Effect Of Dorsal Column Stimulation Research Articles

The effect of dorsal column stimulation on γ-aminobutyric acid concentrations in the cerebrospinal fluid

Cornelissen, C.; Van Zundert, J.; Boer, W.; Penders, J.; Heylen, R.; Vanelderen, P. Author Information

Dorsal column stimulation induces release of serotonin and substance P in the cat dorsal horn.

The neurohumoral mechanisms behind the pain-suppressing effect of dorsal column stimulation (DCS) still remain obscure. Experimental observations have indicated an inhibitory role for serotonin and, under certain conditions, also for substance P (SP), on nociceptive transmission in the spinal cord. Furthermore, some observations suggest that these substances might be involved in the effect of DCS. The present series of experiments was undertaken to investigate whether serotonin and SP are released in the dorsal horn by DCS. Twenty-one adult cats, in some experiments anesthetized, in others decerebrated at the midcollicular level, were used. Microdialysis probes were implanted bilaterally in lumbar dorsal horns (L5-L7) and perfused with Krebs' solution. Dialysates were analyzed for serotonin by high-performance liquid chromatography or for SP by radioimmunoassay. DCS was applied at the thoracolumbar junction with current parameters similar to those used clinically in humans. DCS induced a significant release of serotonin in the dorsal horn of decerebrated animals (173 +/- 83% increase; mean +/- standard error; n = 4; P less than 0.01), whereas the levels of the metabolite 5-hydroxyindoleacetic acid were not significantly influenced. In contrast, no release of SP could be recorded in response to DCS in the decerebrated preparation, although peripheral nociceptive stimulation (pinch) and noxious electric dorsal root stimulation induced an elevation of the SP levels. However, in intact animals DCS provoked a marked SP release in the dorsal horn (190 +/- 92% increase; n = 7; P less than 0.01). The release of serotonin and SP after DCS may indicate that these substances participate in the mediation of the pain alleviating effect of DCS.(ABSTRACT TRUNCATED AT 250 WORDS)

Spasticityに対する脊髄硬膜外刺激の作用メカニズムに関する研究

Spasticityに対する脊髄硬膜外刺激の作用メカニズムに関する研究

Effect of dorsal-column stimulation on gelatinosa and marginal neurons of cat spinal cord.

Single neuronal units with physiological characteristics of superficial dorsal-horn neurons were recorded extracellularly in laminae 1, 2, and 3 of cat spinal cord. When focal electrical stimulation was applied to the ipsilateral dorsal column, most of the units were excited transsynaptically at various latencies consistent with an effect mediated by large myelinated axons. Units recorded in laminae 2 and 3 had earlier latencies of activation than units in lamina 1. Units with cutaneous receptive fields only for noxious stimuli were activated at significantly longer latencies than units responsive to innocuous stimuli. The time course of these effects was consistent with the concept that many cells in laminae 1 to 3 receive direct excitatory synaptic input from collaterals of dorsal-column fibers, and some lamina 1 cells receive excitatory synaptic input from lamina 2 neurons. Previous reports have emphasized the inhibitory action of dorsal-column stimulation on nociceptive responses of cells in laminae 4 and 5 of the dorsal-horn, particularly those of the spinocervical tract in cats and the spinothalamic tract in primates. The present study suggests that some of this inhibition might be sustained by a network of interneurons in or near the substantia gelatinosa and marginal layer. The therapeutic efficiency of dorsal-column stimulation for pain relief in humans may depend in part on the activation of neurons in the superficial layers of the dorsal horn.

Dorsal column stimulation in multiple sclerosis: effects on bladder and long term findings.

The effect of dorsal column stimulation on bladder function in 15 patients with established multiple sclerosis was analysed by urodynamic tests. Significant improvement in flow rate and urethral sphincter pressure was recorded in about two thirds. Of 31 patients examined over five years only 13 showed initial benefit from stimulation and were given permanent stimulators; of these, only three appeared to receive lasting benefit. Early complications occurred in nine patients and five had a relapse of their disease. These results suggest that at present stimulation of the dorsal column does not have a place in the routine management of multiple sclerosis.

Dorsal Column Stimulation in Man

The effects of cervical epidural dorsal column stimulation on the negative and slow positive waves of the spinal cord potentials recorded from the posterior epidural space at the lumbar enlargement, in response to intense stimulation of the tibial nerve in five neurologically normal subjects during neuroleptanesthesia were studied. Single pulses applied to the cervical dorsal cord near the midline produced slow positive potentials preceded by negative waves in the dorsal spinal cord at the level of the lumbar enlargement. The negative wave, believed to represent synchronized activities of interneurons, was inhibited up to 100 to 120 msec by conditioning dorsal column stimulation. The slow positive wave, though to represent primary afferent depolarization, was facilitated for more than 100 msec with transient inhibitor for 10 to 40 msec. The results suggest that the pain-alleviating effect of dorsal column stimulation in man may be at least partly due to orthodromic and/or antidromic activation of descending inhibitory pathways which inhibit the responsible cells and facilitate primary afferent depolarization.

