עבודה זו נתמכה בחלקו על ידי מרכז המחקר המשותף 1158 (SFB1158 מ nociception לכאב כרוני: מבנה פונקציה המאפיינים של מסלולים עצביים ארגון מחדש שלהם), במימון DFG (דויטשה Forschungsgemeinschaft).

<ol>
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B., Silberstein, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Occipital+Nerve+stimulation+for+primary+headaches.">Occipital Nerve stimulation for primary headaches.</a> J Neurosurg Sci. 56 (4), 307-312 (2012).</li><li>Jakobs, M., Unterberg, A., Treede, R. D., Schuh-Hofer, S., Ahmadi, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Subcutaneous+trigeminal+nerve+field+stimulation+for+refractory+trigeminal+pain:+a+cohort+analysis.">Subcutaneous trigeminal nerve field stimulation for refractory trigeminal pain: a cohort analysis.</a> Acta Neurochir. (Wien). 158 (9), 1767-1774 (2016).</li><li>Klein, J., Sandi-Kahun, S., Schackert, G., Juratli, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Peripheral+nerve+field+stimulation+for+trigeminal+neuralgia,+trigeminal+neuropathic+pain,+and+persistent+idiopathic+facial+pain.">Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain.</a> Cephalalgia. 36 (58), 445-453 (2016).</li><li>Ellis, J. A., Meija Munne, J. C., Winfree, C. 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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motor+cortex+stimulation+for+long-term+relief+of+chronic+neuropathic+pain:+a+10+year+experience.">Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience.</a> Pain. (1-2), 43-52 (2006).</li><li>Merhkens, J. H., Steude, U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+electrostimulation+of+the+trigeminal+ganglion+in+trigeminal+neuropathy:+current+state+and+future+prospects.">Chronic electrostimulation of the trigeminal ganglion in trigeminal neuropathy: current state and future prospects.</a> Acta Neurochir Suppl. 97 (Pt 2), 91-97 (2007).</li><li>Slavin, K. V., Colpan, M. E., Munawar, N., Wess, C., Nersesyan, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trigeminal+an+occipital+peripheral+nerve+stimulation+for+craniofacial+pain:+a+single-institution+experience+and+review+of+the+literature.">Trigeminal an occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature.</a> Neurosurg Focus. 21 (6), E5 (2006).</li><li>Cheng, J. S., Lim, D. A., Chang, E. F., Barbaro, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Review+of+percutaneous+treatments+for+trigeminal+neuralgia.">A Review of percutaneous treatments for trigeminal neuralgia.</a> Neurosurgery. 10, 25-33 (2014).</li></ol>

למחברים אין מה לחשוף.

עם תת עורית טריגמינלית בתחום העצבים גירוי (sTNFS), אנו מציגים טכניקה כירורגית לבצע neuromodulation פולשנית מינימלית עבור כאב עקשן כרונית של עצב trigeminal של etiologies שונים. כדי להפחית סיבוכים חיטוי יסודי של שדה הניתוח כולו הוא חיוני. כל ניקוב עור ?...

