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Avendano-Coy J, Serrano-Munoz D, Taylor J, Goicoechea-Garcia C, Gomez-Soriano J. Peripheral Nerve Conduction Block by High-Frequency Alternating Currents: A Systematic Review. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1131-1140. [DOI: 10.1109/tnsre.2018.2833141] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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52
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Ghazavi A, Cogan SF. Electrochemical characterization of high frequency stimulation electrodes: role of electrode material and stimulation parameters on electrode polarization. J Neural Eng 2018; 15:036023. [DOI: 10.1088/1741-2552/aa9f31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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53
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Patel YA, Butera RJ. Challenges associated with nerve conduction block using kilohertz electrical stimulation. J Neural Eng 2018; 15:031002. [DOI: 10.1088/1741-2552/aaadc0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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54
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Sacramento JF, Chew DJ, Melo BF, Donegá M, Dopson W, Guarino MP, Robinson A, Prieto-Lloret J, Patel S, Holinski BJ, Ramnarain N, Pikov V, Famm K, Conde SV. Bioelectronic modulation of carotid sinus nerve activity in the rat: a potential therapeutic approach for type 2 diabetes. Diabetologia 2018; 61:700-710. [PMID: 29332196 PMCID: PMC6448966 DOI: 10.1007/s00125-017-4533-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/20/2017] [Indexed: 02/08/2023]
Abstract
AIMS/HYPOTHESIS A new class of treatments termed bioelectronic medicines are now emerging that aim to target individual nerve fibres or specific brain circuits in pathological conditions to repair lost function and reinstate a healthy balance. Carotid sinus nerve (CSN) denervation has been shown to improve glucose homeostasis in insulin-resistant and glucose-intolerant rats; however, these positive effects from surgery appear to diminish over time and are heavily caveated by the severe adverse effects associated with permanent loss of chemosensory function. Herein we characterise the ability of a novel bioelectronic application, classified as kilohertz frequency alternating current (KHFAC) modulation, to suppress neural signals within the CSN of rodents. METHODS Rats were fed either a chow or high-fat/high-sucrose (HFHSu) diet (60% lipid-rich diet plus 35% sucrose drinking water) over 14 weeks. Neural interfaces were bilaterally implanted in the CSNs and attached to an external pulse generator. The rats were then randomised to KHFAC or sham modulation groups. KHFAC modulation variables were defined acutely by respiratory and cardiac responses to hypoxia (10% O2 + 90% N2). Insulin sensitivity was evaluated periodically through an ITT and glucose tolerance by an OGTT. RESULTS KHFAC modulation of the CSN, applied over 9 weeks, restored insulin sensitivity (constant of the insulin tolerance test [KITT] HFHSu sham, 2.56 ± 0.41% glucose/min; KITT HFHSu KHFAC, 5.01 ± 0.52% glucose/min) and glucose tolerance (AUC HFHSu sham, 1278 ± 20.36 mmol/l × min; AUC HFHSu KHFAC, 1054.15 ± 62.64 mmol/l × min) in rat models of type 2 diabetes. Upon cessation of KHFAC, insulin resistance and glucose intolerance returned to normal values within 5 weeks. CONCLUSIONS/INTERPRETATION KHFAC modulation of the CSN improves metabolic control in rat models of type 2 diabetes. These positive outcomes have significant translational potential as a novel therapeutic modality for the purpose of treating metabolic diseases in humans.
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Affiliation(s)
- Joana F Sacramento
- CEDOC, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, Rua Camara Pestana, no. 6, 6A, edificio II, piso 3, 1150-082, Lisboa, Portugal
| | | | - Bernardete F Melo
- CEDOC, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, Rua Camara Pestana, no. 6, 6A, edificio II, piso 3, 1150-082, Lisboa, Portugal
| | | | | | - Maria P Guarino
- CEDOC, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, Rua Camara Pestana, no. 6, 6A, edificio II, piso 3, 1150-082, Lisboa, Portugal
- Escola Superior de Saúde de Leiria-Instituto Politécnico de Leiria, Leiria, Portugal
| | | | - Jesus Prieto-Lloret
- CEDOC, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, Rua Camara Pestana, no. 6, 6A, edificio II, piso 3, 1150-082, Lisboa, Portugal
| | | | | | | | | | | | - Silvia V Conde
- CEDOC, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, Rua Camara Pestana, no. 6, 6A, edificio II, piso 3, 1150-082, Lisboa, Portugal.
