Intramuscular Stimulation of Muscle Afferents Attains Prolonged Tremor Reduction in Essential Tremor Patients
Artikel i vetenskaplig tidskrift, 2021

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 Marañón 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.

Intramuscular

Tremor reduction

Essential tremor

Neuromodulation

Sensory stimulation

Författare

Alejandro Pascual-Valdunciel

Instituto Cajal

Universidad Politecnica de Madrid

Miguel Gonzalez-Sanchez

Hospital General Universitario Gregorio Maranon

Silvia Muceli

Chalmers, Elektroteknik, Signalbehandling och medicinsk teknik, Medicinska signaler och system

Beatriz Adan-Barrientos

Universidad Carlos III de Madrid

Viviana Escobar-Segura

Universidad Complutense de Madrid

Javier Ricardo Perez-Sanchez

Hospital General Universitario Gregorio Maranon

Moon Ki Jung

Imperial College London

Andreas Schneider

Fraunhofer-Institut fur Biomedizinische Technik - IBMT

Klaus Peter Hoffmann

Fraunhofer-Institut fur Biomedizinische Technik - IBMT

Juan Camilo Moreno

Instituto Cajal

Francisco Grandas

Hospital General Universitario Gregorio Maranon

Universidad Complutense de Madrid

Dario Farina

Imperial College London

Jose L. Pons

Instituto Cajal

Northwestern University

Filipe O. Barroso

Instituto Cajal

IEEE Transactions on Biomedical Engineering

0018-9294 (ISSN)

Vol. 68 6 1768-1776 9171555

Ämneskategorier

Kirurgi

Oto-rhino-laryngologi

Neurologi

DOI

10.1109/TBME.2020.3015572

PubMed

32813648

Mer information

Senast uppdaterat

2021-06-10