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Modification of blood flow to the extremities by electrical stimulation of the nervous system.

Sixteen patients who had electrical stimulation applied to various portions of the nervous system were examined for increase in blood flow to the extremities. Clinical observations and a one-channel plethysmograph were used to measure arterial dilatation. Seven patients had transcutaneous stimulation applied over the cervical or thoracic spinal cord, peripheral nerves, or low lumbar region; eight had electrical stimulators implanted over the spinal cord in attempts to relieve intractable pain or some of the symptoms of multiple sclerosis; and one patient had electrical stimulators implanted over the C-6 dorsal roots for small artery disease of the upper extremities. Twelve of 13 patients who had electrical stimulation applied to the spinal cord or dorsal roots had significant arterial dilatation in one or more extremities. Electrical stimulation applied to the ulnar nerves did cause arterial dilatation. One patient did not show any change in the central arterial pressure curve during transcutaneous stimulation of the cervical spinal cord.

Blood Flow Velocity↗

Treatment of motor and sensory detrusor instability by electrical stimulation.

A new application of electrical stimulation to inhibit detrusor activity has been used in 15 patients with a variety of neural lesions. The results were astonishingly good and the device was well tolerated. In patients treated successfully for detrusor instability an absence of urgency occurred as a by-product of electrical stimulation. Therefore, stimulation was used to treat uncomfortable bladder urgency without detrusor instability and was successful in the majority of patients.

Adult↗

Electrical stimulation of hybridoma cells producing monoclonal antibody to cAMP.

Electrical stimulation was applied to hybridoma cells in order to activate metabolic activities and increase the monoclonal antibody production. Hybridoma cells that produce monoclonal antibody to adenosine 3':5'-cyclic monophosphate were placed on a transparent glass electrode immersed in medium and subjected to electric pulses (pulse shape, alternating rectangular; field strength, 4 X 10(3) V X m-1; frequency, 5 kHz; pulse mode, 0.5 min application and 4.5 min pause). After 48 h of incubation, the concentration of lactic acid in the medium reached 8.4 mM, approx. 30% higher than that obtained without electric stimulation. Similarly, cell growth rate was promoted by the electric stimulation, reaching a maximum stimulation after 40 h. When the hybridoma was cultured for 48 h with electrical stimulation, the antibody concentration in the medium reached 22.3 microgram X ml-1, approx. 10% higher than the control, with a concomitant 16% increase in cell concentration. Longer periods of electric pulse application, however, caused an inhibitory effect on the hybridoma growth. The most probable cause of the inhibition are reactive oxygen species such as superoxide and hydrogen peroxide, which are inevitably generated by electrolysis. The presence of superoxide dismutase (EC 1.15.1.1) reduced the inhibitory effects. In conclusion, metabolic activities including monoclonal antibody production were activated by the electrical stimulation.

Animals↗

Electrical stimulation of osteogenesis.

The three electrical stimulation systems available for treating nonunion of long bones are successful in approximately 85% of cases. The percutaneous direct current bone growth stimulator is partially invasive, allows patient mobility, can be used with magnetic fixation devices, and can be monitored for proper function, but it requires an operation, cannot be used where infection exists, and is subject to breakage. The implantable direct current bone growth stimulator is similar, but is totally invasive. The external pulsing electromagnetic field bone growth stimulator is noninvasive and can be used where infection exists, but it requires long, exact patient compliance and cannot be used with magnetic fixation devices or at certain sites. None of the systems can be used where synovial pseudarthrosis or a sizeable gap between bone ends exists, nor are they more effective than bone grafting. Whether their use might evoke malignant transformation or might accelerate or retard epiphyseal growth patterns is not known. Many controlled studies are needed before it is clear how commonly electrical stimulation should be used to treat bony ununion.

Bone Transplantation↗

[Muscle electric stimulation in sports medicine].

Neuromuscular electrical stimulation (NMES) is frequently used to strengthen the normal muscle. In medicine, several investigators have highlighted the value of NMES when treating amyotrophy related to immobilization. The efficacy of NMES of the quadriceps during rehabilitation following anterior cruciate ligament surgery has been well documented. These electrical stimulation programs are composed of stimulation--rest cycles and are performed with the aid of percutaneous electrodes situated in regard to muscle motor points. The stimulation frequency is chosen to induce tetanic contractions and is generally situated between 50 and 100 Hz. During NMES, the trainer or the physiotherapist can accurately modulate a large number of parameters but the sensory discomfort linked to the current intensity remains the major limitation for strength improvement. In the context of rehabilitation, the association of NMES with voluntary exercises is superior to the isolated utilization of the classic program composed of isometric voluntary contractions. To explain this advantage of associating NMES with voluntary contractions, it has been hypothesized that the electrically induced contractions impose specific patterns of muscle recruitment and a particular metabolic solicitation.