Effect of Dorsal Column Stimulation on Pain-Induced Intracerebral Impulse Patterns

Evoked electrical potentials were recorded via intracerebral electrodes in a patient with stump and phantom limb pain who had a previously implanted dorsal column stimulator. When pain was elicited by peripheral stimulation it was found that positive deflections appeared in the ventrolateral nucleus of the thalamus at time latencies corresponding to the propagation velocities of A delta- and C-fibres. Dorsal column stimulation completely eliminated the C-fibres. Dorsal column stimulation completely eliminated the C-fibre deflection and partially eliminated the A delta-fibre deflection.

The effect of dorsal column stimulation on the nociceptive response of dorsal horn cells and its relevance for pain suppression

The effect of single and repetitive electrical stimulation of the dorsal columns on cells in laminae IV and V of the ipsilateral dorsal horn at S 1 was examined in spinalized cats. About two-thirds of the cells responded to thermal nociceptive cutaneous stimulation and of these most responded also to low threshold mechanical stimulation. The other one-third of the cells were innervated by mechanoreceptors including type I or Haarscheiben. A single shock to the dorsal columns typically caused short latency activation of the cells, followed by inhibition lasting about 100 msec. Several minutes of repetitive dorsal column stimulation (DCS) at 3 Hz or 50 Hz had no prolonged effect on about two-thirds of the cells. The rest of the cells were less responsive for up to 30 min after the cessation of 50 Hz. Assuming that the studied interneurons have a pain-mediating function, the results indicate that some cumulative and poststimulatory DCS suppression of pain may be ascribed to spinal mechanisms. The more effective and longer lasting suppression produced by DCS in pain patients would, however, be dependent on other types of interneurons, on suprasegmental loops and/or on effects on pathophysiological mechanisms which may be operative in the chronic pain state. The lack of cumulative inhibition in most of the cells in this study is compatible with the previous observation of a retained perception of acute pain during DCS in man.

Dorsal column stimulation: Its effect on medial bulboreticular unit activity evoked by noxious stimuli

Single-unit extracellular recordings were made from 161 cells in the medial bulboreticular formation evoked by supramaximal electrical stimulation of the contralateral forepaw. Conditioning dorsal column stimulation suppressed the evoked response to supramaximal electrical and natural noxious stimuli. By comparing the results of conditioning stimulation applied rostrally or caudally to a complete dorsal column transection, we concluded that the modulating effect of dorsal column stimulation probably occurred at a spinal segmental level. Rostral dorsal column shocks were ineffective as conditioning stimuli and produced no cellular evoked response in themselves. Caudal dorsal column pulses produced an initial response, followed by subsequent inhibition to repetitive dorsal column shocks and to supramaximal peripheral stimulation. Trains of supramaximal stimuli given peripherally yielded no inhibitory phenomena. We postulated that spinoreticular neurons projecting to the medial bulboreticular formation could be fired by supramaximal peripheral stimulation or antidromic activation of dorsal column collaterals. The latter fibers also activated inhibitory mechanisms which suppressed further neuronal response to subsequent afferent input.

Effects of dorsal column stimulation on primate spinothalamic tract neurons.

The effect of dorsal column stimulation on spinothalamic tract cells was investigated in anesthetized monkeys. The dorsal column stimuli were applied at midthoracic or at cervical levels of the cord, while the responses of spinothalamic tract cells of the lumbosacral enlargement were examined. A dorsal column volley depressed the activity of spinothalamic tract cells for about 150 ms. A similar depression was observed whether the spinothalamic tract cell was classified as hair activated, low, or high threshold, based on its response properties to cutaneous stimulation. The hair-activated and low-threshold spinothalamic tract cells were initially excited by the dorsal column volley, but often it was possible to demonstrate that a depression could be produced by stimuli which were too weak to cause excitation of these cells. Depression was produced both of the responses of spinothalamic tract cells to electrical stimulation of peripheral nerves and to mechanical stimulation of cutaneous nociceptors. A similar depression was produced by electrical stimulation of large afferents in peripheral nerves. The pathway mediating the depression of spinothalamic tract cells was shown to involve antidromic invasion of collaterals of dorsal column fibers. The best points for stimulation of the cord to produce a depression were over the ipsilateral dorsal column. A lesion interrupting the dorsal column eliminated the depression of cells below the lesion, whereas a lesion of much of the lateral column had no effect. The mechanism of the depression is likely to be complex. Apart from interactions at an interneuronal level, dorsal column volleys can be presumed to collide with sensory input from afferents which project up the dorsal column; collision would interfere chiefly with the responses of hair-activated and low-threshold spinothalamic tract cells. In addition, dorsal column volleys were shown to evoke inhibitory postsynaptic potentials in some spinothalamic tract neurons, and they also produced primary afferent depolarization, at least of large cutaneous afferemts. The excitation of hair-activated and low-threshold spinothalamic tract cells argues against their participation in signaling pain, since dorsal column stimulation in humans does not produce pain at stimulus intensities and frequencies which should activate such neurons. Alternatively, an ascending volley in the dorsal column or in other pathways may interfere with pain transmission in the brain.

