Neurostimulation for fecal incontinence after correction of repair of imperforate anus

We are reporting the case of a 32-year-old female who had suffered from fecal incontinence(FI). She was born with an imperforate anus and a recto-vaginal fistula; she underwent repair at 6 mo of age. At 29 years of age, she was still fecally incontinent despite extensive pelvic floor reeducation. A magnetic resonance imaging and an anal electromyography were performed. Because her symptoms were considered to be probably due to extra-sphincteric implantation of the neo-anus, a redo was performed of the recto-neo-anal intra-sphincteric anastomosis. A neurostimulator device was subsequently implanted for persistent incontinence. Solid and liquid FI resolved, and her quality of life improved markedly. Combining surgery to correct the position of the neo-anus within the anal sphincter complex and neurostimulation could thus become a new approach in cases of refractory FI for patients with imperforate anus as a newborn. Follow-up into adulthood after pediatric imperforate anus surgery should be recommended for adult patients with persistent FI.

Emerging Noninvasive Neurostimulation Technologies: CN-NINM and SYMPATOCORECTION

Two emerging noninvasive neurostimulation technologies, based on electrocutaneius stimulation of the tongue (CN-NINM) and the neck (SYMPATOCORRECTION) are presented. Currently, two portable devices were developed and introduced in clinical practice: PoNSTM (portable neurostimulator) and SYMPATOCOR. Both technologies are complement each other and demonstrate perspectives in various applications for purpose of neurorehabilitation and neurological symptoms management in such difficult rehabilitation areas, as traumatic brain injury, stroke, Parkinson’s disease, multiple sclerosis and many other neurological disorders.

Triboelectric nanogenerators for self-powered neurostimulation

The burgeoning field of soft bioelectronics heralds a new dawn in medical treatment for neurological and psychiatric conditions,presenting innovative methods for the stimulation,inhibition,and precise sensing of neuronal activities.Central to these advancements is the challenge of power supply;devices dependent on traditional batteries face limitations regarding miniaturization and require invasive surgeries for battery replacement.Triboelectric nanogenerators(TENGs),which generate power from biomechanical movements,offer a promising solution for developing self-powered neurostimulation devices without the need for an external power supply.This review delves into recent progress in TENGs,with a focus on their application in selfpowered neurostimulation systems.The utility of TENGs across various nervous systems—including the center,autonomic,and somatic nervous systems—is explored and presented,highlighting the potential for these devices to facilitate neurological treatments.By summarizing TENGs’operational details and the potential for clinical translation,this review also identifies challenges associated with the implantation and integration of neural electrodes and presents recent advances in solutions,aiming to reshape electric treatments for neurological diseases.

Pathogenesis, diagnosis, and treatment of epilepsy: electromagnetic stimulation-mediated neuromodulation therapy and new technologies

Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.

Diabetic peripheral neuropathy and neuromodulation techniques:a systematic review of progress and prospects

Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition.Diabetic peripheral neuropathy,a common complication of diabetes,is characterized by nerve damage due to high blood sugar levels that lead to symptoms,such as pain,tingling,and numbness,primarily in the hands and feet.The aim of this systematic review was to evaluate the efficacy of neuromodulatory techniques as potential therapeutic interventions for patients with diabetic peripheral neuropathy,while also examining recent developments in this domain.The investigation encompassed an array of neuromodulation methods,including frequency rhythmic electrical modulated systems,dorsal root ganglion stimulation,and spinal cord stimulation.This systematic review suggests that neuromodulatory techniques may be useful in the treatment of diabetic peripheral neuropathy.Understanding the advantages of these treatments will enable physicians and other healthcare providers to offer additional options for patients with symptoms refractory to standard pharmacologic treatments.Through these efforts,we may improve quality of life and increase functional capacity in patients suffering from complications related to diabetic neuropathy.

Optical-neural Stimulation in Non-human Primates:Modulating Brain Function and Behavior

Optical-neural stimulation,which encompasses cutting-edge techniques such as optogenetics and infrared neurostimulation,employs distinct mechanisms to modulate brain function and behavior.These advanced neuromodulation techniques offer accurate manipulation of targeted areas,even selectively modulating specific neurons,in the brain.This makes it possible to investigate the cause-and-effect connections between neural activity and behavior,allowing for a better comprehension of the intricate brain dynamics towards complex environments.Non-human primates serve as an essential animal model for investigating these complex functions in brain research,bridging the gap between the basic research and clinical applications.One of the earliest optical studies utilizing optogenetic neuromodulation in monkeys was conducted in 2009.Since then,the optical-neural stimulations have been effectively applied in non-human primates.This review summarises recent research that employed optogenetics or infrared neurostimulation techniques to regulate brain function and behavior in non-human primates.The current state of optical-neural stimulations discussed here demonstrates their efficacy in advancing the understanding of brain systems.Nevertheless,there are still challenges that need to be addressed before they can fully achieve their potential.

