Cervical Stimulation Research Articles

Effects of repetitive magnetic cervical stimulation of phrenic roots on diaphragmatic function in healthy volunteers

Effects of repetitive magnetic cervical stimulation of phrenic roots on diaphragmatic function in healthy volunteers

Cervical Spinal Stimulation at Different Levels Evoked Multisegmental Motor Responses in the Lower Limbs

Cervical Spinal Stimulation at Different Levels Evoked Multisegmental Motor Responses in the Lower Limbs

Vagal Nerve Stimulation Attenuates Ischemia-Reperfusion Induced Retina Dysfunction in Acute Ocular Hypertension

Purpose: The present study aimed to investigate whether cervical vagal nerve stimulation (VNS) could prevent retinal ganglion cell (RGC) loss and retinal dysfunction after ischemia/reperfusion (I/R) injury.Methods: First, rats were randomly divided into sham group (n = 4) and VNS group (n = 12). Activation of the nodose ganglia (NOG), nucleus of the solitary tract (NTS), superior salivatory nucleus (SSN), and pterygopalatine ganglion (PPG) neural circuit were evaluated by c-fos expression at 0 h after sham VNS and at 0 h (n = 4), 6 h (n = 4), 72 h (n = 4) after VNS. Secondly, rats were randomly assigned to I/R group (pressure-induced retinal ischemia for 1 h and reperfusion for 1 h in the right eye, n = 16) and I/R+VNS group (right cervical VNS for 2 h during the I/R period, n = 16). The left eye of each rat served as a control. Electroretinogram (ERG), RGC numbers, tumor necrosis factor-α (TNF-α) and vasoactive intestinal polypeptide (VIP) levels in retina were determined. Additionally, the level of VIP in PPG was evaluated.Results: In the first part of the study, compared with the sham group, the VNS group exhibited significantly increased expression of c-fos in NOG, NTS, SSN, and PPG tissues at 0, 6, and 72 h. In the second part of the study, compared with left eyes, retinal function in right eyes (as assessed by the a-wave, b-wave and the oscillatory potential amplitudes of ERG and RGC data) was significantly decreased by I/R. The decreased retinal function was attenuated by VNS. In addition, I/R induced an increase in inflammation, which was reflected by elevated TNF-α expression in the retina. VNS significantly attenuated the increase in I/R-induced inflammation. Moreover, VIP expression in the retina and PPG, which may contribute to the inhibition of the inflammatory response, was significantly increased after VNS.Conclusion: VNS could protect against retinal I/R injury by downregulating TNF-α. Upregulation of VIP expression due to activation of the NOG-NTS-SSN-PPG neural circuit may underlie to the protective effects of VNS.

Abstract #127: Non-Invasive Cervical Root Stimulation to Facilitate Corticospinal Transmission

Abstract #127: Non-Invasive Cervical Root Stimulation to Facilitate Corticospinal Transmission

Pilot study: Determination of the subjective trunk vertical in upright head position

Consensus has been established that the subjective vertical (SV) is aresult of multimodal sensory integration. In order to be able to calculate the vestibulocervical sensory competence for the SV, the isolated subjective trunk vertical axis (STV) was measured under conditions of vertical head fixation. Young, healthy volunteers (n = 49) were compared to older, healthy volunteers (n = 50) on athree-dimensionally deflectable (tilt, torsion, pitch) trunk excursion chair in which the volunteer's head remains in an upright position. Another young, healthy group was divided into aplacebo (n = 27) and amonophasic cervical transcutaneous electrical nerve stimulation (C-TENS; n = 22) group to examine verticality perception. In the STV after trunk pitch, age was asignificant variable (p = 0.021). The older, healthy group of subjects missed the physical vertical by an average of 1.8° more than the younger group. Only the placebo group showed an average improvement in STV of 4.3° after torsion. Apart from the macular organs the vestibulocervical sensory afference is involved in finding the trunk vertical. Adifference in age to the disadvantage of the older healthy subjects was observed, as well as alack of learning success after applied C‑TENS. The presented pilot study was able to confirm that acorrect vertical trunk sensation is caused by vestibulocervical sensory afference in upright head position.

