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In vitro diagnosis of malignant hyperthermia: influence of electrical stimulation on the contracture response to caffeine.

We have examined the influence of electrical stimulation on caffeine-induced tension generation during contracture testing used to diagnose malignant hyperthermia. The cumulative contracture response to caffeine was compared in pairs of morphologically comparable muscle bundles obtained from the same patient. Only one of the two bundles was stimulated electrically during the test. Statistically significant differences in tension were found at caffeine concentrations greater than or equal to 4 mmol litre-1, the tension developed being invariably larger in the unstimulated fascicles. These results suggest that electrical stimulation results in suppression of the dose-dependent, caffeine-induced contracture. This effect could be a result of the potentiation of twitch tension by caffeine, muscle fatigue, or both. Overall, the observed differences did not alter the in vitro diagnosis of malignant hyperthermia.

Caffeine↗

Biopotentials as command and feedback signals in functional electrical stimulation systems.

Today Functional Electrical Stimulation (FES) is available as a clinical tool in muscle activation used for picking up objects, for standing and walking, for controlling bladder emptying, and for breathing. Despite substantial progress in development and new knowledge, many challenges remain to be resolved to provide a more efficient functionality of FES systems. The most important task of these challenges is to improve control of the activated muscles through open loop or feedback systems. Command and feedback signals can be extracted from biopotentials recorded from muscles (Electromyogram, EMG), nerves (Electroneurogram, ENG), and the brain (Electroencephalogram (EEG) or individual cells). This paper reviews work in which EMG, ENG, and EEG signals in humans have been used as command and feedback signals in systems using electrical stimulation of motor nerves to restore movements after an injury to the Central Nervous System (CNS). It is concluded that the technology is ready to push for more substantial clinical FES investigations in applying muscle and nerve signals. Brain-computer interface systems hold great prospects, but require further development of faster and clinically more acceptable technologies.

Action Potentials↗

Adaptive fuzzy logic restriction rules for error correction and safe stimulation patterns during functional electrical stimulation.

Adaptive restriction rules based on fuzzy logic have been developed to eliminate errors and to increase stimulation safety in the foot-drop correction application, specifically when using adaptive logic networks to provide a stimulation control signal based on neural activity recorded from peripheral sensory nerve branches. The fuzzy rules were designed to increase flexibility and offer easier customization, compared to earlier versions of restriction rules. The rules developed quantified the duration of swing and stance phases into states of accepting or rejecting new transitions, based on the cyclic nature of gait and statistics on the current gait patterns. The rules were easy to custom design for a specific application, using linguistic terms to model the actions of the rules. The rules were tested using pre-recorded gait data processed through a gait event detector and proved to reduce detection delay and the number of errors, compared to conventional rules.

Electric Stimulation Therapy↗

[Examination of the rectosphincteric reflex by means of endoscopic electrical stimulation. A new device].

An endoscopic electrical stimulation method (the new method) for the examination of the rectosphincteric reflex was devised to overcome difficulties attributable to the manometric method using balloon stimulation. Safety of the electrical stimulation under the conditions used routinely, was confirmed symptomatically and histologically. It was found that the optimal parameters of electrical stimulation to obtain the recto-sphincteric reflex were: 1 ms, 20 Hz, 5 to 7mA, and for 3 sec. The degree of the reflex relaxation became less and the time lag of the response to the stimulation became longer, as the distance of the stimulation site from the anal verge was increased. These relationships were significant. In the cases which received anterior resection of the rectum, the rectosphincteric reflex was examined using the new method. In 12 of 39 cases the recto-sphincteric reflex was induced by stimulation at the oral side of the anastomosis. In all of them the reflex was observed at 9 or more months postoperatively. Incidence of postoperative reflex appearance tended to be higher after end-to-end anastomosis than after side-to-end anastomosis. In two cases which received Duhamel-Okamoto's operation and in one which received Soave-Denda's operation, it was possible to analyze the relationship between the stimulating site and presence or absence of the reflex-like phenomenon.

