Selective Decrease in Allodynia With High-Frequency Neuromodulation via High-Electrode-Count Intrafascicular Peripheral Nerve Interface After Brachial Plexus Injury

Duncan, Christopher C.; Kluger, David T.; Davis, Tyler; Warren, David J.; Page, David M.; Hutchinson, Douglas T.; Clark, Gregory A.

doi:10.1111/ner.12802

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…The third participant (subject 7; S7) was a 48-year-old male whose right forearm was electively amputated due to chronic complex regional pain syndrome (CRPS) with simultaneous intraoperative implantation of the USEA and iEMG devices [4,5]. Results for participants S1-S4 have been reported previously [7,8], and are not reported herein.…”

Section: Human Subjectsmentioning

confidence: 99%

“…The Utah Slanted Electrode Array (USEA) consists of a 10 × 10 grid of electrodes with depths from 0.5-1.5 mm that penetrate peripheral nerves to enable single-unit neural recordings and intraneural microstimulation [1]. USEAs implanted in the peripheral nerves serve as a bi-directional sensorimotor neural interface, and have now been used to reanimate motionless limbs [2,3], to provide intuitive control of and sensory feedback from bionic arms [4][5][6][7][8][9], and to alleviate neuropathic pain [10,11]. The high electrode count and intrafascicular nature of the USEA yields improved specificity [6,12].…”

Section: Introductionmentioning

confidence: 99%

“…The long-term viability of USEAs implanted in humans has become increasingly important as the field of neural prostheses moves rapidly towards clinical translation, with a current emphasis on multiyear, unsupervised, take-home trials [15][16][17]. Work with four prior human amputee subjects demonstrated short-term (< 5 weeks) viability of USEAs as a sensorimotor interface for neural prostheses [7,8]. The present study extends these prior works by increasing the study duration well beyond 5 weeks and by providing additional data and performance analysis from iEMGs implanted in three new subjects.…”

Section: Introductionmentioning

confidence: 99%

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Long-term performance of Utah slanted electrode arrays and intramuscular electromyographic leads implanted chronically in human arm nerves and muscles

et al. 2020

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Objective. We explore the long-term performance and stability of seven percutaneous Utah Slanted Electrode Arrays (USEAs) and intramuscular recording leads (iEMGs) implanted chronically in the residual arm nerves and muscles of three human participants as a means to permanently restore sensorimotor function after transradial amputations. Approach. We quantify the number of functional recording and functional stimulating electrodes over time. We also calculate the signal-to-noise ratio (SNR) of USEA and iEMG recordings and quantify the stimulation current necessary to evoke detectable sensory percepts. Furthermore, we quantify the consistency of the sensory modality, receptive field location, and receptive field size of USEA-evoked percepts. Main results. In the most recent subject, involving USEAs with technical improvements, neural recordings persisted for 502 d (entire implant duration) and the number of functional recording electrodes for one USEA increased over time. However, for six out of seven USEAs across the three participants, the number of functional recording electrodes decreased within the first 2 months after implantation. The SNR of neural recordings and electromyographic recordings stayed relatively consistent over time. Sensory percepts were consistently evoked over the span of 14 months, were not significantly different in size, and highlighted the nerves’ fascicular organization. The percentage of percepts with consistent modality or consistent receptive field location between sessions (∼1 month apart) varied between 0%–86.2% and 9.1%–100%, respectively. Stimulation thresholds and electrode impedances increased initially but then remained relatively stable over time. Significance. This work demonstrates improved performance of USEAs, and provides a basis for comparing the longevity and stability of USEAs to that of other neural interfaces. USEAs provide a rich repertoire of neural recordings and sensory percepts. Although their performance still generally declines over time, functionality can persist long-term. Future work should leverage the results presented here to further improve USEA design or to develop adaptive algorithms that can maintain a high level of performance.

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Section: Human Subjectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term performance of Utah slanted electrode arrays and intramuscular electromyographic leads implanted chronically in human arm nerves and muscles

et al. 2020

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“…Unfortunately lead fracture, displacement or infection can spoil an initial successful result [116,120]. A further refinement is to apply the stimulating electrodes not through a cuff around the affected nerve but by direct selective nerve fascicle stimulation [122]. In this way only the affected sensory fascicles are stimulated and not the motor ones, improving the results and reducing the side effects, particularly muscle spasms [122].…”

