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Jayaprakash N, Song W, Toth V, Vardhan A, Levy T, Tomaio J, Qanud K, Mughrabi I, Chang YC, Rob M, Daytz A, Abbas A, Nassrallah Z, Volpe BT, Tracey KJ, Al-Abed Y, Datta-Chaudhuri T, Miller L, Barbe MF, Lee SC, Zanos TP, Zanos S. Organ- and function-specific anatomical organization of vagal fibers supports fascicular vagus nerve stimulation. Brain Stimul 2023; 16:484-506. [PMID: 36773779 DOI: 10.1016/j.brs.2023.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Vagal fibers travel inside fascicles and form branches to innervate organs and regulate organ functions. Existing vagus nerve stimulation (VNS) therapies activate vagal fibers non-selectively, often resulting in reduced efficacy and side effects from non-targeted organs. The transverse and longitudinal arrangement of fibers inside the vagal trunk with respect to the functions they mediate and organs they innervate is unknown, however it is crucial for selective VNS. Using micro-computed tomography imaging, we tracked fascicular trajectories and found that, in swine, sensory and motor fascicles are spatially separated cephalad, close to the nodose ganglion, and merge caudad, towards the lower cervical and upper thoracic region; larynx-, heart- and lung-specific fascicles are separated caudad and progressively merge cephalad. Using quantified immunohistochemistry at single fiber level, we identified and characterized all vagal fibers and found that fibers of different morphological types are differentially distributed in fascicles: myelinated afferents and efferents occupy separate fascicles, myelinated and unmyelinated efferents also occupy separate fascicles, and small unmyelinated afferents are widely distributed within most fascicles. We developed a multi-contact cuff electrode to accommodate the fascicular structure of the vagal trunk and used it to deliver fascicle-selective cervical VNS in anesthetized and awake swine. Compound action potentials from distinct fiber types, and physiological responses from different organs, including laryngeal muscle, cough, breathing, and heart rate responses are elicited in a radially asymmetric manner, with consistent angular separations that agree with the documented fascicular organization. These results indicate that fibers in the trunk of the vagus nerve are anatomically organized according to functions they mediate and organs they innervate and can be asymmetrically activated by fascicular cervical VNS.
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Affiliation(s)
| | - Weiguo Song
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Viktor Toth
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Todd Levy
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Khaled Qanud
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Yao-Chuan Chang
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Moontahinaz Rob
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Anna Daytz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Adam Abbas
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Zeinab Nassrallah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Bruce T Volpe
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Kevin J Tracey
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Yousef Al-Abed
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Larry Miller
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Sunhee C Lee
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Stavros Zanos
- Feinstein Institutes for Medical Research, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA.
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Leon-Ariza JS, Mosquera MA, Siomin V, Fonseca A, Leon-Ariza DS, Gualdron MA, Leon-Sarmiento FE. The Vagus Nerve Somatosensory-evoked Potential in Neural Disorders: Systematic Review and Illustrative Vignettes. Clin EEG Neurosci 2022; 53:256-263. [PMID: 33709798 DOI: 10.1177/15500594211001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To review the scientific publications reporting vagal nerve somatosensory-evoked potential (VSEP) findings from individuals with brain disorders, and present novel physiological explanations on the VSEP origin. Methods. We did a systematic review on the papers reporting VSEP findings from individuals with brain disorders and their controls. We evaluated papers published from 2003 to date indexed in PubMed, Web of Science, and Scielo databases. We extracted the following information: number of patients and controls, type of neural disorder, age, gender, stimulating/recording and grounding electrodes as well as stimulus side, intensity, duration, frequency, and polarity. Information about physiological parameters, neurobiological variables, and correlation studies was also reviewed. Representative vignettes were included to add support to our conclusions. Results. The VSEP was studied in 297 patients with neural disorders such as Parkinson's disease (PD), Alzheimer's disease, vascular dementia, mild cognitive impairment, subjective memory impairment, major depression, and multiple sclerosis. Scalp responses marked as the VSEP showed high variability, low validity, and poor reproducibility. VSEP latencies and amplitudes did not correlate with disease duration, unified PD rating scale score, or heart function in PD patients nor with cerebrospinal fluid β amyloid, phosphor-τ, and cognitive tests from patients with mental disorders. Vignettes demonstrated that the VSEP was volume conduction propagating from muscles surrounding the scalp recording electrodes. Conclusion. The VSEP is not a brain-evoked potential of neural origin but muscle activity induced by electrical stimulation of the tragus region of the ear. This review and illustrative vignettes argue against assessing the parasympathetic system using the so-called VSEP.
