Nerve Fiber Activation During Peripheral Nerve Field Stimulation: Importance of Electrode Orientation and Estimation of Area of Paresthesia

Muscle Activation During Peripheral Nerve Field Stimulation Occurs Due to Recruitment of Efferent Nerve Fibers, Not Direct Muscle Activation

“…Therefore, a downwards diagonal electrode may therefore yield lower activation threshold compared to vertical and horizontal electrodes. This idea is based on the fact that we have previously shown that when a single straight nerve fiber model is parallel to the electrode this has the lowest threshold, and when perpendicular the threshold is highest . However, this study showed that this may not be the case after all.…”

“…The fact that the sensory nerves also yields the lowest thresholds for between‐lead stimulation (Fig. ), may in part be explained due to a lack of the cutaneous nerve fiber branching .…”

“…Thus, the findings regarding the sensory nerves may in part primarily represent activation of the trunks of the sensory nerves and not the activation of the reticular branching network found in the superficial skin. Our previous studies have focused on the activation of the network of cutaneous branching nerve fibers .…”

“…Both the sensory and motor fiber models were implemented in C# (.NET 4.0) and interfaced to MATLAB R2013a as a .NET assembly . Euler's method with a time step of 0.1 µsec was used to integrate the differential equations.…”

Computational Study of the Effect of Electrode Polarity on Neural Activation Related to Paresthesia Coverage in Spinal Cord Stimulation Therapy

“…However, the effect of DGC polarity has never been compared with that of the other polarities in SCS. This effect has only been evaluated in a peripheral nerve field stimulation study from Frahm et al , where DGC presented a larger activating area than GC, and in a cathodal field steering study from Manola et al , where DGC showed extended recruitment of DC fibers as compared with dual cathode (two consecutive cathodes without anodes). Therefore, given the lack of studies on the effect of electrode polarity in SCS and the wider paresthesia coverage obtained empirically using DGC in our clinical practice, we included DGC polarity in this study.…”