1
|
Lee JI, Werginz P, Kameneva T, Im M, Fried SI. Membrane depolarization mediates both the inhibition of neural activity and cell-type-differences in response to high-frequency stimulation. Commun Biol 2024; 7:734. [PMID: 38890481 PMCID: PMC11189419 DOI: 10.1038/s42003-024-06359-3] [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] [Received: 03/16/2023] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Neuromodulation using high frequency (>1 kHz) electric stimulation (HFS) enables preferential activation or inhibition of individual neural types, offering the possibility of more effective treatments across a broad spectrum of neurological diseases. To improve effectiveness, it is important to better understand the mechanisms governing activation and inhibition with HFS so that selectivity can be optimized. In this study, we measure the membrane potential (Vm) and spiking responses of ON and OFF α-sustained retinal ganglion cells (RGCs) to a wide range of stimulus frequencies (100-2500 Hz) and amplitudes (10-100 µA). Our findings indicate that HFS induces shifts in Vm, with both the strength and polarity of the shifts dependent on the stimulus conditions. Spiking responses in each cell directly correlate with the shifts in Vm, where strong depolarization leads to spiking suppression. Comparisons between the two cell types reveal that ON cells are more depolarized by a given amplitude of HFS than OFF cells-this sensitivity difference enables the selective targeting. Computational modeling indicates that ion-channel dynamics largely account for the shifts in Vm, suggesting that a better understanding of the differences in ion-channel properties across cell types may improve the selectivity and ultimately, enhance HFS-based neurostimulation strategies.
Collapse
Affiliation(s)
- Jae-Ik Lee
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Paul Werginz
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institute of Biomedical Electronics, TU Wien, Vienna, Austria
| | - Tatiana Kameneva
- School of Science, Computing, and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Maesoon Im
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
- Division of Bio-Medical Science & Technology, KIST School, University of Science and Technology (UST), Seoul, South Korea
- KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, Republic of Korea
| | - Shelley I Fried
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Boston VA Healthcare System, Rehabilitation, Research and Development, Boston, MA, USA
| |
Collapse
|
2
|
Kapural L, Melton J, Kim B, Mehta P, Sigdel A, Bautista A, Petersen EA, Slavin KV, Eidt J, Wu J, Elshihabi S, Schwalb JM, Garrett Jr HE, Veizi E, Barolat G, Rajani RR, Rhee PC, Guirguis M, Mekhail N. Primary 3-Month Outcomes of a Double-Blind Randomized Prospective Study (The QUEST Study) Assessing Effectiveness and Safety of Novel High-Frequency Electric Nerve Block System for Treatment of Post-Amputation Pain. J Pain Res 2024; 17:2001-2014. [PMID: 38860215 PMCID: PMC11164212 DOI: 10.2147/jpr.s463727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
Purpose This multicenter, randomized, double-blinded, active sham-controlled pivotal study was designed to assess the efficacy and safety of high-frequency nerve block treatment for chronic post-amputation and phantom limb pain. Patients and Methods QUEST enrolled 180 unilateral lower-limb amputees with severe post-amputation pain, 170 of whom were implanted with the Altius device, were randomized 1:1 to active-sham or treatment groups and reached the primary endpoint. Responders were those subjects who received ≥50% pain relief 30 min after treatment in ≥50% of their self-initiated treatment sessions within the 3-month randomized period. Differences between the active treatment and sham control groups as well as numerous secondary outcomes were determined. Results At 30-min, (primary outcome), 24.7% of the treatment group were responders compared to 7.1% of the control group (p=0.002). At 120-minutes following treatment, responder rates were 46.8% in the Treatment group and 22.2% in the Control group (p=0.001). Improvement in Brief Pain Inventory interference score of 2.3 ± 0.29 was significantly greater in treatment group than the 1.3 ± 0.26-point change in the Control group (p = 0.01). Opioid usage, although not significantly different, trended towards a greater reduction in the treatment group than in the control group. The incidence of adverse events did not differ significantly between the treatment and control groups. Conclusion The primary outcomes of the study were met, and the majority of Treatment patients experienced a substantial improvement in PAP (regardless of meeting the study definition of a responder). The significant in PAP was associated with significantly improved QOL metrics, and a trend towards reduced opioid utilization compared to Control. These data indicate that Altius treatment represents a significant therapeutic advancement for lower-limb amputees suffering from chronic PAP.
Collapse
Affiliation(s)
- Leonardo Kapural
- Carolinas Pain Institute and Center for Clinical Research, Winston-Salem, NC, USA
| | - Jim Melton
- Department of Vascular Surgery, Cardiovascular Health Clinic, Oklahoma City, OK, USA
| | - Billy Kim
- Department of Vascular Surgery, The Surgical Clinic, Nashville, TN, USA
| | - Priyesh Mehta
- Department of Pain Medicine, Meta Medical Research Institute, Dayton, OH, USA
| | - Abindra Sigdel
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Alexander Bautista
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas, Little Rock, AR, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Department of Neurology, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - John Eidt
- Department of Vascular Surgery, Baylor Scott and White Heart and Vascular Hospital Dallas, Dallas, TX, USA
| | - Jiang Wu
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Said Elshihabi
- Department of Neurosurgery, Legacy Brain & Spine Surgical Center, Atlanta, GA, USA
| | | | - H Edward Garrett Jr
- Department of Vascular Surgery, University of Tennessee-Memphis, Memphis, TN, USA
| | - Elias Veizi
- Department of Pain Medicine, VA Northeast OH Healthcare System, Cleveland, OH, USA
| | - Giancarlo Barolat
- Department of Neurosurgery, Barolat Neuroscience, Presbyterian/St Luke’s Medical Center, Denver, CO, USA
| | - Ravi R Rajani
- Department of Vascular Surgery, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Peter C Rhee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maged Guirguis
- Department of Interventional Pain Management, Ochsner Health System, New Orleans, LA, USA
| | - Nagy Mekhail
- Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Dewberry LS, Porche K, Koenig T, Allen KD, Otto KJ. High frequency alternating current neurostimulation decreases nocifensive behavior in a disc herniation model of lumbar radiculopathy. Bioelectron Med 2023; 9:15. [PMID: 37434246 DOI: 10.1186/s42234-023-00119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate if kilohertz frequency alternating current (KHFAC) stimulation of peripheral nerve could serve as a treatment for lumbar radiculopathy. Prior work shows that KHFAC stimulation can treat sciatica resulting from chronic sciatic nerve constriction. Here, we evaluate if KHFAC stimulation is also beneficial in a more physiologic model of low back pain which mimics nucleus pulposus (NP) impingement of a lumbar dorsal root ganglion (DRG). METHODS To mimic a lumbar radiculopathy, autologous tail NP was harvested and placed upon the right L5 nerve root and DRG. During the same surgery, a cuff electrode was implanted around the sciatic nerve with wires routed to a headcap for delivery of KHFAC stimulation. Male Lewis rats (3 mo., n = 18) were separated into 3 groups: NP injury + KHFAC stimulation (n = 7), NP injury + sham cuff (n = 6), and sham injury + sham cuff (n = 5). Prior to surgery and for 2 weeks following surgery, animal tactile sensitivity, gait, and static weight bearing were evaluated. RESULTS KHFAC stimulation of the sciatic nerve decreased behavioral evidence of pain and disability. Without KHFAC stimulation, injured animals had heightened tactile sensitivity compared to baseline (p < 0.05), with tactile allodynia reversed during KHFAC stimulation (p < 0.01). Midfoot flexion during locomotion was decreased after injury but improved with KHFAC stimulation (p < 0.05). Animals also placed more weight on their injured limb when KHFAC stimulation was applied (p < 0.05). Electrophysiology measurements at end point showed decreased, but not blocked, compound nerve action potentials with KHFAC stimulation (p < 0.05). CONCLUSIONS KHFAC stimulation decreases hypersensitivity but does not cause additional gait compensations. This supports the idea that KHFAC stimulation applied to a peripheral nerve may be able to treat chronic pain resulting from sciatic nerve root inflammation.
Collapse
Affiliation(s)
- Lauren Savannah Dewberry
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
| | - Ken Porche
- Lillian S Wells Department of Neurosurgery at the University of Florida, College of Medicine, 1505 SW Archer Road Gainesville, FL, 32608, Gainesville, USA
| | - Travis Koenig
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
| | - Kyle D Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA
- Pain Research & Intervention Center of Excellence, University of Florida, CTSI 2004 Mowry Road, Gainesville, FL, USA
- Department of Orthopedics and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Dr. JG56, P.O. Box 116131, Gainesville, FL, 32611, USA.
- Department of Neuroscience, University of Florida, 1149 Newell Dr. L1-100, P.O. Box 100244, Gainesville, FL, USA.
- Department of Electrical and Computer Engineering, University of Florida, 968 Center Dr, Gainesville, FL, 32611, USA.
- Department of Chemical Engineering, University of Florida, 1030 Center Drive, P.O. Box 116005, Gainesville, FL, 32611, USA.
- Department of Materials Science and Engineering, University of Florida, 549 Gale Lemerand Dr, P.O. Box 116400, Gainesville, FL, 32611, USA.
- Department of Neurology, 1149 Newell Dr, P.O. Box 100236, Gainesville, FL, L3-10032610, USA.
- Nanoscience Institute for Medical and Engineering Technology (NIMET), University of Florida, 1041 Center Drive, Gainesville, FL, 32611, USA.
| |
Collapse
|
4
|
Park D, Kim Y. Kilohertz-frequency interferential current induces hypoalgesic effects more comfortably than TENS. Sci Rep 2023; 13:8644. [PMID: 37244893 DOI: 10.1038/s41598-023-35489-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023] Open
Abstract
Recent research on transcutaneous electrical stimulation has shown that inhibiting nerve conduction with a kilohertz frequency is both effective and safe. This study primarily aims to demonstrate the hypoalgesic effect on the tibial nerve using transcutaneous interferential-current nerve inhibition (TINI), which injects the kilohertz frequency produced by the interferential currents. Additionally, the secondary objective was to compare the analgesic effect and comfort of TINI and transcutaneous electrical nerve stimulation (TENS). Thirty-one healthy adults participated in this cross-over repeated measures study. The washout period was set to 24 h or more. Stimulus intensity was set just below the pain threshold level. TINI and TENS were applied for 20 min each. The ankle passive dorsiflexion range of motion, pressure pain threshold (PPT), and tactile threshold were measured at the baseline, pre-test, test (immediately before ceasing intervention), and post-test (30 min after ceasing intervention) sessions. After the interventions, the participants evaluated the level of discomfort for TINI and TENS on a 10 cm visual analog scale (VAS). As the results, PPT significantly increased compared to baseline in test and posttest sessions of TINI, but not in those of TENS. Also, participants reported that TENS was 36% more discomfort than TINI. The hypoalgesic effect was not significantly different between TINI and TENS. In conclusion, we found that TINI inhibited mechanical pain sensitivity and that the inhibitory effect persisted long after electrical stimulation ceased. Our study also shows that TINI provides the hypoalgesic effect more comfortably than TENS.
