[Electrical stimulation of the heart: history, current trends and prospects]

Part 1 of this review is devoted to the history of development of temporary and continuous electric stimulation (ES) of the heart. Up-to-date concepts of bradyarrhythmia are considered along with the most important techniques for its management with the use of two-chamber and frequency-adaptive systems. Algorithms for the choice of optimal ES regimes taking account of the type of bradyarrhythmia are discussed. Current concepts of physiological ES of the heart are considered. The authors describe their own experience with the application of ES of the heart.

Moxa in nineteenth-century medical practice

While we may think of moxa as a therapeutic technique that has been introduced to the United States in the last few decades of the twentieth century, this oriental healing procedure that applies the heat of burning herbs to acupuncture points was first employed in the United States by American physicians nearly two hundred years ago. Conceptualized as a counter-irritation method, moxa was used to treat a range of conditions, including inflammation, organ dysfunction, pain, and paralysis. Moxa's presence in nineteenth-century medicine was neither widespread nor of long duration, however, and notes of its use appear in medical records and doctors' daybooks only from the 1820s to the 1840s. Ultimately, moxa would be replaced by new procedures such as galvanism and the electro-magnetic machine. The tale of how doctors acquired and used moxa in the early nineteenth century is interesting in its own right. But the story of why this treatment was abandoned ties moxa to the larger saga of medicine's paradigm shift to bio-medical science and technology.

Impotence in the 18th and 19th century: concepts of etiology and approaches to therapy

The old word impotence is derived from the Latin word impotencia, which literally translated means "lack of power." Impotence, in the course of the history, has been attributed to mental pathology, anxiety, or demons or witches. Historically, the pharmacological treatments for impotence started in Greek times, when a myriad of herbal medications were applied locally to the genitals to enhance "sexual strength." In the 18th century, theories about the main factors inducing impotence saw it as an abnormal state of the fibers, a defect in the solid or liquid substances or a bad structure (tumor, inflammation, abscess, ulcer or foreign body). According to these mechanisms, when impotence depended on the state of the muscular fibers, treatment included a tepid bath and a clyster. In very fat or very weak people, who get particularly tired, it was important to use the remedies able to give energy to the fibers, such as ferrous mineral waters, for a month. Moreover, other suggestions were to ride a horse, to sleep few hours, to breathe good country air, to take a purge every 2 weeks, to drink half a glass of wine from Borgogne or to distract the mind continuously. In the 19th century, therapies regarding impotence included slight electric stimulation through the application of stimulators on the scrotum in the testis or epididymis areas, until pain was induced. In the same period, another method for treating impotence was flagellation. This method consisted of little flagellations with leather strips.

The role of The Gentleman's Magazine in the dissemination of knowledge about electric fish in the eighteenth century

Although torpedoes and Malopterurus, a Nile catfish, had been described and even used medically in antiquity, their discharges were poorly understood before the second half of the eighteenth century. It was then that their actions, along with those of certain South American "eels," became firmly associated with electricity. The realization that an animal could produce electricity marked a turning point in the history of neurophysiology, which had long described nerve actions with recourse to animal spirits. By examining The Gentleman's Magazine during the period when electric fish were becoming electrical, one can begin to appreciate how new discoveries about these unusual creatures captured the imagination of scientists and were filtered down to the literate public.

Interventional neurophysiology and an implantable system for neurostimulation of the sacral area

Surgical or interventional neurophysiology is a term commonly used to refer to a large number of neurosurgical procedures involving the brain, cranial nerves, spinal cord and peripheral nervous system which, to be efficient and safe, demand specific neurophysiological know-how. As a result of the development of these procedures and their increasing use in the operating room, the role of clinical neurophysiology, traditionally diagnostic, has been extended. With the advent of 'neurostimulation' and 'neuromodulation', some neurophysiological techniques have, in themselves, progressively become more therapeutic, the therapeutic alteration of nervous system activity being achieved not only by surgical ablation or medication but also through electrophysiological means via implanted or non-implanted devices, whose development was made possible by extensive studies in the field of neurophysiology. The first application of electrical stimulation in urology opened up the way for progress in the therapeutic direction. Moreover, with regard to the mechanism of action underlying neuromodulation, the application of neurophysiology and neuroimaging procedures has contributed to understanding of the neural control mechanism of visceral (e.g. lower urinary tract) function. In our experience, the advent of sacral neuromodulation for lower urinary tract dysfunction and the use of neurophysiology has made it possible to shed light on the pathophysiological mechanisms of neuro-urological disorders, allowing us to assess and validate new therapeutic approaches and finally to develop a new method and device for chronic pudendal nerve stimulation.

[Electrotherapy and uterine fibroids]

At the end of the 19th century, uterine fibroids cause huge therapeutic issues: on the one hand they can reach an impressive massive volume; on the other hand they provoke endless haemorrhages. Dr Apostoli develops galvanotherapy which becomes the reference in French and international medicine before its rapid downfall as gynaecological surgery makes great progress at the beginning of the 20th Century.

