2021
DOI: 10.2147/jpr.s344568
|View full text |Cite
|
Sign up to set email alerts
|

A New Direction for Closed-Loop Spinal Cord Stimulation: Combining Contemporary Therapy Paradigms with Evoked Compound Action Potential Sensing

Abstract: Spinal cord stimulation (SCS) utilizes the delivery of mild electrical pulses via epidural electrodes placed on the dorsal side of the spinal cord, typically to treat chronic pain. The first clinical use of SCS involved the delivery of paresthesia inducing, low-frequency waveforms to the neural targets corresponding to the painful areas. Contemporary SCS therapies now leverage novel therapeutic pathways to limit paresthesia and deliver superior clinical outcomes. Historically, SCS has largely been delivered wi… Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...
2
2
1

Citation Types

0
7
0

Year Published

2022
2022
2024
2024

Publication Types

Select...
6
3

Relationship

3
6

Authors

Journals

citations
Cited by 20 publications
(7 citation statements)
references
References 43 publications
0
7
0
Order By: Relevance
“…ECAPs are a clinically valuable tool for quantifying changes in electrophysiologic state, whether as a means to relate perception to a direct measure of neural activation or as feedback signal for controlling the volume of tissue activated with SCS waveforms on a pulse-by-pulse basis. 15,26 And, as first described (albeit in a single animal) by Kent et al, 17 ECAPs may be used to advance understanding of neural activation with both tonic and more modern SCS waveforms in rats, a commonly used preclinical model for SCS research. Our work builds on this concept in several important ways.…”
Section: Discussionmentioning
confidence: 99%
“…ECAPs are a clinically valuable tool for quantifying changes in electrophysiologic state, whether as a means to relate perception to a direct measure of neural activation or as feedback signal for controlling the volume of tissue activated with SCS waveforms on a pulse-by-pulse basis. 15,26 And, as first described (albeit in a single animal) by Kent et al, 17 ECAPs may be used to advance understanding of neural activation with both tonic and more modern SCS waveforms in rats, a commonly used preclinical model for SCS research. Our work builds on this concept in several important ways.…”
Section: Discussionmentioning
confidence: 99%
“…SCS traditionally delivers stimulation to the dorsal column with fixed parameters including contacts used, amplitude, frequency, and pulse width. 27 This approach is referred to as “open loop” and does not account for the inevitable and persistent physiological changes within the patient and spinal cord. By contrast, closed-loop systems automatically adjust stimulation parameters in response to real-time physiological variables by learning to optimize parameters using control systems and in more advanced systems, ML algorithms.…”
Section: Programming Optimizationmentioning
confidence: 99%
“…[32][33][34][35] More recently, evoked compound action potentials (ECAPs) have demonstrated efficacy as inputs for adaptive SCS. 27,[36][37][38] Pertinently, both these inputs have demonstrated the capacity to be processed by MLbased classifiers. 39,40 Specifically, patients implanted with SCS commonly experience variations in paresthesia perception because of overstimulation or understimulation caused by postural changes.…”
Section: Programming Optimizationmentioning
confidence: 99%
“…That is, the stimulation parameters are fixed unless manually changed. This approach may lead to sub-optimal therapeutic outcomes as the SCS is under-or over-delivered due to frequent movement of the spinal cord relative to the SCS electrodes [7,8].…”
Section: Introductionmentioning
confidence: 99%