Vagus nerve stimulation (VNS) is an approved therapy for patients suffering from refractory epilepsy. While VNS is currently an open loop system, making the system closed loop can improve the therapeutic efficacy. Electrical recording of peripheral nerve activity using a nerve cuff electrode is a potential long-term solution for implementing a closed-loop controlled VNS system. However, the clinical utility of this approach is significantly limited by various factors, such as poor signal-to-noise ratio (SNR) of the recorded electroneurogram (ENG). In this study, we investigated the effects of (1) modifying the electrode contact dimensions, (2) implementing an external shielding layer on the nerve cuff electrode and (3) exploring shielded bipolar nerve cuff designs on the recorded ENG. Findings from both computer simulations and animal experiments suggest that significant improvements in peripheral nerve recordings can be achieved.

No description available.

Alzheimer’s disease is the most common cause of dementia worldwide. As the disease course progresses, it can be debilitating to the patient and provide a large burden for their families and caregivers alike. As our population ages, it more important than ever to find safe and efficacious strategies to combat the cognitive effects of Alzheimer’s disease. While there have been many recent advances surrounding early identification of the disease including the use of PET imaging with specific targeted ligands or CSF analysis for biomarkers, there has been less progress in the development of disease modifying therapies to halt or reverse the symptoms. Vagus nerve stimulation has been a standard in therapy for drug-resistant epilepsy and depression for many years. It has been proven to be effective and has led to drastic improvement in many patients’ lives whose diseases were refractory to standard medications. There is evidence that stimulation of the vagal nerve leads to a physiologic response that also supports long term potentiation of memory within the hippocampus, though trials have been limited by sample size in the past due to the necessity of surgical implantation of the vagal nerve stimulator device. The recent development of non- invasive vagal nerve stimulation removes this limitation. This non-invasive strategy takes advantage of the auricular branch of the vagus nerve innervation of the ear to access the vagal pathway. The following work includes a proposal for a randomized control study to investigate the cognitive benefits of non-invasive vagal nerve stimulation of the auricular branch of the vagus nerve in a cohort of patients with MCI due to Alzheimer’s disease. This trial is planned for patients of neurology or gerontology practices associated with Boston Medical Center, Massachusetts General Hospital, Beth Israel Hospital, and Brigham and Women’s Hospital. Outcomes of this study will be the change in Mini- Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-Cog) score over a two-year intervention time.

Cardiovascular disease (CVD) is the leading cause of death worldwide and is expected to increase in prevalence. As a result of the individual and systemic healthcare impacts of CVD, heart failure, and its subsets, focusing on the alleviation of cardiac dysfunction and restoration of autonomic imbalance is paramount. Most research regarding cardiovascular disease is focused on mitigating heart failure from a cardiovascular perspective. However, this review will investigate heart failure from a neuroscientific perspective, highlighting the influence of the renin-angiotensin-aldosterone system, autonomic imbalance, and neuroinflammation on the progression of heart failure. By doing so, this research will bring light to how neuroscience may be applied to the cardiovascular system, and how interventions, such as vagal nerve stimulation, may be an untapped resource in mitigating the progression of heart failure. This review examined current relevant research to understand the brain regions implicated in the progression of heart failure, and to better understand how the nervous system may be modulated to improve heart failure outcomes through vagal nerve stimulation. This review sets the conceptual framework for future research to examine the structural changes observed in research animals who receive vagal nerve stimulation.

No description available.

