no significant abnormalities. CONCLUSION: The development of the episode of acute renal failure may have been influenced by the secondary effects of spinal cord stimulation. Since acute renal failure has never been associated with the use of spinal cord stimulation, this singular example does not by itself demonstrate a relationship. However, if future episodes are seen, a link between the 2 events could be drawn. For now, it is not clear if the development of this patient's acute renal failure could, in part, be attributed to the use of the spinal cord stimulator or if it was merely coincidental in nature. We do feel it is useful for the clinician to understand the pathophysiologic changes associated with spinal cord stimulation and to see how, at least in theory, there could be a connection.
Assuntos
Injúria Renal Aguda/etiologia , Terapia por Estimulação Elétrica/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/patologia , Manejo da Dor , Medula Espinal/fisiopatologia , Medula Espinal/efeitos da radiaçãoRESUMO
Spinal cord stimulation (SCS) has been a therapeutic option for chronic pain for over 40 years with a common indication being failed back surgery syndrome (FBSS). This case reports the successful implantation of a spinal cord stimulator in a patient with FBSS and kyphoscoliosis for treatment of radicular pain. Technical considerations and anatomical difficulties that may be encountered during placement with kyphoscoliosis will be discussed. This patient had failed other therapies including oral medications, epidural steroid injections, spinal surgeries, and physical and aquatic therapies. On physical examination the patient had a severely deformed lumbar spine. Careful review of the spine radiographs and CT scan revealed lead placement might be possible at the level of T12-L1 or L1-2. A Medline search did not reveal a case of kyphoscoliosis with radicular pain treated with SCS. After a successful percutaneous trial, a SCS was implanted. Fourteen weeks later, the patient reported being pain free with an increased physical activity level and opioid discontinuation. Technical considerations with kyphoscoliosis may discourage pain physicians from attempting SCS. This case illustrates that with careful selection, some of these patients may be candidates for SCS with good results.
Assuntos
Terapia por Estimulação Elétrica/métodos , Cifose/complicações , Radiculopatia/patologia , Radiculopatia/terapia , Medula Espinal/efeitos da radiação , Idoso , Feminino , Humanos , Vértebras Lombares/fisiopatologia , Vértebras Lombares/efeitos da radiação , Medição da Dor/métodos , Radiculopatia/etiologia , Medula Espinal/fisiopatologiaRESUMO
OBJECTIVES: Electrical spinal cord stimulation (SCS) is used to treat of chronic pain, obstructive arterial-related ischemia, and anginal pain. This study investigated cerebral blood perfusion, cerebrospinal fluid (CSF) catecholamine levels, and oxidative stress before and after cervical SCS in comatose patients. METHODS: We evaluated cerebral blood perfusion, catecholamine (dopamine, norepinephrine, and epinephrine) levels, and oxidative stress in 20 comatose patients before and after SCS. After SCS for six months, cerebral blood perfusion (SPECT index, 2.293 +/- 0.255 vs. 2.779 +/- 0.209, p < 0.001), dopamine (49.0 +/- 12.1 vs. 198.9 +/- 62.6, p = 0.025), and norepinephrine (197.6 +/- 62.9 vs. 379.6 +/- 52.6, p = 0.021) but not epinephrine were significantly increased. Moreover, superoxide free radicals in whole blood were significantly decreased (210,079 +/- 47,763 vs. 109,212 +/- 20,086, p = 0.011) after SCS. Nine patients recovered from the consciousness within 71-287 days. CONCLUSIONS: Increase of cerebral blood perfusion and catecholamines (dopamine and norepinephrine) in CSF after SCS was observed, whereas epinephrine level was unchanged. The superoxide free radicals were decreased after SCS. The results suggest that SCS increases cerebral blood perfusion, attenuates oxidative stress and increases biogenic amines in comatose patients.
