Effects Of Peripheral Nerve Stimulation Research Articles

ID: 336440 The Effects of Peripheral Nerve Stimulation on Chronic Shoulder Pain

ID: 336440 The Effects of Peripheral Nerve Stimulation on Chronic Shoulder Pain

Spatiotemporal Dynamics of Periodic and Aperiodic Brain Activity Under Peripheral Nerve Stimulation With Acupuncture.

Brain activities are a mixture of periodic and aperiodic components, manifesting in the power spectral density (PSD) as rhythmic oscillations with spectral peaks and broadband fluctuations. Periodic oscillatory properties of brain response to external stimulation are widely studied, while aperiodic component responses remain unclear. Here, we investigate spatiotemporal dynamics of periodic and aperiodic brain activity under peripheral nerve stimulation with acupuncture by parameterization of power spectra of EEG signals. Regarding periodic brain activity, spectral peak in delta band emerges in frontal and central brain regions indicates a typical phenomenon of neural entrainment, which is formed by coupling periodic brain activity to external rhythmic acupuncture stimulation. In addition, the statistical results show that alpha periodic power is an important indicator for characterizing the modulatory effects of acupuncture on periodic brain activity. As for aperiodic brain activity, broadband EEG spectral trend analysis demonstrates a steeper aperiodic slope in left parietal lobe and a stronger negative correlation with the aperiodic offset under acupuncture compared with resting state, with the absolute value of correlation coefficient increasing from 0.27 to 0.50. Based on the two parameters that can best characterize the acupuncture effect, alpha periodic power and aperiodic slope, the accurate decoding of acupuncture manipulation is realized with AUC = 0.87. This work shows the modulatory effect of peripheral nerve stimulation with acupuncture on the brain activity by characterizing the periodic and aperiodic spectrum features of EEG, providing new insights into the comprehensive understanding of the response processes of human brain to acupuncture stimulation.

Peripheral Nerve Stimulation on the Brachial Plexus With Ultrasound-guided Percutaneous Technique: A Case Series

IntroductionThe aim of this case series was to assess the safety and effectiveness of peripheral nerve stimulation (PNS) of the brachial plexus performed using a low invasive percutaneous approach with ultrasound guide. Materials and MethodsPatients affected by neuropathic pain with a documented brachial plexus partial avulsion were included in this observational study. A totally implantable PNS system specifically designed for peripheral placement (Neurimpulse, Padua, Italy) was implanted and followed for 18 months, recording the level of pain (Numeric Rating Scale [NRS]), therapy satisfaction (Patient Global Impression of Improvement), quality of life (Short Form Health Survey questionnaire), and change in drug consumption and work status. Descriptive statistic (mean and SD) was used to compare pre- and postimplantation differences. ResultsA total of 18 patients were included in the observational study; 16 of them proceeded with the permanent implantation. System infection (N = 1) and lead migrations (N = 2) were recorded during a follow-up mean of 14.8 ± 5.4 months. The average NRS reduction at 18 months was 41%. Average quality-of-life physical and mental indexes increased by 14% and 32%, respectively. Drug intake was stopped in 22% and reduced in 56% of the patients. ConclusionsPNS systems of the brachial plexus implanted with percutaneous approach appear to be safe and effective in a follow-up period of 18 months. Longer and larger studies are needed to confirm and extend these outcomes.

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy.

Chronic pain is a common source of morbidity in many patient populations worldwide. There are growing concerns about the potential side effects of currently prescribed medications and a continued need for effective treatment. Related to these concerns, peripheral nerve stimulation has been regaining popularity as a potential treatment modality. Peripheral nerve stimulation components include helically coiled electrical leads, which direct an applied current to afferent neurons providing sensory innervation to the painful area. In theory, the applied current to the peripheral nerve will alter the large-diameter myelinated afferent nerve fibers, which interfere with the central processing of pain signals through small-diameter afferent fibers at the level of the spinal cord. Multiple studies have shown success in the use of peripheral nerve stimulation for acute post-surgical pain for orthopedic surgery, including post total knee arthroplasty and anterior cruciate ligament surgery, and chronic knee pain. Many studies have investigated the utility of peripheral nerve stimulation for the management of chronic shoulder pain. Peripheral nerve stimulation also serves as one of the potential non-pharmacologic therapies to treat back pain along with physical therapy, application of transcutaneous electrical neurostimulation unit, radiofrequency ablation, epidural steroid injections, permanently implanted neurostimulators, and surgery. Studies regarding back pain treatment have shown that peripheral nerve stimulation led to significant improvement in all pain and quality-of-life measures and a reduction in the use of opioids. Further studies are needed as the long-term risks and benefits of peripheral nerve stimulation have not been well studied as most information available on the effectiveness of peripheral nerve stimulation is based on shorter-term improvements in chronic pain.