M.Tech. (Homoeopathy) / Neck pain is a common condition usually experienced due to mechanical or degenerative problems (Colledge et al., 2010). The onset of neck pain may be acute and associated with asymmetrical restriction of neck movements and a history of awkward posture or sudden onset. Acute neck pain is an aching pain in the cervical paraspinal muscles and ligaments. It is associated with muscle spasm, stiffness and tightness in the upper back and shoulders that lasts up to six weeks. Headaches may be present (Bickley & Szilagyi, 2009). Causes of neck pain can be mechanical, inflammatory, metabolic, neoplastic, due to referred pain or other underlying aetiologies (Colledge et al., 2010). The most common treatments for neck pain are nonsteroidal anti-inflammatory drugs, physiotherapy, chiropractic adjustment or therapeutic massage (Taylor, 2010). The NeuroTrac® MultiTENS device provides a non-invasive, drug-free method of controlling acute pain by transmitting mild electrical impulses via surface electrodes through the skin (Verity Medical Ltd., 2013). There have been many studies done on Transcutaneous Electrical Nerve Stimulation (TENS) devices, but little on its immediate effect on acute neck pain. The aim of this study was to determine the immediate effect of the NeuroTrac® MultiTENS device on acute neck pain, using the Neck Pain Disability Index, Visual Analogue Scale and the Cervical Range of Motion (CROM). This study was an unblinded, single-group experimental design (Brink, 2010). The study took place at the University of Johannesburg Campus Clinic. Recruitment took place by means of advertisements (Appendix H) placed at the University of Johannesburg campuses. Inclusion criteria consisted of males and females between the ages of eighteen to fifty years. Participants had to be suffering from aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, stiffness and tightness in the upper back and shoulders that was present for more than one day and no longer than one week, with decreased range of motion on CROMs (Appendix G) and a minimum score of 10 on the Neck Pain Disability Index (Appendix D). Exclusion criteria consisted of participants suffering from severe headaches with meningeal signs associated nausea, blurred vision, photophobia and phonophobia or fever; a history of thrombus formation or transient ischaemic attack (Longmore et al., 2010); if they had a pacemaker or if they have had any head and neck surgery; if they suffered from cardiac arrhythmia or myocardial infarction; pregnancy or suspected pregnancy; if they had a general skin sensitivity or known allergy to adhesives or if they have had a recent chiropractic adjustment. A total of forty participants were selected. The participants acted as their own baseline control. The researcher was only required to see participants once for one forty minute session to determine the immediate vi effect of the NeuroTrac® MultiTENS device on acute neck pain. Participants were asked to fill in an Information (Appendix A) and Consent Form (Appendix B). Participants came in for an initial consult where a history was taken on the type of neck pain experienced and the cause of the pain experienced. Vital signs were recorded on a case taking form (Appendix C). Thereafter participants were asked to fill in the Vernon and Mior Neck Pain Disability Index (Appendix D) relating to the neck pain they experienced and to complete a Visual Analogue Scale to rate their neck pain (Appendix F). The CROM goniometer device was placed on the participant’s head to measure all cervical spine ranges of motion, to the limit of pain (Appendix G). All forty participants received treatment at a frequency of 90Hz with a 200μS pulse width with the electronic pads placed on the shoulders. NeuroTrac® MultiTENS device treatment was administered for forty minutes to the participants in a seated position. The treatment was administered by the researcher. Once the treatment ended, participants were asked to fill in an amended questionnaire (Appendix E) that assessed if they noticed a change in the neck pain they were experiencing, to complete the Visual Analogue Scale (Appendix F) and their vital signs were again recorded on a case taking form (Appendix C). The CROM goniometer device was again placed on the participant’s head to measure all cervical spine ranges of motion to assess if there was a change in the readings recorded (Appendix G). The data obtained was statistically analysed by the researcher with the aid of a statistician at Statkon. The Shapiro-Wilk test and the Wilcoxon Signed-Rank test (non-parametric test) were used (Van Staden, 2014) ...

