Pair Of Stimulating Electrodes Research Articles

Water-powered, electronics-free dressings that electrically stimulate wounds for rapid wound closure.

Chronic wounds affect ~2% of the U.S. population and increase risks of amputation and mortality. Unfortunately, treatments for such wounds are often expensive, complex, and only moderately effective. Electrotherapy represents a cost-effective treatment; however, its reliance on bulky equipment limits its clinical use. Here, we introduce water-powered, electronics-free dressings (WPEDs) that offer a unique solution to this issue. The WPED performs even under harsh conditions-situations wherein many present treatments fail. It uses a flexible, biocompatible magnesium-silver/silver chloride battery and a pair of stimulation electrodes; upon the addition of water, the battery creates a radial electric field. Experiments in diabetic mice confirm the WPED's ability to accelerate wound closure and promote healing by increasing epidermal thickness, modulating inflammation, and promoting angiogenesis. Across preclinical wound models, the WPED-treated group heals faster than the control with wound closure rates comparable to treatments requiring expensive biologics and/or complex electronics. The results demonstrate the WPED's potential as an effective and more practical wound treatment dressing.

Parasympathetic control of gastrointestinal motility and cross-branch actions of parasympathetic neuromodulation.

Parasympathetic control of gastrointestinal motility and cross-branch actions of parasympathetic neuromodulation.

NCOG-14. INTRAOPERATIVE COGNITIVE-LINGUISTIC MAPPING GUIDED BY VISUALIZATION OF GAMMA BAND MODULATION ELECTROCORTICOGRAMS: PROOF OF CONCEPT IN A PATIENT WITH LEFT TEMPORAL AND OCCIPITAL LOW-GRADE ASTROCYTOMA

Abstract OBJECTIVE Determine the feasibility and preliminary utility of a novel approach to intraoperative brain mapping guided by visualization of electrocorticography (ECoG) heat maps. METHODS A 39-year-old male with a biopsy-proven left posterior temporal and occipital WHO grade II IDH-mutant astrocytoma underwent awake craniotomy with intraoperative language mapping. Language mapping utilized a dual iPad stimulus presentation system (NeuroMapper) coupled to a portable real-time neural signal processing system capable of both recording cortical activity and delivering direct cortical stimulation in a closed-loop fashion. An ECoG grid (4x8 with 1cm pitch) which covered the majority of the left temporal lobe was used to assess oscillatory cortical activity during administration of language paradigms including object, action, auditory descriptive, and written descriptive naming. ECoG recording and cortical stimulation were synchronized with stimulus presentation via a photosensor attached to the patient-facing tablet. Gamma band modulations in response to language paradigms at each electrode were processed in real-time and visualized as heat maps in MATLAB/Simulink. Following recording and visualization, bipolar direct cortical stimulation from the grid was conducted for each neighboring electrode pair (up to an intensity of 6 mA) during administration of language tasks. RESULTS Despite mild fluent aphasia, a large set of reliable baseline stimuli were obtained for the language mapping paradigms. All naming paradigms resulted in strongest heat map activation at electrode 12 located in the anterior to mid superior temporal gyrus. During stimulation, consistent speech arrest was observed across all paradigms when stimulating electrode pair 11-12, indicating good correspondence with ECoG heat map recordings. Additionally, this region corresponded well with posterior language network representation via resting-state fMRI. CONCLUSION Intraoperative real-time visualization of task-based ECoG gamma band modulation is feasible and may help identify targets for direct cortical stimulation. If validated, this may improve the efficiency and accuracy of intraoperative language mapping.

Annals of Neurology: Volume 84, Number 4, October 2018

A computer‐generated 3D reconstruction of the location of a pair of stimulating electrodes implanted in the internal segment of the globus pallidus (light green) and the border between the ventral oral internal (tan) and the centromedian nucleus (dark green) of the thalamus in a patient with Tourette syndrome. Simultaneous recording of local field potentials at both sites demonstrated oscillations that may be implicated in the pathophysiology of Tourette syndrome. (See Neumann et al., pages 505–514)

Suppressing limbic seizures by stimulating medial dorsal thalamic nucleus: factors for efficacy.