Collapse
Affiliation(s)
- Dahoon Park
- Department of Sports Rehabilitation, Cheongju University, Cheongju, South Korea
| | - Yushin Kim
- Department of Sports Rehabilitation, Cheongju University, Cheongju, South Korea.
| |
Collapse
|
5
|
Jian J, Wang J, Shen B, Shen Z, Goosby K, Scolieri J, Beckel J, de Groat WC, Tai C. Pudendal Nerve Block by Adaptively Stepwise Increasing the Intensity of High-Frequency (10 kHz) Biphasic Stimulation. Neuromodulation 2023:S1094-7159(23)00149-6. [PMID: 37125972 PMCID: PMC10613126 DOI: 10.1016/j.neurom.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The purpose of this study is to determine whether adaptively stepwise increasing the intensity of a high-frequency (10 kHz) biphasic stimulation (HFBS) can produce nerve conduction block without generating a large initial response. MATERIALS AND METHODS In anesthetized cats, three cuff electrodes were implanted on the left pudendal nerve for stimulation or block. The urethral pressure increase induced by pudendal nerve stimulation was used to measure the pudendal nerve block induced by HFBS. RESULTS HFBS applied suddenly with a large step increase in intensity induced a large (86 ± 16 cmH2O) urethral pressure increase before it blocked pudendal nerve conduction. However, HFBS applied by adaptively stepwise increasing the intensity every 10 to 60 seconds over a long period (33-301 minutes; average 108 ± 35 minutes) with many small intensity increases (0.005-0.1 mA) induced no response or low-amplitude high-frequency urethral pressure changes before it blocked pudendal nerve conduction. The minimal HFBS intensities required by the two different methods to block pudendal nerve conduction are similar. CONCLUSION This study is important for better understanding the possible mechanisms underlying the HFBS-induced nerve block and provides the possibility of developing a new nerve block method for clinical applications in which an initial large response is a concern.
Collapse
Affiliation(s)
- Jianan Jian
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhijun Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Khari Goosby
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph Scolieri
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
6
|
Zhong Y, Wang J, Beckel J, de Groat WC, Tai C. Mechanisms Underlying Poststimulation Block Induced by High-Frequency Biphasic Stimulation. Neuromodulation 2023; 26:577-588. [PMID: 34278654 PMCID: PMC8766610 DOI: 10.1111/ner.13501] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/30/2021] [Accepted: 06/21/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To reveal the possible mechanisms underlying poststimulation block induced by high-frequency biphasic stimulation (HFBS). MATERIALS AND METHODS A new axonal conduction model is developed for unmyelinated axons. This new model is different from the classical axonal conduction model by including both ion concentrations and membrane ion pumps to allow analysis of axonal responses to long-duration stimulation. Using the new model, the post-HFBS block phenomenon reported in animal studies is simulated and analyzed for a wide range of stimulation frequencies (100 Hz-10 kHz). RESULTS HFBS can significantly change the Na+ and K+ concentrations inside and outside the axon to produce a post-HFBS block of either short-duration (<500 msec) or long-duration (>3 sec) depending on the duration of HFBS. The short-duration block is due to the fast recovery of the Na+ and K+ concentrations outside the axon in periaxonal space by diffusion of ions into and from the large extracellular space, while the long-duration block is due to the slow restoration of the normal Na+ concentration inside the axon by membrane ion pumps. The 100 Hz HFBS requires the minimal electrical energy to achieve the post-HFBS block, while the 10 kHz stimulation is the least effective frequency requiring high intensity and long duration to achieve the block. CONCLUSION This study reveals two possible ionic mechanisms underlying post-HFBS block of axonal conduction. Understanding these mechanisms is important for improving clinical applications of HFBS block and for developing new nerve block methods employing HFBS.
Collapse
Affiliation(s)
- Yihua Zhong
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
7
|
Chen J, Zhong Y, Wang J, Shen B, Beckel J, de Groat WC, Tai C. Temperature Effect on Nerve Conduction Block Induced by High-Frequency (kHz) Biphasic Stimulation. Neuromodulation 2023; 26:607-613. [PMID: 35088749 PMCID: PMC9206037 DOI: 10.1016/j.neurom.2021.10.017] [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] [Received: 06/21/2021] [Revised: 09/05/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aims to determine temperature effect on nerve conduction block induced by high-frequency (kHz) biphasic stimulation (HFBS). MATERIALS AND METHODS Frog sciatic nerve-muscle preparation was immersed in Ringer's solution at a temperature of 15 or 20 °C. To induce muscle contractions, a bipolar cuff electrode delivered low-frequency (0.25 Hz) stimulation to the nerve. To induce nerve block, a tripolar cuff electrode was placed distal to the bipolar cuff electrode to deliver HFBS (2 or 10 kHz). A bipolar hook electrode distal to the blocking electrode was used to confirm that the nerve block occurred locally at the site of HFBS. A thread tied onto the foot was attached to a force transducer to measure the muscle contraction force. RESULTS At 15 °C, both 2- and 10-kHz HFBSs elicited an initial transient muscle contraction and then produced nerve block during the stimulation (ie, acute block), with the 10 kHz having a significantly (p < 0.001) higher acute block threshold (5.9 ± 0.8 mA peak amplitude) than the 2 kHz (1.9 ± 0.3 mA). When the temperature was increased to 20 °C, the acute block threshold for the 10-kHz HFBS was significantly (p < 0.0001) decreased from 5.2 ± 0.3 to 4.4 ± 0.2 mA, whereas the 2-kHz HFBS induced a tonic muscle contraction during the stimulation but elicited nerve block after terminating the 2-kHz HFBS (ie, poststimulation block) with an increased block duration at a higher stimulation intensity. CONCLUSION Temperature has an important influence on HFBS-induced nerve block. The blocking mechanisms underlying acute and poststimulation nerve blocks are likely to be very different.
Collapse
Affiliation(s)
- Jialiang Chen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yihua Zhong
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
8
|
Álvarez DMC, Serrano-Muñoz D, Fernández-Pérez JJ, Gómez-Soriano J, Avendaño-Coy J. Effect of percutaneous electrical stimulation with high-frequency alternating currents at 30 kHz on the sensory-motor system. Front Neurosci 2023; 17:1048986. [PMID: 36845426 PMCID: PMC9947497 DOI: 10.3389/fnins.2023.1048986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Background Unmodulated high-frequency alternating currents (HFAC) are employed for producing peripheral nerves block. HFAC have been applied in humans with frequencies up to 20 kHz, whether transcutaneously, percutaneously, or via surgically-implanted electrodes. The aim of this study was to assess the effect of percutaneous HFAC, applied with ultrasound-guided needles at 30 kHz, on the sensory-motor nerve conduction of healthy volunteers. Methods A parallel, double-blind, randomized clinical trial with a placebo control was conducted. Percutaneous HFAC at 30 kHz or sham stimulation was applied via ultrasound-guided needles in 48 healthy volunteers (n = 24 in each group) for 20 min. The assessed outcome variables were pressure pain threshold (PPT), mechanical detection threshold (MDT), maximal finger flexion strength (MFFS), antidromic sensory nerve action potential (SNAP), hand temperature, and subjective sensations by the participants. The measurements were recorded pre-intervention, during the stimulation (at 15 min), immediately post-intervention (at 20 min), and 15 min after the end of treatment. Results The PPT increased in the active group compared with sham stimulation, both during the intervention [14.7%; 95% confidence interval (CI): 4.4-25.0], immediately post-intervention (16.9%; 95% CI: -7.2-26.5), and 15 min after the end of the stimulation (14.3%; 95% CI: 4.4-24.3) (p < 0.01). The proportion of participants who reported feelings of numbness and heaviness was significantly higher in the active group (46 and 50%, respectively) than in the sham group (8 and 18%, respectively) (p < 0.05). No intergroup differences were observed in the remaining outcome variables. No unexpected adverse effects derived from the electrical stimulation were reported. Conclusion Percutaneous stimulation with HFAC at 30 kHz applied to the median nerve increased the PPT and subjective perception of numbness and heaviness. Future research should evaluate its potential therapeutic effect in people with pain. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04884932, identifier NCT04884932.
Collapse
Affiliation(s)
- David Martín-Caro Álvarez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| | | | - Juan José Fernández-Pérez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| |
Collapse
|
9
|
Shen Z, Beckel J, de Groat WC, Tai C. Effect of high-frequency membrane potential alternation between depolarization and hyperpolarization on dorsal root ganglion neurons of rats. Physiol Rep 2023; 11:e15582. [PMID: 36695759 PMCID: PMC9875814 DOI: 10.14814/phy2.15582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023] Open
Abstract
The purpose of this study was to determine how sensory neurons respond to high-frequency membrane potential alternation between depolarization and hyperpolarization. Membrane currents were recorded from dissociated dorsal root ganglion (DRG) neurons of adult rats using the whole cell patch clamp technique in voltage clamp mode. Stepwise depolarization of the membrane was applied first to determine the threshold membrane potential for inducing an action potential (AP) current. Then, membrane potential alternation between depolarization (to +20 mV) and hyperpolarization (to -110 mV) was applied to the neuron for 10 s at different frequencies (10 Hz to 1 kHz). The tested DRG neurons had APs of either a long duration (>10 ms) or a short duration (<10 ms). Membrane potential alternation at ≥500 Hz completely disrupted the AP generation, disabled the ion channel gating function, and produced membrane current alternating symmetrically across zero. Replacing extracellular sodium with potassium increased the amplitude of the membrane current response and caused the membrane current to be larger during hyperpolarization than during depolarization. These results support the hypothesis that high-frequency biphasic stimulation blocks axonal conduction by driving the potassium channel open constantly. Understanding neural membrane response to high-frequency membrane potential alternation is important to reveal the possible mechanisms underlying axonal conduction block induced by high-frequency biphasic stimulation.
Collapse
Affiliation(s)
- Zhijun Shen
- Department of UrologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jonathan Beckel
- Department of Pharmacology and Chemical BiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - William C. de Groat
- Department of Pharmacology and Chemical BiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Changfeng Tai
- Department of UrologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Pharmacology and Chemical BiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of BioengineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
| |
Collapse
|
10
|
Waataja JJ, Nihalani RK, Honda CN, Billington CJ. Use of a bio-electronic device comprising of targeted dual neuromodulation of the hepatic and celiac vagal branches demonstrated enhanced glycemic control in a type 2 diabetic rat model as well as in an Alloxan treated swine model. Front Neurosci 2022; 16:1005932. [PMID: 36389223 PMCID: PMC9640365 DOI: 10.3389/fnins.2022.1005932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is an unmet need for new type 2 diabetes treatments providing improved efficacy, durability and customized to improve patient’s compliance. Bio-electronic neuromodulation of Vagus nerve branches innervating organs that regulate plasma glucose, may be a method for treating type 2 diabetes. The pancreas has been shown to release insulin during Vagus stimulation. The hepatic vagal branch, innervating the liver, has been shown to decrease glucose release and decrease insulin resistance following ligation. However, standalone stimulation of the Vagus nerve has shown mixed results and Vagus nerve ligation has undesirable effects. Little is known; however, of the effect on plasma glucose with combined neuromodulation consisting of stimulation of the celiac branch innervating the pancreas with simultaneous high frequency alternating current (HFAC) blockade of the hepatic branch. This study tested the effects of this approach on increasing glycemic control in rat a model of type 2 diabetes and Alloxan treated swine. Materials and methods Zucker obese (fatty) male rats (ZDF fa/fa) were used as a model of type 2 diabetes as well as glucose intolerant Alloxan treated swine. In ZDF rat experiments glycemic control was accessed with an intravenous glucose tolerance test during HFAC-induced hepatic branch block with concurrent celiac stimulation (HFAC + stimulation). In swine experiments glycemic control was accessed by an oral glucose tolerance test during HFAC + stimulation. Insulin measurements were taken prior to and following swine experiments giving insight into beta cell exhaustion. Histopathology was conducted to determine safety of HFAC + stimulation on Vagal branches. Results Zucker rats demonstrated a significant improvement to an intravenous glucose tolerance test during HFAC + stimulation compared to sham. There was no significant difference from sham compared to hepatic vagotomy or celiac stimulation. In Alloxan treated swine, when subjected to HFAC + stimulation, there was a significant improvement in glycemic control as measured by an improvement on oral glucose tolerance tests and a decrease in fasting plasma glucose. Insulin responses were similar prior to and following HFAC + stimulation experiments. Histopathology demonstrated healthy swine Vagus nerves. Conclusion Electrical blockade of the hepatic Vagus branch with simultaneous stimulation of the celiac Vagus branch may be a novel, adjustable and localized approach for a treatment of type 2 diabetes.
