Characterization and applications of evoked responses during epidural electrical stimulation

Bioelectronic Medicine

Research Article

Mingming Zhang¹  Erika Ross¹  Danny Lam¹  Hyun-Joo Park¹  Nishant Verma²  Andrew Shoffstall³  Scott Lempka⁴  Bruce Knudson⁵  Kip Ludwig⁶  Stephan Blanz⁷  Ben Romanauski⁸  Luis Lujan⁹  Yuichiro Nishiyama^1,10  Jian Hao^1,10  Igor Lavrov^1,10 

[1] Abbott Neuromodulation, 6901 Preston Rd, 75024, Plano, TX, USA;Abbott Neuromodulation, 6901 Preston Rd, 75024, Plano, TX, USA;Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA;Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA;Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA;APT Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA;Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA;APT Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA;Department of Biomedical Engineering, Department of Anesthesiology, Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA;Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA;Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA;Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA;Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA;Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, USA;Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA;Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA;University of Wisconsin School of Medicine and Public Health, Madison, WI, USA;Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA;Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA;Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA;Department of Neurology, Department of Physiology and Biomedical Engineering, Mayo Clinic, 500 First Street SW, 55905, Rochester, MN, USA;

关键词: Spinal cord stimulation;    Evoked compound action potential;    Neurophysiology;    Spinally evoked motor potentials;    Neuromodulation;    Neuropathic pain;   

DOI  :  10.1186/s42234-023-00106-5

 received in 2023-01-23, accepted in 2023-02-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundEpidural electrical stimulation (EES) of the spinal cord has been FDA approved and used therapeutically for decades. However, there is still not a clear understanding of the local neural substrates and consequently the mechanism of action responsible for the therapeutic effects.MethodEpidural spinal recordings (ESR) are collected from the electrodes placed in the epidural space. ESR contains multi-modality signal components such as the evoked neural response (due to tonic or BurstDR™ waveforms), evoked muscle response, stimulation artifact, and cardiac response. The tonic stimulation evoked compound action potential (ECAP) is one of the components in ESR and has been proposed recently to measure the accumulative local potentials from large populations of neuronal fibers during EES.ResultHere, we first review and investigate the referencing strategies, as they apply to ECAP component in ESR in the domestic swine animal model. We then examine how ECAP component can be used to sense lead migration, an adverse outcome following lead placement that can reduce therapeutic efficacy. Lastly, we show and isolate concurrent activation of local back and leg muscles during EES, demonstrating that the ESR obtained from the recording contacts contain both ECAP and EMG components.ConclusionThese findings may further guide the implementation of recording and reference contacts in an implantable EES system and provide preliminary evidence for the utility of ECAP component in ESR to detect lead migration. We expect these results to facilitate future development of EES methodology and implementation of use of different components in ESR to improve EES therapy.

【 授权许可】

CC BY   
© Feinstein Institute for Medical Research 2023

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