Effects of peripheral nerve stimulation on paralysed upper limb functional recovery in chronic stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation and occupational therapy: A pilot study

ObjectiveUpper limb paralysis, which is a sequela of stroke, limits patients’ activities of daily living and lowers quality of life. The objective of this study was to examine the effects of peripheral nerve stimulation on hemiparetic upper limb functional recovery in chronic stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation and occupational therapy.MethodsThe subjects were chronic stroke patients who participated in a two-week inpatient programme including repetitive transcranial magnetic stimulation and occupational therapy. There were two groups of patients: the peripheral nerve stimulation group (11 patients who underwent peripheral nerve stimulation) and the control group (11 patients who previously participated in the same inpatient programme but without peripheral nerve stimulation, selected via propensity score matching). The peripheral nerve stimulation group had 1 h of peripheral nerve stimulation on the median and ulnar nerves during occupational therapy. The outcome measures were the Wolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log.ResultsWolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log showed significant improvement after the intervention in the peripheral nerve stimulation group. Particularly, the Fugl-Meyer Assessment hand score significantly improved in the peripheral nerve stimulation group compared to that in the control group (median change: 2 versus 0; p = 0.021, r = 0.49).ConclusionThe combined use of peripheral nerve stimulation with occupational therapy after repetitive transcranial magnetic stimulation may result in a better functional recovery of in hemiparetic upper limb. Peripheral nerve stimulation with stimulation above the sensory threshold and below the motor threshold is easy to combine with occupational therapy upper limb function training and is therefore clinically useful.

A Randomized Controlled Trial of Subcutaneous Nerve Stimulation for Back Pain Due to Failed Back Surgery Syndrome: The SubQStim Study

ObjectivesTo compare the effectiveness of peripheral nerve stimulation utilizing a subcutaneous lead implant technique—subcutaneous nerve stimulation (SQS) plus optimized medical management (SQS + OMM arm) vs. optimized medical management alone (OMM arm) in patients with back pain due to failed back surgery syndrome.Patients and MethodsPatients were recruited from 21 centers, in Europe, Israel, and Australia. Eligible patients were randomized (1:1) to SQS + OMM or OMM arms. Those in the SQS arm were implanted with a neurostimulator and up to two subcutaneous percutaneous cylindrical leads in the area of pain. Patients were evaluated pre‐randomization and at one, three, six, and nine months post‐randomization. The primary endpoint was the proportion of subjects with a ≥50% reduction in back pain intensity (“responder”) from baseline to nine months. Secondary outcomes included proportion of responders with a ≥50% reduction in back pain intensity at six months and ≥30% reduction at nine months, and the mean change from baseline in back pain intensity at six and nine months between the two arms.ResultsDue to the slow rate of recruitment, the study was terminated early with 116 subjects randomized. A total of 33.9% (19/56, missing: n = 20 [36%]) of subjects in the SQS + OMM arm and 1.7% (1/60, missing: n = 24 [40%]) in the OMM arm were responders at Month 9 (p < 0.0001). Secondary objectives showed a significant difference in favor of SQS + OMM arm.ConclusionThe results indicate that the addition of SQS to OMM is more effective than OMM alone in relieving low back pain at up to nine months.

The Effect of Peripheral Nerve Stimulation on Shoulder Biomechanics: A Randomized Controlled Trial in Comparison to Physical Therapy.