Collapse
Affiliation(s)
- Jonathan J. Waataja
- ReShape Lifesciences Inc., San Clemente, CA, United States
- *Correspondence: Jonathan J. Waataja,
| | | | - Chris N. Honda
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Charles J. Billington
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Minnesota Veterans’ Administration Medical Center, Minneapolis, MN, United States
| |
Collapse
|
11
|
Green DB, Kilgore JA, Bender SA, Daniels RJ, Gunzler DD, Vrabec TL, Bhadra N. Effects of waveform shape and electrode material on KiloHertz frequency alternating current block of mammalian peripheral nerve. Bioelectron Med 2022; 8:11. [PMID: 35883133 PMCID: PMC9327420 DOI: 10.1186/s42234-022-00093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES KiloHertz frequency alternating current waveforms produce conduction block in peripheral nerves. It is not clearly known how the waveform shape affects block outcomes, and if waveform effects are frequency dependent. We determined the effects of waveform shape using two types of electrodes. MATERIALS AND METHODS Acute in-vivo experiments were performed on 12 rats. Bipolar electrodes were used to electrically block motor nerve impulses in the sciatic nerve, as measured using force output from the gastrocnemius muscle. Three blocking waveforms were delivered (sinusoidal, square and triangular) at 6 frequencies (10-60 kHz). Bare platinum electrodes were compared with carbon black coated electrodes. We determined the minimum amplitude that could completely block motor nerve conduction (block threshold), and measured properties of the onset response, which is a transient period of nerve activation at the start of block. In-vivo results were compared with computational modeling conducted using the NEURON simulation environment using a nerve membrane model modified for stimulation in the kilohertz frequency range. RESULTS For the majority of parameters, in-vivo testing and simulations showed similar results: Block thresholds increased linearly with frequency for all three waveforms. Block thresholds were significantly different between waveforms; lowest for the square waveform and highest for triangular waveform. When converted to charge per cycle, square waveforms required the maximum charge per phase, and triangular waveforms the least. Onset parameters were affected by blocking frequency but not by waveform shape. Electrode comparisons were performed only in-vivo. Electrodes with carbon black coatings gave significantly lower block thresholds and reduced onset responses across all blocking frequencies. For 10 and 20 kHz, carbon black coating significantly reduced the charge required for nerve block. CONCLUSIONS We conclude that both sinusoidal and square waveforms at frequencies of 20 kHz or higher would be optimal. Future investigation of carbon black or other high charge capacity electrodes may be useful in achieving block with lower BTs and onsets. These findings will be of importance for designing clinical nerve block systems.
Collapse
Affiliation(s)
- David B. Green
- grid.411931.f0000 0001 0035 4528Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH USA
| | - Joseph A. Kilgore
- grid.411931.f0000 0001 0035 4528Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Physical Medicine and Rehabilitation, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Shane A. Bender
- grid.411931.f0000 0001 0035 4528Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Physical Medicine and Rehabilitation, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Robert J. Daniels
- grid.411931.f0000 0001 0035 4528Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Physical Medicine and Rehabilitation, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Douglas D. Gunzler
- grid.411931.f0000 0001 0035 4528Department of Medicine, Population Health Research Institute, Center for Healthcare Research & Policy, MetroHealth Medical Center, Cleveland, OH USA
| | - Tina L. Vrabec
- grid.411931.f0000 0001 0035 4528Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Physical Medicine and Rehabilitation, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Niloy Bhadra
- grid.411931.f0000 0001 0035 4528Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Physical Medicine and Rehabilitation, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| |
Collapse
|
12
|
Zhong Y, Zhang X, Beckel J, de Groat WC, Tai C. Intracellular sodium concentration and membrane potential oscillation in axonal conduction block induced by high-frequency biphasic stimulation. J Neural Eng 2022; 19. [PMID: 35850095 PMCID: PMC9355690 DOI: 10.1088/1741-2552/ac81ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/18/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A new axonal conduction model was used to analyze the interaction between intracellular sodium concentration and membrane potential oscillation in axonal conduction block induced by high-frequency (kHz) biphasic stimulation (HFBS). APPROACH The model includes intracellular and extracellular sodium and potassium concentrations and ion pumps. First, the HFBS (1 kHz, 5.4 mA) was applied for a duration (59.4 seconds) long enough to produce an axonal conduction block after terminating the stimulation, i.e., a post-stimulation block. Then, the intensity of HFBS was reduced to a lower level for 4 seconds to determine if the axonal conduction block could be maintained. MAIN RESULTS The block duration was shortened from 1363 ms to 5 ms as the reduced HFBS intensity was increased from 0 mA to 4.1 mA. The block was maintained for the entire tested period (4000 ms) if the reduced intensity was above 4.2 mA. At the low intensity (<4.2 mA) the membrane potential oscillation disrupted the post-stimulation block caused by the increased intracellular sodium concentration, while at the high intensity (>4.2 mA) the membrane potential oscillation was strong enough to maintain the block and further increased the intracellular sodium concentration. SIGNIFICANCE This study indicates a possibility to develop a new nerve block method to reduce the HFBS intensity, which can extend the battery life for an implantable nerve stimulator in clinical applications to block pain of peripheral origin.
Collapse
Affiliation(s)
- Yihua Zhong
- University of Pittsburgh, Department of Urology, 700 Kaufmann Building, Pittsburgh, Pennsylvania, 15261, UNITED STATES
| | - Xu Zhang
- Capital Medical University, School of Biomedical Engineering and Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University,100069, Beijing, China, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing 100069, China, Beijing, 100054, CHINA
| | - Jonathan Beckel
- University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, Pittsburgh, Pennsylvania, 15261, UNITED STATES
| | - William C de Groat
- University of Pittsburgh School of Medicine, 4200 Fifth Ave, Pittsburgh,, Pittsburgh, Pennsylvania, 15261, UNITED STATES
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, 700 Kaufmann Building, Pittsburgh, PA 15213, USA, Pittsburgh, Pennsylvania, 15261, UNITED STATES
| |
Collapse
|
13
|
Peripheral Nerve Stimulation for Lower Extremity Pain. Biomedicines 2022; 10:biomedicines10071666. [PMID: 35884969 PMCID: PMC9313008 DOI: 10.3390/biomedicines10071666] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022] Open
Abstract
Peripheral nerve stimulation (PNS) is rapidly increasing in use. This interventional pain treatment modality involves modulating peripheral nerves for a variety of chronic pain conditions. This review evaluated its use specifically in the context of chronic lower extremity pain. Studies continue to elucidate the utility of PNS and better define indications, contraindications, as well as short- and long-term benefits of the procedure for the lower extremity. While large, prospective evidence is still lacking, the best available evidence suggests that improvements may be seen in pain scores, functionality, and opioid consumption. Overall, evidence synthesis suggests that PNS for the lower extremities may be a viable option for patients with chronic lower extremity pain.
Collapse
|
14
|
Kapural L, Syed Shah N, Fang ZP, Mekhail N. Multicenter, Double-Blinded, Randomized, Active-Sham Controlled Clinical Study Design to Assess the Safety and Effectiveness of a Novel High Frequency Electric Nerve Block System in the Treatment of Post-Amputation Pain (The QUEST Study). J Pain Res 2022; 15:1623-1631. [PMID: 35685299 PMCID: PMC9172922 DOI: 10.2147/jpr.s353674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic pain that follows amputation of a limb is reported as “one of the most severe pains in the human experience,” due to the magnitude of tissue injury and the multiple potential of pain generators at the local peripheral, spinal, and cortical levels. The Altius® System was developed to deliver high-frequency nerve block (HFNB) therapy via a cuff electrode applied to the peripheral nerve(s) and an implantable pulse generator. We report a novel clinical trial design for the first study of an active-implantable medical device in subjects with lower-limb post-amputation pain utilizing a multicenter, double-blinded, randomized, active-sham controlled clinical study protocol called QUEST, which is an ongoing investigational device exemption study to support United States Food and Drug Administration approval. Methods The study enrollment of 180 subjects was completed in September 2021. Subjects were randomized 1:1 to the treatment group or the active-sham control group for the 3-month primary effectiveness and safety endpoints. After month 3, the active-sham control program group crossed over to the treatment program group and all subjects continued to the 12-month study endpoint. Study effectiveness success is determined by a superiority test between responder rates in the treatment and control groups at 3 months. A responder is defined as someone who experiences a 50% or greater reduction in pain scores – after a 30-minute treatment session – for more than 50% of all pain episodes in which the treatment was used. Discussion The QUEST study design employs an active-sham control group to objectively assess the effectiveness of HFNB therapy. Additionally, the electronic diary repeated measures data collection in QUEST is expected to reduce the intra-subject variation typically observed in pain treatment studies. Finally, the longitudinal measurement of health-related quality of life and use of pain medication may, for example, show effectiveness in reducing opioid use over time.
Collapse
Affiliation(s)
- Leonardo Kapural
- Carolinas Pain Institute, Winston-Salem, NC, USA
- Correspondence: Leonardo Kapural, Carolinas Pain Institute, 145 Kimel Park Drive, Winston-Salem, NC, 27023, USA, Tel +1 336-765-6181, Email
| | | | | | - Nagy Mekhail
- Evidence-Based Pain Management Research, Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
15
|
Fogel HP, Winfree CJ. What’s New in Peripheral Nerve Stimulation. Neurosurg Clin N Am 2022; 33:323-330. [DOI: 10.1016/j.nec.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Álvarez DMC, Serrano-Muñoz D, Fernández-Pérez JJ, Gómez-Soriano J, Avendaño-Coy J. Effect of Percutaneous Electric Stimulation with High-Frequency Alternating Currents on the Sensory-Motor System of Healthy Volunteers: A Double-Blind Randomized Controlled Study. J Clin Med 2022; 11:jcm11071832. [PMID: 35407438 PMCID: PMC8999650 DOI: 10.3390/jcm11071832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
Former studies investigated the application of high-frequency alternating currents (HFAC) in humans for blocking the peripheral nervous system. The present trial aims to assess the effect of HFAC on the motor response, somatosensory thresholds, and peripheral nerve conduction when applied percutaneously using frequencies of 10 kHz and 20 kHz in healthy volunteers. A parallel, placebo-controlled, double-blind, randomized clinical trial was conducted. Ultrasound-guided HFAC at 10 kHz and 20 kHz and sham stimulation were delivered to the median nerve of 60 healthy volunteers for 20 min. The main assessed variables were the maximum isometric flexion strength (MFFS) of the index finger, myotonometry, pressure pain threshold (PPT), mechanical detection threshold (MDT), and sensory nerve action potential (SNAP). A decrease in the MFFS is observed immediately postintervention compared to baseline, both in the 10 kHz group (−8.5%; 95% CI −14.9 to −2.1) and the 20 kHz group (−12.0%; 95% CI −18.3 to −5.6). The between-group comparison of changes in MFFS show a greater reduction of −10.8% (95% CI −19.8 to −1.8) immediately postintervention in the 20 kHz compared to the sham stimulation group. The percutaneous stimulation applying 20 kHz HFAC to the median nerve produces a reversible postintervention reduction in strength with no adverse effects.
