Search Results (48)

Background/Objectives: The cerebellum plays a central role in sensorimotor integration and temporal processing, yet its direct electrophysiological investigation in humans remains challenging, and cerebellar contributions to somatosensory responses remain poorly defined. This study aimed to determine whether cerebellar responses to peripheral nerve stimulation can be detected using scalp EEG and whether time–frequency analysis provides advantages over time-domain approaches. Methods: Scalp EEG was recorded during electrical stimulation of the median nerve and tibial nerve in 16 healthy participants. Electrode montages included posterior fossa placements targeting cerebellar activity, together with standard cortical and subcortical derivations. Data were analyzed in the time domain using evoked potentials and channel comparisons, including bipolar cerebellar derivations, and in the time–frequency domain using spectral power analysis. Results: Time-domain analyses revealed early and intermediate latency components following both upper- and lower-limb stimulation; however, these responses showed limited spatial specificity and were strongly influenced by reference effects and subcortical contamination. In contrast, time–frequency analysis consistently revealed sustained increases in oscillatory power in cerebellar channels. Power increases emerged approximately 50 ms after stimulation and persisted beyond 300 ms, peaking around ~20 Hz for upper-limb stimulation and ~10 Hz for lower-limb stimulation, with evidence of side specificity. Conclusions: Non-invasive EEG can detect cerebellar responses to peripheral nerve stimulation, particularly in the time–frequency domain. Oscillatory dynamics provide a more robust marker of cerebellar involvement than time-locked responses and may complement conventional somatosensory evoked potentials in studies of cerebellar physiology and spinocerebellar pathway integrity. Full article

Background: Repetitive peripheral magnetic stimulation (rPMS) has emerged as a promising non-invasive treatment modality for reducing muscle hypertonus and spasticity. However, standardized protocols regarding stimulation parameters, particularly the number of stimuli required to achieve therapeutic effects, remain largely undefined. Methods: In an exploratory study, seventeen healthy participants (15 male, 2 female) underwent progressive rPMS treatments at 5 Hz frequency with incrementally increasing stimulus counts (105, 210, 315, 420, and 840 stimuli). Seventeen participants served as controls (11 male, 6 female) receiving sham stimulation. Achilles tendon reflexes were elicited using a computer-controlled reflex hammer, and compound muscle action potential (CMAP) peak-to-peak amplitudes were recorded via surface electromyography before and immediately after each stimulation session. Results: The overall repeated-measures ANOVA indicated a significant main effect (F(5, 80) = 4.98, p = 0.001, η²_p = 0.237). All rPMS treatments produced significant reductions in CMAP amplitudes compared to baseline (p < 0.05). No progressive dose-dependent relationship was observed between stimulus count and response magnitude, suggesting a threshold effect rather than progressive inhibition. Control group showed no significant changes (p ≤ 0.56). Conclusions: Low-frequency (5 Hz) rPMS produces rapid inhibitory effects on spinal reflex circuits with onset after as few as 105 stimuli. These findings indicate that treatment effects can be achieved with substantially fewer stimuli than previously assumed. Further research is needed to identify parameters capable of achieving greater reflex suppression. Full article

Background: Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence in women and significantly their affects quality of life. Aim: The aim of this study was to summarize the current evidence about conservative (non-surgical) treatments for female SUI and outline their clinical applicability. Material and methods: A narrative review was performed using structured research involving medical databases over the last 15 years, including systematic reviews, randomized controlled trials, observational studies and key guidelines regarding pelvic floor muscle training (PFMT), electrical and tibial nerve stimulation, acupuncture, pharmacological therapies, local estrogen, pessaries and bulking agents. Results: PFMT represents the primary first-line therapy, with strongest evidence for reducing leakage episodes and improving quality of life when performed correctly and consistently. Other conservative options (electrical and tibial nerve stimulation, acupuncture, duloxetine, local vaginal estrogen, pessaries and bulking agents) may be efficient for selected patients, but generally they have a weaker or more heterogeneous evidence base. They are considered adjuncts or tailored alternatives when PFMT alone is insufficient, not feasible or not accepted. Conclusions: Conservative management, centered on PFMT, should be offered as initial treatment to most women with mild to moderate SUI, with additional modalities being used selectively according to symptom profile, comorbidities and patient preference. A stepwise, individualized approach can control symptoms in many women and may delay or avoid surgical therapy. Full article