On the Effect of Electrical Stimulation of the Dorsal Column System on Sensory Thresholds in Patients with Chronic Pain

Publisher Summary This chapter discusses the effect of electrical stimulation of the dorsal column system on sensory thresholds in patients with chronic pain. Patients who had dorsal column electrodes implanted for the relief of chronic pain are examined for the influence of dorsal column stimulation on the spontaneous pain and on the thresholds for touch, vibration, and cutaneous pain induced by pinching. In these patients, stimulation of the dorsal columns resulted in an almost instantaneous abolition of spontaneous pain. The relief of pain outlasted the period of stimulation by several hours. The normal threshold for induced cutaneous pain is not significantly changed either during or after dorsal column stimulation. The thresholds for tactile and vibratory sensations are increased during dorsal column stimulation, the increase being correlated to the intensity of the stimulation. There is a post-stimulatory effect lasting up to 20 minutes. Different mechanisms may account for the effect of dorsal column stimulation on the spontaneous pain and on the sensory thresholds is indicated.

Functional organization of the cat's dorsal horn: spontaneous activity and central cell response to single impulses in single type I fibers.

Functional organization of the cat's dorsal horn: spontaneous activity and central cell response to single impulses in single type I fibers.P B Brown, H Moraff, and D N TapperP B Brown, H Moraff, and D N TapperPublished Online:01 Sep 1973https://doi.org/10.1152/jn.1973.36.5.827MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByMechanosensory afferent input and neuronal firing properties in rodent spinal laminae III–V: re-examination of relationships with analysis of responses to static and time-varying stimuliBrain Research, Vol. 1034, No. 1-2Interlimb reflex activity after spinal cord injury in man: strengthening response patterns are consistent with ongoing synaptic plasticityClinical Neurophysiology, Vol. 116, No. 1From innervation density to tactile acuityBrain Research, Vol. 1011, No. 1Effects of spinal and peripheral nerve lesions on the intersegmental synchronization of the spontaneous activity of dorsal horn neurons in the cat lumbosacral spinal cordNeuroscience Letters, Vol. 361, No. 1-3Synaptic transmission between single tactile and kinaesthetic sensory nerve fibers and their central target neuronesBehavioural Brain Research, Vol. 135, No. 1-2Modulation of synaptic transmission from segmental afferents by spontaneous activity of dorsal horn spinal neurones in the cat12 August 2004 | The Journal of Physiology, Vol. 529, No. 2Correlation of Peripheral Innervation Density and Dorsal Horn Map ScaleLei Wang, Ronald Millecchia, and Paul B. Brown1 August 1997 | Journal of Neurophysiology, Vol. 78, No. 2Tonic 5-HT modulation of spinal dorsal horn neuron activity evoked by both noxious and non-noxious stimuli: a source of neuronal plasticityPain, Vol. 40, No. 2Lack of spontaneous activity of cutaneous spinal dorsal horn neurons in awake, drug-free, spinally transected catsExperimental Neurology, Vol. 96, No. 2Electrical stimulation reveals relatively ineffective sural nerve projections to dorsal horn neurons in the catBrain Research, Vol. 371, No. 1Anatomical changes in cat dorsal horn cells after transection of a single dorsal rootExperimental Neurology, Vol. 64, No. 3The effect of dorsal column stimulation on the nociceptive response of dorsal horn cells and its relevance for pain suppressionPain, Vol. 4, No. Supp CGeneration of spike trains in CNS neuronsBrain Research, Vol. 84, No. 1Myelinated fiber types in the superficial radial nerve of the cat and their central projectionsBrain Research, Vol. 78, No. 1 More from this issue > Volume 36Issue 5September 1973Pages 827-39 https://doi.org/10.1152/jn.1973.36.5.827PubMed4375707History Published online 1 September 1973 Published in print 1 September 1973 Metrics

Spinal neurons specifically excited by noxious or thermal stimuli: marginal zone of the dorsal horn.

HIGH-THRESHOLD MECHANORECEPTORS and their centrally projecting myelinated fibers make up a functionally distinct group of cutaneous sensory units that have been suggested as part of the afferent apparatus for pain resulting from mechanical damage to the skin (3, 17). The argument for their relation to pain was based on two points: 1) the ability of such afferent elements, unique among those with medullated fibers, to provide signals differentiating noxious from innocuous mechanical events affecting the skin; and 2) the well-established correlation between pain and activity in thin myelinated afferent fibers