The results of a multicenter, double-blind, crossover, randomized controlled trial (RCT) that investigated the effects of rate of stimulation on analgesia in kilohertz frequency (1–10 kHz) spinal cord stimulation (SCS) suggests that patients experienced EQUIVALENT PAIN RELIEF as measured by (e-diary numeric rating scale) ED-NRS (p ≤ 0.002). For details, please see the source.
Patients were implanted with SCS systems and underwent an eight-week search to identify the best location (“sweet spot”) of stimulation at 10 kHz within the searched region (T8–T11). Patients who responded to 10 kHz per ED-NRS pain scores proceeded to double-blind rate randomization. Patients received 1, 4, 7, and 10 kHz SCS at the same sweet spot found for 10 kHz in randomized order (four weeks at each frequency). For each frequency, pulse width and amplitude were titrated to optimize therapy.
All frequencies provided equivalent pain relief, while 1 kHz requiring 60–70% less charge than higher frequencies (p ≤ 0.0002).
One important question is about the sensitivity of analgesia to frequencies outside the range of 1–10 kHz., both below and above.
Benefit of lower frequency would be even lesser charge for higher battery longevity and equivalent pain relief without paresthesia. Lower frequencies for SCS may be effective in the sub-perception modality (although, whether the mechanisms of action underlying burst SCS and kilohertz frequency SCS are the same is an open question). Other questions include whether the mechanisms of action for these two broad modalities of SCS (paresthesia and sub-perception) overlap in frequency range, and whether they can be engaged simultaneously to potentially yield an additive effect that further improves therapy.
The bottom line is: As fundamental understanding of mechanisms of action increases, continued optimization is likely and awaiting researchers.
A full-featured, fully programmable, pulse-generator platform such as Lone Star Neuro's 'indication agnostic platform' may be an ideal tool to empower institutions immediately to further medical research, since the platform can be set to deliver constant current or constant voltage pulses with programmable amplitude and pulse-width, at any frequency from 1 Hz to well above 40 (forty) kHz with simple C-code programming.
The heterogeneous and conductive nature of biological tissue render near-field inductive coupling ineffective in powering devices if implanted deeply. Similar to Lone Star Neuro's pulse-generator platform, SCMR (Strongly Coupled Magnetic Resonance) could overcome this limitation. If further device miniaturization is required, such as a device with dual electrodes and no batteries, mid-field power transfer can now be an option:
Power transfer in the mid-field region can (around a wavelength away from the source) transfer enough power to a millimeter scale implant deep inside a tissue. Further, mid-field region allows power flow lines to be manipulated with an interference pattern for focusing them in a specific spot, and well within the SAR (Specific Absorption Rate) safety limits.
Ho et al explain the theory behind mid-field power transfer, which is straightforward. Design and implementation of a mid-field power transmitter and a miniaturized receiver is also well within the capabilities of today's semiconductor components and manufacturing technologies, promising new millimeter-scale medical implants for a variety of therapy modalities which have not been feasible until recently.
Researchers at the University of California, San Francisco (UCSF), are developing an implantable artificial kidney that can closely replicate the functions of real kidneys. The Kidney Project is raising money to complete preclinical studies of the device modules and to build full-scale prototypes for the first round of human studies. Initial clinical trials on the individual modules are expected to begin early next year. Testing of a working prototype of the bioartificial kidney is slated for 2020.
More than 40% of sleep apnea sufferers refuse to wear CPAP machines, because of noise, mask irritation and claustrophobia. Neuromodulation is an alternative!
An implant that is inserted during minimally-invasive surgery stimulates certain airways and help with breathing. According to Cleveland Clinic's Sleep Disorder Center, the system has not caused any serious complications in clinical testing
According to a recent Washington Examiner article, one third of the US population suffers from chronic pain. Per the same article, 90 percent of doctors practicing medicine in America today do not know how to treat chronic pain. In 2015, 33 thousand lives were lost to opioid-related causes, and 45 percent of those deaths involved a prescription.
Not surprisingly, recently President Trump has declared Opioid Epidemic a Public Health Crisis.
Electronic neurostimulators with little or no side effects can be the answer to many problem, yet, surprisingly less than 100 thousand chronic pain sufferers can receive Spinal Cord Stimulation (SCS) per year.
New advanced neurostimulation devices, including the ones that can be fully programmed for customized personal care can help combat the opioid crises quickly and affordably. Further, programmable neurostimulators promise to accelerate medical research in areas of other neurological disorders.
The bottom line is, with the fully programmable neurostimulators, the solution to opioid crisis and new advanced therapies for many neurological disorders are much closer than we think.
A randomized controlled trial (Click here to access the source) has found excellent pain relief and no clinical difference among spinal cord stimulation frequencies from 1kHz to 10kHz, including 1kHz, 4kHz, 7Khz, and 10Khz.
Since 1kHz stimulation provides similar pain relief using significantly less energy than higher frequencies, devices with higher battery-charge longevity are possible and should be better alternatives to the 10kHz HF10 therapy.
A recent study suggests that executive functions can be rapidly up- or down-regulated by modulating theta phase coupling of distant frontal cortical areas and can contribute to the development of tools for potentially normalizing executive dysfunction in patient populations.
About 75 percent of people with MS (Multiple Sclerosis) report fatigue among their most disabling disease symptoms.
Medications, such as those that treat narcolepsy, behavior-based therapies and even exercise programs are often prescribed but benefits have been found to be unreliable.
When compared to patients who were enrolled in a placebo arm of a recent study those that received transcranial direct current stimulation (tDCS) were found to have about a six-point drop on a 32-point scale measuring fatigue severity, according to the findings recently published online in the Multiple Sclerosis Journal.
The exact mechanism behind tDCS is unclear and requires more research. It is thought to change the brain's cortical excitability by making it easier for neurons to fire, thereby improving connections and expediting learning that takes place during rehabilitation.