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Efthimiou TN, Hernandez MP, Elsenaar A, Mehu M, Korb S. Application of facial neuromuscular electrical stimulation (fNMES) in psychophysiological research: Practical recommendations based on a systematic review of the literature. Behav Res Methods 2024; 56:2941-2976. [PMID: 37864116 PMCID: PMC11133044 DOI: 10.3758/s13428-023-02262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
Facial neuromuscular electrical stimulation (fNMES), which allows for the non-invasive and physiologically sound activation of facial muscles, has great potential for investigating fundamental questions in psychology and neuroscience, such as the role of proprioceptive facial feedback in emotion induction and emotion recognition, and may serve for clinical applications, such as alleviating symptoms of depression. However, despite illustrious origins in the 19th-century work of Duchenne de Boulogne, the practical application of fNMES remains largely unknown to today's researchers in psychology. In addition, published studies vary dramatically in the stimulation parameters used, such as stimulation frequency, amplitude, duration, and electrode size, and in the way they reported them. Because fNMES parameters impact the comfort and safety of volunteers, as well as its physiological (and psychological) effects, it is of paramount importance to establish recommendations of good practice and to ensure studies can be better compared and integrated. Here, we provide an introduction to fNMES, systematically review the existing literature focusing on the stimulation parameters used, and offer recommendations on how to safely and reliably deliver fNMES and on how to report the fNMES parameters to allow better cross-study comparison. In addition, we provide a free webpage, to easily visualise fNMES parameters and verify their safety based on current density. As an example of a potential application, we focus on the use of fNMES for the investigation of the facial feedback hypothesis.
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Affiliation(s)
| | | | - Arthur Elsenaar
- ArtScience Interfaculty, Royal Academy of Art, Royal Conservatory, The Hague, Netherlands
| | - Marc Mehu
- Department of Psychology, Webster Vienna Private University, Vienna, Austria
| | - Sebastian Korb
- Department of Psychology, University of Essex, Colchester, UK.
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.
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2
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North RB, Sung JH, Matthews LA, Zander HJ, Lempka SF. Postural Changes in Spinal Cord Stimulation Thresholds: Current and Voltage Sources. Neuromodulation 2024; 27:178-182. [PMID: 37804279 DOI: 10.1016/j.neurom.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) thresholds are known to change with body position; however, these changes have not been fully characterized for both "constant-voltage" and "constant-current" pulse generators. This study aimed to evaluate and quantify changes in psychophysical thresholds resulting from postural changes that may affect both conventional paresthesia-based SCS and novel paresthesia-free SCS technologies. MATERIALS AND METHODS We measured perceptual, usage, and discomfort thresholds in four body positions (prone, supine, sitting, standing) in 149 consecutive patients, with temporary lower thoracic percutaneous epidural electrodes placed for treating persistent low back and leg pain. We trialed 119 patients with constant-voltage stimulators and 30 patients with constant-current stimulators. RESULTS Moving from supine to the sitting, standing, or prone positions caused all three thresholds (perceptual, usage, and discomfort) to increase by 22% to 34% for constant-voltage stimulators and by 44% to 82% for constant-current stimulators. Changing from a seated to a supine position caused stimulation to exceed discomfort threshold significantly more often for constant-current (87%) than for constant-voltage (63%) stimulators (p = 0.01). CONCLUSIONS Posture-induced changes in SCS thresholds occurred consistently as patients moved from lying (supine or prone) to upright (standing or sitting) positions. These changes were more pronounced for constant-current than for constant-voltage pulse generators and more often led to stimulation-evoked discomfort. These observations are consistent with postural changes in spinal cord position measured in imaging studies, and with computer model predictions of neural recruitment for these different spinal cord positions. These observations have implications for the design, implantation, and clinical application of spinal cord stimulators, not only for conventional paresthesia-based SCS but also for paresthesia-free SCS.
