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Chandrasekaran S, Bhagat NA, Ramdeo R, Ebrahimi S, Sharma PD, Griffin DG, Stein A, Harkema SJ, Bouton CE. Case study: persistent recovery of hand movement and tactile sensation in peripheral nerve injury using targeted transcutaneous spinal cord stimulation. Front Neurosci 2023; 17:1210544. [PMID: 37529233 PMCID: PMC10390294 DOI: 10.3389/fnins.2023.1210544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Peripheral nerve injury can lead to chronic pain, paralysis, and loss of sensation, severely affecting quality of life. Spinal cord stimulation has been used in the clinic to provide pain relief arising from peripheral nerve injuries, however, its ability to restore function after peripheral nerve injury have not been explored. Neuromodulation of the spinal cord through transcutaneous spinal cord stimulation (tSCS), when paired with activity-based training, has shown promising results towards restoring volitional limb control in people with spinal cord injury. We show, for the first time, the effectiveness of targeted tSCS in restoring strength (407% increase from 1.79 ± 1.24 N to up to 7.3 ± 0.93 N) and significantly increasing hand dexterity in an individual with paralysis due to a peripheral nerve injury (PNI). Furthermore, this is the first study to document a persisting 3-point improvement during clinical assessment of tactile sensation in peripheral injury after receiving 6 weeks of tSCS. Lastly, the motor and sensory gains persisted for several months after stimulation was received, suggesting tSCS may lead to long-lasting benefits, even in PNI. Non-invasive spinal cord stimulation shows tremendous promise as a safe and effective therapeutic approach with broad applications in functional recovery after debilitating injuries.
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Affiliation(s)
- Santosh Chandrasekaran
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Nikunj A. Bhagat
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, United States
| | - Richard Ramdeo
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Sadegh Ebrahimi
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Pawan D. Sharma
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Doug G. Griffin
- Northwell Health STARS Rehabilitation, East Meadow, NY, United States
| | - Adam Stein
- Department of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, United States
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of Bioengineering, University of Louisville, Louisville, KY, United States
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Chad E. Bouton
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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Zuccaroli I, Lucke-Wold B, Palla A, Eremiev A, Sorrentino Z, Zakare-Fagbamila R, McNulty J, Christie C, Chandra V, Mampre D. Neural Bypasses: Literature Review and Future Directions in Developing Artificial Neural Connections. OBM NEUROBIOLOGY 2023; 7:158. [PMID: 36908763 PMCID: PMC9997488 DOI: 10.21926/obm.neurobiol.2301158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Reported neuro-modulation schemes in the literature are typically classified as closed-loop or open-loop. A novel group of recently developed neuro-modulation devices may be better described as a neural bypass, which attempts to transmit neural data from one location of the nervous system to another. The most common form of neural bypasses in the literature utilize EEG recordings of cortical information paired with functional electrical stimulation for effector muscle output, most commonly for assistive applications and rehabilitation in spinal cord injury or stroke. Other neural bypass locations that have also been described, or may soon be in development, include cortical-spinal bypasses, cortical-cortical bypasses, autonomic bypasses, peripheral-central bypasses, and inter-subject bypasses. The most common recording devices include EEG, ECoG, and microelectrode arrays, while stimulation devices include both invasive and noninvasive electrodes. Several devices are in development to improve the temporal and spatial resolution and biocompatibility for neuronal recording and stimulation. A major barrier to entry includes neuroplasticity and current decoding mechanisms that regularly require retraining. Neural bypasses are a unique class of neuro-modulation. Continued advancement of neural recording and stimulating devices with high spatial and temporal resolution, combined with decoding mechanisms uninhibited by neuroplasticity, can expand the therapeutic capability of neural bypassing. Overall, neural bypasses are a promising modality to improve the treatment of common neurologic disorders, including stroke, spinal cord injury, peripheral nerve injury, brain injury and more.
