Brainstorming - michaelrees/Trigeminal_Stimulation GitHub Wiki

company Neurosigma

Sources

http://www.medscape.com/viewarticle/780121

http://www.neurology.org/content/61/3/421.short

http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2006.00594.x/full

http://www.sciencedirect.com/science/article/pii/S1042368011000672

http://www.slideshare.net/adorabledrakheel/trigeminal-nerve-19339645

Trigeminal nerve stimulation (TNS) is an emerging neuromodulation therapy with unique advantages: it can be delivered externally, bilaterally, and at low cost.15 and 16 Response during a trial of external TNS can be used to evaluate potential surgical candidates before an implantable stimulation device is inserted.1 The trigeminal ganglion, located in the Meckel cave (cavum trigeminale), projects to the trigeminal nucleus, which has reciprocal projections to the nucleus tractus solitarius (NTS), locus coeruleus, and the reticular formation, Therefore, in the laboratory of Dr M.A.L. Nicolelis in the Department of Neurobiology at Duke University, Unlike VNS, in which typically only the left vagus nerve is stimulated to avoid cardiac side effects, TNS can readily be applied to both trigeminal nerves simultaneously.8, 9, 15 and 16

That is, with unilateral TNS, a stimulus intensity of 11 mA was required to achieve 75% seizure reduction, whereas with bilateral stimulation the same degree of seizure reduction was accomplished with 7 mA of current presented to each nerve simultaneously.17 This result suggests that the effects of TNS increase with multiple nerve stimulation sites, which has implications for the optimization of TNS application in patient populations.17 ... These results showed that TNS could successfully be applied in a closed-loop, seizure-triggered manner.

http://www.surgicalneurologyint.com/article.asp?issn=2152-7806;year=2012;volume=3;issue=5;spage=247;epage=254;aulast=Fanselow

http://www.sciencedirect.com/science/article/pii/S1525505011005579

http://jnnp.bmj.com/content/85/10/e4.191.short We offer patients with drug resistant epilepsy (aged 9+) eTNS and audit outcome. A self-adhesive electrode is placed on the forehead stimulating both trigeminal nerves (120 Hz, 30 seconds on/off). Patients set the current (noticeable/comfortable, <10mA, aiming >8 hours overnight).

ideas:

can an external source activate a neuron from that far away? would this cause activation of sensory fibers close to the electrode in the skin? may be uncomfortable does their specific pulse sequence activate a neuron from that far away?

Does increased trigeminal nerve firing = increases nucleus solitaris firing?