Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines
Introduction and Objectives:. Unlike conventional dorsal spinal cord stimulation (SCS)—which uses single pulses at a fixed rate—burst SCS uses a fixed-rate, five-pulse stimuli cluster as a treatment for chronic pain; mechanistic explanations suggest burst SCS differentially modulate the medial and l...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-12-01
|
| Series: | PAIN Reports |
| Online Access: | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001047 |
| _version_ | 1811186548460224512 |
|---|---|
| author | David A. Dinsmoor Joshua O. Usoro Noah D. Barka Tina M. Billstrom Leonid M. Litvak Lawrence R. Poree |
| author_facet | David A. Dinsmoor Joshua O. Usoro Noah D. Barka Tina M. Billstrom Leonid M. Litvak Lawrence R. Poree |
| author_sort | David A. Dinsmoor |
| collection | DOAJ |
| description | Introduction and Objectives:. Unlike conventional dorsal spinal cord stimulation (SCS)—which uses single pulses at a fixed rate—burst SCS uses a fixed-rate, five-pulse stimuli cluster as a treatment for chronic pain; mechanistic explanations suggest burst SCS differentially modulate the medial and lateral pain pathways vs conventional SCS. Neural activation differences between burst and conventional SCS are quantifiable with the spinal-evoked compound action potential (ECAP), an electrical measure of synchronous neural activation.
Methods:. We implanted 7 sheep with a dorsal stimulation lead at T9/T10, a dorsal ECAP sensing lead at T6/T7, and a lead also at T9/T10 but adjacent to the anterolateral system (ALS). Both burst and conventional SCS with stimulation amplitudes up to the visual motor threshold (vMT) were delivered to 3 different dorsal spinal locations, and ECAP thresholds (ECAPTs) were calculated for all combinations. Then, changes in ALS activation were assessed with both types of SCS.
Results:. Evoked compound action potential thresholds and vMTs were significantly higher (P < 0.05) with conventional vs burst SCS, with no statistical difference (P > 0.05) among stimulation sites. However, the vMT−ECAPT window (a proxy for the useable therapeutic dosing range) was significantly wider (P < 0.05) with conventional vs burst SCS. No significant difference (P > 0.05) in ALS activation was noted between conventional and burst SCS.
Conclusion:. When dosed equivalently, no differentially unique change in ALS activation results with burst SCS vs conventional SCS; in addition, sub-ECAPT burst SCS results in no discernable excitability changes in the neural pathways feeding pain relevant supraspinal sites. |
| first_indexed | 2024-04-11T13:48:27Z |
| format | Article |
| id | doaj.art-6c563ea513fa44dca29f4c97433a735d |
| institution | Directory Open Access Journal |
| issn | 2471-2531 |
| language | English |
| last_indexed | 2024-04-11T13:48:27Z |
| publishDate | 2022-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | PAIN Reports |
| spelling | doaj.art-6c563ea513fa44dca29f4c97433a735d2022-12-22T04:20:53ZengWolters KluwerPAIN Reports2471-25312022-12-0176e104710.1097/PR9.0000000000001047202212000-00011Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovinesDavid A. Dinsmoor0Joshua O. Usoro1Noah D. Barka2Tina M. Billstrom3Leonid M. Litvak4Lawrence R. Poree5a Medtronic plc, Minneapolis, MN, USAa Medtronic plc, Minneapolis, MN, USAa Medtronic plc, Minneapolis, MN, USAa Medtronic plc, Minneapolis, MN, USAa Medtronic plc, Minneapolis, MN, USAb Department of Anesthesia, University of California San Francisco Pain Management Center, San Francisco, CA, USAIntroduction and Objectives:. Unlike conventional dorsal spinal cord stimulation (SCS)—which uses single pulses at a fixed rate—burst SCS uses a fixed-rate, five-pulse stimuli cluster as a treatment for chronic pain; mechanistic explanations suggest burst SCS differentially modulate the medial and lateral pain pathways vs conventional SCS. Neural activation differences between burst and conventional SCS are quantifiable with the spinal-evoked compound action potential (ECAP), an electrical measure of synchronous neural activation. Methods:. We implanted 7 sheep with a dorsal stimulation lead at T9/T10, a dorsal ECAP sensing lead at T6/T7, and a lead also at T9/T10 but adjacent to the anterolateral system (ALS). Both burst and conventional SCS with stimulation amplitudes up to the visual motor threshold (vMT) were delivered to 3 different dorsal spinal locations, and ECAP thresholds (ECAPTs) were calculated for all combinations. Then, changes in ALS activation were assessed with both types of SCS. Results:. Evoked compound action potential thresholds and vMTs were significantly higher (P < 0.05) with conventional vs burst SCS, with no statistical difference (P > 0.05) among stimulation sites. However, the vMT−ECAPT window (a proxy for the useable therapeutic dosing range) was significantly wider (P < 0.05) with conventional vs burst SCS. No significant difference (P > 0.05) in ALS activation was noted between conventional and burst SCS. Conclusion:. When dosed equivalently, no differentially unique change in ALS activation results with burst SCS vs conventional SCS; in addition, sub-ECAPT burst SCS results in no discernable excitability changes in the neural pathways feeding pain relevant supraspinal sites.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001047 |
| spellingShingle | David A. Dinsmoor Joshua O. Usoro Noah D. Barka Tina M. Billstrom Leonid M. Litvak Lawrence R. Poree Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines PAIN Reports |
| title | Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines |
| title_full | Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines |
| title_fullStr | Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines |
| title_full_unstemmed | Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines |
| title_short | Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines |
| title_sort | using evoked compound action potentials to quantify differential neural activation with burst and conventional 40 hz spinal cord stimulation in ovines |
| url | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001047 |
| work_keys_str_mv | AT davidadinsmoor usingevokedcompoundactionpotentialstoquantifydifferentialneuralactivationwithburstandconventional40hzspinalcordstimulationinovines AT joshuaousoro usingevokedcompoundactionpotentialstoquantifydifferentialneuralactivationwithburstandconventional40hzspinalcordstimulationinovines AT noahdbarka usingevokedcompoundactionpotentialstoquantifydifferentialneuralactivationwithburstandconventional40hzspinalcordstimulationinovines AT tinambillstrom usingevokedcompoundactionpotentialstoquantifydifferentialneuralactivationwithburstandconventional40hzspinalcordstimulationinovines AT leonidmlitvak usingevokedcompoundactionpotentialstoquantifydifferentialneuralactivationwithburstandconventional40hzspinalcordstimulationinovines AT lawrencerporee usingevokedcompoundactionpotentialstoquantifydifferentialneuralactivationwithburstandconventional40hzspinalcordstimulationinovines |