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Ghoseiri K, Allami M, Soroush MR, Rastkhadiv MY. Assistive technologies for pain management in people with amputation: a literature review. Mil Med Res 2018; 5:1. [PMID: 29502531 PMCID: PMC5778696 DOI: 10.1186/s40779-018-0151-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/08/2018] [Indexed: 11/13/2022] Open
Abstract
The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The existing assistive devices/technologies for pain management in people with amputation include electrical nerve block devices/technologies, TENS units, elastomeric pumps and catheters, residual limb covers, laser systems, myoelectric prostheses and virtual reality systems, etc. There is a great potential to design, fabricate, and manufacture some portable, wireless, smart, and thin devices/technologies to stimulate the spinal cord or peripheral nerves by electrical, thermal, mechanical, and pharmaceutical stimulus. Although some preliminary efforts have been done, more attention must be paid by researchers, clinicians, designers, engineers, and manufacturers to the post amputation pain and its treatment methods.
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Affiliation(s)
- Kamiar Ghoseiri
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Allami
- Janbazan Medical and Engineering Research Center (JMERC), Farrokh Ave, Velenjak, Tehran, Iran.
| | - Mohammad Reza Soroush
- Janbazan Medical and Engineering Research Center (JMERC), Farrokh Ave, Velenjak, Tehran, Iran
| | - Mohammad Yusuf Rastkhadiv
- Department of Occupational Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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56
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Spinal Cord Stimulation for Peripheral Neuropathic Pain. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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57
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Boggs JW, Chae J, Bennett ME. Peripheral Nerve Stimulation for Pain Suppression. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Parker JL, Shariati NH, Karantonis DM. Electrically evoked compound action potential recording in peripheral nerves. ACTA ACUST UNITED AC 2018. [DOI: 10.2217/bem-2017-0005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Applications for bioelectric medicine can be found in all parts of the nervous system. The CNS – brain and spinal cord – contain targets for commercial neuromodulation therapies. Peripheral nerves are also modulated with commercially available systems during treatment for chronic pain and epilepsy, and developments are in progress for treating many other diseases. The electrically evoked compound action potential is a measure of the electrical response from the tissue to stimulation. It provides a direct insight into the electrophysiology of the stimulation, and despite its incorporation into cochlear implants it is a technology that is yet to find its way into commercial peripheral nerve stimulation applications. This review outlines the status of evoked compound action potential measurements on peripheral nerves and highlights the challenges which need to be overcome.
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Affiliation(s)
- John L Parker
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, New South Wales, Australia
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Patel YA, Kim BS, Butera RJ. Kilohertz Electrical Stimulation Nerve Conduction Block: Effects of Electrode Material. IEEE Trans Neural Syst Rehabil Eng 2018; 26:11-17. [DOI: 10.1109/tnsre.2017.2737954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pelot NA, Behrend CE, Grill WM. Modeling the response of small myelinated axons in a compound nerve to kilohertz frequency signals. J Neural Eng 2017; 14:046022. [PMID: 28361793 PMCID: PMC5677574 DOI: 10.1088/1741-2552/aa6a5f] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There is growing interest in electrical neuromodulation of peripheral nerves, particularly autonomic nerves, to treat various diseases. Electrical signals in the kilohertz frequency (KHF) range can produce different responses, including conduction block. For example, EnteroMedics' vBloc® therapy for obesity delivers 5 kHz stimulation to block the abdominal vagus nerves, but the mechanisms of action are unclear. APPROACH We developed a two-part computational model, coupling a 3D finite