Application of neurophysiology in electrical cervical spinal cord stimulation for persistent vegetative state

Objective To investigate the correlation between the overall scores of multimodal neurophysiological methods [electroencephalography (EEG), brainstem auditory evoked potential (BAEP), somatosensory evoked potential (SEP)] and therapeutic effect of cervical spinal cord stimulation (cSCS) in patients with persistent vegetative state (PVS) resulting from non-traumatic brain injury. Methods A retrospective analysis was conducted on the clinical data, neurophysiological scores and 1-year outcomes of 48 PVS patients who underwent treatment of cSCS (study group) at Department of Neurosurgery, Daqing Oilfield General Hospital from January 2010 to February 2017. The results were compared with the clinical data and outcomes of 50 patients undergoing conservative resuscitating treatment (control group) during the same period. We investigated the relationship between multimodal neurophysiological scores and therapeutic effect of cSCS treatment by Spearman rank correlation analysis in the study group. Results In the study group, 18 cases (37.5%) were resuscitated from PVS, 11 cases (22.9%) reported obvious therapeutic effect. In the control group, 3 cases (6.0%) were resuscitated from PVS, 4 cases (8.0%) had obvious therapetuic effect at 1 year post treatment. The treatment effect was significantly different between study group (R=0.6077) and control group (R=0.3966) by Ridit analysis (P<0.05). The cSCS treatment demonstrated better therapeutic effect than conservative resuscitating treatment. The Spearman rank correlation analysis showed that there was a positive correlation between the cSCS efficacy and neurophysiological scores (rs=0.854, P<0.05), i. e., higher overall neurophysiological scores indicated better therapeutic effect of cSCS. Conclusions (1) The cSCS awakening technology could promote neurological rehabilitation, improve the awakening ratio in PVS patients and facilitate early wake-up of PVS patients. (2) There is a positive correlation between multimodal neurophysiological scores and therapeutic effect of cSCS treatment. Multimodal neurophysiological scores play an important role in helping doctor choose cSCS awakening technology in clinical practice. Key words: Persistent vegetative state; Electrophysiology; Cervical spinal cord stimulation; Multimodal neurophysiology

Spinal cord neuronal components involved in the reflex activity of female rat pubococcygeus motoneurons

Evoked EMG reflex activity from the pubococcygeus muscle of female Wistar rats has been reported, but has not been carefully analyzed. Here, we studied this reflex activity through mechanical stimulation of the clitoris, perigenital skin, caudal vagina and foot, all of which produced bilateral reflex multiunit electromyographic (MEMG) tonic “on” activity and displayed a rapid adaptation. However, deep vagina and cervical stimulation did not modify MEMG baseline activity even if it was combined with clitoris, perigenital skin and foot stimulation. Electrical stimulation of the dorsal nerve of the clitoris produced bilateral MEMG activity that when recorded at fast sweep speed, it was possible to observe that the ipsilateral response had an 8 ms latency, while the contralateral response had a 10 ms latency. These data suggest that bilateral reflex activation of pubococcygeus muscle motoneurons is produced by several sensory sources in which a specialized neural circuitry of afferent and efferent components and several spinal cord interneurons are involved. This is in accordance with the multi functionality of this muscle in reproductive and behavioral processes.

Evolution of Godoy & Godoy manual lymph drainage. Technique with linear Movements.

Manual lymph drainage has become the mainstay in the treatment of lymphedema for decades now. Five evolving variants have been described by Godoy &amp; Godoy over the years: i) manual lymph drainage using rollers; ii) self-applied manual lymph drainage using rollers; iii) manual lymph drainage using the hands (manual lymphatic therapy); iv) mechanical lymphatic therapy using the RAGodoy® device; and v) lymphatic therapy using cervical stimulation in general lymphatic treatment. After breast cancer treatment using adapted technique with intermittent compression therapy. Lymphoscintigraphy, volumetry and bioimpedance were employed to analyze such treatment techniques applied to the upper and lower extremities. These treatment and evaluation topics are described in this brief report.