החימוש הנוירוכירגי לטיפול בכאב טריגמינלי הוא גדול ומגוון כמו האטיולוגיה הבסיסית. במקרים של טריגמיאלגיה טריגמינלית neuralgia (TN) הנגרמת על ידי דחיסת עורקים באזור הכניסה של שורש המוח, של לחץ הדם העצבי הטרימינלי (MVD), הוא יעיל ביותר. טכניקות הרסניות שונות של גנגליון גסריאני (כגון תדר רדיו תדר רדיו, הזרקה של גליצרול או דחיסת בלון 2 ) והקרנות סטריאוטקטיות ל trigeminal neuralgia 3 יכולות להיות מיושמות במקרים ללא קונפליקט נוירווסקולרי או בכל פעם שיש התוויות נגד מיקרוסורגיה פתוחה. עם זאת, כל הטכניקות קשורות עם שיעורי החזרה מסוימים של כאב. יתר על כן, הטיפול עצמו נושא סיכונים לנזק עצבי וכתוצאה מכך כאב נוירופתי או אפילו נוירופתיה טריגמית פוסט-טראומטית כואבת. לבסוף, כאב טריגמינלי ממוצא מרכזי(כגון כאב של שבץ פוסט) לא יגיב ל- MVD או טכניקות הרסניות בגנגליון הגאסאריאלי, אך צריך לטפל בו על ידי ניירומודולציה כגון גירוי מוחי עמוק (DBS) או גירוי קליפת המוח (MCS). Neuromodulation הוא מונח המשמש טכניקות כירורגיות, כי נראה לשנות את הפעילות העצבית מבלי לגרום נזק לרקמות בלתי הפיך. טיפולים נוירו-רפואיים הם הפיכים, ניתנים להתאמה ולרוב עובדים עם יישום לסירוגין של זרם חשמלי לחלקים של מערכת העצבים ההיקפית או המרכזית. ישנם מספר טיפולים מאושרים (CE ו- FDA) לטיפול בכאב כרוני ו / או נוירופתי של תא המטען והגפיים כגון גירוי של חוט השדרה באפידורל (SCS), גירוי שדה העצבים ההיקפי (PNFS) או גירוי הגנגליון הגבי (DRG) 4 . עם זאת, כרגע אין אישור CE או ה- FDA אישר זמין עבור כאב נוירופתי כרונית כאב טריגמינלי/ P&gt; גירוי מוחי עמוק (DBS) ו גירויים קליפת המוח (MCS) יושמו בסדרה מקרה מרובים עבור חולים עם כאבים בפנים כרוניים של מקורות שונים 5 . עם זאת, שתי הטכניקות מציגות רמה גבוהה של מורכבות ולדרוש מומחיות מיוחדת לרופא. יש צורך פשוט, יעיל עלות ויעיל neuromodulation עבור כאב טריגמינלי וכאב בפנים כאשר טיפול שמרני נכשל טכניקות הרס רוצה להימנע. מלבד גישות כירורגיות מערך של צורות לא פולשניות או זמניות של neuromodulation זמין לטיפול בכאב כרוני ( למשל PENS: נוירוסטימולציה חשמלית percutaneous, TENS: נוירוסטימולציה חשמלי transcutaneous, TMS: גירוי מגנטי transcranial). תת עורית היקפית גירוי שדה העצבים (sPNFS) הוא הצורה הפחות פולשנית של neuromodulation 6 . אחת או יותר אלקטרודות אממוקם מחדש ברקמה תת עורית באזור הכואב. גירוי חשמלי רציף מוחל כדי ליצור paresthesia נעים המכסה את האזור הכואב. מנגנון הפעולה המדויק אינו ידוע. עם זאת, למרות כל החסרונות מנגנונים דומים כמו התיאוריה בקרת השער - או וריאציות של זה - אשר postulates אפנון של קלט nociceptive על ידי סיבים מעכב הוא מוחל לעתים קרובות. יתר על כן בלוק dolarization המקומי של סיבי העצבים ההיקפיים עם רגישות מופחתת ושינויים בסביבה מיקרו לגבי חלבונים דלקתיים דנים 7 . כמו ברוב נוירומודולציה ניסוי מבחן עם אלקטרודות חיצוניות מחובר גנרטור הדופק מבוצעת כדי להעריך את האפקטיביות לפני גנרטור הדופק במלואו implantable (IPG) ממוקם ברקמה תת עורית מחוברת האלקטרודות כמקור כוח לגירוי ב מקרה של טיפול תרופתיCcess. אין הגדרה כללית של ניסוי מבחן חיובי אולם ירידה בכאב של 50% או יותר בקנה מידה אנלוגי חזותי (VAS) נחשב לעתים קרובות כקריטריון ההיכר. יתר על כן, הפחתת תרופות כאבים דרך הפה או עלייה באיכות החיים יכול להיות גורמים לטובת השתלת מערכת קבע. גירוי שדה העצבים ההיקפי הוא מאושר לשימוש בכאב גב תחתון 8 וכבר נעשה שימוש בתסמונות כאב כרוניות מקומיות ( כגון כאב פוסט-סניטורי). הוא משמש גם גירוי עצבי occipital (ONS) לטיפול מיגרנה כרונית כאבי ראש מצרר 9 . מספר מחקרים לא אקראיים הראו את השימוש ב- sPNFS בדרמטומים של טריגמינל לכאב נוקשה כרוני וכאבי נוירופתי של מקורות שונים (TN קלאסי, TN לא טיפוסי, נוירופתיה טריגמינלית פוסט-הרפטית, נוירופתיה טריגמינלית הקשורה בטרשת נפוצה, כאבי פרצוף אידיופתיים מתמשכים) 10 </suP&gt; , 11 , 12 . תת עורית טריגמינלית עצב שדה גירוי (sTNFS) הוא קל ומהיר לבצע. בניגוד ל- DBS או ל- MCS, ניתן לבצע sTNFS כנוהל אשפוז (אם יוחזר). אין סכנה של דימום תוך גולגולתי או אפידורל. ההתקפים אינם מתרחשים. גירוי הניסוי מבוצע בסביבה אמבולטורית, כך שהחולה יכול להעריך את השפעת הגירוי בזמן ביצוע שגרת היום יום שלו במקום להיות קשור למיטת בית החולים. אין צורך בהדמיה אינטרה או טרום ניתוחית מוקדמת כדי לקבוע את המיקום הנכון של האלקטרודות. STNFS יכול להיחשב כאפשרות טיפולית כדי לשנות את תפיסת הכאב ואת העיבוד לפני יישום הליך הרסני percutaneous או סוג פולשני פחות של neuromodulation לפני לחשוב על MCS או DBS בחולים עם כאב נוירופתי או מרכזי.