element model of a cuff electrode around the human abdominal vagus nerve with biophysically-realistic electrical circuit equivalent (cable) model axons (1, 2, and 5.7 µm in diameter). We developed an automated algorithm to classify conduction responses as subthreshold (transmission), KHF-evoked activity (excitation), or block. We quantified neural responses across kilohertz frequencies (5-20 kHz), amplitudes (1-8 mA), and electrode designs. MAIN RESULTS We found heterogeneous conduction responses across the modeled nerve trunk, both for a given parameter set and across parameter sets, although most suprathreshold responses were excitation, rather than block. The firing patterns were irregular near transmission and block boundaries, but otherwise regular, and mean firing rates varied with electrode-fibre distance. Further, we identified excitation responses at amplitudes above block threshold, termed 're-excitation', arising from action potentials initiated at virtual cathodes. Excitation and block thresholds decreased with smaller electrode-fibre distances, larger fibre diameters, and lower kilohertz frequencies. A point source model predicted a larger fraction of blocked fibres and greater change of threshold with distance as compared to the realistic cuff and nerve model. SIGNIFICANCE Our findings of widespread asynchronous KHF-evoked activity suggest that conduction block in the abdominal vagus nerves is unlikely with current clinical parameters. Our results indicate that compound neural or downstream muscle force recordings may be unreliable as quantitative measures of neural activity for in vivo studies or as biomarkers in closed-loop clinical devices.
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Affiliation(s)
- N A Pelot
- Department of Biomedical Engineering, Duke University, Room 1427, Fitzpatrick CIEMAS, 101 Science Drive, Campus Box 90281, Durham, NC 27708, United States of America
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Crosby ND, Janik JJ, Grill WM. Modulation of activity and conduction in single dorsal column axons by kilohertz-frequency spinal cord stimulation. J Neurophysiol 2016; 117:136-147. [PMID: 27760823 DOI: 10.1152/jn.00701.2016] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 11/22/2022] Open
Abstract
Kilohertz-frequency spinal cord stimulation (KHF-SCS) is a potential paresthesia-free treatment for chronic pain. However, the effects of KHF-SCS on spinal dorsal column (DC) axons and its mechanisms of action remain unknown. The objectives of this study were to quantify activation and conduction block of DC axons by KHF-SCS across a range of frequencies (1, 5, 10, or 20 kHz) and waveforms (biphasic pulses or sinusoids). Custom platinum electrodes delivered SCS to the T10/T11 dorsal columns of anesthetized male Sprague-Dawley rats. Single DC axons and compound action potentials were recorded during KHF-SCS to evaluate SCS-evoked activity. Responses to KHF-SCS in DC axons included brief onset firing, slowly accommodating asynchronous firing, and conduction block. The effects of KHF-SCS mostly occurred well above motor thresholds, but isolated units were activated at amplitudes shown to reduce behavioral sensitivity in rats. Activity evoked by SCS was similar across a range of frequencies (5-20 kHz) and waveforms (biphasic and sinusoidal). Stimulation at 1-kHz SCS evoked more axonal firing that was also more phase-synchronized to the SCS waveform, but only at amplitudes above motor threshold. These data quantitatively characterize the central nervous system activity that may modulate pain perception and paresthesia, and thereby provide a foundation for continued investigation of the mechanisms of KHF-SCS and its optimization as a therapy for chronic pain. Given the asynchronous and transient nature of DC activity, it is unlikely that the same mechanisms underlying conventional SCS (i.e., persistent, periodic DC activation) apply to KHF-SCS. NEW & NOTEWORTHY Kilohertz-frequency spinal cord stimulation (KHF-SCS) is a new mode of SCS that may offer better pain relief than conventional SCS. However, the mechanism of action is poorly characterized, especially the effects of stimulation on dorsal column (DC) axons, which are the primary target of stimulation. This study provides the first recordings of single DC axons during KHF-SCS to quantify DC activity that has the potential to mediate the analgesic effects of KHF-SCS.