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Affiliation(s)
| | - Mario A Mosquera
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | - Vitaly Siomin
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | - Angelo Fonseca
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | | | | | - Fidias E Leon-Sarmiento
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA.,Parkinson's Disease Research Laboratory, 5450Florida International University, Miami, FL, USA
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Ottaviani MM, Vallone F, Micera S, Recchia FA. Closed-Loop Vagus Nerve Stimulation for the Treatment of Cardiovascular Diseases: State of the Art and Future Directions. Front Cardiovasc Med 2022; 9:866957. [PMID: 35463766 PMCID: PMC9021417 DOI: 10.3389/fcvm.2022.866957] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 01/07/2023] Open
Abstract
The autonomic nervous system exerts a fine beat-to-beat regulation of cardiovascular functions and is consequently involved in the onset and progression of many cardiovascular diseases (CVDs). Selective neuromodulation of the brain-heart axis with advanced neurotechnologies is an emerging approach to corroborate CVDs treatment when classical pharmacological agents show limited effectiveness. The vagus nerve is a major component of the cardiac neuroaxis, and vagus nerve stimulation (VNS) is a promising application to restore autonomic function under various pathological conditions. VNS has led to encouraging results in animal models of CVDs, but its translation to clinical practice has not been equally successful, calling for more investigation to optimize this technique. Herein we reviewed the state of the art of VNS for CVDs and discuss avenues for therapeutic optimization. Firstly, we provided a succinct description of cardiac vagal innervation anatomy and physiology and principles of VNS. Then, we examined the main clinical applications of VNS in CVDs and the related open challenges. Finally, we presented preclinical studies that aim at overcoming VNS limitations through optimization of anatomical targets, development of novel neural interface technologies, and design of efficient VNS closed-loop protocols.
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Affiliation(s)
- Matteo Maria Ottaviani
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and Artificial Intelligence, The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Fabio Vallone
- Department of Excellence in Robotics and Artificial Intelligence, The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Silvestro Micera
- Department of Excellence in Robotics and Artificial Intelligence, The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neural Engineering, Center for Neuroprosthetics, Institute of Bioengineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Fabio A. Recchia
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
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Leon-Ariza JS, Mosquera MA, Joy-Arriaga J, Fonseca A, Leon-Ariza DS, Gualdron-Leon MA, Bayona-Prieto J, Patel K, Leon-Sarmiento FE. The vagus nerve somatosensory evoked potential in the intact brain: state-of-evidence and some representative vignettes. Somatosens Mot Res 2020; 38:41-47. [PMID: 33200653 DOI: 10.1080/08990220.2020.1840346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Scalp-recorded evoked potentials elicited by applying afferent electrical stimulation at the tragus region of the human external ear have shown inconsistent results. We aim to disentangle discrepant findings and interpretations, and put forward novel physiological explanations on the origin of the vagus nerve somatosensory evoked potentials (VSEP). METHODS We systematically search and critically appraise in PubMed, Web of Science, and Scielo databases the scientific reports publishing VSEP findings elicited by afferent electrical stimulation at the tragus region from individuals without brain disorders. Eligible studies published from January 2000 to April 2020 were extracted. The following information was identified from each article: number of participants; age; gender; stimulating/recording and grounding electrodes as well as stimulus side, intensity, duration, frequency, and polarity. Information about physiological parameters and neurobiological variables was also extracted. Representative vignettes with novel scalp responses induced by stimulating the tragus were also included to add support to our conclusions. RESULTS 140 healthy participants were identified from six selected reports. Mean age ranged from 24.3 to 61.5 years. Stimulating and recording aspects were miscellaneous among studies. Scalp responses marked as the VSEP were recorded in 76% of participants, and showed high variability, low validity and poor reproducibility. Age correlated with response latencies. There were not gender differences in scalp response parameters. Cardiovascular function was unaltered by tragus stimulation. Vignettes showed that the VSEP was scalp muscle responses. CONCLUSION VSEP did not fulfil evoked potential guidelines. VSEP corresponded to volume conduction propagating from muscles surrounding scalp recording sites.