<table border="0" cellpadding="0" cellspacing="0" width="1257">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">myStim Patient Programmer</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97740</td>
			<td style="width:709px;">enables the patient to turn off and on stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Prime Advanced</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97702</td>
			<td>non-rechargeable IPG as powersource for stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Restore Ultra</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97712</td>
			<td>rechargeable IPG as powersource for stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Charging System</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97754</td>
			<td>used by the patient to recharge the Restore Ultra IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">N&#39;Vision Programmer</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">8840</td>
			<td>used by the physician to program the IPG and define stimulation parameters</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">External Neurostimulator</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">37022</td>
			<td>external IPG as powersource for trial stimulation with externalized electrodes</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Advanced Screening Cable</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">355531</td>
			<td>connects externalized electrodes to the external neurostimulator during trial stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Tunnelling Spear 60cm</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3655-60</td>
			<td>used to subcutaneously tunnel the permanent electrodes to an infraclavicular pocket that houses the IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Tunnelling Spear 38cm</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3655-38</td>
			<td>used to subcutaneously tunnel the permanent electrodes to an infraclavicular pocket that houses the IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Tuhoy Cannula</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3550-32</td>
			<td>14 gauge Epidural Tuhoy cannula (length 9cm) to subcutaneously implant the electrodes</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">InjexFixation Device</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97791 / 97792</td>
			<td>used to fixate the electrodes on the skin or on the muscle fascia</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Octad Compact</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3878-60</td>
			<td>permanent electrode (length 60cm) implanted in the subcutaneous tissue with 8 contacts</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Vectris Trial Lead</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">977D260</td>
			<td>externalized electrode (length 60cm) used during the stimulation trial</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Ethilon*II 3-0</td>
			<td style="width:213px;">Ethicon</td>
			<td style="width:119px;">EH7933H</td>
			<td>non-absorbable suture for skin closure</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Seide 2-0</td>
			<td style="width:213px;">Resorba</td>
			<td style="width:119px;">40221</td>
			<td>non-absorbable silk suture to fixate electrodes and IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Resolon DS21</td>
			<td style="width:213px;">Resorba</td>
			<td style="width:119px;">881413</td>
			<td>absorbable suture for subcutaneous wound closure</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Feather disposable scalpel</td>
			<td style="width:213px;">Feather</td>
			<td style="width:119px;">5205052</td>
			<td>single use scalpel for skin incision and suture cutting</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Scandicain 1%</td>
			<td style="width:213px;">Astra Zeneca</td>
			<td style="width:119px;">23186</td>
			<td>1% Mepivacain solution for local anesthesia</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cosmopor E steril 10x6</td>
			<td style="width:213px;">Hartmann</td>
			<td style="width:119px;">900871</td>
			<td>Sterile draping for IPG wound</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cosmopor E steril 7,2x5</td>
			<td style="width:213px;">Hartmann</td>
			<td style="width:119px;">900870</td>
			<td>Sterile draping for skin punctures and small incisions</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Foliodrape Comfort 50x50</td>
			<td style="width:213px;">Hartmann</td>
			<td style="width:119px;">252302</td>
			<td>Sterile draping for the surgical field</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cephazolin</td>
			<td style="width:213px;">Fresenius</td>
			<td style="width:119px;">6062403.00.00</td>
			<td>Single shot perioperative antibiotic</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Kepinol forte 800mg/160mg</td>
			<td style="width:213px;">Dr. R. Pfleger Chemische Fabrik</td>
			<td style="width:119px;">2485177</td>
			<td>Postoperative prophylactic oral antibiotic</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Poly-Alcohol</td>
			<td style="width:213px;">Antiseptica</td>
			<td style="width:119px;">UN1219</td>
			<td>Coloured skin disinfectant used during the permanent implantation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cutasept F</td>
			<td style="width:213px;">Bode</td>
			<td style="width:119px;">976800</td>
			<td>Un-Coloured skin disinfectant used during the trial implantation</td>
		</tr>
	</tbody>
</table>

