Reduction in excitability of the auditory nerve following acute electrical stimulation at high stimulus rates: III. Capacitive versus non-capacitive coupling of the stimulating electrodes

Capacitive electrical stimulation of a conducting polymeric thin film induces human mesenchymal stem cell osteogenesis

Electroactive materials based on conductive polymers are promising options for tissue engineering and regenerative medicine applications. In the present work, the conducting copolymers of poly (3,4-ethylenedioxythiophene) and poly (d, l-lactic acid) (PEDOT-co-PDLLA) with PEDOT:PDLLA molar ratios of 1:50, 1:25, and 1:5 were synthesized and compared to the insulating macromonomer of EDOT-PDLLA as an experimental control. Bone marrow-derived human mesenchymal stem cells (hMSC-BM) were cultured on the copolymers and the macromonomer thin films inside a bioreactor that induced a capacitive electrical stimulation (CES) with an electric field of 100 mV/mm for 2 h per day for 21 days. Under CES, the copolymers exhibited good cell viability and promoted the differentiation from hMSC-BM to osteogenic lineages, revealed by higher mineralization mainly when the contents of conducting segments of PEDOT (i.e., copolymer with 1:25 and 1:5 PEDOT:PDLLA ratios) were increased. The results indicate that the intrinsic electrical conductivity of the substrates is an important key point for the effectiveness of the electric field generated by the CES, intending to promote the differentiation effect for bone cells.

On the DC Offset Current Generated during Biphasic Stimulation: Experimental Study

This paper deals with the DC offset currents generated by a platinum electrode matrix during biphasic stimulation. A fully automated test bench evaluates the nanoampere range DC offset currents in a realistic and comprehensive scenario by using platinum electrodes in a saline solution as a load for the stimulator. Measurements are performed on different stimulation patterns for single or dual hexagonal stimulation sites operating simultaneously and alternately. The effectiveness of the return electrode presence in reducing the DC offset current is considered. Experimental results show how for a defined nominal injected charge, the generated DC offset currents differ depending on the stimulation patterns, frequency, current amplitude, and pulse width of a biphasic signal.

Design and In Vivo Verification of a CMOS Bone-Guided Cochlear Implant Microsystem

OBJECTIVE

To develop and verify a CMOS bone-guided cochlear implant (BGCI) microsystem with electrodes placed on the bone surface of the cochlea and the outside of round window for treating high-frequency hearing loss.

METHODS

The BGCI microsystem consists of an external unit and an implanted unit. The external system-on-chip is designed to process acoustic signals through an acquisition circuit and an acoustic DSP processor to generate stimulation patterns and commands that are transmitted to the implanted unit through a 13.56 MHz wireless power and bidirectional data telemetry. In the wireless power telemetry, a voltage doubler/tripler (2X/3X) active rectifier is used to enhance the power conversion efficiency and generate 2 and 3 V output voltages. In the wireless data telemetry, phase-locked loop based binary phase-shift keying and load-shift keying modulators/demodulators are adopted for the downlink and uplink data through high-Q coils, respectively. The implanted chip with four-channel high-voltage-tolerant stimulator generates biphasic stimulation currents up to 800 μA.

RESULTS

Electrical tests on the fabricated BGCI microsystem have been performed to verify the chip functions. The in vivo animal tests in guinea pigs have shown the evoked third wave of electrically evoked auditory brainstem response waveforms. It is verified that auditory nerves can be successfully stimulated and acoustic hearing can be partially preserved.

CONCLUSION AND SIGNIFICANCE

Different from traditional cochlear implants, the proposed BGCI microsystem is less invasive, preserves partially acoustic hearing, and provides an effective alternative for treating high-frequency hearing loss.

The development of neural stimulators: a review of preclinical safety and efficacy studies

OBJECTIVE

Given the rapid expansion of the field of neural stimulation and the rigorous regulatory approval requirements required before these devices can be applied clinically, it is important that there is clarity around conducting preclinical safety and efficacy studies required for the development of this technology.

APPROACH

The present review examines basic design principles associated with the development of a safe neural stimulator and describes the suite of preclinical safety studies that need to be considered when taking a device to clinical trial.

