Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients

Onders, Raymond P.; Elmo, Mary Jo; Khansarinia, Saeid; Bowman, Brock; Yee, John; Road, Jeremy; Bass, Barbara L.; Dunkin, Brian J.; Ingvarsson, Páll; Oddsdóttir, Margrét

doi:10.1007/s00464-008-0223-3

Cited by 158 publications

(158 citation statements)

References 22 publications

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“…These electrodes are usually implanted in the mediastinum. More recently, diaphragmatic intramuscular electrodes provided with self-securing polypropylene anchors (Peterson, Synapse Biomedical, Inc; Oberlin, Ohio) have been used to deliver phrenic nerve stimulation [3][4].…”

Section: Introductionmentioning

confidence: 99%

“…The first limitation is insufficient ventilation during episodes of high demand, such as during respiratory pneumonia; thus, the ability to induce larger tidal volumes is needed [1]. The second limitation is diaphragm muscle atrophy, and this requires a period of training to restore muscle strength for individuals starting with phrenic pacing [4]. The third limitation is damage of the phrenic nerve motor neurons, which may preclude pacing.…”

Section: Introductionmentioning

confidence: 99%

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Respiratory muscle pacing with chronically implanted intramuscular Permaloc electrodes: A feasibility study

Walter¹,

Wurster²,

Zhu³

et al. 2011

JRRD

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Abstract-We tested the feasibility of stimulating upperintercostal and abdominal muscles plus the diaphragm by using chronically implanted intramuscular electrodes. During two survival surgeries with six dogs, intramuscular electrodes were implanted bilaterally in the three respiratory muscles. Standard stimulation of the diaphragm was conducted. The dorsolateral and ventrolateral abdominal wall areas were stimulated with a 25 mA current. The second to fourth intercostal spaces were stimulated to elicit the largest tidal volume associated with the least coactivation of the serratus and latissimus muscles. Lone diaphragm and upper-intercostal muscle pacing produced inhaled tidal volumes (mean +/-standard error of the mean) of 293 +/-36 mL and 59 +/-17 mL, respectively. Lone abdominal muscle pacing produced an exhaled volume of 55 +/-17 mL. Combined pacing of diaphragm and intercostal muscles increased the inhaled volume to 389 +/-39 mL. The addition of abdominal pacing following the combined stimulation of diaphragm and intercostals increased the exhaled volume to 472 +/-54 mL. During autopsy, dislodgement of the electrodes overlying the ribs was a concern and probably resulted from loose animal jackets. Chronic intramuscular Permaloc electrodes can be implanted in several respiratory muscles and increase tidal volumes more than diaphragm stimulation alone.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Respiratory muscle pacing with chronically implanted intramuscular Permaloc electrodes: A feasibility study

Walter¹,

Wurster²,

Zhu³

et al. 2011

JRRD

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show abstract

“…The monopolar Peterson R electrode does not have this stretching problem because of a polypropylene suture in the middle of the lead that prevents stretching; thus, future work with Permaloc TM electrodes should include a similar inner suture to prevent stretching. The bipolar Permaloc TM electrode is similar to the monopolar Peterson R electrodes that are currently implanted in the diaphragm of high-level-SCI patients for respiratory pacing [26] and implanted in SCI patients arms and legs for neuroprosthetic applications [27]. However, as noted above, a design change for the bipolar Permaloc TM electrode is needed for our bladder application, a greater range of distances is needed between the two stimulating surfaces.…”

Section: Implantable Bladder Stimulators and Proposed Development Workmentioning

confidence: 99%

Evaluation of Bipolar Permaloc™ Electrodes for Direct Bladder Stimulation

Walter¹,

Allen²,

Sayers³

et al. 2012

TOREHJ

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Abstract:Purpose: A bladder control system for spinal cord injured (SCI) patients is needed that can be implanted with minimally invasive methods. New Permaloc bipolar electrodes consisting of 6 mm helical, wire, stimulating surfaces separated by 3 mm and a polypropylene securing barb (Synapse Biomedical Inc) were developed for this application. They are implanted on the bladder wall with a 16 gauge needle, a minimally invasive method.Methods: Seven swines were anesthetized, the lower urinary tract exposed and instrumented with pressure transducers. Four Permaloc TM electrodes were implanted following identification of effective bladder wall stimulation sites next to the ureters and dorsal neurovascular bundle. Bladder stimulation to induce high pressures was conducted at 40 Hz, 400 s pulses, 5 s stimulation periods and a high stimulating current of 40 mA.Results: At the high stimulating current peak bladder pressures were low, ranging from 12±2 to15±3 cm H 2 0, insufficient to induce urination. Urethral sphincter contractions occurred during high bladder pressure. A spinal reflex role for high sphincter pressures during stimulation was shown by similar high pressures recorded during a bladder squeeze test without stimulation. Conclusions:Stimulation with Permaloc TM bipolar electrodes at high currents produced insufficient bladder pressures for urination. Further modifications of the electrode such as greater separation of the bipolar stimulating surfaces or changes in the testing methods such as alternative animal models are needed to induce high bladder pressures without side effects.

