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Introduction: For interplanetary and orbital missions in human space flight, knowledge about the gravity-sensitivity of the central nervous system (CNS) is required. The objective of this study was to assess neurophysiological correlates in variable hetero gravity conditions in regard to their timing and shaping. Methods: In ten subjects, peripheral nerve stimulation was used to elicit H-reflexes and M-waves in the M. soleus in Lunar, Martian, Earth and hypergravity. Gravity-dependencies were described by means of reflex latency, inter-peak-interval, duration, stimulation threshold and maximal amplitudes. Experiments were executed during the CNES/ESA/DLR JEPPFs. Results: H-reflex latency, inter-peak-interval and duration decreased with increasing gravitation (P<0.05); likewise, M-wave inter-peak-interval was diminished and latency prolonged with increasing gravity (P<0.05). Stimulation threshold of H-reflexes and M-waves decreased (P<0.05) while maximal amplitudes increased with an increase in gravitation (P<0.05). Conclusion: Adaptations in neurophysiological correlates in hetero gravity are associated with a shift in timing and shaping. For the first time, our results indicate that synaptic and axonal nerve conduction velocity as well as axonal and spinal excitability are diminished with reduced gravitational forces on the Moon and Mars and gradually increased when gravitation is progressively augmented up to hypergravity. Interrelated with the adaptation in threshold we conclude that neuronal circuitries are significantly affected by gravitation. As a consequence, movement control and countermeasures may be biased in extended space missions involving transitions between different force environments. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to present a case of successful relief of bilateral occipital neuralgia (ON) using unilateral occipital nerve stimulation (ONS) and to discuss the possible underlying mechanisms. Materials and methods: We present the case of a 59-year-old female patient with severe bilateral ON treated with unilateral ONS. We systematically reviewed previous studies of ONS for ON, discussing the possible mechanisms of ONS in the relief of ON. Results: The patient reported complete pain relief after consistent unilateral ONS during the follow-up period. The underlying mechanisms may be linked to the relationship between pain and several brain regions, including the pons, midbrain, and periaqueductal gray. Conclusion: ONS is an effective and safe option for treating ON. Future studies will be required to clarify the mechanisms by which unilateral occipital stimulation provided relief for bilateral neuralgia in this case. [ABSTRACT FROM AUTHOR]

Although there are many biochemical methods to measure amyloid-β (Aβ)42 concentration, one of the critical issues in the study of the effects of Aβ42 on the nervous system is a simple physiological measurement. The in vitro rat sciatic nerve model is employed and the nerve action potential (NAP) is quantified with different stimuli while exposed to different concentrations of Aβ42. Aβ42 predominantly reduces the NAP amplitude with minimal effects on other parameters except at low stimulus currents and short inter-stimulus intervals. The effects of Aβ42 are significantly concentration-dependent, with a maximum reduction in NAP amplitude at a concentration of 70 nM and smaller effects on the NAP amplitude at higher and lower concentrations. However, even physiologic concentrations in the range of 70 pM did reduce the NAP amplitude. The effects of Aβ42 became maximal 5-8 h after exposure and did not reverse during a 30 min washout period. The in vitro rat sciatic nerve model is sensitive to the effects of physiologic concentrations of Aβ42. These experiments suggest that the effect of Aβ42 is a very complex function of concentration that may be the result of amyloid-related changes in membrane properties or sodium channels.

