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Hamza M, Carron R, Dibué M, Moiraghi A, Barrit S, Filipescu C, Landré E, Gavaret M, Domenech P, Pallud J, Zanello M. Right-sided vagus nerve stimulation for drug-resistant epilepsy: A systematic review of the literature and perspectives. Seizure 2024; 117:298-304. [PMID: 38615369 DOI: 10.1016/j.seizure.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Right-sided vagus nerve stimulation (RS-VNS) is indicated when the procedure was deemed not technically feasible or too risky on the indicated left side. OBJECTIVE The present study aims to systematically review the literature on RS-VNS, assessing its effectiveness and safety. METHODS A systematic review following PRISMA guidelines was conducted: Pubmed/MEDLINE, The Cochrane Library, Scopus, Embase and Web of science databases were searched from inception to August 13th,2023. Gray literature was searched in two libraries. Eligible studies included all studies reporting, at least, one single case of RS-VNS in patients for the treatment of drug-resistant epilepsy. RESULTS Out of 2333 initial results, 415 studies were screened by abstract. Only four were included in the final analysis comprising seven patients with RS-VNS for a drug-resistant epilepsy. One patient experienced nocturnal asymptomatic bradycardia whereas the other six patients did not display any cardiac symptom. RS-VNS was discontinued in one case due to exercise-induced airway disease exacerbation. Decrease of epileptic seizure frequency after RS-VNS ranged from 25 % to 100 % in six cases. In the remaining case, VNS effectiveness was unclear. In one case, RS-VNS was more efficient than left-sided VNS (69 % vs 50 %, respectively) whereas in another case, RS-VNS was less efficient (50 % vs 95 %, respectively). CONCLUSION Literature on the present topic is limited. In six out of seven patients, RS-VNS for drug-resistant epilepsy displayed reasonable effectiveness with a low complication rate. Further research, including prospective studies, is necessary to assess safety and effectiveness of RS-VNS for drug-resistant epilepsy patients.
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Affiliation(s)
- Meissa Hamza
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Romain Carron
- Aix Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille, France; Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France
| | - Maxine Dibué
- Department of Neurosurgery, Friedrich-Schiller University, Jena, Germany; Medical Affairs Neuromodulation International, LivaNova PLC, London United Kingdom
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France
| | - Sami Barrit
- Department of Neurosurgery, Erasmus Hospital, Free University of Brussels, Belgium
| | - Cristina Filipescu
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Elisabeth Landré
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martine Gavaret
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France; Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Philippe Domenech
- Neuromodulation Institute, GHU Paris, Psychiatrie et neurosciences, Hôpital Saint-Anne, Université Paris Cité, Paris, France; Cognitive Neuroimaging Unit, INSERM, CEA, CNRS, Université Paris-Saclay, NeuroSpin Center, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France.
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2
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Mao X, Chang YC, Zanos S, Lajoie G. Personalized inference for neurostimulation with meta-learning: a case study of vagus nerve stimulation. J Neural Eng 2024; 21:016004. [PMID: 38131193 DOI: 10.1088/1741-2552/ad17f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023]
Abstract
Objective. Neurostimulation is emerging as treatment for several diseases of the brain and peripheral organs. Due to variability arising from placement of stimulation devices, underlying neuroanatomy and physiological responses to stimulation, it is essential that neurostimulation protocols are personalized to maximize efficacy and safety. Building such personalized protocols would benefit from accumulated information in increasingly large datasets of other individuals' responses.Approach. To address that need, we propose a meta-learning family of algorithms to conduct few-shot optimization of key fitting parameters of physiological and neural responses in new individuals. While our method is agnostic to neurostimulation setting, here we demonstrate its effectiveness on the problem of physiological modeling of fiber recruitment during vagus nerve stimulation (VNS). Using data from acute VNS experiments, the mapping between amplitudes of stimulus-evoked compound action potentials (eCAPs) and physiological responses, such as heart rate and breathing interval modulation, is inferred.Main results. Using additional synthetic data sets to complement experimental results, we demonstrate that our meta-learning framework is capable of directly modeling the physiology-eCAP relationship for individual subjects with much fewer individually queried data points than standard methods.Significance. Our meta-learning framework is general and can be adapted to many input-response neurostimulation mapping problems. Moreover, this method leverages information from growing data sets of past patients, as a treatment is deployed. It can also be combined with several model types, including regression, Gaussian processes with Bayesian optimization, and beyond.
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Affiliation(s)
- Ximeng Mao
- Mila-Quebec Artificial Intelligence Institute, 6666 St-Urbain, Montréal, QC H2S 3H1, Canada
- Department of Computer Science and Operations Research, University of Montréal, 2920 chemin de la Tour, Montréal, QC H3T 1J4, Canada
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States of America
- Medtronic, 710 Medtronic Parkway, Minneapolis, MN 55432, United States of America
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States of America
| | - Guillaume Lajoie
- Mila-Quebec Artificial Intelligence Institute, 6666 St-Urbain, Montréal, QC H2S 3H1, Canada
- Department of Mathematics and Statistics, University of Montréal, 2920 chemin de la Tour, Montréal, QC H3T 1J4, Canada
- Canada CIFAR AI Chair, Toronto, ON M5G 1M1, Canada
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3
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Tovbis D, Lee E, Koh RGL, Jeong R, Agur A, Yoo PB. Enhancing the selective electrical activation of human vagal nerve fibers: a comparative computational modeling study with validation in a rat sciatic model. J Neural Eng 2023; 20:066012. [PMID: 37963401 DOI: 10.1088/1741-2552/ad0c60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/14/2023] [Indexed: 11/16/2023]
Abstract
Objective.Vagus nerve stimulation (VNS) is an emerging treatment option for a myriad of medical disorders, where the method of delivering electrical pulses can vary depending on the clinical indication. In this study, we investigated the relative effectiveness of electrically activating the cervical vagus nerve among three different approaches: nerve cuff electrode stimulation (NCES), transcutaneous electrical nerve stimulation (TENS), and enhanced TENS (eTENS). The objectives were to characterize factors that influenced nerve activation and to compare the nerve recruitment properties as a function of nerve fiber diameter.Methods.The Finite Element Model, based on data from the Visible Human Project, was implemented in COMSOL. The three simulation types were compared under a range of vertical and horizontal displacements relative to the location of the vagus nerve. Monopolar anodic stimulation was examined, along with latency and activation of different fiber sizes. Nerve activation was determined via the activating function and McIntyre-Richardson-Grill models, and activation thresholds were validated in anin-vivorodent model.Results.While NCES produced the lowest activation thresholds, eTENS generally performed superior to TENS under the range of conditions and fiber diameters, producing activation thresholds up to three times lower than TENS. eTENS also preserved its enhancement when surface electrodes were displaced away from the nerve. Anodic stimulation revealed an inhibitory region that removed eTENS benefits. eTENS also outperformed TENS by up to four times when targeting smaller diameter nerve fibers, scaling similar to a cuff electrode. In latency and activation of smaller diameter nerve fibers, eTENS results resembled those of NCES more than a TENS electrode. Activation threshold ratios were consistent inin-vivovalidation.Significance.Our findings expand upon previously identified mechanisms for eTENS and further demonstrate how eTENS emulates a nerve cuff electrode to achieve lower activation thresholds. This work further characterizes considerations required for VNS under the three stimulation methods.
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Affiliation(s)
- Daniel Tovbis
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Eugene Lee
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
| | - Ryan G L Koh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Rania Jeong
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Anne Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Paul B Yoo
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
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Behrens R, Dutschmann M, Trewella M, Mazzone SB, Moe AAK. Regulation of vagally-evoked respiratory responses by the lateral parabrachial nucleus in the mouse. Respir Physiol Neurobiol 2023; 316:104141. [PMID: 37597796 DOI: 10.1016/j.resp.2023.104141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
Vagal sensory inputs to the brainstem can alter breathing through the modulation of pontomedullary respiratory circuits. In this study, we set out to investigate the localised effects of modulating lateral parabrachial nucleus (LPB) activity on vagally-evoked changes in breathing pattern. In isoflurane-anaesthetised and instrumented mice, electrical stimulation of the vagus nerve (eVNS) produced stimulation frequency-dependent changes in diaphragm electromyograph (dEMG) activity with an evoked tachypnoea and apnoea at low and high stimulation frequencies, respectively. Muscimol microinjections into the LPB significantly attenuated eVNS-evoked respiratory rate responses. Notably, muscimol injections reaching the caudal LPB, previously unrecognised for respiratory modulation, potently modulated eVNS-evoked apnoea, whilst muscimol injections reaching the intermediate LPB selectively modulated the eVNS-evoked tachypnoea. The effects of muscimol on eVNS-evoked breathing rate changes occurred without altering basal eupneic breathing. These results highlight novel roles for the LPB in regulating vagally-evoked respiratory reflexes.
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Affiliation(s)
- Robert Behrens
- Department of Anatomy and Physiology, University of Melbourne, VIC, Australia
| | - Mathias Dutschmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Matthew Trewella
- Department of Anatomy and Physiology, University of Melbourne, VIC, Australia
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, VIC, Australia.
| | - Aung Aung Kywe Moe
- Department of Anatomy and Physiology, University of Melbourne, VIC, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
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Qin P, Lin Q, Xie Y, Chang YC, Zanos S, Wang H, Payne S, Shivdasani MN, Tsai D, Lovell NH, Dokos S, Guo T. Modulating functionally-distinct vagus nerve fibers using microelectrodes and kilohertz frequency electrical stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082599 DOI: 10.1109/embc40787.2023.10340796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Modulation of functionally distinct nerve fibers with bioelectronic devices provides a therapeutic opportunity for various diseases. In this study, we began by developing a computational model including four major subtypes of myelinated fibers and one unmyelinated fiber. Second, we used an intrafascicular electrode to perform kHz-frequency electric stimulation to preferentially modulate a population of fibers. Our model suggests that fiber physical properties and electrode-to-fascicle distance severely impacts stimulus-response relationships. Large diameter fibers (Aα- and Aβ-) were only minimally influenced by the fascicle size and electrode location, while smaller diameter fibers (Aδ-, B- and C-) indicated a stronger dependency.Clinical Relevance- Our findings support the possibility of selectively modulating functionally-distinct nerve fibers using electrical stimulation in a small, localized region. Our model provides an effective tool to design next-generation implantable devices and therapeutic stimulation strategies toward minimizing off-target effects.
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Lim J, Eiber CD, Sun A, Maples A, Powley TL, Ward MP, Lee H. Fractal Microelectrodes for More Energy-Efficient Cervical Vagus Nerve Stimulation. Adv Healthc Mater 2023; 12:e2202619. [PMID: 36973998 PMCID: PMC10522801 DOI: 10.1002/adhm.202202619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/06/2023] [Indexed: 03/29/2023]
Abstract
Vagus nerve stimulation (VNS) has the potential to treat various peripheral dysfunctions, but the traditional cuff electrodes for VNS are susceptible to off-target effects. Microelectrodes may enable highly selective VNS that can mitigate off-target effects, but they suffer from the increased impedance. Recent studies on microelectrodes with non-Euclidean geometries have reported higher energy efficiency in neural stimulation applications. These previous studies use electrodes with mm/cm-scale dimensions, mostly targeted for myelinated fibers. This study evaluates fractal microelectrodes for VNS in a rodent model (N = 3). A thin-film device with fractal and circle microelectrodes is fabricated to compare their neural stimulation performance on the same radial coordinate of the nerve. The results show that fractal microelectrodes can activate C-fibers with up to 52% less energy (p = 0.012) compared to circle microelectrodes. To the best of the knowledge, this work is the first to demonstrate a geometric advantage of fractal microelectrodes for VNS in vivo.
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Affiliation(s)
- Jongcheon Lim
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
| | - Calvin D Eiber
- Synchron Inc., Melbourne, VIC, 3004, Australia
- Department of Medicine (RMH), Faculty of Medicine, Health and Dentistry, the University of Melbourne, Melbourne, VIC, 3050, Australia
| | - Anina Sun
- Department of Biology, Purdue University, West Lafayette, IN, 47907, USA
| | - Amanda Maples
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Terry L Powley
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, 47907, USA
- Purdue Institute of Integrative Neuroscience, Purdue University, West Lafayette, IN, 47907, USA
| | - Matthew P Ward
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Hyowon Lee
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
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7
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Sun T, Tsaava T, Peragine J, Crosfield C, Lopez MF, Modi R, Sharma R, Li C, Sohal H, Chang EH, Rieth L. Flexible IrO x neural electrode for mouse vagus nerve stimulation. Acta Biomater 2023; 159:394-409. [PMID: 36669547 PMCID: PMC10823593 DOI: 10.1016/j.actbio.2023.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Vagus nerve stimulation (VNS) is being actively explored as a treatment for multiple conditions as part of bioelectronic medicine research. Reliable and safe VNS in mouse models is a critical need for understanding mechanisms of these. We report on the development and evaluation of a microfabricated cuff electrode (MouseFlex) constructed of polyimide (PI) and with iridium oxide (IrOx) electrodes that is thermoformed to 86 µm ± 12 µm radius to interface the mouse cervical vagus nerve (r ≈ 50 µm). Innovative bench-top methods were used to evaluate the stimulation stability and electrochemical properties of electrodes. Our aggressive stimulation stability (Stim-Stab) test utilized 1 billion pulses at a 1000 Hz with a current density of 6.28 A/cm2 (1.51 mC/cm2/phase) delivering 3023 × 103 C/cm2 to evaluate electrode lifetimes, and all electrodes remained functional. We also investigated the effects of thermoforming on their impedance, charge storage capacity (CSC), and charge injection capacity (CIC). The modest changes in electrochemical properties indicate that the thermoforming process was well tolerated. Thermoformed electrode safety and efficacy were evaluated in-vivo by performing acute VNS in mice and monitoring their heart and respiration rate as biomarkers. Their electrochemical properties were also measured before, during and after VNS. Bradycardia and bradypnea were reliably induced at stimulation currents of 100 to 200 µA, well below the in-vivo CIC of ∼1250 µA (∼0.5 mC/cm2), supporting their safety and efficacy. The electrode impedance increased and CIC decreased during in-vivo use, but largely reversed these changes in in-vitro testing after enzymatic cleaning, supporting their tolerance for surgical use. STATEMENT OF SIGNIFICANCE: Vagus nerve stimulation (VNS) is a rapidly growing aspect of healthcare and bioelectronic medicine research. Reliable and safe VNS in mice with small diameter (d ≈ 100 µm) nerves has been a challenge due to achieving intimate contact with the nerve, and the stimulation stability of commonly used electrodes. We demonstrate a microfabricated (MouseFlex) cuff electrode constructed of polyimide with IrOx electrodes that is thermoformed to contact the mouse cervical vagus. Bench studies highlight the stimulation stability exceeded 109 pulses at 6.28 A/cm2 and their electrochemical properties were measured before, during, and after bench and nerve stimulation. Nerve stimulation induced bradycardia and bradypnea at currents below the in-vivo charge injection capacity, supporting their safety, efficacy, and tolerance for surgical handling.