subcutaneous trigeminal nerve field stimulation for refractory facial pain

כאב ראש כרוני או נוירופתי של טריגמינלי יכול להיות מאתגר לטיפול. יש ליישם נהלים נוירוכירורגיים כאשר הטיפול השמרני נכשל. טכניקות נוירומודולציה לכאבי פרקים כרוניים כוללות גירוי מוחי עמוק וגירוי קליפת המוח, שהם מורכבים לביצוע. תת עורית תת עורית גירוי הוא מוסמך עבור כאבים בגב כרוני הוא הצורה הפחות פולשנית של neuromodulation. השתמשנו בטכניקה זו לטיפול בכאב כרוני טריאמינלי כרוני וכטיפול נוירופתי כמושג טיפול אישי. ראשית, גירוי המשפט מבוצע. מוליכים תת עוריים ממוקמים הדרמטום trigiminal כואבת תחת הרדמה מקומית. מוביל מחוברים neurostimulator חיצוני זה חל גירוי מתמיד. חולים עוברים 12 יום ניסיון חוץ כדי להעריך את ההשפעה של הגירוי. אלקטרודות יוסרו לאחר המשפט. אם המטופל מדווח על הפחתת כאב של לפחות 50% בעוצמה ו / או בתדירות ההתקפה, ירידהתרופות או עלייה באיכות החיים, השתלה קבועה מתוכננת. אלקטרודות חדשות מושתלים תחת הרדמה כללית והם subcutaneous במנהרה גנרטור פנימי infraclavular פולס. חולים מסוגלים להפעיל גירוי לסירוגין כדי להגדיל או להקטין את משרעת גירוי לפי הצורך. טכניקה זו מייצגת אלטרנטיבה פולשנית מינימלית לאמצעים פולשניים נוספים של נוירומודולציה לכאב טריגמינלי כגון גירוי קליפת המוח או גירוי מוחי עמוק.

<html> כמו תת עורית טריגמינלית בתחום העצבים גירוי (sTNFS) הוא לא טיפול סטנדרטי ומספר חולים שיכולים ליהנות ממנו הוא קטן יחסית בהשוואה למחלות אחרות, יש רק במקרה קטן סדרה המראים תוצאות של sTNFS. בסדרה אחת, 10 חולים עברו גירוי בדיקה עבור sTNFS. שמונה מהחולים הגיבו לט?...

Watch this Scientific Journal Video about Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain at JoVE.com

Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain

טיפול בכאב כרוני או נוירופתי יכול להיות מאתגר כאשר טיפול רפואי או סטנדרטי נכשל. גירוי תת-עורתי תת-עורתי הוא הצורה הפחות פולשנית של נוירומודולציה ומשמש כאבי גב כרוניים. השתמשנו בטכנולוגיה זו לטיפול בכאבי פרקים כרוניים וכרומטיים נוירופתים.