Adult↗

Blood flow and muscle fatigue in SCI individuals during electrical stimulation.

Our purpose was to measure blood flow and muscle fatigue in chronic, complete, spinal cord-injured (SCI) and able-bodied (AB) individuals during electrical stimulation. Electrical stimulation of the quadriceps muscles was used to elicit similar activated muscle mass. Blood flow was measured in the femoral artery by Doppler ultrasound. Muscle fatigue was significantly greater (three- to eightfold, P < or = 0.001) in the SCI vs. the AB individuals. The magnitude of blood flow was not significantly different between groups. A prolonged half-time to peak blood flow at the beginning of exercise (fivefold, P = 0.001) and recovery of blood flow at the end of exercise (threefold, P = 0.009) was found in the SCI vs. the AB group. In conclusion, the magnitude of the muscle blood flow to electrical stimulation was not associated with increased muscle fatigue in SCI individuals. However, the prolonged time to peak blood flow may be an explanation for increased fatigue in SCI individuals.

Adult↗

Electrical stimulation of the median or dorsal raphe nuclei reduces light-induced FOS protein in the suprachiasmatic nucleus and causes circadian activity rhythm phase shifts.

Several pharmacological studies have suggested that the large median raphe serotonergic projection to the circadian clock in the suprachiasmatic nucleus may modulate circadian rhythm phase. The present experiments studied the role of dorsal and median raphe nuclei as regulators of circadian rhythmicity by evaluating the ability of electrical stimulation to shift rhythm phase or to alter photic induction of FOS protein synthesis. Male hamsters implanted with bipolar electrodes in either the median or dorsal raphe nucleus were stimulated during the early subjective night coincident with exposure to a saturating light pulse. About 90 min later, animals were anesthetized, perfused and the brains processed for FOS protein immunoreactivity. As previously demonstrated, light alone induces FOS immunoreactivity in nuclei of suprachiasmatic nucleus neurons. This was significantly attenuated by stimulation of either the median or dorsal raphe nucleus, with the extent of attenuation proportional to the intensity of stimulation. Electrical stimulation without light exposure had no effect on FOS expression. The effect of light on FOS expression in the suprachiasmatic nucleus was not modified by pre-treatment with the 5-HT1/2 serotonin receptor antagonist, metergoline, although it greatly reduced electrical stimulation-induced FOS expression in the hippocampus. In a second experiment, hamsters housed with running wheels in constant light were electrically stimulated in the median or dorsal raphe nucleus 6 h prior to (CT6) or 2 h after (CT14) expected activity onset. Regardless of which raphe nucleus was electrically stimulated, approximately 22 min phase advances were elicited at CT6 and 36 min phase delays were elicited at CT14. Despite the fact that the sole direct projection from the raphe complex to the suprachiasmatic nucleus is from the median nucleus, the present data do not distinguish between the median and dorsal raphe with respect to their impact on circadian rhythm regulation. Instead, two possible roles for each raphe nucleus are demonstrated. One main effect is that both raphe nuclei modulate rhythm phase. The second is an interaction between raphe efferent activity and light which, in the present studies, is demonstrated by the ability of raphe stimulation to modulate the action of light on the circadian system. While serotonin is a likely neurotransmitter mediating one or both effects, alternatives such as GABA, must be considered.

Animals↗

Evaluation of cutaneous sensation in myelodysplastic children, using electrical stimulation.

A new method, cutaneous electrical stimulation, was compared with the standard neurological examination for its effectiveness in detecting cutaneous sensation. Both methods provided clear and congruous results for 45 per cent of the patients. However, for the other 55 per cent, cutaneous electrical stimulation frequently detected sensation at sites which were classified as anaesthetic on standard neurological examination. Electrical stimulation also was able to indicate sensation in a group of infants too young to be evaluated by standard neurological evaluation.

Adolescent↗

A novel MEA/AFM platform for measurement of real-time, nanometric morphological alterations of electrically stimulated neuroblastoma cells.