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Affiliation(s)
- Tao Sun
- Mechanical & Aerospace Engineering Department, Benjamin M. Statler College of Engineering & Mineral Resources, West Virginia University, Morgantown, WV 26505, United States
| | - Téa Tsaava
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York 11030, United States
| | - Joanne Peragine
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York 11030, United States
| | - Christine Crosfield
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York 11030, United States
| | | | - Romil Modi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York 11030, United States
| | - Rohit Sharma
- Electrical and Computer Engineering Department, University of Utah, Salt Lake City, UT 84112, United States; Applied Biosensors, Salt Lake City, UT 84115, United States
| | - Chunyan Li
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York 11030, United States
| | | | - Eric H Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York 11030, United States
| | - Loren Rieth
- Mechanical & Aerospace Engineering Department, Benjamin M. Statler College of Engineering & Mineral Resources, West Virginia University, Morgantown, WV 26505, United States.
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Ganouna-Cohen G, Marcouiller F, Bairam A, Joseph V. Orchiectomy exacerbates sleep-disordered breathing induced by intermittent hypoxia in mice. Respir Physiol Neurobiol 2023; 313:104052. [PMID: 36990336 DOI: 10.1016/j.resp.2023.104052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
We tested the hypothesis that low testosterone levels alter the regulation of breathing in mice exposed to intermittent hypoxia (IH). We used orchiectomized (ORX) or control (Sham-operated) mice exposed to normoxia or IH (12h/day, 10 cycles/h, 6% O2) for 14 days. Breathing was measured by whole-body plethysmography to asses the stability of the breathing pattern (frequency distribution of total cycle time - Ttot) and the frequency and duration of spontaneous and post-sigh apneas (PSA). We characterized sighs as inducing one (S1) or more (S2) apnea and determined the sigh parameters (volume, peak inspiratory and expiratory flows, cycle times) associated with PSA. IH increased the frequency and duration of PSA and the proportion of S1 and S2 sighs. The PSA frequency was mostly related to the sigh expiratory time. The effects of IH on PSA frequency were amplified in ORX-IH mice. Our experiments using ORX support the hypothesis that testosterone is involved in the regulation of breathing in mice following IH.
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9
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Farrand A, Jacquemet V, Verner R, Owens M, Beaumont E. Vagus nerve stimulation parameters evoke differential neuronal responses in the locus coeruleus. Physiol Rep 2023; 11:e15633. [PMID: 36905173 PMCID: PMC10006695 DOI: 10.14814/phy2.15633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
Vagus nerve stimulation (VNS) is used to treat drug-resistant epilepsy and depression, with additional applications under investigation. The noradrenergic center locus coeruleus (LC) is vital for VNS effects; however, the impact of varying stimulation parameters on LC activation is poorly understood. This study characterized LC activation across VNS parameters. Extracellular activity was recorded in rats' left LC while 11 VNS paradigms, utilizing variable frequencies and bursting characteristics, were pseudorandomly delivered to the left cervical vagus for five cycles. Neurons' change from baseline firing rate and timing response profiles were assessed. The proportion of neurons categorized as responders over 5 VNS cycles doubled in comparison to the first VNS cycle (p < 0.001) for all VNS paradigms, demonstrating an amplification effect. The percentage of positively consistent/positive responders increased for standard VNS paradigms with frequencies ≥10 Hz and for bursting paradigms with shorter interburst intervals and more pulses per burst. The synchrony between pairs of LC neurons increased during bursting VNS but not standard paradigms. Also, the probability of evoking a direct response during bursting VNS was higher with longer interburst intervals and a higher number of pulses per burst. Standard paradigms between 10-30 Hz best positively activates LC with consistency to VNS while the best bursting paradigm to increase activity was 300 Hz, seven pulses per burst separated by 1 s. Bursting VNS was effective in increasing synchrony between pairs of neurons, suggesting a common network recruitment originating from vagal afferents. These results indicate differential activation of LC neurons depending on the VNS parameters delivered.
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Affiliation(s)
- Ariana Farrand
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Vincent Jacquemet
- Department of Pharmacology and PhysiologyInstitute of Biomedical Engineering, University of MontrealMontrealQuebecCanada
- Research CenterSacred Heart Hospital of MontrealMontrealQuebecCanada
| | - Ryan Verner
- Neuromodulation DivisionLivaNova PLCHoustonTexasUSA
| | - Misty Owens
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Eric Beaumont
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
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10
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Blanz SL, Musselman ED, Settell ML, Knudsen BE, Nicolai EN, Trevathan JK, Verner RS, Begnaud J, Skubal AC, Suminski AJ, Williams JC, Shoffstall AJ, Grill WM, Pelot NA, Ludwig KA. Spatially selective stimulation of the pig vagus nerve to modulate target effect versus side effect. J Neural Eng 2023; 20:10.1088/1741-2552/acb3fd. [PMID: 36649655 PMCID: PMC10339030 DOI: 10.1088/1741-2552/acb3fd] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/17/2023] [Indexed: 01/18/2023]
Abstract
Electrical stimulation of the cervical vagus nerve using implanted electrodes (VNS) is FDA-approved for the treatment of drug-resistant epilepsy, treatment-resistant depression, and most recently, chronic ischemic stroke rehabilitation. However, VNS is critically limited by the unwanted stimulation of nearby neck muscles-a result of non-specific stimulation activating motor nerve fibers within the vagus. Prior studies suggested that precise placement of small epineural electrodes can modify VNS therapeutic effects, such as cardiac responses. However, it remains unclear if placement can alter the balance between intended effect and limiting side effect. We used an FDA investigational device exemption approved six-contact epineural cuff to deliver VNS in pigs and quantified how epineural electrode location impacts on- and off-target VNS activation. Detailed post-mortem histology was conducted to understand how the underlying neuroanatomy impacts observed functional responses. Here we report the discovery and characterization of clear neuroanatomy-dependent differences in threshold and saturation for responses related to both effect (change in heart rate) and side effect (neck muscle contractions). The histological and electrophysiological data were used to develop and validate subject-specific computation models of VNS, creating a well-grounded quantitative framework to optimize electrode location-specific activation of nerve fibers governing intended effect versus unwanted side effect.
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Affiliation(s)
- Stephan L Blanz
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Eric D Musselman
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Megan L Settell
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Bruce E Knudsen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Evan N Nicolai
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States of America
- Mayo Clinic, Rochester, MN, United States of America
| | - James K Trevathan
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Ryan S Verner
- LivaNova USA Inc., Houston, TX, United States of America
| | - Jason Begnaud
- LivaNova USA Inc., Houston, TX, United States of America
| | - Aaron C Skubal
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
| | - Aaron J Suminski
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Justin C Williams
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Andrew J Shoffstall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- APT Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Warren M Grill
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States of America
- Department of Neurobiology, Duke University, Durham, NC, United States of America
- Department of Neurosurgery, Duke University, Durham, NC, United States of America
| | - Nicole A Pelot
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Kip A Ludwig
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, United States of America
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
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11
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Kaufmann EM, Krause S, Geisshuesler L, Scheidegger O, Haeberlin A, Niederhauser T. Feasibility of transesophageal phrenic nerve stimulation. Biomed Eng Online 2023; 22:5. [PMID: 36717872 PMCID: PMC9885573 DOI: 10.1186/s12938-023-01071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Every year, more than 2.5 million critically ill patients in the ICU are dependent on mechanical ventilation. The positive pressure in the lungs generated by the ventilator keeps the diaphragm passive, which can lead to a loss of myofibers within a short time. To prevent ventilator-induced diaphragmatic dysfunction (VIDD), phrenic nerve stimulation may be used. OBJECTIVE The goal of this study is to show the feasibility of transesophageal phrenic nerve stimulation (TEPNS). We hypothesize that selective phrenic nerve stimulation can efficiently activate the diaphragm with reduced co-stimulations. METHODS An in vitro study in saline solution combined with anatomical findings was performed to investigate relevant stimulation parameters such as inter-electrode spacing, range to target site, or omnidirectional vs. sectioned electrodes. Subsequently, dedicated esophageal electrodes were inserted into a pig and single stimulation pulses were delivered simultaneously with mechanical ventilation. Various stimulation sites and response parameters such as transdiaphragmatic pressure or airway flow were analyzed to establish an appropriate stimulation setting. RESULTS Phrenic nerve stimulation with esophageal electrodes has been demonstrated. With a current amplitude of 40 mA, similar response figures of the diaphragm activation as compared to conventional stimulation with needle electrodes at 10mA were observed. Directed electrodes best aligned with the phrenic nerve resulted in up to 16.9 % higher amplitude at the target site in vitro and up to 6 cmH20 higher transdiaphragmatic pressure in vivo as compared to omnidirectional electrodes. The activation efficiency was more sensitive to the stimulation level inside the esophagus than to the inter-electrode spacing. Most effective and selective stimulation was achieved at the level of rib 1 using sectioned electrodes 40 mm apart. CONCLUSION Directed transesophageal phrenic nerve stimulation with single stimuli enabled diaphragm activation. In the future, this method might keep the diaphragm active during, and even support, artificial ventilation. Meanwhile, dedicated sectioned electrodes could be integrated into gastric feeding tubes.
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Affiliation(s)
- Elisa M. Kaufmann
- grid.424060.40000 0001 0688 6779Institute of Human Centered Engineering HuCE, Bern University of Applied Sciences, Biel, Switzerland ,grid.5734.50000 0001 0726 5157Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Sven Krause
- grid.424060.40000 0001 0688 6779Institute of Human Centered Engineering HuCE, Bern University of Applied Sciences, Biel, Switzerland
| | - Lukas Geisshuesler
- grid.424060.40000 0001 0688 6779Institute of Human Centered Engineering HuCE, Bern University of Applied Sciences, Biel, Switzerland
| | - Olivier Scheidegger
- grid.5734.50000 0001 0726 5157Department Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- grid.5734.50000 0001 0726 5157Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Niederhauser
- grid.424060.40000 0001 0688 6779Institute of Human Centered Engineering HuCE, Bern University of Applied Sciences, Biel, Switzerland ,grid.5734.50000 0001 0726 5157Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
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12
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Ravagli E, Ardell J, Holder D, Aristovich K. A combined cuff electrode array for organ-specific selective stimulation of vagus nerve enabled by Electrical Impedance Tomography. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1122016. [PMID: 37138728 PMCID: PMC10149952 DOI: 10.3389/fmedt.2023.1122016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Previously developed spatially-selective Vagus Nerve Stimulation (sVNS) allows the targeting of specific nerve fascicles through current steering in a multi-electrode nerve cuff but relies on a trial-and-error strategy to identify the relative orientation between electrodes and fascicles. Fast Neural Electrical Impedance Tomography (FN-EIT) has been recently used for imaging neural traffic in the vagus nerves of pigs in a cross-correlation study with sVNS and MicroCT fascicle tracking. FN-EIT has the potential for allowing targeted sVNS; however, up to now, stimulation and imaging have been performed with separate electrode arrays. In this study, different options were evaluated in-silico to integrate EIT and stimulation into a single electrode array without affecting spatial selectivity. The original pig vagus EIT electrode array geometry was compared with a geometry integrating sVNS and EIT electrodes, and with direct use of sVNS electrodes for EIT imaging. Modelling results indicated that both new designs could achieve image quality similar to the original electrode geometry in all tested markers (e.g., co-localisation error <100 µm). The sVNS array was considered to be the simplest due to the lower number of electrodes. Experimental results from testing evoked EIT imaging of recurrent laryngeal activity using electrodes from the sVNS cuff returned a signal-to-noise ratio similar to our previous study (3.9 ± 2.4 vs. 4.1 ± 1.5, N = 4 nerves from 3 pigs) and a lower co-localisation error (≈14% nerve diameter vs. ≈25%, N = 2 nerves from 2 pigs). Performing FN-EIT and sVNS on the same nerve cuff will facilitate translation to humans, simplify surgery and enable targeted neuromodulation strategies.
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Affiliation(s)
- Enrico Ravagli
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Correspondence: Enrico Ravagli
| | - Jeffrey Ardell
- Department of Medicine, CardiacArrhythmia Centre, University of California Los Angeles, Los Angeles, CA, United States
| | - David Holder
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Kirill Aristovich
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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13
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Steins H, Mierzejewski M, Brauns L, Stumpf A, Kohler A, Heusel G, Corna A, Herrmann T, Jones PD, Zeck G, von Metzen R, Stieglitz T. A flexible protruding microelectrode array for neural interfacing in bioelectronic medicine. MICROSYSTEMS & NANOENGINEERING 2022; 8:131. [PMID: 36568135 PMCID: PMC9772315 DOI: 10.1038/s41378-022-00466-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 05/31/2023]
Abstract
Recording neural signals from delicate autonomic nerves is a challenging task that requires the development of a low-invasive neural interface with highly selective, micrometer-sized electrodes. This paper reports on the development of a three-dimensional (3D) protruding thin-film microelectrode array (MEA), which is intended to be used for recording low-amplitude neural signals from pelvic nervous structures by penetrating the nerves transversely to reduce the distance to the axons. Cylindrical gold pillars (Ø 20 or 50 µm, ~60 µm height) were fabricated on a micromachined polyimide substrate in an electroplating process. Their sidewalls were insulated with parylene C, and their tips were optionally modified by wet etching and/or the application of a titanium nitride (TiN) coating. The microelectrodes modified by these combined techniques exhibited low impedances (~7 kΩ at 1 kHz for Ø 50 µm microelectrode with the exposed surface area of ~5000 µm²) and low intrinsic noise levels. Their functionalities were evaluated in an ex vivo pilot study with mouse retinae, in which spontaneous neuronal spikes were recorded with amplitudes of up to 66 µV. This novel process strategy for fabricating flexible, 3D neural interfaces with low-impedance microelectrodes has the potential to selectively record neural signals from not only delicate structures such as retinal cells but also autonomic nerves with improved signal quality to study neural circuits and develop stimulation strategies in bioelectronic medicine, e.g., for the control of vital digestive functions.