Collapse
|
17
|
Helm S, Shirsat N, Calodney A, Abd-Elsayed A, Kloth D, Soin A, Shah S, Trescot A. Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety. Pain Ther 2021; 10:985-1002. [PMID: 34478120 PMCID: PMC8586061 DOI: 10.1007/s40122-021-00306-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022] Open
Abstract
Peripheral nerve stimulation (PNS) was the first application of neuromodulation. Widespread application of PNS was limited by technical concerns. Recent advances now allow the percutaneous placement of leads with ultrasound or fluoroscopic guidance, while the transcutaneous powering of these leads removes the need for leads to cross major joints. This systematic review was written to assess the current status of high-quality evidence supporting the use of PNS for pain conditions treated by interventional pain physicians. The available literature on PNS, limited to conditions treated by interventional pain physicians, was reviewed and the quality assessed. Literature from 1966 to June 2021 was reviewed. The outcome measures were pain relief and functional improvement. One hundred and two studies were identified. Five randomized controlled trials (RCT) and four observational studies, all case series, met the inclusion criteria. One RCT was of high quality and four were of moderate quality; all four case series were of moderate quality. Three of the RCTs and all four case series evaluated peripheral nerve neuropathic pain. Based upon these studies, there is level II evidence supporting the use of PNS to treat refractory peripheral nerve injury. One moderate-quality RCT evaluated tibial nerve stimulation for pelvic pain, providing level III evidence for this indication. One moderate-quality RCT evaluated surgically placed cylindrical leads for cluster headaches, providing level III evidence for this indication. The evidence suggests that approximately two-thirds of patients with peripheral neuropathic pain will have at least 50% sustained pain relief. Adverse events from PNS are generally minor. A major advantage of PNS over spinal cord stimulation is the absence of any risk of central cord injury. The study was limited by the paucity of literature for some indications. No studies dealt with joint-related osteoarthritic pain.
Collapse
Affiliation(s)
- Standiford Helm
- Department of Anesthesiology and Pain Management, University of California, Irvine, Orange, CA, USA.
| | - Nikita Shirsat
- School of Medicine, University of California, Irvine, Orange, CA, USA
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology and Pain Management, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Shalini Shah
- Department of Anesthesiology and Pain Management, University of California, Irvine, Orange, CA, USA
| | | |
Collapse
|
18
|
Zhong Y, Wang J, Beckel J, de Groat WC, Tai C. High-frequency stimulation induces axonal conduction block without generating initial action potentials. J Comput Neurosci 2021; 50:203-215. [PMID: 34800252 PMCID: PMC9035068 DOI: 10.1007/s10827-021-00806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this modeling study is to develop a novel method to block nerve conduction by high frequency biphasic stimulation (HFBS) without generating initial action potentials. An axonal conduction model including both ion concentrations and membrane ion pumps is used to analyze the axonal response to 1 kHz HFBS. The intensity of HFBS is increased in multiple steps while maintaining the intensity at a sub-threshold level to avoid generating an action potential. Axonal conduction block by HFBS is defined as the failure of action potential propagation at the site of HFBS. The simulation analysis shows that step-increases in sub-threshold intensity during HFBS can successfully block axonal conduction without generating an initial response because the excitation threshold of the axon can be gradually increased by the sub-threshold HFBS. The mechanisms underlying the increase in excitation threshold involve changes in intracellular and extracellular sodium and potassium concentration, change in the resting potential, partial inactivation of the sodium channel and partial activation of the potassium channel by HFBS. When the excitation threshold reaches a sufficient level, an acute block occurs first and after additional sub-threshold HFBS it is followed by a post-stimulation block. This study indicates that step-increases in sub-threshold HFBS intensity induces a gradual increase in axonal excitation threshold that may allow HFBS to block nerve conduction without generating an initial response. If this finding is proven to be true in human, it will significantly impact clinical applications of HFBS to treat chronic pain.
Collapse
Affiliation(s)
- Yihua Zhong
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,School of Biomedical Engineering, Capital Medical University, Beijing, P.R. China
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
19
|
Peterken F, Benjaber M, Doherty S, Perkins T, Creasey G, Donaldson N, Andrews B, Denison T. Adapting the Finetech-Brindley Sacral Anterior Root Stimulator for Bioelectronic Medicine . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6406-6411. [PMID: 34892578 DOI: 10.1109/embc46164.2021.9630995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Finetech-Brindley Sacral Anterior Root Stimulator (SARS) is a low cost and reliable system. The architecture has been used for various bioelectric treatments, including several thousand implanted systems for restoring bladder function following spinal cord injury (SCI). Extending the operational frequency range would expand the capability of the system; enabling, for example, the exploration of eliminating the rhizotomy through an electrical nerve block. The distributed architecture of the SARS system enables stimulation parameters to be adjusted without modifying the implant design or manufacturing. To explore the design degrees-of-freedom, a circuit simulation was created and validated using a modified SARS system that supported stimulation frequencies up to 600 Hz. The simulation was also used to explore high frequency (up to 30kHz) behaviour, and to determine the constraints on charge delivered at the higher rates. A key constraint found was the DC blocking capacitors, designed originally for low frequency operation, not fully discharging within a shortened stimulation period. Within these current implant constraints, we demonstrate the potential capability for higher frequency operation that is consistent with presynaptic stimulation block, and also define targeted circuit improvements for future extension of stimulation capability.
Collapse
|
20
|
Chen J, Jian J, Wang J, Shen Z, Shen B, Wang W, Beckel J, de Groat WC, Chermansky C, Tai C. Low pressure voiding induced by stimulation and 1 kHz post-stimulation block of the pudendal nerves in cats. Exp Neurol 2021; 346:113860. [PMID: 34487735 DOI: 10.1016/j.expneurol.2021.113860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
The goal of this study is to induce low-pressure voiding by stimulation and bilateral 1 kHz post-stimulation block of the pudendal nerves. In anesthetized cats, wire hook electrodes were placed on the left and/or right pudendal nerves. Stimulus pulses (30 Hz, 0.2 ms) were applied to one pudendal nerve to induce a reflex bladder contraction and to produce contractions of the external urethral sphincter (EUS). High frequency (1 kHz) biphasic stimulation was applied to block axonal conduction in both pudendal nerves and block EUS activity. In 4 cats, a catheter was inserted into the distal urethra to perfuse and measure the back pressure caused by the EUS contraction. In another 5 cats, a catheter was inserted into the bladder dome and the urethra was left open to allow voiding. The 1 kHz stimulation (30-60 s, 0.5-5 mA) delivered via a wire hook electrode completely blocked pudendal nerve conduction for ≥2 min after terminating the stimulation, i.e., a post-stimulation block. The block gradually disappeared in 6-18 min. The block duration increased with increasing amplitude or duration of the 1 kHz stimulation. Without the 1 kHz block, 30 Hz stimulation alone induced high-pressure (90 cmH2O) voiding. When combined with the 1 kHz block, the 30 Hz stimulation induced low-pressure (≤50 cmH2O) voiding with a high voiding efficiency (80%). In summary, a minimally invasive surgical approach might be developed to restore voiding function after spinal cord injury by stimulation and block of the pudendal nerves using lead electrodes.
Collapse
Affiliation(s)
- Jialiang Chen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Jianan Jian
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhijun Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
21
|
Hyung B, Wiseman-Hakes C. A scoping review of current non-pharmacological treatment modalities for phantom limb pain in limb amputees. Disabil Rehabil 2021; 44:5719-5740. [PMID: 34293999 DOI: 10.1080/09638288.2021.1948116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Phantom limb pain (PLP) is a chronic neuropathic pain condition of a missing limb following amputation. Pain management is multi-modal, including various non-pharmacological therapies. The purpose of this scoping review was to investigate the evidence surrounding current non-pharmacological treatment modalities for PLP and provide insight into their clinical feasibility. METHOD A systematic search was conducted using four databases (Medline, Embase, PsychInfo, and CINAHL) following the PRISMA-ScR method. Results from papers meeting the inclusion criteria were charted to summarize findings, demographics, and use of neuroimaging. RESULTS A total of 3387 papers were identified, and full texts of 142 eligible papers were assessed. Eleven treatment modalities for PLP were identified with varying levels of evidence. Overall, there were 25 RCTs, 58 case reports, and 59 a combination of pilot, quasi-experimental, observational, and other study designs. CONCLUSIONS Currently, the evidence surrounding most treatment modalities is limited and only a fraction of studies are supported by strong evidence. The findings of this review demonstrated a clear need to conduct more rigorous research with diverse study designs to better understand which modalities provide the most benefit and to incorporate neuroimaging to better determine the neural correlates of PLP and mechanisms of various treatments.Implications for RehabilitationPhantom limb pain (PLP) is a prevalent and debilitating condition following amputation and health care professionals should incorporate an evidence-based pain management protocol into their rehabilitation program.There exist a number of different non-pharmacological therapies to address PLP, however the scientific rigor and levels of evidence vary across modalities.Prescription of interventions for PLP should consider individual patient differences, accessibility to the patient, and quite possibly, a multi-modal approach, particularly for those who also experience residual limb pain.Imagery-based therapies provide the highest level of current evidence based on robust and large randomized control trials, are readily accessible, and are thus most recommended for relief of PLP.
Collapse
Affiliation(s)
- Brian Hyung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Catherine Wiseman-Hakes
- School of Rehabilitation Sciences Institute, McMaster University, Hamilton, Canada.,KITE-University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| |
Collapse
|
22
|
Sondekoppam RV, Ip V, Tsui BCH. Feasibility of Combining Nerve Stimulation and Local Anesthetic Infusion to Treat Acute Postamputation Pain: A Case Report of a Hybrid Technique. A A Pract 2021; 15:e01487. [PMID: 34100779 DOI: 10.1213/xaa.0000000000001487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pain following amputation is often poorly controlled despite the use of nerve blocks. We describe a novel pain management approach in a 56-year-old woman with episodes of poorly controlled pain following below-knee amputation despite a multimodal analgesic regimen with continuous sciatic nerve block. Effective analgesia was observed during those episodes when the nerve block catheter was briefly stimulated at low frequency using a nerve stimulator designed for regional anesthesia procedural guidance. This case report explains the utilization and rationale of this hybrid technique of combined peripheral nerve stimulation and locoregional analgesia via perineural nerve block catheters to augment analgesia.