The optimal sites and stimulation protocols for brain stimulation in epilepsy have not been found. Clinical trials, which have shown modest benefit in seizure reduction, have involved patients with poorly localized intractable focal epilepsy and stimulation sites without clear relations to specific underlying seizure circuits. The medial dorsal thalamic nucleus is a key node in limbic seizure circuits, and we wished to know what stimulation parameters might control seizures in a kindling model of limbic epilepsy. In urethane-anesthetized rats, we induced limbic seizures by stimulation of the piriform cortex or CA3 of the hippocampus while recording in the entorhinal cortex or CA1 of the contralateral hippocampus to determine the effect of specific stimulation parameters on seizure duration. Stimulation consistently suppressed seizure duration from baseline by over 80% (p < 0.001), frequently completely preventing the seizures. Position of the thalamic electrode, stimulus intensity and frequency had a significant influence, with higher stimulus intensities (40 V vs. 20 V) and frequencies (20 Hz vs. 7 Hz) significantly suppressing seizures. The most effective position was the lateral dorsal area of the medial dorsal nucleus (MD), which corresponded to the region of axon entry. Stimulation in the MD center was not effective. An anterior-posterior relationship of the stimulating electrode pair was effective, whereas a medial lateral orientation was not. Successful stimulation suppressed the evoked responses in the entorhinal cortex or CA1. Position and orientation of the stimulating electrode has to be precise, which suggests that the placement of the electrodes must be tailored to the individual's own seizure circuit. The data also indicate that successful deep brain stimulation induces a fundamental change in system physiology, which could be a marker to guide the development of stimulation parameters for each patient.

Objective Measures of Electrode Discrimination With Electrically Evoked Auditory Change Complex and Speech-Perception Abilities in Children With Auditory Neuropathy Spectrum Disorder

This study aimed to (1) determine the sensitivity of the electrically evoked auditory change complex (eACC) to changes in stimulating electrode position; and (2) investigate the association between results of eACC measures and behavioral electrode discrimination and their association with speech-perception performance in pediatric cochlear implant (CI) users who have auditory neuropathy spectrum disorder (ANSD). Fifteen children with ANSD ranging in age between 5.4 and 18.6 years participated in this study. All subjects used Cochlear Nucleus devices. For each subject, open-set speech-perception ability was assessed using the Phonetically Balanced Kindergarten word lists presented at 60 dB SPL, using monitored live voice in a sound booth. Behavioral and objective measures of electrode discrimination were assessed in a nonclinical test environment. The stimuli used to elicit these measures were 800 msec biphasic pulse trains delivered by a direct interface to the CI. Data were collected from two basic stimulation conditions. In the standard condition, the entire pulse train was delivered to a mid-array electrode (electrode 11 or 12) at the maximum comfortable level (C level). In the change condition, the stimulus was split into two 400 msec pulse train segments presented sequentially on two different electrodes. The stimulation level of the second 400 msec pulse train was loudness balanced to the C level of the mid-array electrode used in the standard condition. The separation between the pair of stimulating electrodes was systematically varied. For behavioral electrode-discrimination measures, each subject was required to determine whether he or she heard one or two sounds for stimuli presented in different stimulation conditions. For the eACC measures, two replicates of 100 artifact-free sweeps were recorded for each stimulation condition. The eACC in response to changes in stimulating electrode position was recorded from all subjects with ANSD using direct electrical stimulation. Electrode-discrimination thresholds determined with the eACC and behavioral measures were consistent. Children with ANSD using CIs who showed poorer speech performance also required larger separations between the stimulating electrode pair to reliably elicit the eACC than subjects with better speech-perception performance. There was a robust correlation between electrode-discrimination capacities and speech-perception performances in subjects tested in this study. The effect of electrode separation on eACC amplitudes was not monotonic. These results demonstrate the feasibility of using eACC to evaluate electrode-discrimination capacities in children with ANSD. These results suggest that the eACC elicited by changes in stimulating electrode position holds great promise as an objective tool for evaluating spectral-pattern detection in such subjects, which may be predictive of their potential speech-perception performance.