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Affiliation(s)
- Helen Steins
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Michael Mierzejewski
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Lisa Brauns
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Angelika Stumpf
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Alina Kohler
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Gerhard Heusel
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Andrea Corna
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Institute of Biomedical Electronics, TU Wien, Vienna, Austria
| | - Thoralf Herrmann
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Peter D. Jones
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Günther Zeck
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Institute of Biomedical Electronics, TU Wien, Vienna, Austria
| | - Rene von Metzen
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
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14
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Payne SC, Romas E, Hyakumura T, Muntz F, Fallon JB. Abdominal vagus nerve stimulation alleviates collagen-induced arthritis in rats. Front Neurosci 2022; 16:1012133. [DOI: 10.3389/fnins.2022.1012133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory disease. Despite therapeutic advances, a significant proportion of RA patients are resistant to pharmacological treatment. Stimulation of the cervical vagus nerve is a promising alternative bioelectric neuromodulation therapeutic approach. However, recent clinical trials show cervical vagus nerve stimulation (VNS) was not effective in a significant proportion of drug resistant RA patients. Here we aim to assess if abdominal vagus nerve stimulation reduces disease severity in a collagen-induced arthritis (CIA) rat model. The abdominal vagus nerve of female Dark Agouti rats was implanted and CIA induced using collagen type II injection. VNS (1.6 mA, 200 μs pulse width, 50 μs interphase gap, 27 Hz frequency) was applied to awake freely moving rats for 3 h/day (days 11–17). At 17 days following the collagen injection, unstimulated CIA rats (n = 8) had significantly worse disease activity index, tumor necrosis factor-alpha (TNF-α) and receptor activator of NFκB ligand (RANKL) levels, synovitis and cartilage damage than normal rats (n = 8, Kruskal–Wallis: P < 0.05). However, stimulated CIA rats (n = 5–6) had significantly decreased inflammatory scores and ankle swelling (Kruskal–Wallis: P < 0.05) compared to unstimulated CIA rats (n = 8). Levels of tumor necrosis factor-alpha (TNF-α) remained at undetectable levels in stimulated CIA rats while levels of receptor activator of NFκB ligand (RANKL) were significantly less in stimulated CIA rats compared to unstimulated CIA rats (P < 0.05). Histopathological score of inflammation and cartilage loss in stimulated CIA rats were no different from that of normal (P > 0.05). In conclusion, abdominal VNS alleviates CIA and could be a promising therapy for patients with RA.
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15
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Chang YC, Ahmed U, Jayaprakash N, Mughrabi I, Lin Q, Wu YC, Gerber M, Abbas A, Daytz A, Gabalski AH, Ashville J, Dokos S, Rieth L, Datta-Chaudhuri T, Tracey KJ, Guo T, Al-Abed Y, Zanos S. kHz-frequency electrical stimulation selectively activates small, unmyelinated vagus afferents. Brain Stimul 2022; 15:1389-1404. [PMID: 36241025 PMCID: PMC10164362 DOI: 10.1016/j.brs.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Vagal reflexes regulate homeostasis in visceral organs and systems through afferent and efferent neurons and nerve fibers. Small, unmyelinated, C-type afferents comprise over 80% of fibers in the vagus and form the sensory arc of autonomic reflexes of the gut, lungs, heart and vessels and the immune system. Selective bioelectronic activation of C-afferents could be used to mechanistically study and treat diseases of peripheral organs in which vagal reflexes are involved, but it has not been achieved. METHODS We stimulated the vagus in rats and mice using trains of kHz-frequency stimuli. Stimulation effects were assessed using neuronal c-Fos expression, physiological and nerve fiber responses, optogenetic and computational methods. RESULTS Intermittent kHz stimulation for 30 min activates specific motor and, preferentially, sensory vagus neurons in the brainstem. At sufficiently high frequencies (>5 kHz) and at intensities within a specific range (7-10 times activation threshold, T, in rats; 15-25 × T in mice), C-afferents are activated, whereas larger, A- and B-fibers, are blocked. This was determined by measuring fiber-specific acute physiological responses to kHz stimulus trains, and by assessing fiber excitability around kHz stimulus trains through compound action potentials evoked by probing pulses. Aspects of selective activation of C-afferents are explained in computational models of nerve fibers by how fiber size and myelin shape the response of sodium channels to kHz-frequency stimuli. CONCLUSION kHz stimulation is a neuromodulation strategy to robustly and selectively activate vagal C-afferents implicated in physiological homeostasis and disease, over larger vagal fibers.
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Affiliation(s)
- Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Ibrahim Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Qihang Lin
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Yi-Chen Wu
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Michael Gerber
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Adam Abbas
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Anna Daytz
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Arielle H Gabalski
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Jason Ashville
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Loren Rieth
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, 26506, United States
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Tianruo Guo
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
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16
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Jeong H, Cho A, Ay I, Bonmassar G. Short-pulsed micro-magnetic stimulation of the vagus nerve. Front Physiol 2022; 13:938101. [PMID: 36277182 PMCID: PMC9585240 DOI: 10.3389/fphys.2022.938101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Vagus nerve stimulation (VNS) is commonly used to treat drug-resistant epilepsy and depression. The therapeutic effect of VNS depends on stimulating the afferent vagal fibers. However, the vagus is a mixed nerve containing afferent and efferent fibers, and the stimulation of cardiac efferent fibers during VNS may produce a rare but severe risk of bradyarrhythmia. This side effect is challenging to mitigate since VNS, via electrical stimulation technology used in clinical practice, requires unique electrode design and pulse optimization for selective stimulation of only the afferent fibers. Here we describe a method of VNS using micro-magnetic stimulation (µMS), which may be an alternative technique to induce a focal stimulation, enabling a selective fiber stimulation. Micro-coils were implanted into the cervical vagus nerve in adult male Wistar rats. For comparison, the physiological responses were recorded continuously before, during, and after stimulation with arterial blood pressure (ABP), respiration rate (RR), and heart rate (HR). The electrical VNS caused a decrease in ABP, RR, and HR, whereas µM-VNS only caused a transient reduction in RR. The absence of an HR modulation indicated that µM-VNS might provide an alternative technology to VNS with fewer heart-related side effects, such as bradyarrhythmia. Numerical electromagnetic simulations helped estimate the optimal coil orientation with respect to the nerve to provide information on the electric field’s spatial distribution and strength. Furthermore, a transmission emission microscope provided very high-resolution images of the cervical vagus nerve in rats, which identified two different populations of nerve fibers categorized as large and small myelinated fibers.
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Affiliation(s)
- Hongbae Jeong
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Annabel Cho
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
- Department of Bioengineering, Harvard University, Cambridge, MA, United States
| | - Ilknur Ay
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
- *Correspondence: Giorgio Bonmassar,
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17
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Alhawwash A, Muzquiz MI, Richardson L, Vetter C, Smolik M, Goodwill A, Yoshida K. In vivo peripheral nerve activation using sinusoidal low-frequency alternating currents. Artif Organs 2022; 46:2055-2065. [PMID: 35730955 PMCID: PMC9795871 DOI: 10.1111/aor.14347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/19/2022] [Accepted: 06/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The sinusoidal low-frequency alternating current (LFAC) waveform was explored recently as a novel means to evoke nerve conduction block. In the present work, we explored whether increasing the amplitude of the LFAC waveform results in nerve fiber activation in autonomic nerves. In-silico methods and preliminary work in somatic nerves indicated a potential frequency dependency on the threshold of activation. The Hering-Breuer (HB) reflex was used as a biomarker to detect cervical vagus nerve activation. METHODS Experiments were conducted in isoflurane-anesthetized swine (n = 5). Two stimulating bipolar cuff electrodes and a tripolar recording cuff electrode were implanted on the left vagus nerve. To ensure the electrical stimulation affects only the afferent pathways, the nerve was crushed caudal to the electrodes to eliminate cardiac effects. (1) Standard pulse stimulation (Vstim) using a monophasic train of pulses was applied through the caudal electrode to elicit HB reflex and to identify the activated nerve fiber type. (2) Continuous sinusoidal LFAC waveform with a frequency ranging from 5 through 20 Hz was applied to the rostral electrode without Vstim to explore the activation thresholds at each LFAC frequency. In both cases, the activation of nerve fibers was detected by a HB reflex-induced reduction in the breathing rate. RESULTS LFAC was found to be capable of eliciting an HB response. The LFAC activation thresholds were found to be frequency-dependent. The HB threshold was 1.02 ± 0.3 mAp at 5 Hz, 0.66 ± 0.3 mAp at 10 Hz, and 0.44 ± 0.2 mAp at 20 Hz. In comparison, it was 0.7 ± 0.47 mA for a 100 μs pulse. The LFAC amplitude was within the linear limits of the electrode interface. Damage to the cuff electrodes or the nerve tissues was not observed. Analysis of Vstim-based compound nerve action potentials (CNAP) indicated that the decrease in breathing rate was found to be correlated with the activation of slower components of the CNAP suggesting that LFAC reached and elicited responses from these slower fibers associated with afferents projecting to the HB response. CONCLUSIONS These results suggest the feasibility of the LFAC waveform at 5, 10, and 20 Hz to activate autonomic nerve fibers and potentially provide a new modality to the neurorehabilitation field.
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Affiliation(s)
- Awadh Alhawwash
- Weldon School of Biomedical EngineeringPurdue UniversityWest LafayetteIndianaUSA,Biomedical Technology DepartmentKing Saud UniversityRiyadhSaudi Arabia
| | - M. Ivette Muzquiz
- Department of Biomedical EngineeringIndiana University ‐ Purdue University IndianapolisIndianapolisIndianaUSA
| | - Lindsay Richardson
- Department of Biomedical EngineeringIndiana University ‐ Purdue University IndianapolisIndianapolisIndianaUSA
| | - Christian Vetter
- Department of Biomedical EngineeringIndiana University ‐ Purdue University IndianapolisIndianapolisIndianaUSA
| | - Macallister Smolik
- Department of BiologyIndiana University ‐ Purdue University IndianapolisIndianapolisIndianaUSA
| | - Adam Goodwill
- Department of Integrative Medical SciencesNortheast Ohio Medical UniversityRootstownOhioUSA
| | - Ken Yoshida
- Department of Biomedical EngineeringIndiana University ‐ Purdue University IndianapolisIndianapolisIndianaUSA
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18
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Olsen LK, Moore RJ, Bechmann NA, Ethridge VT, Gargas NM, Cunningham SD, Kuang Z, Whicker JK, Rohan JG, Hatcher-Solis CN. Vagus nerve stimulation-induced cognitive enhancement: Hippocampal neuroplasticity in healthy male rats. Brain Stimul 2022; 15:1101-1110. [PMID: 35970317 DOI: 10.1016/j.brs.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) improves cognition in humans and rodents, but the effects of a single session of VNS on performance and plasticity are not well understood. OBJECTIVE Behavioral performance and hippocampal (HC) electrophysiology/neurotrophin expression were measured in healthy adult rats after VNS paired training to investigate changes in cognition and synaptic plasticity. METHODS Platinum/iridium electrodes were surgically implanted around the left cervical branch of the VN of anesthetized male Sprague-Dawley rats (N = 47). VNS (100 μs biphasic pulses, 30 Hz, 0.8 mA) paired Novel Object Recognition (NOR)/Passive Avoidance Task (PAT) were assessed 24 h after training and post-mortem tissue was collected 48 h after VNS (N = 28). Electrophysiology recordings were collected using a microelectrode array system to assess functional effects on HC slices 90 min after VNS (N = 19). Sham received the same treatment without VNS and experimenters were blinded. RESULTS Stimulated rats exhibited improved performance in NOR (p < 0.05, n = 12) and PAT (p < 0.05, n = 14). VNS enhanced long-term potentiation (p < 0.05, n = 7-12), and spontaneous spike amplitude (p < 0.05, n = 7-12) and frequency (p < 0.05, n = 7-12) in the CA1. Immunohistochemical analysis found increased brain-derived neurotrophic factor expression in the CA1 (p < 0.05, n = 8-9) and CA2 (p < 0.01, n = 7-8). CONCLUSION These findings suggest that our VNS parameters promote synaptic plasticity and target the CA1, which may mediate the positive cognitive effects of VNS. This study significantly contributes to a better understanding of VNS mediated HC synaptic plasticity, which may improve clinical utilization of VNS for cognitive enhancement.
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Affiliation(s)
- Laura K Olsen
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Raquel J Moore
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Infoscitex, Inc., Dayton, OH, USA
| | - Naomi A Bechmann
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Infoscitex, Inc., Dayton, OH, USA
| | - Victoria T Ethridge
- Naval Medical Research Unit Dayton, Wright-Patterson AFB, OH, USA; Odyssey Systems Consulting Group, Wakefield, MA, USA
| | - Nathan M Gargas
- Naval Medical Research Unit Dayton, Wright-Patterson AFB, OH, USA; Odyssey Systems Consulting Group, Wakefield, MA, USA
| | - Sylvia D Cunningham
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Zhanpeng Kuang
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA
| | - Joshua K Whicker
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA
| | - Joyce G Rohan
- Naval Medical Research Unit Dayton, Wright-Patterson AFB, OH, USA
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19
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Kharbanda RK, van der Does WFB, van Staveren LN, Taverne YJHJ, Bogers AJJC, de Groot NMS. Vagus Nerve Stimulation and Atrial Fibrillation: Revealing the Paradox. Neuromodulation 2022; 25:356-365. [PMID: 35190246 DOI: 10.1016/j.neurom.2022.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The cardiac autonomic nervous system (CANS) plays an important role in the pathophysiology of atrial fibrillation (AF). Cardiovascular disease can cause an imbalance within the CANS, which may contribute to the initiation and maintenance of AF. Increased understanding of neuromodulation of the CANS has resulted in novel emerging therapies to treat cardiac arrhythmias by targeting different circuits of the CANS. Regarding AF, neuromodulation therapies targeting the vagus nerve have yielded promising outcomes. However, targeting the vagus nerve can be both pro-arrhythmogenic and anti-arrhythmogenic. Currently, these opposing effects of vagus nerve stimulation (VNS) have not been clearly described. The aim of this review is therefore to discuss both pro-arrhythmogenic and anti-arrhythmogenic effects of VNS and recent advances in clinical practice and to provide future perspectives for VNS to treat AF. MATERIALS AND METHODS A comprehensive review of current literature on VNS and its pro-arrhythmogenic and anti-arrhythmogenic effects on atrial tissue was performed. Both experimental and clinical studies are reviewed and discussed separately. RESULTS VNS exhibits both pro-arrhythmogenic and anti-arrhythmogenic effects. The anatomical site and stimulation settings during VNS play a crucial role in determining its effect on cardiac electrophysiology. Since the last decade, there is accumulating evidence from experimental studies and randomized clinical studies that low-level VNS (LLVNS), below the bradycardia threshold, is an effective treatment for AF. CONCLUSION LLVNS is a promising novel therapeutic modality to treat AF and further research will further elucidate the underlying anti-arrhythmogenic mechanisms, optimal stimulation settings, and site to apply LLVNS.