Section: Neuromodulation Proceduresmentioning

confidence: 99%

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Saiz-Sapena¹,

Vanaclocha‐Vanaclocha²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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Brachial plexus injuries are commonly followed by chronic pain, mostly with neuropathic characteristics. This is due to peripheral nerve lesions, particularly nerve root avulsions, as well as upper limb amputations, and complex regional pain syndrome (CRPS). The differential diagnosis between CRPS and neuropathic pain is essential as the treatment is different for each of them. Medical treatments are the first step, but for refractory cases there are two main types of surgical alternatives: ablative techniques and neuromodulation. The first group involves destruction of the posterior horn deafferented neurons and usually provides a better pain control but has a 10% complication rate. The second group provides pain control with function preservation but with limited effectiveness. Each case has to be thoroughly evaluated to apply the treatment modality best suited for it. due to iatrogenia [8][9][10][11][12][13][14][15][16], particularly during lymph node biopsy [17, 18] or treatment of some malignancies [19]. The pain is chronic [20], persistent [7], constant [21], burning [22] and throbbing [17], with paroxysmal discharges [3, 6, 23], particularly upon gentle rubbing the affected area [4].The pain is distributed in the distal areas of the upper limb, covering several dermatomes, mostly the caudal ones [24] and particularly the hand [5, 17, 23, 25]. The paroxysmal pain is felt in the arm [26]. Allodynia, hypersensitivity and electric-like discharges are present at the border between the normal and affected dermatomes [17,[26][27][28][29], particularly between T 1 and T 2 at the posterior aspect of the elbow [26].The pain severity correlates with the magnitude of the brachial plexus injury [2,3] and to the number of avulsed nerve roots [2-4, 21, 26, 30-33], particularly when the lower roots are affected [24,34,35]. Nevertheless, Bertelli et al. [21] found that in isolated C 8 and T 1 nerve root avulsions, there was no pain at all.The pain does not appear immediately after the injury but a few days later [24] and no longer than 3 months after it [5, 6, 24, 26,35,36].The neuropathic pain can be associated with phantom [37] or stump pain [38] in case of upper limb amputation, or to complex regional pain syndrome (CRPS) [6], inducing a complex pain condition rather difficult to control [19,30,31].Self-mutilation has been described in 5-29% of obstetric brachial plexus injury cases [39,40].The quality of life is seriously impaired with sleep disorders, family troubles, unemployment, chronic depression and social withdrawal [2, 5, 6, 17, 21,[41][42][43][44]. Additionally, the chronic pain is a further hindrance to comply with a good rehabilitation programme, impairing a possible functional recovery [6,45,46]. Among all the disabilities induced by the brachial plexus injury, the pain has been found to be the symptom that most negatively affects the quality of life [47].Treatment of this chronic pain can be troublesome, as the response to the different treatment modalities is poor and not all of them allow preservatio...

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“…The Utah Slanted Electrode Array (USEA) consists of a 10 × 10 grid of electrodes with depths from 0.5 to 1.5 mm that penetrate peripheral nerves to enable single-unit neural recordings and intraneural microstimulation [1]. USEAs implanted in the peripheral nerves serve as a bi-directional sensorimotor neural interface, and have now been used to reanimate motionless limbs [2,3], to provide intuitive control of and sensory feedback from bionic arms [4][5][6][7][8][9], and to alleviate neuropathic pain [10,11]. The high electrode count and intrafasicular nature of the USEA yields improved specificity [6,12].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Performance of Utah Slanted Electrode Arrays and Intramuscular Electromyographic Leads Implanted Chronically in Human Arm Nerves and Muscles

George

Page

Davis

et al. 2020

Preprint

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Objective. We explore the long-term performance and stability of seven percutanous Utah Slanted Electrode Arrays (USEAs) and intramuscular recording leads (iEMGs) implanted chronically in the residual arm nerves and muscles of three human amputees as a means to permanently restore sensorimotor function after upper-limb. Approach. We quantify the number of functional recording and functional stimulating electrodes over time. We also calculate the signal-to-noise ratio of USEA and iEMG recordings and quantify the stimulation amplitude necessary to evoke detectable sensory percepts. Furthermore, we quantify the consistency of the sensory modality, receptive field location, and receptive field size of USEAevoked percepts. Main Results. In the most recent subject, involving USEAs with technical improvements, neural recordings persisted for 502 days (entire implant duration) and the number of functional recording electrodes for one USEA increased over time. However, for six out of seven USEAs the number of functional recording electrodes decreased within the first two months after implantation. The signal-to-noise ratio of neural recordings and electromyographic recordings stayed relatively consistent over time. Sensory percepts were consistently evoked over the span of 14 months, were not significantly different in size, and highlighted the nerves' fascicular organization. The percentage of percepts with consistent modality or consistent receptive field location between sessions (~1 month apart) varied between 0-86.2% and 9.1-100%, respectively. Stimulation thresholds and electrode impedances increased initially but then remained relatively stable over time. Significance. This work demonstrates improved performance of USEAs, and provides a basis for comparing the longevity and stability of USEAs to that of other neural interfaces. Although USEAs provide a rich repertoire of neural recordings and sensory percepts, performance still generally declines over time. Future work should leverage the results presented here to further improve USEA design or to develop adaptive algorithms that can maintain a high level of performance. 2

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Selective Decrease in Allodynia With High-Frequency Neuromodulation via High-Electrode-Count Intrafascicular Peripheral Nerve Interface After Brachial Plexus Injury

Cited by 7 publications

References 29 publications

Long-term performance of Utah slanted electrode arrays and intramuscular electromyographic leads implanted chronically in human arm nerves and muscles

Long-term performance of Utah slanted electrode arrays and intramuscular electromyographic leads implanted chronically in human arm nerves and muscles

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Long-Term Performance of Utah Slanted Electrode Arrays and Intramuscular Electromyographic Leads Implanted Chronically in Human Arm Nerves and Muscles

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