Transcutaneous calf-muscle electro-stimulation : a prospective treatment for diabetic claudicants?

Background: First-line therapy for claudicants with diabetes include supervised exercise programmes to improve walking distance. However, exercise comes with a number of barriers and may be contraindicated in certain conditions. The aim of this study was to evaluate whether calf-muscle electro-stimulation improves claudication distance. Method: A prospective, one-group, pretest-posttest study design was employed on 40 participants living with type 2 diabetes mellitus, peripheral artery disease (ankle-brachial pressure index < 0.90) and calf-muscle claudication. Calf-muscle electro-stimulation of varying frequencies (1-250 Hz) was applied on both ischaemic limbs (N = 80) for 1 h per day for 12 consecutive weeks. The absolute claudication distance was measured at baseline and following the intervention. Results: The cohort (n = 40; 30 males; mean age = 71 years; mean ankle-brachial pressure index = 0.70) registered a mean baseline absolute claudication distance of 333.71 m (standard deviation = 208). Following 91.68 days (standard deviation = 6.23) of electrical stimulation, a significant mean increase of 137 m (standard deviation = 136) in the absolute claudication distance was registered (p = 0.000, Wilcoxon signed rank test). Conclusion: Electrical stimulation of varying low to high frequencies on ischaemic calf muscles significantly increased the maximal walking capacity in claudicants with type 2 diabetes. This therapeutic approach may be considered in patients with impaired exercise tolerance or as an adjunct treatment modality.peer-reviewe

Activation of Long Descending Propriospinal Neurons in Cat Spinal Cord

Isolated mammalian spinal cord has been shown capable of generating locomotor activity. Propriospinal systems assumed to coordinate fore- and hindlimb activity are poorly understood. This study characterizes the long descending propriospinal (LDP) neurons in terms of the location of the somas and their peripheral inputs by direct neuronal recording. Anatomical studies using axonal retrograde transport of horseradish peroxidase from the lumbar to the cervical spinal cord as a tracer first described these neurons. Two hundred and thirty-one LDP neurons were identified in electrophysiological experiments. Of these, 123 responded to natural stimulation, and about 50% of the others were activated only by electrical stimulation. The majority of cells were located in laminae VII and VIII in agreement with anatomical data. The most effective stimuli were mechanical stimulation of skin, deep pressure to subcutaneous tissues, and paw joint movement. Bot excitatory and inhibitory responses were observed

GABA increases electrical excitability in a subset of human unmyelinated peripheral axons

A proportion of small diameter primary sensory neurones innervating human skin are chemosensitive. They respond in a receptor dependent manner to chemical mediators of inflammation as well as naturally occurring algogens, thermogens and pruritogens. The neurotransmitter GABA is interesting in this respect because in animal models of neuropathic pain GABA pre-synaptically regulates nociceptive input to the spinal cord. However, the effect of GABA on human peripheral unmyelinated axons has not been established

3D Neuro-electronic interface devices for neuromuscular control: Design studies and realisation steps

In order to design the shape and dimensions of new 3D multi-microelectrode information transducers properly, i. e. adapted to the scale of information delivery to and from peripheral nerve fibres, a number of studies were, and still are, being performed on modelling and simulation of electrical volume conduction inside and outside nerves, on animal experiments on stimulation and recording with single wires and linear arrays, and on new technologies for 3D micro-fabrication. This paper presents a selection of the results of these `Neurotechnology¿ studies at the University of Twente. The experimental and simulation results apply primarily to the peripheral motor nerves of the rat, but are also of interest for neural interfacing with myelinated nerves in man, as fascicles in man are about the same size as in the rat

Large-scale changes in cortical dynamics triggered by repetitive somatosensory electrical stimulation.