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Affiliation(s)
- Rohit K Kharbanda
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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20
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Berger A, Vespa S, Dricot L, Dumoulin M, Iachim E, Doguet P, Vandewalle G, El Tahry R. How Is the Norepinephrine System Involved in the Antiepileptic Effects of Vagus Nerve Stimulation? Front Neurosci 2021; 15:790943. [PMID: 34924947 PMCID: PMC8675889 DOI: 10.3389/fnins.2021.790943] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 01/09/2023] Open
Abstract
Vagus Nerve Stimulation (VNS) is an adjunctive treatment for patients suffering from inoperable drug-resistant epilepsy. Although a complete understanding of the mediators involved in the antiepileptic effects of VNS and their complex interactions is lacking, VNS is known to trigger the release of neurotransmitters that have seizure-suppressing effects. In particular, norepinephrine (NE) is a neurotransmitter that has been associated with the clinical effects of VNS by preventing seizure development and by inducing long-term plastic changes that could restore a normal function of the brain circuitry. However, the biological requisites to become responder to VNS are still unknown. In this review, we report evidence of the critical involvement of NE in the antiepileptic effects of VNS in rodents and humans. Moreover, we emphasize the hypothesis that the functional integrity of the noradrenergic system could be a determining factor to obtain clinical benefits from the therapy. Finally, encouraging avenues of research involving NE in VNS treatment are discussed. These could lead to the personalization of the stimulation parameters to maximize the antiepileptic effects and potentially improve the response rate to the therapy.
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Affiliation(s)
- Alexandre Berger
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Synergia Medical SA, Mont-Saint-Guibert, Belgium.,GIGA-Cyclotron Research Center-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Simone Vespa
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Laurence Dricot
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Manon Dumoulin
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Evelina Iachim
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Department of Pediatric Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Gilles Vandewalle
- GIGA-Cyclotron Research Center-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Center for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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21
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Bowles S, Williamson WR, Nettles D, Hickman J, Welle CG. Closed-loop automated reaching apparatus (CLARA) for interrogating complex motor behaviors. J Neural Eng 2021; 18:10.1088/1741-2552/ac1ed1. [PMID: 34407518 PMCID: PMC8699662 DOI: 10.1088/1741-2552/ac1ed1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
Objective.Closed-loop neuromodulation technology is a rapidly expanding category of therapeutics for a broad range of indications. Development of these innovative neurological devices requires high-throughput systems for closed-loop stimulation of model organisms, while monitoring physiological signals and complex, naturalistic behaviors. To address this need, we developed CLARA, a closed-loop automated reaching apparatus.Approach.Using breakthroughs in computer vision, CLARA integrates fully-automated, markerless kinematic tracking of multiple features to classify animal behavior and precisely deliver neural stimulation based on behavioral outcomes. CLARA is compatible with advanced neurophysiological tools, enabling the testing of neurostimulation devices and identification of novel neurological biomarkers.Results.The CLARA system tracks unconstrained skilled reach behavior in 3D at 150 Hz without physical markers. The system fully automates trial initiation and pellet delivery and is capable of accurately delivering stimulation in response to trial outcome with short latency. Kinematic data from the CLARA system provided novel insights into the dynamics of reach consistency over the course of learning, suggesting that learning selectively improves reach failures but does not alter the kinematics of successful reaches. Additionally, using the closed-loop capabilities of CLARA, we demonstrate that vagus nerve stimulation (VNS) improves skilled reach performance and increases reach trajectory consistency in healthy animals.Significance.The CLARA system is the first mouse behavior apparatus that uses markerless pose tracking to provide real-time closed-loop stimulation in response to the outcome of an unconstrained motor task. Additionally, we demonstrate that the CLARA system was essential for our investigating the role of closed-loop VNS stimulation on motor performance in healthy animals. This approach has high translational relevance for developing neurostimulation technology based on complex human behavior.
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Affiliation(s)
- S Bowles
- Neurosurgery, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
- These authors contributed equally
| | - W R Williamson
- NeuroTechnology Center, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
- These authors contributed equally
| | - D Nettles
- Neurosurgery, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - J Hickman
- Neurosurgery, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - C G Welle
- Neurosurgery, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
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22
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Muzquiz MI, Richardson L, Vetter C, Smolik M, Alhawwash A, Goodwill A, Bashirullah R, Carr M, Yoshida K. In-vivo application of low frequency alternating currents on porcine cervical vagus nerve evokes reversible nerve conduction block. Bioelectron Med 2021; 7:9. [PMID: 34187586 PMCID: PMC8243469 DOI: 10.1186/s42234-021-00072-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes a method to reversibly block nerve conduction through direct application of a 1 Hz sinusoidal current waveform delivered through a bipolar nerve cuff electrode. This low frequency alternating current (LFAC) waveform was previously shown to reversibly block the effects of vagal pulse stimulation evoked bradycardia in-vivo in the anaesthetised rat model (Mintch et al. 2019). The present work measured the effectiveness of LFAC block on larger caliber myelinated vagal afferent fibers in human sized nerve bundles projecting to changes in breathing rate mediated by the Hering-Breuer (HB) reflex in anaesthetized domestic swine (n=5). METHODS Two bipolar cuff electrodes were implanted unilaterally to the left cervical vagus nerve, which was crushed caudal to the electrodes to eliminate cardiac effects. A tripolar recording cuff electrode was placed rostral to the bipolar stimulating electrodes on the same nerve to measure changes in the compound nerve action potentials (CNAP) elicited by the vagal pulse stimulation and conditioned by the LFAC waveform. Standard pulse stimulation was applied at a sufficient level to induce a reduction in breathing rate through the HB reflex. If unblocked, the HB reflex would cause breathing to slow down and potentially halt completely. Block was quantified by the ability of LFAC to reduce the effect of the HB reflex by monitoring the respiration rate during LFAC alone, LFAC and vagal stimulation, and vagal stimulation alone. RESULTS LFAC achieved 87.2 ±8.8% block (n=5) at current levels of 1.1 ±0.3 mAp (current to peak), which was well within the water window of the working electrode. CNAP showed changes that directly correlated to the effectiveness of LFAC block, which manifested itself as the slowing and amplitude reduction of components of the CNAP. CONCLUSION These novel findings suggest that LFAC is a potential alternative or complementary method to other electrical blocking techniques in clinical applications.
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Affiliation(s)
- Maria Ivette Muzquiz
- Department of Biomedical Engineering, Indiana University - Purdue University Indianapolis, Indianapolis, USA.
| | - Lindsay Richardson
- Department of Biomedical Engineering, Indiana University - Purdue University Indianapolis, Indianapolis, USA
| | - Christian Vetter
- Department of Biomedical Engineering, Indiana University - Purdue University Indianapolis, Indianapolis, USA
| | - Macallister Smolik
- Department of Biology, Indiana University - Purdue University Indianapolis, Indianapolis, USA
| | - Awadh Alhawwash
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, USA.,Biomedical Technology Department, King Saud University, Riyadh, Saudi Arabia
| | - Adam Goodwill
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, USA
| | | | - Michael Carr
- Galvani Bioelectronics, Glaxo Smith Kline, GSK, King of Prussia, USA
| | - Ken Yoshida
- Department of Biomedical Engineering, Indiana University - Purdue University Indianapolis, Indianapolis, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, USA
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23
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Ahmed U, Chang YC, Lopez MF, Wong J, Datta-Chaudhuri T, Rieth L, Al-Abed Y, Zanos S. Implant- and anesthesia-related factors affecting cardiopulmonary threshold intensities for vagus nerve stimulation. J Neural Eng 2021; 18. [PMID: 34036940 DOI: 10.1088/1741-2552/ac048a] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/24/2021] [Indexed: 11/11/2022]
Abstract
Objective.Vagus nerve stimulation (VNS) is typically delivered at increasing stimulus intensity until a neurological or physiological response is observed ('threshold') for dose calibration, preclinically and therapeutically. Factors affecting VNS thresholds have not been studied systematically. In a rodent model of VNS we measured neural and physiological responses to increasing VNS intensity, determined neurological and physiological thresholds and examined the effect of implant- and anesthesia-related factors on thresholds.Approach.In acute and chronic vagus implants (45 and 20 rats, respectively) VNS was delivered under isoflurane, ketamine-xylazine, or awake conditions. Evoked compound action potentials (CAPs) were recorded and activation of different fiber types was extracted. Elicited physiological responses were registered, including changes in heart rate (HR), breathing rate (BR), and blood pressure (BP). CAP and physiological thresholds were determined.Main results. The threshold for evoking discernable CAPs (>10µV) (CAP threshold) is significantly lower than what elicits 5%-10% drop in heart rate (heart rate threshold, HRT) (25µA ± 1.8 vs. 80µA ± 5.1, respectively; mean ± SEM). Changes in BP and small changes in BR (bradypnea) occur at lowest intensities (70µA ± 8.3), followed by HR changes (80µA ± 5.1) and finally significant changes in BR (apnea) (310μA ± 32.5). HRT and electrode impedance are correlated in chronic (Pearson correlationr= 0.47;p< 0.001) but not in acute implants (r= -0.34;pNS); HRT and impedance both increase with implant age (r= 0.44;p< 0.001 andr= 0.64;p< 0.001, respectively). HRT is lowest when animals are awake (200µA ± 35.5), followed by ketamine-xylazine (640µA ± 151.5), and isoflurane (1000µA ± 139.5). The sequence of physiological responses with increasing VNS intensity is the same in anesthetized and awake animals. Pulsing frequency affects physiological responses but not CAPs.Significance. Implant age, electrode impedance, and type of anesthesia affect VNS thresholds and should be accounted for when calibrating stimulation dose.
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Affiliation(s)
- Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Maria F Lopez
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Jason Wong
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Loren Rieth
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
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24
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Fitchett A, Mastitskaya S, Aristovich K. Selective Neuromodulation of the Vagus Nerve. Front Neurosci 2021; 15:685872. [PMID: 34108861 PMCID: PMC8180849 DOI: 10.3389/fnins.2021.685872] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 01/01/2023] Open
Abstract
Vagus nerve stimulation (VNS) is an effective technique for the treatment of refractory epilepsy and shows potential for the treatment of a range of other serious conditions. However, until now stimulation has generally been supramaximal and non-selective, resulting in a range of side effects. Selective VNS (sVNS) aims to mitigate this by targeting specific fiber types within the nerve to produce functionally specific effects. In recent years, several key paradigms of sVNS have been developed-spatially selective, fiber-selective, anodal block, neural titration, and kilohertz electrical stimulation block-as well as various stimulation pulse parameters and electrode array geometries. sVNS can significantly reduce the severity of side effects, and in some cases increase efficacy of the treatment. While most studies have focused on fiber-selective sVNS, spatially selective sVNS has demonstrated comparable mitigation of side-effects. It has the potential to achieve greater specificity and provide crucial information about vagal nerve physiology. Anodal block achieves strong side-effect mitigation too, but is much less specific than fiber- and spatially selective paradigms. The major hurdle to achieving better selectivity of VNS is a limited knowledge of functional anatomical organization of vagus nerve. It is also crucial to optimize electrode array geometry and pulse shape, as well as expand the applications of sVNS beyond the current focus on cardiovascular disease.
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Affiliation(s)
| | - Svetlana Mastitskaya
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Kirill Aristovich
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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25
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Mastitskaya S, Thompson N, Holder D. Selective Vagus Nerve Stimulation as a Therapeutic Approach for the Treatment of ARDS: A Rationale for Neuro-Immunomodulation in COVID-19 Disease. Front Neurosci 2021; 15:667036. [PMID: 33927594 PMCID: PMC8076564 DOI: 10.3389/fnins.2021.667036] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is the most severe form of acute lung injury. It is induced by sepsis, aspiration, and pneumonia, including that caused by SARS coronavirus and human influenza viruses. The main pathophysiological mechanism of ARDS is a systemic inflammatory response. Vagus nerve stimulation (VNS) can limit cytokine production in the spleen and thereby dampen any systemic inflammation and inflammation-induced tissue damage in the lungs and other organs. However, the effects of increased parasympathetic outflow to the lungs when non-selective VNS is applied may result in bronchoconstriction, increased mucus secretion and enhance local pulmonary inflammatory activity; this may outweigh the beneficial systemic anti-inflammatory action of VNS. Organ/function-specific therapy can be achieved by imaging of localized fascicle activity within the vagus nerve and selective stimulation of identified organ-specific fascicles. This may be able to provide selective neuromodulation of different pathways within the vagus nerve and offer a novel means to improve outcome in ARDS. This has motivated this review in which we discuss the mechanisms of anti-inflammatory effects of VNS, progress in selective VNS techniques, and a possible application for ARDS.
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Affiliation(s)
- Svetlana Mastitskaya
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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26
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Sokal DM, McSloy A, Donegà M, Kirk J, Colas RA, Dolezalova N, Gomez EA, Gupta I, Fjordbakk CT, Ouchouche S, Matteucci PB, Schlegel K, Bashirullah R, Werling D, Harman K, Rowles A, Yazicioglu RF, Dalli J, Chew DJ, Perkins JD. Splenic Nerve Neuromodulation Reduces Inflammation and Promotes Resolution in Chronically Implanted Pigs. Front Immunol 2021; 12:649786. [PMID: 33859641 PMCID: PMC8043071 DOI: 10.3389/fimmu.2021.649786] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022] Open
Abstract
Neuromodulation of the immune system has been proposed as a novel therapeutic strategy for the treatment of inflammatory conditions. We recently demonstrated that stimulation of near-organ autonomic nerves to the spleen can be harnessed to modulate the inflammatory response in an anesthetized pig model. The development of neuromodulation therapy for the clinic requires chronic efficacy and safety testing in a large animal model. This manuscript describes the effects of longitudinal conscious splenic nerve neuromodulation in chronically-implanted pigs. Firstly, clinically-relevant stimulation parameters were refined to efficiently activate the splenic nerve while reducing changes in cardiovascular parameters. Subsequently, pigs were implanted with a circumferential cuff electrode around the splenic neurovascular bundle connected to an implantable pulse generator, using a minimally-invasive laparoscopic procedure. Tolerability of stimulation was demonstrated in freely-behaving pigs using the refined stimulation parameters. Longitudinal stimulation significantly reduced circulating tumor necrosis factor alpha levels induced by systemic endotoxemia. This effect was accompanied by reduced peripheral monocytopenia as well as a lower systemic accumulation of CD16+CD14high pro-inflammatory monocytes. Further, lipid mediator profiling analysis demonstrated an increased concentration of specialized pro-resolving mediators in peripheral plasma of stimulated animals, with a concomitant reduction of pro-inflammatory eicosanoids including prostaglandins. Terminal electrophysiological and physiological measurements and histopathological assessment demonstrated integrity of the splenic nerves up to 70 days post implantation. These chronic translational experiments demonstrate that daily splenic nerve neuromodulation, via implanted electronics and clinically-relevant stimulation parameters, is well tolerated and is able to prime the immune system toward a less inflammatory, pro-resolving phenotype.
