Clinical applications of electrical stimulation for peripheral nerve injury: a systematic review

Abstract

IntroductionPeripheral nerve injuries are common neurologic injuries that are challenging to treat with current therapies. Electrical stimulation has been shown to accelerate reinnervation and enhance functional recovery. This study aims to review the literature on clinical application of electrical stimulation for peripheral nerve injury.MethodsPubMed and Embase were sourced from 1995 to August 2022. Selection was based on predetermined inclusion/exclusion criteria. Eight hundred and thirty-five articles were screened with seven being included in this review.ResultsTwo hundred and twenty-nine patients with peripheral nerve injuries were represented. Six of the studies were randomized controlled trials. A variety of nerve injuries were represented with all being in the upper extremity and supraclavicular region. Electrical stimulation protocols and evaluation varied. Electrodes were implanted in four studies with one also implanting the stimulator. Length of stimulation per session was either 20 mins or 1 h. Median stimulation frequency was 20 Hz. Stimulation intensity varied from 3 to 30V; pulse width ranged from 0.1 to 1.007 ms. Three protocols were conducted immediately after surgery. Patients were followed for an average of 13.5 months and were evaluated using electrophysiology and combinations of motor, sensory, and functional criteria.DiscussionPatients who received electrical stimulation consistently demonstrated better recovery compared to their respective controls. Electrical stimulation for peripheral nerve injury is a novel treatment that has not been well-studied in humans. Our review illustrates the potential benefit in implementing this approach into everyday practice. Future research should aim to optimize protocol for clinical use.

A Systematic Review of Registered Clinical Trials for Peripheral Nerve Injuries

“…Techniques such as electrical stimulation therapy have been found to promote axon growth during nerve repair and hasten sensorimotor recovery. 19,21,24,29,30,[33][34][35][110][111][112][113] A systematic review by Costello et al 114 further corroborates the potential of electrical stimulation as a beneficial nonsurgical intervention for PNIs, aligning with the diverse treatment methodologies emphasized in this review.…”

Enhancing regeneration and repair of long-distance peripheral nerve defect injuries with continuous microcurrent electrical nerve stimulation

“…Before comprehensively evaluating the effect of continuous microcurrent electrical nerve stimulation (cMENS) on long-distance peripheral nerve defect repair, we optimized the electrical stimulation parameters. Given the established acceptance of a frequency of 20 Hz and pulse width of 200 us for peripheral nerve injury treatment (Park et al, 2019;Costello et al, 2023), our focus was on screening stimulation intensity and duration. Stimulation intensities of 1 mA and 100 uA, along with durations of one-time 15-min and continuous 10-day, 15-min sessions, were set in this study.…”

“…These studies have yielded promising therapeutic outcomes, emphasizing the potential of these approaches in enhancing peripheral nerve regeneration. Among these therapeutic modalities, electrical stimulation (ES) has a long history in the field of nerve injury repair, and its clinical efficacy has gained widespread recognition (ElAbd et al, 2022;Costello et al, 2023). Previous research has demonstrated that electrical stimulation can expedite the process of Wallerian degeneration (Li et al, 2023), encourage axonal regeneration (Zuo et al, 2020), and ultimately facilitate the restoration of motor and sensory functions.…”

Current Treatments and Future Directions for Facial Paralysis

“…Cost-effectiveness and technical limitations also impede ES adaptation. Furthermore, measures such as motor unit number estimation (MUNE) are currently limited to the laboratory setting, hampering their use in the clinical environment 88 .…”