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Affiliation(s)
- Marta J.I. Airaghi Leccardi
- Medtronic Chair in Neuroengineering Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École polytechnique fédérale de Lausanne 1202 Geneva Switzerland
| | - Diego Ghezzi
- Medtronic Chair in Neuroengineering Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École polytechnique fédérale de Lausanne 1202 Geneva Switzerland
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Güemes Gonzalez A, Etienne-Cummings R, Georgiou P. Closed-loop bioelectronic medicine for diabetes management. Bioelectron Med 2020; 6:11. [PMID: 32467827 PMCID: PMC7227365 DOI: 10.1186/s42234-020-00046-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
Modulation of the nervous system by delivering electrical or pharmaceutical agents has contributed to the development of novel treatments to serious health disorders. Recent advances in multidisciplinary research has enabled the emergence of a new powerful therapeutic approach called bioelectronic medicine. Bioelectronic medicine exploits the fact that every organ in our bodies is neurally innervated and thus electrical interfacing with peripheral nerves can be a potential pathway for diagnosing or treating diseases such as diabetes. In this context, a plethora of studies have confirmed the important role of the nervous system in maintaining a tight regulation of glucose homeostasis. This has initiated new research exploring the opportunities of bioelectronic medicine for improving glucose control in people with diabetes, including regulation of gastric emptying, insulin sensitivity, and secretion of pancreatic hormones. Moreover, the development of novel closed-loop strategies aims to provide effective, specific and safe interfacing with the nervous system, and thereby targeting the organ of interest. This is especially valuable in the context of chronic diseases such as diabetes, where closed-loop bioelectronic medicine promises to provide real-time, autonomous and patient-specific therapies. In this article, we present an overview of the state-of-the-art for closed-loop neuromodulation systems in relation to diabetes and discuss future related opportunities for management of this chronic disease.
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Affiliation(s)
- Amparo Güemes Gonzalez
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Ralph Etienne-Cummings
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA
| | - Pantelis Georgiou
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
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Pashaei V, Dehghanzadeh P, Enwia G, Bayat M, Majerus SJA, Mandal S. Flexible Body-Conformal Ultrasound Patches for Image-Guided Neuromodulation. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:305-318. [PMID: 31831437 DOI: 10.1109/tbcas.2019.2959439] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The paper presents the design and validation of body-conformal active ultrasound patches with integrated imaging and modulation modalities for image-guided neural therapy. A mechanically-flexible linear 64-element array of piezoelectric transducers with a resonance frequency of 5 MHz was designed for nerve localization. A second 8-element array using larger elements was integrated on the wearable probe for low intensity focused ultrasound neuromodulation at a resonance frequency of 1.3 MHz. Full-wave simulations were used to model the flexible arrays and estimate their generated pressure profiles. A focal depth of 10-20 mm was assumed for beamforming and focusing to support modulation of the vagus, tibial, and other nerves. A strain sensor integrated on the probe provides patient-specific feedback information on array curvature for real-time optimization of focusing and image processing. Each patch also includes high voltage (HV) multiplexers, transmit/receive switches, and pre-amplifiers that simplify connectivity and also improve the signal-to-noise ratio (SNR) of the received echo signals by ∼ 5 dB. Experimental results from a flexible prototype show a sensitivity of 80 kPa/V with ∼ 3 MHz bandwidth for the modulation and 20 kPa/V with ∼ 6 MHz bandwidth for the imaging array. An algorithm for accurate and automatic localization of targeted nerves based on using nearby blood vessels (e.g., the carotid artery) as image markers is also presented.
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54
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Won SM, Song E, Reeder JT, Rogers JA. Emerging Modalities and Implantable Technologies for Neuromodulation. Cell 2020; 181:115-135. [DOI: 10.1016/j.cell.2020.02.054] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 02/08/2023]
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Hosseini S, Laursen K, Rashidi A, Moradi F. Multi-Ring Ultrasonic Transducer on a Single Piezoelectric Disk For Powering Biomedical Implants. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3827-3830. [PMID: 31946708 DOI: 10.1109/embc.2019.8857473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents a novel ultrasonic transmitter with the ability of focusing ultrasonic waves for maximum power transmission at different depths for brain neurostimula-tor implants. The most important advantages of the proposed multi-ring ultrasonic transducer (MRUT) is its simplicity and no requirement of any lens or air cavity for focusing the ultrasonic waves. Furthermore, adjusting the focal point compared to the conventional transducers is significantly easier, especially as the location of implants may vary due to, for example, head movement or the need of using these implants at different depths. By the use of multiple rings on a single piezoelectric disk in our transducer, not only more focused ultrasound beams can be achieved, but also the side lobes can be diminished by exciting each rings with different electrical signal. The proposed transmitter is envisioned to be used for optogenetic stimulation of neurons in freely-moving animals.