Collapse
Affiliation(s)
- Rakesh V Sondekoppam
- From the Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Vivian Ip
- Department of Anesthesia and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| |
Collapse
|
23
|
Eggers T, Kilgore J, Green D, Vrabec T, Kilgore K, Bhadra N. Combining direct current and kilohertz frequency alternating current to mitigate onset activity during electrical nerve block. J Neural Eng 2021; 18. [PMID: 33662942 PMCID: PMC9511888 DOI: 10.1088/1741-2552/abebed] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/04/2021] [Indexed: 11/12/2022]
Abstract
Objective. Electrical nerve block offers the ability to immediately and reversibly block peripheral nerve conduction and would have applications in the emerging field of bioelectronics. Two modalities of electrical nerve block have been investigated—kilohertz frequency alternating current (KHFAC) and direct current (DC). KHFAC can be safely delivered with conventional electrodes, but has the disadvantage of having an onset response, which is a period of increased neural activation before block is established and currently limits clinical translation. DC has long been known to block neural conduction without an onset response but creates damaging reactive species. Typical electrodes can safely deliver DC for less than one second, but advances in high capacitance electrodes allow DC delivery up to 10 s without damage. The present work aimed to combine DC and KHFAC into a single waveform, named the combined reduced onset waveform (CROW), which can initiate block without an onset response while also maintaining safe block for long durations. This waveform consists of a short, DC pre-pulse before initiating KHFAC. Approach. Simulations of this novel waveform were carried out in the axonal simulation environment NEURON to test feasibility and gain insight into the mechanisms of action. Two sets of acute experiments were then conducted in adult Sprague–Dawley rats to determine the effectiveness of the waveform in mitigating the onset response. Main results. The CROW reduced the onset response both in silico and in vivo. The onset area was reduced by over 90% with the tested parameters in the acute experiments. The amplitude of the DC pulse was shown to be particularly important for effective onset mitigation, requiring amplitudes 6–8 times the DC block threshold. Significance. This waveform can reliably reduce the onset response due to KHFAC and could allow for wider clinical implementation of electrical nerve block.
Collapse
Affiliation(s)
- Thomas Eggers
- Emory University School of Medicine, Atlanta, GA, United States of America
| | - Joseph Kilgore
- MetroHealth Medical Center, Cleveland, OH, United States of America
| | - David Green
- MetroHealth Medical Center, Cleveland, OH, United States of America
| | - Tina Vrabec
- MetroHealth Medical Center, Cleveland, OH, United States of America
| | - Kevin Kilgore
- MetroHealth Medical Center, Cleveland, OH, United States of America.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.,Louis Stokes Cleveland Department Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | - Niloy Bhadra
- MetroHealth Medical Center, Cleveland, OH, United States of America
| |
Collapse
|
24
|
Neudorfer C, Chow CT, Boutet A, Loh A, Germann J, Elias GJ, Hutchison WD, Lozano AM. Kilohertz-frequency stimulation of the nervous system: A review of underlying mechanisms. Brain Stimul 2021; 14:513-530. [PMID: 33757930 DOI: 10.1016/j.brs.2021.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electrical stimulation in the kilohertz-frequency range has gained interest in the field of neuroscience. The mechanisms underlying stimulation in this frequency range, however, are poorly characterized to date. OBJECTIVE/HYPOTHESIS To summarize the manifold biological effects elicited by kilohertz-frequency stimulation in the context of the currently existing literature and provide a mechanistic framework for the neural responses observed in this frequency range. METHODS A comprehensive search of the peer-reviewed literature was conducted across electronic databases. Relevant computational, clinical, and mechanistic studies were selected for review. RESULTS The effects of kilohertz-frequency stimulation on neural tissue are diverse and yield effects that are distinct from conventional stimulation. Broadly, these can be divided into 1) subthreshold, 2) suprathreshold, 3) synaptic and 4) thermal effects. While facilitation is the dominating mechanism at the subthreshold level, desynchronization, spike-rate adaptation, conduction block, and non-monotonic activation can be observed during suprathreshold kilohertz-frequency stimulation. At the synaptic level, kilohertz-frequency stimulation has been associated with the transient depletion of the available neurotransmitter pool - also known as synaptic fatigue. Finally, thermal effects associated with extrinsic (environmental) and intrinsic (associated with kilohertz-frequency stimulation) temperature changes have been suggested to alter the neural response to stimulation paradigms. CONCLUSION The diverse spectrum of neural responses to stimulation in the kilohertz-frequency range is distinct from that associated with conventional stimulation. This offers the potential for new therapeutic avenues across stimulation modalities. However, stimulation in the kilohertz-frequency range is associated with distinct challenges and caveats that need to be considered in experimental paradigms.
Collapse
Affiliation(s)
- Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Canada
| | - Gavin Jb Elias
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Canada
| | - William D Hutchison
- Krembil Research Institute, University of Toronto, Ontario, Canada; Department of Physiology, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Research Institute, University of Toronto, Ontario, Canada.
| |
Collapse
|
25
|
Restoring both continence and micturition after chronic spinal cord injury by pudendal neuromodulation. Exp Neurol 2021; 340:113658. [PMID: 33639209 DOI: 10.1016/j.expneurol.2021.113658] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/23/2021] [Accepted: 02/22/2021] [Indexed: 01/23/2023]
Abstract
Neurogenic bladder management after spinal cord injury (SCI) is very challenging. Daily urethral catheterization is most commonly used to empty the bladder, which causes frequent infections of the lower urinary tract. This study reports a novel idea to restore both continence and micturition after SCI by an implantable pudendal nerve stimulator (PNS). The PNS was surgically implanted in four cats with complete SCI at T9-T10 spinal level and tested weekly for 13-14 weeks under awake conditions. These chronic SCI cats consistently exhibited large residual bladder volumes (average 40-50 ml) due to their inability to void efficiently, while urine leakage also occurred frequently. The PNS which consisted of stimulating the pudendal nerve at 20-30 Hz to trigger a spinal reflex bladder contraction and at the same time blocking the pudendal nerves bilaterally with 10 kHz stimulation to relax the external urethral sphincter and reduce the urethral outlet resistance successfully induced highly efficient (average 80-100%), low pressure (<50 cmH2O) voiding. The PNS at 5 Hz also promoted urine storage by inhibiting reflex bladder activity and increasing bladder capacity. At the end of 14-week chronic testing, low pressure efficient voiding induced by PNS was further confirmed under anesthesia by directly measuring voiding pressure using a bladder catheter inserted through the bladder dome. This study demonstrated the efficacy and safety of the PNS in awake chronic SCI cats, suggesting that a novel neuroprosthesis can be developed for humans to restore bladder function after SCI by stimulating and/or blocking the pudendal nerves.
Collapse
|
26
|
Zhong Y, Wang J, Beckel J, de Groat WC, Tai C. Model Analysis of Post-Stimulation Effect on Axonal Conduction and Block. IEEE Trans Biomed Eng 2021; 68:2974-2985. [PMID: 33544668 DOI: 10.1109/tbme.2021.3057522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To reveal the possible contribution of changes in membrane ion concentration gradients and ion pump activity to axonal conduction/block induced by long-duration electrical stimulation. METHODS A new model for conduction and block of unmyelinated axons based on the classical Hodgkin-Huxley (HH) equations is developed to include changes in Na+ and K+ concentrations and ion pumps. The effects of long-duration stimulation on axonal conduction/block is analyzed by computer simulation using this new model. RESULTS The new model successfully simulates initiation, propagation, and block of action potentials induced by short-duration (multiple milliseconds) stimulations that do not significantly change the ion concentrations in the classical HH model. In addition, the activity-dependent effects such as action potential attenuation and broadening observed in animal studies are also successfully simulated by the new model. Finally, the model successfully simulates axonal block occurring after terminating a long-duration (multiple seconds) direct current (DC) stimulation as observed in recent animal studies and reveals 3 different mechanisms for the post-DC block of axonal conduction. CONCLUSION Ion concentrations and pumps play an important role in post-stimulation effects and activity-dependent effects on axonal conduction/block. The duration of stimulation is a determinant factor because it influences the total charges applied to the axon, which in turn determines the ion concentrations inside and outside the axon. SIGNIFICANCE Despite recent clinical success of many neurostimulation therapies, the effects of long-duration stimulation on axonal conduction/block are poorly understood. This new model could significantly impact our understanding of the mechanisms underlying different neurostimulation therapies.
Collapse
|
27
|
Dewberry LS, Dru A, Gravenstine M, Nguyen B, Anderson J, Vaziri S, Hoh D, Allen K, Otto KJ. Partial high frequency nerve block decreases neuropathic signaling following chronic sciatic nerve constriction injury. J Neural Eng 2020; 18. [PMID: 33027782 DOI: 10.1088/1741-2552/abbf03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/07/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE High frequency (HF) block can quickly and reversibly stop nerve conduction. We hypothesized HF block at the sciatic nerve would minimize nociception by preventing neuropathic signals from reaching the central nervous system. APPROACH Lewis rats were implanted with a constriction cuff and a distal cuff electrode around their right sciatic nerve. Tactile sensitivity was evaluated using the 50% paw withdrawal threshold determined using Chaplan's method for von Frey monofilaments. Over the course of 49 days, the 50% paw withdrawal threshold was measured 1) before HF block, 2) during HF block (50 kHz, 3 Vpp), and 3) after HF block. Gait was observed and scored before and during block. At end point, HF block efficacy was directly evaluated using additional cuff electrodes to elicit and record compound neural action potentials across the HF blocking cuff. MAIN RESULTS At days 7 and 14 days post-operation, tactile sensitivity was significantly lower during HF block compared to before and after block (p < 0.005). Additionally, an increase in gait disability was not visually observed during HF block. SIGNIFICANCE HF block can reduce tactile sensitivity in a limb with a neuropthic injury in a rapidly reversible fashion.
Collapse
Affiliation(s)
- Lauren Savannah Dewberry
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Biomedical Sciences Building JG56, Gainesville, FL 32611-6131, Gainesville, Florida, 32611-7011, UNITED STATES
| | - Alexander Dru
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, UNITED STATES
| | - Maxwell Gravenstine
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, UNITED STATES
| | - Brian Nguyen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, UNITED STATES
| | - James Anderson
- Department of Microbiology and Cell Science, University of Florida, Gainesville, Florida, UNITED STATES
| | - Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, UNITED STATES
| | - Daniel Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, UNITED STATES
| | - Kyle Allen
- Department of Biomedical Engineering, University of Florida, P.O. Box 116131, USA, Gainesville, Florida, 32611-6131, UNITED STATES
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, 32611-7011, UNITED STATES
| |
Collapse
|
28
|
Daggubati LC, Davanzo JR, Rizk EB. Peripheral nerve stimulator for terminal sciatic nerve neuromas in an amputee. NEUROSURGICAL FOCUS: VIDEO 2020; 3:V7. [PMID: 36285269 PMCID: PMC9542685 DOI: 10.3171/2020.7.focvid2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022]
Abstract
Neuromas are a difficult-to-treat peripheral nerve pathology that can cause crippling pain. Optimal treatment is widely debated as pharmacological intervention frequently is not sufficient and surgical interventions are plagued with recurrence. The majority of amputees report severe and chronic stump pain. Avoiding complex surgery at the stump site would prevent infection or wound dehiscence. Recent advances in neuromodulation with external pulse emitters allow for pain relief with localized nerve stimulation. The authors describe the novel placement of a sciatic nerve stimulator in a 77-year-old man for painful stump neuromas of the common peroneal and tibial nerves. The video can be found here: https://youtu.be/96kKs3qjtqc
Collapse
|
29
|
Shapiro K, Guo W, Armann K, Pace N, Shen B, Wang J, Beckel J, de Groat W, Tai C. Pudendal Nerve Block by Low-Frequency (≤1 kHz) Biphasic Electrical Stimulation. Neuromodulation 2020; 24:1012-1017. [PMID: 32762142 DOI: 10.1111/ner.13241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To test the hypothesis that poststimulation block of nerve conduction can be achieved by low-frequency (≤1 kHz) biphasic stimulation (LFBS). MATERIALS AND METHODS A tripolar cuff electrode was placed around the pudendal nerve in cats to deliver LFBS (1 kHz, 500 Hz, and 100 Hz). Two bipolar hook electrodes were placed central and distal to the cuff electrode to induce external urethral sphincter (EUS) contractions. A catheter was inserted into the urethra to record EUS contraction pressure. Pudendal nerve block by LFBS was confirmed by the failure of the central hook electrode stimulation to induce EUS contractions, while the distal hook electrode stimulation still induced contractions. RESULTS Pudendal nerve conduction was completely blocked by LFBS at different frequencies (1 kHz, 500 Hz, and 100 Hz) after terminating LFBS. The post-LFBS block induced at the minimal stimulation intensity and duration was fully reversible within the same time period (10-15 min on average) for the three frequencies. However, the stimulation duration to induce block significantly (p < 0.05) increased from 23 ± 8 sec to 95 ± 14 sec when frequency increased from 100 Hz to 1 kHz. CONCLUSION This study discovered that LFBS (≤1 kHz), like high-frequency (≥5 kHz) biphasic stimulation (HFBS), can induce poststimulation block. The result provides support for the theory that biphasic stimulation waveforms block axonal conduction by changing intracellular and extracellular ion concentrations. The post-LFBS block provides the opportunity to develop new neuromodulation devices for clinical applications where initial nerve firing is acceptable.
