Download to read offline
Uploaded byShaun Comfort
Intro to Neurostimulation ASENT Feb 28 2013
This document provides an overview of neurostimulation presented by Shaun Comfort at the 15th Annual Meeting of the American Society for Experimental NeuroTherapeutics. It outlines the history of neurostimulation from early uses by the Romans to treat pain to modern applications. Key developments include the advent of implantable microelectronics and advances in neuroscience and computing power that have enabled treatments such as spinal cord stimulation, transcutaneous electrical nerve stimulation, deep brain stimulation, and vagus nerve stimulation. The document also discusses challenges in the field including clinical trials and developing long-term power sources for implantable devices.
Intro to Neurostimulation ASENT Feb 28 2013
- 1. Neurostimulation: An Overview Thursday Feb28th Shaun Comfort, MD, MBA Adaptix Clinical Solutions, LLC American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 2. Disclosure(s) Consulting relationships with multiplePharma, Bio, and Medical Device Companies Equity: J&J American Society for Experimental NeuroTherapeutics | 15th Annual Meeting Other: I will discuss some currently unapproved Rx/Research technologies Learning Objectives • Outline the context & history of Neurostimulation • Identify several current Neurostim therapies
- 3. The Brave NewWorld of Neurostimulation American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 4. Basic Definitions • FundamentalQuantity: Charge = Coulomb • Negative Charges: Electrons = 1.6 x 10-19 C • Moving Charges: Current = Amp {C/sec} • Charge Source (eg Battery): Voltage = Potential Energy/Ch = Volt {Joules/C} • Useful Relation: Ohm’s Law V = iR • Other Useful Terms: • Frequency = Cycles/sec {Hertz} American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 5. Basic Definitions, cont AmericanSociety for Experimental NeuroTherapeutics | 15th Annual Meeting
- 6. Neurostimulation? • Neurostimulation? • Themodulation of nervous system activity by electrically activating individual or groups of neurons in the body, to achieve a clinical goal. • Can be achieved using: • Surface electrodes • Implantable electrodes • Indirect: Vector Force Fields (TMS) American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 7. Early Neurostimulation? • Firstapplication of neurostimulation: • Scribonius Largus, 65 AD • Torpedo fish (electric ray) • for relieving pain (Early TENS?) • Empirical findings that electricity applied to skin had interesting effects such as pain reduction American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 8. Coincidental Physics American Societyfor Experimental NeuroTherapeutics | 15th Annual Meeting
- 9. American Society forExperimental NeuroTherapeutics | 15th Annual Meeting
- 10. Faradization for PainRelief American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 11. The Good OldDays? • Early Faradization primitive and overly broad claims: • “Electreat” device – Willie Kent 1st person prosecuted under FD&C (1938) for Unsubstantiated Claims • Claims later limited to pain • However, this approach evolved into Transcutaneous Electrical Stimulation (TENS) used today for pain (eg, Shealy MD & Medtronics, 1970s) American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 12. Beyond Peripheral Faradization •Early 20th century - co-incident advances in electronics and medicine produced new tools for electrophysiology: ECG (1911), EEG (Berger, 1924) and therapy: ECT (Cerletti & Bini, 1938) American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 13. If That Isthe Past, Where Are We Today? • We are riding the 20th Century wave of Neuroscience + Moore’s Law • The results are: • Implantable micro-electronics • Open (VNS, DBS) - and Closed-loop (?) therapies • Wireless monitoring (eg, Implanted EEG) • Smart diagnostics (eg, ECG/EEG Interpretation) • Rapid advances in Neurosurgery, fMRI, etc American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 14. Moore’s Law To 1stapproximation, doubling of transistor density & computing efficiency every 18 months American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 15. SCS, TENS, tDCS,etc American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 16. TENS, TMS, DBS,VNS, etc American Society for Experimental NeuroTherapeutics | 15th Annual Meeting
- 17. American Society forExperimental NeuroTherapeutics | 15th Annual Meeting NS Classification Grid External Implanted Peripheral NS • TENS - Pn • CI – Aud • GES - GI • SNS - GU Central NS • ECT – Dep • TMS – Dep • TNS – HA • tDCS • SCS – Pn • OI –Vis • VNS-Ep • DBS-PD, Et, Ep • CtS - Ep Aud = Auditory; CI = Cochlear Implant; CtS = Cortical Stimulation; Dep = Depression; Ep = Epilepsy; Et = Essential Tremor; GI = Gastrointestinal; GNS = GastricElectric Stimulation; GU = Genitorurological; HA = Headache; OI = Occipital Implant;PD = Parkinson’s Dz; Pn = Pain/Analgesia; SCS = Spinal Cord Stimulation; SNS = Sacral Nerve Stimulation; TNS = Trigeminal Nerve Stmulation; Vis = Vision Current NS Treatment Modalities
- 18. What Are theChallenges? • Clinical Trials: Demonstrating efficacy under placebo conditions difficult due to blinding & operator characteristics • Long-term Stable Power Sources: Bigger batteries vs. recharging for implantables • Closed Loop vs. Open Loop Methodologies • Support: Implantable Neurostim looking much like pharma/biologic development: Time and $$$
- 19. Impact on ClinicalCare and Practice • NS has a long history of use in medicine • NS is a useful adjunctive tool in the treatment of Neurologic conditions • Several therapies have proven efficacy and safety for various disease conditions (eg, ET, Epilepsy) • Much interest in new approaches: • Implantable cortical and Deep Brain Stim for Epilepsy + other conditions • Non-invasive surface Trigeminal & Vagal Stimulation • Clinical trials, development timelines can be challenging • NS is still maturing
- 20.
- 21. References/Data/Graphic Sources • tp://en.wikipedia.org/wiki/Electric_current •antenna-theory.com; Physlink.com, various Google Images • tp://www.burtonreport.com/infspine/NSHistNeurostimPar tI.htm • thefullwiki.org; http://en.wikipedia.org/wiki/Electroconvulsive_therapy and ../Electroencephalography • http://www.economist.com/blogs/dailychart/2011/10/comp uting-power & letshavetheconversation.blogspot.com • Osteoarthritis.about.com; Scientific American.com; http://www.burtonreport.com/infspine/NSHistNeurostimPar tI.htm • Osteoarthritis.about.com; Medtronic.com; Cyberonics.com