תת עורית גידולי שדה העצבים עבור כאב פנים עקשן

Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. ...

subcutaneous-trigeminal-nerve-field-stimulation-for-refractory-facial

Research

JoVE Journal

Medicine

18.6K Views.  University Hospital Heidelberg.  טיפול בכאב כרוני או נוירופתי יכול להיות מאתגר כאשר טיפול רפואי או סטנדרטי נכשל. גירוי תת-עורתי תת-עורתי הוא הצורה הפחות פולשנית של נוירומודולציה ומשמש כאבי גב כרוניים. השתמשנו בטכנולוגיה זו לטיפול בכאבי פרקים כרוניים וכרומטיים נוירופתים. ...

Video: Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain

Chronic Constriction of the Sciatic Nerve and Pain Hypersensitivity Testing in Rats

Chronic neuropathic pain, resulting from damage to the central or peripheral nervous system, is a prevalent and debilitating condition, affecting 7-18% of the population1,2. Symptoms include spontaneous (tingling, burning, electric-shock like) pain, dysaesthesia, paraesthesia, allodynia (pain resulting from normally non-painful stimuli) and hyperalgesia (an increased response to painful stimuli). The sensory symptoms are co-morbid with behavioural disabilities, such as insomnia and depression. To study chronic neuropathic pain several animal models mimicking peripheral nerve injury have been developed, one of the most widely used is Bennett and Xie's (1988) unilateral sciatic nerve chronic constriction injury (CCI)3 (Figure 1). Here we present a method for performing CCI and testing pain hypersensitivity.
CCI is performed under anaesthesia, with the sciatic nerve on one side exposed by making a skin incision, and cutting through the connective tissue between the gluteus superficialis and biceps femoris muscles. Four chromic gut ligatures are tied loosely around the sciatic nerve at 1 mm intervals, to just occlude but not arrest epineural blood flow. The wound is closed with sutures in the muscle and staples in the skin. The animal is then allowed to recover from surgery for 24 hrs before pain hypersensitivity testing begins.
For behavioural testing, rats are placed into the testing apparatus and are allowed to habituate to the testing procedure. The area tested is the mid-plantar surface of the hindpaw (Figure 2), which falls within the sciatic nerve distribution. Mechanical withdrawal threshold is assessed by mechanically stimulating both injured and uninjured hindpaws using an electronic dynamic plantar von Frey aesthesiometer or manual von Frey hairs4. The mechanical withdrawal threshold is the maximum pressure exerted (in grams) that triggers paw withdrawal. For measurement of thermal withdrawal latency, first described by Hargreaves et al (1988), the hindpaw is exposed to a beam of radiant heat through a transparent glass surface using a plantar analgesia meter5,6. The withdrawal latency to the heat stimulus is recorded as the time for paw withdrawal in both injured and uninjured hindpaws. Following CCI, mechanical withdrawal threshold, as well as thermal withdrawal latency in the injured paw are both significantly reduced, compared to baseline measurements and the uninjured paw (Figure 3). The CCI model of peripheral nerve injury combined with pain hypersensitivity testing provides a model system to investigate the effectiveness of potential therapeutic agents to modify chronic neuropathic pain. In our laboratory, we utilise CCI alongside thermal and mechanical sensitivity of the hindpaws to investigate the role of neuro-immune interactions in the pathogenesis and treatment of neuropathic pain.

Due to the simplicity of surgery and the robust behavioural outcome, chronic constriction of the sciatic nerve is one of the pre-eminent animal models of neuropathic pain. Within 24 hrs following surgery, pain hypersensitivity is established and can be quantitatively measured using a von Frey aesthesiometer (mechanical test) and plantar analgesia meter (thermal test).

היצרות כרונית של העצב Sciatic ואת רגישות יתר לכאב בדיקה אצל חולדות

Chronic neuropathic pain, resulting from damage to the central or peripheral nervous system, is a prevalent and debilitating condition, affecting 7-18% of ...

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

The purpose is to present a new method, breathing-control electrical stimulation (BreEStim) for management of neuropathic pain and spasticity.