Collapse
Affiliation(s)
- Katherine Shapiro
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wenbin Guo
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China
| | - Kody Armann
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Natalie Pace
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, PA, USA
| | - William de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
30
|
Morgan T, Zhang Y, Pace N, Cai H, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Thermal block of mammalian unmyelinated C fibers by local cooling to 15-25°C after a brief heating at 45°C. J Neurophysiol 2020; 123:2173-2179. [PMID: 32374221 DOI: 10.1152/jn.00133.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to examine the changes in cold block of unmyelinated C fibers in the tibial nerve by preconditioning with heating and to develop a safe method for thermal block of C-fiber conduction. In seven cats under α-chloralose anesthesia, C-fiber-evoked potentials elicited by electrical stimulation were recorded on the tibial nerve during block of axonal conduction induced by exposing a small segment (9 mm) of the nerve to cooling (from 35°C to ≤5°C) or heating (45°C). Before heating, partial, reproducible, and reversible cold block was first detected at a threshold cold block temperature of 15°C and complete cold block occurred at a temperature of ≤5°C. After the nerve was heated at 45°C for 5-35 min, the threshold cold block temperature significantly (P < 0.05) increased from 15°C to 25°C and the complete cold block temperature significantly (P < 0.05) increased from ≤5°C to 15°C on average. The increased cold block temperatures persisted for the duration of the experiments (30-100 min) while the amplitude of the C-fiber-evoked potential measured at 35°C recovered significantly (P < 0.05) to ~80% of control. This study discovered a novel thermal method to block mammalian C fibers at an elevated temperature (15-25°C), providing the opportunity to develop a thermal nerve block technology to suppress chronic pain of peripheral origin. The interaction between heating and cooling effects on C-fiber conduction indicates a possible interaction between different temperature-sensitive channels known to be present in the mammalian C fibers.NEW & NOTEWORTHY Our study discovered that the temperature range for producing a partial to complete cold block of mammalian C-fiber axons can be increased from 5-15°C to 15-25°C on average after a preheating at 45°C. This discovery raises many basic scientific questions about the influence of temperature on nerve conduction and block. It also raises the possibility of developing a novel implantable nerve block device to treat many chronic diseases including chronic pain.
Collapse
Affiliation(s)
- Tara Morgan
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yan Zhang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Transplantation Center, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Peoples Republic of China
| | - Natalie Pace
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Haotian Cai
- School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
31
|
Deer TR, Naidu R, Strand N, Sparks D, Abd-Elsayed A, Kalia H, Hah JM, Mehta P, Sayed D, Gulati A. A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions. Bioelectron Med 2020; 6:9. [PMID: 32346553 PMCID: PMC7181529 DOI: 10.1186/s42234-020-00045-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Peripheral Nerve Stimulation has been used to treat human disease including pain for several decades. Innovation has made it a more viable option for treatment of common chronic pain processes, and interest in the therapy is increasing. Main body While clinical data is forthcoming, understanding factors that influence successful outcomes in the use of PNS still needs to be delineated. This article reviews the evolution and bioelectronic principles of peripheral nerve stimulation including patient selection, nerve targets, techniques and guidance of target delivery. We collate the current evidence for outcomes and provide recommendations for salient topics in PNS. Conclusion Peripheral nerve stimulation has evolved from a surgically invasive procedure to a minimally invasive technique that can be used early in the treatment of peripheral nerve pain. This review identifies and addresses many of the variables which influence the success of PNS in the clinical setting.
Collapse
Affiliation(s)
- Timothy R Deer
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Ramana Naidu
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Natalie Strand
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Dawn Sparks
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Alaa Abd-Elsayed
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Hemant Kalia
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Jennifer M Hah
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Pankaj Mehta
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Dawood Sayed
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| | - Amitabh Gulati
- Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA
| |
Collapse
|
32
|
Fishman MA, Antony A, Esposito M, Deer T, Levy R. The Evolution of Neuromodulation in the Treatment of Chronic Pain: Forward-Looking Perspectives. PAIN MEDICINE 2020; 20:S58-S68. [PMID: 31152176 PMCID: PMC6600066 DOI: 10.1093/pm/pnz074] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The field of neuromodulation is continually evolving, with the past decade showing significant advancement in the therapeutic efficacy of neuromodulation procedures. The continued evolution of neuromodulation technology brings with it the promise of addressing the needs of both patients and physicians, as current technology improves and clinical applications expand. Design This review highlights the current state of the art of neuromodulation for treating chronic pain, describes key areas of development including stimulation patterns and neural targets, expanding indications and applications, feedback-controlled systems, noninvasive approaches, and biomarkers for neuromodulation and technology miniaturization. Results and Conclusions The field of neuromodulation is undergoing a renaissance of technology development with potential for profoundly improving the care of chronic pain patients. New and emerging targets like the dorsal root ganglion, as well as high-frequency and patterned stimulation methodologies such as burst stimulation, are paving the way for better clinical outcomes. As we look forward to the future, neural sensing, novel target-specific stimulation patterns, and approaches combining neuromodulation therapies are likely to significantly impact how neuromodulation is used. Moreover, select biomarkers may influence and guide the use of neuromodulation and help objectively demonstrate efficacy and outcomes.
Collapse
Affiliation(s)
| | | | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia
| | - Robert Levy
- Institute for Neuromodulation, Boca Raton, Florida, USA
| |
Collapse
|
33
|
|
34
|
Pelot NA, Grill WM. In vivo quantification of excitation and kilohertz frequency block of the rat vagus nerve. J Neural Eng 2020; 17:026005. [PMID: 31945746 DOI: 10.1088/1741-2552/ab6cb6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE There is growing interest in treating diseases by electrical stimulation and block of peripheral autonomic nerves, but a paucity of studies on the excitation and block of small-diameter autonomic axons. We conducted in vivo quantification of the strength-duration properties, activity-dependent slowing (ADS), and responses to kilohertz frequency (KHF) signals for the rat vagus nerve (VN). APPROACH We conducted acute in vivo experiments in urethane-anaesthetized rats. We placed two cuff electrodes on the left cervical VN and one cuff electrode on the anterior subdiaphragmatic VN. The rostral cervical cuff was used to deliver pulses to quantify recruitment and ADS. The caudal cervical cuff was used to deliver KHF signals. The subdiaphragmatic cuff was used to record compound action potentials (CAPs). MAIN RESULTS We quantified the input-output recruitment and strength-duration curves. Fits to the data using standard strength-duration equations were qualitatively similar, but the resulting chronaxie and rheobase estimates varied substantially. We measured larger thresholds for the slowest fibres (0.5-1 m s-1), especially at shorter pulse widths. Using a novel cross-correlation CAP-based analysis, we measured ADS of ~2.3% after 3 min of 2 Hz stimulation, which is comparable to the ADS reported for sympathetic efferents in somatic nerves, but much smaller than the ADS in cutaneous nociceptors. We found greater ADS with higher stimulation frequency and non-monotonic changes in CV in select cases. We found monotonically increasing block thresholds across frequencies from 10 to 80 kHz for both fast and slow fibres. Further, following 25 s of KHF signal, neural conduction could require tens of seconds to recover. SIGNIFICANCE The quantification of mammalian autonomic nerve responses to conventional and KHF signals provides essential information for the development of peripheral nerve stimulation therapies and for understanding their mechanisms of action.
Collapse
Affiliation(s)
- N A Pelot
- Department of Biomedical Engineering, Duke University, Room 1427, Fitzpatrick CIEMAS, 101 Science Drive, Campus Box 90281, Durham, NC 27708, United States of America
| | | |
Collapse
|
35
|
Serrano-Muñoz D, Avendaño-Coy J, Simón-Martínez C, Taylor J, Gómez-Soriano J. 20-kHz alternating current stimulation: effects on motor and somatosensory thresholds. J Neuroeng Rehabil 2020; 17:22. [PMID: 32075666 PMCID: PMC7031925 DOI: 10.1186/s12984-020-00661-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High frequency alternating current (HFAC) stimulation have been shown to produce a peripheral nerve conduction block. Currently, all the studies applying HFAC stimulation in clinical studies, have employed frequencies below 10 kHz. The main aim of this work was to investigate the neuromodulatory effect of transcutaneous 20 kHz stimulation on somatosensory and pain thresholds, and maximal handgrip strength. METHODS A randomized, crossover, single-blinded, placebo-controlled trial was conducted following recruitment of fourteen healthy volunteers. Transcutaneous stimulation at 20 kHz and sham stimulation were applied over the ulnar and median nerves of fourteen healthy volunteers for 20 min. Maximal handgrip strength (MHS), mechanical detection threshold (MDT) and pressure pain threshold (PPT) were registered prior to, during (15 min), immediately after the end (20 min), and 10 min following stimulation. RESULTS The 20 kHz stimulation showed a lower MHS during the stimulation at the 15 min (30.1 kgs SE 2.8) and at 20 min (31.8 kgs, SE 2.8) when compared to sham stimulation (35.1 kgs, SE 3.4; p < 0.001 and 34.2 kgs, SE 3.4; p = 0.03, respectively). The 20 kHz stimulation resulted in a slight increase in MDT at 15 min (0.25 mN; 0.25-2.00) when compared to the sham stimulation (0.25 mN; 0.25-0.25; p = 0.02), and no effects were showed for PPT. CONCLUSIONS High-frequency stimulation at 20 kHz suggests a partial block of nerve activity. Studies in subjects with neurological disorders characterized by nerve hyperactivity are needed to confirm the clinical impact of this non-invasive electrical stimulation technique. TRIAL REGISTRATION NCT, NCT02837458. Registered on 12 April 2017.