MAIN RESULTS

Neural stimulators are active implantable devices that provide therapeutic intervention, sensory feedback or improved motor control via electrical stimulation of neural or neuro-muscular tissue in response to trauma or disease. Because of their complexity, regulatory bodies classify these devices in the highest risk category (Class III), and they are therefore required to go through a rigorous regulatory approval process before progressing to market. The successful development of these devices is achieved through close collaboration across disciplines including engineers, scientists and a surgical/clinical team, and the adherence to clear design principles. Preclinical studies form one of several key components in the development pathway from concept to product release of neural stimulators. Importantly, these studies provide iterative feedback in order to optimise the final design of the device. Key components of any preclinical evaluation include: in vitro studies that are focussed on device reliability and include accelerated testing under highly controlled environments; in vivo studies using animal models of the disease or injury in order to assess efficacy and, given an appropriate animal model, the safety of the technology under both passive and electrically active conditions; and human cadaver and ex vivo studies designed to ensure the device's form factor conforms to human anatomy, to optimise the surgical approach and to develop any specialist surgical tooling required.

SIGNIFICANCE

The pipeline from concept to commercialisation of these devices is long and expensive; careful attention to both device design and its preclinical evaluation will have significant impact on the duration and cost associated with taking a device through to commercialisation. Carefully controlled in vitro and in vivo studies together with ex vivo and human cadaver trials are key components of a thorough preclinical evaluation of any new neural stimulator.

Post stimulus effects of high frequency biphasic electrical current on a fibre's conductibility in isolated frog nerves

OBJECTIVE

High frequency biphasic (HFB) electrical currents are widely used in nerve blocking studies. Their safety margins largely remain unknown and need to be investigated.

APPROACH

This study, exploring the post stimulus effects of HFB electrical currents on a nerve's conductibility, was performed on bullfrog sciatic nerves. Both compound action potentials (CAPs) and differential CAPs (DCAPs, i.e. control CAPs subtracted by CAPs following HFB currents) were obtained, and N1 and N2 components, which were the first and second upward components of DCAPs, were used for analyses of the effects introduced by HFB electrical stimulation.

MAIN RESULTS

First, HFB currents of 10 kHz at a completely blocking threshold were applied for 5 s. The maximum amplitudes and conducting velocities of the CAPs were significantly (P < 0.02) decreased within the observed period (60 s) following HFB currents. The DCAPs displayed clear N1 and N2 components, demonstrating respectively the losses of the fibres' normal conductibility and the appearances of new delayed conductions. Decreases of N1 amplitudes along time, regarded as the recovery of the nerve's conductibility, exhibited two distinct phases: a fast one lasting several seconds and a slow one lasting longer than 5 min. Further tests showed a linear relationship between the HFB stimulation durations and recovering periods of N1 amplitudes. Supra-threshold blocking did not cause higher N1 amplitudes.

SIGNIFICANCE

This study indicates that HFB electrical currents lead to long lasting post stimulus reduction of a nerve's conductibility, which might relate to potential nerve injuries. A possible mechanism, focusing on changes in intracellular and periaxonal ionic concentrations, was proposed to underlie the reduction of the nerve's conductibility and potential nerve injuries. Greater caution and stimulation protocols with greater safety margins should be explored when utilizing HFB electrical current to block nerve conductions.

Sensory adaptation and short term plasticity as Bayesian correction for a changing brain

Neurons in the sensory system exhibit changes in excitability that unfold over many time scales. These fluctuations produce noise and could potentially lead to perceptual errors. However, to prevent such errors, postsynaptic neurons and synapses can adapt and counteract changes in the excitability of presynaptic neurons. Here we ask how neurons could optimally adapt to minimize the influence of changing presynaptic neural properties on their outputs. The resulting model, based on Bayesian inference, explains a range of physiological results from experiments which have measured the overall properties and detailed time-course of sensory tuning curve adaptation in the early visual cortex. We show how several experimentally measured short term plasticity phenomena can be understood as near-optimal solutions to this adaptation problem. This framework provides a link between high level computational problems, the properties of cortical neurons, and synaptic physiology.