Objectives: We aimed to evaluate the effect of non-invasive NESA neuromodulation compared to posterior tibial nerve stimulation (PTNS) in patients with an overactive bladder (OAB), also given the same exercises and patient education, on quality of life, symptoms, discomfort and sleep quality. Method: Twenty-four women, aged 38–85 years with OAB, were included in this preliminary randomized controlled trial. Each patient attended ten sessions, twice a week. Patient pelvic floor function and urinary incontinence symptoms were collected throughout ICIQ-SF and B-SAQ questionnaires. Patient QoL and sleep quality were reported using SF-36 and PSQI, respectively. All outcomes were measured using three assessments: previous treatment (T1), immediately after treatment (T2) and two-month follow-up (T3). Results: Both groups showed significant improvements in pelvic floor function and urinary incontinence symptoms, as well as in sleep quality (p < 0.05). Although no significant differences between the groups were observed for any of the variables (p > 0.05), only the NESA group showed compelling improvements in quality of life (p < 0.05). Conclusions: The two treatments improved OAB symptoms, discomfort, and sleep quality in the short term yet only the non-invasive NESA group improved quality of life in women with OAB. These findings warrant further investigation in larger trials. Full article

This study aimed to evaluate the regenerative effects of various microcurrent waveforms in cast-induced gastrocnemius muscle atrophy in rabbits, integrating both in vitro and in vivo analyses. After two weeks of enforced hindlimb immobilization via casting, twenty-four rabbits were divided into four groups and treated for two weeks: Group-1 (control) received sham microcurrent, Group-2 was treated with a square waveform microcurrent, Group-3 with a sine waveform, and Group-4 with a triangular waveform. Treatments were administered daily for one hour. Calf circumference, muscle thickness (via ultrasound), tibial nerve CMAP, muscle fiber CSA, and protein expression (via Western blot analysis) were assessed. Among the groups, the sine waveform microcurrent resulted in significantly enhanced recovery across all measured parameters (p < 0.05), showing superior improvements in muscle thickness, CMAP amplitude, and fiber CSA. Immunohistochemical analysis revealed increased expression of proliferation and angiogenesis markers, including BrdU, PCNA, VEGF, and PECAM-1, while Western blotting demonstrated robust upregulation of myogenic regulatory factors such as MyoD and myogenin. Furthermore, levels of inflammatory and apoptotic markers, including TNF-α, NF-κB, and cleaved caspase-3, and stress response proteins, including p-CHK1 and p-CHK2, were markedly reduced. Collectively, these findings indicate that sine waveform microcurrent stimulation most effectively promotes muscle regeneration in both dexamethasone-induced C2C12 myoblasts and cast-induced muscle atrophy, underscoring its therapeutic potential and warranting further studies to optimize clinical application parameters. Full article

In this review, we summarize current insights into the treatment of functional constipation (FC) in children. Constipation is a global issue in the pediatric population, with a prevalence of approximately 9.5%. Initial management involves a combination of non-pharmacological and pharmacological interventions. However, a significant number of children continue to experience therapy-resistant FC despite optimal non-pharmacological and pharmacological treatments. While studies on novel pharmacological options in children are limited, adult trials have shown promising results. New agents such as lubiprostone, prucalopride, linaclotide, and plecanatide have demonstrated improved outcomes compared to placebo or conventional therapies, particularly in increasing spontaneous bowel movements. Neurostimulation presents an additional treatment modality. Posterior tibial nerve stimulation appears to be a promising new option, offering high treatment satisfaction and a favorable safety profile with a low rate of severe adverse events. For children who do not respond to optimal conservative therapy, the impact on quality of life can be substantial. In such cases, surgical interventions may be considered, including intrasphincteric botulinum toxin injections, antegrade continence enema surgery, and, in severe cases, colonic resection or a diverting ostomy. The choice of surgical treatment remains a subject of ongoing debate. Therapy-resistant FC in children is a complex and impactful condition. An individualized, stepwise approach is essential, with surgical options such as colonic resection reserved as a last resort. Full article