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Affiliation(s)
- David M. Sokal
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | - Alex McSloy
- Clinical Science & Services, The Royal Veterinary College, Hatfield, United Kingdom
| | - Matteo Donegà
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | - Joseph Kirk
- Clinical Science & Services, The Royal Veterinary College, Hatfield, United Kingdom
| | - Romain A. Colas
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, United Kingdom
| | - Nikola Dolezalova
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Esteban A. Gomez
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, United Kingdom
| | - Isha Gupta
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | | | - Sebastien Ouchouche
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | - Paul B. Matteucci
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | - Kristina Schlegel
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | - Rizwan Bashirullah
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | - Dirk Werling
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
| | - Kim Harman
- Clinical Science & Services, The Royal Veterinary College, Hatfield, United Kingdom
| | - Alison Rowles
- Non-Clinical Safety, GlaxoSmithKline, Ware, United Kingdom
| | | | - Jesmond Dalli
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, United Kingdom
| | - Daniel J. Chew
- Translation and Engineering, Galvani Bioelectronics, Stevenage, United Kingdom
| | - Justin D. Perkins
- Clinical Science & Services, The Royal Veterinary College, Hatfield, United Kingdom
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27
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Butler AG, O'Callaghan EL, Allen AM, McDougall SJ. Use of a physiological reflex to standardize vagal nerve stimulation intensity improves data reproducibility in a memory extinction assay. Brain Stimul 2021; 14:450-459. [PMID: 33647477 DOI: 10.1016/j.brs.2021.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Modulating brainstem activity, via electrical vagus nerve stimulation (VNS), influences cognitive functions, including memory. However, controlling for changes in stimulus efficacy during chronic studies, and response variability between subjects, is problematic. OBJECTIVE/HYPOTHESIS We hypothesized that recruitment of an autonomic reflex, the Hering-Breuer reflex, would provide robust confirmation of VNS efficacy. We compared this to measurement of electrode resistance over time. We also examined whether VNS modulates contextual memory extinction. METHODS Electrodes for VNS and diaphragm electromyography recording were implanted into anesthetized Sprague Dawley rats. When conscious, we measured the electrode resistance as well as the minimum VNS current required to evoke the Hering-Breuer reflex, before, and after, an inhibitory avoidance assay - a two chamber, dark/light model, where the dark compartment was paired with an aversive foot shock. The extinction of this contextual memory was assessed in sham and VNS treated rats, with VNS administered for 30 s at 1.5 times the Hering-Breuer reflex threshold during extinction memory formation. RESULTS Assessment of VNS-evoked Hering-Breuer reflex successfully identified defective electrodes. VNS accelerated extinction memory and decreased multiple physiological metrics of fear expression. We observed an inverse relationship between memory extinction and respiratory rate during the behavioural assay. Additionally, no current - response relationship between VNS and extinction memory formation was established. CONCLUSION These data demonstrate that reliable, experimental VNS studies can be produced by verifying reflex initiation as a consequence of stimulation. Further, studies could be standardised by indexing stimulator efficacy to initiation of autonomic reflexes.
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Affiliation(s)
- Andrew G Butler
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia; Department of Physiology, University of Melbourne, Parkville, Victoria, Australia
| | - Erin L O'Callaghan
- Department of Physiology, University of Melbourne, Parkville, Victoria, Australia
| | - Allen M Allen
- Department of Physiology, University of Melbourne, Parkville, Victoria, Australia.
| | - Stuart J McDougall
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
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28
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Darrow MJ, Mian TM, Torres M, Haider Z, Danaphongse T, Seyedahmadi A, Rennaker RL, Hays SA, Kilgard MP. The tactile experience paired with vagus nerve stimulation determines the degree of sensory recovery after chronic nerve damage. Behav Brain Res 2021; 396:112910. [PMID: 32971197 PMCID: PMC7572822 DOI: 10.1016/j.bbr.2020.112910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022]
Abstract
Loss of sensory function is a common consequence of neurological injury. Recent clinical and preclinical evidence indicates vagus nerve stimulation (VNS) paired with tactile rehabilitation, consisting of delivery of a variety of mechanical stimuli to the hyposensitive skin surface, yields substantial and long-lasting recovery of somatosensory function after median and ulnar nerve transection and repair. Here, we tested the hypothesis that a specific component of the tactile rehabilitation paired with VNS is necessary for recovery of somatosensory function. In a second experiment in a separate cohort, we investigated whether VNS paired with tactile rehabilitation could improve skilled forelimb motor function. Elements of the study design, including planned sample size, assessments, and statistical comparisons, were preregistered prior to beginning data collection (https://osf.io/3tm8u/). Animals received a peripheral nerve injury (PNI) causing chronic sensory loss. Eight weeks after injury, animals were given a VNS implant followed by six weeks of tactile rehabilitation sessions consisting of repeated application of one of two distinct mechanical stimuli, a filament or a paintbrush, to the previously denervated forepaw. VNS paired with either filament indentation or brushing of the paw significantly improved recovery of forelimb withdrawal thresholds after PNI compared to tactile rehabilitation without VNS. The effect size was twice as large when VNS was paired with brushing compared to VNS paired with point indentation. An independent replication in a second cohort confirmed that VNS paired with brush restored forelimb withdrawal thresholds to normal. These rats displayed significant improvements in performance on a skilled forelimb task compared to rats that did not receive VNS. These findings support the utility of pairing VNS with tactile rehabilitation to improve recovery of somatosensory and motor function after neurological injury. Additionally, this study demonstrates that the sensory characteristics of the rehabilitation paired with VNS determine the degree of recovery.
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Affiliation(s)
- Michael J Darrow
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Tabarak M Mian
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Miranda Torres
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Zainab Haider
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Tanya Danaphongse
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Armin Seyedahmadi
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Robert L Rennaker
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States.
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
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Booth LC, Yao ST, Korsak A, Farmer DGS, Hood SG, McCormick D, Boesley Q, Connelly AA, McDougall SJ, Korim WS, Guild SJ, Mastitskaya S, Le P, Teschemacher AG, Kasparov S, Ackland GL, Malpas SC, McAllen RM, Allen AM, May CN, Gourine AV. Selective optogenetic stimulation of efferent fibers in the vagus nerve of a large mammal. Brain Stimul 2020; 14:88-96. [PMID: 33217609 PMCID: PMC7836098 DOI: 10.1016/j.brs.2020.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background Electrical stimulation applied to individual organs, peripheral nerves, or specific brain regions has been used to treat a range of medical conditions. In cardiovascular disease, autonomic dysfunction contributes to the disease progression and electrical stimulation of the vagus nerve has been pursued as a treatment for the purpose of restoring the autonomic balance. However, this approach lacks selectivity in activating function- and organ-specific vagal fibers and, despite promising results of many preclinical studies, has so far failed to translate into a clinical treatment of cardiovascular disease. Objective Here we report a successful application of optogenetics for selective stimulation of vagal efferent activity in a large animal model (sheep). Methods and results Twelve weeks after viral transduction of a subset of vagal motoneurons, strong axonal membrane expression of the excitatory light-sensitive ion channel ChIEF was achieved in the efferent projections innervating thoracic organs and reaching beyond the level of the diaphragm. Blue laser or LED light (>10 mW mm−2; 1 ms pulses) applied to the cervical vagus triggered precisely timed, strong bursts of efferent activity with evoked action potentials propagating at speeds of ∼6 m s−1. Conclusions These findings demonstrate that in species with a large, multi-fascicled vagus nerve, it is possible to stimulate a specific sub-population of efferent fibers using light at a site remote from the vector delivery, marking an important step towards eventual clinical use of optogenetic technology for autonomic neuromodulation. Described is a method of selective efferent vagus nerve stimulation using light. Vagal preganglionic neurons are targeted to express light-sensitive channels. Specific efferent VNS by light delivery to the cervical vagus is achieved in a large animal model. Demonstrates feasibility of using optogenetic technology for autonomic neuromodulation.
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Affiliation(s)
- Lindsea C Booth
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Song T Yao
- Florey Department of Neuroscience and Mental Health, MDHS, University of Melbourne, Melbourne, Australia
| | - Alla Korsak
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - David G S Farmer
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Department of Physiology, The University of Melbourne, Melbourne, Australia
| | - Sally G Hood
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Daniel McCormick
- Department of Physiology and Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Quinn Boesley
- Department of Physiology and Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Angela A Connelly
- Department of Physiology, The University of Melbourne, Melbourne, Australia
| | - Stuart J McDougall
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Willian S Korim
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Sarah-Jane Guild
- Department of Physiology and Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Svetlana Mastitskaya
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Phuong Le
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Anja G Teschemacher
- Physiology, Neuroscience and Pharmacology, University of Bristol, Bristol, UK
| | - Sergey Kasparov
- Physiology, Neuroscience and Pharmacology, University of Bristol, Bristol, UK; Baltic Federal University, Kaliningrad, Russian Federation
| | - Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon C Malpas
- Department of Physiology and Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Robin M McAllen
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrew M Allen
- Department of Physiology, The University of Melbourne, Melbourne, Australia
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
| | - Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK.
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30
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Pelot NA, Goldhagen GB, Cariello JE, Musselman ED, Clissold KA, Ezzell JA, Grill WM. Quantified Morphology of the Cervical and Subdiaphragmatic Vagus Nerves of Human, Pig, and Rat. Front Neurosci 2020; 14:601479. [PMID: 33250710 PMCID: PMC7672126 DOI: 10.3389/fnins.2020.601479] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 12/27/2022] Open
Abstract
It is necessary to understand the morphology of the vagus nerve (VN) to design and deliver effective and selective vagus nerve stimulation (VNS) because nerve morphology influences fiber responses to electrical stimulation. Specifically, nerve diameter (and thus, electrode-fiber distance), fascicle diameter, fascicular organization, and perineurium thickness all significantly affect the responses of nerve fibers to electrical signals delivered through a cuff electrode. We quantified the morphology of cervical and subdiaphragmatic VNs in humans, pigs, and rats: effective nerve diameter, number of fascicles, effective fascicle diameters, proportions of endoneurial, perineurial, and epineurial tissues, and perineurium thickness. The human and pig VNs were comparable sizes (∼2 mm cervically; ∼1.6 mm subdiaphragmatically), while the rat nerves were ten times smaller. The pig nerves had ten times more fascicles-and the fascicles were smaller-than in human nerves (47 vs. 7 fascicles cervically; 38 vs. 5 fascicles subdiaphragmatically). Comparing the cervical to the subdiaphragmatic VNs, the nerves and fascicles were larger at the cervical level for all species and there were more fascicles for pigs. Human morphology generally exhibited greater variability across samples than pigs and rats. A prior study of human somatic nerves indicated that the ratio of perineurium thickness to fascicle diameter was approximately constant across fascicle diameters. However, our data found thicker human and pig VN perineurium than those prior data: the VNs had thicker perineurium for larger fascicles and thicker perineurium normalized by fascicle diameter for smaller fascicles. Understanding these differences in VN morphology between preclinical models and the clinical target, as well as the variability across individuals of a species, is essential for designing suitable cuff electrodes and stimulation parameters and for informing translation of preclinical results to clinical application to advance the therapeutic efficacy of VNS.
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Affiliation(s)
- Nicole A. Pelot
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Gabriel B. Goldhagen
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Jake E. Cariello
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Eric D. Musselman
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Kara A. Clissold
- Histology Research Core, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - J. Ashley Ezzell
- Histology Research Core, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Warren M. Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States
- Department of Neurobiology, Duke University, Durham, NC, United States
- Department of Neurosurgery, School of Medicine, Duke University, Durham, NC, United States
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31
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Kawada T, Sonobe T, Nishikawa T, Hayama Y, Li M, Zheng C, Uemura K, Akiyama T, Pearson JT, Sugimachi M. Contribution of afferent pathway to vagal nerve stimulation-induced myocardial interstitial acetylcholine release in rats. Am J Physiol Regul Integr Comp Physiol 2020; 319:R517-R525. [PMID: 32903042 DOI: 10.1152/ajpregu.00080.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vagal nerve stimulation (VNS) has been explored as a potential therapy for chronic heart failure. The contribution of the afferent pathway to myocardial interstitial acetylcholine (ACh) release during VNS has yet to be clarified. In seven anesthetized Wistar-Kyoto rats, we implanted microdialysis probes in the left ventricular free wall and measured the myocardial interstitial ACh release during right VNS with the following combinations of stimulation frequency (F in Hz) and voltage readout (V in volts): F0V0 (no stimulation), F5V3, F20V3, F5V10, and F20V10. F5V3 did not affect the ACh level. F20V3, F5V10, and F20V10 increased the ACh level to 2.83 ± 0.47 (P < 0.01), 4.31 ± 1.09 (P < 0.001), and 4.33 ± 0.82 (P < 0.001) nM, respectively, compared with F0V0 (1.76 ± 0.22 nM). After right vagal afferent transection (rVAX), F20V3 and F20V10 increased the ACh level to 2.90 ± 0.53 (P < 0.001) and 3.48 ± 0.63 (P < 0.001) nM, respectively, compared with F0V0 (1.61 ± 0.19 nM), but F5V10 did not (2.11 ± 0.24 nM). The ratio of the ACh levels after rVAX relative to before was significantly <100% in F5V10 (59.4 ± 8.7%) but not in F20V3 (102.0 ± 8.7%). These results suggest that high-frequency and low-voltage stimulation (F20V3) evoked the ACh release mainly via direct activation of the vagal efferent pathway. By contrast, low-frequency and high-voltage stimulation (F5V10) evoked the ACh release in a manner dependent on the vagal afferent pathway.
