Repetitive transcranial magnetic stimulation (rTMS) represents a non-invasive therapeutic modality acknowledged for augmenting neurological function recovery following stroke. Nonetheless, uncertainties remain regarding its efficacy in promoting cognitive function recovery in patients diagnosed with vascular dementia (VD). In this study, VD was experimentally induced in a rat model utilizing the bilateral common carotid artery occlusion method. Following a recuperation period of seven days, rats were subjected to high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) at a frequency of 10 Hz. Cognitive function was assessed utilizing the Morris water maze test, and the levels of IL-6, TNF-alpha, SOD, GSH, MDA, and Fe2+ in cerebral tissue were quantitatively analyzed through enzyme-linked immunosorbent assay. Moreover, the gene and protein expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and glutathione peroxidase 4 (GPx4) were meticulously investigated via quantitative polymerase chain reaction (qPCR) and Western blotting techniques. The use of HF-rTMS notably augmented cognitive function in rats with VD, concomitantly reducing neuroinflammation, oxidative stress, and ferroptosis within the brain. The group subjected to HF-rTMS demonstrated an increase in the levels of both proteins and genes associated with Nrf2 and GPx4, in comparison to the VD group. These results highlight the potential of HF-rTMS treatment in enhancing cognitive function in rats diagnosed with VD through the modulation of the Nrf2/GPx4 signaling pathway. This modulation, in turn, mitigates processes linked with neuroinflammation, oxidative stress, and ferroptosis. Nevertheless, additional studies are essential to comprehensively elucidate the underlying mechanisms and clinical implications of HF-rTMS treatment in the treatment of VD.
- MeSH
- NF-E2-Related Factor 2 * metabolism MeSH
- Phospholipid Hydroperoxide Glutathione Peroxidase * metabolism MeSH
- Cognition * physiology MeSH
- Rats MeSH
- Disease Models, Animal MeSH
- Oxidative Stress MeSH
- Rats, Sprague-Dawley MeSH
- Rats, Wistar MeSH
- Signal Transduction * MeSH
- Transcranial Magnetic Stimulation * methods MeSH
- Dementia, Vascular * metabolism therapy psychology MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Neuropatická bolest patří k častým klinickým příznakům onemocnění periferního (mononeuropatie, polyneuropatie) i centrálního nervového systému (míšní léze, stavy po cévních mozkových příhodách apod.). Významně snižuje kvalitu života pacientů, interferuje se spánkem a je často provázena úzkostí a/nebo depresí. Léčba neuropatické bolesti je dominantně založena na farmakoterapii, pro kterou je k dispozici řada preparátů využitelných v monoterapii či v rámci kombinované léčby. K lékům první volby (s průkazem účinnosti na úrovni IA) patří některá antiepileptika a antidepresiva. Z antiepileptik jde především o modulátory alfa-2-delta podjednotky kalciových kanálů, tedy gabapentin a pregabalin. Oba léky byly dlouhodobě považovány za srovnatelně účinné, v posledních 5–7 letech však bylo publikováno několik negativních studií vysoké kvality s pre- gabalinem, zatímco evidence účinku gabapentinu je nadále velmi robustní. Z antiepileptik je pro dosažení analgetického účinku klíčová blokáda zpětného vychytávání noradrenalinu. Využitelné jsou proto především léky ze skupiny inhibitorů zpětného vychytávání serotoninu a noradrenalinu (SNRI, např. duloxetin či venlafaxin) a také tricyklická antidepresiva (TCA, především amitriptylin), zatímco efekt inhibitorů zpětného vychytávání serotoninu (SSRI) v terapii neuropatické bolesti prokázán nebyl. Účinné jsou také opioidy (tramadol, morfin, oxykodon, tapentadol), které jsou využívány jako léky druhé či třetí volby, a to jako monoterapie či add-on terapie k lékům první volby. U pacientů s lokalizovanou neuropatickou bolestí (např. u postherpetické neuralgie) lze využít topicky aplikované preparáty (např. kapsaicin či topicky aplikovaný lidokain), jejichž výhodou je excelentní bezpečnostní profil. Prakticky u všech zmíněných léků je pokračování terapie podmíněno dokumentací jejich účinnosti, např. poklesem intenzity bolesti hodnocené pomocí numerické škály bolesti. Vedle farmakoterapie lze v léčbě neuropatické bolesti využít také postupy nefarmakologické, síla doporučení pro jejich využití (vycházející z evidence jejich účinnosti) je však u většiny těchto postupů daleko nižší než v případě farmakoterapie, obvykle z dů- vodu absence kvalitních a dostatečně velkých studií. Většina používaných neinvazivních nefarmakologických metod má vynikající bezpečnostní profil a jejich použití je obzvláště výhodné u pacientů vyššího věku. U pacientů s periferní neuropatickou bolestí jde především o transkutánní elektrickou nervovou stimulaci (TENS), která vykazuje excelentní bezpečnost a u pacientů s lokalizovanou bolestí je doporučována dokonce jako jedna z metod 1. volby. Účinnost v léčbě neuropatické bolesti i fibromyalgie je prokázána také u vysokofrekvenční repetitivní transkraniální mozkové stimulace (rTMS) kontralaterální primární motorické kůry (M1), případně dalších oblastí mozku. U závažných refrakterních typů neuropatické bolesti je možné využít stimulaci míšní (SCS), případně stimulaci periferního nervu (PENS). Jedná se však již o invazivní metody indikované u malého procenta pacientů s vysokou intenzitou bolesti a nejnižší odpovědí na konvenční terapie. Využitelné jsou také některé psychoterapeutické metody, zejména mindfulness či kognitivně-behaviorální terapie, které lze s výhodou použít zejména jako přídatnou (add-on) terapii na úrovni druhé volby. Ostatní nefarmakologické postupy vykazují v provedených metaanalýzách nekonkluzivní výsledky a jejich užití se dle aktuální úrovně evidence spíše nedoporučuje.