Cochlear implants: system design, integration, and evaluation

As the most successful neural prosthesis, cochlear implants have provided partial hearing to more than 120000 persons worldwide; half of which being pediatric users who are able to develop nearly normal language. Biomedical engineers have played a central role in the design, integration and evaluation of the cochlear implant system, but the overall success is a result of collaborative work with physiologists, psychologists, physicians, educators, and entrepreneurs. This review presents broad yet in-depth academic and industrial perspectives on the underlying research and ongoing development of cochlear implants. The introduction accounts for major events and advances in cochlear implants, including dynamic interplays among engineers, scientists, physicians, and policy makers. The review takes a system approach to address critical issues in cochlear implant research and development. First, the cochlear implant system design and specifications are laid out. Second, the design goals, principles, and methods of the subsystem components are identified from the external speech processor and radio frequency transmission link to the internal receiver, stimulator and electrode arrays. Third, system integration and functional evaluation are presented with respect to safety, reliability, and challenges facing the present and future cochlear implant designers and users. Finally, issues beyond cochlear implants are discussed to address treatment options for the entire spectrum of hearing impairment as well as to use the cochlear implant as a model to design and evaluate other similar neural prostheses such as vestibular and retinal implants.

Safety and effectiveness considerations for clinical studies of visual prosthetic devices

With the advent of new designs of visual prostheses for the blind, FDA is faced with developing guidance for evaluating their engineering, safety and patient performance. Visual prostheses are considered significant risk medical devices, and their use in human clinical trials must be approved by FDA under an investigation device exemption (IDE). This paper contains a series of test topics and design issues that sponsors should consider in order to assess the safety and efficacy of their device. The IDE application includes a series of pre-clinical and clinical data sections. The pre-clinical section documents laboratory, animal and bench top performance tests of visual prostheses safety and reliability to support a human clinical trial. The materials used in constructing the implant should be biocompatible, sterile, corrosion resistant, and able to withstand any forces exerted on it during normal patient use. The clinical data section is composed of items related to patient-related evaluation of device performance. This section documents the implantation procedure, trial design, statistical analysis and how visual performance is assessed. Similar to cochlear implants, a visual prosthesis is expected to last in the body for many years, and good pre-clinical and clinical testing will help ensure its safety, durability and effectiveness.

The mechanism of extracellular stimulation of nerve cells on an electrolyte-oxide-semiconductor capacitor

Extracellular excitation of neurons is applied in studies of cultured networks and brain tissue, as well as in neuroprosthetics. We elucidate its mechanism in an electrophysiological approach by comparing voltage-clamp and current-clamp recordings of individual neurons on an insulated planar electrode. Noninvasive stimulation of neurons from pedal ganglia of Lymnaea stagnalis is achieved by defined voltage ramps applied to an electrolyte/HfO2/silicon capacitor. Effects on the smaller attached cell membrane and the larger free membrane are distinguished in a two-domain-stimulation model. Under current-clamp, we study the polarization that is induced for closed ion channels. Under voltage-clamp, we determine the capacitive gating of ion channels in the attached membrane by falling voltage ramps and for comparison also the gating of all channels by conventional variation of the intracellular voltage. Neuronal excitation is elicited under current-clamp by two mechanisms: Rising voltage ramps depolarize the free membrane such that an action potential is triggered. Falling voltage ramps depolarize the attached membrane such that local ion currents are activated that depolarize the free membrane and trigger an action potential. The electrophysiological analysis of extracellular stimulation in the simple model system is a basis for its systematic optimization in neuronal networks and brain tissue.

