Effect of pulsed magnetic stimulation of the facial nerve on cerebral blood flow

Borsody, Mark K.; Yamada, Chisa; Bielawski, Dawn M.; Heaton, Tamara; Lyeth, Bruce G.; García, Andrea; Castro-Prado, Fernando; Azpiroz, J.; Sacristán, E.

doi:10.1016/j.brainres.2013.06.022

Cited by 22 publications

(32 citation statements)

References 32 publications

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“…(a) Frontal cortex cerebral blood flow responses as measured by laser Doppler flowmetry. (b) Anteroposterior cerebral angiograms[ 41 ]…”

Section: Clinical Development Of Facial Nerve Stimulator Devicesmentioning

confidence: 99%

“…[ 40 ] The frequency dependency of stimulation may extend to the duration of the CBF response as well, with 10 Hz stimulation producing longer-lasting increases in CBF than 5 or 20 Hz stimulation. [ 41 ] Continuous stimulation appears to be more effective than does burst stimulation at increasing CBF,[ 16 ] and the CBF response to brief periods (e.g., a minute[ 8 ]) of stimulation develops within a matter of tens of seconds. CBF increases with an ipsilateral predominance after unilateral facial nerve stimulation in most animal models[ 8 16 31 ] and bilateral stimulation has never been assessed.…”

Section: Introductionmentioning

confidence: 99%

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Facial nerve stimulation as a future treatment for ischemic stroke

Borsody¹,

Sacristán²

2016

Brain Circ

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Stimulation of the autonomic parasympathetic fibers of the facial nerve system (hereafter simply “facial nerve”) rapidly dilates the cerebral arteries and increases cerebral blood flow whether that stimulation is delivered at the facial nerve trunk or at distal points such as the sphenopalatine ganglion. Facial nerve stimulation thus could be used as an emergency treatment of conditions of brain ischemia such as ischemic stroke. A rich history of scientific research has examined this property of the facial nerve, and various means of activating the facial nerve can be employed including noninvasive means. Herein, we review the anatomical and physiological research behind facial nerve stimulation and the facial nerve stimulation devices that are in development for the treatment of ischemic stroke.

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“…(a) Frontal cortex cerebral blood flow responses as measured by laser Doppler flowmetry. (b) Anteroposterior cerebral angiograms[ 41 ]…”

Section: Clinical Development Of Facial Nerve Stimulator Devicesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Facial nerve stimulation as a future treatment for ischemic stroke

Borsody¹,

Sacristán²

2016

Brain Circ

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“…Benzonate gelcaps (100 mg) were used as fiducial markers. Neuronavigation-guided positioning of the stimulation coil was performed as described previously [ 19 , 20 ] using a commercially-available neuronavigation system (Brain Science Tools; Utrecht, the Netherlands). Briefly, the target segment of the facial nerve (the intracanalicular segment at the point of the geniculate ganglion) was identified by its location anterior to the semicircular canals, lateral and inferior to the cochlea, and medial to the ear canal.…”

Section: Methodsmentioning

confidence: 99%

“…A commercially-available 6.5 cm figure-8 magnetic stimulation coil (Cool B65; MagVenture; Copenhagen, Denmark) cooled by a circulating fluid pump and powered by a stimulus generator (MagPro R30) was used in the pig experiments [ 19 , 20 ]. The stimulation coil was placed over the left ear of the pig and held in place using a mechanical arm.…”

Section: Methodsmentioning

confidence: 99%

Facial nerve stimulation in normal pigs and healthy human volunteers: transitional development of a medical device for the emergency treatment of ischemic stroke