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Affiliation(s)
- Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takashi Sonobe
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yohsuke Hayama
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Meihua Li
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Can Zheng
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tsuyoshi Akiyama
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - James T Pearson
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Physiology and Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
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Descending Modulation of Laryngeal Vagal Sensory Processing in the Brainstem Orchestrated by the Submedius Thalamic Nucleus. J Neurosci 2020; 40:9426-9439. [PMID: 33115928 DOI: 10.1523/jneurosci.2430-20.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022] Open
Abstract
The nodose and jugular vagal ganglia supply sensory innervation to the airways and lungs. Jugular vagal airway sensory neurons wire into a brainstem circuit with ascending projections into the submedius thalamic nucleus (SubM) and ventrolateral orbital cortex (VLO), regions known to regulate the endogenous analgesia system. Here we investigate whether the SubM-VLO circuit exerts descending regulation over airway vagal reflexes in male and female rats using a range of neuroanatomical tracing, reflex physiology, and chemogenetic techniques. Anterograde and retrograde neuroanatomical tracing confirmed the connectivity of the SubM and VLO. Laryngeal stimulation in anesthetized rats reduced respiration, a reflex that was potently inhibited by activation of SubM. Conversely, inhibition of SubM potentiated laryngeal reflex responses, while prior lesions of VLO abolished the effects of SubM stimulation. In conscious rats, selective chemogenetic activation of SubM neurons specifically projecting to VLO significantly inhibited respiratory responses evoked by inhalation of the nociceptor stimulant capsaicin. Jugular vagal inputs to SubM via the medullary paratrigeminal nucleus were confirmed using anterograde transsynaptic conditional herpes viral tracing. Respiratory responses evoked by microinjections of capsaicin into the paratrigeminal nucleus were significantly attenuated by SubM stimulation, whereas those evoked via the nucleus of the solitary tract were unaltered. These data suggest that jugular vagal sensory pathways input to a nociceptive thalamocortical circuit capable of regulating jugular sensory processing in the medulla. This circuit organization suggests an intersection between vagal sensory pathways and the endogenous analgesia system, potentially important for understanding vagal sensory processing in health and mechanisms of hypersensitivity in disease.SIGNIFICANCE STATEMENT Jugular vagal sensory pathways are increasingly recognized for their important role in defensive respiratory responses evoked from the airways. Jugular ganglia neurons wire into a central circuit that is notable for overlapping with somatosensory processing networks in the brain rather than the viscerosensory circuits in receipt of inputs from the nodose vagal ganglia. Here we demonstrate a novel and functionally relevant example of intersection between vagal and somatosensory processing in the brain. The findings of the study offer new insights into interactions between vagal and spinal sensory processing, including the medullary targets of the endogenous analgesia system, and offer new insights into the central processes involved in airway defense in health and disease.
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33
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Jiman AA, Ratze DC, Welle EJ, Patel PR, Richie JM, Bottorff EC, Seymour JP, Chestek CA, Bruns TM. Multi-channel intraneural vagus nerve recordings with a novel high-density carbon fiber microelectrode array. Sci Rep 2020; 10:15501. [PMID: 32968177 PMCID: PMC7511947 DOI: 10.1038/s41598-020-72512-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/27/2020] [Indexed: 01/03/2023] Open
Abstract
Autonomic nerves convey essential neural signals that regulate vital body functions. Recording clearly distinctive physiological neural signals from autonomic nerves will help develop new treatments for restoring regulatory functions. However, this is very challenging due to the small nature of autonomic nerves and the low-amplitude signals from their small axons. We developed a multi-channel, high-density, intraneural carbon fiber microelectrode array (CFMA) with ultra-small electrodes (8-9 µm in diameter, 150-250 µm in length) for recording physiological action potentials from small autonomic nerves. In this study, we inserted CFMA with up to 16 recording carbon fibers in the cervical vagus nerve of 22 isoflurane-anesthetized rats. We recorded action potentials with peak-to-peak amplitudes of 15.1-91.7 µV and signal-to-noise ratios of 2.0-8.3 on multiple carbon fibers per experiment, determined conduction velocities of some vagal signals in the afferent (0.7-4.4 m/s) and efferent (0.7-8.8 m/s) directions, and monitored firing rate changes in breathing and blood glucose modulated conditions. Overall, these experiments demonstrated that CFMA is a novel interface for in-vivo intraneural action potential recordings. This work is considerable progress towards the comprehensive understanding of physiological neural signaling in vital regulatory functions controlled by autonomic nerves.
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Affiliation(s)
- Ahmad A Jiman
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Electrical and Computer Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
| | - David C Ratze
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
| | - Elissa J Welle
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Paras R Patel
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Julianna M Richie
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth C Bottorff
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - John P Seymour
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
| | - Tim M Bruns
- Department of Biomedical Engineering, University of Michigan, NCRC - B10 - A-169, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.
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Chang YC, Cracchiolo M, Ahmed U, Mughrabi I, Gabalski A, Daytz A, Rieth L, Becker L, Datta-Chaudhuri T, Al-Abed Y, Zanos TP, Zanos S. Quantitative estimation of nerve fiber engagement by vagus nerve stimulation using physiological markers. Brain Stimul 2020; 13:1617-1630. [PMID: 32956868 DOI: 10.1016/j.brs.2020.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cervical vagus nerve stimulation (VNS) is an emerging bioelectronic treatment for brain, metabolic, cardiovascular and immune disorders. Its desired and off-target effects are mediated by different nerve fiber populations and knowledge of their engagement could guide calibration and monitoring of VNS therapies. OBJECTIVE Stimulus-evoked compound action potentials (eCAPs) directly provide fiber engagement information but are currently not feasible in humans. A method to estimate fiber engagement through common, noninvasive physiological readouts could be used in place of eCAP measurements. METHODS In anesthetized rats, we recorded eCAPs while registering acute physiological response markers to VNS: cervical electromyography (EMG), changes in heart rate (ΔHR) and breathing interval (ΔBI). Quantitative models were established to capture the relationship between A-, B- and C-fiber type activation and those markers, and to quantitatively estimate fiber activation from physiological markers and stimulation parameters. RESULTS In bivariate analyses, we found that EMG correlates with A-fiber, ΔHR with B-fiber and ΔBI with C-fiber activation, in agreement with known physiological functions of the vagus. We compiled multivariate models for quantitative estimation of fiber engagement from these markers and stimulation parameters. Finally, we compiled frequency gain models that allow estimation of fiber engagement at a wide range of VNS frequencies. Our models, after calibration in humans, could provide noninvasive estimation of fiber engagement in current and future therapeutic applications of VNS.
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Affiliation(s)
- Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Marina Cracchiolo
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Ibrahim Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Arielle Gabalski
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Anna Daytz
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Loren Rieth
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Lance Becker
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA.
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35
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Farrand AQ, Verner RS, McGuire RM, Helke KL, Hinson VK, Boger HA. Differential effects of vagus nerve stimulation paradigms guide clinical development for Parkinson's disease. Brain Stimul 2020; 13:1323-1332. [PMID: 32629028 DOI: 10.1016/j.brs.2020.06.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) modifies brain rhythms in the locus coeruleus (LC) via the solitary nucleus. Degeneration of the LC in Parkinson's disease (PD) is an early catalyst of the spreading neurodegenerative process, suggesting that stimulating LC output with VNS has the potential to modify disease progression. We previously showed in a lesion PD model that VNS delivered twice daily reduced neuroinflammation and motor deficits, and attenuated tyrosine hydroxylase (TH)-positive cell loss. OBJECTIVE The goal of this study was to characterize the differential effects of three clinically-relevant VNS paradigms in a PD lesion model. METHODS Eleven days after DSP-4 (N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine, noradrenergic lesion, administered systemically)/6-OHDA (6-hydroxydopamine, dopaminergic lesion, administered intrastriatally) rats were implanted with VNS devices, and received either low-frequency VNS, standard-frequency VNS, or high-frequency microburst VNS. After 10 days of treatment and behavioral assessment, rats were euthanized, right prefrontal cortex (PFC) was dissected for norepinephrine assessment, and the left striatum, bilateral substantia nigra (SN), and LC were sectioned for immunohistochemical detection of catecholamine neurons, α-synuclein, astrocytes, and microglia. RESULTS At higher VNS frequencies, specifically microburst VNS, greater improvements occurred in motor function, attenuation of TH-positive cell loss in SN and LC, and norepinephrine concentration in the PFC. Additionally, higher VNS frequencies resulted in lower intrasomal α-synuclein accumulation and glial density in the SN. CONCLUSIONS These data indicate that higher stimulation frequencies provided the greatest attenuation of behavioral and pathological markers in this PD model, indicating therapeutic potential for these VNS paradigms.
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Affiliation(s)
- Ariana Q Farrand
- Department of Neuroscience and Center on Aging, Medical University of South Carolina, 173 Ashley Ave, BSB Suite 403, MSC 510, Charleston, SC, 29425, USA
| | - Ryan S Verner
- Neuromodulation Division of LivaNova, PLC, 100 Cyberonics Blvd, Houston, TX, 77058, USA
| | - Ryan M McGuire
- Neuromodulation Division of LivaNova, PLC, 100 Cyberonics Blvd, Houston, TX, 77058, USA
| | - Kristi L Helke
- Department of Comparative Medicine, 114 Doughty St, STB 648, MSC 777; Department of Pathology and Laboratory Medicine, 165 Ashley Ave, Children's Hospital 309, MSC 908, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Vanessa K Hinson
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 309, MSC 606, Charleston, SC, 29425, USA
| | - Heather A Boger
- Department of Neuroscience and Center on Aging, Medical University of South Carolina, 173 Ashley Ave, BSB Suite 403, MSC 510, Charleston, SC, 29425, USA.
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Ahmed U, Chang YC, Cracchiolo M, Lopez MF, Tomaio JN, Datta-Chaudhuri T, Zanos TP, Rieth L, Al-Abed Y, Zanos S. Anodal block permits directional vagus nerve stimulation. Sci Rep 2020; 10:9221. [PMID: 32513973 PMCID: PMC7280203 DOI: 10.1038/s41598-020-66332-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
Vagus nerve stimulation (VNS) is a bioelectronic therapy for disorders of the brain and peripheral organs, and a tool to study the physiology of autonomic circuits. Selective activation of afferent or efferent vagal fibers can maximize efficacy and minimize off-target effects of VNS. Anodal block (ABL) has been used to achieve directional fiber activation in nerve stimulation. However, evidence for directional VNS with ABL has been scarce and inconsistent, and it is unknown whether ABL permits directional fiber activation with respect to functional effects of VNS. Through a series of vagotomies, we established physiological markers for afferent and efferent fiber activation by VNS: stimulus-elicited change in breathing rate (ΔBR) and heart rate (ΔHR), respectively. Bipolar VNS trains of both polarities elicited mixed ΔHR and ΔBR responses. Cathode cephalad polarity caused an afferent pattern of responses (relatively stronger ΔBR) whereas cathode caudad caused an efferent pattern (stronger ΔHR). Additionally, left VNS elicited a greater afferent and right VNS a greater efferent response. By analyzing stimulus-evoked compound nerve potentials, we confirmed that such polarity differences in functional responses to VNS can be explained by ABL of A- and B-fiber activation. We conclude that ABL is a mechanism that can be leveraged for directional VNS.
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Affiliation(s)
- Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Marina Cracchiolo
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
- Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria F Lopez
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Jacquelyn N Tomaio
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Loren Rieth
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA.
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Morrison RA, Danaphongse TT, Pruitt DT, Adcock KS, Mathew JK, Abe ST, Abdulla DM, Rennaker RL, Kilgard MP, Hays SA. A limited range of vagus nerve stimulation intensities produce motor cortex reorganization when delivered during training. Behav Brain Res 2020; 391:112705. [PMID: 32473844 DOI: 10.1016/j.bbr.2020.112705] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Abstract
Pairing vagus nerve stimulation (VNS) with rehabilitation has emerged as a potential strategy to improve recovery after neurological injury, an effect ascribed to VNS-dependent enhancement of synaptic plasticity. Previous studies demonstrate that pairing VNS with forelimb training increases forelimb movement representations in motor cortex. However, it is not known whether VNS-dependent enhancement of plasticity is restricted to forelimb training or whether VNS paired with other movements could induce plasticity of other motor representations. We tested the hypothesis that VNS paired with orofacial movements associated with chewing during an unskilled task would drive a specific increase in jaw representation in motor cortex compared to equivalent behavioral experience without VNS. Rats performed a behavioral task in which VNS at a specified intensity between 0 and 1.2 mA was paired with chewing 200 times per day for five days. Intracortical microstimulation (ICMS) was then used to document movement representations in motor cortex. VNS paired with chewing at 0.8 mA significantly increased motor cortex jaw representation compared to equivalent behavioral training without stimulation (Bonferroni-corrected unpaired t-test, p < 0.01). Higher and lower intensities failed to alter cortical plasticity. No changes in other movement representations or total motor cortex area were observed between groups. These results demonstrate that 0.8 mA VNS paired with training drives robust plasticity specific to the paired movement, is not restricted to forelimb representations, and occurs with training on an unskilled task. This suggests that moderate intensity VNS may be a useful adjuvant to enhance plasticity and support benefits of rehabilitative therapies targeting functions beyond upper limb movement.
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Affiliation(s)
- Robert A Morrison
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States.
| | - Tanya T Danaphongse
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - David T Pruitt
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Katherine S Adcock
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Jobin K Mathew
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Stephanie T Abe
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Dina M Abdulla
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Robert L Rennaker
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Michael P Kilgard
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, TX, United States
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Bucksot JE, Morales Castelan K, Skipton SK, Hays SA. Parametric characterization of the rat Hering-Breuer reflex evoked with implanted and non-invasive vagus nerve stimulation. Exp Neurol 2020; 327:113220. [PMID: 32027928 PMCID: PMC7089831 DOI: 10.1016/j.expneurol.2020.113220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/01/2020] [Indexed: 12/17/2022]
Abstract
Vagus nerve stimulation (VNS) has rapidly gained interest as a treatment for a variety of disorders. A number of methods have been employed to stimulate the vagus nerve, but the most common relies on a cuff electrode implanted around the cervical branch of the nerve. Recently, two non-invasive methods have increased in popularity: transcutaneous cervical VNS (tcVNS) and transcutaneous auricular VNS (taVNS). Despite promising clinical results, there has been little direct comparison of these methods to stimulation delivered via an implanted device. In this study, we directly compared both non-invasive strategies to stimulation with an implanted cuff electrode on activation of the Hering-Breuer (HB) reflex, a non-invasive biomarker of A-fiber activation in the vagus. Stimulation was delivered across a wide range of parameters using tcVNS, taVNS, and an implanted cuff electrode in female rats. Activation of the HB reflex, changes in heart rate, and neck muscle twitch force were recorded. Consistent with low thresholds reported in previous studies, we found that the threshold to activate the HB reflex using an implanted cuff electrode was 0.406 ± 0.066 mA. tcVNS was capable of activating the HB reflex, but the threshold was 34.18 ± 1.86 mA, over 15 fold higher than the stimulation intensity that caused twitching of the neck muscles (2.09 ± 0.16 mA). No activation of the HB reflex was observed with taVNS at any parameters. These results describe activation of the HB reflex with each strategy and provide initial evidence regarding differences in the activation of the vagus nerve with invasive and non-invasive methods.
