经皮神经电刺激的镇痛机制及其临床应用

经皮神经电刺激(transcutaneous electrical nerve stimulation,TENS)是一种非侵入式的通过电流脉冲来激活外周神经纤维的镇痛疗法,具有非药理性、安全无创伤、费用低等多方面优点,已用于临床中多种疼痛的缓解。然而,TENS的临床镇痛效果存在较大的差异,这可能是由于不同刺激参数下的TENS涉及不同的镇痛机制。为推进TENS相关的基础研究与临床应用,本文首先综述了不同类型TENS镇痛的神经生理和生化机制,进而从刺激位置、脉冲参数(电流强度、频率与脉宽)以及使用时长和使用频度等多个方面讨论了影响TENS镇痛效果的因素,并总结了TENS在临床镇痛的相关应用,包括术后痛、慢性腰背痛、分娩痛等情况下的应用。最后,为实现更好的临床镇痛效果,本文提出在TENS相关的临床应用中,应充分考虑到不同刺激参数对TENS镇痛效果的影响以及患者个体间差异所导致的TENS镇痛效果的差别,优化TENS参数设置,建立基于患者疼痛评分与TENS刺激输入之间的动态关系模型,自适应地根据患者实时疼痛评分调整TENS刺激模式。     

肌神经刺激和穴位电针诱发的延脑网状巨细胞核的单位放电

电刺激麻痹家兔的腓深神经,在延脑内侧网状结构记录诱发电位和单位反应。此外,还观察电针足三里-三阴交穴对后者的影响。结果如下:1.根据动作电位各成分的大小,测得:腓深神经Ⅰ、Ⅱ、Ⅲ类纤维的兴奋阈分别是1、2和5—10T,而最大反应阈则分别是2、4—10和15—25T。当电刺激强度达到5T 时,通常能在双侧网状巨细胞核区记录到诱发反应,并随强度增大而增大。中缝大核区的反应相似。2.分析了共81个单位对不同刺激强度的放电反应,大体划为三类:Ⅰ类有5个,Ⅱ类24个,Ⅲ类52个。在Ⅱ类单位中,有14个仅对Ⅱ类传入发生反应,另10个则对Ⅱ和Ⅲ类传入均产生反应,称作“会聚型”单位。此外,还观察到半数单位能被皮神经δ类传入所兴奋。3.5个巨细胞核单位和2个中缝大核单位对电针穴位的反应表现为:电针频率为2周/秒时,细胞放电率虽增不多,但在20分钟的电针期间能维持同样的兴奋水平;频率为80周/秒时,初期放电率明显增加,但5分钟后迅速下降至低于2周/秒时水平。这似可提示临床远节段穴位电针以低频刺激为宜。     

不同频率经皮穴位电刺激对妇科腹腔镜手术患者术后认知功能的影响

目的:评价不同频率经皮穴位电刺激对妇科腹腔镜手术患者术后认知功能的影响。方法:共选取择期行妇科腹腔镜手术患者80例,根据经皮穴位电刺激频率不同随机分成4组,N组患者20人不做经皮穴位电刺激,E1-E3组患者60人术中在内关、百会和风池穴使用经皮穴位电刺激,其中E1组经皮穴位电刺激频率为2Hz,E2组频率为100 Hz,E3组频率为2/100 Hz。观察四组患者术后认知功能障碍发生率之间的差异。结果:与N组比较E1-E3组POCD的发生率明显较低,差异具有统计学意义(P0.05)。但E1、E2、E3组患者POCD的发生率比较无明显差异(P0.05)。结论:经皮穴位电刺激内关、百会和风池穴可有效降低妇科腹腔镜手术患者术后认知功能障碍的发生率,但不同频率参数的刺激效果无明显差异。     

视频暴力与攻击行为的神经成像研究进展

认知神经科学促进了心理学领域有关视频暴力与攻击行为的神经生理机制研究.近几年,国外研究者使用功能性磁共振成像研究了视频暴力与攻击行为的神经生理机制,并提出了新的攻击行为模型:神经发展模型.研究发现:长时间暴露在视频暴力下人类对暴力的威胁的脑反应是真实的并且可以察觉到的;能导致前额皮层、杏仁核、前扣带皮层、海马和海马回的激活;能增加潜在的攻击行为.文章介绍了认知神经科学领域中视频暴力和攻击行为神经成像研究的发展现状并展望了其前景.     

