Characterization and applications of evoked responses during epidural electrical stimulation
Abstract Background Epidural electrical stimulation (EES) of the spinal cord has been FDA approved and used therapeutically for decades. However, there is still not a clear understanding of the local neural substrates and consequently the mechanism of action responsible for the therapeutic effects....
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Bioelectronic Medicine |
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| Online Access: | https://doi.org/10.1186/s42234-023-00106-5 |
| _version_ | 1797557631516147712 |
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| author | Nishant Verma Ben Romanauski Danny Lam Luis Lujan Stephan Blanz Kip Ludwig Scott Lempka Andrew Shoffstall Bruce Knudson Yuichiro Nishiyama Jian Hao Hyun-Joo Park Erika Ross Igor Lavrov Mingming Zhang |
| author_facet | Nishant Verma Ben Romanauski Danny Lam Luis Lujan Stephan Blanz Kip Ludwig Scott Lempka Andrew Shoffstall Bruce Knudson Yuichiro Nishiyama Jian Hao Hyun-Joo Park Erika Ross Igor Lavrov Mingming Zhang |
| author_sort | Nishant Verma |
| collection | DOAJ |
| description | Abstract Background Epidural electrical stimulation (EES) of the spinal cord has been FDA approved and used therapeutically for decades. However, there is still not a clear understanding of the local neural substrates and consequently the mechanism of action responsible for the therapeutic effects. Method Epidural spinal recordings (ESR) are collected from the electrodes placed in the epidural space. ESR contains multi-modality signal components such as the evoked neural response (due to tonic or BurstDR™ waveforms), evoked muscle response, stimulation artifact, and cardiac response. The tonic stimulation evoked compound action potential (ECAP) is one of the components in ESR and has been proposed recently to measure the accumulative local potentials from large populations of neuronal fibers during EES. Result Here, we first review and investigate the referencing strategies, as they apply to ECAP component in ESR in the domestic swine animal model. We then examine how ECAP component can be used to sense lead migration, an adverse outcome following lead placement that can reduce therapeutic efficacy. Lastly, we show and isolate concurrent activation of local back and leg muscles during EES, demonstrating that the ESR obtained from the recording contacts contain both ECAP and EMG components. Conclusion These findings may further guide the implementation of recording and reference contacts in an implantable EES system and provide preliminary evidence for the utility of ECAP component in ESR to detect lead migration. We expect these results to facilitate future development of EES methodology and implementation of use of different components in ESR to improve EES therapy. |
| first_indexed | 2024-03-10T17:19:21Z |
| format | Article |
| id | doaj.art-7bd592ec32724536a78189261a49d5f9 |
| institution | Directory Open Access Journal |
| issn | 2332-8886 |
| language | English |
| last_indexed | 2024-03-10T17:19:21Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Bioelectronic Medicine |
| spelling | doaj.art-7bd592ec32724536a78189261a49d5f92023-11-20T10:23:17ZengBMCBioelectronic Medicine2332-88862023-02-019111610.1186/s42234-023-00106-5Characterization and applications of evoked responses during epidural electrical stimulationNishant Verma0Ben Romanauski1Danny Lam2Luis Lujan3Stephan Blanz4Kip Ludwig5Scott Lempka6Andrew Shoffstall7Bruce Knudson8Yuichiro Nishiyama9Jian Hao10Hyun-Joo Park11Erika Ross12Igor Lavrov13Mingming Zhang14Abbott NeuromodulationDepartment of Neurologic Surgery, Mayo ClinicAbbott NeuromodulationDepartment of Neurologic Surgery, Mayo ClinicDepartment of Biomedical Engineering, University of Wisconsin MadisonDepartment of Biomedical Engineering, University of Wisconsin MadisonDepartment of Biomedical Engineering, Case Western Reserve UniversityDepartment of Biomedical Engineering, Case Western Reserve UniversityDepartment of Biomedical Engineering, University of Wisconsin MadisonDepartment of Neurology, Department of Physiology and Biomedical Engineering, Mayo ClinicDepartment of Neurology, Department of Physiology and Biomedical Engineering, Mayo ClinicAbbott NeuromodulationAbbott NeuromodulationDepartment of Neurology, Department of Physiology and Biomedical Engineering, Mayo ClinicAbbott NeuromodulationAbstract Background Epidural electrical stimulation (EES) of the spinal cord has been FDA approved and used therapeutically for decades. However, there is still not a clear understanding of the local neural substrates and consequently the mechanism of action responsible for the therapeutic effects. Method Epidural spinal recordings (ESR) are collected from the electrodes placed in the epidural space. ESR contains multi-modality signal components such as the evoked neural response (due to tonic or BurstDR™ waveforms), evoked muscle response, stimulation artifact, and cardiac response. The tonic stimulation evoked compound action potential (ECAP) is one of the components in ESR and has been proposed recently to measure the accumulative local potentials from large populations of neuronal fibers during EES. Result Here, we first review and investigate the referencing strategies, as they apply to ECAP component in ESR in the domestic swine animal model. We then examine how ECAP component can be used to sense lead migration, an adverse outcome following lead placement that can reduce therapeutic efficacy. Lastly, we show and isolate concurrent activation of local back and leg muscles during EES, demonstrating that the ESR obtained from the recording contacts contain both ECAP and EMG components. Conclusion These findings may further guide the implementation of recording and reference contacts in an implantable EES system and provide preliminary evidence for the utility of ECAP component in ESR to detect lead migration. We expect these results to facilitate future development of EES methodology and implementation of use of different components in ESR to improve EES therapy.https://doi.org/10.1186/s42234-023-00106-5Spinal cord stimulationEvoked compound action potentialNeurophysiologySpinally evoked motor potentialsNeuromodulationNeuropathic pain |
| spellingShingle | Nishant Verma Ben Romanauski Danny Lam Luis Lujan Stephan Blanz Kip Ludwig Scott Lempka Andrew Shoffstall Bruce Knudson Yuichiro Nishiyama Jian Hao Hyun-Joo Park Erika Ross Igor Lavrov Mingming Zhang Characterization and applications of evoked responses during epidural electrical stimulation Bioelectronic Medicine Spinal cord stimulation Evoked compound action potential Neurophysiology Spinally evoked motor potentials Neuromodulation Neuropathic pain |
| title | Characterization and applications of evoked responses during epidural electrical stimulation |
| title_full | Characterization and applications of evoked responses during epidural electrical stimulation |
| title_fullStr | Characterization and applications of evoked responses during epidural electrical stimulation |
| title_full_unstemmed | Characterization and applications of evoked responses during epidural electrical stimulation |
| title_short | Characterization and applications of evoked responses during epidural electrical stimulation |
| title_sort | characterization and applications of evoked responses during epidural electrical stimulation |
| topic | Spinal cord stimulation Evoked compound action potential Neurophysiology Spinally evoked motor potentials Neuromodulation Neuropathic pain |
| url | https://doi.org/10.1186/s42234-023-00106-5 |
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