To establish the effects on shoulder biomechanics from a peripheral nerve stimulation (PNS) treatment compared to physical therapy (PT) in stroke survivors with chronic hemiplegic shoulder pain. Single-site, pilot, randomized controlled trial for adults with chronic shoulder pain after stroke. Participants were randomized to receive a 3-week treatment of single-lead PNS or physical therapy (PT). The outcomes included isometric shoulder abduction strength, pain-free shoulder external rotation range of motion (ROM), delay in initiation and termination of shoulder abduction electromyogram (EMG) activity, and the Fugl-Meyer Motor Assessment (upper extremity section). Outcomes were measured at baseline, and at weeks 1, 4, 12, and 16. Twenty-five participants were recruited, 13 to PNS and 12 to PT. There were significant improvements for both PNS and PT in maximum isometric shoulder abduction strength, pain-free external rotation ROM, and Fugl-Meyer Motor Assessment. There were no significant changes in delay of initiation or termination of deltoid EMG with either treatment. Both PNS and PT are capable of improving shoulder biomechanics in those with HSP, though changes in biomechanics alone do not account for the greater pain relief associated with PNS than PT.

Randomized Trial of Peripheral Nerve Stimulation to Enhance Modified Constraint-Induced Therapy After Stroke

Constraint-based therapy and peripheral nerve stimulation can significantly enhance movement function after stroke. No studies have investigated combining these interventions for cases of chronic, mild-to-moderate hemiparesis following stroke. This study aims to determine the effects of peripheral nerve stimulation paired with a modified form of constraint-induced therapy on upper extremity movement function after stroke. Nineteen adult stroke survivors with mild-to-moderate hemiparesis more than 12 mo after stroke received 2 hours of either active (n = 10) or sham (n = 9) peripheral nerve stimulation preceding 4 hours of modified constraint-induced therapy (10 sessions). Active peripheral nerve stimulation enhanced modified constraint-induced therapy more than sham peripheral nerve stimulation (significance at P < 0.05), both immediately after intervention (Wolf Motor Function Test: P = 0.006 (timed score); P = 0.001 (lift score); Fugl-Meyer Assessment: P = 0.022; Action Research Arm Test: P = 0.007) and at 1-mo follow-up (Wolf Motor Function Test: P = 0.025 (timed score); P = 0.007 (lift score); Fugl-Meyer Assessment: P = 0.056; Action Research Arm Test: P = 0.028). Pairing peripheral nerve stimulation with modified constraint-induced therapy can lead to significantly more improvement in upper extremity movement function than modified constraint-induced therapy alone. Future research is recommended to help establish longitudinal effects of this paired intervention, particularly as it affects movement function and daily life participation. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Understand the role that afferent input plays with regard to movement function; (2) Understand general concepts of delivering modified constraint-based therapy in stroke rehabilitation research; and (3) Understand the rationale for applying an adjuvant intervention to optimize outcomes of constraint-based therapy following stroke. Advanced : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Efectividad de la estimulación nerviosa periférica en la recuperación de la función del miembro superior en sujetos con secuela de ictus: revisión sistemática y metaanálisis

In 30-66% of the cases, people who survive a stroke suffer from an affected non functional upper limb. Somatosensory stimulation might positively influence the muscular activity of patients with motor deficiencies caused by a stroke. To carry out a systematic review and a meta-analysis of the effectiveness of peripheral nerve stimulation (PNS) use in the improvement of the plegic/paretic upper limb function in patients with a stroke sequel. Randomized and non randomized clinically controlled tests and crossover studies published until November 2014 in Medline electronic database, Cochrane Central Register of Controlled Trials, LILACS, SciELO and Open Grey were included. Studies at high risk of bias were excluded. Two independent researchers assessed the studies' eligibility criteria and retrieved and analyzed all data. A total of 1,967 studies were found, five of them were included for data retrieval and analysis, using a risk of bias fashion of 6/10 at the PEDro scale. 224 patients were included, 95 of them received PNS in multiple modalities and 129 received other interventions as a control group. The analyzed data suggest that the function of the plegic/paretic upper limb improves after the application of PNS either with or without functional training. On the other hand, the meta-analysis result indicates that there is still insufficient evidence to guarantee the effectiveness of PNS use for the recovery of the plegic/paretic upper limb function in patients with a stroke sequel.