INTRODUÇÂO: Fibromialgia é caracterizada como síndrome, a qual inclui dor muscular, fadiga e distúrbio do sono. Ansiedade e depressão estão freqüentemente associados, porém a causa é desconhecida. A intensidade da dor piora ao se deitar, durante a noite e no despertar. Normalmente a dor se difunde na região lombar e cervical. A TENS é um método não medicamentoso, estabelecido para controle da dor, o qual minimiza o consumo de analgésicos. OBJETIVOS: Este estudo visou avaliar a utilização de dispositivos de TENS simultâneos em pacientes portadores de Fibromialgia. MÉTODOS: Após aprovação do Comitê de Ètica em Pesquisa e consentimento, 39 pacientes portadores de Fibromialgia foram avaliados de forma prospectiva, aleatória e duplamente-encoberta. Avaliou-se a utilidade clínica de um novo, muito pequeno e leve dispositivo de a TENS (TANYX). Dois dispositivos de TENS, foram aplicados de forma simultânea em cada paciente: 1) na região lombar (perpendicular à coluna sobre L5), e 2) na região cervical (perpendicular à coluna, entre C7 e T1), durante 20-min, a cada 12 horas, durante 7 dias consecutivos (antes de se deitar, à noite, e antes de se levantar, pela manhã). Os pacientes foram divididos em 3 grupos (n=13). O grupo placebo (GP) utilizou adesivos que não transmitiam estímulo elétrico, semelhantes aos originais. O grupo de únicoTENS (TENS-1) (n=13), utilizou um adesivo de TENS ativo na área mais dolorida (cervical ou lombar) e placebo na área menos doloroa. O terceiro grupo (TENS-2) utilizou dois adesivos ativos de TENS nas áreas cervical e lombar, simultaneamente. Para controlar a dor, diclofenaco (50mg) foi utilizado como analgésico de resgate, até três vezes ao dia. Foram avaliados a intensidade da dor através da escala numérica visual (ENV 0-10 cm), consumo de analgésicos de resgate, qualidade do sono e fadiga. RESULTADOS: Os pacientes foram demograficamente semelhantes. 36 pacientes completaram o estudo. Três pacientes do grupo placebo desistiram no 4o dia de ausência de alívio da dor. A avaliação entre cada grupo antes e após o tratamento revelou que pacientes do grupo placebo não apresentaram alívio da dor (ENV 8 cm, p>0,05), da fatiga, ou melhora do padrão de sono, enquanto o grupo TENS-1 apresentou diminuição de 2,5 cm na ENV para dor (ENV anterior 8,5 cm e após 6 cm) (p<0,05). Finalmente, o grupo TENS-2 referiu redução de 4 cm na intensidade da dor (ENV anterior ao tratamento 8,5 cm e 4,3 cm após tratamento) (p<0,02). O consumo de analgésicos diários foi menor para TENS-1 (p<0,05) e TENS-2 (p<0,02). A comparação entre os 3 grupos revelou que a analgesia, qualidade de sono e melhora da fadiga foi: grupo TENS-2 > TENS-1 > GP (p<0,05). Os participantes consideraram os aparelhos ativos úteis. Não foram observados efeitos adversos. CONCLUSÕES: enquanto a aplicação de um dispositivo de TENS na área dolorida, lombar ou cervical, amenizou a dor em pacientes portadores de fibromialgia, a fadiga e a qualidade do sono foram minimizadas apenas quando dois dispositivos foram utilizados, demonstrando que este novo dispositivo pode ser adjuvante para dor da fibromialgia. / BACKGROUND: Fibromyalgia is characterized by a range of symptoms that include muscle pain, fatigue and sleep disorders. Anxiety and depression are often also present, and the cause is unknown. Worst pain is normally felt during bedtime, at night and before waking up in the morning, and pain is normally widespread at the low back and cervical area. Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief, which does not involve the use of medication and can be advantageous, as adjuvant, for pain control. OBJECTIVES: The purpose of the study was to evaluate the effectiveness and safety of the use of two simultaneously new TENS devices for Fibromyalgia pain. METHODS: The local Ethics Committee approved the study, and informed consent was obtained. This prospective, double-blind randomized study evaluated the clinical utility of a new, very small and light, high frequency TENS device (TANYX) in 39 patients suffering from Fibromyalgia. Two TENS device were applied simultaneously in each patient: 1) at the lower back (perpendicular to the vertebrae canal, at the level of the 5th lumbar vertebrae), and 2) centrally above and below the space between the