Sweet a Wall v roce 1965 poprvé využili periferní nervovou stimulaci (PNS) k dlouhodobé analgézii. Od té doby se tato metoda používá k lécbe nekterých chronických bolestivých syndromu. K nejcastejším indikacím PNS patrí komplexní regionální bolestivý syndrom (KRBS) I. a zejména II. typu (dríve oznacovaného jako kauzalgie), fantomové bolesti, operacní a nervová traumata a úžinové syndromy, tedy zejména syndromy související s mononeuropatickým postižením. Analgetický efekt PNS je pravdepodobne zprostredkován periferním i centrálním mechanismem. Velmi duležitá podmínka pri použití PNS je správný výber nemocných, predevším tech, u nichž selhal jiný zpusob lécby chronické neuropatické bolesti. Pri PNS se chirurgicky implantuje trvalá periferní elektroda k nervu vedoucímu bolest z príslušné inervované oblasti. Implantovaná elektroda se poté spojí s docasným generátorem pro provedení zkušebního období, které trvá nekolik dní. U nemocných, kterí splní ve zkušebním období všechny podmínky pro trvalou stimulacní lécbu, je v 2. fázi implantován podkožní generátor proudu a propojen s periferní elektrodou. Výsledkem úspešného použití PNS není pouze snížení bolesti (o více než 50 %), ale též snížení analgetické lécby, zlepšení funkcnosti nemocného a kvality jeho života. Zatím jsme implantovali dva nemocné s posttraumatickou mononeuropatickou kauzalgií v oblasti n. medianus. I když se jedná o malý soubor a doba implantace je krátká (12 + 9 mesícu), jsou prozatímní výsledky velmi povzbudivé. Budoucnost PNS je ve vývoji a použití mikroskopických elektrod implantovaných k jednotlivým nervum a ve stimulaci periferních nervu v ruzných oblastech lidského tela. PNS se ukazuje jako efektivní a bezpecná neuromodulacní metoda v lécbe nejhure postižených nemocných s chronickou mononeuropatickou bolestí.
The first permanent implantation of a peripheral nerve electrode for long-term analgesia was performed by Sweet and Wall in 1965. Since then, peripheral nerve stimulation (PNS) has been applied for the treatment of pain in several chronic pain syndromes, including complex regional pain syndrome (CRPS) I and, particularly, II (former causalgia), phantom pain, operative neurological trauma and injuries, entrapment neuropathies, especially syndromes in the region of mononeuropathy. The analgesic effect of PNS is accomplished by peripheral as well as central mechanisms. A most important consideration is the proper selection of criteria for patients with chronic neuropathic pain, who are otherwise hopeless and desperate for any type of suitable therapy. In PNS, a permanent electrode is implanted, which requires surgical exposure of the nerve whose distribution corresponds to patient’s pain. The implanted electrode is connected to a temporary generator for a trial period lasting several days. In patients fulfilling all criteria for implantation, a subcutaneous generator is surgically implanted and connected with the peripheral electrode. Successful PNS results not only in pain relief (a reduction by more than 50 %) but, also, a reduced need for the use of pain killers, improved body function and quality of life. To date, we have performed implantation in two patients with posttraumatic mononeuropathic causalgia in the region of the median nerve. We know that the number of patients is very small and the duration of both implantations is short (12 and 9 months), but the results obtained as yet are very encouraging. The future of PNS seems to lie in the development and use of microelectrodes sutured to nerves, and in the stimulation of peripheral nerves in various parts of the human body. PNS appears to be a very effective and safe part of neuromodulation methods for the treatment of the most affected patients with chronic mononeuropathic pain.
- MeSH
- Electric Stimulation MeSH
- Electrodes, Implanted MeSH
- Humans MeSH
- Peripheral Nervous System Diseases pathology therapy MeSH
- Pain, Intractable pathology therapy MeSH
- Patient Selection MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Peripheral nerve stimulation (PNS) is a neurostimulation analgesic technique. PNS is utilized to treat peripheral neuropathic pain. It is highly sophisticated and a specialized technique used where other forms of treatment have failed. This paper describes the PNS procedure, its therapeutic principles, indications, and the comprehensive care for patients after the PNS implant. First, we summarize our experience using this type of invasive treatment. In the second part, a case of intractable neuropathic pain following repeated surgery to the ulnar nerve is reported. Prior to PNS, the patient underwent multiple types of antineuralgic treatment with no significant result. Only after the PNS application, was a significant analgesic effect achieved.
