Effect of neurostimulation on cognition and mood in refractory epilepsy.

Epilepsy is a common, debilitating neurological disorder characterized by recurrent seizures. Mood disorders and cognitive deficits are common comorbidities in epilepsy that, like seizures, profoundly influence quality of life and can be difficult to treat. For patients with refractory epilepsy who are not candidates for resection, neurostimulation, the electrical modulation of epileptogenic brain tissue, is an emerging treatment alternative. Several forms of neurostimulation are currently available, and therapy selection hinges on relative efficacy for seizure control and amelioration of neuropsychiatric comorbidities. Here, we review the current evidence for how invasive and noninvasive neurostimulation therapies affect mood and cognition in persons with epilepsy. Invasive therapies include vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). Noninvasive therapies include trigeminal nerve stimulation (TNS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). Overall, current evidence supports stable cognition and mood with all neurostimulation therapies, although there is some evidence that cognition and mood may improve with invasive forms of neurostimulation. More research is required to optimize the effects of neurostimulation for improvements in cognition and mood

Neuromodulation

Neuromodulation is a new promising treatment for headache disorders. It consists of peripheral nerve neurostimulation and central neurostimulation. © 2016, Touch Briefings. All rights reserved

Mathematical Model Investigating the Effects of Neurostimulation Therapies on Neural Functioning: Comparing the Effects of Neuromodulation Techniques on Ion Channel Gating and Ionic Flux Using Finite Element Analysis

Neurostimulation therapies demonstrate success as a medical intervention for individuals with neurodegenerative diseases, such as Parkinson’s and Alzheimer’s disease. Despite promising results from these treatments, the influence of an electric current on ion concentrations and subsequent transmembrane voltage is unclear. This project focuses on developing a unique cellular-level mathematical model of neurostimulation to better understand its e↵ects on neuronal electrodynamics. The mathematical model presented here integrates the Poisson-Nernst-Planck system of PDEs and Hodgkin-Huxley based ODEs to model the e↵ects of this neurotherapy on transmembrane voltage, ion channel gating, and ionic mobility. This system is decoupled using the Gauss-Seidel method and then the equations are solved using the finite element method on a biologically-inspired discretized domain. Results demonstrate the influence of transcranial electrical stimulation on membrane voltage, ion channel gating, and transmembrane flux. Simulations also compare the e↵ects of two di↵erent types of neurostimulation (transcranial electrical stimulation and deep brain stimulation) showcasing cellular-level di↵erences resulting from these distinct forms of electrical therapy. Hopefully this work will ultimately help elucidate the principles by which neurostimulation alleviates disease symptoms

Modulation of speech-in-noise comprehension through transcranial current stimulation with the phase-shifted speech envelope

This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see http://creativecommons.org/licenses/by/4.0/Neural activity tracks the envelope of a speech signal at latencies from 50 ms to 300 ms. Modulating this neural tracking through transcranial alternating current stimulation influences speech comprehension. Two important variables that can affect this modulation are the latency and the phase of the stimulation with respect to the sound. While previous studies have found an influence of both variables on speech comprehension, the interaction between both has not yet been measured. We presented 17 subjects with speech in noise coupled with simultaneous transcranial alternating current stimulation. The currents were based on the envelope of the target speech but shifted by different phases, as well as by two temporal delays of 100 ms and 250 ms. We also employed various control stimulations, and assessed the signal-to-noise ratio at which the subject understood half of the speech. We found that, at both latencies, speech comprehension is modulated by the phase of the current stimulation. However, the form of the modulation differed between the two latencies. Phase and latency of neurostimulation have accordingly distinct influences on speech comprehension. The different effects at the latencies of 100 ms and 250 ms hint at distinct neural processes for speech processing.Peer reviewe

Postoperative pain and morphine consumption after ultrasound-guided femoral and sciatic combined nerve block versus neurostimulation for femoral and sciatic combined nerve block or neurostimulation for femoral nerve block in primary elective total knee arthroplasty.