C7 and T1 spinous processes, perpendicular to the spine. The two devices were applied during 20-min at 12-hour interval during 7 consecutive days (Before bed-time and just after waking up in the morning). Patients were randomly divided into three groups (n=13): For the placebo group (PG), the two devices did not transmitted electrical stimulus, although they were externally similar to the active ones. The single-TENS group (STG) had applied one active TENS device at the worst area of pain (low back or cervical), and the placebo device at the less painful area. The third group double-TENS group (DTG) applied both active TENS devices at the low back and cervical areas. Diclofenac (50 mg) up to three times daily was used as rescue analgesic if necessary for pain control. The efficacy measures were pain relief evaluated on a visual analogue scale (VAS 0-10 cm),, reduction in use of daily analgesic tablets, quality of sleep, and fatigue. MAIN RESULTS: Patients were demographically similar. 36 patients completed the study. Three patients from the PG give up the study on the fourth day for absence of any pain relief. The evaluation within groups revealed that patients from DPG refereed no pain relief when compared to their previous VAS pain score (8-cm, p>0.05), while patients from the STG refereed improvement of 2.5 cm in the pain VAS (previous 8.5 cm compared to 6-cm after treatment) (p<0.05); and the DPG refereed daily maintained reduction of 4 cm in the VAS-pain (previous 8.5-cm to 4.3-cm) (p<0.02). Concurrent daily consumption of analgesic tablets was reduced in both STG (p<0.05) and DTG (p<0.02). Comparison among groups revealed that analgesia, as well as quality of sleep and disposition was: DTG > STG > PG (p<0.05). Participants subjectively found the active device useful. No adverse effects were observed. CONCLUSIONS: while the application of one active TENS device at either the lower back or cervical area improved pain relief in patients suffering from Fibromyalgia pain, the pain and fatigue were further improved when two actives devices were simultaneously applied, reflecting this new device an useful adjuvant for Fibromyalgia pain.

Heart failure is a prevalent health concern within the western world. It has huge economic, financial and personal implications. Despite the development of several clinically available treatments, heart failure associated mortality remains high. Heart failure patients display with dysfunction of the autonomic nervous system, including a high degree of vagal withdrawal. Consequently, the up-regulation of cardiac vagal tone, using vagal nerve stimulation (VNS) has recently gained attention as a potential new therapeutic approach to the treatment of heart failure. Clinical trials of VNS have produced mixed outcomes and very little is known about the mechanisms mediating the cardioprotective effects of VNS. This study has therefore implemented VNS in an ovine tachypaced model of heart failure, with the primary aim of quantifying its therapeutic effect in this model. Secondly, two potential underlying mechanisms of VNS have been investigated: 1) the effects of VNS on cellular calcium handling and 2) the effects of VNS on myocardial S-nitrosylation (S•NO).VNS treatment in this model of heart failure had a modest therapeutic effect. However, no differences in echocardiographic parameters, including those used as outcome measures in ongoing clinical trials, were observed between treated and untreated animals. Similarly, no differences in calcium handling parameters were observed between ventricular myocytes isolated from treated and untreated animals. Finally, VNS caused an increase in S•NO of several identified myocardial proteins when compared to untreated heart failure controls. However, this was a relatively small change compared to that observed between control and heart failure tissues. This data, as with studies before, highlights the need for a greater understanding of autonomic regulation and VNS in the heart failure setting, so that treatment strategies can be more effectively optimised. Given the limited therapeutic effect observed in this study, these potential mechanisms cannot be excluded as contributing to the cardioprotective effects of VNS observed in other studies.