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Affiliation(s)
- Richard B North
- Neuromodulation Foundation, Inc, Baltimore, MD; Departments of Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jung H Sung
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Liam A Matthews
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI; Biointerfaces Institute, University of Michigan, Ann Arbor, MI
| | - Hans J Zander
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI; Biointerfaces Institute, University of Michigan, Ann Arbor, MI
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI; Biointerfaces Institute, University of Michigan, Ann Arbor, MI; Department of Anesthesiology, University of Michigan, Ann Arbor, MI
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Sivanesan E, North RB, Russo MA, Levy RM, Linderoth B, Hayek SM, Eldabe S, Lempka SF. A Definition of Neuromodulation and Classification of Implantable Electrical Modulation for Chronic Pain. Neuromodulation 2024; 27:1-12. [PMID: 37952135 DOI: 10.1016/j.neurom.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Neuromodulation therapies use a variety of treatment modalities (eg, electrical stimulation) to treat chronic pain. These therapies have experienced rapid growth that has coincided with escalating confusion regarding the nomenclature surrounding these neuromodulation technologies. Furthermore, studies are often published without a complete description of the effective stimulation dose, making it impossible to replicate the findings. To improve clinical care and facilitate dissemination among the public, payors, research groups, and regulatory bodies, there is a clear need for a standardization of terms. APPROACH We formed an international group of authors comprising basic scientists, anesthesiologists, neurosurgeons, and engineers with expertise in neuromodulation. Because the field of neuromodulation is extensive, we chose to focus on creating a taxonomy and standardized definitions for implantable electrical modulation of chronic pain. RESULTS We first present a consensus definition of neuromodulation. We then describe a classification scheme based on the 1) intended use (the site of modulation and its indications) and 2) physical properties (waveforms and dose) of a neuromodulation therapy. CONCLUSIONS This framework will help guide future high-quality studies of implantable neuromodulatory treatments and improve reporting of their findings. Standardization with this classification scheme and clear definitions will help physicians, researchers, payors, and patients better understand the applications of implantable electrical modulation for pain and guide informed treatment decisions.
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Affiliation(s)
- Eellan Sivanesan
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Richard B North
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Marc A Russo
- Hunter Pain Specialists, Broadmeadow, New South Wales, Australia
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
| | - Bengt Linderoth
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Salim M Hayek
- Division of Pain Medicine, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
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Single PS, Scott JB, Mugan D. Measures of Dosage for Spinal-Cord Electrical Stimulation: Review and Proposal. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4653-4660. [PMID: 37983153 DOI: 10.1109/tnsre.2023.3335100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
This manuscript proposes an electrical definition of therapeutic dose for spinal-cord systems used for the treatment of chronic pain, analogous to the pharmacological definition. Dose-response relationships are fundamental to pharmacology, radio-therapy, and other treatments, but have never been properly established for neuromodulation. This manuscript offers a robust measure of dose, pre-requisite to establishing a reliable and repeatable dose-response relationship. The new definition, enabled by the system transresistance obtained from measurement of evoked action potentials, recognizes the mechanism of action of spinal cord stimulation (SCS), and should improve acceptance of the therapy as compared to pharmacological treatments which are currently used more frequently for the treatment of chronic pain. The new definition suggests methods for personalization and standardization of the dose in SCS, and is potentially generalizable to all neuromodulation therapies in which nervous tissue is excited including sacral nerve stimulation (SNS), vagal nerve stimulation (VNS) and deep-brain stimulation (DBS). Formulas are provided, and applied using patient data. Powerful conclusions are drawn from application of the new measure.
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Shanthanna H, Eldabe S, Provenzano DA, Chang Y, Adams D, Kashir I, Goel A, Tian C, Couban RJ, Levit T, Hagedorn JM, Narouze S. Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review. Reg Anesth Pain Med 2023; 48:251-272. [PMID: 37001887 DOI: 10.1136/rapm-2022-103820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/22/2022] [Indexed: 04/03/2023]
Abstract
Background/importancePatient selection for spinal cord stimulation (SCS) therapy is crucial and is traditionally performed with clinical selection followed by a screening trial. The factors influencing patient selection and the importance of trialing have not been systematically evaluated.ObjectiveWe report a narrative review conducted to synthesize evidence regarding patient selection and the role of SCS trials.Evidence reviewMedline, EMBASE and Cochrane databases were searched for reports (any design) of SCS in adult patients, from their inception until March 30, 2022. Study selection and data extraction were carried out using DistillerSR. Data were organized into tables and narrative summaries, categorized by study design. Importance of patient variables and trialing was considered by looking at their influence on the long-term therapy success.FindingsAmong 7321 citations, 201 reports consisting of 60 systematic reviews, 36 randomized controlled trials (RCTs), 41 observational studies (OSs), 51 registry-based reports, and 13 case reports on complications during trialing were included. Based on RCTs and OSs, the median trial success rate was 72% and 82%, and therapy success was 65% and 61% at 12 months, respectively. Although several psychological and non-psychological determinants have been investigated, studies do not report a consistent approach to patient selection. Among psychological factors, untreated depression was associated with poor long-term outcomes, but the effect of others was inconsistent. Most RCTs except for chronic angina involved trialing and only one RCT compared patient selection with or without trial. The median (range) trial duration was 10 (0–30) and 7 (0–56) days among RCTs and OSs, respectively.ConclusionsDue to lack of a consistent approach to identify responders for SCS therapy, trialing complements patient selection to exclude patients who do not find the therapy helpful and/or intolerant of the SCS system. However, more rigorous and large studies are necessary to better evaluate its role.
