NEUROMODULATION THERAPY FOR FECAL INCONTINENCE

大便失禁的神经调节疗法

基本信息

批准号：
8807593
负责人：
Satish SC Rao
金额：
$ 21.81万
依托单位：
AUGUSTA UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-01 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8807593
关键词：
Address Adverse effects Affect Anus Area Under Curve Bilateral Development Elderly woman Esthesia Etiology Evoked Potentials Fecal Incontinence Feces Frequencies Goals Healthcare Intestines Knowledge Lower Gastrointestinal Tract Lumbar Regions Magnetism Measurement Modality Monitor Motor Evoked Potentials Multicenter Studies Neurons Neuropathy Nursing Homes Outcome Outcome Measure Pain Pathogenesis Patients Pelvic floor dysfunction Perception Peripheral Play Population Quality of life Randomized Risk Role Sacral Region Safety Sensory Thresholds Severities Signal Pathway Signal Transduction Symptoms Testing Therapeutic Therapeutic Effect base care burden compliance behavior cost improved motor disorder muscle strength nerve supply neuromuscular neuroregulation neurotransmission novel pressure primary outcome psychosocial public health relevance rectal relating to nervous system response secondary outcome sphincter ani muscle structure therapy development

项目摘要

DESCRIPTION (provided by applicant): Fecal Incontinence (FI) affects 8-15 % of the US population, predominantly women and elderly, and 45% of nursing home residents. It significantly impairs quality of life and poses a major health care burden. FI is characterized by significant neuromuscular dysfunction of the pelvic floor that includes bilateral lumbo-anorectal and sacro-anorectal neuropathy and sensori-motor dysfunction. This multifactorial etiology suggests that maladaptive neuroplastic changes in the neural innervation of lower gastrointestinal tract could play a significant role in the pathogenesis of FI. A critical barrier o progress in the treatment of FI is the lack of understanding of how treatments affect the core pathophysiological mechanisms of FI and the absence of mechanistically based non-invasive therapies. Our goal is to address the problem of FI by developing therapies that modulate peripheral and central neuronal perturbations and thereby improve visceromotor control and sensori-motor dysfunctions, and to understand the neurobiologic basis of these treatments. Our central hypothesis is that a novel non-invasive treatment, consisting of combined translumbar magnetic stimulation (rTLMS) and transsacral magnetic stimulation (rTSMS), will significantly improve FI by enhancing peripheral and central neural excitability and will provide a multidimensional therapeutic effect by enhancing anal muscle strength, improving stool perception and improving rectal capacity. Our approach is based on our preliminary studies which suggest that repetitive translumbar magnetic stimulation (rTLMS) and transsacral magnetic stimulation (rTSMS) improve anorectal pain and neuropathy and induce central neuroplastic changes. Our objectives are to 1) address the significant gap in our knowledge regarding the peripheral and central neuroenteric axis and how perturbations in the afferent and efferent neural signaling can affect FI; 2) develop a new treatment for FI with repetitive magnetic stimulation and determine the feasibility, safety and optimal frequency setting of rTLMS and rTSMS; 3) determine the mechanistic basis for this neuromodulation therapy; 4) identify if the locus for improvement lies in the afferent or efferent signaling or both. Our expected outcomes include development of new treatment approaches for FI which are mechanistically based, effective, safe, low cost, less invasive, low risk and less dependent on patient compliance. The impact of our project include a new non-invasive treatment modality for FI, a scientific basis for the development of this treatment and improved understanding of the peripheral and central neuroenteric axis in FI.

描述（由申请人提供）：粪便失禁（FI）影响了8-15％的美国人口，主要是妇女和老年人，占养老院居民的45％。它极大地损害了生活质量，并带来了重大的医疗保健负担。 FI的特征是骨盆底的明显神经肌肉功能障碍，包括双侧腔液压动脉直肠直肠和sacro-Anor骨直肠神经病和感觉运动运动功能障碍。该多因素病因表明，胃肠道下部神经神经神经神经神经神经神经神经神经神经神经的不良神经塑性变化可能在FI的发病机理中起重要作用。 FI治疗中的关键障碍进展是对治疗方法如何影响FI的核心病理生理机制以及缺乏机械基于机械性的非侵入性疗法的关键进展。我们的目标是通过开发调节外围和中枢神经元扰动的疗法来解决FI问题，从而改善内脏控制和感觉运动运动功能障碍，并了解这些治疗方法的神经生物学基础。我们的核心假设是，一种新型的非侵入性治疗方法，包括易流磁刺激（RTLMS）和跨跨磁刺激（RTSMS）组成，将通过增强外围和中心神经兴奋性来显着改善FI，并将通过增强多维治疗效果来增强多维治疗效果，从而提高肌肉的强度，改善肌感，改善稳定性的稳定性。我们的方法基于我们的初步研究，该研究表明重复的易转磁刺激（RTLMS）和跨跨磁刺激（RTSMS）改善了厌食和神经病，并诱导中央神经塑性变化。我们的目标是1）解决我们有关周围和中央神经脑轴的显着差距，以及传入和传染性神经信号传导中的扰动如何影响FI； 2）用重复磁的FI开发新的治疗方法刺激并确定RTLM和RTSM的可行性，安全性和最佳频率设置； 3）确定这种神经调节疗法的机械基础； 4）确定改进的轨迹是否在于传入或传出信号传导或两者兼有。我们的预期结果包括开发FI的新治疗方法，这些方法基于机械，有效，安全，低成本，侵入性较小，风险较低，并且依赖患者的依从性较小。我们项目的影响包括一种新的非侵入性治疗方式，是FI的发展，这是该处理的发展的科学基础，并提高了对FI中外围和中央神经脑轴的理解。