A Flexible Platform for Biofeedback-Driven Control and Personalization of Electrical Nerve Stimulation Therapy

Ward, Matthew; Qing, Kurt Y.; Otto, Kevin J.; Worth, Robert M.; John, Simon W. M.; Irazoqui, Pedro P.

doi:10.1109/tnsre.2014.2351271

Cited by 42 publications

(41 citation statements)

References 12 publications

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“…We designed and made custom cuffs for bi-polar stimulation of the vagus nerve in awake mice, based on our previous design in rats (Fig. 1A,top) (Ward et al, 2014). The cuffs were implanted on the left cervical vagus nerve (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Graded recruitment of pupil-linked neuromodulation by parametric stimulation of the vagus nerve

Mridha

Gee

Shi

et al. 2019

Preprint

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Vagus nerve stimulation (VNS) is thought to alter the state of the brain by recruiting global neuromodulators. VNS is used in treatment-resistant epilepsy, and is increasingly being explored for other brain disorders, such as depression, and as a cognitive enhancer. However, the promise of VNS is only partially fulfilled due to a lack of mechanistic understanding of the transfer function between stimulation parameters and neuromodulatory response, together with a lack of biosensor for assaying stimulation efficacy in real time. We here develop an approach to VNS in head-fixed mice on a treadmill, and use it to show that pupil dilation is a biosensor for VNS-evoked cortical neuromodulation. In a 'goldilocks' zone of stimulation parameters, current leakage and off-target effects are minimized and the extent of pupil dilation tracks VNS-evoked basal-forebrain cholinergic axon activity in auditory cortex. Thus, pupil dilation is a sensitive readout of the moment-by-moment titratable effects of VNS on brain state.

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Section: Resultsmentioning

confidence: 99%

“…We adapted the implanted cuff design from prior work in rats (Ward et al, 2014). The bipolar stimulating cuff was custom built based around an improved Howland Current Pump (Texas Instruments) driven by an 18-bit NI DAQ (National Instruments).…”

Section: Vagus Nerve Stimulator Cuff Designmentioning

confidence: 99%

Graded recruitment of pupil-linked neuromodulation by parametric stimulation of the vagus nerve

Mridha

Gee

Shi

et al. 2019

Preprint

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“…A real-time responsive vagus nerve stimulation system has been demonstrated in rats [40]. In this system, the stimulus delivery is controlled on the basis of real-time feedback control from the measured compound action potentials.…”

Section: Vagal Nerve Compound Action Potential Recordingmentioning

confidence: 99%

Electrically Evoked Compound Action Potential Recording in Peripheral Nerves

2017

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Applications for bioelectric medicine can be found in all parts of the nervous system. The CNS -brain and spinal cord -contain targets for commercial neuromodulation therapies. Peripheral nerves are also modulated with commercially available systems during treatment for chronic pain and epilepsy, and developments are in progress for treating many other diseases. The electrically evoked compound action potential is a measure of the electrical response from the tissue to stimulation. It provides a direct insight into the electrophysiology of the stimulation, and despite its incorporation into cochlear implants it is a technology that is yet to find its way into commercial peripheral nerve stimulation applications. This review outlines the status of evoked compound action potential measurements on peripheral nerves and highlights the challenges which need to be overcome. Recording of the neural activity generated by electrical stimulation forms the basis of a number of diagnostic procedures. It is often performed in an acute setting and the technology has found its way into several active implantable devices. The techniques rely on a stimulus applied to the nerve or tissue to evoke a compound action potential. The stimulus simultaneously and synchronously recruits many fibers and hence the response is referred to as a compound action potential because it is the sum of the many potentials recruited. Summation and synchronous generation increase the amplitude of the response and thus makes detection feasible. Recording the electrical activity of peripheral nerve neurons is common place in a number of diagnostic procedures [1]. Nerve conduction studies are performed to assess the integrity of the nerve and form part of a diagnosis of a range of conditions including Guillain Barre, carpal tunnel syndrome [2], herniated discs, chronic inflammatory polyneuropathies and other nerve disorders including peripheral nerve injury. The direct response from the nerve or the response from a muscle that the nerve innervates is recorded (EMG) in these studies. The nerve conduction velocity is a measure of nerve health -velocities between 50 and 60 ms -1 are considered in the normal range and velocities outside this range could be an indicator of disease. Neural monitoring, measurement of peripherally evoked potentials from the somatosensory cortex, is used to ensure safety during spine surgery [3]. Compound action potential measurement capabilities are built into cochlear implants and are used as objective measures during device setup and programming [4]. Peripheral nerve recordings form the basis of numerous scientific investigations and are used to assess the impact of drugs or to provide baseline calibration of neural activities as part of deeper investigations.Recordings from the nervous system inform clinicians about the health of nerves or their safety during procedures. They inform researchers about mechanisms of action and provide fundamental data for mechanism-based research. Their scope and use is broad but here we will f...

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“…An Autonomous Neural Control (ANC) algorithm has been developed to map stimulation parameters to nerve activation profiles (Ward et al 2014). Given this map, the algorithm dynamically adjusts the stimulus to maintain the nerve activation at a therapeutic level over time.…”

Section: Interventionmentioning

confidence: 99%

“…Therapeutic efficacy may be improved by providing therapy modulated by physiological activity of the patient. Closed-loop methods which adjust the timing of stimulation based on measured physiological activity (Ward et al 2014) have been proposed for treatment of tremor, but have not yet been applied to epilepsy. This may be for several reasons, including that seizures are changing so rapidly that it is difficult to have a clear signal upon which to determine the stimulation timing.…”

Section: Interventionmentioning

confidence: 99%

Future of Seizure Prediction and Intervention

Nagaraj

Lee

Krook-Magnuson

et al. 2015

Journal of Clinical Neurophysiology

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The ultimate goal of epilepsy therapies is to provide seizure control for all patients while eliminating side effects. Improved specificity of intervention through on-demand approaches may overcome many of the limitations of current intervention strategies. This article reviews progress in seizure prediction and detection, potential new therapies to provide improved specificity, and devices to achieve these ends. Specifically, we discuss 1) potential signal modalities and algorithms for seizure detection and prediction, 2) closed-loop intervention approaches, and 3) hardware for implementing these algorithms and interventions. Seizure prediction and therapies maximize efficacy while minimizing side-effects through improved specificity may represent the future of epilepsy treatments.

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A Flexible Platform for Biofeedback-Driven Control and Personalization of Electrical Nerve Stimulation Therapy

Cited by 42 publications

References 12 publications

Graded recruitment of pupil-linked neuromodulation by parametric stimulation of the vagus nerve

Graded recruitment of pupil-linked neuromodulation by parametric stimulation of the vagus nerve

Electrically Evoked Compound Action Potential Recording in Peripheral Nerves

Future of Seizure Prediction and Intervention

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