The Impact of Peripheral Nerve Stimulation on Coronary Blood Flow and Endothelial Function.

The geko™ device is a small transcutaneous nerve stimulator that is applied non-invasively to the skin over the common peroneal nerve to stimulate peripheral blood flow. The purpose of this study was to investigate the effect of peripheral nerve stimulation on coronary flow dynamics and systemic endothelial function. We enrolled 10 male patients, age 59±11years, with symptomatic obstructive coronary disease undergoing percutaneous coronary intervention (PCI). Coronary flow dynamics were assessed invasively using Doppler flow wire at baseline and with nerve stimulation for 4min. Measurements were taken in the stenotic coronary artery and in a control vessel without obstructive disease. At a separate visit, peripheral blood flow at the popliteal artery (using duplex ultrasound assessment) and endothelial function assessed by peripheral artery tonometry (PAT) were measured at baseline and after one hour of nerve stimulation. Compared to baseline, there was a significant increase in coronary blood flow as measured by average peak velocity (APV) in the control vessel with nerve stimulation (20.3±7.7 to 23.5±10cm/s; p=0.03) and non-significant increase in the stenotic vessel (21.9±12 to 23.9±12.9cm/s; p=0.23). Coronary flow reserve did not change significantly. Reactive hyperemia-peripheral arterial tonometry (Rh-PAT) increased from 2.28±0.39 to 2.67±0.6, p=0.045. A few minutes of peripheral nerve stimulation may improve coronary blood flow. This effect is more prominent in non-stenotic vessels. Longer stimulation improved endothelial function.

Contribution of Corticospinal Modulation and Total Electrical Energy for Peripheral-Nerve-Stimulation-Induced Neuroplasticity as Indexed by Additional Muscular Force.

Protocols to induce motor related neuroplasticity are usually directed to central neural structures such as the motor cortex or the spinal cord. Herein, we aimed to evaluate the effects of peripheral nerve stimulation using a current intensity (stimulation intensity) approach to understand the contribution of the corticospinal system and total energy to electrically-induced neuroplasticity. Electrical stimulation trains of lower intensity, interlaced with 2-s bursts of higher intensity, were applied to anesthetized rabbits. Nerve blocks were applied to the proximal side of the stimulation site with identical stimulation trains in a different session to block the contribution of corticospinal volleys during intensity-modulated electrical stimulation. Additional force corresponding to additional recruitment of motoneurons was observed when a 2-s burst of high intensity was present (burst/constant: 24.7 ± 3.6%/2.09 ± 4.8%; p < .001). Additional force was absent in sessions when the neural pathway to the spinal cord was blocked (unblocked/blocked: 29.3 ± 3.8%/-2.49 ± 4.8%; p < .001). The results suggest that induced neuroplasticity indexed by the additional force is dependent on the total energy applied and connectivity to central structures. These results give additional evidence for the contribution of two factors for induced neuroplasticity: (i) modulation by corticospinal structures and (ii) total energy of stimulation. Further protocols should explore simultaneous peripheral and central stimulation.

Intraoperative Somatosensory Evoked Potential Monitoring Decreases EEG Burst Suppression Ratio During Deep General Anesthesia

The burst suppression (BS) EEG patterns induced by general anesthesia can react to somatosensory stimuli. We investigated this reactivity by studying the effect of peripheral nerve stimulation used for routine intraoperative spinal cord monitoring by somatosensory evoked potentials on BS patterns. The relative time spent in suppression expressed as BS ratio (BSR) and mean burst duration were measured before (BSR(Pre)), during (BSR(Stim)), and after (BSR(Post)) a 60-second repetitive electrical ulnar nerve stimulation in nine patients under total intravenous general anesthesia with propofol. The BS reactivity was measured as BSR(Pre)-BSR(Stim). Overall, 27 trials were included with BSR(Pre) up to 77%, indistinguishable from BSR(Post). During stimulation, the mean BSR transiently decreased from 42% to 35%. For each 1% increase in BSR(Pre), the BS reactivity increased with 0.6%, whereas the burst duration remained approximately 3 seconds. For BSR(Pre) below 30%, the BS reactivity was negligible. Data from this study show that somatosensory input can evoke bursts, altering the "spontaneous" deep BS patterns (BSR(Pre) >30%). Further studies are necessary to objectively assess the clinical relevance of stimulus-induced BS reactivity during deep general anesthesia.