Anterior Cruciate Ligament Injuries↗

Quantitative estimation of anaerobic and oxidative energy metabolism and contraction characteristics in intact human skeletal muscle in response to electrical stimulation.

A set up for electrical stimulation of the human quadriceps femoris muscle and registration of tension is described. Normal values for the frequency-tension relations and relaxation time are presented. There was no relationship between contraction characteristics and fibre type distribution. Muscle tissue was sampled after electrical stimulation by percutaneous biopsy technique. Phosphocreatine (PCr) decreased during a 75 s isometric contraction from 76 mmol per kg dry muscle down to a mean value of 9 mmol. Lactate increased during the same time period from 5 mmol per kg dry muscle to 100 mmol. At end of contraction there was a rapid resynthesis of PCr with a half time of about 20 s while the lactate content decreased slowly. The relaxation time of the muscle was prolonged from 38 ms, in non-fatigued muscle, to 128 ms after 75 s of isometric contraction. The relaxation time was normalized after the contraction at the same rate as the resynthesis of PCr. It is proposed that the relationship between PCr and lactate of contracting muscle can be used as an index of glycolytic capacity and that the rate of resynthesis of PCr after contraction is a measure of oxidative capacity. Relaxation time measurements alone may be used as a non-invasive estimation of the oxidative capacity.

Adenosine Diphosphate↗

Effects of locus coeruleus stimulation on the responses of SI neurons of the rat to controlled natural and electrical stimulation of the skin.

1. The effects of microstimulation of the locus coeruleus (LC) region on the spontaneous discharge and the response of SI neurons to natural and electrical stimulation of the skin have been investigated in 26 urethane anesthetized Sprague-Dawley rats. In particular, one or two air puffs, 5-10 msec in duration, 1-2 psi, usually separated by an interval of 40 msec, were applied on the hairy skin of the wrist or the forepaw at the presentation rate of 1/sec. For units unresponsive to air puffs, similar presentation of low intensity electrical stimuli (0.2-5.0 V, 0.2-0.4 msec pulses) were applied through two needles inserted on the most effective area of the skin. Both natural and electrical stimulations of the skin were applied under control conditions, as well as 50 msec after a 250 msec train of 0.3 msec pulses at 40 Hz. 20-30 microA applied stereotaxically to the LC complex through a tungsten microelectrode. 2. Not all cortical units exhibited spontaneous discharge. Most of the units, however, which were spontaneously active, were inhibited by electrical stimulation of the LC complex, while the remaining ones were excited. The sites of stimulation, which included either the LC proper or the locus subcoeruleus, were identified following both anatomical and physiological criteria. 3. SI neurons recorded at sites between 400 and 950 microns below the surface of the cortex, thus being most likely granule cells of layers III and IV, responded to cutaneous stimuli with spikes which occurred with a latency of 20-30 msec in response to single air puffs and a latency of 15-20 msec in response to single electrical pulses to the skin. In both instances the response to the second stimulus applied at the interstimulus interval of 40 msec was markedly reduced or abolished due to postexcitatory inhibition following the response to the first stimulus (in-field inhibition). In contrast, units particularly located at or below 1000 microns from the cortical surface, which were of very large size probably corresponding to large layer V pyramidal cells, were often difficult to activate with air puffs applied at the centre of the receptive field (RF) and were submitted to electrical stimulation of the skin. 4. Among the 59 isolated SI units tested either to air puffs (45 neurons) or to electrical skin stimulation (14 neurons), 15 units (i.e., 25.4%) were facilitated, while 12 units (i.e., 20.3%) were inhibited following stimulation of the LC complex. 5. A marked feature of the facilitatory effects which usually involved the predominant response to the first air puff, but also the smaller response to the second puff, was that the increase in the number of spikes per stimulus was accompanied by a temporal focusing of the responses characterized by a clear tightening of the latency and narrowing of the peak of activity, which was often accompanied by some level of tonic inhibition of the background discharge. Thus, LC stimulation increased the signal-to-noise ratio of SI neuronal responses to skin stimulation. When inhibitory effects were induced by LC stimulation, they clearly affected the unit response to the first air puff, which was severely depressed. However, the response to the second puff could be facilitated, suggesting that LC stimulation might have produced inhibition of those inhibitory interneurons responsible for the postexcitatory inhibition of the units under examination. Evidence for spatial focusing of the response was not easily documented. In some units, however, LC stimulation produced either facilitation of the responses to puffs at the receptive field center and inhibition of the responses to puffs at the edge at the receptive field or vice versa. 6. Since the LC complex contains in the rat a predominant population of noradrenergic neurons, it is likely that the effects described above were mainly due to activation of these noradrenergic neurons. 7. (ABSTRACT TRUNCATED)

