Evaluation of Bipolar Permaloc™ Electrodes for Direct Bladder Stimulation

Walter, James S.; Allen, J. Corey; Sayers, Scott; Singh, Sanjay; Cera, Lee; Thomas, D. K.; Wheeler, John S.; Ave, S. Michigan

doi:10.2174/1874943701205010014

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…Terminal studies were conducted in 14-23 kg (mean weight: 17.5 + 0.6 kg; n=11) canines of either sex (Oak Hills Genetics, Inc; St. Louis, MO). Anesthesia was initiated with intravenous propofol (3-6 mg/kg, IV to effect) in the cephalic vein prior to intubation; next isoflurane (0.5% to effect) was delivered through an endotracheal tube in combination with continuous IV infusion of fentanyl (5-10 mcg/kg/hr) [12]. During surgery, animals were artificially ventilated to maintain an end-tidal CO 2 partial pressure of 35 mmHg.…”

Section: Materials and Methodologymentioning

confidence: 99%

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Stimulation Along the Vagal Pre and Postganglionic Pathway to Selectively Enhance Vagal Tone to the Heart

Sayers¹,

Thomas²,

Walter³

et al. 2013

TOCTSJ

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Objectives: Sympathetic overactivity and vagal withdrawal are cardinal presentations in patients with heart failure that predisposes them to malignant arrhythmias and sudden cardiac death. To develop therapy to enhance vagal tone and regain autonomic balance we conducted stimulation recruitment tests at three locations along the cardiac vagal pathway. Materials and Methodology: In anesthetized canines, small electrodes were placed against the vagus nerve (n=4) or in epicardial fat containing the sinoatrial or ventricular cardiac ganglia (n=8). Results: Stimulation of the vagus nerve induced vocal cord evoked potentials at 0.5 mA and increases in heart rate at 1.3 ± 0.3 mA. Higher currents were needed to induce parasympathetic effects of decreased heart rate and blood pressure, 3.7 ± 1.0 mA. Stimulation of the sinoatrial node ganglia decreased heart rate at a threshold current of 4.4 ± 2.1 mA. Stimulation of the ventricular ganglia, produced sympathetic effects at 9.3 ± 0.7 mA of current and ventricular arrhythmias or pacing at 10.7 ± 0.7 mA; using small wire electrodes unwanted sympathetic and ventricular pacing effects occurred at even lower stimulating currents. Conclusion: Our results show that the effects of stimulation are highly dependent upon the site of stimulation and stimulation currents. Further, given the significant side effects of whole nerve stimulation an important need exists for more selective vagal and cardiac ganglia stimulation technology as offered by microelectrode arrays.

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Section: Materials and Methodologymentioning

confidence: 99%

“…Pulse stimulators (S-88, Astromed, Inc; West Warwick, RI) with capacitor-coupled charge balancing were used at 20 Hz frequency and 1 ms pulse duration [12]. Recruitment testing was conducted with stepwise increases in the current from 0.5 mA to 6 mA every 5 to 10 s. Currents were increased until there was a heart rate slowing of 40 bpm.…”

Section: Vagus Nervementioning

confidence: 99%

Stimulation Along the Vagal Pre and Postganglionic Pathway to Selectively Enhance Vagal Tone to the Heart

Sayers¹,

Thomas²,

Walter³

et al. 2013

TOCTSJ

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“…Between 1993 and 1997 woven-eye and suture electrodes were tested on the bladder wall [37,38,49] and in 2005 microstimulators were tested [50]. In 2008 we also tested monopolar Permaloc ® Intramuscular electrodes [51]. The above studies were conducted in several different animal models including acute felines and canines with intact spinal cords and chronic SCI felines both with lower and upper motor neuron lesions.…”

Section: Dbws Studiesmentioning

confidence: 99%

Neuroprosthetics for SCI Bladder Management: The Argument for Direct Bladder Stimulation

