Detailed magnetoelectric analysis of a nerve impulse propagation along the brachial plexus.

OBJECTIVE: To visualize impulse conduction along the brachial plexus through simultaneous electromagnetic measurements. METHODS: Neuromagnetic fields following median nerve stimulation were recorded above the clavicle with a superconducting quantum interference device biomagnetometer system in 7 healthy volunteers. Compound nerve action potentials (CNAPs) were obtained from 12 locations. Pseudocolor maps of equivalent currents reconstructed from magnetic fields and isopotential contour maps were superimposed onto X-ray images. Surface potentials and current waveforms at virtual electrodes along the brachial plexus were compared. RESULTS: In magnetic field analysis, the leading axonal current followed by a trailing backward current traveled rostrally along the brachial plexus. The spatial extent of the longitudinal intra-axonal currents corresponded to the extent of the positive-negative-positive potential field reflecting transmembrane volume currents. The peaks and troughs of the intra-axonal biphasic current waveforms coincided with the zero-crossings of triphasic CNAP waveforms. The amplitudes of CNAPs and current moments were linearly correlated. CONCLUSIONS: Reconstructed neural activity in magnetic field analysis visualizes not only intra-axonal currents, but also transmembrane volume currents, which are in good agreement with the surface potential field. SIGNIFICANCE: Magnetoneurography is a novel non-invasive functional imaging modality for the brachial plexus whose performance can surpass that of electric potential measurement.

A Three months Electrodiagnostic Follow-Up of Patients Suspected of having Ulnar Nerve Involvement at Elbow Level with Normal Conventional Electrodiagnostic Study at First Evaluation.

Background: Compression of ulnar nerve at the elbow is the second most common peripheral neuropathy of the upper extremity. Objective: Due to the lack of the gold diagnostic standard for ulnar nerve involvement at elbow level (UNE) and the lack of sufficient study in this field, we decided to evaluate patients with symptoms of this disease who have normal conventional electrodiagnostic study (EDX) in first evaluation. Materials and Methods: In this cross-sectional study, 18 persons were selected from patients who were referred to the clinic of Physical Medicine and Rehabilitation. If conventional EDX was normal, compound nerve action potential (CNAP) test (peak latency and amplitude) was carried out. Patients with normal conventional EDX but abnormal ulnar CNAP included to our study. After 3 months, if they had not been treated for ulnar neuropathy, they were reexamined by conventional EDX plus ulnar CNAP measurement. Results: In total, 18 patients (11 females, 7 males) aged 28-58 years old (mean = 40.11) were analyzed in this study. After 3 months, 14 patients (77.8%) demonstrated parameter changes consistent with UNE in conventional EDX. Conclusion: Based on the results of this study, ulnar CNAP has diagnostic value in patients with symptoms of UNE who have normal routine EDX. Therefore, ulnar CNAP should be taken into account for early diagnosis of ulnar neuropathy when routine electrodiagnostic tests are normal.

Electrophysiological Evaluation of Pacific Oyster (Crassostrea gigas) Sensitivity to Saxitoxin and Tetrodotoxin.

Pacific oysters (Crassostrea gigas) may bio-accumulate high levels of paralytic shellfish toxins (PST) during harmful algal blooms of the genus Alexandrium. These blooms regularly occur in coastal waters, affecting oyster health and marketability. The aim of our study was to analyse the PST-sensitivity of nerves of Pacific oysters in relation with toxin bio-accumulation. The results show that C. gigas nerves have micromolar range of saxitoxin (STX) sensitivity, thus providing intermediate STX sensitivity compared to other bivalve species. However, theses nerves were much less sensitive to tetrodotoxin. The STX-sensitivity of compound nerve action potential (CNAP) recorded from oysters experimentally fed with Alexandrium minutum (toxic-alga-exposed oysters), or Tisochrysis lutea, a non-toxic microalga (control oysters), revealed that oysters could be separated into STX-resistant and STX-sensitive categories, regardless of the diet. Moreover, the percentage of toxin-sensitive nerves was lower, and the STX concentration necessary to inhibit 50% of CNAP higher, in recently toxic-alga-exposed oysters than in control bivalves. However, no obvious correlation was observed between nerve sensitivity to STX and the STX content in oyster digestive glands. None of the nerves isolated from wild and farmed oysters was detected to be sensitive to tetrodotoxin. In conclusion, this study highlights the good potential of cerebrovisceral nerves of Pacific oysters for electrophysiological and pharmacological studies. In addition, this study shows, for the first time, that C. gigas nerves have micromolar range of STX sensitivity. The STX sensitivity decreases, at least temporary, upon recent oyster exposure to dinoflagellates producing PST under natural, but not experimental environment.