et al. 2018

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BackgroundMagnetic stimulation of the facial nerve has been tested in preclinical studies as a new, non-invasive emergency treatment of ischemic stroke that acts by increasing cerebral blood flow (CBF). The objective of the studies reported herein was to identify minimal stimulation parameters that increase CBF in large animals and then test those stimulation parameters in healthy volunteers for safety, tolerability, and effectiveness at increasing CBF. This translational research is necessary preparation for clinical studies in ischemic stroke patients.MethodsInitial experiments in anesthetized Yorkshire pigs were undertaken in order to identify the lowest stimulus power and duration that increase CBF. A full 3 × 3 factorial design was used to evaluate magnetic stimulation of the facial nerve at various stimulation powers (1.3, 1.6, and 1.9 Tesla field strength at coil surface) and for various durations (2, 3.5, and 5 min). CBF was measured with contrast MRI perfusion imaging and the internal carotid arteries were assessed with MR angiography. Magnetic facial nerve stimulation with parameters identified in the pig study was then applied to 35 healthy volunteers. Safety was assessed with adverse event reports and by medical examination. Tolerability was defined as each volunteer’s ability to withstand at least 2 min of stimulation. Volunteers could determine the maximum power of stimulation they received during a ramp-up period.ResultsIn pigs, unilateral facial nerve stimulation increased CBF by as much as 77% over pre-stimulation baseline when administered across a range of 1.3–1.9 Tesla power and for 2- to 5-min duration. No clear dose–response relationship could be observed across this range, but lower powers and durations than these were markedly less effective. The effect of a single stimulation lasted 90 min. A second stimulation delivered 100 min after the first stimulation sustained the increased CBF without evidence of tachyphylaxis. In human, bilateral facial nerve stimulation caused only non-serious adverse events that were limited to the 2-min stimulation period. Tolerability was greatly improved by gentle encouragement from the study staff, which enabled most volunteers to tolerate 1.6–1.8 Tesla of stimulation power. CBF measures taken approximately 10 min after stimulation demonstrated on average a 32 ± 6% increase in CBF, with ≥ 25% increases in CBF occurring in 10 of the 31 volunteers who had adequate CBF measurements.ConclusionsThe minimal effective stimulation parameters defined by increased CBF, as identified in the pig study, translated into safe, tolerable, and effective stimulation of healthy volunteers. These results support the future development and evaluation of non-invasive facial nerve stimulation for the emergency treatment of ischemic stroke.Trial Registration retrospectively registered with clinicaltrials.gov NRV_P1_01_15 on June 6, 2017

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“…For recanalization approaches, the time to vessel reopening, differences in final lesion sizes, or a reduced complication frequency in comparison to the gold standard might be adequate. Other experimental therapies such as application of inhalative nitric oxide or facial nerve stimulation aim at preserving the penumbra to gain more time for recanalization [16,17]. The ideal outcome measure for such studies might be the time difference in penumbra decline under experimental intervention.…”

Section: Defining Optimal Outcome Measuresmentioning

confidence: 98%

Academic-industry Collaborations in Translational Stroke Research

Boltze

Wagner

Barthel

et al. 2016

Transl. Stroke Res.

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Academic-industry collaborations are an emerging format of translational stroke research. Next to classic contract research models, a multitude of collaboration models has been developed, some of which even allowing for multinational or intercontinental research programs. This development has recently been paralleled by first successful attempts to overcome the translational stroke research road block, such as the unprecedented success of novel endovascular approaches or the advent of the multicenter preclinical trial concept. While the first underlines the role of the industry as a major innovation driver in stroke research, the latter will require enrollment of industrial partners for optimal output. Moreover, academic-industry partnerships are invaluable to bridge the translational "valley of death" as well as funding gaps in times of dwindling public funding and declining high risk capital investments. However, these collaborations are also subject to relevant challenges because interests, values, and aims often significantly differ between cademia and industry. Here, we describe common academic-industry collaboration models as well as associated benefits and challenges in the stroke research arena. We also suggest strategies for improved planning, implementation, guidance, and utilization of academic-industry collaborations to the maximum mutual benefit.

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Effect of pulsed magnetic stimulation of the facial nerve on cerebral blood flow

Cited by 22 publications

References 32 publications

Facial nerve stimulation as a future treatment for ischemic stroke

Facial nerve stimulation as a future treatment for ischemic stroke

Facial nerve stimulation in normal pigs and healthy human volunteers: transitional development of a medical device for the emergency treatment of ischemic stroke

Academic-industry Collaborations in Translational Stroke Research

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