胡须信息在大鼠双侧初级体感皮层间的传递路径

大鼠的初级体感皮层(primary somatosensory cortex,SⅠ)虽然只接受来自对侧胡须的上行输入,但仍可以被同侧胡须刺激所激活.解剖学研究发现,在两侧SⅠ皮层之间有两条传递胡须信息胼胝体通路:一条是类颗粒区(perigranular zone,PGZ)通路;另一条是异颗粒区(dysgranular zone,DZ)通路.然而,哪一条通路在传递胡须刺激信息的过程中起主要作用还不清楚.本研究使用电压敏感染料(voltage-sensitive dye,VSD)成像技术来观察胡须刺激时整个SⅠ的神经元群体活动的空间分布和时间特性.实验发现,对侧胡须刺激首先激活barrel(颗粒区,granular zone,GZ),然后以兴奋波的形式传播到胡须感觉区(sub-barrel field cortex,BFC)外侧的DZ.而与首先激活BFC的对侧胡须刺激不同,同侧胡须刺激首先激活SⅠ的DZ.所激发的皮层兴奋以波的形式传播并扩散至BFC.失活另一侧皮层可以抑制这种同侧反应.电刺激另一侧半球皮层与刺激同侧胡须类似,也首先激活成像侧DZ.我们的实验结果显示,胡须刺激激活对侧SⅠ,在经过胼胝体传导后,另一侧半球的DZ(同侧于被刺激的胡须)被激活.连接双侧皮层DZ区的胼胝体连接在SⅠ对同侧胡须刺激的反应中起了主导作用.     

明视人听词分类任务时的视皮层激活——跨感觉通道的新证据

近期的脑成像研究在盲人等感官缺陷被试者身上发现了感觉替换现象,即传统上认为仅对单一感觉通道刺激反应的皮层区域也参与其他感觉通道的信息加工．类似的效应在感觉剥夺(蒙住眼睛)的明视人被试中也被观察到,提示脑内可能预存着多感觉交互作用的神经通路．通常认为,上述神经通路在常态的人脑中是以潜伏形式存在的,只有当感觉剥夺时才显露出来或得到加强．但是,感觉剥夺是否是该类神经通路发挥作用的必要条件,已有的研究尚缺乏确切的证据．采用统计力度较强的实验设计,给未蒙眼明视人被试听觉呈现一组名词,要求其对听到的每一个词语做出是人工物体还是自然物体的语义判断．对同步采集的功能磁共振信号进行统计分析,观察到视皮层脑区有显著激活．这些结果表明,跨感觉通道的神经通路在未实施感觉剥夺的条件下依然能够显示出来,因而在常态人脑中也不是完全以潜伏形式存在的．上述研究为建立多感觉交互作用神经机制的具体理论模型提供了一个约束条件．     