Walter¹,

Wheeler²,

Bresler³

et al. 2014

Int J Phys Med Rehabil

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Implantable neuroprosthetic systems are an important area of practice and research in urinary care for individuals with spinal cord injury (SCI). These devices need to manage three lower urinary tract conditions: urethral sphincter contractions during bladder contractions, an underactive bladder producing poor voiding responses, and neurogenic detrusor overactivity causing urinary incontinence. Two neuroprosthetic approaches have addressed these conditions: sacral anterior root stimulation (SARS) and direct bladder wall stimulation (DBWS). The SARS approach is commercialized for SCI bladder management as the Brindley-Finetech Bladder Control System and is available in Europe. Limitations of this device include invasive surgery and the need for rhizotomy of sacral dorsal (sensory) nerve roots. The DBWS implants produced daily voiding in many SCI individuals, however, clinical use was discontinued primarily because of technical concerns with stimulators and electrodes as well as some cases of poor voiding responses and side effects. These limitations are reviewed as well as efforts to return DBWS to clinical investigations using Permaloc ® Systems (Synapse Biomedical Inc., Oberlin OH). This new neuroprosthetic platform includes mapping and intramuscular electrodes as well as multilead cables and new stimulator devices.

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“…Our laboratory has been developing bladder stimulation methods by testing electrodes on post pelvic-plexus nerves innervating the bladder. [15][16][17][18] In the current animals, and reported elsewhere, 19 direct bladder wall stimulation using the bipolar Permaloc TM electrodes was also used and may be useful in SCI patients.…”

Section: 10mentioning

confidence: 99%

Comparison of Bipolar Lead Electrodes for High-Frequency Blocking of the Pudendal Nerve

Allen¹,

Walter²,

Sayers³

et al. 2012

IJU

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Aims: High-frequency (HF) pudendal-nerve blocking that includes lead electrodes on the nerve are needed for spinal cord injury (SCI) patients to manage detrusor sphincter dyssynergia (DSD) that causes high urethral resistance. Several bipolar lead electrodes were compared using HF blocking stimulation parameters. Methods: Seven swine were anesthetized and urethral and anal sphincter pressures recorded. The left pudendal nerve adjacent to the sacral spine was exposed and proximal electrode used to induce intermittent contractions of urethral and anal sphincters. Blocking of sphincter contractions with electrodes at a distal location on the pudendal nerve with HF was evaluated. Initial HF tests used bipolar TECA R electrodes at 1.2, 10 and 40 kHz; then, different electrodes and stimulating parameters were evaluated.Results: Initial results with HF demonstrated blocking of intermittent sphincter contractions induced by the proximal nerve electrode. Sphincter contraction blocking was greatest at 1.2 and 10 kHz at currents above 0.25 mA and was reduced at 40 kHz. Sphincter pressures, however, were elevated at the end of the 15 seconds of HF stimulation. These unwanted stimulatory effects on sphincter contraction were greatest at 1.2 kHz, reduced at 10 kHz, and least at 40 kHz. Further tests showed reduced nerve blocking effects using electrodes separated from the nerve or small helical Permaloc electrodes. Cutting the pudendal nerve centrally had no effect indicating that afferent fibers were not involved in the HF blocking effects. Conclusions: Bipolar TECA R lead electrodes on the pudendal nerve stimulated at 10 kHz with1 to 5 mA of current were most effective in their nerve blocking effects with least unwanted stimulator effects. Nerve blocking without unwanted nerve stimulation was not observed with the variables tested. Therefore, unwanted stimulatory side effects should be anticipated in SCI patients when HF nerve blocking of the pudendal nerve with lead electrodes is implemented for urethral resistance. Thus, further testing is needed.

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Evaluation of Bipolar Permaloc™ Electrodes for Direct Bladder Stimulation

Cited by 9 publications

References 27 publications

Stimulation Along the Vagal Pre and Postganglionic Pathway to Selectively Enhance Vagal Tone to the Heart

Stimulation Along the Vagal Pre and Postganglionic Pathway to Selectively Enhance Vagal Tone to the Heart

Neuroprosthetics for SCI Bladder Management: The Argument for Direct Bladder Stimulation

Comparison of Bipolar Lead Electrodes for High-Frequency Blocking of the Pudendal Nerve

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