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Affiliation(s)
| | - Sam Eldabe
- James Cook University Hospital, Middlesbrough, UK
| | | | - Yaping Chang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Adams
- Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Imad Kashir
- University of Waterloo, Waterloo, Ontario, Canada
| | - Akash Goel
- Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chenchen Tian
- Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Tal Levit
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan M Hagedorn
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samer Narouze
- Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Desai MJ, Aschenbrener R, Carrera EJ, Thalla N. Spinal Cord Stimulation. Phys Med Rehabil Clin N Am 2022; 33:335-357. [DOI: 10.1016/j.pmr.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tilborghs S, De Wachter S. Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects. Expert Rev Med Devices 2022; 19:161-187. [DOI: 10.1080/17434440.2022.2032655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sam Tilborghs
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
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Malone IG, Nosacka RL, Nash MA, Otto KJ, Dale EA. Electrical epidural stimulation of the cervical spinal cord: implications for spinal respiratory neuroplasticity after spinal cord injury. J Neurophysiol 2021; 126:607-626. [PMID: 34232771 DOI: 10.1152/jn.00625.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Traumatic cervical spinal cord injury (cSCI) can lead to damage of bulbospinal pathways to the respiratory motor nuclei and consequent life-threatening respiratory insufficiency due to respiratory muscle paralysis/paresis. Reports of electrical epidural stimulation (EES) of the lumbosacral spinal cord to enable locomotor function after SCI are encouraging, with some evidence of facilitating neural plasticity. Here, we detail the development and success of EES in recovering locomotor function, with consideration of stimulation parameters and safety measures to develop effective EES protocols. EES is just beginning to be applied in other motor, sensory, and autonomic systems; however, there has only been moderate success in preclinical studies aimed at improving breathing function after cSCI. Thus, we explore the rationale for applying EES to the cervical spinal cord, targeting the phrenic motor nucleus for the restoration of breathing. We also suggest cellular/molecular mechanisms by which EES may induce respiratory plasticity, including a brief examination of sex-related differences in these mechanisms. Finally, we suggest that more attention be paid to the effects of specific electrical parameters that have been used in the development of EES protocols and how that can impact the safety and efficacy for those receiving this therapy. Ultimately, we aim to inform readers about the potential benefits of EES in the phrenic motor system and encourage future studies in this area.
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Affiliation(s)
- Ian G Malone
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida.,Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida
| | - Rachel L Nosacka
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Marissa A Nash
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Kevin J Otto
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida.,Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida.,Department of Neuroscience, University of Florida, Gainesville, Florida.,Department of Neurology, University of Florida, Gainesville, Florida.,Department of Materials Science and Engineering, University of Florida, Gainesville, Florida.,McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Erica A Dale
- Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida.,Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida.,Department of Neuroscience, University of Florida, Gainesville, Florida.,McKnight Brain Institute, University of Florida, Gainesville, Florida
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Yen TY, Ker MD. Design of Dual-Mode Stimulus Chip With Built-In High Voltage Generator for Biomedical Applications. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:961-970. [PMID: 32746341 DOI: 10.1109/tbcas.2020.2999398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this work, a dual-mode stimulus chip with a built-in high voltage generator was proposed to offer a broad-range current or voltage stimulus patterns for biomedical applications. With an on-chip and built-in high voltage generator, this stimulus chip could generate the required high voltage supply without additional supply voltage. With a nearly 20 V operating voltage, the overstress and reliability issues of the stimulus circuits were thoroughly considered and carefully addressed in this work. This stimulus system only requires an area of 0.22 mm2 per single channel and is fully on-chip implemented without any additional external components. The dual-mode stimulus chip was fabricated in a 0.25-μm 2.5V/5V/12V CMOS (complementary metal-oxide-semiconductor) process, which can generate the biphasic current or voltage stimulus pulses. The current level of stimulus is up to 5 mA, and the voltage level of stimulus can be up to 10 V. Moreover, this chip has been successfully applied to stimulate a guinea pig in an animal experiment. The proposed dual-mode stimulus system has been verified in electrical tests and also demonstrated its stimulation function in animal experiments.
