Neuromodulation with electromagnetic stimulation for seizure suppression: From electrode to magnetic coil

Neuromodulation for Treatment of Tinnitus: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the treatment efficacy of neuromodulation versus sham for the treatment of tinnitus.

DATA SOURCES

Cochrane Library, CINAHL, PubMed, Scopus.

REVIEW METHODS

The Cochrane Library, CINAHL, PubMed, and Scopus were searched from inception through May 2023 for English language articles documenting "neuromodulation" and "tinnitus" stratified by sham-controlled randomized control trials with 40 or more patients. Data collected included Beck Anxiety Inventory, Beck Depression Inventory (BDI), Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire, and Visual Analog Scale. A Meta-analysis of continuous measures (mean) and proportions (%) were conducted.

RESULTS

A total of 19 randomized control trials (N = 1186) were included. The mean age was 48.4 ± 5.3 (range: 19-74), mean duration of tinnitus was 3.8 ± 3.4 years, 61% [56.2-65.7] male, and 55.7% [46-65] with unilateral tinnitus. The short-term effect of transcutaneous electrical nerve stimulation and transcranial direct current stimulation on THI score is -16.2 [-23.1 to -9.3] and -19 [-30.1 to -7.8], respectively. The long-term effect of repetitive transcranial magnetic stimulation on THI score is -8.6 [-11.5 to -5.7]. Transcranial direct current stimulation decreases BDI score by -11.8 [-13.3 to -10.3].

CONCLUSION

As measured by the Tinnitus Handicap Index, our findings suggest the effects of transcutaneous electrical nerve stimulation and transcranial direct current stimulation reach significant benefit in the short term, whereas repetitive transcranial magnetic stimulation reaches significant benefit in the long term. Based on the BDI, transcranial direct current stimulation significantly reduces comorbid depression in patients with tinnitus.

Transcranial magnetic stimulation in non-human primates: A systematic review

Transcranial magnetic stimulation (TMS) is widely employed as a tool to investigate and treat brain diseases. However, little is known about the direct effects of TMS on the brain. Non-human primates (NHPs) are a valuable translational model to investigate how TMS affects brain circuits given their neurophysiological similarity with humans and their capacity to perform complex tasks that approach human behavior. This systematic review aimed to identify studies using TMS in NHPs as well as to assess their methodological quality through a modified reference checklist. The results show high heterogeneity and superficiality in the studies regarding the report of the TMS parameters, which have not improved over the years. This checklist can be used for future TMS studies with NHPs to ensure transparency and critical appraisal. The use of the checklist would improve methodological soundness and interpretation of the studies, facilitating the translation of the findings to humans. The review also discusses how advancements in the field can elucidate the effects of TMS in the brain.

Closed-loop seizure modulation via extreme learning machine based extended state observer

Neuromodulation is a promising way in clinical treatment of epilepsy, but the existing methods cannot adjust stimulations according to patients' real-time reactions. Therefore, it is necessary to acquire a systematic and a scientific regulation method based on patients' real-time reactions. The linear active disturbance rejection control can adapt to complex epileptic dynamics and improve the epilepsy regulation, even if little model information is available, and various uncertainties and external disturbances exist. However, a linear extended state observer estimates the time-varying total disturbance with a steady-state error. To improve regulation, it is crucial to estimate the total disturbance in a more accurate manner. An extreme learning machine is capable of approximating any nonlinear function. Its initial parameter generation is more convenient, adjustable parameters are fewer, and learning speed is faster. Thus, a nonlinear time-varying function can be estimated more timely and accurately. Then, an extreme learning machine based extended state observer is proposed to get a more satisfactory total disturbance estimation and more desired closed-loop regulation. The convergence of the extreme learning machine based extended state observer is verified and the stability of the closed-loop system is analyzed. Numerical results show that the proposed extended state observer is much better than a linear extended state observer in estimating the total disturbance. It guarantees a more satisfied closed-loop neuromodulation.