Electrotherapy and mental illness: then and now

Today electrotherapy has reappeared as a therapy of choice for the treatment of depression and other forms of mental illness. It had de facto vanished from allopathic medicine from the 1920s to the end of the century. The debates about electrotherapy mirror the question of whether mental illness was somatic and to be treated by somatic means or psychological to be treated with psychotherapy. Sigmund Freud's move from an advocate to an opponent of electrotherapy is exemplary for a shift in attitude and the decline of electrotherapy. With the re-somaticization of mental illness over the past decades has come the reappearance of somatic therapies such as electrotherapy.

Electrotherapy and the Human Voice: A Literature Review of the Historical Origins and Contemporary Applications

SUMMARY

The present article surveys the literature on the electrotherapy treatment for voice disorders from the mid-18th century to World War I (1914--1918) and the post 1970s reappearance of such therapies. The reappearance of electrotherapy as treatment for voice disorders in the past 20 years has been heralded as a major breakthrough. In light of our reading of the scientific literature of the 19th century, it can be shown to repeat many of the presuppositions of electrotherapists of that time. The current resurgence of interest and research in electrical stimulation of the larynx is buoyed by technological innovations analogous to those in the 19th century. Although the current state of research has enhanced our understanding of vocal fold physiology, it does not necessarily provide a new therapeutic approach as a survey of the most recent literature shows.

[Nikola Tesla in medicine, too]

Using primary and secondary sources we have shown in this paper the influence of Nikola Tesla's work on the field of medicine. The description of his experiments conduced within secondary-school education programs aimed to present the popularization of his work in Croatia. Although Tesla was dedicated primarily to physics and was not directly involved in biomedical research, his work significantly contributed to paving the way of medical physics particularly radiology and high-frequency electrotherapy.

[Birth of medical electricity]

In the mid-eighteenth century Jallabert treated an hemiplegia using electrostatic electricity and published the patient's recovery. Immediately, physicians and clergymen started to use the Nollet's machine to treat many neurological diseases and published their results. The Galvani's constant was also a medical seism when he though the had discovered animal electricity. Galvanism entered immediately medical practice for a long time.

Surgical therapy of neurogenic detrusor overactivity (hyperreflexia) in paraplegic patients by sacral deafferentation and implant driven micturition by sacral anterior root stimulation: methods, indications, results, complications, and future prospects

Spinal cord injured patients with a suprasacral lesion usually develop a spastic bladder. The neurogenic detrusor overactivity (NDO) and the overactive external sphincter cause incontinence and threaten these patients with recurrent urinary tract infections (UTI), renal failure and autonomic dysreflexia. All of these severe disturbances may be well managed by sacral deafferentation (SDAF) and implantation of a sacral anterior root stimulator (SARS). Since September 1986 to December 2002, 464 paraplegic patients (220 females, 244 males) received a SDAF-SARS. The SDAF was done intradurally in almost all cases, which means that we used a single operation field to do a two-stages procedure (SDAF and SARS). The results include data on 440 patients with a mean follow-up of 8.6 years (18 months to 18 years) until December 2004. The complete deafferentation was successful in 95.2%. Of these patients, 420 paraplegics use the SARS for voiding, (frequency 4.7 per day) and 401 for defecation (frequency 4.7 per week). Continence was achieved in 364 patients (83%). UTIs decreased from 6.3 per year preoperatively to 1.2 per year postoperatively. Kidney function remained stable. Early complications were 6 CSF leaks and 5 implant infections. Late compli cations included receiver or cable failures and required surgical repair in 44 patients. A step-by-step program for trouble-shooting distinguishes implant failure from myogenic or neurogenic failure. SDAF is able to restore the reservoir function of urinary bladder and makes the patient achieve continence. Autonomic dysreflexia disappeared in most cases. By accurate adjustment of stimulation parameters, it is possible for the patient to have a low resistance micturition. The microsurgical technique requires intensive education. In addition, the therapist should be able to manage late complications.

Designed electromagnetic pulsed therapy: Clinical applications

First reduced to science by Maxwell in 1865, electromagnetic technology as therapy received little interest from basic scientists or clinicians until the 1980s. It now promises applications that include mitigation of inflammation (electrochemistry) and stimulation of classes of genes following onset of illness and injury (electrogenomics). The use of electromagnetism to stop inflammation and restore tissue seems a logical phenomenology, that is, stop the inflammation, then upregulate classes of restorative gene loci to initiate healing. Studies in the fields of MRI and NMR have aided the understanding of cell response to low energy EMF inputs via electromagnetically responsive elements. Understanding protein iterations, that is, how they process information to direct energy, we can maximize technology to aid restorative intervention, a promising step forward over current paradigms of therapy.