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McNicol E, Ferguson M, Bungay K, Rowe EL, Eldabe S, Gewandter JS, Hayek SM, Katz N, Kopell BH, Markman J, Rezai A, Taylor RS, Turk DC, Dworkin RH, North RB, Thomson S. Systematic Review of Research Methods and Reporting Quality of Randomized Clinical Trials of Spinal Cord Stimulation for Pain. THE JOURNAL OF PAIN 2020; 22:127-142. [PMID: 32574787 DOI: 10.1016/j.jpain.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022]
Abstract
This systematic review assessed design characteristics and reporting quality of published randomized clinical trials of spinal cord stimulation (SCS) for treatment of pain in adults and adolescents. The study protocol was registered with PROSPERO (CRD42018090412). Relevant articles were identified by searching the following databases through December 31, 2018: MEDLINE, Embase, WikiStim, The Cochrane Database of Systematic Reviews, and The Cochrane Central Register of Controlled Trials. Forty-six studies were included. Eighty-seven percent of articles identified a pain-related primary outcome. Secondary outcomes included physical functioning, health-related quality of life, and reductions in opioid use. Nineteen of the 46 studies prespecified adverse events as an outcome, with 4 assessing them as a primary outcome. Eleven studies stated that they blinded participants. Of these, only 5 were assessed as being adequately blinded. The number of participants enrolled was generally low (median 38) and study durations were short (median 12 weeks), particularly in studies of angina. Fifteen studies employed an intention-to-treat analysis, of which only seven specified a method to accommodate missing data. Review of these studies identified deficiencies in both reporting and methodology. The review's findings suggest areas for improving the design of future studies and increasing transparency of reporting. PERSPECTIVE: This article presents a systematic review of research methods and reporting quality of randomized clinical trials of SCS for the treatment of various pain complaints. The review identifies deficiencies in both methodology and reporting, which may inform the design of future studies and improve reporting standards.
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Affiliation(s)
- Ewan McNicol
- Department of Pharmacy Practice, MCPHS University, Boston, Massachusetts.
| | - McKenzie Ferguson
- Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, Illinois
| | | | | | - Sam Eldabe
- University of Exeter, Exeter, UK; Durham University, Durham, UK
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio
| | - Nathaniel Katz
- Analgesic Solutions, Wayland, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Brian H Kopell
- Departments of Neurosurgery, Neurology, Psychiatry and Neuroscience, The Icahn School of Medicine at Mount Sinai, NY, New York
| | - John Markman
- Translational Pain Research Program, Department of Neurosurgery, University of Rochester, New York
| | - Ali Rezai
- Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK; College of Medicine and Health, University of Exeter, Exeter, UK
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | | | - Simon Thomson
- Basildon and Thurrock University Hospitals, Essex, UK
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Mottaghi S, Afshari N, Buchholz O, Liebana S, Hofmann UG. Modular Current Stimulation System for Pre-clinical Studies. Front Neurosci 2020; 14:408. [PMID: 32425752 PMCID: PMC7203490 DOI: 10.3389/fnins.2020.00408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
Electric stimulators with precise and reliable outputs are an indispensable part of electrophysiological research. From single cells to deep brain or neuromuscular tissue, there are diverse targets for electrical stimulation. Even though commercial systems are available, we state the need for a low-cost, high precision, functional, and modular (hardware, firmware, and software) current stimulation system with the capacity to generate stable and complex waveforms for pre-clinical research. The system presented in this study is a USB controlled 4-channel modular current stimulator that can be expanded and generate biphasic arbitrary waveforms with 16-bit resolution, high temporal precision (μs), and passive charge balancing: the NES STiM (Neuro Electronic Systems Stimulator). We present a detailed description of the system's structural design, the controlling software, reliability test, and the pre-clinical studies [deep brain stimulation (DBS) in hemi-PD rat model] in which it was utilized. The NES STiM has been tested with MacOS and Windows operating systems. Interfaces to MATLAB source codes are provided. The system is inexpensive, relatively easy to build and can be assembled quickly. We hope that the NES STiM will be used in a wide variety of neurological applications such as Functional Electrical Stimulation (FES), DBS and closed loop neurophysiological research.
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Affiliation(s)
- Soheil Mottaghi
- Section for Neuroelectronic Systems, Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Technical Faculty, University of Freiburg, Freiburg, Germany
| | - Niloofar Afshari
- Section for Neuroelectronic Systems, Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Oliver Buchholz
- Section for Neuroelectronic Systems, Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Samuel Liebana
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Ulrich G. Hofmann
- Section for Neuroelectronic Systems, Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Technical Faculty, University of Freiburg, Freiburg, Germany
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Bhat A, Graham AR, Trivedi H, Hogan MK, Horner PJ, Guiseppi-Elie A. Engineering the ABIO-BIO interface of neurostimulation electrodes using polypyrrole and bioactive hydrogels. PURE APPL CHEM 2020. [DOI: 10.1515/pac-2019-1107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Following spinal cord injury, the use of electrodes for neurostimulation in animal models has been shown to stimulate muscle movement, however, the efficacy of such treatment is impaired by increased interfacial impedance caused by fibrous encapsulation of the electrode. Sputter-deposited gold-on-polyimide electrodes were modified by potentiostatic electrodeposition of poly(pyrrole-co-3-pyrrolylbutyrate-conj-aminoethylmethacrylate): sulfopropyl methacrylate [P(Py-co-PyBA-conj-AEMA):SPMA] to various charge densities (0–100 mC/cm2) to address interfacial impedance and coated with a phosphoryl choline containing bioactive hydrogel to address biocompatibility at the ABIO-BIO interface. Electrodes were characterized with scanning electron microscopy (surface morphology), multiple-scan rate cyclic voltammetry (peak current and electroactive area), and electrochemical impedance spectroscopy (charge transfer resistance and membrane resistance). SEM analysis and electroactive area calculations identified films fabricated with a charge density of 50 mC/cm2 as well suited for neurostimulation electrodes. Charge transfer resistance demonstrated a strong inverse correlation (−0.83) with charge density of electrodeposition. On average, the addition of polypyrrole and hydrogel to neurostimulation electrodes decreased charge transfer resistance by 82 %. These results support the use of interfacial engineering techniques to mitigate high interfacial impedance and combat the foreign body response towards epidurally implanted neurostimulation electrodes.
