Lateral Rectus Reanimation following Sixth Nerve Palsy

第六神经麻痹后的外直肌复苏

• 批准号: 6943839
• 负责人: ARTHUR ROSENBAUM
• 金额: $ 15.45万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6943839
• 关键词: Macaca mulatta; bioengineering /biomedical engineering; biomaterial development /preparation; biomaterial evaluation; biomedical equipment development; biosensor device; botulinum toxins; cranial nerves; electronic recording system; extraocular muscle; eye movement disorders; implant; medical implant science; muscle function; neuromuscular stimulator; paralysis

DESCRIPTION (provided by applicant): Nearly ten million people suffer from a form of strabismus in the United States alone, with 2-4% of the population developing strabismus within the first six years of life [1]. During this period, the visual system is extremely susceptible to developmental problems from strabismus, such as amblyopia. Lesions to the sixth cranial nerve, or abducens nerve, results in selective paralysis of the ipsilateral lateral rectus muscle, which causes convergent strabismus. Symptoms of sixth nerve palsy include loss of horizontal eye control, convergent strabismus, and functional loss of sight in the affected eye. In moderate cases, the medial rectus is treated with Botulinum toxin to effectively balance horizontal eye muscle forces. In severe cases, the superior and inferior rectus muscles are surgically re-inserted laterally, followed by physical therapy and minimal recovery of horizontal eye motility. Our approach involves reanimating the lateral rectus based on force measurements from the opposing medial rectus. Previous studies have indicated that a relationship exists between horizontal rectus muscle force and eye position and velocity. An innovative implantable stimulation device exploiting this relationship can lead to reanimation of lateral rectus tissue and recovery of horizontal eye control. A feasibility study involving implantable muscle force transducers (MFT), control electronics, and long-term stimulating electrodes is a necessary precursor to the development of this device. We have developed a unique laboratory setting to study the feasibility of reanimating the lateral rectus muscle, using non-human primates as the subjects for our experiments. The subjects will perform visual tasks in this environment, while eye position and muscle force output can be recorded. Eye position is accurately obtained through pickup of an implanted scleral search coil in generated differential electromagnetic fields. Muscle force is directly measured with implanted muscle force transducers (MFT). The lateral rectus muscle will be temporarily dennervated through metered injections of Botox, and will be stimulated with implanted electrodes using the MFT frame as a platform. The final implanted device will encompass the stimulation control system, which will be optimized in individual tests within our laboratory setting.

描述（由申请人提供）：仅在美国就有近千万人患有某种形式的斜视，其中 2-4% 的人口在生命的前六年内出现斜视 [1]。在此期间，视觉系统极易受到斜视引起的发育问题，例如弱视。第六对脑神经或外展神经的损伤会导致同侧外直肌选择性麻痹，从而导致会聚性斜视。第六神经麻痹的症状包括受影响眼睛的水平眼球控制丧失、会聚性斜视和功能性视力丧失。在中度情况下，使用肉毒杆菌毒素治疗内直肌，以有效平衡水平眼部肌肉力量。在严重的情况下，需要通过手术将上直肌和下直肌重新横向插入，然后进行物理治疗，并尽量恢复眼球水平运动。我们的方法包括根据相对的内直肌的力测量来恢复外直肌的活力。 先前的研究表明，水平直肌力量与眼睛位置和速度之间存在关系。利用这种关系的创新植入式刺激装置可以使外直肌组织复活并恢复水平眼球控制。涉及植入式肌肉力传感器（MFT）、控制电子设备和长期刺激电极的可行性研究是开发该设备的必要前提。 我们开发了一个独特的实验室环境来研究复活外直肌的可行性，使用非人类灵长类动物作为我们的实验对象。受试者将在这种环境中执行视觉任务，同时可以记录眼睛位置和肌肉力量输出。通过在生成的差分电磁场中拾取植入的巩膜搜索线圈，可以准确获得眼睛位置。肌肉力量通过植入的肌肉力量传感器（MFT）直接测量。外直肌将通过肉毒杆菌的计量注射暂时去神经支配，并使用 MFT 框架作为平台通过植入电极进行刺激。最终的植入设备将包含刺激控制系统，该系统将在我们实验室环境中的单独测试中进行优化。