Percutaneous Peripheral Nerve Stimulation for Chronic Pain in Subacromial Impingement Syndrome: A Case Series

The objective of this study was to determine the effect of peripheral nerve stimulation (PNS) on pain reduction for those with refractory subacromial impingement syndrome (SIS) and to evaluate the association with reduced disability, impairment, and safety. Our hypotheses are that PNS will be associated with a reduction in pain, impairment and disability, and improvement in quality of life while demonstrating safety. Adults with shoulder pain of at least six months duration were recruited for a three-week treatment of percutaneous PNS applied through a percutaneous electrode to the axillary motor points of the deltoid muscle. Subjects were followed for 12 weeks after treatment. The primary outcome was the worst pain in the last week, and secondary outcomes included pain interference, the Disabilities of the Arm, Shoulder, and Hand questionnaire, shoulder abduction range of motion, and safety. Analysis was with a linear mixed model. Ten subjects were recruited. Longitudinal analysis demonstrated significant reduction in pain relative to baseline (F(1, 66) = 12.9, p < 0.01). After correcting for multiple comparisons, there were significant reductions at explantation and all follow-up time points when compared with baseline. There were also significant improvements in pain interference (F(1,65) = 15.0, p < 0.01), the Disabilities of the Arm, Shoulder, and Hand questionnaire (F(1,35) = 7.0, p = 0.01), and shoulder abduction range of motion (F(1,35) = 6.3, p = 0.02). Intramuscular PNS for chronic shoulder pain due to SIS is a safe treatment associated with pain reduction, lower pain interference with activities of daily living, reduced disability, and improved shoulder abduction. Pain reduction is maintained for at least 12 weeks after treatment.

The effect of single-pulse transcranial magnetic stimulation and peripheral nerve stimulation on complexity of EMG signal: fractal analysis

The aim of this study was to examine whether single-pulse transcranial magnetic stimulation (spTMS) affects the pattern of corticospinal activity once voluntary drive has been restored after spTMS-induced EMG silence. We used fractal dimension (FD) to explore the 'complexity' of the electromyography (EMG) signal, and median frequency of the spectra (MDF) to examine changes in EMG spectral characteristics. FD and MDF of the raw EMG epochs immediately before were compared with those obtained from epochs after the EMG silence. Changes in FD and MDF after spTMS were examined with three levels of muscle contraction corresponding to weak (20-40%), moderate (40-60%) and strong (60-80% of maximal voluntary contraction) and three intensities of stimulation set at 10, 20 and 30% above the resting motor threshold. FD was calculated using the Higuchi fractal dimension algorithm. Finally, to discern the origin of FD changes between the CNS and muscle, we compared the effects of spTMS with the effects of peripheral nerve stimulation (PNS) on FD and MDF. The results show that spTMS induced significant decrease in both FD and MDF of EMG signal after stimulation. PNS did not have any significant effects on FD nor MDF. Changes in TMS intensity did not have any significant effect on FD or MDF after stimulation nor had the strength of muscle contraction. However, increase in contraction strength decreased FD before stimulation but only between weak and moderate contraction. The results suggest that the effects of spTMS on corticospinal activity, underlying voluntary motor output, outlast the TMS stimulus. It appears that the complexity of the EMG signal is reduced after spTMS, suggesting that TMS alters the dynamics of the ongoing corticospinal activity most likely temporarily synchronizing the neural network activity. Further studies are needed to confirm whether observed changes after TMS occur at the cortical level.