Reduced Threshold Potential of the Trigeminal Nerve in Equine Headshaking

AimAlthough the aetiopathogenesis of headshaking remains elusive, trigeminal neuralgia is regarded as the likely explanation of observed clinical signs. The aim of this study was to compare sensory nerve conduction threshold and velocity of the trigeminal nerve using the infraorbital nerve in control and headshaking horses.MethodsControl group (n = 6 horses) and headshaking group (n = 6) were subject to general anaesthesia. A Nicolet Viking IV evoked potential system was used for sensory nerve conduction study. Stimulating, recording and reference electrodes were used. A pair of stimulating electrodes was placed at the gingival mucosa, one each at the rostral and caudal aspects of the maxillary canine tooth. Four pairs of recording electrodes were placed at 4 different points along the tract of the infraorbital nerve (point 1 at infraorbital foramen), maxillary nerve (point 2 at exit of trigeminal canal), spinal somatosensory (point 3 at level of C1 spinal cord segment), and cortical somatosensory evoked potentials (point 4 at level of frontal cerebral cortex). A reference electrode was placed at a distance half way between the stimulating and recording electrodes at point 1. Stimuli were applied at 2.5, 5, 10, 15, 20 mA. The duration of each stimulus was 0.1 ms. Thresholds were recorded and conduction velocities calculated for each group.ResultsThe threshold of sensory nerve action potential occurred at low stimuli (2.5 and 5 mA) in horses with headshaking; and at higher stimuli (10 mA in 3 horses, 15 mA in 1 horse, and 25 mA in 2 horses) in control horses. Although there were differences in conduction velocity between groups, this was not significant.Conclusions and practical significanceHeadshaking horses have a low threshold for inducing sensory action potentials upon minimal stimulation compared with control horses supporting involvement of the trigeminal nerve in the pathogenesis of affected horses.Ethical animal researchStudy approved by the UC Davis IACUC. Sources of funding: Private donation. Competing interests: None.

A comparison of the accuracy of ulnar versus median nerve stimulation for neuromuscular monitoring

BackgroundInexperienced anesthesiologists are frequently unclear as to whether to stimulate the ulnar or median nerve to monitor the adductor pollicis. The primary purpose of this study was to determine whether monitoring the adductor pollicis by positioning the stimulating electrodes over the median nerve is an acceptable alternative to applying electrodes over the ulnar nerve.MethodsIn 20 patients anesthetized with propofol and remifentanil, one pair of stimulating electrodes was positioned over the ulnar nerve. A second pair was placed over the median nerve on the other hand. The acceleromyographic response was monitored on both hands. Rocuronium 0.6 mg/kg was administered. Single twitch (ST) and train-of-four (TOF) stimulations were applied alternatively to both sites.ResultsNone of the patients showed a twitch response at either site after injection of rocuronium. There were no differences in the mean supramaximal threshold, mean initial TOF ratio, or mean initial ST ratio between the two sites. Bland-Altman analysis revealed a bias (limit of agreement) in the TOF and ST ratios over the median nerve of 7% (± 31%) and 26% (± 73%), respectively, as compared with the ulnar nerve. The median nerve TOF ratio was overestimated by 16.2%, as compared with that of the ulnar nerve value, and the median nerve ST ratio was overestimated by 72.9%, as compared to that of the ulnar nerve.ConclusionsThe ulnar and median nerves cannot be used interchangeably for accurate neuromuscular monitoring.