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Powell K, Shah K, Hao C, Wu YC, John A, Narayan RK, Li C. Neuromodulation as a new avenue for resuscitation in hemorrhagic shock. Bioelectron Med 2019; 5:17. [PMID: 32232106 PMCID: PMC7098257 DOI: 10.1186/s42234-019-0033-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/23/2019] [Indexed: 02/07/2023] Open
Abstract
Hemorrhagic shock (HS), a major cause of early death from trauma, accounts for around 40% of mortality, with 33–56% of these deaths occurring before the patient reaches a medical facility. Intravenous fluid therapy and blood transfusions are the cornerstone of treating HS. However, these options may not be available soon after the injury, resulting in death or a poorer quality of survival. Therefore, new strategies are needed to manage HS patients before they can receive definitive care. Recently, various forms of neuromodulation have been investigated as possible supplementary treatments for HS in the prehospital phase of care. Here, we provide an overview of neuromodulation methods that show promise to treat HS, such as vagus nerve stimulation, electroacupuncture, trigeminal nerve stimulation, and phrenic nerve stimulation and outline their possible mechanisms in the treatment of HS. Although all of these approaches are only validated in the preclinical models of HS and are yet to be translated to clinical settings, they clearly represent a paradigm shift in the way that this deadly condition is managed in the future.
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Affiliation(s)
- Keren Powell
- Translational Brain Research Laboratory, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Kevin Shah
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Caleb Hao
- Translational Brain Research Laboratory, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Yi-Chen Wu
- Translational Brain Research Laboratory, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Aashish John
- Translational Brain Research Laboratory, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Raj K Narayan
- Translational Brain Research Laboratory, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Chunyan Li
- Translational Brain Research Laboratory, Feinstein Institutes for Medical Research, Manhasset, NY USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA.,Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030 USA
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57
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Bockbrader MA, Francisco G, Lee R, Olson J, Solinsky R, Boninger ML. Brain Computer Interfaces in Rehabilitation Medicine. PM R 2019; 10:S233-S243. [PMID: 30269808 DOI: 10.1016/j.pmrj.2018.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/22/2018] [Accepted: 05/31/2018] [Indexed: 12/24/2022]
Abstract
One innovation currently influencing physical medicine and rehabilitation is brain-computer interface (BCI) technology. BCI systems used for motor control record neural activity associated with thoughts, perceptions, and motor intent; decode brain signals into commands for output devices; and perform the user's intended action through an output device. BCI systems used for sensory augmentation transduce environmental stimuli into neural signals interpretable by the central nervous system. Both types of systems have potential for reducing disability by facilitating a user's interaction with the environment. Investigational BCI systems are being used in the rehabilitation setting both as neuroprostheses to replace lost function and as potential plasticity-enhancing therapy tools aimed at accelerating neurorecovery. Populations benefitting from motor and somatosensory BCI systems include those with spinal cord injury, motor neuron disease, limb amputation, and stroke. This article discusses the basic components of BCI for rehabilitation, including recording systems and locations, signal processing and translation algorithms, and external devices controlled through BCI commands. An overview of applications in motor and sensory restoration is provided, along with ethical questions and user perspectives regarding BCI technology.
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Affiliation(s)
- Marcia A Bockbrader
- Department of Physical Medicine & Rehabilitation, The Ohio State University, 480 Medical Center Dr, Columbus, OH 43210; and Neurological Institute, Ohio State University Wexner Medical Center, Columbus, OH(∗).
| | - Gerard Francisco
- Department of Physical Medicine & Rehabilitation, The University of Texas, Houston, TX(†)
| | - Ray Lee
- Department of Orthopaedic and Rehabilitation, Schwab Rehabilitation Hospital, University of Chicago, Chicago, IL(‡)
| | - Jared Olson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO(§)
| | - Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston; and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA(¶)
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh; and VA Pittsburgh Health Care System, Pittsburgh, PA(#)
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Bernardo R, Rodrigues A, Soares Dos Santos MP, Carneiro P, Lopes A, Sequeira Amaral J, Sequeira Amaral V, Morais R. Novel magnetic stimulation methodology for low-current implantable medical devices. Med Eng Phys 2019; 73:77-84. [PMID: 31477429 DOI: 10.1016/j.medengphy.2019.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/10/2019] [Accepted: 07/28/2019] [Indexed: 12/15/2022]
Abstract
Recent studies highlight the ability of inductive architectures to deliver therapeutic magnetic stimuli to target tissues and to be embedded into small-scale intracorporeal medical devices. However, to date, current micro-scale biomagnetic devices require very high electric current excitations (usually exceeding 1 A) to ensure the delivery of efficient magnetic flux densities. This is a critical problem as advanced implantable devices demand self-powering, stand-alone and long-term operation. This work provides, for the first time, a novel small-scale magnetic stimulation system that requires up to 50-fold lower electric current excitations than required by relevant biomagnetic technology recently proposed. Computational models were developed to analyse the magnetic stimuli distributions and densities delivered to cellular tissues during in vitro experiments, such that the feasibility of this novel stimulator can be firstly evaluated on cell culture tests. The results demonstrate that this new stimulative technology is able to deliver osteogenic stimuli (0.1-7 mT range) by current excitations in the 0.06-4.3 mA range. Moreover, it allows coil designs with heights lower than 1 mm without significant loss of magnetic stimuli capability. Finally, suitable core diameters and stimulator-stimulator distances allow to define heterogeneity or quasi-homogeneity stimuli distributions. These results support the design of high-sophisticated biomagnetic devices for a wide range of therapeutic applications.