Recent advancements in noninvasive brain modulation for individuals with autism spectrum disorder

Autism spectrum disorder is classified as a spectrum of neurodevelopmental disorders with an unknown definitive etiology.Individuals with autism spectrum disorder show deficits in a variety of areas including cognition,memory,attention,emotion recognition,and social skills.With no definitive treatment or cure,the main interventions for individuals with autism spectrum disorder are based on behavioral modulations.Recently,noninvasive brain modulation techniques including repetitive transcranial magnetic stimulation,intermittent theta burst stimulation,continuous theta burst stimulation,and transcranial direct current stimulation have been studied for their therapeutic properties of modifying neuroplasticity,particularly in individuals with autism spectrum disorder.Preliminary evidence from small cohort studies,pilot studies,and clinical trials suggests that the various noninvasive brain stimulation techniques have therapeutic benefits for treating both behavioral and cognitive manifestations of autism spectrum disorder.However,little data is available for quantifying the clinical significance of these findings as well as the long-term outcomes of individuals with autism spectrum disorder who underwent transcranial stimulation.The objective of this review is to highlight the most recent advancements in the application of noninvasive brain modulation technology in individuals with autism spectrum disorder.

Posterior tibial nerve stimulation for fecal incontinence:Where are we?

Neurostimulation remains the mainstay of treatment for patients with faecal incontinence who fails to respond to available conservative measures.Sacral nerve stimulation(SNS)is the main form of neurostimulation that is in use today.Posterior tibial nerve stimulation(PTNS)-both the percutaneous and the transcutaneous routes-remains a relatively new entry in neurostimulation.Though in its infancy,PTNS holds promise to be an effective,patient friendly,safe and cheap treatment.However,presently PTNS only appears to have a minor role with SNS having the limelight in treating patients with faecal incontinence.This seems to have arisen as the strong,uniform and evidence based data on SNS remains to have been unchallenged yet by the weak,disjointed and unsupported evidence for both percutaneous and transcutaneous PTNS.The use of PTNS is slowly gaining acceptance.However,several questions remain unanswered in the delivery of PTNS.These have raised dilemmas which as long as they remain unsolved can considerably weaken the argument that PTNS could offer a viable alternative to SNS.This paper reviews available information on PTNS and focuses on these dilemmas in the light of existing evidence.

Modulated-Power Implantable Neuromodulation Devices and Their Impact on Surrounding Tissue Temperatures

This project was intended to determine whether the preprogrammed time-varying recharge protocol for a battery incased in a neuromodulation implant can give rise to tissue temperatures that surpass a safe level or are otherwise benign. The study included the development of a highly accurate model of all the thermal processes that are activated by the recharging of the battery contained within the neuromodulation implant. The model was implemented by numerical simulations performed for several realistic operating conditions. The computed spatial and temporal tissue temperature distributions were employed to estimate possible tissue damage by making use of two independent methodologies. Independent calorimeter-based experiments were performed to provide validation for the calculated rates of heat generation in the coils of the implant. Spatial and temporal tissue temperature distributions extracted from the numerical simulations revealed the thermal effects associated with several realistic operating protocols. None of the operating protocols gave rise to temperatures above 42℃. Numerical values of thermal tissue damage metrics were determined and compared with accepted values which correspond to the absence and the presence of tissue damage. The experimentally determined rate of heat generation in the implant coils validated that from electrical measurements to within 2%. Both the tissue temperature results and the thermal damage metrics found no evidence of tissue injury when time-varying preprogrammed protocols are used in the recharging of neuromodulation implant-encased batteries.

A Review of the Surgical Procedures for the Treatment of Drug-Resistant Epilepsy and Their Seizure Control Outcomes

Background: Drug-resistant epilepsy can be defined as the existence of seizures within 6 months, despite adequate therapy regimens with one or more antiepileptic drugs. Epilepsy surgery has been the standard therapy to help those patients who suffer from drug-resistant epilepsy. The goal of this surgery is to halt or reduce the intensity of seizures. This literature review aims to provide an overview of existing surgical procedures for the treatment of drug-resistant epilepsy and the degree of seizure control they provide based on available literature. Methods: Data were collected from medical journal databases, aggregators, and individual publications. The most used databases were PubMed, Medline and NCBI. Some of the keywords used to search these databases include: “drug resistant epilepsy”, “seizure control”, and “neurosurgery”. Results: Epileptic surgery is divided into resective and non-resective procedures. Studies have shown that a full resection of the epileptogenic brain area increases the probability of seizure eradication, however, the risks of postoperative impairments grow as the resection area is extended. On the other hand, patients who are unsuitable for seizure focus removal by resective surgery, such as those with multifocal seizures or overlapping epileptogenic zone with a functional cortex, may benefit from non-resective surgical options such as Vagus Nerve Stimulation and Responsive Neurostimulation. Conclusion: This literature review discusses the comprehensive treatment of epilepsy, especially the surgical treatment of drug-resistant epilepsy. The reviewed studies have shown that epilepsy surgery has promising outcomes in achieving seizure freedom/reducing seizure frequency with minimal adverse effects when performed correctly with the appropriate choice of surgical candidates.