Studies of electrically induced morphological changes in neurons have either been limited by the resolution of light microscopy or the cell fixation required for electron microscopy. Atomic force microscopy (AFM), however, mechanically maps cell topography, offering exquisite resolution of evolving processes in three dimensions. In this paper, we present a microelectrode array (MEA) based platform for the real-time detection of subtle, electrically induced variations in neuronal morphology, with AFM. This platform required the customized design and production of a silicon-based MEA, integration with a commercial AFM, and the development of biological techniques for culture of neuroblastoma (SH-SY5Y) cells onto the device. Biphasic pulse trains (1 Hz) of electric current were delivered to a microelectrode interfaced with a neuroblastoma cell, and the AFM continuously recorded a cross-sectional height profile. Proof-of-principle experiments demonstrate that electric stimulation may induce fluctuations ranging in the 100-300-nm range, 75-fold greater than the systemic resolution, but smaller than the resolution of light microscopy modalities. In addition, the real-time capabilities of AFM captured a collapse (30%-40%) of a neurite cross section, seconds after electric stimulation. Ultimately, this platform can be used to nanocharacterize cell responses to electric stimulation and other biochemical cues, for use in neuronal patterning and regeneration studies.

Cell Culture Techniques↗

Cardiovascular responses to chemical and electrical stimulation of amygdala in rats.

Electrical stimulation of the amygdala has been shown to produce changes in cardiovascular variables. To locate neuronal cell bodies responsible for these changes, responses of arterial pressure (AP) and heart rate (HR) to DL-homocysteate (DLH, 0.15 M, 50-100 nl) microinjected into sites in three amygdaloid nuclei were compared with responses to electrical (90-150 microA) stimulation of the same sites in 35 artificially ventilated, paralyzed, urethan-anesthetized rats. Electrical stimulation resulted in depressor responses in most sites (89%). Changes in AP were accompanied by variable changes in HR. Chemical stimulation produced significantly fewer (25%) depressor responses. Similar results were obtained with injections of 1.0 M DLH. To eliminate the influence of the anesthetic on these responses, AP was recorded in nine conscious rats while stimulating the amygdala. Changes in behavior and AP in these animals could be obtained only by electrical stimulation. These results may be interpreted to indicate either that cell bodies responsible for changes in cardiovascular variables during electrical stimulation are not located in the amygdala or that chemical and electrical stimulation affect different neuronal elements in circuits located in the same anatomic site.

Amygdala↗

Apparent water diffusion measurements in electrically stimulated neural tissue.

The effect of stimulation on diffusion characteristics of electrically stimulated neural tissue was examined. Bullfrog nerves and spinal cords were excised and stimulated electrically during magnetic resonance imaging, and the apparent diffusion coefficients (ADCs) of water parallel and perpendicular to the long axes of the specimens were mapped with and without stimulation of the tissue. Electrophysiological recordings were used to determine the viability of the tissue after each experiment. No stimulus-related ADC changes were observed in either the peripheral nervous system or the central nervous system tissue. These experiments may help to define further the nature of previously reported ADC changes in stimulated neural tissue in situ.

Animals↗

Masked cochlear whole-nerve response intensity functions altered by electrical stimulation of the crossed olivocochlear bundle.

Cochlear whole-nerve response (CAP) intensity functions were recorded from the guinea pig round window. The intensity functions were obtained in the presence of masking noise, with electrical stimulation of the crossed olivocochlear bundle (COCB), and the combination of masking noise and COCB stimulation. Electrical stimulation of the COCB produced the expected reduction of CAP magnitude for low- to moderate-intensity tone bursts. Masking noise produced reductions in CAP magnitude over the whole signal intensity range used in this study. The combination of electrical stimulation of the COCB with the masking noise produced CAP magnitude changes graded between reduction and enhancement dependent on signal and masker levels. In general, at low signal levels, the masked CAP magnitude is reduced compared to the masked alone condition. At high signal levels, the masked CAP is increased in magnitude. These results confirm and extend the earlier observations of Nieder and Nieder [Exp. Neurol. 28, 174-188 (1970); also, Nature 227, 184-185 (1970)].