גירוי נשימה מבוקרת חשמל (BreEStim) לטיפול בכאב נוירופתי וספסטיות

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

The Sciatic Nerve Cuffing Model of Neuropathic Pain in Mice

Neuropathic pain arises as a consequence of a lesion or a disease affecting the somatosensory system. This syndrome results from maladaptive changes in injured sensory neurons and along the entire nociceptive pathway within the central nervous system. It is usually chronic and challenging to treat. In order to study neuropathic pain and its treatments, different models have been developed in rodents. These models derive from known etiologies, thus reproducing peripheral nerve injuries, central injuries, and metabolic-, infectious- or chemotherapy-related neuropathies. Murine models of peripheral nerve injury often target the sciatic nerve which is easy to access and allows nociceptive tests on the hind paw. These models rely on a compression and/or a section. Here, the detailed surgery procedure for the &#34;cuff model&#34; of neuropathic pain in mice is described. In this model, a cuff of PE-20 polyethylene tubing of standardized length (2 mm) is unilaterally implanted around the main branch of the sciatic nerve. It induces a long-lasting mechanical allodynia, i.e., a nociceptive response to a normally non-nociceptive stimulus that can be evaluated by using von Frey filaments. Besides the detailed surgery and testing procedures, the interest of this model for the study of neuropathic pain mechanism, for the study of neuropathic pain sensory and anxiodepressive aspects, and for the study of neuropathic pain treatments are also discussed.

Neuropathic pain is a consequence of a lesion or disease affecting the somatosensory system. The &#8220;cuff model&#8221; of neuropathic pain in mice consists of the implantation of a polyethylene cuff around the main branch of the sciatic nerve. Mechanical allodynia is tested using von Frey filaments.

דגם השת עצב איזוק של כאב נוירופתי בעכברים

Neuropathic pain arises as a consequence of a lesion or a disease affecting the somatosensory system. This syndrome results from maladaptive changes in ...

Facial Nerve Axotomy in Mice: A Model to Study Motoneuron Response to Injury

The goal of this surgical protocol is to expose the facial nerve, which innervates the facial musculature, at its exit from the stylomastoid foramen and either cut or crush it to induce peripheral nerve injury. Advantages of this surgery are its simplicity, high reproducibility, and the lack of effect on vital functions or mobility from the subsequent facial paralysis, thus resulting in a relatively mild surgical outcome compared to other nerve injury models. A major advantage of using a cranial nerve injury model is that the motoneurons reside in a relatively homogenous population in the facial motor nucleus in the pons, simplifying the study of the motoneuron cell bodies. Because of the symmetrical nature of facial nerve innervation and the lack of crosstalk between the facial motor nuclei, the operation can be performed unilaterally with the unaxotomized side serving as a paired internal control. A variety of analyses can be performed postoperatively to assess the physiologic response, details of which are beyond the scope of this article. For example, recovery of muscle function can serve as a behavioral marker for reinnervation, or the motoneurons can be quantified to measure cell survival. Additionally, the motoneurons can be accurately captured using laser microdissection for molecular analysis. Because the facial nerve axotomy is minimally invasive and well tolerated, it can be utilized on a wide variety of genetically modified mice. Also, this surgery model can be used to analyze the effectiveness of peripheral nerve injury treatments. Facial nerve injury provides a means for investigating not only motoneurons, but also the responses of the central and peripheral glial microenvironment, immune system, and target musculature. The facial nerve injury model is a widely accepted peripheral nerve injury model that serves as a powerful tool for studying nerve injury and regeneration.

We present a surgical protocol detailing how to perform a cut or crush axotomy on the facial nerve in the mouse. The facial nerve axotomy can be employed to study the physiological response to nerve injury and test therapeutic techniques.

Axotomy פנים עצב של עכברים: דגם לחקר תגובת Motoneuron לפגיעה

The goal of this surgical protocol is to expose the facial nerve, which innervates the facial musculature, at its exit from the stylomastoid foramen and ...