Animals↗

Effect of noxious electrical stimulation of the peroneal nerve on stretch reflex activity of the hamstring muscle in rats: possible implications of neuronal mechanisms in the development of tight hamstrings in lumbar disc herniation.

STUDY DESIGN: The effect of noxious electrical stimulation of the peroneal nerve on the stretch reflex electromyogram activity of the hamstring muscle (semitendinous) was studied. OBJECTIVE: To verify the following hypothetical mechanisms underlying tight hamstrings in lumbar disc herniation: stretch reflex muscle activity of hamstrings is increased by painful inputs from an injured spinal nerve root and the increased stretch reflex muscle activity is maintained by central sensitization. SUMMARY OF BACKGROUND DATA: It is reported that stretch reflex activity of the trunk muscles is induced by noxious stimulation of the sciatic nerve and maintained by central sensitization. METHODS: In spinalized rats (transected spinal cord), the peroneal nerve was stimulated electrically as a conditioning stimulus. Stretch reflex electromyogram activity of the semitendinous muscle was recorded before and after the conditioning stimulus. RESULTS: Even after electrical stimulation was terminated, an increased stretch reflex activity of the hamstring muscle was observed. CONCLUSIONS: It is likely that a central sensitization mechanism at the spinal cord level was involved in the increased reflex activity. Central sensitization may play a part in the neuronal mechanisms of tight hamstrings in lumbar disc herniation.

Animals↗

Depletion of calcitonin gene-related peptide from the caudal trigeminal nucleus of the rat after electrical stimulation of the Gasserian ganglion.

Electrical stimulation of the Gasserian ganglion resulted in partial depletion of calcitonin gene-related peptide (CGRP) from ipsilateral central terminals of pseudounipolar primary sensory ganglion cells. Affected terminals exhibit decreased CGRP immunoreactivity as shown by cytophotometric densitometry of the caudal trigeminal nucleus. The decrease in CGRP immunoreactivity is statistically significant only in the medial one-third of the caudal trigeminal nucleus. Since earlier studies have shown that electrical stimulation of the Gasserian ganglion induces first accumulation then depletion of CGRP from perivascular sensory terminals in the dura mater, the present experiments suggest that CGRP is depleted also from central terminals of primary sensory trigeminal neurons, which might be of importance in the pathogenesis of migraine headache.

Animals↗

Dual effects on gastric acid secretion of electrical stimulation of anterior parts of the rat hypothalamus.

The effect of electrical stimulation of anterior parts of the hypothalamus on gastric acid secretion was examined in rats anesthetized with urethane. Electrical stimulation (0.5 mA, 2 msec, 10 Hz, for 10 min) of the lateral hypothalamic area (LHA) induced a marked increase in basal gastric acid output. Electrical stimulation of the preoptic area (PO), the paraventricular nucleus (PVN) and the anterior hypothalamus (AH) also induced increases in basal acid secretion. Electrical stimulation of the PO, PVN and AH inhibited the increase in acid secretion induced by electrical stimulation of the vagus nerve (1 mA, 0.5 msec, 3 Hz). These inhibitory effects were abolished by bilateral cutting of the splanchnic nerves. On the other hand, the stimulation of the LHA had no effects on vagally stimulated gastric acid secretion. Electrical stimulation of the anterior parts of the hypothalamus induces dual effects, vagally mediated increases in basal gastric acid output and splanchnic mediated inhibition of the vagally stimulated gastric acid output.

Animals↗

Postoperative analgesia by percutaneous electrical stimulation in gynecology and obstetrics.