A Potential and Novel Therapy for Obesity: “Appendix” Electrical Stimulation in Dogs

Intestinal electrical stimulation (IES) has been introduced as a potential therapy for obesity. However, it is unknown whether the effects of IES on gastrointestinal motility and food intake are location-specific. The aim of this study was to assess the effects of "appendix" (cecum in dog) electrical stimulation (AES) on gastric tone, gastric emptying, and food intake in dogs. Twelve healthy dogs were used in three experiments. In experiments 1 and 2, gastric tone and food intake were studied in six dogs implanted with a gastric cannula and one pair of stimulation electrodes in the "appendix." Experiment 3 was performed to study gastric emptying in six dogs with a duodenal cannula and one pair of stimulation electrodes in the "appendix." (1) AES resulted in proximal gastric distention, with gastric volume increased from 114.9 ± 10.7mL at baseline to 301.7 ± 37.1mL during AES (p = 0.001), and the effect was completely blocked by a nitric oxide synthase inhibitor. (2) Gastric emptying was delayed at 90min from 69.8 ± 9.5% in the control session to 15.2 ± 3.6% in the AES session (p = 0.002). 3) AES reduced food intake (average daily intake over a 1-week period) by 55.4% (550.4 ± 17.6g at control vs. 245.7 ± 17.1g with AES, p < 0.001). AES reduces gastric tone via the nitrergic pathway, delays gastric emptying, and inhibits food intake in healthy dogs. These data suggest the therapeutic potential of AES for obesity. Additionally, AES is technically more feasible than electrical stimulation of the stomach or duodenum because a stimulator with electrodes may be placed into the appendix via colonoscopy.

Hepatic electrical stimulation reduces blood glucose in diabetic rats

The aim of this study was to investigate the feasibility and mechanisms of controlling blood glucose using hepatic electrical stimulation (HES). The study was performed in regular Sprague-Dawley (SD) rats, streptozotocin-induced type 1 diabetic rats and Zucker diabetic fatty (ZDF) rats chronically implanted with one pair of stimulation electrodes on two lobes of the liver tissues. (i) Hepatic electrical stimulation was effective in reducing blood glucose by 27%-31% at time points 60, 75 and 90 min after oral glucose in normal rats; (ii) HES reduced blood glucose in both fasting and fed states in both type 1 and type 2 diabetic rats; (iii) Chronic HES decreased the blood glucose level, and, delayed gastric empty and increased plasma glucagon-like peptide-1 (GLP-1) level; and (iv) No adverse events were noted in any rats during HES. Histopathological analyses and liver function tests revealed no electrode dislodgement, tissue damages or liver enzyme changes with HES. Hepatic electrical stimulation is capable of reducing both fasting and fed blood glucose in normal, and type 1 and type 2 diabetic rats and the effect may be partially mediated via an increase in GLP-1 release.

Gastric Electrical Stimulation With Parameters for Gastroparesis Enhances Gastric Accommodation and Alleviates Distention-Induced Symptoms in Dogs

Gastric electrical stimulation (GES) improves symptoms in patients with gastroparesis. We sought to determine if stimulation at fundus with parameters used for gastroparesis could affect gastric accommodation and distention-induced symptoms in dogs. Nine dogs were implanted with a gastric cannula at the anterior stomach and 1 pair of stimulation electrodes in the fundus. Assessment of gastric accommodation and a series of gastric distention were performed using a barostat. Stimulation parameters were of short pulse trains of 14 Hz, 5 mA, 0.3 ms, and 0.1 s on, 5 s off. GES at fundus significantly decreased fasting gastric tone. Fasting gastric volume was significantly increased from 56.3+/-10.4 mL at baseline to 102.4+/-23.1 mL with stimulation (P=.011). Postprandial gastric accommodation was significantly enhanced with stimulation. The extent of accommodation increased from 249.3+/-39.9 mL in the control session to 325.8+/-25.1 mL with stimulation (P=.011). Symptom scores induced by balloon distention of the stomach were significantly lower during stimulation in comparison with those of baseline (P=.016). In conclusion, GES with parameters for gastroparesis enhances postprandial gastric accommodation and reduces visceral perception in normal dogs. This effect, if seen also in humans, may explain in part the symptomatic improvement associated with GES therapy in patients with gastroparesis.

