Intramuscular stimulation of muscle afferents attains prolonged tremor reduction in essential tremor patients.
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Published version
Author(s)
Pascual Valdunciel, Alejandro
Gonzalez-Sanchez, Miguel
Muceli, Silvia
Adan-Barrientos, Beatriz
Escobar-Segura, Viviana
Type
Journal Article
Abstract
This study proposes and clinically tests intramuscular electrical stimulation below motor threshold to achieve prolonged reduction of wrist flexion/extension tremor in Essential Tremor (ET) patients. The developed system consisted of an intramuscular thin-film electrode structure that included both stimulation and electromyography (EMG) recording electrodes, and a control algorithm for the timing of intramuscular stimulation based on EMG (closed-loop stimulation). Data were recorded from nine ET patients with wrist flexion/extension tremor recruited from the Gregorio Maran Hospital (Madrid, Spain). Patients participated in two experimental sessions comprising: 1) sensory stimulation of wrist flexors/extensors via thin-film multichannel intramuscular electrodes; and 2) surface stimulation of the nerves innervating the same target muscles. For each session, four of these patients underwent random 60-s trials of two stimulation strategies for each target muscle: 1) selective and adaptive timely stimulation (SATS) - based on EMG of the antagonist muscle; and 2) continuous stimulation (CON) of target muscles. Two patients underwent SATS stimulation trials alone while the other three underwent CON stimulation trials alone in each session. Kinematics of wrist, elbow, and shoulder, together with clinical scales, were used to assess tremor before, right after, and 24 h after each session. Intramuscular SATS achieved, on average, 32% acute (during stimulation) tremor reduction on each trial, while continuous stimulation augmented tremorgenic activity. Furthermore, tremor reduction was significantly higher using intramuscular than surface stimulation. Prolonged reduction of tremor amplitude (24 h after the experiment) was observed in four patients. These results showed acute and prolonged (24 h) tremor reduction using a minimally invasive neurostimulation technology based on SATS of primary sensory afferents of wrist muscles. This strategy might open the possibility of an alternative therapeutic approach for ET patients.
Date Issued
2020-08-19
Date Acceptance
2020-08-01
Citation
IEEE Transactions on Biomedical Engineering, 2020, PP
ISSN
0018-9294
Publisher
Institute of Electrical and Electronics Engineers
Journal / Book Title
IEEE Transactions on Biomedical Engineering
Volume
PP
Copyright Statement
© 2020 The Author(s). This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/.
License URL
Sponsor
Commision of the European Communities
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32813648
Grant Number
779982
Subjects
0801 Artificial Intelligence and Image Processing
0903 Biomedical Engineering
0906 Electrical and Electronic Engineering
Biomedical Engineering
Publication Status
Published online
Coverage Spatial
United States
Date Publish Online
2020-08-19