The decrease in diurnal oxygen production in Elodea under the influence of high geomagnetic variability: the role of light, temperature and atmospheric pressure

Epidemiological studies have indicated adverse effects of geomagnetic disturbance on human health, including increased mortality. There is evidence from plant and animal studies that help to elucidate this interaction. This study tests the hypothesis that geomagnetic disturbance affects living systems, by modifying the metabolic process of photosynthesis, in the natural environment.Continuous 24-h measurements of dissolved oxygen in flasks containing Holtfreiter's solution and strands of healthy Elodea were recorded from May 1996, until September 1998, in an electromagnetically quiet, purpose built, garden shed environment, without mains electricity. Sensormeter recordings of oxygen, light, temperature and air pressure were uploaded weekly to a PC. The hourly total geomagnetic field measurements were obtained from the nearest observatory.Significant decrease in oxygen (diurnal volume of oxygen divided by plant mass and diurnal light), (O/WL), was found on days of high geomagnetic field variability throughout 11 recorded months of the year 1997. This result was independent of temperature and atmospheric pressure. No significant decrease in O/WL during high geomagnetic variability was found for the 7 months recorded in 1996. The 1996 and 1997 data both showed a significant decrease in the diurnal time lag between peak light and peak oxygen for diurnal high geomagnetic variability compared with low geomagnetic variability. Cross correlation analysis for 1997 and 1998 data showed a decrease in positive correlation of oxygen with light in high geomagnetic variability, compared with low geomagnetic variability, and increased positive correlation with the geomagnetic field instead. These experiments support a hypothesis of high geomagnetic field variability as a weak zeitgeber, and a metabolic depressant for photosynthetic oxygen production in plants.

The increase in c-fos expression in epileptic seizures is inhibited by magnetic field application, but not KCa1.1 channel expression

The aim of this study was to understand the expression of big potassium (BK, KCa1.1) channels in epileptic seizures under magnetic field application. Forty Wistar albino adult male rats were divided into five groups (n = 8). First group rats were control group. Pentylenetetrazole (PTZ) administrated to second group rats to induce the seizures with 35 mg/kg intraperitoneally injection every two days. Levetiracetam (LEV) i.p. at a dose of 108 mg/kg was given to third group rats as positive control group (PC) before 20 minutes PTZ administration. Pulsed magnetic field with 1.5 mT was exposed to the fourth group rats for 3 hours a day for 1 month as magnetic field (MF) group. 1.5 mT pulsed magnetic field was exposed to the fifth group rats for 3 hours a day for 1 month in addition to PTZ administration (PTZ+MF). KCa1.1 not changed in hippocampus of PTZ rats while increased in frontal cortex and pons for PTZ group but not changed with magnetic field exposure. KCa1.1 increased in heart of PTZ animals and turned back to mean control values with magnetic field exposure. Suppressing the expected increase of c-fos protein expression in seizures with magnetic field application but not being able to change the KCa1.1 expression shows that new studies can be done by increasing the frequency of 1.5 mT magnetic field.

A Model for the Propagation of Seizure Activity in Normal Brain Tissue

Epilepsies are characterized by paroxysmal electrophysiological events and seizures, which can propagate across the brain. One of the main unsolved questions in epilepsy is how epileptic activity can invade normal tissue and thus propagate across the brain. To investigate this question, we consider three computational models at the neural network scale to study the underlying dynamics of seizure propagation, understand which specific features play a role, and relate them to clinical or experimental observations. We consider both the internal connectivity structure between neurons and the input properties in our characterization. We show that a paroxysmal input is sometimes controlled by the network while in other instances, it can lead the network activity to itself produce paroxysmal activity, and thus will further propagate to efferent networks. We further show how the details of the network architecture are essential to determine this switch to a seizure-like regime. We investigated the nature of the instability involved and in particular found a central role for the inhibitory connectivity. We propose a probabilistic approach to the propagative/non-propagative scenarios, which may serve as a guide to control the seizure by using appropriate stimuli.

