Role of Electrical Stimulation in Peripheral Nerve Regeneration: A Systematic Review

Abstract

Background: Functional recovery after peripheral nerve injury is often suboptimal despite the intrinsic permissive growth environment of the peripheral nervous system. The objective of this systematic review is to explore the use of electrical stimulation (ES) for peripheral nerve regeneration. Methods: A systematic literature search was conducted from inception to March 2, 2021 to retrieve articles on ES for peripheral nerve regeneration using the PubMed, Ovid MEDLINE, and Embase databases. Primary outcome measures included objective measures of motor and sensory nerve function. Results: Four randomized control trials, two case reports, and three case series that addressed the aims were identified. The stimulation parameters varied greatly between studies, without an apparent commonality for a given electrical conduit.Outcomes measured included motor (n = 8) and sensory (n = 7) modalities (cold detection, static two-point discrimination, tactile discrimination, and pressure detection), nerve-specific muscle function and bulk, and electromyography (EMG) motor and sensory terminal latency. Different parameters for measurement were utilized and improvement was observed across the studies compared with controls (n = 4) or pre-intervention measurements (n = 5). One randomized control trial reported no benefit of ES and attributed their findings to their stimulation protocol. Complications were documented in three patients only and included wire remnant removal, skin pigmentation, and bone formation. Conclusions: ES in peripheral nerve regeneration is beneficial in improving and accelerating recovery. A meta-analysis was not performed due to the heterogeneity, but all studies showed positive findings and minor to no complications. These results provide a primer for further development of delivery methods.

Does Electrical Stimulation through Nerve Conduits Improve Peripheral Nerve Regeneration?—A Systematic Review

“…One of the most important observations we made when comparing these studies to one another was the high variation in electrical stimulation protocols with regard to frequency, duration, stimulation onset or conduit type. This was also noticed by ElAbd et al [ 44 ] in 2022. Since ES + NGC treatment is a rather new approach, no standardized guidelines have been established so far.…”

Traumatic peripheral nerve injuries: diagnosis and management

“…However, there may be a role for this approach after muscle reinnervation has occurred to increase muscle strength as an adjunct to sensory re-education. Low-frequency repetitive nerve stimulation is a more promising technique and has been shown to stimulate rapid motor reinnervation postoperatively [76–78,79 ▪ ,80,81 ▪ ]. Optimization of stimulation settings and evaluation of this technique in specific clinical scenarios is still required [76,82].…”

Neuromodulation for Peripheral Nerve Regeneration: Systematic Review of Mechanisms and In Vivo Highlights

“…The diagnostic basis for neuromodulation is the same for surgical interventions and includes an electrophysiological examination of motor nerve conduction and the physical symptoms supporting nerve injury (e.g., numbness, weakness). Specifically, there is some evidence that PNS/electrical stimulation (ES) is effective [ 26 , 27 ]. Jo et al demonstrated in a comparative study on mice that ES is equally as efficacious as FK506 (Tacrolimus) treatment [ 28 ].…”