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“…All five electrode leads pass through the skin at separate exit sites that are situated close together, and are connected to a small, battery-powered stimulator. Successful respiratory pacing with this system has been reported in over 100 SCI patients with up to ten years of use [2].A 12-Channel Neuroprosthetic Platform is being developed in a collaborative effort between Synapse Biomedical Inc and our laboratory, Research Service, Hines Veterans Administration Hospital, [3,4]. For this platform, several types of electrodes are under investigation including surface, mapping, intramuscular, and a multilead implantable cable with connectors.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

A 12-channel neuroprosthetic platform for SCI: Applications in the urinary, respiratory and muscle atrophy areas

S¹,

Joseph²,

John³

et al. 2017

Phys Med Rehabil Res

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in quadriplegic spinal cord injury (SCI) patients. The electrode is an intramuscular barb type with a polypropylene anchor, and the electrode evolved from the original Peterson Intramuscular Electrode developed for diaphragmatic pacing in quadriplegic SCI patients at Case Western Reserve University and Cleveland Veterans Administration FES Center [1]. The NeuRx ® system was commercialized by Synapse Biomedical, Inc. in Oberlin, Ohio and uses four Permaloc ® electrodes implanted in the diaphragm and a fifth electrode implanted under the skin as a return electrode for monopolar stimulation. All five electrode leads pass through the skin at separate exit sites that are situated close together, and are connected to a small, battery-powered stimulator. Successful respiratory pacing with this system has been reported in over 100 SCI patients with up to ten years of use [2].A 12-Channel Neuroprosthetic Platform is being developed in a collaborative effort between Synapse Biomedical Inc and our laboratory, Research Service, Hines Veterans Administration Hospital, [3,4]. For this platform, several types of electrodes are under investigation including surface, mapping, intramuscular, and a multilead implantable cable with connectors. Several FES applications are also being investigated including respiration, urinary and muscle disuse atrophy with current work focused on optimization of stimulation. Further development of the neuroprosthetic platform is ongoing with a future goal of a small, home-use device.Optimization of respiratory stimulation is focused on extradiaphragmatic muscles. Positive inspiratory results were obtained in a canine model with surface electrodes applied to the upper thorax (submitted for publication). Large inspiratory volumes were also obtained using three or four sets of bilateral Permaloc ® electrodes implanted in intercostal spaces ventral to the axilla and stimulated at 50 Hz, and 30 to 50 mA [5][6][7]. Positive expiratory results were also obtained for abdominal muscles using surface and Permaloc ® electrodes [5][6][7]. Further work is needed to study effects of stimulation on muscle fatigue and metabolic responses. In one long term study we identified a problem with securing Permaloc ® electrodes in extradiaphragmatic muscles [8]. To address this concern we plan to test opening the polypropylene securing barb and snaking the electrode lead away from the muscle exit site and using multiple sutures. A future goal is to combine extradiaphragmatic muscles with diaphragm stimulation for a more complete respiratory and cough management program. A model of glottal closure for cough has been demonstrated [7].For urinary applications, we are investigating Permaloc ® Intramuscular Electrodes for direct bladder wall stimulation and voiding as well as bilateral pudendal nerve stimulation for neuromodulation and bladder inhibition [3,[8][9][10][11]. Successful clinical methods of Magasi and Simon [12] for direct bladder wall stimulation and Possover et al. [13] for pudendal nerve stimulation and neuromo...

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Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients

Cited by 158 publications

References 22 publications

Respiratory muscle pacing with chronically implanted intramuscular Permaloc electrodes: A feasibility study

Respiratory muscle pacing with chronically implanted intramuscular Permaloc electrodes: A feasibility study

Evaluation of Bipolar Permaloc™ Electrodes for Direct Bladder Stimulation

A 12-channel neuroprosthetic platform for SCI: Applications in the urinary, respiratory and muscle atrophy areas

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