Animals↗

Applying fuzzy logic to control cycling movement induced by functional electrical stimulation.

This study examines the design of a rational stimulation pattern for electrical stimulation and a robust closed-loop control scheme to improve cycling system efficacy for subjects with paraplegia. The stimulation patterns were designed by analyzing gravitation potential needed for the cycling movement of the lower limbs against a frictionless cycling ergometer and the response delay of electrically stimulated muscles. To simplify the cycling control system, the stimulation patterns were fixed and only the single gain of the stimulation patterns was adjusted via a feedback control algorithm. To circumvent the complexity involved with exactly modeling a stimulated muscle and cycling ergometer, a model-free fuzzy logic controller (FLC) was adopted herein for our control scheme. Comparison between FLC and conventional proportional-derivative (PD) controllers demonstrated that the FLC with asymmetrical membership function enabled the subject with paraplegia to maintain varied desired cycling speeds, particularly at lower cycling speed. By incorporating the rational stimulation patterns, the FLC can produce a smooth and prolonged cycling movement deemed necessary for designing various training protocols.

Biomedical Engineering↗

Stochastically-modulated stimulation to slow down muscle fatigue at stimulated sites in paraplegics using functional electrical stimulation for leg extension.

This short communication is a preliminary report on a study concerning slowing down the rate of muscle fatigue when FES (Functional Electrical Stimulation) is applied for standing and walking by complete (traumatic) thoracic-level paraplegics. It is shown that randomly modulating the inter-pulse interval between FES pulses (which serve to trigger action potentials in the peripheral nerves concerned) results in a significantly lower rate of muscle fatigue, as tested in a series of leg extensions, when FES was applied at the quadriceps. Specifically, we report that the best results (longest durations of leg extension prior to onset of muscle-fatigue) were achieved with a +/- 5 msec uniformly-distributed (pseudo-) white-noise modulation at a 42 msec inter-pulse interval (24 pulses per sec). These resulted in an average increase in duration of leg extension of approximately 37% in this pilot study, as compared with unmodulated (fixed-rate) trains of FES pulses. This significant increase, even in a very preliminary study appears to merit careful further examination, since it may allow a possibly significant increase in standing duration and in walking range of paraplegics using FES for ambulation.

Electric Stimulation Therapy↗

Self-triggered functional electrical stimulation during swallowing.

Hyolaryngeal elevation is essential for airway protection during swallowing and is mainly a reflexive response to oropharyngeal sensory stimulation. Targeted intramuscular electrical stimulation can elevate the resting larynx and, if applied during swallowing, may improve airway protection in dysphagic patients with inadequate hyolaryngeal motion. To be beneficial, patients must synchronize functional electrical stimulation (FES) with their reflexive swallowing and not adapt to FES by reducing the amplitude or duration of their own muscle activity. We evaluated the ability of nine healthy adults to manually synchronize FES with hyolaryngeal muscle activity during discrete swallows, and tested for motor adaptation. Hooked-wire electrodes were placed into the mylo- and thyrohyoid muscles to record electromyographic activity from one side of the neck and deliver monopolar FES for hyolaryngeal elevation to the other side. After performing baseline swallows, volunteers were instructed to trigger FES with a thumb switch in synchrony with their swallows for a series of trials. An experimenter surreptitiously disabled the thumb switch during the final attempt, creating a foil. From the outset, volunteers synchronized FES with the onset of swallow-related thyrohyoid activity (approximately 225 ms after mylohyoid activity onset), preserving the normal sequence of muscle activation. A comparison between average baseline and foil swallows failed to show significant adaptive changes in the amplitude, duration, or relative timing of activity for either muscle, indicating that the central pattern generator for hyolaryngeal elevation is immutable with short term stimulation that augments laryngeal elevation during the reflexive, pharyngeal phase of swallowing.

Adult↗