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Affiliation(s)
- Ankita Bhat
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering , Texas A&M University , College Station, TX 77843 , USA
| | - Alexa R. Graham
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering , Texas A&M University , College Station, TX 77843 , USA
| | - Hemang Trivedi
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
| | - Matthew K. Hogan
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
| | - Philip J. Horner
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
| | - Anthony Guiseppi-Elie
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering , Texas A&M University , College Station, TX 77843 , USA
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
- Department of Electrical and Computer Engineering , Texas A&M University , College Station, TX 77843 , USA
- ABTECH Scientific, Inc., Biotechnology Research Park , 800 East Leigh Street , Richmond, VA 23219 , USA , Tel.: +1(979) 458 1239, Fax: +1(979) 845 4450
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13
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Spinal cord stimulation programming: a crash course. Neurosurg Rev 2020; 44:709-720. [PMID: 32291559 DOI: 10.1007/s10143-020-01299-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/20/2020] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
Abstract
The aim of this comprehensive review is to provide an instructional guide for providers regarding the parameters and programming of spinal cord stimulation (SCS) devices. Knowing these fundamentals will aid in providing superior pain relief to patients. SCS has four programmable parameters: contact (electrode) selection, amplitude, pulse width, and frequency. Each parameter needs to be accounted for when assessing which program works for which patient. Traditional open-loop systems allow for different "programs," or combinations of these four parameters, to be pre-set by the provider and medical device representative. These allow for flexibility in the type of stimulation delivered to the patient depending on activity. Patients are also given control over programs and changing the amplitudes of these programs. However, some open-loop systems place the burden of toggling between programs to manage pain control on patients, though this tends to be less in subparesthesia programs. Newer closed-loop systems make it possible for stimulation settings to automatically adjust in response to accelerometry and evoked compound action potential feedback, and therefore have the potential to streamline the patient experience. This article provides practitioners with the basic knowledge of SCS parameters and programming systems. Understanding their use is essential to providing optimal pain relief to patients.
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Blok B, Van Kerrebroeck P, de Wachter S, Ruffion A, Van der Aa F, Perrouin-Verbe MA, Elneil S. Two-year safety and efficacy outcomes for the treatment of overactive bladder using a long-lived rechargeable sacral neuromodulation system. Neurourol Urodyn 2020; 39:1108-1114. [PMID: 32243625 PMCID: PMC7217215 DOI: 10.1002/nau.24317] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/23/2020] [Indexed: 02/03/2023]
Abstract
AIMS Sacral neuromodulation (SNM) therapy for overactive bladder (OAB) has proven long-term safety and efficacy. Historically, the only commercially available SNM device was nonrechargeable requiring replacement surgery due to battery depletion. The Axonics System is the first rechargeable SNM device and is qualified to last a minimum of 15 years in the body. The study objective was to evaluate the safety and efficacy of this rechargeable SNM system. This study reports 2-year outcomes. METHODS A total of 51 subjects were implanted with the Axonics System in a single nonstaged procedure. Subjects had OAB, confirmed on a 3-day voiding diary (≥8 voids/day and/or ≥2 incontinence episodes over 72 hours). Test Responders were defined as subjects that were responders at 1 month postimplant. The efficacy analysis included therapy responder rates, change in the quality of life, and subject satisfaction reported in Test Responders (n = 30) and all implanted subjects (n = 37) that completed the follow-up visits. Adverse events (AEs) are reported in all implanted subjects. RESULTS At 2 years, 90% of the Test Responders continued to respond to the therapy based on voiding diary criteria. Satisfaction with therapy was reported by 93% of subjects and 86% found their charging experience acceptable. Of the urinary incontinence Test Responders, 88% continued to be responders at 2 years, and 28% were completely dry. There were no unanticipated (AEs) or serious device-related AEs. CONCLUSIONS The Axonics System® provides sustained clinically meaningful improvements in OAB subjects at 2 years. There were no serious device-related AEs. Subjects reported continued satisfaction with their therapy.