基于fMRI观察正常人脑中枢对针刺得气感反应的初步研究

目的:运用功能性磁共振成像技术观察正常人脑中枢对针刺得气感的反应特点,探索针刺得气的物质基础。方法:按照纳入排除标准收集男、女健康志愿者各35例,随机分为2组,针刺组40人,假针刺组30人,分别以外关穴针刺与假针刺作为刺激因素。采用Block方法设计刺激程序,运用功能性磁共振成像技术收集脑中枢反应信号。扫描完毕随即使用针刺感觉量表评价受试对象的感觉,依据感觉量化结果将图像数据分为针刺得气感组与无感觉对照组,以P≤0.0001,uncorrected,K10为统计检验显著性标准,以对照无感觉组为基线,在Matlab平台上采用SPM2.0软件包对图像数据进行处理和分析。结果:(1)得气效应:针刺组29人、假针刺组1人以酸麻胀重等得气指征为主,VAS评分4.62±3.05;针刺组2人轻微刺痛感,假针刺组21人无感觉、5人轻微刺痛感。(2)脑中枢激活效应:针刺得气激活的脑功能区有双侧额上回(BA6)、额下回(BA47)、缘上回(BA40),左侧额中回(BA47)、中央前回(BA10)、颞中回(BA21),右侧额中回(BA10)、顶下小叶(BA40)、中央前回(BA6)、颞上回(BA10)、颞中回(BA39)、颞下回(BA20)。结论:针刺得气感能特异性的激活正常人脑功能区,针刺得气效应与脑中枢密切相关。     

躯体传入冲动对丘脑腹后外侧核单位电活动的影响

实验在筒箭毒制动和人工呼吸维持下的清醒家兔上进行.用玻璃微电极在丘脑腹后外侧核(VPL)记录正中神经和腓神经刺激所引起的单位反应。Ⅰ、Ⅱ、Ⅲ、Ⅳ类纤维的传入冲动能特异地分别激活VPL内不同的神经元;这四类纤维的传入冲动能非特异地激活另一些神经元—R神经元。能被Ⅱ类纤维激活的14个βγ神经元和R神经元的活动不受对侧同名神经Ⅱ和Ⅳ类纤维条件刺激的影响;但对侧同名神经Ⅱ和Ⅳ类纤维的条件刺激对那些能被Ⅳ类纤维激活的C神经元和R神经元的活动有显著的抑制作用,使其长潜伏期的第二串放电的频率和时程减低。     

不同频率的电针对大鼠神经源性痛的治疗作用

目的：探讨不同频率的电针能否减轻大鼠神经源性痛。方法：将大鼠右侧L5／L6脊神经结扎,用引起50％抬足的机械刺激阈值评价机械性痛觉超敏,用大鼠5min内从5℃冷权上的抬足次数反映冷诱发的持续性疼痛。用韩氏穴位神经刺激仪给与2Hz或100Hz电刺激。结果：①2Hz和100Hz电针均一轻痛觉超敏,2Hz起效较早。②两种频率电针均能减轻冷诱发的持续性疼痛,但2Hz持续的时间长,多次电针后2Hz的镇痛效果可持续长达48h。③针刺而不通电也能显著减轻冷诱发的持续性痛。结论：电针能减轻神经源性痛,且低频（2Hz）电针的镇痛效果优于高频（100Hz）电针。     

功能磁共振和脑电神经成像技术与大脑刺激相结合的研究进展

随着对神经机制问题阐述水平的迅速提高,所应用的神经成像技术、方法及各种工具的复杂程度也在不断提高．一方面是神经成像技术本身的不断发展,另一方面则是大脑直接刺激与神经成像技术同步记录方法的发展．经颅磁刺激-功能磁共振成像同步技术(TMS-fMRI)和经颅磁刺激-脑电技术(TMS-EEG)能为研究大脑网络的功能和有效连通性提供技术手段,该技术在多种认知领域的发展和应用,为神经科学、认知心理学、神经信息学等学科的研究者对人脑的研究开启了多条通道,更加有利于深入地理解人类大脑的工作机制．     