Abstract Congreso XXXVII National Meeting of the Spanish Society of Pharmacology with guest society: The British Pharmacological SocietyBackground and Aims: Total knee arthroplasty injuries are extremely painful and merit prompt attention to adequate postoperative analgesia. We aim to compare femoral and sciatic ultrasound-guided combined nerve block vs. neurostimulation for femoral and sciatic combined nerve block or for femoral nerve block in postoperative pain in primary elective total knee prosthesis. Summary of work and outcomes: A three arms, prospective longitudinal study of patients having primary elective unilateral knee prosthesis and randomly assigned to catheter insertion guided by ultrasound or neurostimulation was done: 1) Ultrasound-guided femoral and sciatic combined nerve block (USFSCN) (N=15); 2) Neurostimulation for femoral and sciatic combined nerve block (NSFSCN) (N=17); 3) Neurostimulation for femoral nerve block (NSFN) (N=11). Total analgesia (morphine) consumption after 48 hours was the primary endpoint. The postoperative pain intensity (visual analogue pain scale (VAS)) at post-anaesthetic recovery unit (PARU), 6, 24, 48 h, and during movement and postoperative complications were secondary outcomes. Results and discussion: 43 patients (68.3±8 years old, 77% female) subjected to elective unilateral knee prosthesis were enrolled. There were no differences in the demographic, anaesthetic and surgical variables between groups. Pain intensity was lower in the USFSCN group compared with NSFSCN and NSFN during the first 48 h post-surgery (% of intense pain at PARU/6h/24h/48h): USFSCN 0.8/1.4/3.2/1.6; NSFSCN 5.6/8.3/7.5/3; NSFN 7.2/5.3/6.4/5.4. The average consumption of morphine within 48 h after surgery was similar in the groups USFSCN and NSFSCN (3 mg vs. 3.11 mg), and significantly lower than NSFN (4.19 mg) (p<0.05). And the number of complications was significantly lower in the USFSCN group compared with NSFSCN and NSFN during the first 48 h of postoperative. Conclusion: Ultrasound-guided femoral and sciatic combined nerve block presented better analgesia and was more safety than neurostimulation for femoral and sciatic combined nerve block or for femoral nerve block in primary elective total knee arthroplasty.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Clinically indicated electrical stimulation strategies to treat patients with medically refractory epilepsy.

Focal epilepsies represent approximately half of all diagnoses, and more than one-third of these patients are refractory to pharmacologic treatment. Although resection can result in seizure freedom, many patients do not meet surgical criteria, as seizures may be multifocal in origin or have a focus in an eloquent region of the brain. For these individuals, several U.S. Food and Drug Administration (FDA)-approved electrical stimulation paradigms serve as alternative options, including vagus nerve stimulation, responsive neurostimulation, and stimulation of the anterior nucleus of the thalamus. All of these are safe, flexible, and lead to progressive seizure control over time when used as an adjunctive therapy to antiepileptic drugs. Focal epilepsies frequently involve significant comorbidities such as cognitive decline. Similar to antiepilepsy medications and surgical resection, current stimulation targets and parameters have yet to address cognitive impairments directly, with patients reporting persistent comorbidities associated with focal epilepsy despite a significant reduction in the number of their seizures. Although low-frequency theta oscillations of the septohippocampal network are critical for modulating cellular activity and, in turn, cognitive processing, the coordination of neural excitability is also imperative for preventing seizures. In this review, we summarize current FDA-approved electrical stimulation paradigms and propose that theta oscillations of the medial septal nucleus represent a novel neuromodulation target for concurrent seizure reduction and cognitive improvement in epilepsy. Ultimately, further advancements in clinical neurostimulation strategies will allow for the efficient treatment of both seizures and comorbidities, thereby improving overall quality of life for patients with epilepsy

A Mathematical Solution for Medicine’s Unanswered Questions

An RWU math professor leads an undergraduate research team using computational math to solve knowledge gaps in the biomedical field