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Affiliation(s)
- Rodrigo Bernardo
- Department of Mechanical Engineering, University of Aveiro, Aveiro, Portugal
| | - André Rodrigues
- Department of Mechanical Engineering, University of Aveiro, Aveiro, Portugal
| | - Marco P Soares Dos Santos
- Department of Mechanical Engineering, University of Aveiro, Aveiro, Portugal; Centre for Mechanical Technology and Automation (TEMA), University of Aveiro, Aveiro, Portugal; Associated Laboratory for Energy, Transports and Aeronautics (LAETA), Portugal.
| | - Pedro Carneiro
- Department of Mechanical Engineering, University of Aveiro, Aveiro, Portugal
| | - António Lopes
- Department of Physics, University of Aveiro, Aveiro, Portugal; Aveiro Institute of Materials, Aveiro, Portugal
| | - João Sequeira Amaral
- Department of Physics, University of Aveiro, Aveiro, Portugal; Aveiro Institute of Materials, Aveiro, Portugal
| | - Vítor Sequeira Amaral
- Department of Physics, University of Aveiro, Aveiro, Portugal; Aveiro Institute of Materials, Aveiro, Portugal
| | - Raul Morais
- University of Trás-os-Montes e Alto Douro, Vila Real, Portugal; Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
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59
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Soybaş Z, Şimşek S, Erol FMB, Erdoğan UÇ, Şimşek EN, Şahin B, Marçalı M, Aydoğdu B, Elbüken Ç, Melik R. Real-Time In Vivo Control of Neural Membrane Potential by Electro-Ionic Modulation. iScience 2019; 17:347-358. [PMID: 31326701 PMCID: PMC6651852 DOI: 10.1016/j.isci.2019.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/11/2019] [Accepted: 06/28/2019] [Indexed: 11/11/2022] Open
Abstract
Theoretically, by controlling neural membrane potential (Vm) in vivo, motion, sensation, and behavior can be controlled. Until now, there was no available technique that can increase or decrease ion concentration in vivo in real time to change neural membrane potential. We introduce a method that we coin electro-ionic modulation (EIM), wherein ionic concentration around a nerve can be controlled in real time and in vivo. We used an interface to regulate the Ca2+ ion concentration around the sciatic nerve of a frog and thus achieved stimulation and blocking with higher resolution and lower current compared with electrical stimulation. As EIM achieves higher controllability of Vm, it has potential to replace conventional methods used for the treatment of neurological disorders and may bring a new perspective to neuromodulation techniques. EIM regulates extracellular ion concentration in vivo in real time EIM stimulates or blocks the nerve via Ca2+ ion depletion or enhancement EIM achieves selective stimulation or blocking of large or small axons EIM is the most superior neuromodulation method for real-life applications
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Affiliation(s)
- Zafer Soybaş
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Sefa Şimşek
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - F M Betül Erol
- Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - U Çiya Erdoğan
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Esra N Şimşek
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Büşra Şahin
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey
| | - Merve Marçalı
- Institute of Materials Science and Nanotechnology, National Nanotechnology Research Center (UNAM), Bilkent University, Ankara 06800, Turkey
| | - Bahattin Aydoğdu
- Department of Pediatric Surgery, Dicle University Medical Faculty, Diyarbakır 21280, Turkey
| | - Çağlar Elbüken
- Institute of Materials Science and Nanotechnology, National Nanotechnology Research Center (UNAM), Bilkent University, Ankara 06800, Turkey
| | - Rohat Melik
- Department of Electrical and Electronics Engineering, TOBB University of Economics & Technology, Ankara 06510, Turkey.
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60
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Bertucci C, Koppes R, Dumont C, Koppes A. Neural responses to electrical stimulation in 2D and 3D in vitro environments. Brain Res Bull 2019; 152:265-284. [PMID: 31323281 DOI: 10.1016/j.brainresbull.2019.07.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/29/2019] [Accepted: 07/12/2019] [Indexed: 12/17/2022]
Abstract
Electrical stimulation (ES) to manipulate the central (CNS) and peripheral nervous system (PNS) has been explored for decades, recently gaining momentum as bioelectronic medicine advances. The application of ES in vitro to modulate a variety of cellular functions, including regenerative potential, migration, and stem cell fate, are being explored to aid neural degeneration, dysfunction, and injury. This review describes the materials and approaches for the application of ES to the PNS and CNS microenvironments, towards an improved understanding of how ES can be harnessed for beneficial clinical applications. Emphasized are some recent advances in ES, including conductive polymers, methods of charge transfer, impact on neural cells, and a brief overview of alternative methodologies for cellular targeting including magneto, ultrasonic, and optogenetic stimulation. This review will examine how heterogenous cell populations, including neurons, glia, and neural stem cells respond to a wide range of conductive 2D and 3D substrates, stimulation regimes, known mechanisms of response, and how cellular sources impact the response to ES.
