Spiral Cuff for Fiber-Diameter Selective VNS

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.




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.