The need to be competent in neuromodulation is and should be a prerequisite prior to completing a fellowship in interventional pain medicine. Unfortunately, many programs lack acceptable candidates for these advanced therapies, and fellows may not receive adequate exposure to neuromodulation procedures. The American Society of Pain and Neuroscience (ASPN) desires to create a consensus of experts to set a minimum standard of competence for neurostimulation procedures, including spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), and peripheral nerve stimulation (PNS). The executive board of ASPN accepted nominations for colleagues with excellence in the subject matter of neuromodulation and physician education. This diverse group used peer-reviewed literature and, based on grading of evidence and expert opinion, developed critical consensus guides for training that all accredited fellowship programs should adopt. For each consensus point, transparency and recusal were used to eliminate bias, and an author was nominated for evidence grading oversight and bias control. Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation sets a standard for neuromodulation training in pain fellowship training programs. The consensus panel has determined several recommendations to improve care in the United States for patients undergoing neuromodulation. As neuromodulation training in the United States has evolved dramatically, these therapies have become ubiquitous in pain medicine. Unfortunately, fellowship programs and the Accreditation Council for Graduate Medical Education (ACGME) pain program requirements have not progressed training to match the demands of modern advancements. PEAK sets a new standard for fellowship training and presents thirteen practice areas vital for physician competence in neuromodulation., Competing Interests: Alaa Abd-Elsayed, MD, MPH, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Medtronic, Curonix, Avanos, Averitas, SPR Therapeutics. Krishnan Chakravarthy, MD, PhD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Vertos Medical, Medtronic, Mainstay Medical; Stock Options: Neuronoff, Higgs Boson Health, Rune Labs; Owner: NXTSTIM INC., Accufix Medical. Kenneth B. Chapman, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Research: Abbott. Sandy Christiansen, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Research: Sorrento, GLG, Pacific Spine and Pain Society. Timothy R. Deer, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Vertos, SpineThera, Saluda, Nalu, CornerLoc, Ethos, SPR Therapeutics, Medtronic, Boston Scientific, PainTEQ, Tissue Tech, Spinal Simplicity, Biotronik; Advisory Board: Biotronik, Abbott, Nalu, SPR Therapeutics, Tissue Tech; Stock Options: Vertos, SpineThera, Ethos, Saluda, Nalu, CornerLoc, SPR Therapeutics, PainTeq, Spinal Simplicity; Pending Patent: Abbott; Research: Abbott, Vertos, Saluda, Mainstay, SPR Therapeutics, Boston Scientific, PainTEQ, Avanos. Alexander Escobar, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Boston Scientific Vertiflex, PainTEQ; Advisory Board: Medtronic, Nevro, Vertos Medical; Speaker’s Bureau: Medtronic, Nevro. Christopher J. Gilligan, MD, has had a financial agreement or affiliation with the following commercial interests in the form of consultant: Mainstay Medical, Saluda, Persica, Iliad Lifesciences. Johnathan H. Goree, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Saluda Medical, Stratus Medical. Maged Guirguis, MD, has had a financial agreement or affiliation with the following commercial interests in the form of consultant: Nevro, Boston Scientific, Abbott, Avertis pharmaceutical, Saluda, Avanos, Omnia, SPR Therapeutics; Research: Nevro, Boston Scientific, Saluda, Avanos. Amitabh Gulati, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Medtronic, Inc., SPR Therapeutics, Nalu Medical, Averitas Medical; Advisory Board: AIS Healthcare, Hinge Health, Tersera Medical, Neurovasis. Jonathan M. Hagedorn, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Boston Scientific, Nevro Corp, Saluda Medical. Jessica Jameson MD, FASA, has had a financial agreement or affiliation with the following commercial interests in the form of Research/Consultant: Nevro, Abbott, SPR, Vertos, SI Bone, Boston Scientific, Medtronic, Saluda Medical. Leonardo Kapural, MD, PhD, has had a financial agreement or affiliation with the following commercial interests in the form of Advisory Board: Avanos, Biotronik, Gimer, Medtronic, Neuralace, Neuros, PainTEQ, Nevro, Presidio; Research: Avanos, Neuros, Nevro, FUS Mobile, Nalu, Saluda. David W. Lee, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Medtronic, Mainstay Medical, Biotronik, Boston Scientific, Petal Surgical. Michael S. Leong, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Sorrento Therapeutics; Research: Wex Pharmaceuticals. Timothy R. Lubenow, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Boston Scientific, Nevro, Medtronic, PainTEQ, PenTec. Chris J. Mallard, MD, has had a financial agreement of affiliation with the following commercial interest in the form of consultant: Zavation. Melissa Z Murphy, MD, MPH, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Medtronic, Relievant; Researcher: Medtronic; Advisor/Speaker: Medtronic. Kiran V. Patel, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Abbott Neuromodulation. Jason E. Pope, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Abbott, Medtronic, Saluda, Flowonix, SpineThera, Painteq, Vertos, Vertiflex, SPR Therapeutics, Tersera, Aurora, Spark, Ethos, Biotronik, Mainstay, WISE, Boston Scientific, Thermaquil; Grant/Research Support: Abbott, Flowonix, Saluda, Aurora, Painteq, Ethos, Muse, Boston Scientific, SPR Therapeutics, Mainstay, Vertos, AIS, Thermaquil; Shareholder: Painteq, Vertos, SPR Therapeutics, Aurora, Spark, Celeri Health, Neural Integrative Solutions (NIS), Pacific Research Institute, Saluda, Thermaquil and Anesthetic Gas Reclamation. In addition, he also has a patent Neuro monitoring DRG issued to NIS. Scott G. Pritzlaff, MD, CIPS, FIPP, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Bioness, Bioventus, SPR Therapeutics, Nalu Medical, EBT Medical; Royalties: Oxford University Press, Wolters Kluwer; Research Grants; Medtronic, Nevro Corp, Abbott. Dawood Sayed, MD, has had an agreement or affiliation with the following commercial interests in the form of Consultant: PainTEQ, Saluda, Abbott, Nevro, Vertos, Surgentec. Samir J Sheth, MD has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Boston Scientific, Medtronic, Nevro, SPR Therapeutics, Vertos. Vinita Singh, MD, has no financial relationships to disclose. Tolga Suvar, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Nalu, Medtronic, Nevro. Chau M. Vu, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant/Research: Saluda Medical, PainTEQ. The authors report no other conflicts of interest in this work., (© 2023 Pritzlaff et al.)