Pattern of ovulation in an ancient, solitary mole-rat lineage:Heliophobius argenteocinereus eminifrom Tanzania

The genus Heliophobius Peters, 1846 is an ancient subterranean rodent lineage within the family Bathyergidae that displays seasonal breeding over a broad geographical range. In East Africa, reproduction in these solitary mole-rats has been shown to coincide with the long rains, but it is not clear whether the silvery mole-rat subspecies Heliophobius argenteocinereus emini Noack, 1894 from Tanzania is an induced or spontaneous ovulator. To address this, urinary progesterone was measured every second day over a period of 132 days in six wild-caught females subjected to three sequential experimental treatments. In the first, control (C) treatment, females were housed singly for a period of 44 days, following which nonphysical contact (NPC) with a vasectomised male and then physical contact (PC) with the same vasectomised male occurred in each of the subsequent 44-day treatments. Noninvasive monitoring of ovarian cyclicity confirmed that mean urinary progesterone concentration was higher during PC than during either NPC or C, despite the fact that the males were vasectomised and incapable of fertilising the females. Examination of penile morphology revealed that males possess epidermal projections on the glans penis, which probably bring about cervical stimulation during coitus. These findings together with the female progesterone profiles imply the species is an induced ovulator stimulated by penile intromission.

The effects of artificial rearing and fostering on the growth, carcass and meat quality of lambs

Lamb rearing is a key point to ensure good quality at the end of the production cycle. Fostering and artificial rearing are techniques commonly used when natural rearing is compromised. However, there is a lack of research investigating their impact on the product’s quality, especially when lambs are slaughtered late, around 6 months of age. The current study investigated the effects of artificially reared and fostered lambs on growth, carcass and meat quality. The three foster methods under study were birth fluids, cervical stimulation combined with birth fluids and restraint. Animals were weaned at 3 months of age, and processed at 6 months of age. Artificially reared lambs presented lower weight gains than ewe reared ones at young ages. They also presented worse conformation scores at the processing plant. No differences could be found for growth rates, carcass or meat quality among the foster methods tested.

Effect Of Vagus Nerve Stimulation Technique On Ventilatory Function In Acute Exacerbation Of Bronchial Asthma

Background: Asthma when uncontrolled, can severely limit the patient's daily life.Little, no, or excess delivery of the active drug substance will place patients with asthma at substantial risk. As physical therapist it is our responsibility to find physical techniques as substitutions or complementary for medications to reduce its use, dose and/or side effects. Purpose: to measure the efficacy of bilateral non invasive cervical vagus nerve stimulation technique on ventilatory function in acute exacerbation of patient diagnosed with bronchial asthma. Subjects and procedures: 30 patients aged between 21-70 years were assigned randomly into two groups 2/1ratio:vagus nerve stimulation group (A) and placebo group (B) both groups underwent pulmonary function test (flow-volume curve)to measure parameters of pulmonary function test (FVC,FEV1,PEF and FEF25-75%) as a percentage of predicted ,after that the vagus nerve stimulation group underwent positioning of four adhesive electrodes for bilateral non invasive cervical vagus nerve stimulation for 20 minutes and the placebo group underwent positioning of four adhesive electrodes without vagus nerve stimulation for 20 minutes after that spirometry was repeated to measure any changes in both groups. Results: for vagus nerve stimulation group (FVC,FEV1,PEF and FEF25-75%) as a percentage of predicted showed significant increase and reversibility of 10.76% ,10.19% ,10.43% and 10.40% respectively . For sham vagus nerve stimulation group FVC, FEV1 and PEF as a percentage of predicted showed insignificant differences and decline of 0.4%, 1.7% and 5.5% respectively and FEF25-75% showed significant decline of 6.8% . Comparing between the two groups in relative changes %;FVC as % of predicted was indicative of insignificant difference ,for FEV1, PEF and FEF25-75% as % of predicted relative changes % were indicative of statistically significant difference conclusion: a technique bilateral vagus nerve electrical stimulation in patients diagnosed with bronchial asthma in acute exacerbation is an effective technique in reversibility of FVC ,FEV1,PEF and FEF25-75% the improvement may be attributed to stimulation of afferent vagus with central desensitization.