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Affiliation(s)
- Nathan D Crosby
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | | | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina; .,Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina.,Department of Neurobiology, Duke University, Durham, North Carolina.,Department of Surgery, Duke University, Durham, North Carolina; and
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Bicket MC, Dunn RY, Ahmed SU. High-Frequency Spinal Cord Stimulation for Chronic Pain: Pre-Clinical Overview and Systematic Review of Controlled Trials. PAIN MEDICINE 2016; 17:2326-2336. [PMID: 28025366 DOI: 10.1093/pm/pnw156] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the evidence base for high-frequency spinal cord stimulation (HFSCS). HFSCS has the potential to provide paresthesia-free pain relief for patients with chronic pain, in contrast to conventional spinal cord stimulation, which produces distracting and potentially unpleasant paresthesias. DESIGN A systematic review following standard methodological guidelines (Prospero #CRD42015029215). METHODS We searched PubMed to March 14, 2016 without language restriction and hand-checked reference lists. Two authors independently performed study selection, bias evaluations, and data extraction. The pre-clinical review selected studies focusing on the mechanism and non-human experience with HFSCS. Clinically, any prospective study of adults using HFSCS (≥ 1000 Hz) was included. RESULTS Pre-clinical studies have characterized many aspects underlying the mechanism of HFSCS. For the clinical systematic review, eight trials (236 participants randomized or 160 followed prospectively) met inclusion criteria. All trials of HFSCS focused on patients with chronic low back pain with one exception, which included patients with chronic migraine. All but one trial documented funding by industry. Performance bias due to unmasked participants, physicians, and outcome assessors limited the quality of all but one study. CONCLUSIONS Significant growth in the preclinical and clinical evidence base for HFSCS suggests that HFSCS may differ from conventional SCS in mechanism of action and efficacy of treatment, respectively. Addressing current knowledge gaps in clinical evidence will require standardization in trial reporting and leveraging the paresthesia-free characteristic of HFSCS to enable masking in high-quality randomized controlled trials.
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Affiliation(s)
- Mark C Bicket
- *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger Y Dunn
- Tufts University School of Medicine, Boston, Massachusetts
| | - Shihab U Ahmed
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Yang G, Xiao Z, Wang J, Shen B, Roppolo JR, de Groat WC, Tai C. Post-stimulation block of frog sciatic nerve by high-frequency (kHz) biphasic stimulation. Med Biol Eng Comput 2016; 55:585-593. [PMID: 27370786 DOI: 10.1007/s11517-016-1539-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
This study determined if high-frequency biphasic stimulation can induce nerve conduction block that persists after the stimulation is terminated, i.e., post-stimulation block. The frog sciatic nerve-muscle preparation was used in the study. Muscle contraction force induced by low-frequency (0.5 Hz) nerve stimulation was recorded to indicate the occurrence and recovery of nerve block induced by the high-frequency (5 or 10 kHz) biphasic stimulation. Nerve block was observed during high-frequency stimulation and after termination of the stimulation. The recovery from post-stimulation block occurred in two distinct phases. During the first phase, the complete block induced during high-frequency stimulation was maintained. The average maximal duration for the first phase was 107 ± 50 s. During the second phase, the block gradually or abruptly reversed. The duration of both first and second phases was dependent on stimulation intensity and duration but not frequency. Stimulation of higher intensity (1.4-2 times block threshold) and longer duration (5 min) produced the longest period (249 ± 58 s) for a complete recovery. Post-stimulation block can be induced by high-frequency biphasic stimulation, which is important for future investigations of the blocking mechanisms and for optimizing the stimulation parameters or protocols in clinical applications.
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Affiliation(s)
- Guangning Yang
- Department of Urology, University of Pittsburgh, 700 Kaufmann Building, Pittsburgh, PA, 15213, USA.,Department of Biomedical Engineering, Beijing Jiaotong University, Beijing, China
| | - Zhiying Xiao
- Department of Urology, University of Pittsburgh, 700 Kaufmann Building, Pittsburgh, PA, 15213, USA.,Department of Urology, The Second Hospital, Shandong University, Jinan, China
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, 700 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Bing Shen
- Department of Urology, University of Pittsburgh, 700 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, 700 Kaufmann Building, Pittsburgh, PA, 15213, USA. .,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.
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