An implantable neurostimulator with an integrated high-voltage inductive powerrecovery frontend

This paper present a highly-integrated neurostimulator with an on-chip inductive power-recovery fron- tend and high-voltage stimulus generator. In particular, the power-recovery frontend includes a high-voltage full- wave rectifier （up to 100 V AC input）, high-voltage series regulators （24/5 V outputs） and a linear regulator （1.8/ 3.3 V output） with bandgap voltage reference. With the high voltage output of the series regulator, the proposed neurostimulator could deliver a considerably large current in high electrode-tissue contact impedance. This neu- rostimulator has been fabricated in a CSMC 1 μm 5/40/700 V BCD＇process and the total silicon area including pads is 5.8 mm2. Preliminary tests are successful as the neurostimulator shows good stability under a 13.56 MHz AC supply. Compared to previously reported works, our design has advantages of a wide induced voltage range （26-100 V）, high output voltage （up to 24 V） and high-level integration, which are suitable for implantable neu- rostimulators.

A bidirectional brain-computer interface for effective epilepsy control

Brain-computer interfaces(BCIs) can provide direct bidirectional communication between the brain and a machine. Recently, the BCI technique has been used in seizure control. Usually, a closed-loop system based on BCI is set up which delivers a therapic electrical stimulus only in response to seizure onsets. In this way, the side effects of neurostimulation can be greatly reduced. In this paper, a new BCI-based responsive stimulation system is proposed. With an efficient morphology-based seizure detector, seizure events can be identified in the early stages which trigger electrical stimulations to be sent to the cortex of the brain. The proposed system was tested on rats with penicillin-induced epileptic seizures. Online experiments show that 83% of the seizures could be detected successfully with a short average time delay of 3.11 s. With the therapy of the BCI-based seizure control system, most seizures were suppressed within 10 s. Compared with the control group, the average seizure duration was reduced by 30.7%. Therefore, the proposed system can control epileptic seizures effectively and has potential in clinical applications.

Hypoglossal nerve stimulation for obstructive sleep apnea:A review of the literature

Objective:To review the indications and clinical evidence supporting hypoglossal nerve stimulation (HNS) therapy for the treatment of moderate-to-severe obstructive sleep ap-nea (OSA). Methods:Peer reviewed literature on hypoglossal nerve stimulation therapy for obstructive sleep apnea from 2001 to 2016. Results:The only currently FDA-approved HNS device for the treatment of moderate-to-severe OSA is produced by Inspire Medical Systems, which recently published its 36-month outcomes data from its Stimulation Therapy for Apnea Reduction (STAR) trial. HNS therapy is currently indicated for moderate-to-severe OSA patients who are CPAP-intolerant, have a body mass in-dex <32, apnea-hypopnea index <50, and without a concentric pattern of upper airway collapse on sleep endoscopy. Conclusions:Data from the STAR trial suggests that a subset of OSA patients can achieve a sig-nificant therapeutic response from hypoglossal nerve stimulation. However, these results may be limited in their generalizability to the broader OSA population.

Neuromodulation for temporal lobe epilepsy:a scoping review

Temporal lobe epilepsy(TLE)is difficult to treat as it is often refractory to treatment.Apart from traditional medical treatment,surgical resection is also a choice of treatment,but it may be associated with significant cognitive deficits.As a result,treatment strategies using targeted and adjustable stimulation of malfunctioning brain circuits have been developed.These neuromodulatory therapies using approaches of electric and magnetic neuromodulation are already in clinical use for refractory epilepsy while others such as optogenetics,chemo-genetics and ultrasound modulation are being tested in pre-clinical TLE animal models.In this review,we conducted an in-depth literature search on the clinically available neuromodulatory approaches for TLE,focusing on the possible mechanism of action and the clinical outcomes including adverse effects.Techniques that are currently explored in preclinical animal models but may have therapeutic applications in future are also discussed.The efficacy and subsequent adverse effects vary among the different neuromodulatory approaches and some still have unclear mechanisms of action in TLE treatment.Further studies evaluating the benefits and potential limitations are needed.Continued research on the therapeutic mechanisms and the epileptic brain network is critical for improving therapies for TLE.

Affected cortico-striatal-cerebellar network inschizophrenia with catatonia revealed by magneticresonance imaging:indications for electroconvulsive therapy and repetitive transcranial magnetic stimulation

Catatonia is a psychomotor syndrome that can occur in a broad spectrum of brain disorders,including schizophrenia.Current findings suggest that the neurobiological process underlying catatonia symptoms in schizophrenia is poorly understood.However,emerging neuroimaging studies in catatonia patients have indicated that a disruption in anatomical connectivity of the cortico-striatal-cerebellar system is part of the neurobiology of catatonia,which could serve as a target of neurostimulation such as electroconvulsive therapy and repetitive transcranial magnetic stimulation.