Purpose of Review: Peripheral nerve stimulation has seen a recent upsurge in utilization for various chronic pain conditions, specifically from a neuropathic etiology, where a single peripheral nerve can be pinpointed as a culprit for pain., Recent Findings: There is conflicting evidence about the efficacy and long-term outcomes of peripheral nerve stimulation for chronic pain, with most studies being small sized. The focus of this article is to review available evidence for the utilization of peripheral nerve stimulation for chronic pain syndromes as well as upcoming evidence in the immediate postoperative realm. The indications for the use of PNS have expanded from neuropathic pain such as occipital neuralgia and post-amputation pain, to more widespread disease processes such as chronic low back pain. Percutaneous PNS delivered over a 60-day period may provide significant carry-over effects including pain relief, potentially avoiding the need for a permanently implanted system while enabling improved function in patients with chronic pain., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Vast scientific effort in recent years have been focused on the search for effective and safe treatments for cognitive decline. In this regard, non-invasive neuromodulation has gained increasing attention for its reported effectiveness in promoting the recovery of multiple cognitive domains after central nervous system damage. In this short review, we discuss the available evidence supporting a possible cognitive effect of trigeminal nerve stimulation (TNS). In particular, we ask that, while TNS has been widely and successfully used in the treatment of various neuropsychiatric conditions, as far as research in the cognitive field is concerned, where does TNS stand? The trigeminal nerve is the largest cranial nerve, conveying the sensory information from the face to the trigeminal sensory nuclei, and from there to the thalamus and up to the somatosensory cortex. On these bases, a bottom-up mechanism has been proposed, positing that TNS-induced modulation of the brainstem noradrenergic system may affect the function of the brain networks involved in cognition. Nevertheless, despite the promising theories, to date, the use of TNS for cognitive empowering and/or cognitive decline treatment has several challenges ahead of it, mainly due to little uniformity of the stimulation protocols. However, as the field continues to grow, standardization of practice will allow for data comparisons across studies, leading to optimized protocols targeting specific brain circuitries, which may, in turn, influence cognition in a designed manner.

