Application of extracorporeal shock wave therapy in nervous system diseases: A review

BackgroundThe role of distinct type- and energy-based extracorporeal shockwave therapy (ESWT) in clinical practice is unclear.ObjectivesTo appraise meta-analytically determined effectiveness and safety of type- and energy-based ESWT for diseases or conditions, and visualize evidence maps of findings.MethodsNine online databases and reference lists were systematically searched for systematic reviews (SRs) of randomized controlled trials (RCTs) evaluating the effectiveness or safety of ESWT from inception to September 2023. SRs were then updated if up-to-date RCTs were eligible. Overall effects were re-estimated using random-effects model and reported as relative risk or standardized mean difference with 95% confidence intervals. Methodological quality, certainty of evidence, and safety were assessed with AMSTAR 2, GRADE tool, and MedDRA, respectively.ResultsOur research identified 210 relevant SRs encompassing 636 RCTs and 41649 participants across 7 therapeutic areas and 37 diseases and conditions. Methodological quality of most published SRs was low or critically low. Four treatment statuses of type- and energy-based ESWT were identified, including potential dominant efficacy (plantar fasciitis, erectile dysfunction, lateral epicondylitis, knee osteoarthritis, frozen shoulder, cerebral palsy spasticity, post-stroke lower limb spasticity; GRADE moderate), potential positive efficacy (chronic prostatitis/chronic pelvic pain syndrome, myofascial pain syndrome, patellar tendinopathy, achilles tendinopathy, stenosing tenosynovitis, frozen shoulder, rotator cuff tear, cerebral palsy spasticity, post-stroke upper limb spasticity, cervical spondylotic radiculopathy; GRADE low or very low), potential similar efficacy (osteonecrosis of the femoral head, plantar heel pain, patellar tendinopathy; GRADE low or very low), and potential adverse efficacy (patellar tendinopathy; GRADE very low). Along with courses of ESWT treatment, pain, flushing, and swelling were the most prevalent side effects and serious adverse reactions were limited.ConclusionVariable type- and energy-based ESWT is probably effective and safe in clinical practice. Due to lack of available data and high certainty in current evidence, future research should prioritize large-scale and well-designed studies.RegistrationPROSPERO number CRD42023477234

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Emerging role of extracellular vesicles and exogenous stimuli in molecular mechanisms of peripheral nerve regeneration

Izhiman,

Esfandiari

2024

Front. Cell. Neurosci.

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Peripheral nerve injuries lead to significant morbidity and adversely affect quality of life. The peripheral nervous system harbors the unique trait of autonomous regeneration; however, achieving successful regeneration remains uncertain. Research continues to augment and expedite successful peripheral nerve recovery, offering promising strategies for promoting peripheral nerve regeneration (PNR). These include leveraging extracellular vesicle (EV) communication and harnessing cellular activation through electrical and mechanical stimulation. Small extracellular vesicles (sEVs), 30–150 nm in diameter, play a pivotal role in regulating intercellular communication within the regenerative cascade, specifically among nerve cells, Schwann cells, macrophages, and fibroblasts. Furthermore, the utilization of exogenous stimuli, including electrical stimulation (ES), ultrasound stimulation (US), and extracorporeal shock wave therapy (ESWT), offers remarkable advantages in accelerating and augmenting PNR. Moreover, the application of mechanical and electrical stimuli can potentially affect the biogenesis and secretion of sEVs, consequently leading to potential improvements in PNR. In this review article, we comprehensively delve into the intricacies of cell-to-cell communication facilitated by sEVs and the key regulatory signaling pathways governing PNR. Additionally, we investigated the broad-ranging impacts of ES, US, and ESWT on PNR.

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Application of extracorporeal shock wave therapy in nervous system diseases: A review

Cited by 9 publications

References 150 publications

Correlation between gyral size, brain size, and head impact risk across mammalian species

Correlation between gyral size, brain size, and head impact risk across mammalian species

Effectiveness and Safety of Type- and Energy-based Extracorporeal Shockwave Therapy in Clinical Practice: Umbrella Review and Evidence Mapping

Emerging role of extracellular vesicles and exogenous stimuli in molecular mechanisms of peripheral nerve regeneration

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