Intensive Treatment of Elephantiasis in A Child: A Case Report

Introduction: There are few publications on the treatment of elephantiasis in children. Objective: The aim of this study is to report on the intensive treatment of lower limb elephantiasis of a child in an outpatient setting. Case report: We report the case of an eight-year-old boy who was born with scrotum and lower limb lymphedema. The initial diagnostic difficulty and therapeutic conduct over the years did not produce results and there were complications such as erysipelas. The lymphedema progressed to the most advanced stage, elephantiasis (stage III), with the mobility of the child limited affecting the quality of his life, including academically. A five-day intensive outpatient treatment program was proposed including Cervical Stimulation Therapy, Manual Lymphatic Therapy, Mechanical Lymphatic Therapy and compression using a custom-made stocking made of a grosgrain fabric. Results: There was a reduction of 45% of the limb volume in five days. Conclusion: Intensive treatment of elephantiasis in children is a new therapeutic option that allows significant reductions in volume in a short time.

Intraoperative electrophysiological monitoring for C1-2 spinal cord stimulation.

OBJECTIVE This study is a retrospective case series involving C1-2 spinal cord stimulation in patients with complex regional pain syndrome (CRPS) under general endotracheal anesthesia. Currently, C1-2 paddle lead placement is an accepted practice, which provides effective cervical stimulation to ameliorate upper-extremity and sometimes lower-extremity symptoms experienced by patients with CRPS. However, this technique must be performed under general endotracheal anesthesia rather than in an awake or semiconscious state due to intraoperative safety concerns and patient comfort. The authors aim to provide additional data to support the following novel technique: the use of somatosensory evoked potential (SSEP) diminution data to assist with proper midline placement of C1-2 leads under general anesthesia. METHODS SSEP median nerve (MN) and posterior tibial nerve (PTN) data were collected from 6 patients undergoing placement of C1-2 leads under general anesthesia. Fluoroscopy was used as an initial guide for proper anatomical midline placement. This was followed by the activation of the spinal cord stimulator and simultaneous collection of primarily MN SSEPs as well as PTN SSEPs for physiological midline placement. Unilateral and bilateral reductions in SSEPs assisted with the correct lateralization of the lead to ensure effective postoperative coverage according to the patient's individual preoperative symptoms. RESULTS Six patients were monitored using SSEPs and repeatable, reliable MN and PTN baseline responses were obtained from all. A reduction in amplitude ranging from 5% to 87% was observed, confirming inhibition of dorsal column conduction, and an average pain relief of 63% at short-term and 64% at long-term follow-up was recorded with 6 of 6 and 5 of 6 patients responding, respectively. CONCLUSIONS Intraoperative SSEP collision study testing appears to be a safe technique to monitor placement of C1-2 paddle leads intraoperatively under general anesthesia.

23. Transcranial magnetic stimulation (TMS) in neurological diseases

The use transcranial magnetic stimulation (TMS) in clinical settings has grown over the last three decades. Since its introduction by Barker in 1985, TMS has been used to assess central motor pathways, as well as cortical function and intrinsic circuitry. Single-pulse TMS can map motor cortical outputs, and with cervical, thoracic and lumbar spinal cord stimulation, one can study the central motor conduction time. In addition, TMS document cortical hyperexcitability, as in early phases of sporadic ALS, or hypo excitability as in ischemic infarcts or central demyelinating diseases. With Single-pulse TMS techniques, one can study the corticomotoneuronal function using motor threshold, motor evoked potential (MEP) amplitude, central conduction time, cortical silent period, intracortical inhibition, and facilitation. The magnetic field produced by the coil assess, cortico-cortical projections (IPSP and EPSP) of pyramidal cells of the firth layer, thus it is required integrity of gray matter. In this presentation, I will present the usefulness of MEPs in upper motor neuron diseases as multiple sclerosis, ALS, vascular brain injuries, abnormal movements, spinal cord lesions, early stages of facial nerve palsies, among other neurological diseases. In addition, the capacity to predict motor function recovery, after ischemic brain insults, will be discussed.

Pattern of ovulation in the East African root rat (Tachyoryctes splendens) from Tanzania: induced or spontaneous ovulator?