BackgroundRepetitive somatosensory electrical stimulation (SES) of forelimb peripheral nerves is a promising therapy; studies have shown that SES can improve motor function in stroke subjects with chronic deficits. However, little is known about how SES can directly modulate neural dynamics. Past studies using SES have primarily used noninvasive methods in human subjects. Here we used electrophysiological recordings from the rodent primary motor cortex (M1) to assess how SES affects neural dynamics at the level of single neurons as well as at the level of mesoscale dynamics.MethodsWe performed acute extracellular recordings in 7 intact adult Long Evans rats under ketamine-xylazine anesthesia while they received transcutaneous SES. We recorded single unit spiking and local field potentials (LFP) in the M1 contralateral to the stimulated arm. We then compared neural firing rate, spike-field coherence (SFC), and power spectral density (PSD) before and after stimulation.ResultsFollowing SES, the firing rate of a majority of neurons changed significantly from their respective baseline values. There was, however, a diversity of responses; some neurons increased while others decreased their firing rates. Interestingly, SFC, a measure of how a neuron's firing is coupled to mesoscale oscillatory dynamics, increased specifically in the δ-band, also known as the low frequency band (0.3- 4 Hz). This increase appeared to be driven by a change in the phase-locking of broad-spiking, putative pyramidal neurons. These changes in the low frequency range occurred without a significant change in the overall PSD.ConclusionsRepetitive SES significantly and persistently altered the local cortical dynamics of M1 neurons, changing both firing rates as well as the SFC magnitude in the δ-band. Thus, SES altered the neural firing and coupling to ongoing mesoscale dynamics. Our study provides evidence that SES can directly modulate cortical dynamics

Spectral and Spatial Dependence of Diffuse Optical Signals in Response to Peripheral Nerve Stimulation

Using non-invasive, near-infrared spectroscopy we have previously reported optical signals measured at or around peripheral nerves in response to their stimulation. Such optical signals featured amplitudes on the order of 0.1% and peaked about 100 ms after peripheral nerve stimulation in human subjects. Here, we report a study of the spatial and spectral dependence of the optical signals induced by stimulation of the human median and sural nerves, and observe that these optical signals are: (1) unlikely due to either dilation or constriction of blood vessels, (2) not associated with capillary bed hemoglobin, (3) likely due to blood vessel(s) displacement, and (4) unlikely due to fiber-skin optical coupling effects. We conclude that the most probable origin of the optical response to peripheral nerve stimulation is from displacement of blood vessels within the optically probed volume, as a result of muscle twitch in adjacent areas.National Institutes of Health (R01-NS059933); U.S. Army Medical Acquisition Activity (W81XWH-07-2-0011

Analysis of Passive Charge Balancing for Safe Current-Mode Neural Stimulation

Charge balancing has been often considered as one of the most critical requirement for neural stimulation circuits. Over the years several solutions have been proposed to precisely balance the charge transferred to the tissue during anodic and cathodic phases. Elaborate dynamic current sources/sinks with improved matching, and feedback loops have been proposed with a penalty on circuit complexity, area or power consumption. Here we review the dominant assumptions in safe stimulation protocols, and derive mathematical models to determine the effectiveness of passive charge balancing in a typical application scenario

Electrical neurostimulation for chronic pain: on selective relay of sensory neural activities in myelinated nerve fibers

Chronic pain affects about 100 million adults in the US. Despite their great need, neuropharmacology and neurostimulation therapies for chronic pain have been associated with suboptimal efficacy and limited long-term success, as their mechanisms of action are unclear. Yet current computational models of pain transmission suffer from several limitations. In particular, dorsal column models do not include the fundamental underlying sensory activity traveling in these nerve fibers. We developed a (simple) simulation test bed of electrical neurostimulation of myelinated nerve fibers with underlying sensory activity. This paper reports our findings so far. Interactions between stimulation-evoked and underlying activities are mainly due to collisions of action potentials and losses of excitability due to the refractory period following an action potential. In addition, intuitively, the reliability of sensory activity decreases as the stimulation frequency increases. This first step opens the door to a better understanding of pain transmission and its modulation by neurostimulation therapies

Occipital nerve stimulation for headache disorders

Occipital nerve stimulation (ONS) was originally described in the treatment of occipital neuralgia. However, the spectrum of possible indications has expanded in recent years to include primary headache disorders, such as migraine and cluster headaches. Retrospective and some prospective studies have yielded encouraging results, and evidence from controlled clinical trials is emerging, offering hope for refractory headache patients. In this article we discuss the scientific rationale to use ONS to treat headache disorders, with emphasis on the trigeminocervical complex. ONS is far from a standardized technique at the moment and the recent literature on the topic is reviewed, both with respect to the procedure and its possible complications. An important way to move forward in the scientific evaluation of ONS to treat refractory headache is the clinical phenotyping of patients to identify patients groups with the highest likelihood to respond to this modality of treatment. This requires multidisciplinary assessment of patients. The development of ONS as a new treatment for refractory headache offers an exciting prospect to treat our most disabled headache patients. Data from ongoing controlled trials will undoubtedly shed new light on some of the unresolved questions