Background: Post-herpetic neuralgia (PHN) is a painful condition that presents after herpes zoster reactivation in the peripheral and central nervous system. When medical treatment fails, options are limited, and patients may suffer with chronic pain indefinitely., Case Presentation: We present the case of a gentleman with a 3-year history of PHN in the distribution of the right lesser occipital and greater auricular nerves that failed to respond to medical treatment. He underwent a trial of neuromodulation, and post-operative pain scores improved by 80%, and at 60 days post-operatively his average pain score was 0 out of 10., Conclusions: PNS is an effective and safe option for the treatment of chronic pain, and we present a report of successful treatment of PHN in a particularly difficult anatomic distribution. PNS of the lesser occipital and greater auricular nerves is a novel treatment for PHN and shows promise as an effective, safe therapy when other treatment fails.

Background: Peripheral nerve stimulation is used in both clinical and fundamental research for therapy and exploration. At present, non-invasive peripheral nerve stimulation still lacks the penetration depth to reach deep nerve targets and the stimulation focality to offer selectivity. It is therefore rarely employed as the primary selected nerve stimulation method. We have previously demonstrated that a new stimulation technique, temporal interference stimulation, can overcome depth and focality issues., Methods: Here, we implement a novel form of temporal interference, bilateral temporal interference stimulation, for bilateral hypoglossal nerve stimulation in rodents and humans. Pairs of electrodes are placed alongside both hypoglossal nerves to stimulate them synchronously and thus decrease the stimulation amplitude required to activate hypoglossal-nerve-controlled tongue movement., Results: Comparing bilateral temporal interference stimulation with unilateral temporal interference stimulation, we show that it can elicit the same behavioral and electrophysiological responses at a reduced stimulation amplitude. Traditional transcutaneous stimulation evokes no response with equivalent amplitudes of stimulation., Conclusions: During first-in-man studies, temporal interference stimulation was found to be well-tolerated, and to clinically reduce apnea-hypopnea events in a subgroup of female patients with obstructive sleep apnea. These results suggest a high clinical potential for the use of temporal interference in the treatment of obstructive sleep apnea and other diseases as a safe, effective, and patient-friendly approach., Trial Registration: The protocol was conducted with the agreement of the International Conference on Harmonisation Good Clinical Practice (ICH GCP), applicable United States Code of Federal Regulations (CFR) and followed the approved BRANY IRB File # 22-02-636-1279., (© 2023. Feinstein Institute for Medical Research.)

Purpose: Peripheral nerve stimulation (PNS) limits the image encoding performance of both body gradient coils and the latest generation of head gradients. We analyze a variety of head gradient design aspects using a detailed PNS model to guide the design process of a new high-performance asymmetric head gradient to raise PNS thresholds and maximize the usable image-encoding performance., Methods: A novel three-layer coil design underwent PNS optimization involving PNS predictions of a series of candidate designs. The PNS-informed design process sought to maximize the usable parameter space of a coil with <10% nonlinearity in a 22 cm region of linearity, a relatively large inner diameter (44 cm), maximum gradient amplitude of 200 mT/m, and a high slew rate of 900 T/m/s. PNS modeling allowed identification and iterative adjustment of coil features with beneficial impact on PNS such as the number of winding layers, shoulder accommodation strategy, and level of asymmetry. PNS predictions for the final design were compared to measured thresholds in a constructed prototype., Results: The final head gradient achieved up to 2-fold higher PNS thresholds than the initial design without PNS optimization and compared to existing head gradients with similar design characteristics. The inclusion of a third intermediate winding layer provided the additional degrees of freedom necessary to improve PNS thresholds without significant sacrifices to the other design metrics., Conclusion: Augmenting the design phase of a new high-performance head gradient coil by PNS modeling dramatically improved the usable image-encoding performance by raising PNS thresholds., (© 2023 International Society for Magnetic Resonance in Medicine.)