Collapse
Affiliation(s)
- Diego Serrano-Muñoz
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, 45071, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain.
| | - Cristina Simón-Martínez
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, 45071, Toledo, Spain
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| |
Collapse
|
36
|
Rohatgi P, Chivukula S, Kashanian A, Bari AA. Peripheral Nerve Stimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
37
|
Wang Z, Pace N, Cai H, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Poststimulation Block of Pudendal Nerve Conduction by High-Frequency (kHz) Biphasic Stimulation in Cats. Neuromodulation 2019; 23:747-753. [PMID: 32840020 DOI: 10.1111/ner.13060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the relationship between various parameters of high-frequency biphasic stimulation (HFBS) and the recovery period of post-HFBS block of the pudendal nerve in cats. MATERIALS AND METHODS A tripolar cuff electrode was implanted on the pudendal nerve to deliver HFBS in ten cats. Two hook electrodes were placed central or distal to the cuff electrode to stimulate the pudendal nerve and induce contractions of external urethral sphincter (EUS). A catheter was inserted toward the distal urethra to slowly perfuse the urethra and record the back-up pressure generated by EUS contractions. After determining the block threshold (T), HFBS (6 or 10 kHz) of different durations (1, 5, 10, 20, 30 min) and intensities (1T or 2T) was used to produce the post-HFBS block. RESULTS HFBS at 10 kHz and 1T intensity must be applied for at least 30 min to induce post-HFBS block. However, 10 kHz HFBS at a higher intensity (2T) elicited post-HFBS block after stimulation of only 10 min; and 10 kHz HFBS at 2T for 30 min induced a longer-lasting (1-3 h) post-HFBS block that fully recovered with time. HFBS of 5-min duration at 6 kHz produced a longer period (20.4 ± 2.1 min, p < 0.05, N = 5 cats) of post-HFBS block than HFBS at 10 kHz (9.5 ± 2.1 min). CONCLUSION HFBS of longer duration, higher intensity, and lower frequency can produce longer-lasting reversible post-HFBS block. This study is important for developing new methods to block nerve conduction by HFBS.
Collapse
Affiliation(s)
- Zhaoxia Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Urology, Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
| | - Natalie Pace
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Haotian Cai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
38
|
Kim Y, Bulea TC, Park HS. Transcutaneous high-frequency alternating current for rapid reversible muscle force reduction below pain threshold. J Neural Eng 2019; 16:066013. [PMID: 31344687 DOI: 10.1088/1741-2552/ab35ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The development of non-invasive, quickly reversible techniques for controlling undesired muscle force production (e.g. spasticity) could expand rehabilitation approaches in those with pathology by increasing the type and intensity of exercises that can be performed. High-frequency alternating current (HFAC) has been previously established as a viable method for blocking neural conduction in peripheral nerves. However, clinical application of HFAC for nerve conduction block is limited due to the invasiveness of surgical procedures and the painful onset response. This study aimed to examine the use of transcutaneous HFAC (tHFAC) at various stimulation frequencies to address these shortfalls. APPROACH Ten individuals participated in the study. Surface electrodes were utilized to apply tHFAC (0.5-12 kHz) to the median and ulnar nerves. Individual pain threshold was determined by gradual increase of stimulation amplitude. Subjects then performed a force-matching task by producing grip forces up to the maximal voluntary contraction level with and without application of tHFAC below the pain threshold. MAIN RESULTS Pain threshold current amplitude increased linearly with stimulation frequency. Statistical analysis showed that both stimulation frequency and charge injected per phase had significant effects (p < 0.05) on grip force reduction. At the group level, application of tHFAC below pain threshold reduced grip force by a maximum of 40.7% ± 8.1%. Baseline grip force trials interspersed between tHFAC trials showed consistent grip force, indicating that fatigue was not a factor in force reduction. SIGNIFICANCE Our results demonstrate the effectiveness of tHFAC at reducing muscle force when applied below the pain threshold, suggesting its potential clinical viability. Future studies are necessary to further elucidate the mechanism of force reduction before clinical application.
Collapse
Affiliation(s)
- Yushin Kim
- Major of Sports Health Rehabilitation, Cheongju University, Cheongju, Republic of Korea
| | | | | |
Collapse
|
39
|
Forte AJ, Boczar D, Huayllani MT, Lu X, McLaughlin SA. Sympathetic Nerve Block in Lymphedema Treatment: A Systematic Review. Cureus 2019; 11:e5700. [PMID: 31720168 PMCID: PMC6823032 DOI: 10.7759/cureus.5700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although the sympathetic nerve system has been described as a modulator of lymphatic circulation, it has not been targeted in the treatment of lymphedema. We conducted a systematic review of publications assessing the use of sympathetic nerve block in lymphedema treatment. We hypothesized that sympathetic nerve block may be a promising treatment option for lymphedema patients. We conducted a comprehensive systematic review of the published literature on the use of sympathetic nerve block in lymphedema treatment using the PubMed database. Eligibility criteria excluded papers that reported other types of lymphedema treatment or any other anesthesiology procedure. Abstracts, presentations, reviews, and meta-analyses were also excluded. Extracted data included the year of study, country, author affiliation, type of study, patient characteristics, nerve block technique, and key findings. From 81 potential papers, eight studies fulfilled the eligibility criteria. All papers identified were clinical, reporting on a total of 187 patients. Sympathetic nerve block was proposed with local anesthetics, whether or not associated with triamcinolone. Treatment with a nerve block promoted lymphedema improvement expressed by decreased limb circumference and patient-reported outcomes. Large randomized clinical trials are still pending, but sympathetic nerve block seems to be a promising alternative for lymphedema patients who do not respond to conservative therapy.
Collapse
Affiliation(s)
- Antonio J Forte
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Daniel Boczar
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Maria T Huayllani
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Xiaona Lu
- Division of Plastic Surgery, Yale University, New Haven, USA
| | - Sarah A McLaughlin
- Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| |
Collapse
|
40
|
Petrini FM, Bumbasirevic M, Valle G, Ilic V, Mijović P, Čvančara P, Barberi F, Katic N, Bortolotti D, Andreu D, Lechler K, Lesic A, Mazic S, Mijović B, Guiraud D, Stieglitz T, Alexandersson A, Micera S, Raspopovic S. Sensory feedback restoration in leg amputees improves walking speed, metabolic cost and phantom pain. Nat Med 2019; 25:1356-1363. [PMID: 31501600 DOI: 10.1038/s41591-019-0567-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/31/2019] [Indexed: 11/09/2022]
Abstract
Conventional leg prostheses do not convey sensory information about motion or interaction with the ground to above-knee amputees, thereby reducing confidence and walking speed in the users that is associated with high mental and physical fatigue1-4. The lack of physiological feedback from the remaining extremity to the brain also contributes to the generation of phantom limb pain from the missing leg5,6. To determine whether neural sensory feedback restoration addresses these issues, we conducted a study with two transfemoral amputees, implanted with four intraneural stimulation electrodes7 in the remaining tibial nerve (ClinicalTrials.gov identifier NCT03350061). Participants were evaluated while using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. These sensors drive neural stimulation, which elicits sensations of knee motion and the sole of the foot touching the ground. We found that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural sensory feedback compared to the no stimulation trials. Furthermore, participants exhibited reduced phantom limb pain with neural sensory feedback. The results from these proof-of-concept cases provide the rationale for larger population studies investigating the clinical utility of neuroprostheses that restore sensory feedback.
Collapse
Affiliation(s)
- Francesco Maria Petrini
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.,SensArs Neuroprosthetics, Lausanne, Switzerland.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Marko Bumbasirevic
- Orthopaedic Surgery Department, School of Medicine University of Belgrade, Belgrade, Serbia.,Clinic of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Giacomo Valle
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | - Vladimir Ilic
- Faculty of Sport and Physical Education, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Paul Čvančara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Federica Barberi
- SensArs Neuroprosthetics, Lausanne, Switzerland.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | | | | | - David Andreu
- Inria, University of Montpellier, Montpellier, France
| | | | - Aleksandar Lesic
- Orthopaedic Surgery Department, School of Medicine University of Belgrade, Belgrade, Serbia.,Clinic of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Mazic
- Institute of Medical Physiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - David Guiraud
- Inria, University of Montpellier, Montpellier, France
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,Cluster of Excellence BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | - Stanisa Raspopovic
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland. .,SensArs Neuroprosthetics, Lausanne, Switzerland.
| |
Collapse
|
41
|
Abstract
Phantom limb pain is a chronic neuropathic pain that develops in 45-85% of patients who undergo major amputations of the upper and lower extremities and appears predominantly during two time frames following an amputation: the first month and later about 1 year. Although in most patients the frequency and intensity of pain diminish over time, severe pain persists in about 5-10%. It has been proposed that factors in both the peripheral and central nervous systems play major roles in triggering the development and maintenance of pain associated with extremity amputations. Chronic pain is physically and mentally debilitating, affecting an individual's capacity for self-care, but also diminishing an individual's daily capacity for personal and economic independence. In addition, the pain may lead to depression and feelings of hopelessness. A National Center for Biotechnology Information study found that in the USA alone, the annual cost of dealing with neuropathic pain is more than $600 billion, with an estimated 20 million people in the USA suffering from this condition. Although the pain can be reduced by antiepileptic drugs and analgesics, they are frequently ineffective or their side effects preclude their use. The optimal approach for eliminating neuropathic pain and improving individuals' quality of life is the development of novel techniques that permanently prevent the development and maintenance of neuropathic pain, or that eliminate the pain once it has developed. What is still required is understanding when and where an effective novel technique must be applied, such as onto the nerve stump of the transected peripheral axons, dorsal root ganglion neurons, spinal cord, or cortex to induce the desired influences. This review, the second of two in this journal volume, examines the techniques that may be capable of reducing or eliminating chronic neuropathic pain once it has developed. Such an understanding will improve amputees' quality of life by blocking the mechanisms that trigger and/or maintain PLP and chronic neuropathic pain.
Collapse
Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, University of Puerto Rico, Medical Science Campus, 201 Blvd. del Valle, San Juan, PR, 00901, Puerto Rico.
| |
Collapse
|
42
|
Banks GP, Winfree CJ. Evolving Techniques and Indications in Peripheral Nerve Stimulation for Pain. Neurosurg Clin N Am 2019; 30:265-273. [PMID: 30898277 DOI: 10.1016/j.nec.2018.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Peripheral nerve stimulation is the direct electrical stimulation of named nerves outside the central neuraxis to alleviate pain in the distribution of the targeted peripheral nerve. These treatments have shown efficacy in treating a variety of neuropathic, musculoskeletal, and visceral refractory pain pathologies; although not first line, these therapies are an important part of the treatment repertoire for chronic pain. With careful patient selection and judicious choice of stimulation technique, excellent results can be achieved for a variety of pain etiologies and distributions. This article reviews current and past practices of peripheral nerve stimulation and upcoming advancements in the field.