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Affiliation(s)
- Bertil Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Alain Ruffion
- Department of Urology, Hôpital Lyon Sud, Lyon, Pierre Bénite, France
| | | | | | - Sohier Elneil
- Department of Uro-Neurology, National Hospital of Neurology and Neurosurgery, London, UK
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15
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Khajei S, Shalchyan V, Daliri MR. Ratbot navigation using deep brain stimulation in ventral posteromedial nucleus. Bioengineered 2019; 10:250-260. [PMID: 31204562 PMCID: PMC6592397 DOI: 10.1080/21655979.2019.1631103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Deep Brain Stimulation (DBS) is a medical-practical method and has been applied to solve many medical complications. Animal usage as sensors and actuators, mind-controlled machines, and animal navigation are some of the non-medical DBS applications. One of the brain areas used in ratbot navigation is the Ventral Posteromedial Nucleus (VPM), which creates non-volunteer head rotation. Rat training by water/food restriction can be used to create forward movement. In this study, a combination of VPM stimulation and water/food restriction has been employed to establish a complete navigation system. Five rats responded to VPM stimulations. However, with three of them, rats rotated to the same direction after the stimulations of either VPM side of the brain. Two rats rotated bilaterally, proportionate to the VPM stimulation side. These two rats were trained in a T-shape maze and became ratbots. The results of the 3-session test showed that their navigation performances were 96% and 86%, respectively. These ratbots are suitable for navigational purposes and are ready to complete the missions that are dangerous or impossible for humans.
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Affiliation(s)
- Sina Khajei
- a Neuroscience & Neuroengineering Research Lab., Biomedical Engineering Department, School of Electrical Engineering , Iran University of Science and Technology (IUST) , Tehran , Iran
| | - Vahid Shalchyan
- a Neuroscience & Neuroengineering Research Lab., Biomedical Engineering Department, School of Electrical Engineering , Iran University of Science and Technology (IUST) , Tehran , Iran
| | - Mohammad Reza Daliri
- a Neuroscience & Neuroengineering Research Lab., Biomedical Engineering Department, School of Electrical Engineering , Iran University of Science and Technology (IUST) , Tehran , Iran
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16
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Systematic review and meta-analysis of placebo/sham controlled randomised trials of spinal cord stimulation for neuropathic pain. Pain 2019; 161:24-35. [DOI: 10.1097/j.pain.0000000000001689] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Duarte RV, McNicol E, Colloca L, Taylor RS, North RB, Eldabe S. Randomized Placebo-/Sham-Controlled Trials of Spinal Cord Stimulation: A Systematic Review and Methodological Appraisal. Neuromodulation 2019; 23:10-18. [PMID: 31305001 PMCID: PMC7004207 DOI: 10.1111/ner.13018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/30/2019] [Accepted: 06/04/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The recent availability of paraesthesia/sensation free spinal cord stimulation (SCS) modalities allow the design of clinical trials of SCS using placebo/sham controls and blinding of patients, clinicians, and researchers. The aims of this study were to: 1) systematically review the current evidence base of randomized controlled trials (RCTs) of SCS placebo/sham trials and 2) to undertake a methodological critique of their methods. Based on this critique, we developed a checklist for the design and reporting of future RCTs of SCS. MATERIALS AND METHODS Electronic data bases were searched from inception until January 2019 for RCTs of SCS using a placebo/sham control. RCTs with only an active comparator arm were excluded. The results are presented as a narrative synthesis. RESULTS Searches identified 12 eligible RCTs. SCS modalities included paraesthesia stimulation, subthreshold, burst, and high-frequency SCS and were mainly conducted in patients with failed back surgery syndrome, complex regional pain syndrome, and refractory angina. The quality and transparency of reporting of the methods of placebo stimulation, blinding of patients, clinicians, and researchers varied markedly across studies. CONCLUSIONS To date the methods of placebo/sham control and blinding in RCTs have been poorly reported, leading to concerns about the validity and replicability of the findings. Important aspects that need to be clearly reported in the design of placebo-/sham-controlled RCTs of SCS include the transparent reporting of stimulation programming parameters, patient position during perception threshold measurement, management of the patient handheld programmer, frequency of recharging, and assessment of the fidelity of blinding.
