Characterization and applications of evoked responses during epidural electrical stimulation.
Characterization and applications of evoked responses during epidural electrical stimulation.
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硬膜外电刺激期间诱发反应的表征和应用。
DOI：
10.1186/s42234-023-00106-5
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发表时间：
2023-02-28
影响因子：
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通讯作者：
Zhang, Mingming
中科院分区：
文献类型：
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作者：
Verma, Nishant;Romanauski, Ben;Lam, Danny;Lujan, Luis;Blanz, Stephan;Ludwig, Kip;Lempka, Scott;Shoffstall, Andrew;Knudson, Bruce;Nishiyama, Yuichiro;Hao, Jian;Park, Hyun-Joo;Ross, Erika;Lavrov, Igor;Zhang, Mingming
硬膜外脊髓电刺激(EES)已经被FDA批准并用于治疗数十年。然而，对于局部神经基质以及由此导致的治疗效果的作用机制仍然没有清楚的了解。硬膜外脊髓记录(ESR)是从放置在硬膜外间隙中的电极收集的。血沉包含多种信号成分，如诱发的神经反应(由紧张性或爆发性DR™波形引起)、诱发的肌肉反应、刺激伪影和心脏反应。紧张性刺激诱发复合动作电位(ECAP)是ESR的组成部分之一，最近被提出用来测量EES过程中大量神经元纤维的累积局部电位。在这里，我们首先回顾和研究参考策略，因为它们适用于家猪动物模型ESR中的ECAP成分。然后，我们研究如何使用ECAP组件来检测铅迁移，铅迁移是放置铅后的不利结果，可能会降低治疗效果。最后，我们展示并分离了EES过程中局部背部和腿部肌肉的同时激活，证明了从记录接触中获得的ESR包含ECAP和EMG成分。这些发现可能进一步指导在植入性EES系统中实施记录和参考接触，并为在ESR中使用ECAP组件检测铅迁移提供初步证据。我们期望这些结果有助于未来EES方法学的发展和ESR中使用不同成分来改善EES治疗的实施。网上版载有补充材料，可在10.1186/s42234-023-00106-5查阅。
Epidural electrical stimulation (EES) of the spinal cord has been FDA approved and used therapeutically for decades. However, there is still not a clear understanding of the local neural substrates and consequently the mechanism of action responsible for the therapeutic effects. Epidural spinal recordings (ESR) are collected from the electrodes placed in the epidural space. ESR contains multi-modality signal components such as the evoked neural response (due to tonic or BurstDR™ waveforms), evoked muscle response, stimulation artifact, and cardiac response. The tonic stimulation evoked compound action potential (ECAP) is one of the components in ESR and has been proposed recently to measure the accumulative local potentials from large populations of neuronal fibers during EES. Here, we first review and investigate the referencing strategies, as they apply to ECAP component in ESR in the domestic swine animal model. We then examine how ECAP component can be used to sense lead migration, an adverse outcome following lead placement that can reduce therapeutic efficacy. Lastly, we show and isolate concurrent activation of local back and leg muscles during EES, demonstrating that the ESR obtained from the recording contacts contain both ECAP and EMG components. These findings may further guide the implementation of recording and reference contacts in an implantable EES system and provide preliminary evidence for the utility of ECAP component in ESR to detect lead migration. We expect these results to facilitate future development of EES methodology and implementation of use of different components in ESR to improve EES therapy. The online version contains supplementary material available at 10.1186/s42234-023-00106-5.