Neuromodulation:神经肌肉电刺激可减轻腰椎退行性疾病患者的腿部抽筋,一项随机安慰剂对照试验

2022-01-21 MedSci原创 MedSci原创

在 65 岁及以上的人群中,甚至有二分之一的人报告说在休息时经常出现腿部抽筋。腰椎退行性疾病(如腰椎管狭窄症 (LSS) 和腰椎间盘突出症 (LDH))患者腿部抽筋频率更高,其心理和身体压力以及社会相

在 65 岁及以上的人群中,甚至有二分之一的人报告说在休息时经常出现腿部抽筋。腰椎退行性疾病(如腰椎管狭窄症 (LSS) 和腰椎间盘突出症 (LDH))患者腿部抽筋频率更高,其心理和身体压力以及社会相关性被低估了。经常发生和疼痛的腿抽筋会,通常在手术后存在,且易恶化。这些腿抽筋通常发生在休息时,迫使患者在夜间醒来。脊髓压迫通常与 LDH 和 LSS 同时发生,并已被证明会导致痉挛性无力,是可能在很大程度上导致这些疾病更容易发生痉挛的病理机制之一 。在 LDH 患者中,肌肉痉挛的频繁发生似乎是特征性的,因为痉挛诱导试验已成为 LDH 的诊断工具。在这种情况下,要求患者弯曲膝盖以抵抗手动阻力以引起腘绳肌痉挛。 

发现对腓肠肌进行神经肌肉电刺激 (NMES),每周两次,持续六周,可将腿抽筋的频率降低多达 78%。该试验包括 19 名易抽筋的男性,其中 9 名在 LDH 后开始经常出现腿部抽筋。尤其是这些 LDH 参与者报告说,NMES 后的生活质量得到了改善,因为他们经历的(夜间)抽筋明显减少。然而,当前使用的 NMES 协议的一个主要缺点是与在高电流设置下执行的应用小腿刺激相关的明显不适,这可能会引发抽筋。因此,本研究旨在评估 NMES 在各种刺激强度下与假刺激相比在减少 LDH 和 LSS 患者腿抽筋频率方面的功效和耐受性。我们假设与伪刺激相比,所有 NMES 治疗都会减少腿抽筋的频率。文章发表在《Neuromodulation: Technology at the Neural Interface》。

三十二名患有抽筋的LSS和/或LDH的男性和女性(63 ± 9 岁)被随机分配到四个不同的组。 在超过 4 周的时间内,每周两次对腓肠肌进行单侧刺激(3 × 6 × 5 秒的刺激训练,以高于个体痉挛阈值频率 [CTF] 的 30 Hz 进行)。 三组接受其最大耐受刺激强度的 85%、55% 或 25%,而一组仅接受假刺激。刺激过程包括三组双相矩形波脉冲电流,频率高于单个 CTF 30 Hz;每组包括 6 × 5 秒的刺激训练,刺激之间休息 10 秒。根据抽筋记录,只有主要受肌肉痉挛影响的腿部内侧腓肠肌受到刺激。如果 CTF 在干预的中途(中)增加,则随后调整刺激频率以保持高于 CTF 30 Hz。施加的刺激频率范围为 36-70 Hz。

研究流程

在刺激过程中,参与者坐在高高的长凳上,以使他们的小腿肌肉在他们的小腿自由下垂时被动地缩短。每次刺激后都有至少 24 小时的休息时间。根据个体的分组情况,将刺激幅度设置为最大耐受刺激强度 (mTSI) 的 85%、55% 或 25%,在每个会话开始时进行测试。

NMES治疗4 周后,25%、55%和85%NMES组的腿抽筋次数显着减少,其中85%NMES组减少最多。假刺激方案后腿抽筋的发生保持不变,表明三个刺激组中腿抽筋的减少确实是由于 NMES 的作用。NMES参数的应用刺激强度可能在减少腿抽筋的发生方面发挥关键作用。只有 25% NMES 方案显着减少了夜间腿部抽筋。然而,值得一提的是,25% NMES 组由肌肉痉挛发生率非常高的个体组成,导致 组间 的差异很大(11 ± 14 次痉挛)。考虑到在不同程度的疼痛感知下,所有三个刺激组中腿部抽筋的总数同样减少,似乎有理由建议即使应用低电流 NMES(最大耐受刺激强度的 25% [mTSI] ),足以减少与 LDH 和 LSS 相关的腿抽筋的发生。因此,最好使用 25%NMES 以尽量减少与刺激相关的疼痛。

施加的刺激强度与八次治疗中的疼痛感 

LSS和LDH常伴有频繁发生的腿抽筋,严重影响患者的生活和睡眠质量。 本研究提供了第一个证据,表明定期应用小腿肌肉 NMES 可以减少 LSS/LDH 患者的腿部抽筋。 即使只有轻微疼痛感的低电流 (25%NMES) 也会减少腿部抽筋,而在伪刺激方案后腿部抽筋的发生率保持不变。 作为非药物治疗方法之一,NMES具有很大的应用价值。

Harmsen, J.-F., Sistig, A., Fasse, A., Hackl, M., Wegmann, K. and Behringer, M. (2021), Neuromuscular Electrical Stimulation Reduces Leg Cramps in Patients With Lumbar Degenerative Disorders: A Randomized Placebo-Controlled Trial. Neuromodulation: Technology at the Neural Interface, 24: 1483-1492. https://doi.org/10.1111/ner.13315

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href='/topic/show?id=a054e00031c' target=_blank style='color:#2F92EE;'>#电刺激#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70003, encryptionId=a054e00031c, topicName=电刺激)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqTLTjicBiccpdUyHMGZV43nOBI6QIQqxVcy2EzXz67E390Q5j0R7QWjym391HxsyiaYt7NzbrcojRDw/132, createdBy=64462500151, createdName=ms705947299214030, createdTime=Wed Jan 19 16:30:30 CST 2022, time=2022-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585586, encodeId=55921585586dd, content=<a href='/topic/show?id=04514581178' target=_blank style='color:#2F92EE;'>#安慰剂对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45811, encryptionId=04514581178, topicName=安慰剂对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b4217235139, createdName=guoyibin, createdTime=Wed Jan 19 16:30:30 CST 2022, time=2022-01-19, status=1, ipAttribution=)]
    2022-10-27 amyloid
  4. 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  5. 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  6. 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  7. 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