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Affiliation(s)
- Rui V Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Ewan McNicol
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA.,Department of Pain Medicine, Atrius Health, Boston, MA, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA.,Department of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, MD, USA.,Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, USA
| | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK.,College of Medicine and Health, University of Exeter, Exeter, UK
| | - Richard B North
- Neurosurgery, Anesthesiology and Critical Care Medicine (ret.), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
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18
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Abstract
Spinal cord stimulation (SCS) has been well established as a safe and effective treatment of pain derived from a wide variety of etiologies. Careful patient selection including a rigorous trial period and psychological evaluation are essential. When patients proceed to permanent implantation, various considerations should be made, such as the type of lead, type of anesthesia, and waveform patterns for SCS. This article discusses the common indications for SCS, patient selection criteria, and pertinent outcomes from randomized clinical trials related to common indications treated with SCS. Technical considerations, such as type of implant, anesthesia, and programming, are also discussed.
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Affiliation(s)
- Andrew K Rock
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Huy Truong
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Yunseo Linda Park
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA; Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA.
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19
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Maheshwari A, Pope JE, Deer TR, Falowski S. Advanced methods of spinal stimulation in the treatment of chronic pain: pulse trains, waveforms, frequencies, targets, and feedback loops. Expert Rev Med Devices 2019; 16:95-106. [PMID: 30625000 DOI: 10.1080/17434440.2019.1567325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Spinal cord stimulation has emerged as a state-of-the-art evidence-based treatment for chronic neuropathic pain and mixed nociceptive-neuropathic pain. In recent years, several newer devices and treatment algorithms have provided unique and effective ways of treating chronic pain by spinal cord stimulation. In a previous review, the authors commented on the 5-year forecast for high frequency and Burst waveforms, as the only two paresthesia independent SCS strategies. Over the last 5 years, there has been considerable addition to the outcome data related to these modalities. Additionally, new treatment algorithms and modalities for spinal cord stimulation have emerged. In this review, the authors provide an up to date summary of these modalities of treatment, indications, and evidence on all different modalities and programming paradigms that are available today. AREAS COVERED A literature review was performed using key bibliographic databases to find outcomes related studies pertaining to spinal cord stimulation, limited to the English language and human data, between 2010 and 2018. The literature search yielded the following based on our inclusion criteria; six articles on burst stimulation, three articled on high density/high dose stimulation, six articles on Dorsal Root Ganglion stimulation, nine articles on high-frequency stimulation, and one article on closed-loop stimulation. We have also included in the discussion some smaller and anecdotal studies. EXPERT COMMENTARY The evidence to support outcomes of spinal cord stimulation has evolved considerably since our last review in 2014. New targets, frequencies and pulse trains, and feedback appear to have advanced the efficacy of spinal cord stimulation. Future developments aim to continue to refine patient selection and maintenance of patients in therapy.
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Affiliation(s)
- Ankit Maheshwari
- a Case Western Reserve University, University Hospitals , Cleveland , OH , USA
| | - Jason E Pope
- b Evolve Restorative Center , Santa Rosa , CA , USA
| | - Timothy R Deer
- c The Spine and Nerve Centers of Virginia , Charleston , WV , USA
| | - Steven Falowski
- d Functional Neurosurgery , St. Lukes University Health Network , Bethlehem , PA , USA
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20
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Cohn JA, Kowalik CG, Kaufman MR, Reynolds WS, Milam DF, Dmochowski RR. Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction. Expert Rev Med Devices 2016; 14:3-14. [PMID: 27915486 DOI: 10.1080/17434440.2017.1268913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many cases because of a failed battery. A rechargeable SNM system, with a manufacturer-reported battery life of 15 years or more, has entered post-market clinical testing in Europe but has not yet been approved for clinical testing in the United States. Areas covered: We review existing neuromodulation technologies for the treatment of lower urinary tract and bowel dysfunction and explore the limitations of available technology. In addition, we discuss implantation technique and device specifications and programming of the rechargeable SNM system in detail. Lastly, we present existing evidence for the use of SNM in bladder and bowel dysfunction and evaluate the anticipated trajectory of neuromodulation technologies over the next five years. Expert commentary: A rechargeable system for SNM is a welcome technological advance. However surgical revision not related to battery changes is not uncommon. Therefore, while a rechargeable system would be expected to reduce costs, it will not eliminate the ongoing maintenance associated with neuromodulation. No matter the apparent benefits, all new technologies require extensive post-market monitoring to ensure safety and efficacy.
