title: Photobiomodulation Triple Treatment in Peripheral Nerve Injury: Nerve and Muscle Response.
abstract: BACKGROUND
  Muscle preservation or decrease in muscle degeneration and progressive atrophy are major challenges in patients with severe peripheral nerve injury (PNI). Considerable interest exists in the potential therapeutic value of laser phototherapy (photobiomodulation) for restoring denervated muscle atrophy and for enhancing regeneration of severely injured peripheral nerves. As previously published, the laser phototherapy has a protective and immediate effect in PNI. Laser phototherapy in the early stages of muscle atrophy may preserve the denervated muscle by maintaining creatinine kinase (CK) activity and the amount of acetylcholine receptor (AChR).
  
  
  OBJECTIVE
  In the present study, the effectiveness of triple treatment laser phototherapy, namely, applied simultaneously at three areas: injured area of the peripheral nerve, corresponding segments of the spinal cord, and corresponding denervated muscle (triple treatment), was evaluated for the treatment of incomplete PNI in rats with the ultimate goal of achieving improved limb function.
  
  
  RESULTS
  Forty-five days after the sciatic nerve insult, all rats regained normal walking (functional sciatic index values returned to baseline); however, the long laser irradiation (7 min) group presented the fastest recovery as opposed to short laser irradiation (3 min). A histological evaluation of the nerves revealed that long laser irradiation led to a higher amount of neuronal fibers that were larger than 4 μm (543 ± 76.8, p < 0.01) than short irradiation (283 ± 35.36). A histological evaluation of muscular atrophy showed that long laser irradiation evolved with significantly less muscle atrophy (8.06% ± 1.23%, p < 0.05) than short irradiation (24.44% ± 7.26%).
  
  
  CONCLUSIONS
  The present study and our previous investigations showed that the laser phototherapy increases biochemical activity and improves morphological recovery in muscle and, thus, could have direct therapeutic applications on muscle, especially during progressive atrophy resulting from PNI.
authors.affiliation: 1 Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Mira M
authors.initials: MM
authors.lastname: Mandelbaum-Livnat
authors.affiliation: 1 Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Mara
authors.initials: M
authors.lastname: Almog
authors.affiliation: 1 Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Moshe
authors.initials: M
authors.lastname: Nissan
authors.affiliation: 2 Pharmaseed , Ness Ziona, Israel .
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Loeb
authors.affiliation: 1 Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Yuval
authors.initials: Y
authors.lastname: Shapira
authors.affiliation: 1 Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Shimon
authors.initials: S
authors.lastname: Rochkind
mesh_terms: D000818:Animals; D005260:Female; D028022:Low-Level Light Therapy / Q000379:methods*; D018482:Muscle, Skeletal / Q000502:physiology; D009133:Muscular Atrophy / Q000473:pathology*; D059348:Peripheral Nerve Injuries / Q000532:radiotherapy*; D051381:Rats; D017208:Rats, Wistar
keywords: laser therapy; muscle/musculoskeletal system; nerve; nerve regeneration; peripheral nerve injury