Objective: A novel protocol for paired associative stimulation (PAS), called high PAS, consists of high-intensity transcranial magnetic stimulation (TMS) and high-frequency peripheral nerve stimulation (PNS). High PAS was developed for spinal cord injury rehabilitation and targets plastic changes in stimulated pathways in the corticospinal tract, which improves motor function. As therapy interventions can last many weeks, it is important to fully understand the effects of high PAS, including its effect on the cardiovascular system. Heart rate variability (HRV) has been used to measure changes in both sympathetic and parasympathetic systems., Methods: We used short-term HRV measurements to evaluate the effects of one 20-min session of high PAS on 17 healthy individuals. HRV was recorded for 5 min before (PRE), during (STIM), immediately after (POST), 30 min after (POST30), and 60 min after (POST60) the stimulation. Five participants repeated the HRV setup with sham stimulation., Results: A significant decrease in low-frequency (LF) power (n.u.) ( p  = 0.002), low-frequency to high-frequency (HF) ratio ( p  = 0.017), in Poincaré plot [the standard deviation of RR intervals perpendicular to (SD1) and along (SD2) the line of identity SD2/SD1 ratio p  < 0.001], and an increase in HF power (n.u.) ( p  = 0.002) were observed between PRE and STIM conditions; these changes were fully reversible immediately after stimulation. PRE to POST by 3% ( p  = 0.015) and continued to decline until POST60 by 5% ( p  = 0.011). LF power (ms 2 ) ( p  = 0.017) and SD2 ( p  = 0.015) decreased from PRE to STIM and increased from PRE to POST ( p  = 0.025 and p  = 0.017, respectively). The results from sham PAS exhibited a trend similar to active high-PAS stimulation., Conclusions: High PAS does not have sustained effects during 60-min follow-up on cardiovascular functions, as measured by HRV. None of the short-term results indicates activation of the sympathetic nervous system in healthy individuals. Observed changes in HRV indicate higher parasympathetic activity during stimulation, which is reversible, and is plausibly explained by the fact that the participants spend 20 min without moving, talking, or using phones while being stimulated., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Haakana, Holopainen, Nätkynmäki, Kirveskari, Tarvainen and Shulga.)

Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson's Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Evancho, Tyler and McGregor.)

Background: Autonomic nerve stimulation is used as a treatment for a growing number of diseases. We have previously demonstrated that application of efferent vagus nerve stimulation (eVNS) has promising glucose lowering effects in a rat model of type 2 diabetes. This paradigm combines high frequency pulsatile stimulation to block nerve activation in the afferent direction with low frequency stimulation to activate the efferent nerve section. In this study we explored the effects of the parameters for nerve blocking on the ability to inhibit nerve activation in the afferent direction. The overarching aim is to establish a blocking stimulation strategy that could be applied using commercially available implantable pulse generators used in the clinic., Methods: Male rats (n = 20) had the anterior abdominal vagus nerve implanted with a multi-electrode cuff. Evoked compound action potentials (ECAP) were recorded at the proximal end of the electrode cuff. The efficacy of high frequency stimulation to block the afferent ECAP was assessed by changes in the threshold and saturation level of the response. Blocking frequency and duty cycle of the blocking pulses were varied while maintaining a constant 4 mA current amplitude., Results: During application of blocking at lower frequencies (≤ 4 kHz), the ECAP threshold increased (ANOVA, p < 0.001) and saturation level decreased (p < 0.001). Application of higher duty cycles (> 70%) led to an increase in evoked neural response threshold (p < 0.001) and a decrease in saturation level (p < 0.001). During the application of a constant pulse width and frequency (1 or 1.6 kHz, > 70% duty cycle), the charge delivered per pulse had a significant influence on the magnitude of the block (ANOVA, p = 0.003), and was focal (< 2 mm range)., Conclusions: This study has determined the range of frequencies, duty cycles and currents of high frequency stimulation that generate an efficacious, focal axonal block of a predominantly C-fiber tract. These findings could have potential application for the treatment of type 2 diabetes., (© 2023. The Author(s).)

