The Effect of Clinically Controllable Factors on Neural Activation During Dorsal Root Ganglion Stimulation
The Effect of Clinically Controllable Factors on Neural Activation During Dorsal Root Ganglion Stimulation
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DOI：
10.1111/ner.13211
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发表时间：
2020-06-24
期刊：
影响因子：
2.8
通讯作者：
Lempka, Scott F.
中科院分区：
文献类型：
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作者：
Graham, Robert D.;Bruns, Tim M.;Lempka, Scott F.
目的刺激背根神经节（DRGS）是治疗慢性疼痛的有效方法，但其作用机制尚不清楚。目前，我们还不清楚临床可控参数（如电极位置、刺激脉宽）如何影响神经对DRGS的直接反应。因此，本研究的目的是利用计算建模方法来表征不同的临床可控参数如何改变DRGS期间的神经激活谱。我们将人类L5 DRG的有限元模型与初级感觉神经元（即α -、β -、δ -和c -神经元）的多室模型相结合。我们计算了在每个神经元中引起一个或多个动作电位所需的刺激幅度，并检查了不同的临床可控参数如何影响神经激活谱。结果一般来说，DRGS主要激活大髓鞘A α和A β神经元。将电极移至离神经节2毫米以上的位置，可消除大多数drgs诱导的神经激活。当刺激脉冲宽度增加到500 μ s或更大时，激活的A δ神经元数量增加，而较短的脉冲宽度通常只激活A α和A β神经元。将阴极放置在神经根附近，或将阳极放置在神经节体附近，可以最大限度地激活a-机械感受器。保护性主动接触构型并不比常规双极构型激活更多的A -机械感受器。结论在典型临床范围内的刺激参数下，DRGS主要激活A -机械受体。一般来说，不同的临床可控参数会影响A -机械感受器的激活数量，尽管较长的脉冲宽度可以增加A - δ神经元的激活。我们的数据支持几个神经调节适当性共识委员会关于临床实施DRGS的指南。
Objective Dorsal root ganglion stimulation (DRGS) is an effective therapy for chronic pain, though its mechanisms of action are unknown. Currently, we do not understand how clinically controllable parameters (e.g., electrode position, stimulus pulse width) affect the direct neural response to DRGS. Therefore, the goal of this study was to utilize a computational modeling approach to characterize how varying clinically controllable parameters changed neural activation profiles during DRGS. Materials and Methods We coupled a finite element model of a human L5 DRG to multicompartment models of primary sensory neurons (i.e., A alpha-, A beta-, A delta-, and C-neurons). We calculated the stimulation amplitudes necessary to elicit one or more action potentials in each neuron, and examined how neural activation profiles were affected by varying clinically controllable parameters. Results In general, DRGS predominantly activated large myelinated A alpha- and A beta-neurons. Shifting the electrode more than 2 mm away from the ganglion abolished most DRGS-induced neural activation. Increasing the stimulus pulse width to 500 mu s or greater increased the number of activated A delta-neurons, while shorter pulse widths typically only activated A alpha- and A beta-neurons. Placing a cathode near a nerve root, or an anode near the ganglion body, maximized A beta-mechanoreceptor activation. Guarded active contact configurations did not activate more A beta-mechanoreceptors than conventional bipolar configurations. Conclusions Our results suggest that DRGS applied with stimulation parameters within typical clinical ranges predominantly activates A beta-mechanoreceptors. In general, varying clinically controllable parameters affects the number of A beta-mechanoreceptors activated, although longer pulse widths can increase A delta-neuron activation. Our data support several Neuromodulation Appropriateness Consensus Committee guidelines on the clinical implementation of DRGS.