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Affiliation(s)
| | - Mario A Mosquera
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | - Jose Joy-Arriaga
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | - Angelo Fonseca
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | | | | | | | - Kunal Patel
- Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA
| | - Fidias E Leon-Sarmiento
- Mediciencias Research Group, Miami, FL, USA.,Miami Neuroscience Institute, Baptist Hospital South Florida, Miami, FL, USA.,Universidad Nacional, Bogota, Colombia.,Department of Electrical and Computer Engineering, Florida International University, Miami, FL
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Stakenborg N, Gomez‐Pinilla PJ, Verlinden TJM, Wolthuis AM, D’Hoore A, Farré R, Herijgers P, Matteoli G, Boeckxstaens GE. Comparison between the cervical and abdominal vagus nerves in mice, pigs, and humans. Neurogastroenterol Motil 2020; 32:e13889. [PMID: 32476229 PMCID: PMC7507132 DOI: 10.1111/nmo.13889] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/25/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vagus nerve (VN) stimulation is currently evaluated as a novel approach to treat immune-mediated disorders. The optimal stimulation parameters, however, largely depend on the VN composition potentially impacting on its clinical translation. Hence, we evaluated whether morphological differences exist between the cervical and abdominal VNs across different species. MATERIALS AND METHODS The cervical and abdominal VNs of mouse, pig, and humans were stained for major basic protein and neurofilament F to identify the percentage and size of myelinated and non-myelinated fibers. RESULTS The percentage of myelinated fibers was comparable between species, but was higher in the cervical VN compared with the abdominal VN. The cervical VN contained 54 ± 4%, 47 ± 7%, and 54 ± 7% myelinated fibers in mouse, pig, and humans, respectively. The myelinated fibers consisted of small-diameter (mouse: 71%, pig: 80%, and humans: 63%), medium-diameter (mouse: 21%, pig: 18%, and humans: 33%), and large-diameter fibers (mouse: 7%, pig: 2%, and humans: 4%). The abdominal VN predominantly contained unmyelinated fibers (mouse: 93%, pig: 90%, and humans: 94%). The myelinated fibers mainly consisted of small-diameter fibers (mouse: 99%, pig: 85%, and humans: 74%) and fewer medium-diameter (mouse: 1%, pig: 13%, and humans: 23%) and large-diameter fibers (mouse: 0%, pig: 2%, and humans: 3%). CONCLUSION The VN composition was largely similar with respect to myelinated and unmyelinated fibers in the species studied. Human and porcine VNs had a comparable diameter and similar amounts of fibrous tissue and contained multiple fascicles, implying that the porcine VN may be suitable to optimize stimulation parameters for clinical trials.
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Affiliation(s)
- Nathalie Stakenborg
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)Translational Research Center for Gastrointestinal Disorders (TARGID)KU LeuvenLeuvenBelgium
| | - Pedro J. Gomez‐Pinilla
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)Translational Research Center for Gastrointestinal Disorders (TARGID)KU LeuvenLeuvenBelgium
| | - Thomas J. M. Verlinden
- Department of Anatomy & EmbryologyFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Albert M. Wolthuis
- Department of Abdominal SurgeryUniversity Hospital of LeuvenLeuvenBelgium
| | - Andre D’Hoore
- Department of Abdominal SurgeryUniversity Hospital of LeuvenLeuvenBelgium
| | - Ricard Farré
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)Translational Research Center for Gastrointestinal Disorders (TARGID)KU LeuvenLeuvenBelgium
| | - Paul Herijgers
- Department of Cardiovascular ScienceKU LeuvenLeuvenBelgium
| | - Gianluca Matteoli
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)Translational Research Center for Gastrointestinal Disorders (TARGID)KU LeuvenLeuvenBelgium
| | - Guy E. Boeckxstaens
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)Translational Research Center for Gastrointestinal Disorders (TARGID)KU LeuvenLeuvenBelgium
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Parker JL, Shariati NH, Karantonis DM. Electrically evoked compound action potential recording in peripheral nerves. ACTA ACUST UNITED AC 2018. [DOI: 10.2217/bem-2017-0005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Applications for bioelectric medicine can be found in all parts of the nervous system. The CNS – brain and spinal cord – contain targets for commercial neuromodulation therapies. Peripheral nerves are also modulated with commercially available systems during treatment for chronic pain and epilepsy, and developments are in progress for treating many other diseases. The electrically evoked compound action potential is a measure of the electrical response from the tissue to stimulation. It provides a direct insight into the electrophysiology of the stimulation, and despite its incorporation into cochlear implants it is a technology that is yet to find its way into commercial peripheral nerve stimulation applications. This review outlines the status of evoked compound action potential measurements on peripheral nerves and highlights the challenges which need to be overcome.
