Posible mecanismo de acción de la neuromodulación tibial en la hiperactividad del detrusor. Papel de las interneuronas

Effects of percutaneous neuromodulation in neuromusculoskeletal pathologies: A systematic review

“…[ 16 – 18 ] Some articles also agree on the effect it has on the intake of drugs after treating with PNM, [ 14 , 16 , 18 , 30 , 31 ] producing a significant change in three of them. [ 1 – 3 , 16 , 30 , 31 ]…”

“…The chronic effect of said neurophysiological process may cause central nervous system plasticity, with lasting clinical effects. [ 2 , 3 ] Neuromodulation is part of the treatment for multiple pathologies with few side effects. [ 4 ]…”

“…The chronic effect of said neurophysiological process may cause central nervous system plasticity, with lasting clinical effects. [2,3] Neuromodulation is part of the treatment for multiple pathologies with few side effects. [4] Nowadays, there are described the following neuromodulation procedures, classified according to the area of application [5,6] : at the brain level, cortical stimulation [7] and deep brain stimulation, [8] at the spinal level, stimulation of the dorsal column of the spinal cord, [9] nerve root stimulation [10] and dorsal root ganglion stimulation [11] and at the level of the peripheral nervous system, the stimulation of the peripheral nerve, [12] the stimulation of the receptive field of the peripheral nerve [13] and the stimulation of the muscular motor point.…”

“…Even though the mechanism of action is not fully known, the PNM spans the ascending and descending pathways, as well as the supraspinal regions of the central nervous system, regulating or modifying the electrical impulses transmitted through said pathways, and thus inhibiting or exciting them. [3,14]…”

Eficacia de la neuromodulacion transcutánea vs percutánea del nervio tibial en el síndrome de vejiga hiperactiva no neurogénica

“…(14) El mecanismo de acción aún no está claro, aunque parece que consiste en una despolarización de las fibras somáticas sacras y lumbares que produce un efecto inhibitorio sobre la contractibilidad vesical. El impulso generado por la electro-estimulación del nervio tibial provoca la producción de diferentes neuro-péptidos que activan interneuronas inhibitorias a nivel medular y supraespinal provocando una inhibición central de la motoneurona vesical preganglionar, (15) y del núcleo somático de Onuf. (16) Por tanto, es considerada como la forma de estimulación periférica sencilla, mínimamente invasiva, de fácil aplicación y bien tolerada por las pacientes, (17) ha demostrado una tasa de respuesta clínica que varía del 54 al 81%, considerando una buena respuesta clínica cuando hay una mejoría de los síntomas de, al menos, el 50%.…”