Age-dependent interactive changes in serotonergic and noradrenergic cortical axon terminals in F344 rats

In the frontal cortex of aging rats, we found an increase in sprouting of the noradrenergic (NA) axons originated from the locus coeruleus (LC). The serotonergic (5-HT) axons originating from the dorsal raphe (DR) share the same cortical area and their age-dependent changes and interactions with NA axons were still unclear. To compare quantitatively the extent of axonal sprouting of DR and LC neurons in the frontal cortex, we extracellularly recorded from both DR and LC neurons in the same animals and antidromically stimulated 32 cortical sites (a pair of stimulating electrodes was moved at 100-μm intervals from 500 to 2000 μm in depth). In addition, to examine the effects of degeneration of 5-HT axons on NA axons, and vice versa, we used specific neurotoxins for 5-HT (PCA) or NA (DSP-4) axons. We also used noradrenaline uptake inhibitor (maprotiline) to verify the effects of NA on degeneration of 5-HT axons. Results suggested that 5-HT axons sprouted between 15 and 17 months of age and noradrenaline accelerated the age-dependent change of 5-HT axons.

Fatigue and damage to the masseter muscle by prolonged low-frequency stimulation in the rat

This study aimed to examine peripheral fatigue and the resultant damage to the masseter muscle due to prolonged low-frequency stimulation. Thirty male rats were divided into S1, S2, S4, Dantr and Sham groups. The left masseters were used as experimental muscles. A pair of stimulation electrodes was placed on the left masseter. A stimulating session included rectangular electric pulses of 18 Hz (5 mA, approximately 18 V, 0.7 ms) for 2 h with a 3 min rest period between sessions. One session was given to the S1 group, two sessions to the S2 group and four sessions to the S4 group. Four sessions were given to the Dantr group with administration of dantrolene to determine any artifacts of the electrical current. No electric stimulation was given to both side masseters in the Sham group or to the control (right) masseters in the other groups. In each session, jaw-closing force increased to a peak within 1 min and attenuated to the steady force. The peak force decreased as the session advanced in each group. Both side masseters were dissected after the stimulations and examined histologically. The experimental masseter was significantly heavier than that of the controls in the S1, S2 and S4 groups, and the muscle fibres showed irregularity of size and shape with enlargement of interstitial space and infiltration of mononuclear cells into the fibres. However, no such histological change was observed in the Dantr and Sham groups. It was confirmed that fatigue and damage to muscle fibres could be induced in masticatory muscles by prolonged low-frequency stimulation.

Train-of-Four Stimulation for Adductor Pollicis Neuromuscular Monitoring Can Be Applied at the Wrist or Over the Hand

Adductor pollicis stimulation over the ulnar nerve at the wrist is the standard method of monitoring neuromuscular function. Stimulation over a muscle is believed to cause direct muscle contraction, but evidence for this is lacking. In this study we sought to determine whether direct muscle stimulation occurred during stimulation of the adductor pollicis in the hand and whether the responses were comparable to those observed with stimulation at the wrist. In 20 patients anesthetized with sevoflurane, 1 pair of stimulating electrodes was positioned over the ulnar nerve at the wrist. A second pair was placed between the first and second metacarpals on the palmar and dorsal aspects of the hand. The acceleromyographic response was monitored. Rocuronium 0.6 mg/kg was administered. Train-of-four (TOF) stimulations were applied at the wrist site until maximal blockade. Then, stimulation was applied to the hand site. During recovery, both sites were monitored alternately. After injection of rocuronium, 17 of 20 patients showed no twitch response at either site. One patient had a response at both stimulation sites, and two patients had responses only at the wrist site. With a Bland and Altman analysis, TOF ratios during recovery at the hand showed a bias of 0.5% and limits of agreement of +/-11.8% as compared with the wrist. Stimulation in the hand causes no direct muscle stimulation because the response is no more than that produced by stimulation at the wrist. Both sites yield comparable TOF ratios.

Effects of stimulation mode on threshold and loudness growth in multielectrode cochlear implants.