Electricity in the treatment of nervous system disease

Electricity has been used in medicine for almost two millenniums beginning with electrical chocks from the torpedo fish and ending with the implantation of neuromodulators and neuroprostheses. These implantable stimulators aim to improve functional independence and quality of life in various groups of disabled people. New indications for neuromodulation are still evolving and the field is rapidly advancing. Thanks to modern science and computer technology, electrotherapy has reached a degree of sophistication where it can be applied relatively safely and effectively in a variety of nervous system diseases, including pain, movement disorders, epilepsy, Tourette syndrome, psychiatric disease, addiction, coma, urinary incontinence, impotence, infertility, respiratory paralysis, tinnitus and blindness.

John Wesley (1708-91)

John Wesley was a competent physician, quite capable of the diagnosis and care of patients. His Primitive Physic provides a picture of therapy in the eighteenth century but he rejected the bleeding and purging which were common at that time. He was ahead of his time in his emphasis on hygiene, cleanliness and simple living. In this he has been regarded as a pioneer of preventive medicine. He was in the forefront of the philanthropic movement in his provision of Dispensaries for the poor and his care of the sick and elderly. In spite of this he does not seem to have had a direct influence on the physicians of the day. Loudon does not mention him in his Origins and Growth of the Dispensary Movement in England and Clarke only gives him a passing reference in his History of The Royal College of Physicians. He experimented with electrotherapy and it seems likely he was one of those who saw that electricity could be the 'greatest step forward' in medicine as a whole.

Revealing sparks: John Wesley and the religious utility of electrical healing

In the eighteenth century, dramatic electrical performances were favourite entertainments for the upper classes, yet the therapeutic uses of electricity also reached the lower strata of society. This change in the social composition of electrical audiences attracted the attention of John Wesley, who became interested in the subject in the late 1740s. The paper analyses Wesley's involvement in the medical applications of electricity by taking into account his theological views and his proselytizing strategies. It sets his advocacy of medical electricity in the context of his philanthropic endeavours aimed at the sick poor, connecting them to his attempts to spread Methodism especially among the lower classes. It is argued that the healing virtues of electricity entailed a revision of the morality of electrical experiment which made electric sparks powerful resources for the popularization of the Methodist way of life, based on discipline, obedience to established authorities and love and fear of God.

Vagal nerve stimulation for refractory epilepsy in children: indications and experience at The Hospital for Sick Children

OBJECTIVES

The management of intractable epilepsy in children is a challenging problem. For those patients who do not respond to antiepileptic drugs and are not candidates for epilepsy surgery, vagal nerve stimulation (VNS), can be a viable alternative for reducing seizure frequency. We have reviewed the historical and clinical background of VNS treatment. We also include our experience at The Hospital for Sick Children in children who underwent VNS implantation.

METHODS

Forty-one children underwent VNS implantation for epilepsy over 6 years. After a mean follow-up of 31 months, 15 (38%) patients had a seizure frequency reduction of more than 90%. Fifteen (38%) children failed to respond to the VNS treatment. The device was removed in five children: in one, due to late infection; the other four could not tolerate the side effects of chronic VNS therapy. Two patients required reimplantation due to electrode failure. The most common side effects in our series were cough and vocal disturbances.

CONCLUSIONS

Our results show that VNS implantation can be a safe and effective alternative therapy for children with drug-resistant epilepsy who are not candidates for epilepsy surgery.

Benjamin Franklin, electricity, and the palsies: on the 300th anniversary of his birth

Benjamin Franklin was involved not only with the nature of electricity but with its possible medical utility. He conducted electrical experiments on people with palsies, notably those caused by stroke, to see if electricity from machines could restore movement. Franklin recognized that electricity was not the miraculous cure it was hoped to be, and he presented his findings in 1757 as communication to the Royal Society. Although he did not provide names or individual case studies in this communication, subsequently published in 1758, his personal letters reveal that he treated at least two important colonists: James Logan, William Penn's secretary and a prominent public official in Pennsylvania, and Jonathan Belcher, governor of several provinces. Franklin's private letters shed light on how he conducted his clinical "tryals" and why he drew the conclusions he did in his report to the Royal Society.

Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects

Vagal nerve stimulation (VNS) is an approved treatment for epilepsy and is currently under investigation as a therapy for other disorders, including depression, anxiety and Alzheimer's disease. This review examines the pre-clinical and clinical literature relating to VNS. A brief historical perspective is given, followed by consideration of the efficacy of the various clinical applications of VNS. Finally, what is known about the mechanism by which VNS exerts clinical benefit is considered. It is concluded that although the precise mechanism of action of VNS is still unknown, the search for the mechanism has the potential to lend new insight into the neuropathology of depression. It is important that prior assumptions about the influence of VNS on particular aspects of brain function do not constrain the investigations.