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Affiliation(s)
- Christopher Bertucci
- Northeastern University, Department of Chemical Engineering, Boston, MA, 02115, United States.
| | - Ryan Koppes
- Northeastern University, Department of Chemical Engineering, Boston, MA, 02115, United States.
| | - Courtney Dumont
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, 33146, United States.
| | - Abigail Koppes
- Northeastern University, Department of Chemical Engineering, Boston, MA, 02115, United States; Department of Biology, Boston, 02115, MA, United States.
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61
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Blackmore J, Shrivastava S, Sallet J, Butler CR, Cleveland RO. Ultrasound Neuromodulation: A Review of Results, Mechanisms and Safety. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1509-1536. [PMID: 31109842 PMCID: PMC6996285 DOI: 10.1016/j.ultrasmedbio.2018.12.015] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 12/13/2018] [Accepted: 12/29/2018] [Indexed: 05/03/2023]
Abstract
Ultrasonic neuromodulation is a rapidly growing field, in which low-intensity ultrasound (US) is delivered to nervous system tissue, resulting in transient modulation of neural activity. This review summarizes the findings in the central and peripheral nervous systems from mechanistic studies in cell culture to cognitive behavioral studies in humans. The mechanisms by which US mechanically interacts with neurons and could affect firing are presented. An in-depth safety assessment of current studies shows that parameters for the human studies fall within the safety envelope for US imaging. Challenges associated with accurately targeting US and monitoring the response are described. In conclusion, the literature supports the use of US as a safe, non-invasive brain stimulation modality with improved spatial localization and depth targeting compared with alternative methods. US neurostimulation has the potential to be used both as a scientific instrument to investigate brain function and as a therapeutic modality to modulate brain activity.
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Affiliation(s)
- Joseph Blackmore
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Roosevelt Drive, Oxford, UK
| | - Shamit Shrivastava
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Roosevelt Drive, Oxford, UK
| | - Jerome Sallet
- Wellcome Centre for Integrative Nueroimaging, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Robin O Cleveland
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Roosevelt Drive, Oxford, UK.
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62
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Lancashire HT, Jiang D, Demosthenous A, Donaldson N. An ASIC for Recording and Stimulation in Stacked Microchannel Neural Interfaces. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:259-270. [PMID: 30624225 DOI: 10.1109/tbcas.2019.2891284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper presents an active microchannel neural interface (MNI) using seven stacked application specific integrated circuits (ASICs). The approach provides a solution to the present problem of interconnect density in three-dimensional (3-D) MNIs. The 4 mm2 ASIC is implemented in 0.35 μm high-voltage CMOS technology. Each ASIC is the base for seven microchannels each with three electrodes in a pseudo-tripolar arrangement. Multiplexing allows stimulating or recording from any one of 49 channels, across seven ASICs. Connections to the ASICs are made with a five-line parallel bus. Current controlled biphasic stimulation from 5 to 500 μA has been demonstrated with switching between channels and ASICs. The high-voltage technology gives a compliance of 40 V for stimulation, appropriate for the high impedances within microchannels. High frequency biphasic stimulation, up to 40 kHz is achieved, suitable for reversible high frequency nerve blockades. Recording has been demonstrated with mV level signals; common-mode inputs are differentially distorted and limit the CMRR to 40 dB. The ASIC has been used in vitro in conjunction with an oversize (2 mm diameter) microchannel in phosphate buffered saline, demonstrating attenuation of interference from outside the microchannel and tripolar recording of signals from within the microchannel. By using five-lines for 49 active microchannels the device overcomes limitations when connecting many electrodes in a 3-D miniaturized nerve interface.
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63
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Todd N, Zhang Y, Power C, Becerra L, Borsook D, Livingstone M, McDannold N. Modulation of brain function by targeted delivery of GABA through the disrupted blood-brain barrier. Neuroimage 2019; 189:267-275. [PMID: 30659957 PMCID: PMC6422703 DOI: 10.1016/j.neuroimage.2019.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/29/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
The technology of transcranial focused ultrasound (FUS) enables a novel approach to neuromodulation, a tool for selective manipulation of brain function to be used in neurobiology research and with potential applications in clinical treatment. The method uses transcranial focused ultrasound to non-invasively open the blood-brain barrier (BBB) in a localized region such that a systemically injected neurotransmitter chemical can be delivered to the targeted brain site. The approach modulates the chemical signaling that occurs in and between neurons, making it complimentary to most other neuromodulation techniques that affect the electrical properties of neuronal activity. Here, we report delivering the inhibitory neurotransmitter GABA to the right somatosensory cortex of the rat brain during bilateral hind paw electrical stimulation and measure the inhibition of activation using functional MRI (fMRI). In a 2 × 2 factorial design, we evaluated conditions of BBB Closed vs BBB Open and No GABA vs GABA. Results from fMRI measurements of the blood oxygen level-dependent (BOLD) signal show: 1) intravenous GABA injection without FUS-mediated BBB opening does not have an effect on the BOLD response; 2) FUS-mediated BBB opening alone significantly alters the BOLD signal response to the stimulus, both in amplitude and shape of the time course; 3) the combination of FUS-mediated BBB opening and GABA injection further reduces the peak amplitude and spatial extent of the BOLD signal response to the stimulus. The data support the thesis that FUS-mediated opening of the BBB can be used to achieve non-invasive delivery of neuroactive substances for targeted manipulation of brain function.