The effect of increasing the separation between the two members of a stimulating electrode pair was studied in four users of the Nucleus-22 cochlear implant. Two experiments were performed. In experiment 1, detection threshold for a 200-ms, 500-pulses/s biphasic pulse train was measured as the spatial separation between the active and return electrodes was increased. In experiment 2, loudness-growth functions were measured as the electrode separation was increased. The results of experiment 1 indicate that (a) threshold decreases monotonically toward an asymptote (monopolar threshold) as the electrode separation is increased and (b) the threshold versus electrode separation function is similar across subjects and electrode location. The results of experiment 2 indicate that loudness L is related to the current amplitude I by a simple exponential function: L = e beta I, where beta, the exponent of the loudness function, is, to a first approximation, linearly related to the separation between the electrodes of the stimulating pair. Thus, dynamic range and the shape of loudness growth can be directly linked to the spatial separation between active and return electrodes.

Endothelium-mediated negative dromotropic effects of intravascular acetylcholine

Acetylcholine acting through specific muscarinic membrane receptors causes a negative dromotropic effect and, in blood vessels, causes a vasodilation which results from its action on the endothelial cells via release of nitric oxide (NO). We decided to study this effect in isolated Krebs–Henseleit retrogradely perfused guinea pig hearts. A pair of stimulating electrodes was placed in the right atrium and to record the auricular–ventricular interval (A–V delay) one recording electrode was placed on the left atrium and the other on the tip of the ventricle. Hearts were paced at a rate of 3.8±0.1 Hz and perfused at a coronary flow rate of 9±0.25 ml/min. To obtain dose–response curves, single doses (as boluses) of acetylcholine were infused and the maximal A–V delay induced by each dose was determined. Perfusion of agents that inhibit NO accumulation ( l-Arginine methyl ester ( l-NAME) (0.5 mM)) or oxyhemoglobin (6 μM) caused displacement of the acetylcholine dose–response curve downward and to the right. Perfusion of NO-sparing agents like superoxide dismutase and dithiothreitol caused an upward and leftward displacement. Infusion of NO solutions or a NO donor (diethylamine–nitric oxide [DEA–NO]) caused a dose-dependent negative dromotropic effect. In contrast, inhibition of the prostaglandin metabolic pathway by Indomethacin (0.01 mM) caused potentiation of acetylcholine effects which were reversed when it was co-perfused with l-NAME. When endothelial intravascular muscarinic receptors were selectively blocked by perfusion of a non-permeable macromolecule: dextran (>2000 kDa) covalently complexed to the receptor blocker (3-(2′-aminobenzhydryloxy) tropane)), the negative dromotropic effect of intravascular acetylcholine was diminished in a concentration-dependent manner up to complete blockade. Our data indicate that the dromotropic effect caused by intracoronary administration of acetylcholine is the result solely of activation of intravascular endothelial muscarinic receptors, that nitric oxide and prostaglandins are non-synergistic endothelial mediators of this effect and that there may be an interaction between NO and prostaglandin metabolic pathways.

The Use of a Circumferential Cathode Improves Amplitude of Intraoperative Electrical Transcranial Myogenic Motor Evoked Responses

Measurement of motor evoked responses to transcranial electrical stimulation (tc-MER) is a technique for intraoperative monitoring of motor pathways. Since most anesthetics significantly reduce motoneuronal excitability, optimal stimulation paradigms should be sought. We compared the efficiency of stimulus delivery using two different configurations of the cathode component of the stimulating electrode pair (circumferential: Fz, F3, F4, A1, and A2 versus a single cathode at Fz). The anode was positioned at Cz with both cathode configurations. Fourteen neurologically normal patients undergoing spinal surgery were anesthetized with sufentanil-N (2) O-ketamine. Partial neuromuscular blockade (single twitch height 25%) was maintained with vecuronium. Compound action potentials to transcranial stimulation with both cathode configurations were recorded from the tibialis anterior muscle. All recordings were completed before spinal manipulation. The median amplitude response using the Fz cathode configuration was 256 mu V (10th-90th percentiles: 50-641 mu V). With the circumferential cathode configuration, tc-MER amplitude increased to 281 (87-1479) mu V (P < 0.01). There was no significant difference in onset latency between electrode configurations. The observed tc-MER amplitude augmentation with the use of a circumferential cathode might allow tc-MER monitoring in those patients who do not have sufficiently reproducible responses when a single cathode is used. A possible explanation is that the circumferential cathode alters the direction of electrical currents in the cortex, resulting in more efficient depolarization of cortical motor neurons. (Anesth Analg 1996;82:1011-4)