Neuropathic pain is a common clinical symptom of peripheral (mononeuropathy, polyneuropathy) and central nervous systém disorders (spinal cord lesions, post-stroke conditions, etc.). It significantly reduces pa‘ients‘ quality of life, interferes with sleep and is often associated with anxiety and/or depression. The treatment of neuropathic pain is mainly based on pharmacotherapy, for which a number of agents are available for use as monotherapy or in combination therapy. First choice drugs (with evidence of efficacy at the IA level) include some antiepileptics and antidepres- sants. The antiepileptic drugs are mainly alpha-2-delta calcium channel subunit modulators, i.e. gabapentin and pregabalin. Both drugs have long been considered comparably effective, but in the last 5-7 years several negative, high-quality trials have been published with pregabalin, while the evidence for gabapentin remains very robust. Among the antiepileptic drugs, blockade of norepinephrine reuptake is key to achieving analgesia. Therefore, serotonin and noradrenaline reuptake inhibitors (SNRIs) (e.g. duloxetine or venlafaxine) and tricyclic antidepressants (TCAs, especially amitriptyline) are particularly useful, whereas the effect of serotonin reuptake inhibitors (SSRIs) in the treatment of neuropathic pain has not been demonstrated. Opioids (tramadol, morphine, oxycodone, tapentadol) are also effective and are used as second- or third-line drugs, either as monotherapy or as adjunctive therapy to first-line drugs. For patients with localised neuropathic pain (e.g. postherpetic neuralgia), topical agents (e.g. capsaicin or lidocaine) can be used, which have the advantage of an excellent safety profile. For all these agents, continuation of therapy requires documentation of efficacy, e.g. a reduction in pain intensity as assessed by a numerical pain scale. In addition to pharmacotherapy, non-pharmacological treatments can be used to treat neuropathic pain, but the strength of the recommendations for their use (based on evidence of their effectiveness) is much lower than for pharmacotherapy for most of these treatments, usually due to a lack of large, high-quality trials. Most of the non-invasive non-pharmacological methods used have an excellent safety profile and their use is particularly beneficial in older patients. For patients with peripheral neuropathic pain, transcutaneous electrical nerve stimulation (TENS) can be used with excellent safe‘y. It‘s even recommended as a first-line treatment for patients with localised pain. High-frequency repetitive transcranial brain stimulation (rTMS) of the contralateral primary motor cortex or several other brain regions has also been shown to be effective in the treatment of neuropathic pain and fibromyalgia. For refractory forms of neuropathic pain, spinal cord stimulation (SCS) or peripheral nerve stimulation (PENS) can be used, but both are invasive and their use is limited to a small percentage of patients with the most severe pain and least response to conventional therapies. Some psychotherapeutic techniques, particularly mindfulness or cognitive behavioural therapy, may also be used, particularly as second-line adjunctive therapy. Other non-pharmacological treatments have shown inconsistent results in meta-analyses and their use is not recommended based on the current level of evidence.