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Affiliation(s)
| | | | | | - Alexander Eremiev
- Department of Neurosurgery, New York University School of Medicine, New York, USA
| | | | | | - Jack McNulty
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Carlton Christie
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Vyshak Chandra
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - David Mampre
- Johns Hopkins University, Baltimore, USA
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Herrero JL, Smith A, Mishra A, Markowitz N, Mehta AD, Bickel S. Inducing neuroplasticity through intracranial θ-burst stimulation in the human sensorimotor cortex. J Neurophysiol 2021; 126:1723-1739. [PMID: 34644179 PMCID: PMC8782667 DOI: 10.1152/jn.00320.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023] Open
Abstract
The progress of therapeutic neuromodulation greatly depends on improving stimulation parameters to most efficiently induce neuroplasticity effects. Intermittent θ-burst stimulation (iTBS), a form of electrical stimulation that mimics natural brain activity patterns, has proved to efficiently induce such effects in animal studies and rhythmic transcranial magnetic stimulation studies in humans. However, little is known about the potential neuroplasticity effects of iTBS applied through intracranial electrodes in humans. This study characterizes the physiological effects of intracranial iTBS in humans and compare them with α-frequency stimulation, another frequently used neuromodulatory pattern. We applied these two stimulation patterns to well-defined regions in the sensorimotor cortex, which elicited contralateral hand muscle contractions during clinical mapping, in patients with epilepsy implanted with intracranial electrodes. Treatment effects were evaluated using oscillatory coherence across areas connected to the treatment site, as defined with corticocortical-evoked potentials. Our results show that iTBS increases coherence in the β-frequency band within the sensorimotor network indicating a potential neuroplasticity effect. The effect is specific to the sensorimotor system, the β band, and the stimulation pattern and outlasted the stimulation period by ∼3 min. The effect occurred in four out of seven subjects depending on the buildup of the effect during iTBS treatment and other patterns of oscillatory activity related to ceiling effects within the β band and to preexistent coherence within the α band. By characterizing the neurophysiological effects of iTBS within well-defined cortical networks, we hope to provide an electrophysiological framework that allows clinicians/researchers to optimize brain stimulation protocols which may have translational value.NEW & NOTEWORTHY θ-Burst stimulation (TBS) protocols in transcranial magnetic stimulation studies have shown improved treatment efficacy in a variety of neuropsychiatric disorders. The optimal protocol to induce neuroplasticity in invasive direct electrical stimulation approaches is not known. We report that intracranial TBS applied in human sensorimotor cortex increases local coherence of preexistent β rhythms. The effect is specific to the stimulation frequency and the stimulated network and outlasts the stimulation period by ∼3 min.
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Affiliation(s)
- Jose L Herrero
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Alexander Smith
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Akash Mishra
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Noah Markowitz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Ashesh D Mehta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Stephan Bickel
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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Chandrasekaran S, Fifer M, Bickel S, Osborn L, Herrero J, Christie B, Xu J, Murphy RKJ, Singh S, Glasser MF, Collinger JL, Gaunt R, Mehta AD, Schwartz A, Bouton CE. Historical perspectives, challenges, and future directions of implantable brain-computer interfaces for sensorimotor applications. Bioelectron Med 2021; 7:14. [PMID: 34548098 PMCID: PMC8456563 DOI: 10.1186/s42234-021-00076-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
Almost 100 years ago experiments involving electrically stimulating and recording from the brain and the body launched new discoveries and debates on how electricity, movement, and thoughts are related. Decades later the development of brain-computer interface technology began, which now targets a wide range of applications. Potential uses include augmentative communication for locked-in patients and restoring sensorimotor function in those who are battling disease or have suffered traumatic injury. Technical and surgical challenges still surround the development of brain-computer technology, however, before it can be widely deployed. In this review we explore these challenges, historical perspectives, and the remarkable achievements of clinical study participants who have bravely forged new paths for future beneficiaries.