低、高频电针诱导原癌基因c－fos／c－jun和阿片肽基因表达及其关系的比较研究

本工作对低频（２Ｈｚ）和高频（１００Ｈｚ）电针引起大鼠中枢Ｆｏｓ／Ｊｕｎ表达和三类阿片肽基因表达进行了详细的比较研究,并用针对ｃ－ｆｏｓ／ｃ－ｊｕｎ的反义寡核苷酸（ＯＤＮｓ）对电针引起的Ｆｏｓ／Ｊｕｎ表达进行选择性阻断,然后观察阿片肽基因表达是否受到影响,以确定Ｆｏｓ／Ｊｕｎ复合物在电针引起阿片肽基因表达中的作用。主要结果如下：（１）２Ｈｚ和１００Ｈｚ电针引起脑内不同部位的Ｆｏｓ／Ｊｕｎ表达;（２）２Ｈｚ电针使前脑啡肽原（ＰＰＥ）ｍＲＮＡ表达大幅度增高,１００Ｈｚ电针也能增加ＰＰＥｍＲＮＡ的转录,但不如２Ｈｚ电针的作用显著;但１００Ｈｚ电针能使某些脑区的前强啡肽原（ＰＰＤ）基因转录加速,而２Ｈｚ电针没有这一作用;（３）用ｃ－ｆｏｓ／ｃ－ｊｕｎ反义ＯＤＮｓ特异地阻断Ｆｏｓ／Ｊｕｎ表达后,电针引起的ＰＰＤ转录加速被明显阻断,而ＰＰＥ表达不受影响。提示Ｆｏｓ／Ｊｕｎ是电针引起ＰＰＤ（而非ＰＰＥ）基因表达的转录因子。     

大鼠海马神经元对于高频脉冲刺激的暂态响应

闭环刺激是深部脑刺激(deep brain stimulation,DBS)的重要发展方向之一,有望用于治疗多种脑神经系统疾病.与常规开环的长时间持续刺激不同,闭环刺激通常采用短促的高频脉冲序列.而神经元对于高频刺激的响应存在暂态过程,在初期的短时间内会发生很大变化,从而影响闭环刺激的作用.为了研究这种暂态过程,在大鼠...     

Alpha-Band Rhythms in Visual Task Performance: Phase-Locking by Rhythmic Sensory Stimulation

Oscillations are an important aspect of neuronal activity. Interestingly, oscillatory patterns are also observed in behaviour, such as in visual performance measures after the presentation of a brief sensory event in the visual or another modality. These oscillations in visual performance cycle at the typical frequencies of brain rhythms, suggesting that perception may be closely linked to brain oscillations. We here investigated this link for a prominent rhythm of the visual system (the alpha-rhythm, 8–12 Hz) by applying rhythmic visual stimulation at alpha-frequency (10.6 Hz), known to lead to a resonance response in visual areas, and testing its effects on subsequent visual target discrimination. Our data show that rhythmic visual stimulation at 10.6 Hz: 1) has specific behavioral consequences, relative to stimulation at control frequencies (3.9 Hz, 7.1 Hz, 14.2 Hz), and 2) leads to alpha-band oscillations in visual performance measures, that 3) correlate in precise frequency across individuals with resting alpha-rhythms recorded over parieto-occipital areas. The most parsimonious explanation for these three findings is entrainment (phase-locking) of ongoing perceptually relevant alpha-band brain oscillations by rhythmic sensory events. These findings are in line with occipital alpha-oscillations underlying periodicity in visual performance, and suggest that rhythmic stimulation at frequencies of intrinsic brain-rhythms can be used to reveal influences of these rhythms on task performance to study their functional roles.     

Modulation of spinal inhibitory reflexes depends on the frequency of transcutaneous electrical nerve stimulation in spastic stroke survivors