- MeSH
- Acupuncture Therapy MeSH
- Analgesics pharmacology classification therapeutic use MeSH
- Antidepressive Agents administration & dosage pharmacology therapeutic use MeSH
- Anticonvulsants administration & dosage pharmacology therapeutic use MeSH
- Aromatherapy MeSH
- Electric Stimulation methods MeSH
- Hyperesthesia diagnosis MeSH
- Cannabinoids pharmacology therapeutic use MeSH
- Combined Modality Therapy methods MeSH
- Humans MeSH
- Spinal Cord Stimulation MeSH
- Neuralgia * diagnosis drug therapy psychology therapy MeSH
- Paresthesia diagnosis MeSH
- Peripheral Nervous System MeSH
- Transcranial Magnetic Stimulation MeSH
- Mindfulness MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for analyzing the central and peripheral nervous system. TMS could be a powerful therapeutic technique for neurological disorders. TMS has also shown potential in treating various neurophysiological complications, such as depression, anxiety, and obsessive-compulsive disorders, without pain and analgesics. Despite advancements in diagnosis and treatment, there has been an increase in the prevalence of brain cancer globally. For surgical planning, mapping brain tumors has proven challenging, particularly those localized in expressive regions. Preoperative brain tumor mapping may lower the possibility of postoperative morbidity in surrounding areas. A navigated TMS (nTMS) uses magnetic resonance imaging (MRI) to enable precise mapping during navigated brain stimulation. The resulting magnetic impulses can be precisely applied to the target spot in the cortical region by employing nTMS. This review focuses on nTMS for preoperative planning for brain cancer. This study reviews several studies on TMS and its subtypes in treating cancer and surgical planning. nTMS gives wider and improved dimensions of preoperative planning of the motor-eloquent areas in brain tumor patients. nTMS also predicts postoperative neurological deficits, which might be helpful in counseling patients. nTMS have the potential for finding possible abnormalities in the motor cortex areas.
- MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Brain Mapping methods MeSH
- Motor Cortex diagnostic imaging MeSH
- Brain Neoplasms * surgery MeSH
- Neuronavigation methods MeSH
- Preoperative Care * methods MeSH
- Transcranial Magnetic Stimulation * methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Cíl: Představit historii a současnost zrakových korových neuroprotéz a předložit novou metodu stimulace nepoškozených buněk zrakové kůry. Metody: Práce podává nejen přehled o historii a současném stavu stimulace zrakové kůry u těžkých poruch zraku, ale hlavně upozorňuje na jejich nedostatky. K nim se řadí hlavně stimulace právě poškozených korových buněk na malé ploše a z morfologického hlediska pak možné poškození stimulovaných neuronů elektrodami a jejich zapouzdření gliotickou tkání. Výsledky: Práce dále předkládá návrh nové technologie zpracování obrazu a jeho transformace do podoby neinvazivní transkraniální stimulace nepoškozených částí mozku, která je chráněna národním i mezinárodním patentem. Závěr: V práci je předložen ucelený přehled současných možností náhrady ztraceného zraku na úrovni mozkové kůry a návrh nové neinvazivní metody stimulace funkčních neuronů zrakové kůry.
Purpose: The purpose of the article is to present the history and current status of visual cortical neuroprostheses, and to present a new method of stimulating intact visual cortex cells. Methods: This paper contains an overview of the history and current status of visual cortex stimulation in severe visual impairment, but also highlights its shortcomings. These include mainly the stimulation of currently damaged cortical cells over a small area and, from a morphological point of view, possible damage to the stimulated neurons by the electrodes and their encapsulation by gliotic tissue. Results: The paper also presents a proposal for a new technology of image processing and its transformation into a form of non-invasive transcranial stimulation of undamaged parts of the brain, which is protected by a national and international patent. Conclusion: The paper presents a comprehensive review of the current options for compensating for lost vision at the level of the cerebral cortex and a proposal for a new non-invasive method of stimulating the functional neurons of the visual cortex.
- Keywords
- zraková neuroprotéza,
- MeSH
- Quality of Life MeSH
- Humans MeSH
- Retinal Diseases classification therapy MeSH
- Eye, Artificial * classification MeSH
- Primary Visual Cortex MeSH
- Transcranial Magnetic Stimulation * methods instrumentation MeSH
- Vision, Ocular MeSH
- Persons with Visual Disabilities MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
OBJECTIVES: Despite the clinical importance of bipolar depression (BDE), effective treatment options are still limited. Transcranial magnetic stimulation (rTMS) has proven of moderate efficacy in major depression, but the evidence remains inconclusive for BDE. METHODS: A 4-week, double-blind, randomised, parallel-group, sham-controlled study (trial ID ISRCTN77188420) explored the benefits of 10 Hz MRI-guided right ventrolateral (RVL) rTMS and left dorsolateral (LDL) rTMS as add-on treatments for BDE. Outcome measures included changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) score, self-assessment, response and remission rates, and side effects. RESULTS: Sixty patients were randomly assigned to study groups, and forty-six completed the double-blind phase. The mean change from baseline to Week 4 in MADRS was greater in both active groups compared to the sham, yet differences did not achieve significance (RVL vs sham: -4.50, 95%CI -10.63 to 1.64, p = 0.3; LDL vs sham: -4.07, 95%CI -10.24 to 2.10, p = 0.4). None of the other outcome measures yielded significant results. CONCLUSIONS: While not demonstrating the superiority of either 10 Hz rTMS over sham, with the limited sample size, we can not rule out a moderate yet clinically meaningful effect. Further well-powered studies are essential to elucidate the role of rTMS in managing BDE.
- MeSH
- Bipolar Disorder * therapy MeSH
- Adult MeSH
- Double-Blind Method MeSH
- Combined Modality Therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Psychiatric Status Rating Scales MeSH
- Transcranial Magnetic Stimulation * MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