Nerve conduction block utilising high-frequency alternating current

High-frequency alternating current (AC) waveforms have been shown to produce a quickly reversible nerve block in animal models, but the parameters and mechanism of this block are not well understood. A frog sciatic nerve/gastrocnemius muscle preparation was used to examine the parameters for nerve conduction block in vivo, and a computer simulation of the nerve membrane was used to identify the mechanism for block. The results indicated that a 100% block of motor activity can be accomplished with a variety of waveform parameters, including sinusoidal and rectangular waveforms at frequencies from 2 kHz to 20 kHz. A complete and reversible block was achieved in 34 out of 34 nerve preparations tested. The most efficient waveform for conduction block was a 3-5 kHz constant-current biphasic sinusoid, where block could be achieved with stimulus levels as low as 0.01 microCphase(-1). It was demonstrated that the block was not produced indirectly through fatigue. Computer simulation of high-frequency AC demonstrated a steady-state depolarisation of the nerve membrane, and it is hypothesised that the conduction block was due to this tonic depolarisation. The precise relationship between the steady-state depolarisation and the conduction block requires further analysis. The results of this study demonstrated that high-frequency AC can be used to produce a fast-acting, and quickly reversible nerve conduction block that may have multiple applications in the treatment of unwanted neural activity.

The binaural digisonic cochlear implant: surgical technique

The surgical technique of cochlear implantation is currently well established. It is sure and efficient. The results of the cochlear implant concerning speech perception are good and have a favorable cost/efficiency ratio. However, some points remain to be researched. Bilateral implantation allows one to obtain a binaural perception and especially to increase, theoretically, the possibilities of frequency discrimination by reducing interactions between electrodes and therefore improving the patient's performance. Nevertheless, it seems important to caution against placing two implants in one patient, especially for economic reasons. Thus, we have developed, with the MXM Company, a concept of a unique implant able to stimulate both cochleas with a single processor and a single receiver: the Binaural Digisonic cochlear implant. This article describes the Binaural Digisonic system, the surgical technique as developed by postmortem dissection, and the first two implantations in patients.

Chronic microstimulation in the feline ventral cochlear nucleus: physiologic and histologic effects

This study was conducted to help to establish the feasibility of a multi-channel auditory prosthesis based on microstimulation within the human ventral cochlear nucleus, and to define the range of stimulus parameters that can be used safely with such a device. We chronically implanted activated iridium microelectrodes into the feline ventral cochlear nucleus and, beginning 80-250 days after implantation, they were pulsed for 7 h/day, on up to 21 successive days. The stimulus was charge-balanced pulses whose amplitude was modulated by a simulated human voice. The pulse rate (250 Hz/electrode) and the maximum pulse amplitude were selected as those that are likely to provide a patient with useful auditory percepts. The changes in neuronal responses during the multi-day stimulation regimens were partitioned into long-lasting, stimulation-induced depression of neuronal excitability (SIDNE), and short-acting neuronal refractivity (SANR). Both SIDNE and SANR were quantified from the changes in the growth functions of the evoked potentials recorded in the inferior colliculus. All of the stimulation regimens that we tested induced measurable SIDNE and SANR. The combined effect of SIDNE and the superimposed SANR is to depress the neuronal response near threshold, and thereby, to depress the population response over the entire amplitude range of the stimulus pulses. SIDNE and SANR may cause the greatest degradation of the performance of a clinical device at the low end of the amplitude range, and this may represent an inherent limitation of this type of spatially localized, high-rate neuronal stimulation. We determined sets of stimulus parameters which preserved most of the dynamic range of the neuronal response, when using either long (150 micros/phase) or short (40 micros/phase) stimulus pulses. Increasing the amplitude of the stimulus was relatively ineffective as a means of increasing the dynamic range of neuronal response, since the greater stimulus amplitude induced more SIDNE. All of the pulsed and unpulsed electrode sites were examined histologically, and no neuronal changes attributable to the stimulation were detected. There was some aggregation of glial cells immediately adjacent to some of the electrodes that were pulsed with the short-duration pulses, and at the highest current densities.

Reduction in excitability of the auditory nerve following electrical stimulation at high stimulus rates: V. Effects of electrode surface area