INTRODUÇÂO: Fibromialgia é caracterizada como síndrome, a qual inclui dor muscular, fadiga e distúrbio do sono. Ansiedade e depressão estão freqüentemente associados, porém a causa é desconhecida. A intensidade da dor piora ao se deitar, durante a noite e no despertar. Normalmente a dor se difunde na região lombar e cervical. A TENS é um método não medicamentoso, estabelecido para controle da dor, o qual minimiza o consumo de analgésicos. OBJETIVOS: Este estudo visou avaliar a utilização de dispositivos de TENS simultâneos em pacientes portadores de Fibromialgia. MÉTODOS: Após aprovação do Comitê de Ètica em Pesquisa e consentimento, 39 pacientes portadores de Fibromialgia foram avaliados de forma prospectiva, aleatória e duplamente-encoberta. Avaliou-se a utilidade clínica de um novo, muito pequeno e leve dispositivo de a TENS (TANYX). Dois dispositivos de TENS, foram aplicados de forma simultânea em cada paciente: 1) na região lombar (perpendicular à coluna sobre L5), e 2) na região cervical (perpendicular à coluna, entre C7 e T1), durante 20-min, a cada 12 horas, durante 7 dias consecutivos (antes de se deitar, à noite, e antes de se levantar, pela manhã). Os pacientes foram divididos em 3 grupos (n=13). O grupo placebo (GP) utilizou adesivos que não transmitiam estímulo elétrico, semelhantes aos originais. O grupo de únicoTENS (TENS-1) (n=13), utilizou um adesivo de TENS ativo na área mais dolorida (cervical ou lombar) e placebo na área menos doloroa. O terceiro grupo (TENS-2) utilizou dois adesivos ativos de TENS nas áreas cervical e lombar, simultaneamente. Para controlar a dor, diclofenaco (50mg) foi utilizado como analgésico de resgate, até três vezes ao dia. Foram avaliados a intensidade da dor através da escala numérica visual (ENV 0-10 cm), consumo de analgésicos de resgate, qualidade do sono e fadiga. RESULTADOS: Os pacientes foram demograficamente semelhantes. 36 pacientes completaram o estudo. Três pacientes do grupo placebo desistiram no 4o dia de ausência de alívio da dor. A avaliação entre cada grupo antes e após o tratamento revelou que pacientes do grupo placebo não apresentaram alívio da dor (ENV 8 cm, p>0,05), da fatiga, ou melhora do padrão de sono, enquanto o grupo TENS-1 apresentou diminuição de 2,5 cm na ENV para dor (ENV anterior 8,5 cm e após 6 cm) (p<0,05). Finalmente, o grupo TENS-2 referiu redução de 4 cm na intensidade da dor (ENV anterior ao tratamento 8,5 cm e 4,3 cm após tratamento) (p<0,02). O consumo de analgésicos diários foi menor para TENS-1 (p<0,05) e TENS-2 (p<0,02). A comparação entre os 3 grupos revelou que a analgesia, qualidade de sono e melhora da fadiga foi: grupo TENS-2 > TENS-1 > GP (p<0,05). Os participantes consideraram os aparelhos ativos úteis. Não foram observados efeitos adversos. CONCLUSÕES: enquanto a aplicação de um dispositivo de TENS na área dolorida, lombar ou cervical, amenizou a dor em pacientes portadores de fibromialgia, a fadiga e a qualidade do sono foram minimizadas apenas quando dois dispositivos foram utilizados, demonstrando que este novo dispositivo pode ser adjuvante para dor da fibromialgia. / BACKGROUND: Fibromyalgia is characterized by a range of symptoms that include muscle pain, fatigue and sleep disorders. Anxiety and depression are often also present, and the cause is unknown. Worst pain is normally felt during bedtime, at night and before waking up in the morning, and pain is normally widespread at the low back and cervical area. Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief, which does not involve the use of medication and can be advantageous, as adjuvant, for pain control. OBJECTIVES: The purpose of the study was to evaluate the effectiveness and safety of the use of two simultaneously new TENS devices for Fibromyalgia pain. METHODS: The local Ethics Committee approved the study, and informed consent was obtained. This prospective, double-blind randomized study evaluated the clinical utility of a new, very small and light, high frequency TENS device (TANYX) in 39 patients suffering from Fibromyalgia. Two TENS device were applied simultaneously in each patient: 1) at