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Affiliation(s)
- Joshua A Cohn
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Casey G Kowalik
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Melissa R Kaufman
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - W Stuart Reynolds
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Douglas F Milam
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Roger R Dmochowski
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
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21
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Xu Q, Kong L, Zhou H, He J. Epidural Stimulation of Rat Spinal Cord at Lumbosacral Segment Using a Surface Electrode: A Computer Simulation Study. IEEE Trans Neural Syst Rehabil Eng 2016; 25:1763-1772. [PMID: 27834648 DOI: 10.1109/tnsre.2016.2625312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical research indicates that the epidural spinal cord stimulation (ESCS) at lumbosacral segment has shown potential for promoting locomotor recovery in patients with incomplete spinal cord injury. However, the underlying neural mechanism needs to be determined by animal experiments. In order to refine experimental protocols, we used a finite element simulation to investigate the activation of nerve fibers in a rat spinal cord model. Our model is composed of a volume conductor model from L1 to S2 spinal segments and the McIntyre-Richard-Grill axon model, which is used to investigate the threshold of selected spinal fibers with different diameters at varied locations and predict the neural responses of any target fibers with bipolar electrode configuration. Mathematical modeling suggests that the electrode-fiber distance may play an important role in the recruitment of nerve fibers, whereas longer pulse width predicted greater activity of spinal root fibers and dorsal column fibers, as well as may exert an effective influence on the motor system by the ability to increase and even "steer" spatial selectivity with deeper penetration into the dorsal columns. The spikes were initiated at sites along the nerve fibers depending on which component was closest to the cathode among the longitudinal part of the fiber, its entrance into spinal cord, or strong bending at the entry. Our simulation results show good agreement with the previous findings from animal studies. It is concluded that the computational ESCS model is a valuable tool to obtain a better insight into the immediately evoked electrophysiological phenomena in animal models, and provides further guidelines for conducting animal experiments to enhance the exploration of basic neural mechanisms.
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22
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Lee SE, Choi RM, Kee R, Lee KH, Jeon S, Jung JW, Kim WJ, Yoon JS. Epidural anesthesia for permanent spinal cord stimulation with a cylindrical type lead: a case series. Korean J Anesthesiol 2015; 68:179-83. [PMID: 25844138 PMCID: PMC4384407 DOI: 10.4097/kjae.2015.68.2.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/09/2014] [Accepted: 08/22/2014] [Indexed: 11/10/2022] Open
Abstract
Spinal cord stimulation (SCS) in trials involving external stimulation are easily conducted under local anesthesia. However, implantation of a permanent SCS system is painful, and can be intolerable in some patients. Epidural anesthesia can be used to perform the SCS implantation without discomfort if the patient can localize the area of paresthesia. However, little is known about epidural anesthesia for SCS. This paper reports 23 cases of permanent SCS with a cylindrical type lead implanted under the epidural anesthesia. Epidural anesthesia was sufficient in 22 patients without discomfort and significant complications. The remaining patient experienced incomplete epidural anesthesia and required additional analgesics to blunt the pain. All the leads were placed consistent with the patient's report of paresthesia area under epidural anesthesia. Thus, epidural anesthesia is an effective and safe method for the optimal placement of SCS to minimize the discomfort for patients without impairing patients' response to the intraoperative stimulation test.
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Affiliation(s)
- Sang Eun Lee
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Rak Min Choi
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Rim Kee
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Kang Hun Lee
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Sangyoon Jeon
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Jae-Wook Jung
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Woo-Jin Kim
- Department of Rehabilitation Medicine, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Jin Sun Yoon
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, Korea
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23
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Pope JE, Falowski S, Deer TR. Advanced waveforms and frequency with spinal cord stimulation: burst and high-frequency energy delivery. Expert Rev Med Devices 2015; 12:431-7. [PMID: 25846152 DOI: 10.1586/17434440.2015.1026805] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years, software development has been key to the next generation of neuromodulation devices. In this review, we will describe the new strategies for electrical waveform delivery for spinal cord stimulation. A systematic literature review was performed using bibliographic databases, limited to the English language and human data, between 2010 and 2014. The literature search yielded three articles on burst stimulation and four articles on high-frequency stimulation. High-frequency and burst stimulation may offer advantages over tonic stimulation, as data suggest improved patient tolerance, comparable increase in function and possible success with a subset of patients refractory to tonic spinal cord stimulation. High-frequency and burst stimulation are new ways to deliver energy to the spinal cord that may offer advantages over tonic stimulation. These may offer new salvage strategies to mitigate spinal cord stimulation failure and improve cost-effectiveness by reducing explant rate.
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Affiliation(s)
- Jason E Pope
- Center for Pain Relief, Inc., 400 Court Street, Charleston, WV 25301, USA
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24
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Bunch JR, Goldstein HV, Hurley RW. Complete Coverage of Phantom Limb and Stump Pain with Constant Current SCS System: A Case Report and Review of the Literature. Pain Pract 2014; 15:E20-6. [DOI: 10.1111/papr.12226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Jennifer R. Bunch
- Department of Anesthesiology; University of Florida; Gainesville FL U.S.A
| | - Heidi V. Goldstein
- North Florida/South Georgia Veterans Health Administration; Gainesville FL U.S.A
| | - Robert W. Hurley
- Department of Anesthesiology; University of Florida; Gainesville FL U.S.A
- Department of Neurology, Psychiatry, Orthopaedics and Rehabilitation; University of Florida; Gainesville FL U.S.A
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