Collapse
Affiliation(s)
- Garrett P Banks
- Department of Neurosurgery, Columbia University, 710 West 168 Street, 4th Floor, New York, NY 10032, USA.
| | - Christopher J Winfree
- Department of Neurosurgery, Columbia University, 710 West 168 Street, 4th Floor, New York, NY 10032, USA
| |
Collapse
|
43
|
Cai H, Morgan T, Pace N, Shen B, Wang J, Roppolo JR, Horlen K, Khanwilkar P, Groat WC, Tai C. Low pressure voiding induced by a novel implantable pudendal nerve stimulator. Neurourol Urodyn 2019; 38:1241-1249. [DOI: 10.1002/nau.23994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Haotian Cai
- Department of Urology University of Pittsburgh Pittsburgh Pennsylvania
- School of Health and Rehabilitation Science University of Pittsburgh Pittsburgh Pennsylvania
| | - Tara Morgan
- Department of Urology University of Pittsburgh Pittsburgh Pennsylvania
| | - Natalie Pace
- Department of Urology University of Pittsburgh Pittsburgh Pennsylvania
| | - Bing Shen
- Department of Urology University of Pittsburgh Pittsburgh Pennsylvania
| | - Jicheng Wang
- Department of Urology University of Pittsburgh Pittsburgh Pennsylvania
| | - James R. Roppolo
- Department of Pharmacology and Chemical Biology University of Pittsburgh Pittsburgh Pennsylvania
| | | | | | - William C. Groat
- Department of Pharmacology and Chemical Biology University of Pittsburgh Pittsburgh Pennsylvania
| | - Changfeng Tai
- Department of Urology University of Pittsburgh Pittsburgh Pennsylvania
- Department of Pharmacology and Chemical Biology University of Pittsburgh Pittsburgh Pennsylvania
- Department of Bioengineering University of Pittsburgh Pittsburgh Pennsylvania
| |
Collapse
|
44
|
Kuffler DP. Can phantom limb pain be reduced/eliminated solely by techniques applied to peripheral nerves? JOURNAL OF NEURORESTORATOLOGY 2019. [DOI: 10.26599/jnr.2019.9040002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
About 0.5% of the US population (1.7 million) is living with a lost limb and this number is expected to double by 2050. This number is much higher in other parts of the world. Within days to weeks of an extremity amputation, up to 80% of these individuals develop neuropathic pain presenting as phantom limb pain (PLP). The level of PLP increases significantly by one year and remains chronic and severe for about 10% of individuals. PLP has a serious negative impact on individuals’ lives. Current pain treatment therapies, such pharmacological approaches provide limited to no pain relief, some other techniques applied to the central nervous system (CNS) and peripheral nervous system (PNS) reduce or block PLP, but none produces long-term pain suppression. Therefore, new drugs or novel analgesic methods must be developed that prevent PLP from developing, or if it develops, to reduce the level of pain. This paper examines the potential causes of PLP, and present techniques used to prevent the development of PLP, or if it develops, to reduce the level of pain. Finally it presents a novel technique being developed that eliminates/reduces chronic neuropathic pain and which may induce the long-term reduction/elimination of PLP.
Collapse
|
45
|
Rapeaux A, Brunton E, Nazarpour K, Constandinou TG. Preliminary Study of Time to Recovery of Rat Sciatic Nerve from High Frequency Alternating Current Nerve Block. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2671-2674. [PMID: 30440956 DOI: 10.1109/embc.2018.8512832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
High-Frequency alternating current nerve block has great potential for neuromodulation-based therapies. However, no precise measurements have been made of the time needed for nerves to recover from block once the signal has been turned off. This study aims to characterise time to recovery of the rat sciatic nerve after 30 seconds of block at varying amplitudes and frequencies. Experiments were carried out invivo to quantify recovery times and recovery completeness within 0.7 s from the end of block. The sciatic nerve was blocked with an alternating square wave signal of amplitude and frequency ranging from 2 to 9mA and 10 to 50 kHz respectively. To determine the recovery dynamics the nerve was stimulated at 100 Hz after cessation of the blocking stimulus. Electromyogram signals were measured from the gastrocnemius medialis and tibialis anterior muscles during trials as indicators of nerve function. This allowed for nerve recovery to be measured with a resolution of 10 ms. This resolution is much greater than previous measurements of nerve recovery in the literature. Times for the nerve to recover to a steady state of activity ranged from 20 to 430 milliseconds and final relative recovery activity at 0.7 seconds spanned 0.2 to 1 approximately. Higher blocking signal amplitudes increased recovery time and decreased recovery completeness. These results suggest that blocking signal properties affect nerve recovery dynamics, which could help improve neuromodulation therapies and allow more precise comparison of results across studies using different blocking signal parameters.
Collapse
|
46
|
Finch P, Price L, Drummond P. High-Frequency (10 kHz) Electrical Stimulation of Peripheral Nerves for Treating Chronic Pain: A Double-Blind Trial of Presence vs Absence of Stimulation. Neuromodulation 2018; 22:529-536. [PMID: 30444276 DOI: 10.1111/ner.12877] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/29/2018] [Accepted: 09/16/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The study objectives were to perform a clinical audit of patients implanted with 10 kHz spinal cord (SCS) and peripheral nerve (PNS) stimulators for treating chronic pain and to investigate the effect of 10 kHz PNS on pain and other sensory modalities in a double-blind cross-over trial. METHODS Pain, disability, and medication status were audited for 12 months after stimulator implantation in 58 SCS patients and in 11 PNS patients with an electrode positioned along a branch of the occipital or trigeminal nerve (four patients), a limb nerve trunk (four patients), or the S1 nerve root, genito-femoral nerve or ileo-inguinal nerve (one patient each). In PNS patients, pain and other sensory modalities were also assessed double-blind before and after the stimulator was switched either ON or OFF for two hours (protocol 1) or four hours (protocol 2). RESULTS Decreases in pain and disability after stimulator implantation were maintained in both groups at 3-6 months, but these decreases were greater in PNS than SCS patients. In PNS trial patients, pain increased after the system had been turned OFF overnight for at least 12 hours before testing. Pain did not change after two hours of PNS but had decreased significantly after four hours. Other sensory modalities were minimally affected either by two or four hours of stimulation. CONCLUSIONS These findings suggest that PNS at 10 kHz decreases pain when conducted for at least four hours. Stimulation analgesia does not appear to be due to sensory conduction block.
Collapse
Affiliation(s)
- Philip Finch
- Perth Pain Management Centre, Perth, Western Australia, Australia
| | - Leanne Price
- Perth Pain Management Centre, Perth, Western Australia, Australia
| | - Peter Drummond
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| |
Collapse
|
47
|
Sridharan A, Chirania S, Towe BC, Muthuswamy J. Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes. MICROMACHINES 2018; 9:mi9110595. [PMID: 30441831 PMCID: PMC6266837 DOI: 10.3390/mi9110595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/23/2022]
Abstract
We demonstrate a method of neurostimulation using implanted, free-floating, inter-neural diodes. They are activated by volume-conducted, high frequency, alternating current (AC) fields and address the issue of instability caused by interconnect wires in chronic nerve stimulation. The aim of this study is to optimize the set of AC electrical parameters and the diode features to achieve wireless neurostimulation. Three different packaged Schottky diodes (1.5 mm, 500 µm and 220 µm feature sizes) were tested in vivo (n = 17 rats). A careful assessment of sciatic nerve activation as a function of diode–dipole lengths and relative position of the diode was conducted. Subsequently, free-floating Schottky microdiodes were implanted in the nerve (n = 3 rats) and stimulated wirelessly. Thresholds for muscle twitch responses increased non-linearly with frequency. Currents through implanted diodes within the nerve suffer large attenuations (~100 fold) requiring 1–2 mA drive currents for thresholds at 17 µA. The muscle recruitment response using electromyograms (EMGs) is intrinsically steep for subepineurial implants and becomes steeper as diode is implanted at increasing depths away from external AC stimulating electrodes. The study demonstrates the feasibility of activating remote, untethered, implanted microscale diodes using external AC fields and achieving neurostimulation.
Collapse
Affiliation(s)
- Arati Sridharan
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Sanchit Chirania
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Bruce C Towe
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Jit Muthuswamy
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| |
Collapse
|
48
|
Petersen BA, Nanivadekar AC, Chandrasekaran S, Fisher LE. Phantom limb pain: peripheral neuromodulatory and neuroprosthetic approaches to treatment. Muscle Nerve 2018; 59:154-167. [DOI: 10.1002/mus.26294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Bailey A. Petersen
- Department of Bioengineering; University of Pittsburgh; 3520 Fifth Avenue, Pittsburgh Pennsylvania 15213 USA
| | - Ameya C. Nanivadekar
- Department of Bioengineering; University of Pittsburgh; 3520 Fifth Avenue, Pittsburgh Pennsylvania 15213 USA
| | - Santosh Chandrasekaran
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - Lee E. Fisher
- Department of Bioengineering; University of Pittsburgh; 3520 Fifth Avenue, Pittsburgh Pennsylvania 15213 USA
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh; Pittsburgh Pennsylvania USA
| |
Collapse
|
49
|
Kim Y, Cho HJ, Park HS. Technical development of transcutaneous electrical nerve inhibition using medium-frequency alternating current. J Neuroeng Rehabil 2018; 15:80. [PMID: 30126438 PMCID: PMC6102860 DOI: 10.1186/s12984-018-0421-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 08/06/2018] [Indexed: 11/22/2022] Open
Abstract
Background Innovative technical approaches to controlling undesired sensory and motor activity, such as hyperalgesia or spasticity, may contribute to rehabilitation techniques for improving neural plasticity in patients with neurologic disorders. To date, transcutaneous electrical stimulation has used low frequency pulsed currents for sensory inhibition and muscle activation. Yet, few studies have attempted to achieve motor nerve inhibition using transcutaneous electrical stimulation. This study aimed to develop a technique for transcutaneous electrical nerve inhibition (TENI) using medium-frequency alternating current (MFAC) to suppress both sensory and motor nerve activity in humans. Methods Surface electrodes were affixed to the skin of eight young adults to stimulate the median nerve. Stimulation intensity was increased up to 50% and 100% of the pain threshold. To identify changes in sensory perception by transcutaneous MFAC (tMFAC) stimulation, we examined tactile and pressure pain thresholds in the index and middle fingers before and after stimulation at 10 kHz. To demonstrate the effect of tMFAC stimulation on motor inhibition, stimulation was applied while participants produced flexion forces with the index and middle fingers at target forces (50% and 90% of MVC, maximum voluntary contraction). Results tMFAC stimulation intensity significantly increased tactile and pressure pain thresholds, indicating decreased sensory perception. During the force production task, tMFAC stimulation with the maximum intensity immediately reduced finger forces by ~ 40%. Finger forces recovered immediately after stimulation cessation. The effect on motor inhibition was greater with the higher target force (90% MVC) than with the lower target (50% MVC). Also, higher tMFAC stimulation intensity provided a greater inhibition effect on both sensory and motor nerve activity. Conclusion We found that tMFAC stimulation immediately inhibits sensory and motor activity. This pre-clinical study demonstrates a novel technique for TENI using MFAC stimulation and showed that it can effectively inhibit both sensory perception and motor activity. The proposed technique can be combined with existing rehabilitation devices (e.g., a robotic exoskeleton) to inhibit undesired sensorimotor activities and to accelerate recovery after neurologic injury.
Collapse
Affiliation(s)
- Yushin Kim
- Major in Sport, Health & Rehabilitation, Department of Health Administration and Healthcare, Cheongju University, Cheongju, 28503, Republic of Korea.,Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Hang-Jun Cho
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea.
| |
Collapse
|
50
|
Duncan CC, Kluger DT, Davis TS, Warren DJ, Page DM, Hutchinson DT, Clark GA. Selective Decrease in Allodynia With High‐Frequency Neuromodulation via High‐Electrode‐Count Intrafascicular Peripheral Nerve Interface After Brachial Plexus Injury. Neuromodulation 2018; 22:597-606. [DOI: 10.1111/ner.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/18/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - David T. Kluger
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - Tyler S. Davis
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - David J. Warren
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - David M. Page
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | | | - Gregory A. Clark
- Department of Bioengineering University of Utah Salt Lake City UT USA
| |
Collapse
|