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Affiliation(s)
- Nick Todd
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Yongzhi Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chanikarn Power
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lino Becerra
- Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | | | - Nathan McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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64
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Li G, Qiu W, Zhang Z, Jiang Q, Su M, Cai R, Li Y, Cai F, Deng Z, Xu D, Zhang H, Zheng H. Noninvasive Ultrasonic Neuromodulation in Freely Moving Mice. IEEE Trans Biomed Eng 2019; 66:217-224. [DOI: 10.1109/tbme.2018.2821201] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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65
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Assessment of the Complex Refractive Indices of Xenopus Laevis Sciatic Nerve for the Optimization of Optical (NIR) Neurostimulation. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2306-2314. [DOI: 10.1109/tnsre.2018.2878107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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66
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Sridharan A, Chirania S, Towe BC, Muthuswamy J. Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes. MICROMACHINES 2018; 9:mi9110595. [PMID: 30441831 PMCID: PMC6266837 DOI: 10.3390/mi9110595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/23/2022]
Abstract
We demonstrate a method of neurostimulation using implanted, free-floating, inter-neural diodes. They are activated by volume-conducted, high frequency, alternating current (AC) fields and address the issue of instability caused by interconnect wires in chronic nerve stimulation. The aim of this study is to optimize the set of AC electrical parameters and the diode features to achieve wireless neurostimulation. Three different packaged Schottky diodes (1.5 mm, 500 µm and 220 µm feature sizes) were tested in vivo (n = 17 rats). A careful assessment of sciatic nerve activation as a function of diode–dipole lengths and relative position of the diode was conducted. Subsequently, free-floating Schottky microdiodes were implanted in the nerve (n = 3 rats) and stimulated wirelessly. Thresholds for muscle twitch responses increased non-linearly with frequency. Currents through implanted diodes within the nerve suffer large attenuations (~100 fold) requiring 1–2 mA drive currents for thresholds at 17 µA. The muscle recruitment response using electromyograms (EMGs) is intrinsically steep for subepineurial implants and becomes steeper as diode is implanted at increasing depths away from external AC stimulating electrodes. The study demonstrates the feasibility of activating remote, untethered, implanted microscale diodes using external AC fields and achieving neurostimulation.
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Affiliation(s)
- Arati Sridharan
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Sanchit Chirania
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Bruce C Towe
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Jit Muthuswamy
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
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67
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Minusa S, Osanai H, Tateno T. Micromagnetic Stimulation of the Mouse Auditory Cortex In Vivo Using an Implantable Solenoid System. IEEE Trans Biomed Eng 2018; 65:1301-1310. [DOI: 10.1109/tbme.2017.2748136] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Daniels D, Sharabi S, Last D, Guez D, Salomon S, Zivli Z, Castel D, Volovick A, Grinfeld J, Rachmilevich I, Amar T, Liraz-Zaltsman S, Sargsyan N, Mardor Y, Harnof S. Focused Ultrasound-Induced Suppression of Auditory Evoked Potentials in Vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1022-1030. [PMID: 29501283 DOI: 10.1016/j.ultrasmedbio.2018.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 09/29/2017] [Accepted: 01/12/2018] [Indexed: 06/08/2023]
Abstract
The goal of this study was to determine the feasibility of focused ultrasound-based neuromodulation affecting auditory evoked potentials (AEPs) in animals. Focused ultrasound-induced suppression of AEPs was performed in 22 rats and 5 pigs: Repetitive sounds were produced, and the induced AEPs were recorded before and repeatedly after FUS treatment of the auditory pathway. All treated animals exhibited a decrease in AEP amplitude post-treatment in contrast to animals undergoing the sham treatment. Suppression was weaker for rats treated at 2.3 W/cm2 (amplitudes decreased to 59.8 ± 3.3% of baseline) than rats treated at 4.6 W/cm2 (36.9 ± 7.5%, p <0.001). Amplitudes of the treated pigs decreased to 27.7 ± 5.9% of baseline. This effect lasted between 30 min and 1 mo in most treated animals. No evidence of heating during treatment or later brain damage/edema was observed. These results demonstrate the feasibility of inducing significant neuromodulation with non-thermal, non-invasive, reversible focused ultrasound. The long recovery times may have clinical implications.
