Central neuropathic pain (CNP) is believed to be accompanied by increased activation of the sensorimotor cortex. Our knowledge of this interaction is based mainly on functional magnetic resonance imaging studies, but there is little direct evidence on how these changes manifest in terms of dynamic neuronal activity. This study reports on the presence of transient electroencephalography (EEG)-based measures of brain activity during motor imagery in spinal cord–injured patients with CNP. We analyzed dynamic EEG responses during imaginary movements of arms and legs in 3 groups of 10 volunteers each, comprising able-bodied people, paraplegic patients with CNP (lower abdomen and legs), and paraplegic patients without CNP. Paraplegic patients with CNP had increased event-related desynchronization in the theta, alpha, and beta bands (16–24 Hz) during imagination of movement of both nonpainful (arms) and painful limbs (legs). Compared to patients with CNP, paraplegics with no pain showed a much reduced power in relaxed state and reduced event-related desynchronization during imagination of movement. Understanding these complex dynamic, frequency-specific activations in CNP in the absence of nociceptive stimuli could inform the design of interventional therapies for patients with CNP and possibly further understanding of the mechanisms involved.PerspectiveThis study compares the EEG activity of spinal cord–injured patients with CNP to that of spinal cord–injured patients with no pain and also to that of able-bodied people. The study shows that the presence of CNP itself leads to frequency-specific EEG signatures that could be used to monitor CNP and inform neuromodulatory treatments of this type of pain.

BackgroundCentral neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia.MethodsPatients’ EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20–30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three frequency bands accompanied with changes in the coherence most notable in the beta band. The standardized low resolution electromagnetic tomography analysis of EEG before and after neurofeedback therapy showed the statistically significant reduction of power in beta frequency band in all tested patients. Areas with reduced power included the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex and the Insular Cortex.ConclusionsNeurofeedback training produces both immediate and longer term reduction of central neuropathic pain that is accompanied with a measurable short and long term modulation of cortical activity. Controlled trials are required to confirm the efficacy of this neurofeedback protocol on treatment of pain. The study is a registered UKCRN clinical trial Nr 9824.

Conclusion:The KI score can be used as a pre-test to predict the performance of a MI based BCI.The physical presence of the object of an action facilitates motor imagination in poor imagers. Significance:In BCI based on MI, in particular for assisted rehabilitation of the upper extremities.3

The paper shows selective smaller fiber activation in the left and right vagal nerve in in vivo experiments in pigs using three different techniques: anodal block, depolarizing prepulses and slowly rising pulses. All stimulation techniques were performed with the same experimental setup. The techniques have been compared in relation to maximum achievable suppression of nerve activity, maximum required current, maximum achievable stimulation frequency and the required charge per phase. Suppression of the largest fiber activity (expressed as a percentage of the maximum response) was 0-40% for anodal block, 10-25% for depolarizing prepulses and 40-50% for slowly rising pulses (duration up to 5 ms). Incomplete suppression of activation was mainly attributed to the large size of the vagal nerve (3.0-3.5 mA) which resulted in a large difference of the excitation thresholds of nerve fibers at different distances from the electrode, as well as a relatively short duration of slowly rising pulses. The technique of anodal block required the highest currents. The techniques of slowly rising pulses and anodal block required comparable charge per phase that was larger than for the technique of depolarizing prepulses. Depolarizing prepulses were an optimal choice regarding maximum required current and charge per phase but were very sensitive to small changes of the current amplitude. The other two techniques were more robust regarding small changes of stimulation parameters. The maximum stimulation frequency, using typical values of stimulation parameters, was 105 Hz for depolarizing prepulses, 30 Hz for anodal block and 28 Hz for slowly rising pulses. Only a technique of depolarizing prepulses had a charge per phase within the safe limits. For the other two techniques it would be necessary to optimize the shape of a stimulation pulse in order to reduce the charge per phase.

View the article online for updates and enhancements. Objective. To compare neurological and functional outcomes between two groups of hospitalised patients with subacute tetraplegia. Approach. Seven patients received 20 sessions of brain computer interface (BCI) controlled functional electrical stimulation (FES) while five patients received the same number of sessions of passive FES for both hands. The neurological assessment measures were event related desynchronization (ERD) during movement attempt, Somatosensory evoked potential (SSEP) of the ulnar and median nerve; assessment of hand function involved the range of motion (ROM) of wrist and manual muscle test. Main results. Patients in both groups initially had intense ERD during movement attempt that was not restricted to the sensory-motor cortex. Following the treatment, ERD cortical activity restored towards the activity in able-bodied people in BCI-FES group only, remaining wide-spread in FES group. Likewise, SSEP returned in 3 patients in BCI-FES group, having no changes in FES group. The ROM of the wrist improved in both groups. Muscle strength significantly improved for both hands in BCI-FES group. For FES group, a significant improvement was noticed for right hand flexor muscles only. Significance. Combined BCI-FES therapy results in better neurological recovery and better improvement of muscle strength than FES alone. For spinal cord injured patients, BCI-FES should be considered as a therapeutic tool rather than solely a long-term assistive device for the restoration of a lost function.