Spinal Cord Stimulation Affects the Central Mechanisms of Regulation of Heart Rate

Meglio, Mario; Cioni, Beatrice; Gf, Rossi; Sandric, S; Santarelli, P

doi:10.1159/000100138

Cited by 24 publications

(23 citation statements)

References 3 publications

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“…7,8 Although CSCS can augment blood flow in most brain regions, including the MCA core and regions bordering the core, other potential mechanisms must be considered. 8 CSCS may increase activity in the brain stem and can lead to a decrease in cervical sympathetic tone, 21 both of which are neuroprotective. 22 In a combined ischemic and traumatic model in the rabbit, spinal cord stimulation leads to a reduction in lesions and attenuation of the CBF decrease caused by the insult.…”

Section: Discussionmentioning

confidence: 99%

Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Burnett

Shimazu

Szabados

et al. 2006

Stroke

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Background and Purpose-Functional stimulation is accompanied by increases in regional cerebral blood flow which exceed metabolic demands under normal circumstances, but it is unknown whether functional stimulation is beneficial or detrimental in the setting of acute ischemia. The aim of this study was to determine the effect of forepaw stimulation during temporary focal ischemia on neurological and tissue outcome in a rat model of reversible focal forebrain ischemia. Methods-Sprague-Dawley rats were prepared for temporary occlusion of the right middle cerebral artery (MCA) using the filament model. Cerebral blood flow in the MCA territory was continuously monitored with a laser-Doppler flowmeter. Subdermal electrodes were inserted into the dorsal forepaw to stimulate either the forepaw ipsilateral or contralateral to the occlusion starting 1 minute into ischemia and continuing throughout the ischemic period. A neurological evaluation was undertaken after 24 hours of reperfusion, and animals were then euthanized and brain slices stained with 2,3,5-triphenyltetrazolium chloride. Cortical and striatal damage was measured separately. Results-The cortical and striatal infarct volumes were both significantly reduced in the contralateral stimulated group compared with the ipsilateral stimulated group (48% total reduction). There were no statistically significant differences in the neurobehavioral scores between the 2 groups, or in the laser-Doppler flow measurements from the MCA core. Conclusions-Functional stimulation of ischemic tissue may decrease tissue damage and improve outcome from stroke.Although the precise mechanism of this effect remains to be determined, functional stimulation could readily be translated to clinical practice. Key Words: cerebral ischemia, focal Ⅲ electrical stimulation therapy Ⅲ middle cerebral artery occlusion T here remains intense interest in discovering novel neuroprotective therapies for use in acute cerebral ischemia. Most recent research efforts have focused on compounds designed to interfere with the cascade of deleterious events that occur in tissue during and in the minutes and hours after cerebral ischemia. 1 Although many compounds have been investigated, to-date none have proven clinically useful in humans. 2,3 Nonpharmacological treatment techniques, such as hypothermia and hyperoxemia, have also been proposed, 4 but it remains to be seen how they transfer from laboratory to bedside. There are even studies suggesting that electrical stimulation of the cerebellar fastigial nucleus 5,6 before ischemia, or the spinal cord 7-9 weeks and months after the ischemic insult can reduce damage.Functional stimulation is accompanied by an increase in regional cerebral blood flow (CBF) in activated brain regions. We have shown previously in a rat model of graded cerebral ischemia that when CBF is reduced by as much as 90%, forepaw stimulation is still able to elicit an increase in blood flow in the somatosensory cortex, 10 and studies in stroke patients demonstrate that CBF can be activated...

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Section: Discussionmentioning

confidence: 99%

Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Burnett

Shimazu

Szabados

et al. 2006

Stroke

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“…The effect of neurostimulation has been linked to a form of sympathectomy [11,14]. Indeed sympathectomy is used to treat angina, and Apthorp et al [15] found that it relieved angina in about 75% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, in exercise tests spinal cord stimulation applied in the treatment of angina pectoris has shown to increase the patients' working capacity, to increase the period of exercise before angina and to reduce the recovery time [10]. It has also been revealed that heart rate decreased significantly during rest when spinal cord stimulation was used [11]. These beneficial results may be explained by reduced sympathetic activity.…”

Section: Introductionmentioning

confidence: 99%

Does Heart Rate Variability Change in Angina Pectoris Patients Treated with Spinal Cord Stimulation?

Andersen

1997

Cardiology

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To determine whether spinal cord stimulation has any effect on the autonomic nervous tone of the heart, heart rate variability was used as an indicator of autonomic nervous control of the heart. The components time domain and power spectral analyses of heart rate variability were measured in 21 patients with angina pectoris. Twenty-four-hour Holter recordings were obtained before and after 12 months with spinal cord stimulation. No significant attenuation of time domain or spectral components of heart rate variability analyses were found. Apparently, spinal cord stimulation does not influence the autonomic tone of the heart.

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“…For example, a α 2 agonist, clonidine in high doses suppressed SCSinduced vasodilation. Also some patients demonstrated vasodilation with SCS even after chemical or surgical sympathectomy (Meglio et al, 1986;Broseta et al, 1986;Jacobs et al, 1988). It should be noted that, in humans, sympathectomy is rarely total.…”

Section: Sympathetic Mechanism-itmentioning

confidence: 99%

Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: A review of experimental studies

Linderoth

Foreman

2008

Autonomic Neuroscience

159

106

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Spinal cord stimulation (SCS) is a widely used clinical technique to treat ischemic pain in peripheral, cardiac and cerebral vascular diseases. The use of this treatment advanced rapidly during the late 80's and 90's, particularly in Europe. Although the clinical benefits of SCS are clear and the success rate remains high, the mechanisms are not yet completely understood. SCS at lumbar spinal segments (L2-L3) produces vasodilation in the lower limbs and feet which is mediated by antidromic activation of sensory fibers and decreased sympathetic outflow. SCS at thoracic spinal segments (T1-T2) induces several benefits including pain relief, reduction in both frequency and severity of angina attacks, and reduced short-acting nitrate intake. The benefits to the heart are not likely due to an increase, or redistribution of local blood flow, rather, they are associated with SCS-induced myocardial protection and normalization of the intrinsic cardiac nervous system. At somewhat lower cervical levels (C3-C6), SCS induces increased blood flow in the upper extremities. SCS at the upper cervical spinal segments (C1-C2) increased cerebral blood flow, which is associated with a decrease in sympathetic activity, an increase in vasomotor center activity and a release of neurohumoral factors. This review will summarize the basic science studies that have contributed to our understanding about mechanisms through which SCS produces beneficial effects when used in the treatment of vascular diseases. Furthermore, this review will particularly focus on the antidromic mechanisms of SCS-induced vasodilation in the lower limbs and feet.

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Spinal Cord Stimulation Affects the Central Mechanisms of Regulation of Heart Rate

Cited by 24 publications

References 3 publications

Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Does Heart Rate Variability Change in Angina Pectoris Patients Treated with Spinal Cord Stimulation?

Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: A review of experimental studies

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