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Affiliation(s)
- Dianne Daniels
- Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel.
| | - Shirley Sharabi
- Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - David Last
- Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - David Guez
- Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Sharona Salomon
- Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Zion Zivli
- Neurosurgery Department, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Castel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Neufeld Cardiac Research Institute, Sheba Medical Center, Ramat-Gan, Israel
| | | | | | | | | | - Sigal Liraz-Zaltsman
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat-Gan, Israel; School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Narek Sargsyan
- Faculty of Medicine, St. Georges University, London, United Kingdom
| | - Yael Mardor
- Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sagi Harnof
- Neurosurgery Department, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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69
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Fisher JAN, Gumenchuk I. Low-intensity focused ultrasound alters the latency and spatial patterns of sensory-evoked cortical responses in vivo. J Neural Eng 2018; 15:035004. [PMID: 29436519 DOI: 10.1088/1741-2552/aaaee1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The use of transcranial, low intensity focused ultrasound (FUS) is an emerging neuromodulation technology that shows promise for both therapeutic and research applications. Among many, one of the most exciting applications is the use of FUS to rehabilitate or augment human sensory capabilities. While there is compelling empirical evidence demonstrating this capability, basic questions regarding the spatiotemporal extent of the modulatory effects remain. Our objective was to assess the basic, yet often overlooked hypothesis that FUS in fact alters sensory-evoked neural activity within the region of the cerebral cortex at the beam's focus. APPROACH To address this knowledge gap, we developed an approach to optically interrogate patterns of neural activity in the cortex directly at the acoustic focus, in vivo. Implementing simultaneous wide-field optical imaging and FUS stimulation in mice, our experiments probed somatosensory-evoked electrical activity through the use of voltage sensitive dyes (VSDs) and, in transgenic mice expressing GCaMP6f, monitored associated Ca2+ responses. MAIN RESULTS Our results demonstrate that low-intensity FUS alters both the kinetics and spatial patterns of neural activity in primary somatosensory cortex at the acoustic focus. When preceded by 1 s of pulsed ultrasound at intensities below 1 W cm-2 (I sppa), the onset of sensory-evoked cortical responses occurred 3.0 ± 0.7 ms earlier and altered the surface spatial morphology of Ca2+ responses. SIGNIFICANCE These findings support the heretofore unconfirmed assumption that FUS-induced sensory modulation reflects, at least in part, altered reactivity in primary sensory cortex at the site of sonication. The findings are significant given the interest in using FUS to target and alter spatial aspects of sensory receptive fields on the cerebral cortex.
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Affiliation(s)
- Jonathan A N Fisher
- Department of Physiology, New York Medical College, Valhalla, NY 10595, United States of America
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70
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Fernandes J, Vendramini E, Miranda AM, Silva C, Dinis H, Coizet V, David O, Mendes PM. Design and Performance Assessment of a Solid-State Microcooler for Thermal Neuromodulation. MICROMACHINES 2018; 9:mi9020047. [PMID: 30393323 PMCID: PMC6187761 DOI: 10.3390/mi9020047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 01/06/2023]
Abstract
It is well known that neural activity can be modulated using a cooling device. The applications of this technique range from the treatment of medication-resistant cerebral diseases to brain functional mapping. Despite the potential benefits of such technique, its use has been limited due to the lack of suitable thermal modulators. This paper presents the design and validation of a solid-state cooler that was able to modulate the neural activity of rodents without the use of large and unpractical water pipes. A miniaturized thermal control solution based exclusively on solid-state devices was designed, occupying only 5 mm × 5 mm × 3 mm, and featuring the potential for wireless power and communications. The cold side of the device was cooled to 26 °C, while the hot side was kept below 43 °C. This range of temperatures is compatible with brain cooling and efficient enough for achieving some control of neural activity.
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Affiliation(s)
- José Fernandes
- CMEMS, University of Minho, 4800-058 Guimarães, Portugal.
| | - Estelle Vendramini
- Grenoble Institut des Neurosciences, U1216 Inserm, Université Grenoble Alpes, 38400 Grenoble, France.
| | - Ana M Miranda
- CMEMS, University of Minho, 4800-058 Guimarães, Portugal.
| | | | - Hugo Dinis
- CMEMS, University of Minho, 4800-058 Guimarães, Portugal.
| | - Veronique Coizet
- Grenoble Institut des Neurosciences, U1216 Inserm, Université Grenoble Alpes, 38400 Grenoble, France.
| | - Olivier David
- Grenoble Institut des Neurosciences, U1216 Inserm, Université Grenoble Alpes, 38400 Grenoble, France.
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71
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Central nervous system microstimulation: Towards selective micro-neuromodulation. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2017. [DOI: 10.1016/j.cobme.2017.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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72
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Abstract
Recent advances in deep brain stimulators and brain-machine interfaces have greatly expanded the possibilities of neuroprosthetics and neuromodulation. Together with advances in neuroengineering, nanotechnology, molecular biology and material sciences, it is now possible to address fundamental questions in neuroscience in new, more powerful ways. It is now possible to apply these new technologies in ways that range from augmenting and restoring function to neuromodulation modalities that treat neuropsychiatric disorders. Recent developments in neuromodulation methods offer significant advantages and potential clinical benefits for a variety of disorders. Here we describe the current state of the art in neuromodulation methods, and some advances in brain-machine interfaces, describing the advantages and limitations of the clinical applications of each method. The future applications of these new methods and how they will shape the future of psychiatry and medicine, along with safety and ethical implications, are also discussed.