Background: Neurogenic bladder (NB), resulting from neurological disorders, significantly affects quality of life and increases healthcare costs. Although percutaneous tibial nerve stimulation (PTNS) is an established therapy for central nervous system-related lower urinary tract dysfunction (LUTD), its efficacy in treating intervertebral discogenic LUTD remains unexplored. This study presents the first documented case of PTNS applied to NB secondary to severe lumbosacral herniated intervertebral disc (HIVD). Methods: A 39-year-old female, hospitalized twice for worsening HIVD, presented with LUTD, including urgency, weak stream, and nocturia. Magnetic resonance imaging confirmed progressive L5-S1 disc extrusion with sacral nerve compression. PTNS, delivered via electronic stimulation through acupuncture needles at SP6 and KI3, was administered daily for 10 days during hospitalization. Symptom scores relating to LUTD, pain, and physical disability were evaluated. Result: The American Urological Association symptom score showed significant improvement (from 20 to 6 and 22 to 15 at 12 weeks after the first and second hospitalizations, respectively). Recovery of voiding function was slower during the second hospitalization, possibly due to increased sacral nerve compression and chronic pathologic condition. Pain and functional disability, assessed using the NRS and ODI, improved by approximately 50% (from 55 to 25 and 80 to 45 during the first and second hospitalizations, respectively) and two-thirds (from 66 to 42 and 93 to 66, respectively). Conclusions: This case suggests that PTNS may be a viable conservative therapy for HIVD-associated LUTD. Further research is required to elucidate its mechanistic effects and clinical efficacy in peripheral nerve-related bladder dysfunction. Full article

Background: The vestibular postural control system affects standing stability on an unstable surface. However, it is unclear whether maintaining a standing position on different surfaces alters lateral vestibulospinal tract (LVST) excitability and body control responses following vestibular stimulation. This study aimed to investigate the relationship between the soleus H-reflex following galvanic vestibular stimulation (GVSH), a measure of LVST, and post-stimulus body movement responses while standing with eyes closed on different surfaces. Methods: Twelve healthy volunteers (mean age 20.4 ± 0.5 years, 7 females) performed eyes-closed standing GVSH on firm and foam surfaces. Body control responses in each condition were evaluated using an inertial measurement unit to monitor neck and pelvic movements, along with surface electromyography to assess muscle activity in the tibialis anterior and soleus muscles. Body responses to the GVS were averaged over up to a second after tibial nerve stimulation. Results: We observed a significant negative correlation between the H-wave amplitude of the GVSH on the firm surface and the tibialis anterior muscle activity following stimulation (r = −0.666, p = 0.018). No significant differences were observed during the eyes-closed standing GVSH on either firm or foam surfaces (p = 0.568). Conclusions: Postural maintenance in response to vestibular stimulation may contribute to body stability by regulating tibialis anterior muscle contraction via the LVST. Our findings may help elucidate the neural activity of vestibular function-related standing postural control responses. Full article

Background/Objectives: Acute lateral ankle sprain (ALAS) affects balance, often assessed by changes in traditional center of pressure (COP) parameters. Spatiotemporal measures of COP and time-to-boundary (TTB) analysis may offer improved sensitivity in detecting postural deviations associated with ALAS. However, the neurophysiological mechanism underlying these changes remains unknown. This study aimed to explore the effects of ALAS on spinal reflex excitability in the fibularis longus (FL) during single-leg balance and TTB parameters following ALAS. Methods: Fourteen participants with and without ALAS were recruited within 14 days from the onset of the injury. We assessed FL spinal reflex excitability and postural control during a single-leg stance. The primary outcomes included the H/M ratio, H-latency, and TTB parameters. For H-reflex testing, the peripheral electrical stimulation was delivered at the sciatic nerve before bifurcating into the tibial and common fibular nerve while participants maintained a single-leg balance position with the involved side of the limb. The TTB parameters of the medial–lateral (ML) and anterior–posterior (AP) directions of the mean, SD, and minimum were assessed, which indicate postural correction and strategies. Results: Patients with ALAS had a significantly lower AP-TTB minimum compared with healthy uninjured controls, with a moderate effect size (p = 0.039; d = −0.83). However, there was no significant difference in the H/M ratio (ALAS: 0.29 ± 0.16 vs. CON: 0.24 ± 0.10; p = 0.258) and H-reflex latency (ALAS: 34.6 ± 1.92 vs. CON: 33.8 ± 1.75 ms; p = 0.277); Conclusions: These results indicate that reflex control at the spinal level may have a minimal role in response to balance deficits following ALAS. Full article