The Use of a Circumferential Cathode Improves Amplitude of Intraoperative Electrical Transcranial Myogenic Motor Evoked Responses

Measurement of motor evoked responses to transcranial electrical stimulation (tc-MER) is a technique for intraoperative monitoring of motor pathways. Since most anesthetics significantly reduce motoneuronal excitability, optimal stimulation paradigms should be sought. We compared the efficiency of stimulus delivery using two different configurations of the cathode component of the stimulating electrode pair (circumferential: Fz, F3, F4, A1, and A2 versus a single cathode at Fz). The anode was positioned at Cz with both cathode configurations. Fourteen neurologically normal patients undergoing spinal surgery were anesthetized with sufentanil-N2O-ketamine. Partial neuromuscular blockade (single twitch height 25%) was maintained with vecuronium. Compound action potentials to transcranial stimulation with both cathode configurations were recorded from the tibialis anterior muscle. All recordings were completed before spinal manipulation. The median amplitude response using the Fz cathode configuration was 256 microV (10th-90th percentiles: 50-641 microV). With the circumferential cathode configuration, tc-MER amplitude increased to 281 (87-1479) microV (P < 0.01). There was no significant difference in onset latency between electrode configurations. The observed tc-MER amplitude augmentation with the use of a circumferential cathode might allow tc-MER monitoring in those patients who do not have sufficiently reproducible responses when a single cathode is used. A possible explanation is that the circumferential cathode alters the direction of the electrical currents in the cortex, resulting in more efficient depolarization of cortical motor neurons.

The raccoon as an animal model for upper limb neural prosthetics.

The raccoon was evaluated as an animal model for upper limb neural prosthetics. This animal was selected primarily because the functional use of its forelimb mimics in many ways the usage in humans and because of its optimal size and commercial availability. Eight cadaver and fresh specimen forearms were dissected. Important characteristics of the raccoon forearm were: 1) large muscles in the volar forearm, 2) large digits in the paw that appear more similar to humans than to other species such as cat or dog, 3) persistence of two median nerve cords into the forearm, 4) no separation of individual tendons of flexor digitorum superficialis and flexor digitorum profundus in the carpal tunnel, 5) a small thumb digit with little function and 6) a primary origin of flexor policis longus on the proximal ulna with a secondary origin on the radius. Four animals were anesthetized and responses of the forearm and paw to stimulation of the volar forearm muscles with percutaneous electrodes were evaluated. A pair of stimulating electrodes was placed in each of four muscles or muscle groups. Recording electrodes were placed in two muscles which showed the greatest separation of muscle movements to stimulation. Stimulation currents just above threshold produced discrete motion as well as recordable EMG M-waves. Incremental increases in stimulation current produced an increase in M-wave amplitude up to a maximal stimulating current. Torque recordings for pronation, wrist flexion and finger flexion showed graded and selective responses. These results including anatomical descriptions indicate both the limitations of this animal model and its potential use in the development of upper limb neural prosthetics. We conclude that the raccoon model may be superior to other nonprimate animal models such as the cat because of its extensive forearm and paw movements.

The immediate effects of ionomeric and acrylic bone cements on peripheral nerve function

A total of 44 rat saphenous nerves were isolated. A pair of stimulating electrodes was positioned distally (at the ankle) to evoke a compound action potential (CAP) which was recorded proximally (in the thigh) through another pair of electrodes. Bone cement was then placed adjacent to the nerve midway between the electrodes and changes in the CAP recorded over a 30-min period. Nerve conduction was completely blocked within 2 min of placing unset acrylic bone cement adjacent to the nerve. The experimental ionomeric cements (IC) also caused a reduction in the nerve conduction although this did not usually occur until the cement had been positioned adjacent to the nerve for over 10 min. Slow-setting IC blocked nerve conduction more quickly than fast-setting IC but there was no apparant difference between the effects of applying materials early or late in the setting reaction. Set ionomeric porous microimplant particles (lonogran®) had no effect on neural function.