Assuntos
Catecolaminas/líquido cefalorraquidiano , Circulação Cerebrovascular/fisiologia , Coma/terapia , Terapia por Estimulação Elétrica/métodos , Estresse Oxidativo/fisiologia , Medula Espinal/efeitos da radiação , Adulto , Vértebras Cervicais , Cromatografia Líquida de Alta Pressão/métodos , Coma/sangue , Coma/líquido cefalorraquidiano , Coma/patologia , Eletroquímica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/efeitos da radiação , Medula Espinal/fisiologia , Superóxidos/sangue , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
OBJECTIVE: Syndromes resulting from decreased cerebral blood flow and metabolic activity have significant clinical and social repercussion. However, treatment options are limited. Cervical spinal cord stimulation has shown clinical benefit in the management of several ischemic syndromes. The aim of this report was to assess the effect of cervical spinal cord stimulation on cerebral glucose metabolism. MATERIALS AND METHODS: Between April 2000 and December 2005, 16 patients with brain tumors were assessed. Before and during spinal cord stimulation, they had cerebral glucose metabolism evaluated using 18fluoro-2-deoxyglucose positron emission tomography (18FDG-PET) in the healthy cerebral hemisphere contralateral to the lesion area. RESULTS: Following cervical spinal cord stimulation, there was a significant (p<0.001) increase in glucose metabolism in healthy cerebral hemisphere. The measured increase was 37.7%, with an estimated potential maximal contribution of the first 18fluoro-2-deoxyglucose injection to the quantification of the second positron emission tomography study (carry-over effect)Assuntos
Glicemia/metabolismo
, Neoplasias Encefálicas/diagnóstico por imagem
, Neoplasias Encefálicas/terapia
, Terapia por Estimulação Elétrica
, Medula Espinal/efeitos da radiação
, Adulto
, Neoplasias Encefálicas/irrigação sanguínea
, Feminino
, Fluordesoxiglucose F18
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Tomografia por Emissão de Pósitrons/métodos
, Estudos Retrospectivos
, Medula Espinal/fisiopatologia
RESUMO
BACKGROUND: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. OBJECTIVE: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. DESIGN: Case report. METHODS: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. RESULTS: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. CONCLUSION: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back.
Assuntos
Terapia por Estimulação Elétrica , Dor Lombar/terapia , Complicações Pós-Operatórias/terapia , Medula Espinal/efeitos da radiação , Adulto , Doença Crônica , Feminino , Humanos , Falha de TratamentoRESUMO
OBJECTIVE: Several studies suggest that transcutaneous electrical stimulation (TENS) can have a variety of effects on the central nervous system (CNS). In this study, we tried to replicate the physiological effects of TENS and to explore its effects on intracortical circuits. METHODS: We used transcranial magnetic stimulation (TMS) and spinal reflex testing to examine excitability of intracortical and spinal cord circuits before and after a 30-min period of TENS over the flexor carpi radialis (FCR) muscle. We measured the amplitude of TMS-evoked muscle responses (MEP), short interval intracortical inhibition (SICI), intracortical facilitation (ICF) and cortical antagonist inhibition (CAI) in flexor and extensor carpial radialis (FCR, ECR) muscles as well as spinal reciprocal inhibition (RI) and presynaptic inhibition (PI) from ECR to FCR. RESULTS: TENS had no significant effect on any of these measures apart from a reduction in median nerve induced facilitation of FCR when testing CAI. CONCLUSIONS: When compared with previous studies, our results suggest that the effects of TENS are highly variable and unreliable, likely by the difficulty in defining precise parameters of stimulation in individual subjects. SIGNIFICANCE: Care should be taken in assuming that effects after TENS observed in small populations of subjects will apply equally to a wider population.
Assuntos
Potencial Evocado Motor/fisiologia , Estimulação Elétrica Nervosa Transcutânea , Adulto , Estimulação Elétrica/métodos , Eletromiografia/métodos , Humanos , Músculo Esquelético/fisiologia , Músculo Esquelético/efeitos da radiação , Reflexo , Reprodutibilidade dos Testes , Medula Espinal/fisiologia , Medula Espinal/efeitos da radiaçãoRESUMO
The present study investigated the role of inhibitor of protein phosphatases 1 and 2A on the modulation of the phosphorylation of the spinal N-methyl-D-aspartate receptor (NMDAR) NR1 and NR2B subunits following electroacupuncture (EA) stimulation in rats. Bilateral 2Hz EA stimulations with 1.0 mA were delivered at those acupoints corresponding to Zusanli and Sanyinjiao to men via needles for 30 min. EA analgesia was slightly reduced by the intrathecal injection of calyculin A during EA stimulation. At 60 min after the termination of EA stimulation, the levels of c-fos, serine phosphorylation of NR1 and NR2B by Western analysis had increased in the L(4-5) segments of the spinal cord after EA treatment. These expressions were enhanced by the intrathecal injection of calyculin A and immunohistochemical analyses confirmed the significant increase of these proteins. As for the regional reaction of NMDAR subunits, a mean integrated optical density of phosphorylated NR1 and NR2B subunits was potentiated by calyculin A injections in the superficial laminae and neck region and superficial laminae and nucleus proprius, respectively. It can be concluded that protein phosphatase may play an important role in EA analgesia by modulating the phosphorylation state of spinal NMDAR subunits.