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Affiliation(s)
- John L Parker
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, New South Wales, Australia
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Žužek MC, Rozman J, Pečlin P, Vrecl M, Frangež R. Analysis of compound action potentials elicited with specific current stimulating pulses in an isolated rat sciatic nerve. ACTA ACUST UNITED AC 2017; 62:37-48. [DOI: 10.1515/bmt-2015-0167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/26/2016] [Indexed: 11/15/2022]
Abstract
AbstractThe ability to selectively stimulate Aα, Aβ-fibers and Aδ-fibers in an isolated rat sciatic nerve (SNR) was assessed. The stimulus used was a current, biphasic pulse with a quasitrapezoidal cathodic phase and rectangular anodic phase where parameters were systematically varied: intensity of the cathodic phase (i
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Pokrovskii VM, Abushkevich VG, Perova YY, Perova MY, Pokhotko AG, Ardelyan AN. Detection of flashing areas attributed to the frog cardiac function in the vagosympathetic trunk placed into a high frequency electric field. DOKLADY BIOLOGICAL SCIENCES : PROCEEDINGS OF THE ACADEMY OF SCIENCES OF THE USSR, BIOLOGICAL SCIENCES SECTIONS 2016; 468:104-5. [PMID: 27411818 DOI: 10.1134/s0012496616030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Indexed: 11/23/2022]
Abstract
In a high frequency electric field, two flashing areas were observed during each contraction of the heart in the vagosympathetic trunk of a paralyzed frog with an intact brain. One area with a higher diameter was moving along the nerve from the heart at a speed of 16.6 ± 0.2 m/s. It was identified as afferent. Another area with a smaller diameter was spreading along the nerve towards the venous sinus of the frog heart at a speed of 5.6 ± 0.3 m/s, and it was efferent.
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Affiliation(s)
| | | | - Yu Yu Perova
- Kuban State Medical University, Krasnodar, Russia
| | - M Yu Perova
- Kuban State Medical University, Krasnodar, Russia
| | - A G Pokhotko
- Kuban State Medical University, Krasnodar, Russia
| | - A N Ardelyan
- Kuban State Medical University, Krasnodar, Russia
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Li Y, Lao J, Zhao X, Tian D, Zhu Y, Wei X. The optimal distance between two electrode tips during recording of compound nerve action potentials in the rat median nerve. Neural Regen Res 2014; 9:171-8. [PMID: 25206798 PMCID: PMC4146167 DOI: 10.4103/1673-5374.125346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 11/25/2022] Open
Abstract
The distance between the two electrode tips can greatly influence the parameters used for recording compound nerve action potentials. To investigate the optimal parameters for these recordings in the rat median nerve, we dissociated the nerve using different methods and compound nerve action potentials were orthodromically or antidromically recorded with different electrode spacings. Compound nerve action potentials could be consistently recorded using a method in which the middle part of the median nerve was intact, with both ends dissociated from the surrounding fascia and a ground wire inserted into the muscle close to the intact part. When the distance between two stimulating electrode tips was increased, the threshold and supramaximal stimulating intensity of compound nerve action potentials were gradually decreased, but the amplitude was not changed significantly. When the distance between two recording electrode tips was increased, the amplitude was gradually increased, but the threshold and supramaximal stimulating intensity exhibited no significant change. Different distances between recording and stimulating sites did not produce significant effects on the aforementioned parameters. A distance of 5 mm between recording and stimulating electrodes and a distance of 10 mm between recording and stimulating sites were found to be optimal for compound nerve action potential recording in the rat median nerve. In addition, the orthodromic compound action potential, with a biphasic waveform that was more stable and displayed less interference (however also required a higher threshold and higher supramaximal stimulus), was found to be superior to the antidromic compound action potential.
