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Effects of stimulation frequency and intensity in sacral neuromodulation on anorectal inputs to the somatosensory cortex in an experimental model
Oleh:
Evers, J.
;
Devane, L.
;
Carrington, E.V.
;
Scott, S.M.
Jenis:
Article from Article - diterbitkan di jurnal ilmiah internasional
Dalam koleksi:
BJS: British Journal of Surgery vol. 101 no. 10 (Sep. 2014)
,
page 1317-1328.
Topik:
faecal incontinence
;
anal canal
;
treatment
;
electrode polarity
Ketersediaan
Perpustakaan FK
Nomor Panggil:
B15.K
Non-tandon:
1 (dapat dipinjam: 0)
Tandon:
tidak ada
Lihat Detail Induk
Isi artikel
Introduction Although sacral neuromodulation (SNM) is an established treatment for faecal incontinence, stimulation parameters have been derived empirically and only one frequency (14?Hz) is employed clinically. The aim of this study was to test a range of stimulation frequencies to establish an optimal frequency of SNM for maximum augmentation of anal canal cortical evoked potentials (EPs) in an animal model. Methods In female Wistar rats, anal canal EPs were recorded over the primary somatosensory cortex using a flexible multielectrode array, and the effect of SNM was studied. SNM was applied at 0·1–100?Hz and a frequency response curve plotted. The data were fitted to a quadratic equation. Results The magnitude of potentiation of anal canal EPs caused by SNM depended significantly on stimulation frequency (P?0·001). The frequency–potentiation relationship was parabolic in form, with a clear optimum at 2?Hz. The SNM must be applied for at least 3?min. The theoretical maximal potentiation predicted by the model was not found to be statistically different to actual data recorded (P?=?0·514–0·814). The response depended on stimulation amplitude in an ‘all-or-nothing’ fashion. EPs were augmented when the SNM intensity was 0·5 times the motor threshold to tail twitch or greater, but values below this intensity failed to affect the EPs. Conclusion The effect of SNM in this animal model is governed principally by frequency, with an optimum of 2?Hz. If animal data can be translated to humans, optimization of SNM frequency may offer a clinically relevant improvement in the efficacy of SNM. Sacral neuromodulation (SNM) for faecal incontinence currently employs stimulation parameters that have been derived empirically and may not be optimal. This study used an animal model of SNM and focused on its acute effect on anal canal cortical evoked potentials (EPs). It was found that SNM potentiated EPs, with a clear optimum at a frequency of 2?Hz. If this finding is applicable to the mechanism of action of human SNM, this suggests that there may be a clinically relevant improvement by reducing stimulus frequency from its typical value of 14?Hz to 2?Hz.
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