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Affiliation(s)
| | - Ricardo Ewbank Steffen
- Rio de Janeiro State University (UERJ), Institute of Social Medicine, Department of Health Policy and Management.
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73
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Chen R, Canales A, Anikeeva P. Neural Recording and Modulation Technologies. NATURE REVIEWS. MATERIALS 2017; 2:16093. [PMID: 31448131 PMCID: PMC6707077 DOI: 10.1038/natrevmats.2016.93] [Citation(s) in RCA: 289] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Within the mammalian nervous system, billions of neurons connected by quadrillions of synapses exchange electrical, chemical and mechanical signals. Disruptions to this network manifest as neurological or psychiatric conditions. Despite decades of neuroscience research, our ability to treat or even to understand these conditions is limited by the tools capable of probing the signalling complexity of the nervous system. Although orders of magnitude smaller and computationally faster than neurons, conventional substrate-bound electronics do not address the chemical and mechanical properties of neural tissue. This mismatch results in a foreign-body response and the encapsulation of devices by glial scars, suggesting that the design of an interface between the nervous system and a synthetic sensor requires additional materials innovation. Advances in genetic tools for manipulating neural activity have fuelled the demand for devices capable of simultaneous recording and controlling individual neurons at unprecedented scales. Recently, flexible organic electronics and bio- and nanomaterials have been developed for multifunctional and minimally invasive probes for long-term interaction with the nervous system. In this Review, we discuss the design lessons from the quarter-century-old field of neural engineering, highlight recent materials-driven progress in neural probes, and look at emergent directions inspired by the principles of neural transduction.
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Affiliation(s)
- Ritchie Chen
- Department of Materials Science and Engineering, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Andres Canales
- Department of Materials Science and Engineering, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Polina Anikeeva
- Department of Materials Science and Engineering, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
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74
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Rapeaux A, Nikolic K, Williams I, Eftekhar A, Constandinou TG. Fiber size-selective stimulation using action potential filtering for a peripheral nerve interface: A simulation study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:3411-4. [PMID: 26737025 DOI: 10.1109/embc.2015.7319125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Functional electrical stimulation is a powerful tool for restoration of function after nerve injury. However selectivity of stimulation remains an issue. This paper presents an alternative stimulation technique to obtain fiber size-selective stimulation of nerves using FDA-approved electrode implants. The technique was simulated for the ventral roots of Xenopus Laevis, motivated by an application in bladder control. The technique relies on applying a high frequency alternating current to filter out action potentials in larger fibers, resulting in selective stimulation of the smaller fibers. Results predict that the technique can distinguish fibers with only a 2 μm difference in diameter (for nerves not exceeding 2mm in diameter). The study investigates the behaviour of electrically blocked nerves in detail. Model imperfections and simplifications yielded some artefacts in the results, as well as unexpected nerve behaviour which is tentatively explained.
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75
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Lewis PM, Ayton LN, Guymer RH, Lowery AJ, Blamey PJ, Allen PJ, Luu CD, Rosenfeld JV. Advances in implantable bionic devices for blindness: a review. ANZ J Surg 2016; 86:654-9. [PMID: 27301783 PMCID: PMC5132139 DOI: 10.1111/ans.13616] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/03/2016] [Accepted: 03/17/2016] [Indexed: 02/02/2023]
Abstract
Since the 1950s, vision researchers have been working towards the ambitious goal of restoring a functional level of vision to the blind via electrical stimulation of the visual pathways. Groups based in Australia, USA, Germany, France and Japan report progress in the translation of retinal visual prosthetics from the experimental to clinical domains, with two retinal visual prostheses having recently received regulatory approval for clinical use. Regulatory approval for cortical visual prostheses is yet to be obtained; however, several groups report plans to conduct clinical trials in the near future, building upon the seminal clinical studies of Brindley and Dobelle. In this review, we discuss the general principles of visual prostheses employing electrical stimulation of the visual pathways, focusing on the retina and visual cortex as the two most extensively studied stimulation sites. We also discuss the surgical and functional outcomes reported to date for retinal and cortical prostheses, concluding with a brief discussion of novel developments in this field and an outlook for the future.