Cellular mechanisms underlying state-dependent neural inhibition with magnetic stimulation

Novel stimulation protocols for neuromodulation with magnetic fields are explored in clinical and laboratory settings. Recent evidence suggests that the activation state of the nervous system plays a significant role in the outcome of magnetic stimulation, but the underlying cellular and molecular mechanisms of state-dependency have not been completely investigated. We recently reported that high frequency magnetic stimulation could inhibit neural activity when the neuron was in a low active state. In this paper, we investigate state-dependent neural modulation by applying a magnetic field to single neurons, using the novel micro-coil technology. High frequency magnetic stimulation suppressed single neuron activity in a state-dependent manner. It inhibited neurons in slow-firing states, but spared neurons from fast-firing states, when the same magnetic stimuli were applied. Using a multi-compartment NEURON model, we found that dynamics of voltage-dependent sodium and potassium channels were significantly altered by the magnetic stimulation in the slow-firing neurons, but not in the fast-firing neurons. Variability in neural activity should be monitored and explored to optimize the outcome of magnetic stimulation in basic laboratory research and clinical practice. If selective stimulation can be programmed to match the appropriate neural state, prosthetic implants and brain-machine interfaces can be designed based on these concepts to achieve optimal results.

Finding the Location of Axonal Activation by a Miniature Magnetic Coil

Magnetic stimulation for neural activation is widely used in clinical and lab research. In comparison to electric stimulation using an implanted electrode, stimulation with a large magnetic coil is associated with poor spatial specificity and incapability to stimulate deep brain structures. Recent developments in micromagnetic stimulation (μMS) technology mitigates some of these shortcomings. The sub-millimeter coils can be covered with soft, biocompatible material, and chronically implanted. They can provide highly specific neural stimulation in the deep neural structure. Although the μMS technology is expected to provide a precise location of neural stimulation, the exact site of neural activation is difficult to determine. Furthermore, factors that could cause the shifting of the activation site during μMS have not been fully investigated. To estimate the location of axon activation in μMS, we first derived an analytical expression of the activating function, which predicts the location of membrane depolarization in an unmyelinated axon. Then, we developed a multi-compartment, Hodgkin-Huxley (H-H) type of NEURON model of an unmyelinated axon to test the impact of several important coil parameters on the location of axonal activation. The location of axonal activation was dependent on both the parameters of the stimulus and the biophysics properties of the targeted axon during μMS. The activating function analysis predicted that the location of membrane depolarization and activation could shift due to the reversal of the coil current and the change in the coil-axon distance. The NEURON modeling confirmed these predictions. Interestingly, the NEURON simulation further revealed that the intensity of stimulation played a significant role in the activation location. Moderate or strong coil currents activated the axon at different locations, mediated by two distinct ion channel mechanisms. This study reports several experimental factors that could cause a potential shift in the location of neural activation during μMS, which is essential for further development of this novel technology.

Exploring the Inhibitory Effect of Low-frequency Magnetic Fields on Epileptiform Discharges in Juvenile Rat Hippocampus

Stimulation with a low frequency electromagnetic field (LF-EMF) has proven to represent a powerful method for the suppression of seizures, as demonstrated in select clinical and laboratory studies. However, the mechanism by which LF-EMF suppresses seizures remains unclear. The purpose of the present study was to explore the modulatory effect of LF-EMF on epileptiform discharges (EDs) using rat hippocampal slices and investigate the underlying mechanisms that mediate these effects. EDs in hippocampal slices was induced by magnesium-free (zero-Mg²⁺) artificial cerebrospinal fluid (ACSF) and recorded using an in vitro micro-electrode array (MEA). A small sub-decimeter coil was designed and incorporated in a flexible magnetic stimulation device that allowed electromagnetic fields with different parameters to be delivered to slices. After a stable ED event was recorded, magnetic fields of 0.5 Hz (30 min) with a magnetic intensity of 0.13 mT (5 V_pp voltage input) and 0.25 mT (20 V_pp voltage input) were applied. The results indicated that a high-amplitude 0.5 Hz magnetic field could lead to persistent suppression of ictal discharges (IDs), while low-amplitude magnetic fields did not influence IDs. The persistent suppression of complex ED was prevented if the magnetic fields were applied in the presence of 10 μmol/L bicuculline (BIC), a γ-aminobutyric acid type A (GABA_A) receptor antagonist, while the application of BIC subsequent to a magnetic field application led to the reappearance of ID. The addition of BIC resulted in EDs that had previously been inhibited by magnetic fields, reappearing. Low-frequency magnetic stimulation was able to inhibit the conversion from interictal discharges (IIDs) or preictal discharges (PIDs) to IDs. This suppression was attributed to the modulation of GABA_A receptor activity.

