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Great paper by Parker. Developed a way to measure evoked compound ap's from the cord during stim. Turns out its the A beta fibers evoked. He found pain relief to correlate to Both A beta recruitment and paresthesia. Would like to hear his thoughts on Nervo and burst stim.
Closing the Loop in Neuromodulation Therapies: Spinal Cord Evoked Compound Action Potentials During Stimulation for Pain Management (230)
John L . Parker, Implant Systems, NICTA, Eveleigh, Australia; Dean M . Karantonis, NICTA, Eveleigh, Australia; Peter S . Single, NICTA, Eveleigh, Australia; Milan Obradovic, NICTA, Eveleigh, Australia; James Laird, NICTA, Eveleigh, Australia; Robert Gorman, NICTA, Eveleigh, Australia; Michael J . Cousins, University of Sydney at the Royal North Shore Hospital, St . Leonards, Australia
Introduction: Spinal cord stimulation (SCS) for the management of chronic neuropathic pain has been in use for more than 30 years; however, there is still no clear understanding of its mechanism . A major factor limiting the potential therapeutic benefit of SCS arises from movement-induced over- and understimulation . This issue has encouraged the development of strategies to overcome this problem . We propose a solution based on measurement of neuronal responses .
Methods: We have developed methods to record evoked compound action potentials (ECAPs) and characterize the neuro-
nal populations responding to SCS in an animal model and in humans . A custom made recording and stimulating system has been used to characterize the axons responding to stimulation in both animal and human spinal cords . The ECAP magnitude is an indicator of dorsal columns (DC) fiber recruitment levels and has been used as the feedback parameter in active feedback- loop-controlled SCS .
Results: The mechanosensory Aß fibres respond at clinically relevant stimulation levels . At higher stimulation levels, addition- al responses are measured which correspond to the onset of unpleasant "side effects" so often experienced by users of SCS . The ECAP can be used directly to control the stimulating current and eliminate over- and understimulation conditions .
Conclusion: The direct measurement of neuronal properties provides valuable insight to the mechanism of SCS and has broad implications for improvement to SCS therapies . A study of the change in amplitude of the ECAP with stimulus character- istics provides essential data from which new stimulation paradigms and new programming techniques may be developed .
Disclosures: J. L. Parker: None . D. Karantonis: None . P. Single: None . M. Obradovic: None . J. Laird: None . R. Gorman: None . M. Cousins: None .
Closing the Loop in Neuromodulation Therapies: Spinal Cord Evoked Compound Action Potentials During Stimulation for Pain Management (230)
John L . Parker, Implant Systems, NICTA, Eveleigh, Australia; Dean M . Karantonis, NICTA, Eveleigh, Australia; Peter S . Single, NICTA, Eveleigh, Australia; Milan Obradovic, NICTA, Eveleigh, Australia; James Laird, NICTA, Eveleigh, Australia; Robert Gorman, NICTA, Eveleigh, Australia; Michael J . Cousins, University of Sydney at the Royal North Shore Hospital, St . Leonards, Australia
Introduction: Spinal cord stimulation (SCS) for the management of chronic neuropathic pain has been in use for more than 30 years; however, there is still no clear understanding of its mechanism . A major factor limiting the potential therapeutic benefit of SCS arises from movement-induced over- and understimulation . This issue has encouraged the development of strategies to overcome this problem . We propose a solution based on measurement of neuronal responses .
Methods: We have developed methods to record evoked compound action potentials (ECAPs) and characterize the neuro-
nal populations responding to SCS in an animal model and in humans . A custom made recording and stimulating system has been used to characterize the axons responding to stimulation in both animal and human spinal cords . The ECAP magnitude is an indicator of dorsal columns (DC) fiber recruitment levels and has been used as the feedback parameter in active feedback- loop-controlled SCS .
Results: The mechanosensory Aß fibres respond at clinically relevant stimulation levels . At higher stimulation levels, addition- al responses are measured which correspond to the onset of unpleasant "side effects" so often experienced by users of SCS . The ECAP can be used directly to control the stimulating current and eliminate over- and understimulation conditions .
Conclusion: The direct measurement of neuronal properties provides valuable insight to the mechanism of SCS and has broad implications for improvement to SCS therapies . A study of the change in amplitude of the ECAP with stimulus character- istics provides essential data from which new stimulation paradigms and new programming techniques may be developed .
Disclosures: J. L. Parker: None . D. Karantonis: None . P. Single: None . M. Obradovic: None . J. Laird: None . R. Gorman: None . M. Cousins: None .
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