- MeSH
- Administration, Cutaneous MeSH
- Adult MeSH
- Electric Stimulation Therapy MeSH
- Electrodes, Implanted MeSH
- Capsaicin administration & dosage therapeutic use MeSH
- Humans MeSH
- Ulnar Nerve physiology MeSH
- Neuralgia psychology therapy MeSH
- Neurosurgery MeSH
- Neurologic Examination MeSH
- Ulnar Neuropathies therapy MeSH
- Peripheral Nerves physiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- Keywords
- neuropatická chronická bolest, neurostimulační léčba, zkušenosti a výsledky,
- MeSH
- Financing, Organized MeSH
- Electrodes, Implanted utilization MeSH
- Complex Regional Pain Syndromes therapy MeSH
- Humans MeSH
- Peripheral Nervous System Diseases complications MeSH
- Neuralgia drug therapy classification MeSH
- Pain, Intractable etiology drug therapy MeSH
- Transcutaneous Electric Nerve Stimulation methods instrumentation MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Vyšetření vedení periferním nervem, neboli neurografie (kondukční studie) je základní elektromyografickou technikou k posouzení léze periferních nervů (neuropatie v širším slova smyslu). Vyšetřujeme motorická a silně myelinizovaná senzitivní vlákna. Metoda umožní stanovit stupeň a typ postižení (motorické, senzitivní a také axonální či demyelinizační). K vyšetření vedení jsou vhodné polyneuropatie všech etiologií (metabolické, malnutriční, toxické, hereditární, zánětlivé, paraneoplastické) i mononeuropatie (kompresivní, traumatické, zánětlivé), dále nejasné nálezy, nebo kombinované léze centrální a periferní, kde je nutné upřesnit podíl případné polyneuropatie. Při technice repetitivní stimulace se používá stimulace periferních motorických nervů opakovaně v určité frekvenci a její provedení je přínosné při podezření na poruchu nervosvalového spojení. Pochopení základních principů elektromyografie, správná indikace k vyšetření a dobře položená otázka je předpokladem správně provedeného vyšetření s validní a pro klinického neurologa užitečnou odpovědí (nálezem).
Nerve conduction studies are basic electrophysiologic technique for evaluation of damage of peripheral nerves (neuropathies). Motor and thick myelinated sensory fibers are examined, and the method allows to determine the degree and type of the damage (motor, sensory as well as axonal or demyelinating). Indications for the examination of nerve conduction are as follows: polyneuropathies of all kind of aetiology (metabolic, malnutrition, toxic, hereditary, inflammatory, paraneoplastic), mononeuropathies (compressive, traumatic, inflammatory), further unclear findings, as well as combined central and peripheral lesions where it is necessary to assess the potential share of polyneuropathy.The technique of repetitive nerve stimulation is based on the repetitive stimulation of the peripheral motor nerves and is useful in suspected neuromuscular junction disorders. Understanding of the basic principles of EMG, right indication for examination and adequate clinical question are prerequisite for the properly performed examination and valid and meaningful clinical answer/finding.
- Keywords
- neurografie, repetitivní stimulace, distální motorická latence,
- MeSH
- Action Potentials MeSH
- Electric Stimulation methods MeSH
- Electromyography * methods MeSH
- Humans MeSH
- Nervous System Diseases * diagnosis classification physiopathology MeSH
- Nerve Fibers pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
This chapter provides a review of immune reactions involved in classic as well as alternative methods of peripheral nerve regeneration, and mainly with a view to understanding their beneficial effects. Axonal degeneration distal to nerve damage triggers a cascade of inflammatory events alongside injured nerve fibers known as Wallerian degeneration (WD). The early inflammatory reactions of WD comprise the complement system, arachidonic acid metabolites, and inflammatory mediators that are related to myelin fragmentation and activation of Schwann cells. Fine-tuned upregulation of the cytokine/chemokine network by Schwann cells activates resident and hematogenous macrophages to complete the clearance of axonal and myelin debris and stimulate regrowth of axonal sprouts. In addition to local effects, immune reactions of neuronal bodies and glial cells are also implicated in the survival and conditioning of neurons to regenerate severed nerves. Understanding of the cellular and molecular interactions between the immune system and peripheral nerve injury opens new possibilities for targeting inflammatory mediators to improve functional reinnervation.
- MeSH
- Cytokines immunology metabolism MeSH
- Humans MeSH
- Peripheral Nerves immunology metabolism MeSH
- Peripheral Nerve Injuries immunology metabolism MeSH
- Nerve Regeneration physiology MeSH
- Signal Transduction physiology MeSH
- Wallerian Degeneration immunology metabolism MeSH
- Inflammation immunology metabolism MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