Percutaneous electrical stimulation (PES) for relief of acute postoperative pain was applied in 10 patients after cesarean section and in 20 women who had undergone various gynecological operations. Thirty other women, subjected to identical surgical interventions, served as controls. In the latter group, the electrodes were attached to a nonfunctioning apparatus. In all patients, including the controls, the two electrodes were introduced intradermally, one on each side of the incision. Implantation was carried out at the end of the surgical procedure while the patient was still anesthetized, and stimulation was commenced immediately. The electrical stimulation was applied continuously for 1 to 3 postoperative days. The generation of pulses was perceived by the patients as a tingling sensation. Complete pain relief was obtained in 40% of the patients treated with PES, whilst in 27% the pain was markedly diminished. Postoperative analgesic medication in this group was reduced by 50-80% as compared to the analgesic requirements in the control group. Other beneficial effects observed in the treated patients included early ambulation, early peristalsis, postpartum uterine contractions and absence of respiratory complications.

Adnexa Uteri↗

Therapeutic electrical stimulation. The transistorized placebo?

(1) Electrical stimulation therapy for patients suffering with labile signs and symptoms, and these include all varieties of acute and chronic pains, seizures and spasticity, has come into fashion and gone, and come again with each new technological advance for the past two hundred years. (2) A proportion of patients with chronic disease have their suffering made worse if they feel deprived of the latest therapy and may be relieved if they are given it in the right circumstances. In this group the relief will usually be temporary and the limited supply of such reactors will promote the cycle of fashion. In a group of 126 patients with chronic pain associated with organic disease who were offered transcutaneous stimulation, only 23 (18%) continued to use it one year after they started. (3) The cycling of therapeutic fashion is assisted not only because relief is often temporary, but also by the difficulty in establishing the normal range of variability from which significant change can be assessed and by the uncertain relationship between signs and symptoms and for the functions of daily living. For these reasons there is an inevitable tendency to temporary over-optimism and it seems impossible to counter this by the execution of a satisfactory clinical trial, since the patient cannot be "blind" and a significant variable is the enthusiasm with which a therapy is surrounded. (4) Electrical stimulation by cutaneous devices or implants can give much benefit to some patients in whom other methods have failed and there are indications, not only from anecdote and clinical impression but also now from experimental physiology, that it may benefit by mechanisms of interaction at the first sensory synapse. It is, however, an over-simplification to regard any therapy as either strictly physiological or simply fraudulent. Like other so-called placebos, physical methods of therapy can presumably act on hormonal systems associated with stress and the experience of pain.

Clinical Trials as Topic↗

Neuromuscular electrical stimulation and voluntary exercise.

Neuromuscular electrical stimulation (NMES) has been in practice since the eighteenth century for the treatment of paralysed patients and the prevention and/or restoration of muscle function after injuries, before patients are capable of voluntary exercise training. More recently NMES has been used as a modality of strengthening in healthy subjects and highly trained athletes, but it is not clear whether NMES is a substitute for, or a complement to, voluntary exercise training. Moreover the discussion of the mechanisms which underly the specific effects of NMES appears rather complex at least in part because of the disparity in training protocols, electrical stimulation regimens and testing procedures that are used in the various studies. It appears from this review of the literature that in physical therapy, NMES effectively retards muscle wasting during denervation or immobilisation and optimises recovery of muscle strength during rehabilitation. It is also effective in athletes with injured, painful limbs, since NMES contributes to a shortened rehabilitation time and aids a safe return to competition. In healthy muscles, NMES appears to be a complement to voluntary training because it specifically induces the activity of large motor units which are more difficult to activate during voluntary contraction. However, there is a consensus that the force increases induced by NMES are similar to, but not greater than, those induced by voluntary training. The rationale for the complementarity between NMES and voluntary exercise is that in voluntary contractions motor units are recruited in order, from smaller fatigue resistant (type I) units to larger quickly fatiguable (type II) units, whereas in NMES the sequence appears to be reversed. As a training modality NMES is, in nonextreme situations such as muscle denervation, not a substitute for, but a complement of, voluntary exercise of disused and healthy muscles.

Electric Stimulation↗

The treatment of detrusor incontinence by electrical stimulation.