Effects of chewing and swallowing behavior on jaw opening reflex responses in freely feeding rabbits

It has been reported that the jaw opening reflex (JOR) evoked by intra-oral innocuous stimulation was suppressed during a reflex swallow in anesthetized animals only. However, the mechanism of JOR inhibition during swallowing has not yet been elucidated. The aim of the present study was to investigate the effects of peripheral nerve stimulation on masticatory behaviors, as well as the modulation of low threshold afferent evoked JOR responses during chewing and swallowing in freely feeding animals. The JOR in the digastric muscle was evoked by low threshold electrical stimulation of the inferior alveolar nerve (IAN). Changes in the peak-to-peak amplitude of digastric electromyographic responses were compared among the phases of chewing and swallowing. IAN stimulation did not produce any differences in cycle duration, gape of the jaw in one cycle, or swallowing interval, suggesting a minimal effect on feeding behaviors. The JOR amplitude during the fast-closing, slow-closing, and slow-opening phases of chewing was significantly smaller than that of the control (recorded when the animal was at rest) and fast-opening phase. During swallowing, the JOR amplitude was significantly less than the control. Inhibition of the JOR during swallowing is assumed to prevent unnecessary opposing jaw opening motion.

Peripheral Nerve Stimulation of the Thoracic Paravertebral Plexus for Chronic Neuropathic Pain

Persistent post surgical pain is reported in 70% of patients following thoracotomy and mastectomy. This pain is often neuropathic in nature and occasionally it is refractory to traditional medical and interventional management. Neurostimulation of peripheral nerves can be a highly effective clinical modality for the management of neuropathic pain. The placement of a percutaneously sited electrode in the thoracic paravertebral plexus offers a new and novel mode of managing refractory thoracic neuropathic pain. We present 2 cases that demonstrate the effectiveness of this intervention in the long-term management of this clinical dilemma. The first case presented is that of a 61-year-old female, with unilateral neuropathic pain for 6 years following mastectomy refractory to traditional interventions. Targeted field stimulation of the thoracic paravertebral plexus resulted in significant improvement for 12 years. The second case is that of a 65-year-old male, with Type II diabetes with neuropathic thoracic pain for 6 years following multiple rib fractures (T4-T7) who responded positively to neurostimulation of the thoracic paravertebral plexus. Both of these cases demonstrate a relative reduction in pain intensity (&gt; 80%), the elimination of oral analgesics, and improved functionality directly related to the novel use of this intervention. Effective and reproducible pain relief is achieved by specifically using a low frequency (10 Hz) and low amplitude (2 mA) stimulation technique. Equally important is that these cases highlight the increased risk of inadvertent pleural puncture with the development of a pneumothorax that can be associated with this intervention. Possible clinical, investigative and equipment modifications that need to be considered are discussed. The limitations include only 2 case reports, considered as the lowest level of evidence available in the era of evidence-based medicine, and lack of utilization of multiple other modalities of treatments utilized in managing neuropathic pain. In conclusion, these cases demonstrate the effectiveness of peripheral nerve stimulation of the thoracic paravertebral plexus in the long-term management of refractory neuropathic pain. They also serve to underline the importance of clinical awareness in order to improve patient safety. Key words: Peripheral nerve stimulation, thoracic paravertebral plexus, persistent post surgical pain, neuropathic pain, pneumothorax

The effect of transcranial magnetic stimulation and peripheral nerve stimulation on corticomuscular coherence in humans.

Cortex and muscle show coupled oscillations in the 15-35 Hz frequency band during voluntary movements. To obtain evidence of the neuronal network responsible for this rhythmicity we investigated the effect of transcranial magnetic stimulation (TMS) and peripheral nerve stimulation on the coupling between eletcroencephalographic (EEG) activity recorded from the scalp over the motor cortex and electromyographic (EMG) activity recorded from the tibialis anterior (TA) muscle in 15 healthy human subjects. TMS over the leg area at intensities between 0.95 and 1.1 x threshold for a motor evoked potential (MEP) in the TA increased corticomuscular coherence in the 15-35 Hz frequency band. This effect lasted on average for 300 ms, but could last up to 600-800 ms in some subjects. Stimulation of motor nerves from the ankle muscles suppressed corticomuscular coherence in the 15-35 Hz frequency range between leg area EEG and TA EMG for a period up to 600-800 ms. In addition, increased coherence around 10 Hz was observed for a period up to 250 ms after the stimulation. Stimulation of motor nerves in the arm and motor nerves from the ankle muscles in the other leg had no effect. The findings indicate that TMS has direct access to the neuronal circuitry in the motor cortex, which generates the corticomuscular coherence. This effect was caused either by direct activation of corticospinal cells or by activation of local neuronal circuitries in the motor cortex. The effects of peripheral nerve stimulation suggest that an alternative rhythm generator may entrain the cortical cells into a lower 10 Hz rhythm and disrupt the 15-35 Hz rhythm.