the lower back (perpendicular to the vertebrae canal, at the level of the 5th lumbar vertebrae), and 2) centrally above and below the space between the C7 and T1 spinous processes, perpendicular to the spine. The two devices were applied during 20-min at 12-hour interval during 7 consecutive days (Before bed-time and just after waking up in the morning). Patients were randomly divided into three groups (n=13): For the placebo group (PG), the two devices did not transmitted electrical stimulus, although they were externally similar to the active ones. The single-TENS group (STG) had applied one active TENS device at the worst area of pain (low back or cervical), and the placebo device at the less painful area. The third group double-TENS group (DTG) applied both active TENS devices at the low back and cervical areas. Diclofenac (50 mg) up to three times daily was used as rescue analgesic if necessary for pain control. The efficacy measures were pain relief evaluated on a visual analogue scale (VAS 0-10 cm),, reduction in use of daily analgesic tablets, quality of sleep, and fatigue. MAIN RESULTS: Patients were demographically similar. 36 patients completed the study. Three patients from the PG give up the study on the fourth day for absence of any pain relief. The evaluation within groups revealed that patients from DPG refereed no pain relief when compared to their previous VAS pain score (8-cm, p>0.05), while patients from the STG refereed improvement of 2.5 cm in the pain VAS (previous 8.5 cm compared to 6-cm after treatment) (p<0.05); and the DPG refereed daily maintained reduction of 4 cm in the VAS-pain (previous 8.5-cm to 4.3-cm) (p<0.02). Concurrent daily consumption of analgesic tablets was reduced in both STG (p<0.05) and DTG (p<0.02). Comparison among groups revealed that analgesia, as well as quality of sleep and disposition was: DTG > STG > PG (p<0.05). Participants subjectively found the active device useful. No adverse effects were observed. CONCLUSIONS: while the application of one active TENS device at either the lower back or cervical area improved pain relief in patients suffering from Fibromyalgia pain, the pain and fatigue were further improved when two actives devices were simultaneously applied, reflecting this new device an useful adjuvant for Fibromyalgia pain.

abstract: Sleep is an essential human function. Modern day society has made it so that sleep is prioritized less and less. Professionals in critical positions such as doctors, nurses, and emergency medical technicians can often have hectic schedules that are unforgiving toward sleep due to the increase in shift work that dominates these fields. Sleep deficits can have detrimental effects on one’s psyche and mood. Depression and anxiety both have high comorbidity rates with insomnia because of sleeping deficits. Transdermal Electrical Nerve Stimulation (TENS) offers a potential solution to improving sleep quality and mood by modulating the ascending reticular activating system (RAS). This system starts in the anterior portion of the head with trigeminal nerve branches and is stimulated using a 500-550 Hz waveform. In this experiment Positive Affect and Negative Affect Schedule (PANAS) scores are recorded daily to monitor mood differences between pre and post treatment (TENS vs Sham). PANAS scores were found to be insignificant between groups. Pittsburgh Sleep Quality Index (PSQI), and Fitbit were chosen to study perceived sleep, and objective sleep. Both PSQI, and Fitbit found insignificant differences between TENS and Sham. Finally, the Beck Depression and Beck Anxiety Inventories were administered weekly to determine if there are immediate changes to depressive and anxiety symptom, after a week of treatment (TENS vs Sham). A significant difference was found between the pre and post of the TENS treatment group. The TENS group was not found to be significantly different from Sham, potentially the result of a placebo effect. These results were found with n=10 participants in the TENS treatment group and n=6 in the sham group. / Dissertation/Thesis / Masters Thesis Engineering 2018