Background/Objectives: Peripheral nerve conduction velocity (NCV) and nerve cross-sectional area (nCSA) are crucial parameters in neurophysiological assessments, yet their sex-specific differences are not fully understood. This study investigated sex-based variations in NCV and nCSA between upper and lower limbs. Methods: Twenty participants (ten males and ten females) were recruited for this study. The NCV and nCSA of the ulnar and tibial nerves were measured in both the upper and lower limbs. NCV was measured using supramaximal electric stimulation, and nCSA was assessed using peripheral nerve ultrasonography at three regions for each nerve. Supramaximal electric stimulations were applied superficially to the ulnar and tibial nerves at each measurement point. Action potentials were recorded from the abductor digiti minimi and soleus muscles for the ulnar and tibial nerves, respectively. Results: The ulnar nCSA of the upper limbs was significantly greater in males than in females (p < 0.05). However, ulnar NCV was significantly higher in females than in males (p < 0.05). In the lower limbs, no sex differences were observed in tibial NCV or nCSA. Conclusions: These findings reveal sex-specific differences in upper limb peripheral nerve characteristics that may have important implications for clinical assessments and treatment strategies. The contrasting patterns between upper and lower limbs suggest that both developmental and functional factors influence peripheral nerve properties. Full article

Background: Primary dysmenorrhea is a leading cause of chronic cyclic pelvic pain, contributing to a reduced quality of life and sleep disturbances in women. The objective of this study was to assess the effectiveness of transcutaneous tibial nerve stimulation (TTNS) in improving the quality of life, sleep, and overall health perceptions of participants compared to a control group of women with dysmenorrhea over short-term, medium-term, and long-term periods. Methods: A single-blind, controlled clinical trial was conducted, with participants randomly assigned to an experimental group (receiving TTNS) or a control group (receiving sham TTNS). Both groups underwent 12, weekly 30 min sessions using the NeuroTrac™ PelviTone electrostimulation device. Outcomes related to quality of life, sleep deficiency, and overall improvement were evaluated at three time points: short-term (post-treatment), medium-term (1–3 months), and long-term (6 months). Results: Of the 61 participants initially randomized (31 in the experimental group and 30 in the control group), 55 completed the study and were included in the final analysis. A statistically significant improvement was observed in the experimental group in both physical and mental health components, as measured by the SF-36v2^® questionnaire, following 12 weeks of intervention, compared to the control group, persisting 6 months after the intervention. Additionally, statistically significant differences in overall improvement were noted between the two groups, as measured by the PGIC questionnaire at the end of treatment (p = 0.0103) and 6 months post-treatment (p = 0.0432). Conclusions: TTNS appears to be a safe and effective strategy for enhancing quality of life and overall health in women with PD, potentially reducing the reliance on pharmacological treatments or more invasive methods. Full article

Background/Objectives: Multiple sclerosis (MS) frequently results in both urinary and sexual dysfunction, which significantly impairs quality of life. Conventional treatments for bladder dysfunction often prove insufficient, leading to the exploration of alternative therapies such as percutaneous tibial nerve stimulation (PTNS). This study aimed to assess the impact of PTNS on sexual function and bladder symptoms in female MS patients with neurogenic detrusor overactivity (NDO) and female sexual dysfunction (FSD). Methods: A total of 65 female MS patients with NDO were evaluated and underwent 12 weeks of standardized PTNS treatment. Sexual function was assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R), while bladder symptoms were evaluated using the OAB-v8 questionnaire. Participants were grouped based on the presence of sexual dysfunction and distress and compared to a control group of 20 patients who declined PTNS. Results: Significant improvements were observed in FSFI scores across multiple domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) in the treatment groups (p < 0.05). Additionally, 58.46% of patients showed positive responses to PTNS regarding overactive bladder symptoms (OAB-v8 score), while the control group showed no significant changes. Conclusions: PTNS appears to be an effective therapeutic option for improving sexual function and urinary symptoms in female MS patients with NDO and FSD, offering a promising non-invasive alternative for managing these conditions. Full article