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Affiliation(s)
- Yongping Li
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China ; Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jie Lao
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xin Zhao
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Dong Tian
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yi Zhu
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xiaochun Wei
- Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
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Alternative paradigm of selective vagus nerve stimulation tested on an isolated porcine vagus nerve. ScientificWorldJournal 2014; 2014:310283. [PMID: 24683328 PMCID: PMC3933024 DOI: 10.1155/2014/310283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
Alternative paradigm for spatial and fibre-type selective vagus nerve stimulation (VNS) was developed using realistic structural topography and tested in an isolated segment of a porcine cervical left vagus nerve (LVN). A spiral cuff (cuff) containing a matrix of ninety-nine electrodes was developed for selective VNS. A quasitrapezoidal stimulating pulse (stimulus) was applied to the LVN via an appointed group of three electrodes (triplet). The triplet and stimulus were configured to predominantly stimulate the B-fibres, minimizing stimulation of the A-fibres and by-passing the stimulation of the C-fibres. To assess which fibres made the most probable contribution to the neural response (NR) during selective VNS, the distribution of conduction velocity (CV) within the LVN was considered. Experimental testing of the paradigm showed the existence of certain parameters and waveforms of the stimulus, for which the contribution of the A-fibres to the NR was slightly reduced and that of the B-fibres was slightly enlarged. The cuff provided satisfactory fascicle discrimination in selective VNS as well as satisfactory fascicle discrimination during NR recording. However, in the present stage of development, fibre-type VNS remained rather limited.
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Yoo PB, Lubock NB, Hincapie JG, Ruble SB, Hamann JJ, Grill WM. High-resolution measurement of electrically-evoked vagus nerve activity in the anesthetized dog. J Neural Eng 2013; 10:026003. [PMID: 23370017 DOI: 10.1088/1741-2560/10/2/026003] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Not fully understanding the type of axons activated during vagus nerve stimulation (VNS) is one of several factors that limit the clinical efficacy of VNS therapies. The main goal of this study was to characterize the electrical recruitment of both myelinated and unmyelinated fibers within the cervical vagus nerve. APPROACH In anesthetized dogs, recording nerve cuff electrodes were implanted on the vagus nerve following surgical excision of the epineurium. Both the vagal electroneurogram (ENG) and laryngeal muscle activity were recorded in response to stimulation of the right vagus nerve. MAIN RESULTS Desheathing the nerve significantly increased the signal-to-noise ratio of the ENG by 1.2 to 9.9 dB, depending on the nerve fiber type. Repeated VNS following nerve transection or neuromuscular block (1) enabled the characterization of A-fibers, two sub-types of B-fibers, and unmyelinated C-fibers, (2) confirmed the absence of stimulation-evoked reflex compound nerve action potentials in both the ipsilateral and contralateral vagus nerves, and (3) provided evidence of stimulus spillover into muscle tissue surrounding the stimulating electrode. SIGNIFICANCE Given the anatomical similarities between the canine and human vagus nerves, the results of this study provide a template for better understanding the nerve fiber recruitment patterns associated with VNS therapies.
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Affiliation(s)
- Paul B Yoo
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
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Yoo PB, Hincapie JG, Hamann JJ, Ruble SB, Wolf PD, Grill WM. Selective control of physiological responses by temporally-patterned electrical stimulation of the canine vagus nerve. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:3107-10. [PMID: 22254997 DOI: 10.1109/iembs.2011.6090848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Vagus nerve stimulation (VNS) is effective for treating epilepsy and depression, and has emerging indications for anxiety and heart failure. However, stimulation-evoked side effects remain a challenge for long-term compliance. We investigated the feasibility of reducing VNS side effects by using a temporally-modified stimulation pattern. In 4 anesthetized canines, we measured changes in both the heart rate and evoked laryngeal muscle activity. Compared to baseline, we found that a 5% duty cycle (measured by the number of pulses per second of stimulation) could still evoke a 21% reduction in heart rate; whereas compared to continuous stimulation (3 mA, 300 μs pulsewidth, 20 Hz) the same 5% duty cycle reduced the evoked laryngeal muscle activity by 90%. The results of this study indicate that temporally-patterned stimulation may provide an effective tool for optimizing VNS therapy.
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Affiliation(s)
- Paul B Yoo
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
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Anholt TA, Ayal S, Goldberg JA. Recruitment and blocking properties of the CardioFit stimulation lead. J Neural Eng 2011; 8:034004. [DOI: 10.1088/1741-2560/8/3/034004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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