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Affiliation(s)
- Jesse E Bucksot
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, TX, United States of America.
| | - Karen Morales Castelan
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States of America
| | - Samantha K Skipton
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States of America
| | - Seth A Hays
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, TX, United States of America; The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States of America; Texas Biomedical Device Center, Richardson, TX, United States of America
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39
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Souza RR, Robertson NM, Mathew E, Tabet MN, Bucksot JE, Pruitt DT, Rennaker RL, Hays SA, McIntyre CK, Kilgard MP. Efficient parameters of vagus nerve stimulation to enhance extinction learning in an extinction-resistant rat model of PTSD. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109848. [PMID: 31863872 DOI: 10.1016/j.pnpbp.2019.109848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/20/2022]
Abstract
Vagus nerve stimulation (VNS) has shown promise as an adjuvant treatment for posttraumatic stress disorder (PTSD), as it enhances fear extinction and reduces anxiety symptoms in multiple rat models of this condition. Yet, identification of the optimal stimulation paradigm is needed to facilitate clinical translation of this potential therapy. Using an extinction-resistant rat model of PTSD, we tested whether varying VNS intensity and duration could maximize extinction learning while minimizing the total amount of stimulation. We confirmed that sham rats failed to extinguish after a week of extinction training. Delivery of the standard LONG VNS trains (30 s) at 0.4 mA enhanced extinction and reduced anxiety but did not prevent fear return. Increasing the intensity of LONG VNS trains to 0.8 mA prevented fear return and attenuated anxiety symptoms. Interestingly, delivering 1, 4 or 16 SHORT VNS bursts (0.5 s) at 0.8 mA during each cue presentation in extinction training also enhanced extinction. LONG VNS trains or multiple SHORT VNS bursts at 0.8 mA attenuated fear renewal and reinstatement, promoted extinction generalization and reduced generalized anxiety. Delivering 16 SHORT VNS bursts also facilitated extinction in fewer trials. This study provides the first evidence that brief bursts of VNS can enhance extinction training, reduce relapse and support symptom remission using much less VNS than previous protocols. These findings suggest that VNS parameters can be adjusted in order to minimize total charge delivery and maximize therapeutic effectiveness.
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Affiliation(s)
- Rimenez R Souza
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America.
| | - Nicole M Robertson
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - Ezek Mathew
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - Michel N Tabet
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - Jesse E Bucksot
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - David T Pruitt
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - Robert L Rennaker
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - Seth A Hays
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - Christa K McIntyre
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
| | - Michael P Kilgard
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America; School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States of America
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Darrow MJ, Torres M, Sosa MJ, Danaphongse TT, Haider Z, Rennaker RL, Kilgard MP, Hays SA. Vagus Nerve Stimulation Paired With Rehabilitative Training Enhances Motor Recovery After Bilateral Spinal Cord Injury to Cervical Forelimb Motor Pools. Neurorehabil Neural Repair 2020; 34:200-209. [PMID: 31969052 DOI: 10.1177/1545968319895480] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Closed-loop vagus nerve stimulation (VNS) paired with rehabilitative training has emerged as a strategy to enhance recovery after neurological injury. Previous studies demonstrate that brief bursts of closed-loop VNS paired with rehabilitative training substantially improve recovery of forelimb motor function in models of unilateral and bilateral contusive spinal cord injury (SCI) at spinal level C5/6. While these findings provide initial evidence of the utility of VNS for SCI, the injury model used in these studies spares the majority of alpha motor neurons originating in C7-T1 that innervate distal forelimb muscles. Because the clinical manifestation of SCI in many patients involves damage at these levels, it is important to define whether damage to the distal forelimb motor neuron pools limits VNS-dependent recovery. In this study, we assessed recovery of forelimb function in rats that received a bilateral incomplete contusive SCI at C7/8 and underwent extensive rehabilitative training with or without paired VNS. The study design, including planned sample size, assessments, and statistical comparisons, was preregistered prior to beginning data collection ( https://osf.io/ysvgf/ ). VNS paired with rehabilitative training significantly improved recovery of volitional forelimb strength compared to equivalent rehabilitative training without VNS. Additionally, VNS-dependent enhancement of recovery generalized to 2 similar, but untrained, forelimb tasks. These findings indicate that damage to alpha motor neurons does not prevent VNS-dependent enhancement of recovery and provides additional evidence to support the evaluation of closed-loop VNS paired with rehabilitation in patients with incomplete cervical SCI.
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Affiliation(s)
| | | | - Maria J Sosa
- The University of Texas at Dallas, Richardson, TX, USA
| | | | - Zainab Haider
- The University of Texas at Dallas, Richardson, TX, USA
| | | | | | - Seth A Hays
- The University of Texas at Dallas, Richardson, TX, USA
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41
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Darrow MJ, Mian TM, Torres M, Haider Z, Danaphongse T, Rennaker RL, Kilgard MP, Hays SA. Restoration of Somatosensory Function by Pairing Vagus Nerve Stimulation with Tactile Rehabilitation. Ann Neurol 2020; 87:194-205. [PMID: 31875975 DOI: 10.1002/ana.25664] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sensory dysfunction is a common consequence of many forms of neurological injury, including stroke and nerve damage. Rehabilitative paradigms that incorporate sensory retraining can provide modest benefits, but the majority of patients are left with lasting sensory loss. We have developed a novel strategy that uses closed-loop vagus nerve stimulation (VNS) paired with tactile rehabilitation to enhance synaptic plasticity and facilitate recovery of sensory function. METHODS A clinical case report provides initial evidence that a similar implementation of closed-loop VNS paired with a tactile rehabilitation regimen could improve recovery of somatosensory function. Here, we sought to build on these promising initial clinical data and rigorously evaluate the ability of VNS paired with tactile rehabilitation to improve recovery in an animal model of chronic sensory loss. The study design, including planned sample size, assessments, and statistical comparisons, was preregistered prior to beginning data collection (https://osf.io/xsnj5/). RESULTS VNS paired with tactile rehabilitation resulted in a significant and nearly complete recovery of mechanosensory withdrawal thresholds. Equivalent tactile rehabilitation without VNS failed to improve sensory function. This VNS-dependent restoration of sensory thresholds was maintained for several months after the cessation of stimulation, illustrating long-term benefits. Moreover, VNS paired with tactile rehabilitation resulted in significant generalized improvements in other measures of sensorimotor forepaw function. INTERPRETATION Given the safety and tolerability of VNS therapy, these findings suggest that incorporating VNS paired with sensory retraining into rehabilitative regimens may represent a fundamentally new method to increase recovery of sensory function after neurological injury. ANN NEUROL 2020;87:194-205.
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Affiliation(s)
- Michael J Darrow
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX
| | - Tabarak M Mian
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Miranda Torres
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Zainab Haider
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Tanya Danaphongse
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX
| | - Robert L Rennaker
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Michael P Kilgard
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Seth A Hays
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
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42
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Ntiloudi D, Qanud K, Tomaio JN, Giannakoulas G, Al-Abed Y, Zanos S. Pulmonary arterial hypertension: the case for a bioelectronic treatment. Bioelectron Med 2019; 5:20. [PMID: 32232109 PMCID: PMC7098229 DOI: 10.1186/s42234-019-0036-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease of unknown etiology that progresses to right ventricular failure. It has a complex pathophysiology, which involves an imbalance between vasoconstrictive and vasodilative processes in the pulmonary circulation, pulmonary vasoconstriction, vascular and right ventricular remodeling, systemic inflammation, and autonomic imbalance, with a reduced parasympathetic and increased sympathetic tone. Current pharmacological treatments for PAH include several classes of drugs that target signaling pathways in vascular biology and cardiovascular physiology, but they can have severe unwanted effects and they do not typically stop the progression of the disease. Pulmonary artery denervation has been tested clinically as a method to suppress sympathetic overactivation, however it is a nonspecific and irreversible intervention. Bioelectronic medicine, in particular vagus nerve stimulation (VNS), has been used in cardiovascular disorders like arrhythmias, heart failure and arterial hypertension and could, in principle, be tested as a treatment in PAH. VNS can produce pulmonary vasodilation and renormalize right ventricular function, via activation of pulmonary and cardiac vagal fibers. It can suppress systemic inflammation, via activation of fibers that innervate the spleen. Finally, VNS can gradually restore the balance between parasympathetic and sympathetic tone by regulating autonomic reflexes. Preclinical studies support the feasibility of using VNS in PAH. However, there are challenges with such an approach, arising from the need to affect a relatively small number of relevant vagal fibers, and the potential for unwanted cardiac and noncardiac effects of VNS in this sensitive patient population.
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Affiliation(s)
- Despοina Ntiloudi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA.,2Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Khaled Qanud
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
| | - Jacquelyn-Nicole Tomaio
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
| | | | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
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43
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Bucksot JE, Wells AJ, Rahebi KC, Sivaji V, Romero-Ortega M, Kilgard MP, Rennaker RL, Hays SA. Flat electrode contacts for vagus nerve stimulation. PLoS One 2019; 14:e0215191. [PMID: 31738766 PMCID: PMC6862926 DOI: 10.1371/journal.pone.0215191] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/30/2019] [Indexed: 02/01/2023] Open
Abstract
The majority of available systems for vagus nerve stimulation use helical stimulation electrodes, which cover the majority of the circumference of the nerve and produce largely uniform current density within the nerve. Flat stimulation electrodes that contact only one side of the nerve may provide advantages, including ease of fabrication. However, it is possible that the flat configuration will yield inefficient fiber recruitment due to a less uniform current distribution within the nerve. Here we tested the hypothesis that flat electrodes will require higher current amplitude to activate all large-diameter fibers throughout the whole cross-section of a nerve than circumferential designs. Computational modeling and in vivo experiments were performed to evaluate fiber recruitment in different nerves and different species using a variety of electrode designs. Initial results demonstrated similar fiber recruitment in the rat vagus and sciatic nerves with a standard circumferential cuff electrode and a cuff electrode modified to approximate a flat configuration. Follow up experiments comparing true flat electrodes to circumferential electrodes on the rabbit sciatic nerve confirmed that fiber recruitment was equivalent between the two designs. These findings demonstrate that flat electrodes represent a viable design for nerve stimulation that may provide advantages over the current circumferential designs for applications in which the goal is uniform activation of all fascicles within the nerve.
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Affiliation(s)
- Jesse E. Bucksot
- The University of Texas at Dallas, Erik Jonsson School of Engineering and
Computer Science, Richardson, Texas, United States of America
| | - Andrew J. Wells
- The University of Texas at Dallas, Erik Jonsson School of Engineering and
Computer Science, Richardson, Texas, United States of America
| | - Kimiya C. Rahebi
- Texas Biomedical Device Center, Richardson, Texas, United States of
America
| | - Vishnoukumaar Sivaji
- The University of Texas at Dallas, Erik Jonsson School of Engineering and
Computer Science, Richardson, Texas, United States of America
| | - Mario Romero-Ortega
- The University of Texas at Dallas, Erik Jonsson School of Engineering and
Computer Science, Richardson, Texas, United States of America
- Texas Biomedical Device Center, Richardson, Texas, United States of
America
| | - Michael P. Kilgard
- The University of Texas at Dallas, Erik Jonsson School of Engineering and
Computer Science, Richardson, Texas, United States of America
- Texas Biomedical Device Center, Richardson, Texas, United States of
America
- The University of Texas at Dallas, School of Behavioral Brain Sciences,
Richardson, Texas, United States of America
| | - Robert L. Rennaker
- The University of Texas at Dallas, Erik Jonsson School of Engineering and
Computer Science, Richardson, Texas, United States of America
- Texas Biomedical Device Center, Richardson, Texas, United States of
America
- The University of Texas at Dallas, School of Behavioral Brain Sciences,
Richardson, Texas, United States of America
| | - Seth A. Hays
- The University of Texas at Dallas, Erik Jonsson School of Engineering and
Computer Science, Richardson, Texas, United States of America
- Texas Biomedical Device Center, Richardson, Texas, United States of
America
- The University of Texas at Dallas, School of Behavioral Brain Sciences,
Richardson, Texas, United States of America
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Noller CM, Levine YA, Urakov TM, Aronson JP, Nash MS. Vagus Nerve Stimulation in Rodent Models: An Overview of Technical Considerations. Front Neurosci 2019; 13:911. [PMID: 31551679 PMCID: PMC6738225 DOI: 10.3389/fnins.2019.00911] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
Over the last several decades, vagus nerve stimulation (VNS) has evolved from a treatment for select neuropsychiatric disorders to one that holds promise in treating numerous inflammatory conditions. Growing interest has focused on the use of VNS for other indications, such as heart failure, rheumatoid arthritis, inflammatory bowel disease, ischemic stroke, and traumatic brain injury. As pre-clinical research often guides expansion into new clinical avenues, animal models of VNS have also increased in recent years. To advance this promising treatment, however, there are a number of experimental parameters that must be considered when planning a study, such as physiology of the vagus nerve, electrical stimulation parameters, electrode design, stimulation equipment, and microsurgical technique. In this review, we discuss these important considerations and how a combination of clinically relevant stimulation parameters can be used to achieve beneficial therapeutic results in pre-clinical studies of sub-acute to chronic VNS, and provide a practical guide for performing this work in rodent models. Finally, by integrating clinical and pre-clinical research, we present indeterminate issues as opportunities for future research.
