Evolución de los umbrales de estimulación en función de las distintas frecuencias en sistemas recargables para estimulación de los cordones posteriores.

David Abejon; Pablo Rueda; Ricardo Vallejo

doi:10.47924/neurotarget2018110

Authors

David Abejon Unidad de Dolor. Hospital Universitario Quiron, Madrid, España
Pablo Rueda Medtronic, Miami USA.
Ricardo Vallejo Director of Research Millennium Pain Center, IL, USA.

DOI:

https://doi.org/10.47924/neurotarget2018110

Keywords:

High frequency electrical stimulation, low frequency electrical stimulation, neurostimulation, perception threshold, programming

Abstract

Introduction: Pulse frequency (Fc) is one of the most important parameter in neurostimulation, with Pulse Amplitude(Pw) and Amplitude (I). Up to certain Fc, increasing the number pulses will generate action potentials in neighboring neural structures and may facilitate deeper penetration of the electromagnetic fields. In addition, changes in frequency modify the patient’s sensation with stimulation. Rechargeable systems allow for broader ranges of frequency settings.
Materials/Methods: The study was performed in 46 patients. With pulse width fixed at 300 μs, we stimulated at 26 frequency values between 40 and 1200 Hz and assessed the influence of these changes on stimulation thresholds, therapeutic range, paresthesia coverage of the painful area, and patient’s sensation and satisfaction related to the quality of stimulation.
Results: Fc is inversely proportional to all stimulation thresholds and this influence is statistically significant (p<0.05). From 40 to 1200 Hz, mean threshold variations were 7.25 to 1.38 mA (Perception - Tp), 8.17 to 1.63 (Therapeutic - Tt) and Td 9.20 to 1.85 (Discomfort). Significant differences begin at 750 Hz (Tp, Tt) and 650 Hz (Td). Fc variations are also inversely proportional to the obtained therapeutic range (p<0.05) in all Fc levels. No significant influence was found regarding paresthesia coverage. As expected, Fc affects significantly both the sensation and the satisfaction reported by the patient. Most patients (>80%) considered excellent or good paresthesia sensations in the range from 60-80 Hz. Discussion: Modification in Fc variation affects paresthesia quality for tonic/traditional stimulation, so it is useful to select the better “texture” of stimulation for each patient. Most commercially available generators allow Fc between 40 and 1,200 Hz ranges. Extremely high Fc —above the ones analyzed here—may have an effect on neuronal refractory period that eliminates paresthesia while keeping analgesia. Interestingly, within the evaluated parameters higher frequencies are inversely proportional to stimulation thresholds and Tt. It seems that Fc is a vital parameter to achieve therapeutic success.
Conclusions: Changes in Fc is a useful parameter to modulate the patient’s sensory perception. Fc can be successfully used to adjust the quality of the paresthesias and to modify patient’s subjective sensation. Even more, we showed that as the frequency increases, the patient’s satisfaction with the perceived sensation decreases, suggesting that higher Fc may need to be set up at subthreshold amplitude to achieve positive response.

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