Chronic Constriction Injury of the Rat's Infraorbital Nerve (IoN-CCI) to Study Trigeminal Neuropathic Pain

Animal models are important tools to study the pathophysiology and pharmacology of neuropathic pain. This manuscript describes the surgical and behavioral procedures to study trigeminal neuropathic pain in rats. To meet the specificity of trigeminal neuropathic pain syndromes, the infraorbital nerve (IoN) is subjected to a chronic constriction injury (CCI) by loosely ligating the nerve. An intra-orbital approach is presented here to expose and ligate the IoN in the orbital cavity. After IoN ligation, rats exhibit changes in spontaneous behavior and in response to von Frey hair stimulation that are indicative of persistent pain and mechanical allodynia. Two phases can be defined in the development of the behavioral changes. During the first week following IoN-CCI (phase 1), rats show an increased and asymmetric face grooming activity, i.e., with face wash strokes primarily directed to the nerve-injured IoN territory. A distinction is made between face grooming behavior that is part of a more general body grooming behavior, which remains largely unaffected by IoN-CCI, and face grooming that is neither preceded nor followed by body grooming, which is significantly increased after IoN-CCI. During this period, responsiveness to mechanical stimulation of the IoN territory is reduced. This hyporesponsiveness is abruptly replaced by an extreme hyperresponsiveness whereby even very weak stimulus intensities provoke nocifensive behavior (phase 2). The phenomenological similarities between these behavioral alterations and reported signs of facial pain (i.e., responses to noxious stimulation of the face) suggest the presence of dysesthesia/paresthesia and mechanical allodynia in the ligated IoN territory.

Chronic Constriction Injury of the Rat's Infraorbital Nerve IoN-CCI to Study Trigeminal Neuropathic Pain

This manuscript describes a rodent model to study trigeminal neuropathic pain. The methods described include surgical procedures to perform a chronic constriction injury of the rat&#8217;s infraorbital nerve and the post-surgical behavioral tests to measure the changes in spontaneous and evoked behavior that are indicative of persistent pain and allodynia.

התכווצות פציעה כרונית של עצב Infraorbital של העכברוש (יון-CCI) לחקר trigeminal נוירופתי כאב

Animal models are important tools to study the pathophysiology and pharmacology of neuropathic pain. This manuscript describes the surgical and behavioral ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

ניתוח רשת של הקלטות אלקטרודה foramen ovale בחולים עמידים בפני תרופות Temporal Lobe אפילפסיה

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ET can have a significant impact on quality of life, mood, functional activities, and socialization. Patients suffering from ET not sufficiently treated with first line medications may be eligible for alternative strategies such as deep brain stimulation, radiofrequency ablation, and MRI guided focused ultrasound (MRgFUS). High-intensity MRgFUS is an emerging modality to treat ET, its attraction for patients being that it is noninvasive and associated with short recovery time, as patients are home the day after treatment. While MRgFUS centers are still limited, it will become important for clinicians to consider MRgFUS as a treatment alternative, particularly in the case of a patient for whom open surgery is contraindicated. This article outlines the steps of patient selection, equipment setup, sonication, and post-treatment follow-up, as well as critical steps to be aware of when performing a MRgFUS procedure.

High-intensity MRI guided focused ultrasound is an emerging noninvasive technique to precisely ablate brain tissue. It has been shown to be safe and effective in treating medically-refractory essential tremor. This article describes the protocol for thalamotomy from patient selection to equipment setup to post-treatment follow-up.

סאונד ממוקד מונחה MRI Thalamotomy בחולים עם רעד חיוני מבחינה רפואית חסיני אש

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ...

Cavernous Nerve Stimulation and Recording of Intracavernous Pressure in a Rat

The stimulation of the cavernous nerve (CN) and measurement of intracavernous pressure (ICP) have been used extensively to test and evaluate therapies for erectile dysfunction. However, the methods used vary between laboratories, and pitfalls still exist. The goal of this study was to describe a surgical technique that would provide a reliable and reproducible model. By exposing the ischiocavernosus muscle at its point of insertion on the ischial tuberosity, the penile crus could be cannulated with minimal dissection and injury to the structures involved in erectile function. Repeated stimulation of the CN, without the need for lifting and drying, was achieved by using a 125 &#181;m bipolar silver electrode and biocompatible silicon glue to isolate the electrode-nerve complex. This method prevents neuropraxia by reducing stretching and drying the nerve and provides complete isolation of the nerve, negating electrical leakage and preventing stimulation of alternative pathways.

