Zusammenfassung
Das Wissen über die entscheidenden zellulären und molekularen Mechanismen der peripheren Nervenregeneration nimmt zu. Doch es gibt keine effektive Therapie peripherer Nervenverletzungen in der Klinik. Neue quantitative Ansätze zur Vermessung motorischer Defizite ermöglichten Studien innovativer Therapien im Tierexperiment: Funktionell wirkt sich v. a. die tägliche manuelle Stimulation denervierter Muskulatur bei erhaltenem sensorischem Input nach Nervenrekonstruktion gut aus. Sie scheint bei Läsionen des N. facialis geeignet für eine schnelle Translation in den klinischen Alltag. Dagegen scheint die manuelle Stimulation ineffektiv bei Läsionen gemischter peripherer Nerven zu sein. Bei Nagetieren wurde langfristig durch Elektrostimulation die Nervenregeneration nicht besser. Eine kurzzeitige Elektrostimulation direkt nach Trauma des N. facialis hat keinen signifikanten Effekt. Die wiederholte Elektrostimulation der Muskulatur in den Phasen der De- und Reinnervation behindert sogar die Muskelreinnervation. Medikamentös scheint die Applikation von Glykomimetika, Peptiden, die funktionelle Eigenschaften von Karbohydratmolekülen imitieren, besonders vielversprechend für die periphere Nervenregeneration.
Abstract
Despite increasing knowledge of cellular and molecular mechanisms determining the success or failure of peripheral nerve regeneration, no effective treatments for peripheral nerve injury exist. Newly developed and validated approaches for precise numerical assessment of motor deficits have recently allowed testing of novel strategies in experimental animals. One of these approaches is the daily manual stimulation of the denervated musculature. This treatment is effective in cases of cranial nerve lesions with preservation of the sensory input (facial or hypoglossal nerve) and has the potential of direct translation in clinical settings. However, manual stimulation appears to be ineffective for the treatment of mixed peripheral nerve injuries. Generally, no long-term improvement of functional recovery is achieved by electrical stimulation in rodents. While short-term post-traumatic stimulation of the proximal nerve stump has no negative effects, direct electrical stimulation of the muscle during the period of de- and reinnervation appears to hinder muscle fibre reinnervation. Finally, experimental evidence suggests that application of peptides known as glycomimetics, which mimic functional properties of carbohydrate molecules, may provide significant benefits after injuries of mixed peripheral nerves.
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Irintchev, A., Angelov, D. & Guntinas-Lichius, O. Regeneration des N. facialis im Vergleich zu anderen peripheren Nerven. HNO 58, 426–432 (2010). https://doi.org/10.1007/s00106-010-2100-3
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DOI: https://doi.org/10.1007/s00106-010-2100-3