Antiepileptic Efficacy and Network Connectivity Modulation of Repetitive Transcranial Magnetic Stimulation by Vertex Suppression

A core feature of drug-resistant epilepsy is hyperexcitability in the motor cortex, and low-frequency repetitive transcranial magnetic stimulation (rTMS) is a suitable treatment for seizures. However, the antiepileptic effect causing network reorganization has rarely been studied. Here, we assessed the impact of rTMS on functional network connectivity (FNC) in resting functional networks (RSNs) and their relation to treatment response. Fourteen patients with medically intractable epilepsy received inhibitive rTMS with a figure-of-eight coil over the vertex for 10 days spread across two weeks. We designed a 6-week follow-up phase divided into four time points to investigate FNC and rTMS-induced timing-dependent plasticity, such as seizure frequency and abnormal interictal discharges on electroencephalography (EEG). For psychiatric comorbidities, the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A) were applied to measure depression and anxiety before and after rTMS. FNC was also compared to that of a cohort of 17 healthy control subjects. The after-effects of rTMS included all subjects that achieved the significant decrease rate of more than 50% in interictal epileptiform discharges and seizure frequency, 12 (14) patients with the reduction rate above 50% compared to the baseline, as well as emotional improvements in depression and anxiety (p < 0.05). In the analysis of RSNs, we found a higher synchronization between the sensorimotor network (SMN) and posterior default-mode network (pDMN) in epileptic patients than in healthy controls. In contrast to pre-rTMS, the results demonstrated a weaker FNC between the anterior DMN (aDMN) and SMN after rTMS, while the FNC between the aDMN and dorsal attention network (DAN) was greater (p < 0.05, FDR corrected). Importantly, the depressive score was anticorrelated with the FNC of the aDMN-SMN (r = −0.67, p = 0.0022), which was markedly different in the good and bad response groups treated with rTMS (p = 0.0115). Based on the vertex suppression by rTMS, it is possible to achieve temporary clinical efficacy by modulating network reorganization in the DMN and SMN for patients with refractory epilepsy.

Electromagnetic field protects against cognitive and synaptic plasticity impairment induced by electrical kindling in rats

Kindling results in abnormal synaptic potentiation and significant impairment in learning and memory. Electromagnetic field (EMF) effects on learning and memory in kindled animals and its effects on hippocampal neural activity are largely unknown. In the current study, the effects of EMF on learning and memory, as well as hippocampal synaptic plasticity, in kindled rats were investigated. EMF (10 mT; 100 Hz) was applied to fully kindled animals one hour/day for a period of one week. The behavioral and electrophysiological studies were performed 24 h following the EMF application. The kindled rats showed spatial learning deficits during the training phase of the Morris water maze (MWM) test. Moreover, there were increments in escape latency and path length compared to the sham group. The kindled rats spent less time in the target-quadrant probe test, indicating spatial memory impairment. Applying EMF to the KEMF group (kindling + EMF) restored learning and memory, and decreased escape latency and path length significantly compared to the kindled group. EMF alone had no significant effects on the learning and memory parameters. Based on the open field (OF) test results, EMF alone in the EMF group, but not in the kindled or the KEMF groups, decreased the total traveled distance and increased the spent time in the peripheral zone, compared to the sham group. Based on electrophysiological results, applying EMF in the KEMF group returned the ability of synaptic potentiation to the hippocampal CA1 area and high-frequency stimulation induced long-term potentiation (LTP). Accordingly, EMF can be considered a potential therapy for seizure-induced deficits in learning and memory.