Electromagnetic fields in the human body due to switched transverse gradient coils in MRI

Magnetic resonance imaging scans impose large gradient magnetic fields on the patient. Modern imaging techniques require this magnetic field to be switched rapidly for good resolution. However, it is believed that this can also lead to the unwanted side effect of peripheral nerve stimulation, which proves to be a limiting factor to the advancement of MRI technology. This paper establishes an analytical model for the fields produced within an MRI scanner by transverse gradient coils of known current density. Expressions are obtained for the magnetic induction vector and the electric field vector, as well as for the surface charge and current densities that are induced on the patient's body. The expressions obtained are general enough to allow the study of any combination of gradient coils whose behaviour can be approximated by Fourier series. For a realistic example coil current density and switching function, it is found that spikes of surface charge density are induced on the patient's body as the gradient field is switched, as well as loops of surface current density that mimic the coil current density. For a 10 mT m−1 gradient field with a rise time of 100 µs, the magnitude of the radial electric field at the body is found to be 10.3 V m−1. It is also found that there is a finite limit to radial electric field strength as rise time approaches zero.

Memory alterations during acute high-intensity vagus nerve stimulation

Left cervical vagus nerve stimulation (VNS) is an accepted add-on treatment for pharmacoresistant epilepsy. However, it also allows the investigation of the effects of peripheral nerve stimulation on central nervous functions. The impact of 4.5 min high intensity VNS (>1 mA) on material-specific memory and decision times was evaluated in an experimental ‘box car’ design in 11 patients with pharmacoresistant epilepsy. Results indicate reversible deterioration of figural but not verbal memory and a trend of accelerated decision times during VNS. Thus, further support of cognitive effects of VNS is provided. There are indications of a major projection of VNS to activating brain structures of and the right hemisphere. Significant cognitive side effects in clinical application are unlikely because of the reversibility of the effect and differences between experimental and therapeutic stimulation conditions. However, since the effectors and the direction of the cognitive effects of VNS seem to depend strongly on stimulation conditions, we recommend future experimental research covering a larger range of stimulation conditions.

Activation of fibres in rat sciatic nerve alters phosphorylation state of connexin-43 at astrocytic gap junctions in spinal cord: evidence for junction regulation by neuronal–glial interactions

Intercellular communication via gap junction channels composed of connexin-43 is known to be regulated by phosphorylation of this protein. We investigated whether connexin-43 at astrocytic gap junctions is similarly regulated in response to neural activation. The effect of peripheral nerve stimulation on connexin-43 phosphorylation state in the spinal cord of rats was examined with a monoclonal antibody (designated 13-8300) shown previously to recognize selectively a dephosphorylated form of connexin-43. Immunolabelling with 13-8300 was absent in the lumbar spinal cord in control animals, but was induced in the dorsal horn ipsilateral to sciatic nerve electrical stimulation for 15 min or 1 h at a frequency of 1 or 100 Hz. Immunorecognition of connexin-43 by a polyclonal anti-connexin-43 antibody, shown previously to undergo epitope masking under various conditions, was reduced in the dorsal horn on the stimulated side. These responses were abolished by local anaesthetic or tetrodotoxin application proximal to the site of nerve stimulation. Selective electrical stimulation of A-fibres or activation of cutaneous C-fibres by capsaicin evoked labelling with 13-8300 in deep and superficial laminae of the dorsal horn, respectively. Nerve stimulation increased the number of 13-8300-positive astrocytic gap junctions, as well as the levels of dephosphorylated connexin-43 in the dorsal horn on the stimulated side. Sciatic nerve transection produced results similar to those seen after C-fibre activation with capsaicin. Thus, peripheral nerve stimulation evokes astrocytic connexin-43 dephosphorylation in the spinal cord dorsal horn, suggesting that gap junctional coupling between astrocytes in vivo is subject to regulation by neuronal–glial interactions following neural activation.