Molnar Gabriela, Barolat Giancarlo
Medtronic Neuromodulation, Minneapolis, MN, USA.
Neuromodulation. 2014 Jun;17 Suppl 1:12-21. doi: 10.1111/ner.12171.
This study aims to review some of the basic principles of extracellular electrical stimulation used in spinal cord stimulation therapy for intractable pain.
Spinal cord stimulation has been used therapeutically for more than 40 years. We present the basic principles of extracellular stimulation on which the therapy is based, describe electrode operation and current configurations, and explain the implications of these technological advances for the clinical application of spinal cord stimulation.
Computational studies of coupled electric field and neuron models have significantly advanced our understanding of the therapeutic effects of neurostimulation. Neurostimulation is intended to obtain maximal selectivity of desired neural elements while avoiding those resulting in side-effects. Preferential stimulation of the dorsal columns is achieved with a narrow spacing between electrodes using bipolar or tripolar electrode configurations. Stimulus parameters such as amplitude and pulse width may be used to selectively control which neuronal elements are excited during stimulation.
A better understanding of the interaction between electric fields and the targeted neural elements may guide the selection of stimulation parameters in contemporary neurostimulators and lead to continuing advances in engineering solutions for therapeutic spinal cord stimulation.
本研究旨在回顾脊髓刺激疗法用于治疗顽固性疼痛时所采用的一些细胞外电刺激的基本原理。
脊髓刺激疗法已应用于临床治疗40多年。我们阐述了该疗法所基于的细胞外刺激的基本原理，描述了电极操作和电流配置，并解释了这些技术进展对脊髓刺激临床应用的意义。
电场与神经元模型的计算研究显著增进了我们对神经刺激治疗效果的理解。神经刺激旨在最大程度地选择性刺激所需的神经元件，同时避免产生副作用的元件。使用双极或三极电极配置，通过电极之间的窄间距可实现对背柱的优先刺激。刺激参数（如幅度和脉宽）可用于选择性控制刺激过程中哪些神经元元件被激活。
更好地理解电场与目标神经元件之间的相互作用，可能会指导当代神经刺激器中刺激参数的选择，并推动治疗性脊髓刺激工程解决方案的持续进步。