Aim: To assess the effects of diabetes mellitus (DM) and related variables on surgical site infection (SSI) risk in neuromodulation. Methods: This retrospective study followed patients who underwent neuromodulation procedures for at least 9 months to identify postoperative infections. Demographics, clinical characteristics and surgical outcomes were compared. Results: Of 195 cases included, 5 (2.6%) resulted in SSIs. Median HbA1c was significantly higher for the cases with SSIs (8.2 vs 5.6%; p = 0.0044). The rate of SSI was significantly higher among patients with DM (17.9 vs 0%; p = 0.0005), HbA1c≥7% (37.5 vs 0%; p = 0.0009), and perioperative glucose ≥200 mg/dl (40 vs 2.3%; p = 0.0101). Conclusion: DM, elevated HbA1c and perioperative hyperglycemia may all contribute to increased risk of SSIs with neuromodulation procedures.

For clinical application of transcranial static magnetic stimulation (tSMS), it is important to achieve a focal target cortical stimulation. Previous study suggested that the associative stimulation combining non-invasive stimulation of the motor cortex (M1) and the peripheral nerve stimulation (PNS) may be useful to produce cortical excitability change. To test this hypothesis, we measured the M1 excitability and intracortical circuits by using transcranial magnetic stimulation (TMS) before and after the tSMS of short duration (5 min) combined with PNS. Thirty-three normal volunteers were participated; tSMS+PNS (n=11), sham+PNS (n=11) and tSMS alone (n=11). We found the transient suppression of the motor-evoked potential (MEP) of the right abductor pollicis brevis (APB) muscle, but not of the abductor digiti minimi (ADM) muscle, when combining tSMS with PNS over median nerve at the wrist. The lack of suppressive effect on APB in tSMS alone with short duration is in accord with the previous observation. In addition, the tendency of transient enhancement of the short-latency intracortical inhibition was observed immediately after intervention in the tSMS+PNS group. These findings show that the combination of tSMS and PNS can induce the cortical excitability change in target cortical motor area and potentiate the suppression effect.

Exercise-induced fatigue affects the motor control and the ability to generate a given force or power. Surface electroencephalography allows researchers to investigate movement-related cortical potentials (MRCP), which reflect preparatory brain activity 1.5 seconds before movement onset. Although the MRCP amplitude appears to increase after repetitive single-joint contractions, the effects of large-muscle group dynamic exercise on such pre-motor potential remain to be described. Sixteen volunteers exercised 30 minutes at 60% of the maximal aerobic power on a cycle ergometer, followed by a 10-km all-out time trial. Before and after each of these tasks, knee extensor neuromuscular function was investigated using maximal voluntary contractions (MVC) combined with electrical stimulations of the femoral nerve. MRCP was recorded during 60 knee extensions after each neuromuscular sequence.The exercise resulted in a significant decrease in the knee extensor MVC force after the 30-min exercise (-10±8%) and the time trial (-21±9%)). The voluntary activation level (VAL) (-6±8% and -12±10%), peak twitch (Pt) (-21±16% and -32±17%) and paired stimuli (P100Hz) (-7±11% and -12±13%) were also significantly reduced after the 30-min exercise and the time trial. The first exercise was followed by a decrease in the MRCP, mainly above the mean activity measured at electrodes FC1-FC2, whereas the reduction observed after the time trial was related to the FC1-FC2 and C2 electrodes. After both exercises, the reduction in the late MRCP component above FC1-FC2 was significantly correlated with the reduction in P100Hz (r=0.61), and the reduction in the same component above C2 was significantly correlated with the reduction in VAL (r=0.64).In conclusion, large-muscle group exercise induced a reduction in pre-motor potential, which was related to muscle alterations and resulted in the inability to produce a maximal voluntary contraction.

