Percutaneous neuromodulation is emerging as a promising therapeutic approach for atrial fibrillation (AF). This article explores techniques such as ganglionated plexi (GP) ablation, and vagus nerve stimulation, pinpointing their potential in modulating AF triggers and maintenance. Noninvasive methods, such as transcutaneous low-level tragus stimulation, offer innovative treatment pathways, with early trials indicating a significant reduction in AF burden. GP ablation may address autonomic triggers, and the potential for GP ablation in neuromodulation is discussed. The article stresses the necessity for more rigorous clinical trials to validate the safety, reproducibility, and efficacy of these neuromodulation techniques in AF treatment.

Multiple sclerosis is a degenerative inflammatory disease that causes different musculoskeletal problems. Its impact has led to the study of treatment alternatives such as the use of invasive physiotherapy. In this study, we analyze the effects of ultrasound-guided percutaneous neuromodulation to a 51-year-old man suffering from multiple sclerosis and an associated hemiparesis in the left upper limb. A dry needling needle was placed in contact with the median nerve under ultrasound guidance and 10 trains of 10 seconds of electrostimulation with a frequency of 10 Hz and an impulse width of 240 µs were applied, with 10 seconds of pause between them. There was a significant improvement in the grip strength immediately after the treatment which increased progressively at 24 hours and at 4 days follow-up. There was also an improvement in the hand function, with a decrease in the time necessary to perform the 9 Hole Peg Test immediately after the treatment, which was maintained at 24 hours and at 4 days follow-up. Future studies with larger samples are needed to further test the effects of this invasive physiotherapy technique as well as its possible applications to other neurological conditions.

Tibial nerve stimulation is an effective treatment for overactive bladder (OAB) and has been utilized as an in-person recurring session treatment option for many years. The primary objective of this study was to evaluate the safety and efficacy of a long-term implantable device and the method of utilizing a retrograde approach to place the device (a percutaneous implantable pulse generator [pIPG] with integrated quadripolar electrodes) at the tibial nerve (Protect PNS; Uro Medical Corp.).
A novel retrograde implant technique was developed through multiple cadaveric dissections to percutaneously implant a chronic, wireless, minimally invasive pIPG device with integrated quadripolar electrodes (now licensed to Uro Medical) at the tibial nerve. A proof-of-concept pIPG device approved as part of an FDA IDE was designed to gain early experience in subjects with refractory OAB. The pIPG was implanted in the office under local anesthesia using the novel retrograde approach, and stimulation was activated using an external wireless energy source called a transmitter. Initially, a pilot study was designed to compare outcomes in subjects randomized to either percutaneous tibial nerve stimulation (PTNS) or Protect PNS. However, due to the small sample sizes available at this time, it was not possible to compare the two groups. Thus, the purpose of this manuscript is to describe the outcome of subjects who underwent implantation of the Protect PNS system. Twelve-month safety and efficacy were evaluated.
Nine subjects were enrolled in the randomized pilot study; 5 to the pIPG group and 4 to PTNS, and all completed the 13-week primary endpoint. Subsequently, two subjects in the PTNS group chose to cross over and have the pIPG implanted after 13 weeks. Outcomes of the seven subjects who underwent implantation of the pIPG are described. No complications related to the office procedure were noted. Two of the older model pIPG devices became nonresponsive at 1 and 4 weeks and were replaced. Six minor adverse events were reported and resolved. Subjects reported improvement in urge urinary incontinence (UUI) episodes, OAB symptoms, and quality of life. Subjects impanted with a pIPG reported a 50% reduction in UUI as early as 1 week.
Results of this pilot study suggest that retrograde percutaneous implantation of a pIPG is a safe, minimally invasive one-stage office procedure for treatment for urge incontinence related OAB symptoms, without significant complications after 12 months follow-up. Future studies will be required to compare outcomes among treatment modalities.

BACKGROUND: Crossover effects refer to the responses of a non-exercised contralateral limb. There is evidence of this effect, as it relates to muscle fatigue, strength, and stretch, but not as it relates to neuromodulation.
OBJECTIVE: To compare the crossover effects of percutaneous neuromodulation (PNM) on hip range of motion (ROM), observed in a straight leg raise (SLR) test, in asymptomatic participants with bilateral reduced hamstring flexibility, versus the neurodynamic sciatic sliding technique, hamstring stretching and mechanical stimulation of the sciatic nerve using a needle (without electrical stimulation). To evaluate the tensiomyographic changes between the two lower limbs after these interventions.
METHODS: 80 participants with bilateral reduced hamstring flexibility were randomized into four groups: Stretching, Neurodynamic, PNM, and Needle groups. All interventions were performed on the right limb. Each participant\'s leg was subjected to SLR testing and tensiomyography before and after the interventions.
RESULTS: Each group improved their SLR values in the non-intervention limb compared to baseline values, but the PNM and Needle groups obtained higher values for the SLR test in the non-intervention limb compared with the Neurodynamic and Stretching groups. There were statistically significant differences for mean SLR measures between limbs pre- and post-intervention for all groups except the PNM group, suggesting crossover effects for PNM but not the other techniques studied. There were no differences in tensiomyographic assessments between groups or between sides, at baseline or upon completion of the study.
CONCLUSIONS: PNM produced benefits in the SLR test in the non-intervention limb and only 1.5 min was enough to obtain this effect. In addition, no technique interfered with muscle activation.

Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a minimally invasive intervention. This technique consists of the application of percutaneous electrical stimulation (PES) through an acupuncture needle-like electrode that is placed in close proximity to the nerve or motor point of the target muscle under ultrasound guidance.
To examine the immediate effects of a stretching exercise, an eccentric exercise and US-guided PNM on the performance of the flexor hallucis longus (FHL) muscle in young dancers.
Randomised clinical trial. A total of 45 dancers were divided into three groups: Stretching group, Eccentric group and PNM group. The following performance parameters were assessed: range of motion (ROM) of the first metatarsophalangeal joint, balance test and unilateral heel raise fatigue test.
There were no differences between these groups in baseline measurements; at the end of the study, mean balance and endurance values were only significantly higher for the PNM group compared to the Stretching (p = 0.007 and p < 0.001, respectively) and Eccentric groups (p = 0.003 and p < 0.001, respectively). The effect sizes were large for the balance (d = 0.8) and endurance (d = 1.83) tests in the PNM group. Both the Stretching and Eccentric groups exhibited improvements in ROM compared to their baseline values (p = 0.009 and p = 0.004, respectively), whereas there was no significant temporal improvement noted for the PNM group. The effect sizes with respect to ROM values were moderate for stretching (d = 0.6) and eccentric (d = 0.7) exercises.
An isolated PES intervention provides a greater immediate increase in balance and muscular strength than an active stretching and eccentric exercise of the FHL muscle in young ballet dancers.