High rate intracochlear electrical stimulation at high intensities can induce significant reductions in the excitability of the auditory nerve as measured by a decrement in the amplitude of the electrically evoked auditory brainstem response (EABR). Such changes are primarily associated with stimulus induced neuronal activity, although direct current (DC) can also contribute. We examined the extent of stimulus induced change in auditory nerve excitability using large surface area platinum electrodes ('high-Q' electrodes). These electrodes have a surface area approximately 70 times greater than standard Pt electrodes of the same geometric area, resulting in lower DC and charge density (charge/electrode surface area) for a common stimulus. Guinea pigs were bilaterally implanted with either high-Q or standard Pt electrodes, and unilaterally stimulated for 2 h using stimulus intensities of 12 dB or 20-30 dB above EABR threshold (0.34 microC/phase) at stimulus rates of 200, 400, or 1000 pulses per second (pps). EABRs were recorded before and following the acute stimulation. While there were significant reductions in EABR amplitudes and elevated EABR thresholds following stimulation at 12 dB above threshold using 400 and 1000 pps delivered to standard Pt electrodes, there were fewer or no significant changes in the post-stimulus EABR amplitude and threshold using high-Q electrodes under equivalent stimulus conditions. At a higher stimulus intensity (20-30 dB above EABR threshold), no reduction in EABR amplitude was observed at 200 pps for both stimulating electrodes. However, EABRs were reduced significantly at 400 and 1000 pps. There was significantly greater EABR recovery following stimulation using high-Q electrodes compared with standard Pt electrodes at 400 (P<0.05) and 1000 pps (P<0.05). These data indicate that large surface area electrodes can significantly reduce stimulus induced changes in auditory nerve excitability, and may therefore have important clinical application.

Reduction in excitability of the auditory nerve following electrical stimulation at high stimulus rates. IV. Effects of stimulus intensity

High rate intracochlear electrical stimulation using stimulus intensities well above clinical limits can induce a significant reduction in the excitability of the auditory nerve as measured by a reduction in the amplitude of the electrically evoked auditory brainstem response (EABR). The purpose of the present study was to assess the effect of stimulus intensity on these stimulus induced changes by comparing the effects of acute stimulation using stimulus intensities within normal clinical levels (6 dB and 12 dB above EABR threshold) and significantly above normal clinical levels (> 20 dB above EABR threshold; 0.34 microC/phase). Stimulus rates of 200, 400, or 1000 pulses/s (pps) were delivered to bipolar scala tympani electrodes. EABRs were recorded before and periodically following 2 h of continuous stimulation. No reduction in EABR amplitude was observed following stimulation at 6 dB above EABR threshold for the three stimulus rates examined. However, EABRs were reduced when stimulated at 12 dB above EABR threshold at 400 pps, and significantly reduced when stimulated at a rate of 1000 pps. Immediate post-stimulus response amplitudes of wave III were 63% and 35% of the pre-stimulus amplitude at 400 and 1000 pps respectively. More significant reductions in EABR amplitude were observed following stimulation at levels more than 20 dB above EABR threshold for both 400 and 1000 pps stimuli. Our findings indicate that stimulus induced changes in EABR amplitude are related to both stimulus rate and stimulus intensity. Moreover, stimulation using intensities within the normal clinical range show little evidence of prolonged reductions in auditory nerve excitability at stimulus rates of up to 1000 pps.

Electrical stimulation of the auditory nerve: direct current measurement in vivo

Neural prostheses use charge recovery mechanisms to ensure the electrical stimulus is charge balanced. Nucleus cochlear implants short all stimulating electrodes between pulses in order to achieve charge balance, resulting in a small residual direct current (DC). In the present study we sought to characterize the variation of this residual DC with different charge recovery mechanisms, stimulation modes, and stimulation parameters, and by modeling, to gain insight into the underlying mechanisms. In an acute study with anaesthetised guinea pigs, DC was measured in four platinum intracochlear electrodes stimulated using a Nucleus C124M cochlear implant at moderate to high pulse rates (1200-14,500 pulses/s) and stimulus intensities (0.2-1.75 mA at 26-200 microseconds/phase). Both monopolar and bipolar stimulation modes were used, and the effects of shorting or combining a capacitor with shorting for charge recovery were investigated. Residual DC increased as a function of stimulus rate, stimulus intensity, and pulse width. DC was lower for monopolar than bipolar stimulation, and lower still with capacitively coupled monopolar stimulation. Our model suggests that residual DC is a consequence of Faradaic reactions which allow charge to leak through the electrode tissue interface. Such reactions and charge leakage are still present when capacitors are used to achieve charge recovery, but anodic and cathodic reactions are balanced in such a way that the net charge leakage is zero.