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Affiliation(s)
- Santosh Chandrasekaran
- Neural Bypass and Brain Computer Interface Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Matthew Fifer
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Stephan Bickel
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Neurosurgery, Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Luke Osborn
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Jose Herrero
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Breanne Christie
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Junqian Xu
- Departments of Radiology and Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Rory K J Murphy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sandeep Singh
- Good Shepherd Rehabilitation Hospital, Allentown, PA, USA
| | - Matthew F Glasser
- Departments of Radiology and Neuroscience, Washington University in St Louis, Saint Louis, MO, USA
| | - Jennifer L Collinger
- Rehabilitation Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Gaunt
- Rehabilitation Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashesh D Mehta
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Neurosurgery, Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Andrew Schwartz
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chad E Bouton
- Neural Bypass and Brain Computer Interface Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
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Chandrasekaran S, Bickel S, Herrero JL, Kim JW, Markowitz N, Espinal E, Bhagat NA, Ramdeo R, Xu J, Glasser MF, Bouton CE, Mehta AD. Evoking highly focal percepts in the fingertips through targeted stimulation of sulcal regions of the brain for sensory restoration. Brain Stimul 2021; 14:1184-1196. [PMID: 34358704 PMCID: PMC8884403 DOI: 10.1016/j.brs.2021.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Paralysis and neuropathy, affecting millions of people worldwide, can be accompanied by significant loss of somatosensation. With tactile sensation being central to achieving dexterous movement, brain-computer interface (BCI) researchers have used intracortical and cortical surface electrical stimulation to restore somatotopically-relevant sensation to the hand. However, these approaches are restricted to stimulating the gyral areas of the brain. Since representation of distal regions of the hand extends into the sulcal regions of human primary somatosensory cortex (S1), it has been challenging to evoke sensory percepts localized to the fingertips. Objective/hypothesis: Targeted stimulation of sulcal regions of S1, using stereoelectroencephalography (SEEG) depth electrodes, can evoke focal sensory percepts in the fingertips. Methods: Two participants with intractable epilepsy received cortical stimulation both at the gyri via high-density electrocorticography (HD-ECoG) grids and in the sulci via SEEG depth electrode leads. We characterized the evoked sensory percepts localized to the hand. Results: We show that highly focal percepts can be evoked in the fingertips of the hand through sulcal stimulation. fMRI, myelin content, and cortical thickness maps from the Human Connectome Project elucidated specific cortical areas and sub-regions within S1 that evoked these focal percepts. Within-participant comparisons showed that percepts evoked by sulcal stimulation via SEEG electrodes were significantly more focal (80% less area; p = 0.02) and localized to the fingertips more often, than by gyral stimulation via HD-ECoG electrodes. Finally, sulcal locations with consistent modulation of high-frequency neural activity during mechanical tactile stimulation of the fingertips showed the same somatotopic correspondence as cortical stimulation. Conclusions: Our findings indicate minimally invasive sulcal stimulation via SEEG electrodes could be a clinically viable approach to restoring sensation.
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Affiliation(s)
- Santosh Chandrasekaran
- Neural Bypass and Brain Computer Interface Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
| | - Stephan Bickel
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Neurosurgery, Northwell, Manhasset, NY, USA; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Jose L Herrero
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Neurosurgery, Northwell, Manhasset, NY, USA
| | - Joo-Won Kim
- Departments of Radiology and Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Noah Markowitz
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Elizabeth Espinal
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Nikunj A Bhagat
- Neural Bypass and Brain Computer Interface Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Richard Ramdeo
- Neural Bypass and Brain Computer Interface Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Junqian Xu
- Departments of Radiology and Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Matthew F Glasser
- Departments of Radiology and Neuroscience, Washington University in St Louis, Saint Louis, MO, USA
| | - Chad E Bouton
- Neural Bypass and Brain Computer Interface Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
| | - Ashesh D Mehta
- The Human Brain Mapping Laboratory, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Neurosurgery, Northwell, Manhasset, NY, USA
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