Using evoked compound action potentials to quantify differential neural activation with burst and conventional, 40 Hz spinal cord stimulation in ovines.

Autor:	Dinsmoor DA; Medtronic plc, Minneapolis, MN, USA., Usoro JO; Medtronic plc, Minneapolis, MN, USA., Barka ND; Medtronic plc, Minneapolis, MN, USA., Billstrom TM; Medtronic plc, Minneapolis, MN, USA., Litvak LM; Medtronic plc, Minneapolis, MN, USA., Poree LR; Department of Anesthesia, University of California San Francisco Pain Management Center, San Francisco, CA, USA.
Jazyk:	angličtina
Zdroj:	Pain reports [Pain Rep] 2022 Nov 11; Vol. 7 (6), pp. e1047. Date of Electronic Publication: 2022 Nov 11 (Print Publication: 2022).
DOI:	10.1097/PR9.0000000000001047
Abstrakt:	Unlike conventional dorsal spinal cord stimulation (SCS)-which uses single pulses at a fixed rate-burst SCS uses a fixed-rate, five-pulse stimuli cluster as a treatment for chronic pain; mechanistic explanations suggest burst SCS differentially modulate the medial and lateral pain pathways vs conventional SCS. Neural activation differences between burst and conventional SCS are quantifiable with the spinal-evoked compound action potential (ECAP), an electrical measure of synchronous neural activation. Methods: We implanted 7 sheep with a dorsal stimulation lead at T9/T10, a dorsal ECAP sensing lead at T6/T7, and a lead also at T9/T10 but adjacent to the anterolateral system (ALS). Both burst and conventional SCS with stimulation amplitudes up to the visual motor threshold (vMT) were delivered to 3 different dorsal spinal locations, and ECAP thresholds (ECAPTs) were calculated for all combinations. Then, changes in ALS activation were assessed with both types of SCS. Results: Evoked compound action potential thresholds and vMTs were significantly higher ( P < 0.05) with conventional vs burst SCS, with no statistical difference ( P > 0.05) among stimulation sites. However, the vMT-ECAPT window (a proxy for the useable therapeutic dosing range) was significantly wider ( P < 0.05) with conventional vs burst SCS. No significant difference ( P > 0.05) in ALS activation was noted between conventional and burst SCS. Conclusion: When dosed equivalently, no differentially unique change in ALS activation results with burst SCS vs conventional SCS; in addition, sub-ECAPT burst SCS results in no discernable excitability changes in the neural pathways feeding pain relevant supraspinal sites. Competing Interests: L.R. Poree has stock options in Nalu and has received research funding from Abbott, Nalu, and Saluda; he is a consultant for Nalu, Saluda, and Medtronic. All other authors are employees of Medtronic plc.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)
Databáze:	MEDLINE
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