The East African root rat (Tachyoryctes splendens (Rüppell, 1835)) is a solitary subterranean rodent that exhibits a marked seasonal reproduction linked to the bimodal rainfall pattern of East Africa. The current study sets out to determine whether the East African root rat is an induced or spontaneous ovulator. Five wild caught adult females were monitored noninvasively for ovarian cyclicity by measuring urinary progesterone every 2 days over a period of 120 days. Females were subjected to three different experimental treatments, namely, initially singly housed or control (C), nonphysical contact with a male (NPC), and physical contact with a vasectomised male (PC), respectively. The concentration of urinary progesterone was higher during PC than during either NPC or C. The act of coitus appears to be necessary for ovulation to occur in the females. The male East African root rats were found to possess epidermal spines on the penis that can be used to bring about cervical stimulation during coitus. The spines result in the induction of ovulation as has been proposed for other solitary subterranean rodents. The findings from the female progesterone profiles and the assessment of penile morphology suggest that the female East African root rat is an induced ovulator stimulated by penile intromission during coitus.

The vestibular craniovertebral joints

The significance of cervical proprioception for human balance has thus far not been sufficiently elucidated. The aim of this study was to provoke selective cervico-vestibular stimulation using the trunk excursion test (TET) we ourselves constructed. This chair is designed to enable evaluation of cervico-ocular reactions during isolated trunk excursion and possible effects of aging. The previously used head excursion test (HET) was statistically compared to the TET. In both methods, 100healthy subjects of two age groups (group(26): median age= 26years, n= 50; group(50): median age= 50years, n= 50) were randomized for comparison of similar neck-to-trunk-positions. HET enabled detection of significant nystagmus modulation in horizontal and vertical dimensions; whereas in pure cervical stimulation using the new TET, this was only evident in the horizontal dimension and only during trunk torsion. Comparison of the two methods confirmed significantly stronger nystagmus modulation through head excursion. In terms of the HET, group(50) showed significantly more vertical nystagmus activity than group(26). However, no significant difference was found between the groups in terms of their reactions to trunk excursion in the TET. In agroup-specific comparison of the methods, group(26) showed asignificant increase in horizontal nystagmus in head compared to trunk excursion, whereas group(50) generally displayed asignificantly greater response to provocation by head excursion in HET. Analysis of the significant vertical nystagmus modulation produced with the TET method showed predominance of upbeat- (UBN) over downbeat-nystagmus (DBN). Through head excursion with the HET, DBN was more frequently evoked in group(50) than in group(26). No significant age-dependent difference could be derived in UBN. The results of the pilot study indicate that head-to-trunk provocation is asuitable means of evaluating cervicotonic provocation nystagmus. Only by evaluation of adequate excursion limits and consistent analysis of patients with cervical deficiency can the effects of the method be further assessed.

Influence of dynorphin on estradiol- and cervical stimulation-induced prolactin surges in ovariectomized rats.

Prolactin is an anterior pituitary hormone necessary for fertility, pregnancy maintenance, lactation, and aspects of maternal behavior. In rodents, there is a surge of prolactin on the afternoon of proestrus, and a semi-circadian pattern of prolactin surges during early pregnancy, with a diurnal and nocturnal surge every day. Both of these patterns can be replicated in ovariectomized rats. A prior study demonstrated that central antagonism of κ-opioid receptors, the target of dynorphin, largely abolished the nocturnal prolactin surge in pregnant rats. We build on this to determine whether dynorphin, perhaps from the arcuate population that co-express kisspeptin, neurokinin B, and dynorphin (KNDy neurons), also contributes to the estradiol- or cervical stimulation-induced surges in ovariectomized rats. Ovariectomized rats were treated with either estradiol or cervical stimulation to induce prolactin surge(s). Blood samples were taken around the expected surge time to determine the effect of either acute κ-opioid receptor antagonism or previous chemical ablation of the KNDy population on prolactin levels. Dynorphin antagonism does significantly disrupt the nocturnal prolactin surge, but it does not contribute to the estradiol-induced surge. Chemical ablation of KNDy neurons had opposite effects; ablation of 40% of the KNDy neurons had no impact on the nocturnal prolactin surge, while a somewhat larger ablation significantly reduced the size of the estradiol-induced surge. We conclude that dynorphin is likely a controlling factor for the nocturnal surge induced by cervical stimulation, and that other KNDy neuron products must play a role in the estradiol-induced surge.