A multi-channel peripheral nerve stimulator with integrate-and-fire encoding.

Activation of peripheral nervous system (PNS) fibres to produce variable tactile and proprioceptive sensations in advanced bidirectional prosthetic limbs relies on neural stimulators with high spatial selectivity, dynamic range and resolution. A multi-channel application-specific integrated circuit (ASIC) is developed for PNS fibre activation using a wide dynamic range (10 nA-5 mA), high-resolution (30 nA step, 100 ns pulse accuracy) current stimulator, dissipating 0.73-2.75 mW at 3 V. The ASIC also enables encoding of external pressure signals via an integrate-and-fire methodology. Electrophysiological data of compound nerve action potentials were recorded for a range of stimulus amplitudes and pulse widths. This data was used to benchmark the performance of the ASIC with a known neural stimulator.

Quantitative estimation of nerve fiber engagement by vagus nerve stimulation using physiological markers.

BACKGROUND: Cervical vagus nerve stimulation (VNS) is an emerging bioelectronic treatment for brain, metabolic, cardiovascular and immune disorders. Its desired and off-target effects are mediated by different nerve fiber populations and knowledge of their engagement could guide calibration and monitoring of VNS therapies. OBJECTIVE: Stimulus-evoked compound action potentials (eCAPs) directly provide fiber engagement information but are currently not feasible in humans. A method to estimate fiber engagement through common, noninvasive physiological readouts could be used in place of eCAP measurements. METHODS: In anesthetized rats, we recorded eCAPs while registering acute physiological response markers to VNS: cervical electromyography (EMG), changes in heart rate (ΔHR) and breathing interval (ΔBI). Quantitative models were established to capture the relationship between A-, B- and C-fiber type activation and those markers, and to quantitatively estimate fiber activation from physiological markers and stimulation parameters. RESULTS: In bivariate analyses, we found that EMG correlates with A-fiber, ΔHR with B-fiber and ΔBI with C-fiber activation, in agreement with known physiological functions of the vagus. We compiled multivariate models for quantitative estimation of fiber engagement from these markers and stimulation parameters. Finally, we compiled frequency gain models that allow estimation of fiber engagement at a wide range of VNS frequencies. Our models, after calibration in humans, could provide noninvasive estimation of fiber engagement in current and future therapeutic applications of VNS.

Measuring conduction velocity distributions in peripheral nerves using neurophysiological techniques.

OBJECTIVE: To determine how long it takes for neural impulses to travel along peripheral nerve fibers in living humans. METHODS: A collision test was performed to measure the conduction velocity distribution of the ulnar nerve. Two stimuli at the distal and proximal sites were used to produce the collision. Compound muscle or nerve action potentials were recorded to perform the measurements on the motor or mixed nerve, respectively. Interstimulus interval was set at 1-5 ms. A quadri-pulse technique was used to measure the refractory period and calibrate the conduction time. RESULTS: Compound muscle action potential produced by the proximal stimulation started to emerge at the interstimulus interval of about 1.5 ms and increased with the increment in interstimulus interval. Two groups of motor nerve fibers with different conduction velocities were identified. The mixed nerve showed a wider conduction velocity distribution with identification of more subgroups of nerve fibers than the motor nerve. CONCLUSIONS: The conduction velocity distributions in high resolution on a peripheral motor and mixed nerve are different and this can be measured with the collision test. SIGNIFICANCE: We provided ground truth data to verify the neuroimaging pipelines for the measurements of latency connectome in the peripheral nervous system.

