Spiral Cuff for Fiber-Diameter Selective VNS

Authors: P. Pečlin, J. Rozman

Abstract:

In this paper we present the modeling, design, and experimental testing of a nerve cuff multi-electrode system for diameter-selective vagus nerve stimulation. The multi-electrode system contained ninety-nine platinum electrodes embedded within a self-curling spiral silicone sheet. The electrodes were organized in a matrix having nine parallel groups, each containing eleven electrodes. Preliminary testing of the nerve cuff was performed in an isolated segment of a swinish left cervical vagus nerve. For selective vagus nerve stimulation, precisely defined current quasitrapezoidal, asymmetric and biphasic stimulating pulses were applied to preselected locations along the left vagus segment via appointed group of three electrodes within the cuff. Selective stimulation was obtained by anodal block. However, these pulses may not be safe for a long-term application because of a frequently used high imbalance between the cathodic and anodic part of the stimulating pulse. Preliminary results show that the cuff was capable of exciting A and B-fibres, and, that for a certain range of parameters used in stimulating pulses, the contribution of A-fibres to the CAP was slightly reduced and the contribution of B-fibres was slightly larger. Results also showed that measured CAPs are not greatly influenced by the imbalance between a charge Qc injected in cathodic and Qa in anodic phase of quasitrapezoidal, asymmetric and biphasic pulses.

Keywords: Vagus nerve stimulation, multi-electrode nerve cuff.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1062446

References:

[1] A. V. Zamotrinsky, B. Kondratiev, and J. W de Jong, "Vagal neurostimulation in patients with coronary artery disease," Auton Neurosci, vol. 88, pp. 109-116, April 2001.
[2] B. Olshansky, H. N. Sabbah, P. J. Hauptman, and W. S. Colucci, "Parasympathetic nervous system and heart failure: pathophysiology and potential implications for therapy," Circulation, vol. 118(8), pp. 863-71, August 2008.
[3] G. M. De Ferrari, A. Sanzo, and P. J. Schwartz, "Chronic vagal stimulation in patients with congestive heart failure," in Proc 31st Ann Int Conf IEEE Eng Med Biol Soc, Minneapolis, 2009, pp. 2037-2039.
[4] C. Heck, S. L. Helmers, and C M. DeGiorgio, "Vagus nerve stimulation therapy, epilepsy, and device parameters: scientific basis and recommendations for use," Neurology, vol. 59, pp. S31-S37, September 2002).
[5] D. M. Labiner and G. L. Ahern, "Vagus nerve stimulation therapy in depression and epilepsy: therapeutic parameter settings," Acta Neurol Scand, vol. 115(1), pp. 23-33, January 2007.
[6] A. P. Amar, C. N. Heck, M. L. Levy, T. Smith, C. M. DeGiorgio, S. Oviedo, and M. L. J. Apuzzo, "An Institutional Experience with Cervical Vagus Nerve Trunk Stimulation for Medically Refractory Epilepsy: Rationale, Technique and Outcome," Neurosurgery, vol. 43, pp. 1265-1280, December 1998.
[7] I. I. Ali, N. A. Pirzada, Y Kanjwal, B. Wannamaker, M. Medhkour, M. T. Koltz, and D. V. Vaughn, "Complete Heart Block with Ventricular Asystole During Left Vagus Nerve Stimulation for Epilepsy," Epilepsy and Behavior, vol. 5(5), pp. 768-71, 2004.
[8] A. Vuckovic, J. J. Struijk, and N. Rijkhoff, "Diameter selective nerve fiber stimulation in the vagal nerve using anodal block, depolarising prepulses and long exponentially rising pulses," in Proc 9th Ann Conf International Functional Electrical Stimulation Society, Bournemouth, 2004, pp. 330-332.
[9] R. B. Stein, D. Charles, L. Davis, J. Jhamandas, A. Mannard, and T. R. Nichols, "Principles underlying new methods for chronic neural recording," Can J Neurol Sci, vol. 2, pp. 235-244, August 1975.
[10] J. J. Struijk, "The Extracellular Potential of a Myelinated Nerve Fiber in an Unbounded Medium and in Nerve Cuff Models," Biophysical Journal, vol. 72(6), pp. 2457-2469, June 1997.
[11] J. Taylor, N. Donaldson, and J. Winter, "Multiple-electrode nerve cuffs for low-velocity and velocity-selective neural recording," Med Biol Eng Comput, vol. 42, pp. 634-643, September 2004.
[12] J. D. Sweeney, D. A. Ksienski, and J. T. Mortimer, "A nerve cuff technique for selective excitation of peripheral nerve trunk regions," IEEE Trans Biomed Eng, vol. 37(7), pp. 706-15, July 1990.
[13] E.V. Goodall, L. M. Kosterman, J. Holsheimer, and J. J. Struijk, "Modeling study of activation and propagation delays during stimulation of peripheral nerve fibers with a tripolar cuff electrode," IEEE Trans Rehab Eng, vol. 3, pp. 272-282, September 1995.
[14] D. R. McNeal and B. R. Bowman, "Selective activation of muscles using peripheral nerve electrodes," Med & Biol Eng & Comput, vol. 23, pp. May 249-253, 1985.
[15] A. Q. Choi, J. K. Cavanaugh, and D. M. Durand, "Selectivity of Multiple-Contact Nerve Cuff Electrodes: A Simulation Analysis," IEEE Trans Biomed Eng, vol. 48, pp. 165-172, February 2001.
[16] J. Rozman, P. Pe─ìlin, I. Kneževi─ì, T. Mirkovi─ì, B. Ger┼íak, and M Podbregar, "Heart function influenced by selective mid-cervical left vagus nerve stimulation in a human case study," Hypertens res, vol. 32(11), pp. 1041-1043, November 2009.
[17] S. Sunderland and G. M. Bedbrook, "The cross-sectional area of peripheral nerve trunks occupied by the fibres representing individual muscular and cutaneous branches," Brain, vol. 72, pp. 613-624, September 1994.
[18] J. K. Tezis and K. L. Smith, The Peripheral Nerve: Structure, Function and Reconstruction. Raven Press, New York, 1990.
[19] W. F. Agnew and D. B. McCreery, "Considerations for safety with chronically implanted nerve electrodes, Epilepsia, vol. 31 Suppl 2, pp. 27-32, 1990.
[20] B. Onaral, H. H. Sun and H. P. Schwan, "Electrical properties of bioelectrodes," IEEE Trans Biomed Eng vol. 31(12), pp. 827-32, December 1984.
[21] J. D. Sweeney and J.T. Mortimer, "An asymmetric two electrode cuff for generation of unidirectionally propogated action potentials," IEEE Trans Biomed Eng, vol. 33(6), pp. 541 -549, June 1986.
[22] J. F. X. Jones, Y. Wang, and D. Jordan, "Heart rate responses to selective stimulation of cardiac vagal C fibres in anaesthetized cats, rats and rabbits," J Physiol, vol. 489, pp. 203-214, November 1995.
[23] A. Zagon and A. A. Kemeny, "Slow hyperpolarization in cortical neurons: a possible mechanism behind vagus nerve simulation therapy for refractory epilepsy?" Epilepsia, vol. 41(11), pp. 1382-1389, November 2000.
[24] M. Tosato, K. Yoshida, E Toft, and J. J. Struijk, "Quasi-trapezoidal pulses to selectively block the activation of intrinsic laryngeal muscles during vagal nerve stimulation," J Neural Eng, vol. 4(3), pp. 205-212, April 2007.