Toward Closed-Loop Electrical Stimulation of Neuronal Systems: A Review

Biological neuronal cells communicate using neurochemistry and electrical signals. The same phenomena also allow us to probe and manipulate neuronal systems and communicate with them. Neuronal system malfunctions cause a multitude of symptoms and functional deficiencies that can be assessed and sometimes alleviated by electrical stimulation. Our working hypothesis is that real-time closed-loop full-duplex measurement and stimulation paradigms can provide more in-depth insight into neuronal networks and enhance our capability to control diseases of the nervous system. In this study, we review extracellular electrical stimulation methods used in in vivo, in vitro, and in silico neuroscience research and in the clinic (excluding methods mainly aimed at neuronal growth and other similar effects) and highlight the potential of closed-loop measurement and stimulation systems. A multitude of electrical stimulation and measurement-based methods are widely used in research and the clinic. Closed-loop methods have been proposed, and some are used in the clinic. However, closed-loop systems utilizing more complex measurement analysis and adaptive stimulation systems, such as artificial intelligence systems connected to biological neuronal systems, do not yet exist. Our review promotes the research and development of intelligent paradigms aimed at meaningful communications between neuronal and information and communications technology systems, "dialogical paradigms," which have the potential to take neuroscience and clinical methods to a new level.

Electromagnetic activity: a possible player in epilepsy

Epilepsy is a common disease with frequent occurrences. Many precipitating factors contribute to epileptic seizures, such as hyperventilation and alcohol consumption. An increasing number of studies have also found that electromagnetic activity in the environment can also affect epileptic seizures. However, many neuromodulatory devices that produce electromagnetic fields have been applied in the diagnosis and treatment of epilepsy. In this paper, we performed literature search in the PubMed, Medline and EMBASE databases and reviewed retrospective, prospective, or cross-sectional studies and case reports on the effects of electromagnetic activity on epilepsy. The application of electromagnetic activity in the diagnosis and treatment of epilepsy is also reviewed.

Non-pharmacological Interventions for Intractable Epilepsy

In 30% of epileptic individuals, intractable epilepsy represents a problem for the management of seizures and severely affects the patient's quality of life due to pharmacoresistance with commonly used antiseizure drugs (ASDs). Surgery is not the best option for all resistant patients due to its post-surgical consequences. Therefore, several alternative or complementary therapies have scientifically proven significant therapeutic potential for the management of seizures in intractable epilepsy patients with seizure-free occurrences. Various non-pharmacological interventions include metabolic therapy, brain stimulation therapy, and complementary therapy. Metabolic therapy works out by altering the energy metabolites and include the ketogenic diets (KD) (that is restricted in carbohydrates and mimics the metabolic state of the body as produced during fasting and exerts its antiepileptic effect) and anaplerotic diet (which revives the level of TCA cycle intermediates and this is responsible for its effect). Neuromodulation therapy includes vagus nerve stimulation (VNS), responsive neurostimulation therapy (RNS) and transcranial magnetic stimulation therapy (TMS). Complementary therapies such as biofeedback and music therapy have demonstrated promising results in pharmacoresistant epilepsies. The current emphasis of the review article is to explore the different integrated mechanisms of various treatments for adequate seizure control, and their limitations, and supportive pieces of evidence that show the efficacy and tolerability of these non-pharmacological options.

Focal Suppression of Epileptiform Activity in the Hippocampus by a High-frequency Magnetic Field

Electric current has been used for epilepsy treatment by targeting specific neural circuitries. Despite its success, direct contact between the electrode and tissue could cause side effects including pain, inflammation, and adverse biological reactions. Magnetic stimulation overcomes these limitations by offering advantages over biocompatibility and operational feasibility. However, the underlying neurological mechanisms of its action are largely unknown. In this work, a magnetic generating system was assembled that included a miniature coil. The coil was positioned above the CA3 area of mouse hippocampal slices. Epileptiform activity (EFA) was induced with low Mg²⁺/high K⁺ perfusion or with 100 µM 4-aminopyridine (4-AP). The miniature coil generated a sizable electric field that suppressed the local EFA in the hippocampus in the low-Mg²⁺/high-K⁺ model. The inhibition effect was dependent on the frequency and duration of the magnetic stimulus, with high frequency being more effective in suppressing EFA. EFA suppression by the magnetic field was also observed in the 4-AP model, in a frequency and duration - dependent manner. The study provides a platform for further investigation of cellular and molecular mechanisms underlying epilepsy treatment with time varying magnetic fields.