Primary dysmenorrhea is considered one of the main causes of pelvic pain during a woman’s childbearing years, resulting in poor quality of life. The objective was to evaluate the effectiveness of transcutaneous tibial nerve stimulation (TTNS) in painful symptomatology improvement and non-steroidal anti-inflammatory drug (NSAID) intake reduction in women with primary dysmenorrhea (PD) compared with a control group in the short, medium, and long terms. A single-blind, controlled clinical trial was developed. Participants were randomized to the experimental (TTNS) and control group (sham TTNS). Both groups received 12-weekly 30-min sessions with a NeuroTrac^TM PelviTone electrostimulation device. The intensity and severity of pain and non-steroidal anti-inflammatory drug (NSAID) intake were evaluated in the short-term (after treatment), medium-term (1–3 months), and long-term (6 months). A total of 61 participants were randomized, with a split of 31 (experimental group) and 30 (control group), but 55 participants completed the study and were analyzed. Statistically significant differences between both groups in the maximum pain intensity decrease (F = 4.88, p = 0.0043) measured with the visual analogue scale, as well as NSAID intake decrease (F = 4.68, p = 0.011) and days of their ingestion (F = 4.57, p = 0.012) occurred in the short term. Furthermore, significant decreases in the total number of NSAIDs ingested during the cycle (F = 3.82, p = 0.011) and the number of days on which patients ingested NSAIDs (F = 3.59, p = 0.015) in the medium–long term occurred. TTNS could be an effective and safe strategy to reduce pain caused by PD, which could reduce or complement the use of pharmacological techniques and other more invasive methods. Full article

The agonist–antagonist myoneural interface (AMI), a surgical method to reinnervate physiologically-relevant proprioceptive feedback for control of limb prostheses, has demonstrated the ability to provide natural afferent sensations for limb amputees when actuating their prostheses. Following AMI surgery, one potential challenge is atrophy of the disused muscles, which would weaken the reinnervation efficacy of AMI. It is well known that electrical muscle stimulus (EMS) can reduce muscle atrophy. In this study, we conducted an animal investigation to explore whether the EMS can significantly improve the electrophysiological performance of AMI. AMI surgery was performed in 14 rats, in which the distal tendons of bilateral solei donors were connected and positioned on the surface of the left biceps femoris. Subsequently, the left tibial nerve and the common peroneus nerve were sutured onto the ends of the connected donor solei. Two stimulation electrodes were affixed onto the ends of the donor solei for EMS delivery. The AMI rats were randomly divided into two groups. One group received the EMS treatment (designated as EMS_on) regularly for eight weeks and another received no EMS (designated as EMS_off). Two physiological parameters, nerve conduction velocity (NCV) and motor unit number, were derived from the electrically evoked compound action potential (CAP) signals to assess the electrophysiological performance of AMI. Our experimental results demonstrated that the reinnervated muscles of the EMS_on group generated higher CAP signals in comparison to the EMS_off group. Both NCV and motor unit number were significantly elevated in the EMS_on group. Moreover, the EMS_on group displayed statistically higher CAP signals on the indirectly activated proprioceptive afferents than the EMS_off group. These findings suggested that EMS treatment would be promising in enhancing the electrophysiological performance and facilitating the reinnervation process of AMI. Full article

Background and Objectives: This review systematically evaluates the potential of electrical neuromodulation techniques—vagus nerve stimulation (VNS), sacral nerve stimulation (SNS), and tibial nerve stimulation (TNS)—as alternative treatments for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s Disease (CD). It aims to synthesize current evidence on the efficacy and safety of these modalities, addressing the significant burden of IBD on patient quality of life and the limitations of existing pharmacological therapies. Materials and Methods: We conducted a comprehensive analysis of studies from PubMed, focusing on research published between 1978 and 2024. The review included animal models and clinical trials investigating the mechanisms, effectiveness, and safety of VNS, SNS, and TNS in IBD management. Special attention was given to the modulation of inflammatory responses and its impact on gastrointestinal motility and functional gastrointestinal disorders associated with IBD. Results: Preliminary findings suggest that VNS, SNS, and TNS can significantly reduce inflammatory markers and improve symptoms in IBD patients. These techniques also show potential in treating related gastrointestinal disorders during IBD remission phases. However, the specific mechanisms underlying these benefits remain to be fully elucidated, and there is considerable variability in treatment parameters. Conclusions: Electrical neuromodulation holds promise as a novel therapeutic avenue for IBD, offering an alternative to patients who do not respond to traditional treatments or experience adverse effects. The review highlights the need for further rigorous studies to optimize stimulation parameters, understand long-term outcomes, and integrate neuromodulation effectively into IBD treatment protocols. Full article