Su1563 Electrical Stimulation of the Abdominal Vagus Nerve Is as Effective as Cervical Nerve Stimulation in Reducing Postoperative Ileus

Su1563 Electrical Stimulation of the Abdominal Vagus Nerve Is as Effective as Cervical Nerve Stimulation in Reducing Postoperative Ileus

Cervical Spinal Stimulation and Respiratory Recovery after Upper Cervical Spinal Cord Injury

Over half of all spinal cord injuries (SCI) occur at the cervical level leading to disruption of bulbospinal pathways to respiratory motor neurons, respiratory muscle paralysis, and diminished breathing capacity. Of the 6,000 new cervical spinal injuries per year, ~20% will require mechanical ventilatory support. Even when mechanical ventilation is not necessary, breathing impairment greatly increases susceptibility to life‐threatening lung infections. In fact, the leading cause of morbidity and mortality in cervical SCI is respiratory impairment. In this study, rats were implanted with bilateral cervical (C4) stimulating electrodes and bilateral diaphragm EMG recording electrodes. Our previous data have shown that cervical spinal stimulation elicits evoked potentials and modulates diaphragm EMG (Dale et al., 2015). In this study, after obtaining baseline data, rats were given a C2 hemisection (C2HS). After recovery, rats were placed in either control (evoked potentials only; n=6) or Quipazine + stimulation (n=8) groups and were tested at 1, 2, and 4 weeks post‐C2HS. After eliciting spinal evoked potentials (SEP) of increasing intensity, rats received Quipazine (0.3mg/kg; IP), a broad‐spectrum serotonergic agonist, and diaphragm EMG was recorded for 20 min. Next, each rat received 3 bouts (interspersed with 5 min no stim) of cervical stimulation (bipolar) at increasing frequencies but at sub‐motor threshold intensity (5 min at 40Hz, 5min at 80Hz, and 5 min at 100Hz). Another set of SEPs was elicited upon stimulation completion. Our goal is to restore respiratory function in a rat model of cervical spinal injury by utilizing cervical spinal epidural electrical stimulation in combination with serotonergic agonists (e.g. quipazine). By inducing respiratory plasticity after synergistic modulation of the phrenic motor network (e.g. cervical epidural stimulation plus quipazine), we hypothesize that enhancing the contributions from spared motor neurons could be an avenue for preserving ventilatory capacity. This project may lead to novel therapies to extend and improve life for patients with cervical spinal cord injury by preserving breathing.Support or Funding InformationChristopher and Dana Reeve Foundation and NIH U01EB007615

ID 254 – Validation of a method for deriving motor evoked potentials of the diaphragm muscle after transcranial and cervical magnetic stimulation

Objective The aim of the study was to investigate whether by using transcranial and cervical magnetic stimulation valid information on the cortico-diaphragmatic motor system could be obtained. Methods By using surface electrodes the best position for recording a diaphragm motor evoked potential (dmep) without coactiviation of nearby muscles was examined in 47 healthy subjects without any respiratory disorder. Subsequently, the latencies and amplitudes of the dmep of each hemidiaphragm were registered after central and peripheral magnetic stimulation. These measurements were used to determine the latencies of the central motor pathway to the diaphragm. Interference of recorded signals can occur by an incorrect positioning of the electrodes or obesity. Likewise, motor evoked potentials from feet and arms were obtained to exclude participants with interferences of the central motor pathway. Results Latencies gained for the central motor pathway were 10.71 ± 2.01 to the left and 10.77 ± 1.80 ms to the right hemidiaphragm. Repeated measurements of the latencies for the same individual were reproducible and did not significantly differ from each other, when recorded from an optimal position. Conclusions/Key message Magnetic stimulation is a useful tool to examine the integrity of the central motor system to the diaphragm.