Bilateral Transcutaneous Tibial Nerve Stimulation Research Articles

Transcutaneous Tibial Nerve Stimulation as Therapy for Functional Constipation.

Functional constipation is a common disorder that is difficult to treat on occasion. Symptoms of this condition can per- sist despite dietary modification, exercise, and medication. Results of neuromodulation with nerve stimulation have been promising in terms of efficiency for treatment-resistant patients. This study aimed to investigate the efficacy of bilateral transcutaneous tibial nerve stimulation as a noninvasive treatment method for functional constipation. We evaluated 105 patients with functional constipation diagnosed using the Rome IV criteria. Bilateral transcutaneous elec- trical nerve stimulation was utilized for transcutaneous tibial nerve stimulation for 6 weeks; 3 sessions were conducted every week, with each session lasting for at least 30 minutes. The Constipation Severity Instrument was used before treatment, at the end of 6 weeks, and at 12 weeks (6 weeks after the end of treatment). The effects of transcutaneous tibial nerve stimulation on the time spent in the toilet and the use of softeners were investigated. Of the 105 patients included in the study, 41 (39%) were male. The mean age was 43.1 (range, 19-64 years). Transcutaneous tibial nerve stimulation was found to reduce the time patients spent in the toilet. The use of softeners decreased from 76.2% to 20% (P < .001). Obstructive defecation (P < .001), colonic inertia (P < .001), pain (P < .001), and Constipation Severity Instrument total score (P < .001) improved after the 6-week treatment period. The treatment effect persisted until the 12th week. Bilateral transcutaneous tibial nerve stimulation is a noninvasive, easily applicable, and effective treatment for functional constipation, without major adverse effects. Large randomized controlled trials are required so that transcutaneous tibial nerve stimula- tion can be established as an alternative treatment for functional constipation that is resistant to standard care and laxative agents.

Effects of Bilateral Transcutaneous Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Spinal Cord Injury: A Urodynamic Study

ObjectiveTo study the short-term effect of bilateral transcutaneous tibial nerve stimulation (TTNS) on urodynamic study (UDM) parameters in spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO). DesignSingle-blinded sham-controlled study. SettingRehabilitation center. ParticipantsSCI patients with NDO (N=17) were recruited. Fifteen patients (mean age, 40±18y) completed the study. Most of the patients had chronic incomplete SCI. InterventionsUDM was performed 3 times. The first UDM was performed after taking anticholinergics for 1 hour to assess the effects of medication. After stopping anticholinergics for a 5 half-lives, the second UDM was performed immediately after a 20-minute sham TTNS (switch on for 30s at the beginning, switch off for 20min, and switch on for 30s before stopping). The third UDM was performed immediately after a 20-minute bilateral TTNS. Main Outcome MeasuresReflex volume (mL), cystometric capacity (mL), maximum pressure detrusor (mmH2O), and bladder compliance (mL/mmH2O). ResultsUDM tracings were interpreted by 2 blinded assessors. This study used per-protocol analysis and repeated measures Analysis of variance with Bonferroni post hoc analysis. When compared with sham stimulation, bilateral TTNS and anticholinergics produced greater increases in reflex volume (136.1±99.88, 212.2±112.82, and 226.3±111.52 mL; P<.001), cystometric capacity (218.3±137.66, 319.1±143.74, and 350.7±163.43 mL; P<.001), and compliance (5.8±6.81, 7.9±6.74, 9.7±8.12 mL/cmH2O; P=.02). No significant differences were found in reflex volume, cystometric capacity, or compliance between bilateral TTNS and anticholinergics (P>.05). The maximum pressure detrusor was not significantly different between groups (P>.05). ConclusionBilateral TTNS may be an effective short-term intervention to improve UDM parameters in SCI with NDO. Further study is necessary to determine the long-term effects and benefits of combined bilateral TTNS with anticholinergics.

Effects of bilateral transcutaneous tibial nerve stimulation on constipation severity in geriatric patients: A prospective clinical study

Constipation is the most common digestive complaint in the general population, and one of the most frequently encountered health problems in the geriatric population. In the present study, we aimed to determine whether bilateral transcutaneous tibial nerve stimulation affects constipation severity in geriatric patients with refractory chronic constipation. Bilateral transcutaneous tibial nerve stimulation was carried out three times per week for 30 min in geriatric patients aged >65 years with less than three defecations per week. The patients were evaluated, and constipation severity was compared before the treatment, at the end of the 6-week treatment and 12 weeks after the end of the treatment. Assessment carried out using the Constipation Severity Instrument showed that the scores for subscales; that is, obstructive defecation, colonic inertia and pain, improved significantly by the end of the treatment compared with the scores obtained before the treatment. Furthermore, the improvement in pain continued for 12 weeks after the treatment, and although there was a slight decrease in the scores for the other subscales, they significantly improved compared with the scores obtained before the treatment. During the 12-week follow-up period, bilateral transcutaneous tibial nerve stimulation significantly improved constipation severity in geriatric patients with refractory chronic constipation. We believe that this easy-to-use and low-cost method can be applied to eligible geriatric patients who cannot be treated through dietary adjustments and/or medical interventions. Geriatr Gerontol Int 2020; 20: 101-105.

Effects of Bilateral Transcutaneous Tibial Nerve Stimulation on Detrusor Overactivity in Spinal Cord Injury

Effects of Bilateral Transcutaneous Tibial Nerve Stimulation on Detrusor Overactivity in Spinal Cord Injury

Bilateral transcutaneous tibial nerve stimulation for chronic constipation

Chronic constipation is difficult to treat when symptoms are intractable. Colonic propulsion may be altered by distal neuromodulation but this is conventionally delivered percutaneously. Transcutaneous tibial nerve stimulation is noninvasive and cheap: this study aimed to assess its efficacy in chronic constipation. Eighteen patients (median age 46years, 12 female) with chronic constipation were recruited consecutively. Conservative and behavioural therapy had failed to improve symptoms in all 18. Thirty minutes of daily bilateral transcutaneous tibial nerve stimulation was administered by each patient at home for 6weeks. The primary outcome measure was a change in the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. Change in Patient Assessment of Constipation Symptoms (PAC-SYM), weekly bowel frequency and visual analogue scale (VAS) score were also measured. Fifteen patients (12 female) completed the trial. The PAC-QoL score improved significantly with treatment [pretreatment, median 2.95, interquartile range (IQR) 1.18; posttreatment, median 2.50, IQR 0.70; P=0.047]. There was no change in PAC-SYM score (pretreatment, median 2.36, IQR 1.59; posttreatment, median 2.08, IQR 0.92; P=0.53). Weekly stool frequency improved as did VAS score, but these did not reach statistical significance (P=0.229 and 0.161). The PAC-QoL and PAC-SYM scores both improved in four (26%) patients. Two patients reported complete cure. There were no adverse events reported. Bilateral transcutaneous tibial nerve stimulation appears to be effective in a quarter of patients with chronic constipation. Carefully selected patients with less severe disease may benefit more. This requires further study.