Cystometrograms were done on 20 patients before and during transrectal stimulation to determine if electrical stimulation increased the detrusor reflex threshold. In 4 patients the detrusor reflex threshold was increased during stimulation and urinary continence was restored. However, each patient became incontinent when transrectal stimulation was discontinued for 1 to 5 days. Thus, cyclic periods of stimulation were necessary to maintain the beneficial effects of electrical stimulation and a permanent pelvic floor stimulator was implanted since chronic transrectal stimulation was inconvenient.

Adult↗

Peroneal nerve conduction velocity after chronic electrical stimulation.

The effects of electric stimulation on nerve conduction velocity of the peroneal nerve via surgically implanted electrodes was evaluated in a group of nine hemiplegic patients. After a mean duration of 25 months nerve conduction velocity averaged 47.3 meters/sec in the uninvolved and 46.1 meters/sec in the stimulated (paretic) extremity. In a control group of ten hemiplegic subjects who did not receive stimulation, nerve conduction velocity averaged 43.1 meters/sec in the hemiplegic leg, and 41.3 meters/sec in the uninvolved leg. These differences were not statistically significant. Maximum dorsiflexion strength was increased in all patients following chronic stimulation.

Ankle↗

Mechanisms for closure of the human urethra during intravaginal electrical stimulation.

The effect of intravaginal electrical stimulation (IVS) on the urethral pressure profile (UPP) before and during succinylcholine blockade or spinal anaesthesia was studied in patients with stress incontinence and in patients with clinically normal urethral function. During succinylcholine blockade, the UPP was lowered to 74% and during spinal anaesthesia to 39% of the original maximal UPP. IVS could not influence the UPP during succinylcholine blockade, while the UPP could be restored during spinal anaesthesia when the stimulation strength was increased 3 to 4 times. The following conclusions were arrived at: 1) The urethral effect of IVS is due to activation of somatic nerves and not to activation of nerves supplying smooth muscles or direct activation of striated and smooth muscles. 2) The more pronounced depression of the UPP during spinal anaesthesia compared to succinylcholine blockade should be caused by the loss of nervous activity of the smooth muscles. 3) The fact that the UPP could be restored during spinal anaesthesia indicates that activation of somatic efferents can compensate for the loss of striated and smooth muscle activity. Therefore, IVS can control incontinence in partial lower motor neuron lesions, provided a sufficient number of efferent neurons are preserved.

Adult↗

Upper limb functional electrical stimulation for walker ambulation in hemiplegia: a case report.

Electrical stimulation has been sporadically used in the treatment of hemiplegia. Reported benefits include decreasing spasticity, providing a supplementary means for range of motion exercises, increasing strength, and improving local blood flow in a paretic or paralyzed limb. Some studies have also shown functional gains in the hemiplegic upper limb following treatment with electrical stimulation. Nevertheless, there have been very few reports of the use of neuromuscular stimulation to achieve new hemiplegic upper limb activity not possible without the electrical stimulation. This is a case report of a head injury patient who was able to begin ambulation with a walker, without physical assistance, for the first time in the 16 yr since his injury. A new electrical stimulation device (Handmaster) initially used therapeutically, and then functionally, provided a reliable, strong grasp and release and was instrumental in achieving the new level of function. The device proved to be easy to use in the home, giving the patient microprocessor-controlled therapeutic and patterned functional electrical stimulation.

Adult↗

Effect of electrical stimulation on chronic wound healing: a meta-analysis.

The purpose of this meta-analysis was to quantify the effect of electrical stimulation on chronic wound healing. Fifteen studies, which included 24 electrical stimulation samples and 15 control samples, were analyzed. The average rate of healing per week was calculated for the electrical stimulation and control samples. Ninety-five percentage confidence intervals were also calculated. The samples were then grouped by type of electrical stimulation device and chronic wound and reanalyzed. Rate of healing per week was 22% for electrical stimulation samples and 9% for control samples. The net effect of electrical stimulation was 13% per week, an increase of 144% over the control rate. The 95% confidence intervals of the electrical stimulation (18-26%) and control samples (3.8-14%) did not overlap. Electrical stimulation was most effective on pressure ulcers (net effect = 13%). Findings regarding the relative effectiveness of different types of electrical stimulation device were inconclusive. Although electrical stimulation produces a substantial improvement in the healing of chronic wounds, further research is needed to identify which electrical stimulation devices are most effective and which wounds respond best to this treatment.

Electric Stimulation Therapy↗