An emerging method to noninvasively measure and identify vagal response markers to enable bioelectronic control of gastroparesis symptoms with gastric electrical stimulation.

BACKGROUND: Gastric electrical stimulation (GES) can be a life-changing, device-based treatment option for drug-resistant nausea and vomiting associated with diabetic or idiopathic gastroparesis (GP). Despite over two decades of clinical use, the mechanism of action remains unclear. We hypothesize a vagal mechanism. NEW METHOD: Here, we describe a noninvasive method to investigate vagal nerve involvement in GES therapy in 66 human subjects through the compound nerve action potential (CNAP). RESULTS: Of the 66 subjects, 28 had diabetic GP, 35 had idiopathic GP, and 3 had postsurgical GP. Stimulus charge per pulse did not predict treatment efficacy, but did predict a significant increase in total symptom score in type 1 diabetics as GES stimulus charge per pulse increased (p < 0.01), representing a notable side effect and providing a method to identify it. In contrast, the number of significant left and right vagal fiber responses that were recorded directly related to patient symptom improvement. Increased vagal responses correlated with significant decreases in total symptom score (p < 0.05). COMPARISON WITH EXISTING METHOD(S): We have developed transcutaneous recording of cervical vagal activity that is synchronized with GES in conscious human subjects, along with methods of discriminating the activity of different nerve fiber groups with respect to conduction speed and treatment response. CONCLUSIONS: Cutaneous vagal CNAP analysis is a useful technique to unmask relationships among GES parameters, vagal recruitment, efficacy and side-effect management. Our results suggest that CNAP-guided GES optimization will provide the most benefit to patients with idiopathic and type 1 diabetic gastroparesis.

Whole plantar nerve conduction study with disposable strip electrodes.

INTRODUCTION: A new method to evaluate whole plantar nerve conduction with disposable strip electrodes (DSEs) is described. METHODS: Whole plantar compound nerve action potentials (CNAPs) were recorded at the ankle. DSEs were attached to the sole for simultaneous stimulation of medial and lateral plantar nerves. We also conducted medial plantar nerve conduction studies using an established method and compared the findings. RESULTS: Whole plantar CNAPs were recorded bilaterally from 32 healthy volunteers. Mean baseline to peak amplitude for CNAPs was 26.9 ± 11.8 µV, and mean maximum conduction velocity was 65.8 ± 8.3 m/s. The mean amplitude of CNAPs obtained by our method was 58.2% higher than that of CNAPs obtained by the Saeed method (26.9 µV vs. 17.0 µV; P < 0.0001). CONCLUSIONS: The higher mean amplitude of whole plantar CNAPs obtained by our method suggests that it enables CNAPs to be obtained easily, even in elderly people.

The optimal distance between two electrode tips during recording of compound nerve action potentials in the rat median nerve.

The distance between the two electrode tips can greatly influence the parameters used for recording compound nerve action potentials. To investigate the optimal parameters for these recordings in the rat median nerve, we dissociated the nerve using different methods and compound nerve action potentials were orthodromically or antidromically recorded with different electrode spacings. Compound nerve action potentials could be consistently recorded using a method in which the middle part of the median nerve was intact, with both ends dissociated from the surrounding fascia and a ground wire inserted into the muscle close to the intact part. When the distance between two stimulating electrode tips was increased, the threshold and supramaximal stimulating intensity of compound nerve action potentials were gradually decreased, but the amplitude was not changed significantly. When the distance between two recording electrode tips was increased, the amplitude was gradually increased, but the threshold and supramaximal stimulating intensity exhibited no significant change. Different distances between recording and stimulating sites did not produce significant effects on the aforementioned parameters. A distance of 5 mm between recording and stimulating electrodes and a distance of 10 mm between recording and stimulating sites were found to be optimal for compound nerve action potential recording in the rat median nerve. In addition, the orthodromic compound action potential, with a biphasic waveform that was more stable and displayed less interference (however also required a higher threshold and higher supramaximal stimulus), was found to be superior to the antidromic compound action potential.