Neuromodulation techniques have been successfully used for a varietyof neuropathic pain conditions. Th e aim of this paper is to presenta case of the successful use of a subcutaneously placed peripheralnerve stimulator for treatment of intractable postherpetic neuralgia(PHN). A 57-year old man presented with a two-year history of leftthoracic pain that developed aft er a vesicular rash. Focal neuropathic pain had not responded to treatment with multiple analgesic medications and steroid injections. Th e patient had significant relief following implantation of a peripheral nerve stimulator. Th is case represents a contribution to the small but growing body of evidence indicating that peripheral nerve stimulation may be an effective option for treatment of PHN not responsive to less invasive modalities.

Occipital nerve stimulation (ONS) is a form of peripheral nerve stimulation used to treat refractory headaches. The trial of ONS was carried with the midline incision C1-2 level, inserted electrical lead subcutaneously to oblique and cephalad direction followed by trajectory of blunt dissection. We used 8 pole electrical lead to cover lesser occipital nerve, greater occipital nerve, third occipital nerve and great auricular nerve. We anchored the lead at the midline insertion site after confirming the stimulation of the patient. And then we looped and tightened the lead loosely, connected the lead and the extension under right supraspinatus muscle region. After 1 week trial period, we performed the permanent implantation of occipital nerve stimulator. We inserted internal pulse generator under a pocket located at right infraclavicular region. The VAS score dropped from 8/10 to 1-2/10. No serious complications were detected during 1 month follow-up.

We demonstrate a method of neurostimulation using implanted, free-floating, inter-neural diodes. They are activated by volume-conducted, high frequency, alternating current (AC) fields and address the issue of instability caused by interconnect wires in chronic nerve stimulation. The aim of this study is to optimize the set of AC electrical parameters and the diode features to achieve wireless neurostimulation. Three different packaged Schottky diodes (1.5 mm, 500 µm and 220 µm feature sizes) were tested in vivo (n = 17 rats). A careful assessment of sciatic nerve activation as a function of diode⁻dipole lengths and relative position of the diode was conducted. Subsequently, free-floating Schottky microdiodes were implanted in the nerve (n = 3 rats) and stimulated wirelessly. Thresholds for muscle twitch responses increased non-linearly with frequency. Currents through implanted diodes within the nerve suffer large attenuations (~100 fold) requiring 1⁻2 mA drive currents for thresholds at 17 µA. The muscle recruitment response using electromyograms (EMGs) is intrinsically steep for subepineurial implants and becomes steeper as diode is implanted at increasing depths away from external AC stimulating electrodes. The study demonstrates the feasibility of activating remote, untethered, implanted microscale diodes using external AC fields and achieving neurostimulation.

Brain-computer interfaces (BCIs) can be used to induce neural plasticity in the human nervous system by pairing motor cortical activity with relevant afferent feedback, which can be used in neurorehabilitation. The aim of this study was to identify the optimal type or combination of afferent feedback modalities to increase cortical excitability in a BCI training intervention. In three experimental sessions, 12 healthy participants imagined a dorsiflexion that was decoded by a BCI which activated relevant afferent feedback: (1) electrical nerve stimulation (ES) (peroneal nerve—innervating tibialis anterior), (2) passive movement (PM) of the ankle joint, or (3) combined electrical stimulation and passive movement (Comb). The cortical excitability was assessed with transcranial magnetic stimulation determining motor evoked potentials (MEPs) in tibialis anterior before, immediately after and 30 min after the BCI training. Linear mixed regression models were used to assess the changes in MEPs. The three interventions led to a significant (p < 0.05) increase in MEP amplitudes immediately and 30 min after the training. The effect sizes of Comb paradigm were larger than ES and PM, although, these differences were not statistically significant (p > 0.05). These results indicate that the timing of movement imagery and afferent feedback is the main determinant of induced cortical plasticity whereas the specific type of feedback has a moderate impact. These findings can be important for the translation of such a BCI protocol to the clinical practice where by combining the BCI with the already available equipment cortical plasticity can be effectively induced. The findings in the current study need to be validated in stroke populations.