The potential of noninvasive brain stimulation techniques for the treatment of central nervous system demyelinating diseases: a narrative review

Noninvasive brain stimulation techniques have emerged as a promising therapeutic option for various central nervous system demyelinating diseases. Demyelinating diseases represent a group of pathological conditions that impact the central or peripheral nervous system. They are characterized by damage to or loss of the myelin sheath surrounding nerve fibers. This damage to myelin sheaths disrupts nerve signal transmission, leading to a wide range of signs and symptoms associated with neurological impairment. Treatment for demyelinating diseases usually aligns with the specific underlying cause. Noninvasive brain stimulation techniques can affect neuronal electrical activity and glial cell function, suggesting a potential option for intervention. In this narrative review, we explore the potential of noninvasive brain stimulation techniques for the treatment of central nervous system demyelinating disorders. Noninvasive brain stimulation techniques, including transcranial magnetic stimulation, transcranial electrical stimulation, transcranial focused ultrasound stimulation, optogenetic stimulation, low-intensity pulsed ultrasound, and transcranial photobiomodulation, have been shown to potentially intervene in the treatment of demyelinating diseases by affecting the electrical activity of nerve cells and glial cell function. In addition, this review summarizes the applications and mechanisms of noninvasive brain stimulation techniques in the treatment of central nervous system demyelinating diseases and how these techniques promote myelin regeneration and improve disease prognosis. This review also summarizes research advances in noninvasive brain stimulation techniques for the treatment of multiple sclerosis, acute disseminated encephalomyelitis, progressive multifocal leukoencephalopathy, and neuromyelitis optical spectrum disorder. Noninvasive brain stimulation techniques can improve disease symptoms by promoting oligodendrocyte proliferation and differentiation, enhancing myelin regeneration, and modulating immune responses. Although noninvasive brain stimulation techniques have shown potential in the treatment of various neurological disorders, their use in treating demyelinating diseases remains challenging. For example, transcranial focused ultrasound stimulation is a relatively new noninvasive brain stimulation technique with the advantages of high spatial resolution and the ability to stimulate deep brain structures, but its safety and efficacy in clinical applications need to be further investigated. Optogenetic stimulation offers highly precise neuromodulation, but its feasibility in clinical practice is limited by technical and ethical constraints. Overall, noninvasive brain stimulation techniques have significant potential in the treatment of central nervous system demyelinating diseases, but further research is needed to optimize stimulation parameters, improve therapeutic efficacy, and gain insight into their mechanism of action. With the continuous development of technology and in-depth clinical trials, noninvasive brain stimulation techniques are expected to become an effective treatment for central nervous system demyelinating diseases and provide new therapeutic options for such patients.

摘要

非侵入性脑刺激技术已成为各种中枢神经系统脱髓鞘疾病的有希望的治疗选择。脱髓鞘疾病代表了一组影响中枢或外周神经系统的病理状态，其特征是神经纤维周围髓鞘的损伤或丧失。髓鞘的损伤干扰神经信号的传输，导致一系列与神经功能障碍相关的体征和症状。脱髓鞘疾病的治疗通常与特定的潜在原因相一致。非侵入性脑刺激技术可以影响神经元的电活动及胶质细胞的功能，提示其可能成为干预的选项。在这篇叙述性综述中，我们探讨了非侵入性脑刺激技术在中枢神经系统脱髓鞘疾病治疗中的潜力。非侵入性脑刺激技术，包括经颅磁刺激、经颅电刺激、经颅聚焦超声刺激、光遗传刺激、低强度脉冲超声和经颅光生物调节，已显示出通过影响神经细胞的电活动和胶质细胞功能在脱髓鞘疾病治疗中可能产生干预作用。此外，这篇综述总结了非侵入性脑刺激技术在中枢神经系统脱髓鞘疾病治疗中的应用及机制，以及这些技术如何促进髓鞘再生和改善疾病预后。该综述还总结了非侵入性脑刺激技术在多发性硬化、急性弥漫性脑脊髓炎、进行性多灶性白质脑病和神经脊髓炎光谱障碍治疗中的研究进展。非侵入性脑刺激技术可以通过促进少突胶质细胞的增殖和分化、增强髓鞘再生以及调节免疫反应来改善疾病症状。尽管非侵入性脑刺激技术在治疗各种神经系统疾病中显示出潜力，但在治疗脱髓鞘疾病时仍然面临挑战。例如，经颅聚焦超声刺激是一种相对较新的非侵入性脑刺激技术，具有高空间分辨率和刺激深部脑结构的能力，但其在临床应用中的安全性和有效性需要进一步研究。光遗传刺激提供了高度精确的神经调制，但其在临床实践中的可行性受到技术和伦理限制。总体而言，非侵入性脑刺激技术在治疗中枢神经系统脱髓鞘疾病方面具有显著潜力，但仍需进一步研究以优化刺激参数、提高治疗效果，并深入了解其作用机制。随着技术的不断发展和临床试验的深入，非侵入性脑刺激技术有望成为中枢神经系统脱髓鞘疾病的有效治疗方法，为此类患者提供新的治疗选择。