Neurophysiological studies in healthy subjects suggest that increased spinal inhibitory reflexes from the tibialis anterior (TA) muscle to the soleus (SOL) muscle might contribute to decreased spasticity. While 50?Hz is an effective frequency for transcutaneous electrical nerve stimulation (TENS) in healthy subjects, in stroke survivors, the effects of TENS on spinal reflex circuits and its appropriate frequency are not well known. We examined the effects of different frequencies of TENS on spinal inhibitory reflexes from the TA to SOL muscle in stroke survivors. Twenty chronic stroke survivors with ankle plantar flexor spasticity received 50-, 100-, or 200-Hz TENS over the deep peroneal nerve (DPN) of the affected lower limb for 30?min. Before and immediately after TENS, reciprocal Ia inhibition (RI) and presynaptic inhibition of the SOL alpha motor neuron (D1 inhibition) were assessed by adjusting the unconditioned H-reflex amplitude. Furthermore, during TENS, the time courses of spinal excitability and spinal inhibitory reflexes were assessed via the H-reflex, RI, and D1 inhibition. None of the TENS protocols affected mean RI, whereas D1 inhibition improved significantly following 200-Hz TENS. In a time-series comparison during TENS, repeated stimulation did not produce significant changes in the H-reflex, RI, or D1 inhibition regardless of frequency. These results suggest that the frequency-dependent effect of TENS on spinal reflexes only becomes apparent when RI and D1 inhibition are measured by adjusting the amplitude of the unconditioned H-reflex. However, 200-Hz TENS led to plasticity of synaptic transmission from the antagonist to spastic muscles in stroke survivors.     

多次100Hz TENS治疗慢性炎症痛的适宜参数和可能的神经化学机制研究

本工作在单发佐剂性关节炎慢性痛模型大鼠上比较观察了不同时间间隔和不同强度的多次１００Ｈｚ经皮神经电刺激（ＴＥＮＳ）的治疗效果,并对炎症和ＴＥＮＳ过程中Ｐ物质（ＳＰ）和强啡肽的变化规律及其作用进行了初步探讨。     

Influence of transcutaneous electrical nerve stimulation conditions on disynaptic reciprocal Ia inhibition and presynaptic inhibition in healthy adults

This study investigated the influence of stimulus conditions of transcutaneous electrical nerve stimulation (TENS) on disynaptic reciprocal Ia inhibition (RI) and presynaptic inhibition (D1 inhibition) in healthy adults. Eight healthy participants received TENS (stimulus frequencies of 50, 100, and 200?Hz) over the deep peroneal nerve and tibialis anterior (TA) muscle in the resting condition for 30?min. At pre- and post-intervention, the RI from the TA to the soleus (SOL) and D1 inhibition of the SOL alpha motor neuron were assessed by evoked electromyography. The results showed that RI was not changed by TENS at any stimulus frequency condition. Conversely, D1 inhibition was significantly changed by TENS regardless of the stimulus frequency. The present results and previous studies pertaining to RI suggest that the resting condition might strongly influence the lack of pre- vs. post-intervention change in the RI. Regarding the D1 inhibition, the present results suggest that the effect of TENS might be caused by post-tetanic potentiation. The knowledge gained from the present study might contribute to a better understanding of fundamental studies of TENS in healthy adults and its clinical application for stroke survivors.     

Brain stem mechanisms underlying acupuncture modality-related modulation of cardiovascular responses in rats.

The present study was designed to investigate brain stem responses to manual acupuncture (MA) and electroacupuncture (EA) at different frequencies at pericardial P (5-6) acupoints located over the median nerve. Activity of premotor sympathetic cardiovascular neurons in the rostral ventral lateral medulla (rVLM) was recorded during stimulation of visceral and somatic afferents in ventilated anesthetized rats. We stimulated either the splanchnic nerve at 2 Hz (0.1-0.4 mA, 0.5 ms) or the median nerve for 30 s at 2, 10, 20, 40, or 100 Hz using EA (0.3-0.5 mA, 0.5 ms) or at approximately 2 Hz with MA. Twelve of 18 cells responsive to splanchnic and median nerve stimulation could be antidromically driven from the intermediolateral columns of the thoracic spinal cord, T2-T4, indicating that they were premotor sympathetic neurons. All 18 neurons received baroreceptor input, providing evidence of their cardiovascular sympathoexcitatory function. Evoked responses during stimulation of the splanchnic nerve were inhibited by 49 +/- 6% (n = 7) with EA and by 46 +/- 4% (n = 6) with MA, indicating that the extent of inhibitory effects of the two modalities were similar. Inhibition lasted for 20 min after termination of EA or MA. Cardiovascular premotor rVLM neurons responded to 2-Hz electrical stimulation at P 5-6 and to a lesser extent to 10-, 20-, 40-, and 100-Hz stimulation (53 +/- 10, 16 +/- 2, 8 +/- 2, 2 +/- 1, and 0 +/- 0 impulses/30 stimulations, n = 7). These results indicate that rVLM premotor sympathetic cardiovascular neurons that receive convergent input from the splanchnic and median nerves during low-frequency EA and MA are inhibited similarly for prolonged periods by low-frequency MA and EA.     