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Affiliation(s)
- Philip M Lewis
- Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Monash Vision Group, Faculty of Engineering, Monash University, Melbourne, Victoria, Australia.,Monash Institute of Medical Engineering, Monash University, Melbourne, Victoria, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arthur J Lowery
- Monash Vision Group, Faculty of Engineering, Monash University, Melbourne, Victoria, Australia.,Monash Institute of Medical Engineering, Monash University, Melbourne, Victoria, Australia
| | - Peter J Blamey
- Bionics Institute, Department of Medical Bionics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Penelope J Allen
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Monash Vision Group, Faculty of Engineering, Monash University, Melbourne, Victoria, Australia.,Monash Institute of Medical Engineering, Monash University, Melbourne, Victoria, Australia.,F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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76
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Friedman NJ, Butron K, Robledo N, Loudin J, Baba SN, Chayet A. A nonrandomized, open-label study to evaluate the effect of nasal stimulation on tear production in subjects with dry eye disease. Clin Ophthalmol 2016; 10:795-804. [PMID: 27217719 PMCID: PMC4862385 DOI: 10.2147/opth.s101716] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Dry eye disease (DED), a chronic disorder affecting the tear film and lacrimal functional unit, is a widely prevalent condition associated with significant burden and unmet treatment needs. Since specific neural circuits play an important role in maintaining ocular surface health, microelectrical stimulation of these pathways could present a promising new approach to treating DED. This study evaluated the efficacy and safety of nasal electrical stimulation in patients with DED. Methods This prospective, open-label, single-arm, nonrandomized pilot study included 40 patients with mild to severe DED. After undergoing two screening visits, enrolled subjects were provided with a nasal stimulation device and instructed to use it at home four times daily (or more often as needed). Follow-up assessments were conducted up to day 180. The primary efficacy endpoint was the difference between unstimulated and stimulated tear production quantified by Schirmer scores. Additional efficacy endpoints included change from baseline in corneal and conjunctival staining, symptoms evaluated on a Visual Analog Scale, and Ocular Surface Disease Index scores. Safety parameters included adverse event (AE) rates, visual acuity, intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, and endoscopic nasal examinations. Results Mean stimulated Schirmer scores were significantly higher than the unstimulated scores at all visits, and corneal and conjunctival staining and symptom scores from baseline to day 180 were significantly reduced. No serious device-related AEs and nine nonserious AEs (three device-related) were reported. Intraocular pressure remained stable and most subjects showed little or no change in visual acuity at days 30 and 180. No significant findings from other clinical examinations were noted. Conclusion Neurostimulation of the nasolacrimal pathway is a safe and effective means of increasing tear production and reducing symptoms of dry eye in patients with DED.
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Affiliation(s)
- Neil J Friedman
- Department of Ophthalmology, Stanford University, Mid-Peninsula Ophthalmology Medical Group, Palo Alto, CA, USA
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77
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Lewis PM, Thomson RH, Rosenfeld JV, Fitzgerald PB. Brain Neuromodulation Techniques. Neuroscientist 2016; 22:406-21. [DOI: 10.1177/1073858416646707] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The modulation of brain function via the application of weak direct current was first observed directly in the early 19th century. In the past 3 decades, transcranial magnetic stimulation and deep brain stimulation have undergone clinical translation, offering alternatives to pharmacological treatment of neurological and neuropsychiatric disorders. Further development of novel neuromodulation techniques employing ultrasound, micro-scale magnetic fields and optogenetics is being propelled by a rapidly improving understanding of the clinical and experimental applications of artificially stimulating or depressing brain activity in human health and disease. With the current rapid growth in neuromodulation technologies and applications, it is timely to review the genesis of the field and the current state of the art in this area.
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Affiliation(s)
- Philip M. Lewis
- Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Clayton, Victoria, Australia
- Monash Institute of Medical Engineering, Monash University, Clayton, Victoria, Australia
| | - Richard H. Thomson
- Monash Institute of Medical Engineering, Monash University, Clayton, Victoria, Australia
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey V. Rosenfeld
- Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Clayton, Victoria, Australia
- Monash Institute of Medical Engineering, Monash University, Clayton, Victoria, Australia
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Paul B. Fitzgerald
- Monash Institute of Medical Engineering, Monash University, Clayton, Victoria, Australia
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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78
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Colombo E, Feyen P, Antognazza MR, Lanzani G, Benfenati F. Nanoparticles: A Challenging Vehicle for Neural Stimulation. Front Neurosci 2016; 10:105. [PMID: 27047327 PMCID: PMC4803724 DOI: 10.3389/fnins.2016.00105] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/04/2016] [Indexed: 12/12/2022] Open
Abstract
Neurostimulation represents a powerful and well-established tool for the treatment of several diseases affecting the central nervous system. Although, effective in reducing the symptoms or the progression of brain disorders, the poor accessibility of the deepest areas of the brain currently hampers the possibility of a more specific and controlled therapeutic stimulation, depending on invasive surgical approaches and long-term stability, and biocompatibility issues. The massive research of the last decades on nanomaterials and nanoscale devices favored the development of new tools to address the limitations of the available neurostimulation approaches. This mini-review focuses on the employment of nanoparticles for the modulation of the electrophysiological activity of neuronal networks and the related transduction mechanisms underlying the nanostructure-neuron interfaces.
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Affiliation(s)
- Elisabetta Colombo
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia Genova, Italy
| | - Paul Feyen
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia Genova, Italy
| | - Maria Rosa Antognazza
- Center for Nano Science and Technology, Istituto Italiano di Tecnologia Milan, Italy
| | - Guglielmo Lanzani
- Center for Nano Science and Technology, Istituto Italiano di TecnologiaMilan, Italy; Department of Physics, Politecnico di MilanoMilan, Italy
| | - Fabio Benfenati
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di TecnologiaGenova, Italy; Department of Experimental Medicine, Università di GenovaGenova, Italy
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