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Affiliation(s)
- Crystal M. Noller
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, United States
- Section of Neurosurgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | | | - Timur M. Urakov
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
- Jackson Memorial Hospital, Miami, FL, United States
| | - Joshua P. Aronson
- Section of Neurosurgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Mark S. Nash
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL, United States
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Kawada T, Yamamoto H, Uemura K, Hayama Y, Nishikawa T, Sugimachi M. Intravenous ivabradine augments the dynamic heart rate response to moderate vagal nerve stimulation in anesthetized rats. Am J Physiol Heart Circ Physiol 2019; 317:H597-H606. [DOI: 10.1152/ajpheart.00288.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ivabradine is a selective bradycardic agent that reduces the heart rate (HR) by inhibiting the hyperpolarization-activated cyclic nucleotide-gated channels. Although its cardiovascular effect is thought to be minimal except for inducing bradycardia, ivabradine could interact with cardiovascular regulation by the autonomic nervous system. We tested whether ivabradine modifies dynamic characteristics of peripheral vagal HR control. In anesthetized Wistar-Kyoto rats ( n = 7), the right vagal nerve was sectioned and stimulated for 10 min according to a binary white noise sequence with a switching interval of 500 ms. The efferent vagal nerve stimulation (VNS) trials were performed using three different rates (10, 20, and 40 Hz), and were designated as V0–10, V0–20, and V0–40, respectively. The transfer function from the VNS to the HR was estimated before and after the intravenous administration of ivabradine (2 mg/kg). Ivabradine increased the asymptotic dynamic gain in V0–20 [from 3.88 (1.78–5.79) to 6.62 (3.12–8.31) beats·min−1·Hz−1, P < 0.01, median (range)] but not in V0–10 or V0–40. Ivabradine increased the corner frequency in V0–10 [from 0.032 (0.026–0.041) to 0.064 (0.029–0.090) Hz, P < 0.01] and V0–20 [from 0.040 (0.037–0.056) to 0.068 (0.051–0.100) Hz, P < 0.01] but not in V0–40. In conclusion, ivabradine augmented the dynamic HR response to moderate VNS. At high VNS, however, ivabradine did not significantly augment the dynamic HR response, possibly because ivabradine reduced the baseline HR and limited the range for the bradycardic response to high VNS. NEW & NOTEWORTHY Ivabradine is considered to be a pure bradycardic agent that has little effect on cardiovascular function except inducing bradycardia. The present study demonstrated that ivabradine interacts with the dynamic vagal heart rate control in a manner that augments the heart rate response to moderate-intensity efferent vagal nerve stimulation.
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Affiliation(s)
- Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiromi Yamamoto
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yohsuke Hayama
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
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Vespa S, Stumpp L, Bouckaert C, Delbeke J, Smets H, Cury J, Ferrao Santos S, Rooijakkers H, Nonclercq A, Raedt R, Vonck K, El Tahry R. Vagus Nerve Stimulation-Induced Laryngeal Motor Evoked Potentials: A Possible Biomarker of Effective Nerve Activation. Front Neurosci 2019; 13:880. [PMID: 31507360 PMCID: PMC6718640 DOI: 10.3389/fnins.2019.00880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Vagus nerve stimulation (VNS) therapy is associated with laryngeal muscle activation and induces voice modifications, well-known side effects of the therapy resulting from co-activation of the recurrent laryngeal nerve. In this study, we describe the non-invasive transcutaneous recording of laryngeal motor evoked potentials (LMEPs), which could serve as a biomarker of effective nerve activation and individual titration in patients with drug-resistant epilepsy. We recruited drug-resistant epileptic patients treated for at least 6 months with a VNS. Trains of 600-1200 VNS pulses were delivered with increasing current outputs. We placed six skin electrodes on the ventral surface of the neck, in order to record LMEPs whenever the laryngeal muscular threshold was reached. We studied the internal consistency and the variability of LMEP recordings, and compared different methods for amplitude calculation. Recruitment curves were built based on the stimulus-response relationship. We also determined the electrical axis of the LMEPs dipole in order to define the optimal electrode placement for LMEPs recording in a clinical setting. LMEPs were successfully recorded in 11/11 patients. The LMEPs threshold ranged from 0.25 to 1 mA (median 0.50 mA), and onset latency was between 5.37 and 8.77 ms. The signal-to-noise ratio was outstanding in 10/11 patients. In these cases, excellent reliability (Intraclass correlation coefficient, ICC > 0.90 across three different amplitude measurements) was achieved with 10 sample averages. Moreover, our recordings showed very good internal consistency (Cronbach's alpha > 0.95 for 10 epochs). Area-under-the-curve and peak-to-peak measurement proved to be complementary methods for amplitude calculation. Finally, we determined that an optimal derivation requires only two recording electrodes, aligned on a horizontal axis around the laryngeal prominence. In conclusion, we describe here an optimal methodology for the recording of VNS-induced motor evoked responses from the larynx. Although further clinical validation is still necessary, LMEPs might be useful as a non-invasive marker of effective nerve activation, and as an aid for the clinician to perform a more rational titration of VNS parameters.
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Affiliation(s)
- Simone Vespa
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Lars Stumpp
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Jean Delbeke
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Hugo Smets
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Joaquin Cury
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Susana Ferrao Santos
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Centre for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Herbert Rooijakkers
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro And Mechanical Systems, Université Libre de Bruxelles, Brussels, Belgium
| | - Robrecht Raedt
- 4Brain, Institute for Neurosciences, Ghent University, Ghent, Belgium
| | - Kristl Vonck
- 4Brain, Institute for Neurosciences, Ghent University, Ghent, Belgium.,Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Centre for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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47
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Borland MS, Vrana WA, Moreno NA, Fogarty EA, Buell EP, Vanneste S, Kilgard MP, Engineer CT. Pairing vagus nerve stimulation with tones drives plasticity across the auditory pathway. J Neurophysiol 2019; 122:659-671. [PMID: 31215351 DOI: 10.1152/jn.00832.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous studies have demonstrated that pairing vagus nerve stimulation (VNS) with sounds can enhance the primary auditory cortex (A1) response to the paired sound. The neural response to sounds following VNS-sound pairing in other subcortical and cortical auditory fields has not been documented. We predicted that VNS-tone pairing would increase neural responses to the paired tone frequency across the auditory pathway. In this study, we paired VNS with the presentation of a 9-kHz tone 300 times a day for 20 days. We recorded neural responses to tones from 2,950 sites in the inferior colliculus (IC), A1, anterior auditory field (AAF), and posterior auditory field (PAF) 24 h after the last pairing session in anesthetized rats. We found that VNS-tone pairing increased the percentage of IC, A1, AAF, and PAF that responds to the paired tone frequency. Across all tested auditory fields, the response strength to tones was strengthened in VNS-tone paired rats compared with control rats. VNS-tone pairing reduced spontaneous activity, frequency selectivity, and response threshold across the auditory pathway. This is the first study to document both cortical and subcortical plasticity following VNS-sound pairing. Our findings suggest that VNS paired with sound presentation is an effective method to enhance auditory processing.NEW & NOTEWORTHY Previous studies have reported primary auditory cortex plasticity following vagus nerve stimulation (VNS) paired with a sound. This study extends previous findings by documenting that fields across the auditory pathway are altered by VNS-tone pairing. VNS-tone pairing increases the percentage of each field that responds to the paired tone frequency. This is the first study to document both cortical and subcortical plasticity following VNS-sound pairing.
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Affiliation(s)
- Michael S Borland
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Will A Vrana
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Nicole A Moreno
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Elizabeth A Fogarty
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Elizabeth P Buell
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Sven Vanneste
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Crystal T Engineer
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
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48
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Hulsey DR, Shedd CM, Sarker SF, Kilgard MP, Hays SA. Norepinephrine and serotonin are required for vagus nerve stimulation directed cortical plasticity. Exp Neurol 2019; 320:112975. [PMID: 31181199 DOI: 10.1016/j.expneurol.2019.112975] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/18/2022]
Abstract
Vagus nerve stimulation (VNS) paired with forelimb training drives robust, specific reorganization of movement representations in the motor cortex. This effect is hypothesized to be mediated by VNS-dependent engagement of neuromodulatory networks. VNS influences activity in the locus coeruleus (LC) and dorsal raphe nucleus (DRN), but the involvement of these neuromodulatory networks in VNS-directed plasticity is unknown. We tested the hypothesis that cortical norepinephrine and serotonin are required for VNS-dependent enhancement of motor cortex plasticity. Rats were trained on a lever pressing task emphasizing proximal forelimb use. Once proficient, all rats received a surgically implanted vagus nerve cuff and cortical injections of either immunotoxins to deplete serotonin or norepinephrine, or vehicle control. Following surgical recovery, rats received half second bursts of 0.8 mA or sham VNS after successful trials. After five days of pairing intracortical microstimulation (ICMS) was performed in the motor cortex contralateral to the trained limb. VNS paired with training more than doubled cortical representations of proximal forelimb movements. Depletion of either cortical norepinephrine or serotonin prevented this effect. The requirement of multiple neuromodulators is consistent with earlier studies showing that these neuromodulators regulate synaptic plasticity in a complimentary fashion.
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Affiliation(s)
- Daniel R Hulsey
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America.
| | - Christine M Shedd
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, United States of America
| | - Sadmaan F Sarker
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, United States of America
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America
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49
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Payne SC, Furness JB, Burns O, Sedo A, Hyakumura T, Shepherd RK, Fallon JB. Anti-inflammatory Effects of Abdominal Vagus Nerve Stimulation on Experimental Intestinal Inflammation. Front Neurosci 2019; 13:418. [PMID: 31133776 PMCID: PMC6517481 DOI: 10.3389/fnins.2019.00418] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
Electrical stimulation of the cervical vagus nerve is an emerging treatment for inflammatory bowel disease (IBD). However, side effects from cervical vagal nerve stimulation (VNS) are often reported by patients. Here we hypothesized that stimulating the vagus nerve closer to the end organ will have fewer off-target effects and will effectively reduce intestinal inflammation. Specifically, we aimed to: (i) compare off-target effects during abdominal and cervical VNS; (ii) verify that VNS levels were suprathreshold; and (iii) determine whether abdominal VNS reduces chemically-induced intestinal inflammation in rats. An electrode array was developed in-house to stimulate and record vagal neural responses. In a non-recovery experiment, stimulation-induced off-target effects were measured by implanting the cervical and abdominal vagus nerves of anaesthetized rats (n = 5) and recording changes to heart rate, respiration and blood pressure during stimulation (10 Hz; symmetric biphasic current pulse; 320 nC per phase). In a chronic experiment, the efficacy of VNS treatment was assessed by implanting an electrode array onto the abdominal vagus nerve and recording in vivo electrically-evoked neural responses during the implantation period. After 14 days, the intestine was inflamed with TNBS (2.5% 2,4,6-trinitrobenzene sulphonic acid) and rats received therapeutic VNS (n = 7; 10 Hz; 320 nC per phase; 3 h/day) or no stimulation (n = 8) for 4.5 days. Stool quality, plasma C-reactive protein and histology of the inflamed intestine were assessed. Data show that abdominal VNS had no effect (two-way RM-ANOVA: P ≥ 0.05) on cardiac, respiratory and blood pressure parameters. However, during cervical VNS heart rate decreased by 31 ± 9 beats/minute (P ≥ 0.05), respiration was inhibited and blood pressure decreased. Data addressing efficacy of VNS treatment show that electrically-evoked neural response thresholds remained stable (one-way RM ANOVA: P ≥ 0.05) and therapeutic stimulation remained above threshold. Chronically stimulated rats, compared to unstimulated rats, had improved stool quality (two-way RM ANOVA: P < 0.0001), no blood in feces (P < 0.0001), reduced plasma C-reactive protein (two-way RM ANOVA: P < 0.05) and a reduction in resident inflammatory cell populations within the intestine (Kruskal–Wallis: P < 0.05). In conclusion, abdominal VNS did not evoke off-target effects, is an effective treatment of TNBS-induced inflammation, and may be an effective treatment of IBD in humans.
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Affiliation(s)
- Sophie C Payne
- Bionics Institute, Fitzroy, VIC, Australia.,Medical Bionics Department, University of Melbourne, Parkville, VIC, Australia
| | - John B Furness
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia
| | - Owen Burns
- Bionics Institute, Fitzroy, VIC, Australia
| | - Alicia Sedo
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Tomoko Hyakumura
- Bionics Institute, Fitzroy, VIC, Australia.,Medical Bionics Department, University of Melbourne, Parkville, VIC, Australia
| | - Robert K Shepherd
- Bionics Institute, Fitzroy, VIC, Australia.,Medical Bionics Department, University of Melbourne, Parkville, VIC, Australia
| | - James B Fallon
- Bionics Institute, Fitzroy, VIC, Australia.,Medical Bionics Department, University of Melbourne, Parkville, VIC, Australia.,Department of Otolaryngology, University of Melbourne, Parkville, VIC, Australia
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50
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Rios MU, Bucksot JE, Rahebi KC, Engineer CT, Kilgard MP, Hays SA. Protocol for Construction of Rat Nerve Stimulation Cuff Electrodes. Methods Protoc 2019; 2. [PMID: 30957053 PMCID: PMC6448795 DOI: 10.3390/mps2010019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Peripheral nerve stimulation has emerged as a platform therapy to treat a wide range of disorders. Continued development and translation of these strategies requires that researchers have access to reliable, customizable electrodes for nerve stimulation. Here, we detail procedures to build three different configurations of cuff electrodes with varying numbers and orientations of contacts for nerve stimulation in rats. These designs are built with simple, widely available materials, using platinum-iridium electrodes assembled into polyurethane tubing. Moreover, the designs can easily be customized to increase versatility and individualize for specific stimulation applications. This protocol provides a resource to facilitate the construction and customization of stimulation cuffs to support preclinical nerve stimulation research.
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Affiliation(s)
- Manolo U Rios
- School of Brain and Behavioral Sciences, The University of Texas at Dallas, Richardson, TX 75080-3021, USA; (M.U.R.); (M.P.K.), (S.A.H.)
| | - Jesse E Bucksot
- School of Biomedical Engineering, The University of Texas at Dallas, Richardson, TX 75080-3021, USA;
| | - Kimiya C Rahebi
- Texas Biomedical Device Center (TxBDC), The University of Texas at Dallas, Richardson, TX 75080-3021, USA;
| | - Crystal T Engineer
- School of Brain and Behavioral Sciences, The University of Texas at Dallas, Richardson, TX 75080-3021, USA; (M.U.R.); (M.P.K.), (S.A.H.)
- School of Biomedical Engineering, The University of Texas at Dallas, Richardson, TX 75080-3021, USA;
- Texas Biomedical Device Center (TxBDC), The University of Texas at Dallas, Richardson, TX 75080-3021, USA;
| | - Michael P Kilgard
- School of Brain and Behavioral Sciences, The University of Texas at Dallas, Richardson, TX 75080-3021, USA; (M.U.R.); (M.P.K.), (S.A.H.)
- Texas Biomedical Device Center (TxBDC), The University of Texas at Dallas, Richardson, TX 75080-3021, USA;
| | - Seth A Hays
- School of Brain and Behavioral Sciences, The University of Texas at Dallas, Richardson, TX 75080-3021, USA; (M.U.R.); (M.P.K.), (S.A.H.)
- School of Biomedical Engineering, The University of Texas at Dallas, Richardson, TX 75080-3021, USA;
- Texas Biomedical Device Center (TxBDC), The University of Texas at Dallas, Richardson, TX 75080-3021, USA;
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