Dynamic characteristics of the human resonance EEG responses to rhythmic photostimulation

The development of the resonance EEG responses of the left and right occipital areas was studied in right-handed men during prolonged (12 or 120 s) rhythmic, photostimulation with the intensity of 0.7 J and frequencies of 6, 10, and 16 Hz. Analysis of the EEG fine spectral structure was applied to compare the accumulated baseline EEG spectra and EEG spectra during photostimulation, to observe the dynamics of the short-term spectra and to detect power changes in the EEG narrow spectral band sharply coincident with the stimulation frequency. The more pronounced EEG responses to photostimulation were observed in subjects with the initially low EEG baseline, α-rhythm. Two-minute flash trains produced a substantial increase in the EEG power within the stimulation frequency with superposed oscillatory processes with different periods. These fluctuations are considered a reflection of intricate interaction between the adaptive and resonance EEG responses to the presented intermittent stimulation. Under 12-s stimulation the resonance EEG responses are steadily recorded within the first 3 s of stimulation and immediately after the flash cessation EEG power at the stimulation frequency returns to the initial level. The resonance EEG responses were more pronounced in the right hemisphere than in the left one, especially, at the stimulation frequencies of 6 and 16 Hz. With increasing the stimulation frequency, the maximum of resonance EEG responses was reached earlier. Under the stimulation frequency of 6 Hz, the maximal response was recorded 9–12 s after the beginning of flashes, at the frequencies of 10 and 16 Hz, it was recorded within 3–6 and 3 s, respectively.     

Computational modeling of epileptiform activities in medial temporal lobe epilepsy combined with <Emphasis Type="Italic">in vitro</Emphasis> experiments

Electrical stimulation of sub-cortical brain regions (the basal ganglia), known as deep brain stimulation (DBS), is an effective treatment for Parkinson’s disease (PD). Chronic high frequency (HF) DBS in the subthalamic nucleus (STN) or globus pallidus interna (GPi) reduces motor symptoms including bradykinesia and tremor in patients with PD, but the therapeutic mechanisms of DBS are not fully understood. We developed a biophysical network model comprising of the closed loop cortical-basal ganglia-thalamus circuit representing the healthy and parkinsonian rat brain. The network properties of the model were validated by comparing responses evoked in basal ganglia (BG) nuclei by cortical (CTX) stimulation to published experimental results. A key emergent property of the model was generation of low-frequency network oscillations. Consistent with their putative pathological role, low-frequency oscillations in model BG neurons were exaggerated in the parkinsonian state compared to the healthy condition. We used the model to quantify the effectiveness of STN DBS at different frequencies in suppressing low-frequency oscillatory activity in GPi. Frequencies less than 40 Hz were ineffective, low-frequency oscillatory power decreased gradually for frequencies between 50 Hz and 130 Hz, and saturated at frequencies higher than 150 Hz. HF STN DBS suppressed pathological oscillations in GPe/GPi both by exciting and inhibiting the firing in GPe/GPi neurons, and the number of GPe/GPi neurons influenced was greater for HF stimulation than low-frequency stimulation. Similar to the frequency dependent suppression of pathological oscillations, STN DBS also normalized the abnormal GPi spiking activity evoked by CTX stimulation in a frequency dependent fashion with HF being the most effective. Therefore, therapeutic HF STN DBS effectively suppresses pathological activity by influencing the activity of a greater proportion of neurons in the output nucleus of the BG.