This study describes a simplified surgical procedure and technique for performing cavernous nerve stimulation with the isolation of the nerve-electrode complex using silicone glue and intracavernous pressure measurement.

גירוי עצבי חלול ורישום של תרופתי בלחץ עכברוש

The stimulation of the cavernous nerve (CN) and measurement of intracavernous pressure (ICP) have been used extensively to test and evaluate therapies for ...

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression

Vagus nerve stimulation (VNS) is an approved neurostimulation therapy. The purpose of the method is to treat patients with therapy-resistant depression (TRD). VNS exhibits antidepressive and stabilizing effects. This method is particularly useful as a long-term treatment, in which up to two-thirds of patients respond. The vagus nerve stimulator is positioned on the left vagus nerve during a surgical procedure and is activated telemetrically by a wand connected to a handheld computerized device. The treating physician can perform various adjustments of the vagus nerve stimulator during in-office visits (e.g., by modifying stimulation intensity or stimulation frequency) to achieve maximum therapeutic effects with low side effects. Set-up of the device usually takes several months. Typical side effects include wound infection, temporary salivation, coughing, paralysis of the vocal cords, bradycardia, or even asystole. The patient can stop the VNS by placing a magnet over the generator. The current protocol describes delivery of the specific stimulation tool and methods for adjusting the tuning parameters to achieve the best remission rates in patients with TRD.

Vagus nerve stimulation (VNS) has been shown to be effective as an adjunct treatment for treatment-resistant depression (TRD). VNS leads to antidepressive and antisuicidal effects and quality of life improvements. This protocol offers a step-by-step guide to managing and adjusting a vagus nerve stimulator for efficient treatment of TRD.

קוצב וגאלי ככלי בגירוי ניהולה עמיד לטיפול בדיכאון

Vagus nerve stimulation (VNS) is an approved neurostimulation therapy. The purpose of the method is to treat patients with therapy-resistant depression ...

Partial Sciatic Nerve Ligation: A Mouse Model of Chronic Neuropathic Pain to Study the Antinociceptive Effect of Novel Therapies

Management of chronic pain remains challenging to this day, and current treatments are associated with adverse effects, including tolerance and addiction. Chronic neuropathic pain results from lesions or diseases in the somatosensory system. To investigate potential therapies with reduced side effects, animal pain models are the gold standard in preclinical studies. Therefore, well-characterized and well-described models are crucial for the development and validation of innovative therapies. 
Partial ligation of the sciatic nerve (pSNL) is a procedure that induces chronic neuropathic pain in mice, characterized by mechanical and thermal hypersensitivity, ongoing pain, and changes in limb temperature, making this model a great fit to study neuropathic pain preclinically. pSNL is an advantageous model to study neuropathic pain as it reproduces many symptoms observed in humans with neuropathic pain. Furthermore, the surgical procedure is relatively fast and straightforward to perform. Unilateral pSNL of one limb allows for comparison between the ipsilateral and contralateral paws, as well as evaluation of central sensitization. 
To induce chronic neuropathic hypersensitivity, a 9-0 non-absorbable nylon thread is used to ligate the dorsal third of the sciatic nerve. This article describes the surgical procedure and characterizes the development of chronic neuropathic pain through multiple commonly used behavioral tests. As a plethora of innovative therapies are now being investigated to treat chronic pain, this article provides crucial concepts for standardization and an accurate description of surgeries required to induce neuropathic pain.

Partial sciatic nerve ligation induces long-lasting chronic neuropathic pain, characterized by exaggerated responses to thermal and mechanical stimuli. This mouse model of neuropathic pain is commonly used to study innovative therapies for pain management. This article describes in detail the surgical procedure to improve standardization and reproducibility.

קשירת עצבים סיאטית חלקית: מודל עכברי של כאב נוירופתי כרוני לחקר ההשפעה האנטינוסיצפטיבית של טיפולים חדשניים

Management of chronic pain remains challenging to this day, and current treatments are associated with adverse effects, including tolerance and addiction. ...