近五十年前,首次观察三叉神经刺激(TNS)对脑血流的影响。这一暗示直接导致了进一步的研究和TNS作为治疗干预的成功。与关键大脑和脑干区域拥有独特的联系,已经观察到TNS调节脑血管舒张,大脑新陈代谢,大脑自动调节,大脑和全身炎症,和自主神经系统.独特的效果范围使其成为主要的治疗方式,并导致其在偏头痛等慢性疾病中的临床使用,长时间的意识障碍,和抑郁症。这篇综述旨在全面概述TNS研究及其更广泛的治疗潜力。就本次审查而言,从成立之初到2023年8月28日,对PubMed和GoogleScholar进行了搜索,共确定了89项相关研究,临床和临床前。TNS利用血管活性神经肽的释放,调节神经传递,并直接作用于自主神经系统以产生一套强大的多靶标治疗效果。虽然TNS已在临床上应用于慢性病理状况,这些强大的影响最近在许多急性/创伤性病变中显示出巨大的潜力。然而,要使TNS在更广泛的临床环境中成为可行的治疗选择,仍有关键的机制和方法学知识差距有待解决.这些包括双峰或矛盾效应和机制,关于其在急性/创伤条件下的安全性的问题,开发更具选择性的刺激方法,以避免潜在的适应不良效应,以及它与潜水反射的联系,三叉神经介导的保护性内源性反射。这些问题的解决可以克服目前的局限性,并允许TNS在治疗上应用于无数的病理,因此,它现在正处于成为一种突破性治疗方式的边缘。
Nearly 5 decades ago, the effect of trigeminal nerve stimulation (TNS) on cerebral blood flow was observed for the first time. This implication directly led to further investigations and TNS\' success as a therapeutic intervention. Possessing unique connections with key brain and brainstem regions, TNS has been observed to modulate cerebral vasodilation, brain metabolism, cerebral autoregulation, cerebral and systemic inflammation, and the autonomic nervous system. The unique range of effects make it a prime therapeutic modality and have led to its clinical usage in chronic conditions such as migraine, prolonged disorders of consciousness, and depression. This
review aims to present a comprehensive overview of TNS research and its broader therapeutic potentialities. For the purpose of this
review, PubMed and Google Scholar were searched from inception to August 28, 2023 to identify a total of 89 relevant studies, both clinical and pre-clinical. TNS harnesses the release of vasoactive neuropeptides, modulation of
neurotransmission, and direct action upon the autonomic nervous system to generate a suite of powerful multitarget therapeutic effects. While TNS has been applied clinically to chronic pathological conditions, these powerful effects have recently shown great potential in a number of acute/traumatic pathologies. However, there are still key mechanistic and methodologic knowledge gaps to be solved to make TNS a viable therapeutic option in wider clinical settings. These include bimodal or paradoxical effects and mechanisms, questions regarding its safety in acute/traumatic conditions, the development of more selective stimulation methods to avoid potential maladaptive effects, and its connection to the diving reflex, a trigeminally-mediated protective endogenous reflex. The address of these questions could overcome the current limitations and allow TNS to be applied therapeutically to an innumerable number of pathologies, such that it now stands at the precipice of becoming a ground-breaking therapeutic modality.