Novel Minimally Invasive Wireless Nanotechnology

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Research Reviews Journal of Engineering and Technology e ISSN 2319 9873. conventional SCS devices with reported outcomes as high as 50 failures 6 8 while additional failures have been due to equipment. complications contributed by the migration fracture of the electrodes as well as implanted power generator IPG failures and. complications in re charging Post surgical complications like infection hemorrhage and painful operative wound remain inherent. to all open surgical procedures Additionally SCS in its conventional form is incapable of reaching some anatomical locations to. provide targeted therapeutic localized pain relief 6 8 12. Several advancements have been introduced in to the SCS equipment over the past few years which have reduced adverse. events while promoting the efficacy of the modality thereby increasing the indications for its applications 13 Percutaneous. techniques smaller batteries rechargeable batteries increased life of power generators and improved anchoring methods are. some of these advancements Part of the refinement also comes from the advancements in the technology of nanomaterial and. wireless power transfer techniques, NANO ELECTRODES AND WIRELESS TECHNOLOGY FOR NEUROMODULATION. The conventional SCS system has electrodes in a catheter enclosure attached to a long extension cable s that connects the. electrodes to an implantable pulse generator IPG that is placed inside the patient s body and inherits the complications due to. failure or malfunction of any of these components Efforts have been ongoing to reduce the bulk of the implanted material and. yet improve the efficiency of the system Reduction in size has a challenge from the battery life expectancy with the conventional. energy settings Thus this SCS equipment requires implantation of electrodes extension cables and the battery inside the body. requiring multiple incisions along with long segment tunnels under the skin. An advancement in this field is the new external wireless power generator WPG utilizing a dipole antenna for electric field. coupling accomplished with microwaves which are very short length pulsed electromagnetic waves at Giga Hertz frequencies. GHz This device Stimwave instead of lower frequencies of 100 500 kHz of the inductive range for most of the implanted. medical devices is powered by radiative electric field coupling through tissue at microwave frequencies which enables smaller. sized implants which can be placed significantly deep in tissue through a needle It also affords minimal power loss because of. the higher frequency and allows a much better transfer of energy to smaller implants 14 This principle behind the frequency. changes in relation to the wavelength were pointed by Feynman long back If you build a corresponding circuit on a small scale. its natural frequency goes up since the wave length goes down as the scale but the skin depth only decreases with the square. root of the scale ratio and so resistive problems are of increasing difficulty Possibly we can beat resistance through the use of. superconductivity if the frequency is not too high or by other tricks 15. The requirements for dorsal root ganglion DRG stimulation are much lower compared to epidural SCS or muscle stimulation. in terms of current amperage and the micro implant WPG is capable of delivering the range of clinically appropriate stimulation. with dimensions of 800 1350 m diameter a significantly miniature size compared to the conventional SCS IPG This is equal to. the size of a standard lead body that also includes the nanoelectronics on the device itself It can be incorporated in to a variety. of lead types carrying 4 or 8 contacts either in a percutaneous or a paddle type electrode and the receiver wire is mated to the. device internally also transferring power wirelessly Figure 1. Figure 1 Neuro stimulator electrode MRI compatible for both 1 5 and 3 Tesla. A dipole antenna receiver intercepts the high frequency microwave electromagnetic energy coming from outside the body to. produce an oscillating electric field Frequency in the range of GHz was found to be more energy efficient 16 Typically the antenna. within the device lumen can be anywhere from 2 cm to 8 cm long and can be modified depending upon the indications and the. depth at which the device is implanted since the EMF electrode magnetic field energy is dissipated across the tissue layers. of skin fat muscle blood vessels and bone Deeper the placement the longer the antenna should be to receive adequate. power Each contact on the electrodes is provided with independent power a part of an application specific integrated circuit. as the embedded circuitry within the device enables production of charge balanced waveforms This is managed by internalized. addressing systems within the device Figure 2 It is important to note that microwave fields are safe since the high frequencies. fail to activate to cell membranes and thus nervous tissue damage is unlikely. RRJET Volume 6 Issue 4 December 2017 47, Research Reviews Journal of Engineering and Technology e ISSN 2319 9873. Figure 2 Neurostimulator receiver The contacts on the stimulator leads are managed by independent integrated application specific circuits. The embedded circuit system within the device provides charge balanced waveforms. WIRELESS POWER GENERATOR WPG, The WPG employs standard cellular phone technology with an average pulse output power of up to 1 Watt depending upon. the stimulation parameters and according to the requirements of the target tissue A radiofrequency RF transmitter placed. inside the WPG encodes stimulus waveforms into the signal according to the program settings A microprocessor inside this. transmitter controls the data communications and settings Figure 3 Clinicians as well as patients communicate with the WPG. via a controller that uses Bluetooth technology and also can be accessed by a software application app on a mobile phone 14. Figure 3 Freedom SCS external device,DISCUSSION, The wireless SCS system with nanotechnology has been clinically applied for SCS DRG and PNS throughout Europe and in. the USA for several years and multiple trials have shown encouraging results The capabilities of this system however enabled. its utility to be tested in a variety of chronic pain syndromes Poon et al demonstrated that in a biological media the operating. frequency for wireless powered devices was in GHz range as opposed to the MHz could have potential advantages 16 17 At this. frequency range the size reduction of the receiver has been demonstrated in their subsequent studies by Tyler Perryman et al. while the tissue depth relationship to the energy transmission were further elaborated 17 18 Tyler Perryman et al conducted. studies in animals and verified the tissue depths at which the wireless stimulation could achieve effective current density 18. The dipole antenna of the wireless system at 915 MHz could energize the stimulators implanted at a depth of 12 cm in. porcine models especially efficient with a 4 3 cm antenna Notwithstanding the study parameters in the animal study successful. RRJET Volume 6 Issue 4 December 2017 48, Research Reviews Journal of Engineering and Technology e ISSN 2319 9873.
stimulation was observed in providing significant pain relief in patients with back and leg pain following FBSS 19 20 post herpetic. neuralgia 21 refractory craniofacial pain 22 and occipital neuralgia 23 These patients require implantation of electrode s. only while the wireless power generator excludes surgical implantation of the battery inside the body Hence there were no. complications related to extensive surgical procedure multiple incisions and interventions for battery failure in this group of. patients treated with WPG As a result there was reduced operating time consumables and increased comfort to the patient. CONCLUSION, Conventional SCS due to its bulky implantable equipment has been reported to have significant complications and failures. although the technique has proven to be useful in the management of chronic pain syndromes The minimally invasive procedures. of neuromodulation aim to reduce the equipment related adverse events while the symptomatic relief is provided proportionate to. the upgrades to the technology One part deals with the prospects of improvements in the patients symptoms while the other part. deals with the technology refinements to the equipment The former would take multiple variables in to account as the targets of. stimulation and the clinical presentations in their myriad forms attempt to balance with each other. The latter has shown significant changes over the past decade owing to the improved understanding of nanotechnology. and wireless navigation Delivery of higher frequency stimulation with the WPG instead of lower frequencies 100 500 kHz. the inductive range for the conventional implanted devices enables miniature implants to be placed deeper in tissue through a. needle percutaneously also affording minimal power loss and a much better transfer of energy to these nanomaterial implants. Stimwave systems have matched these developments to improve clinical outcomes with reduced adverse events in their clinical. experience so far though limited in numbers Further experience with patients and modifications in the apparatus would demand. larger patient populations to be studied with a wide variety of instruments for outcome measurements. REFERENCES, 1 Turner JA et al Spinal cord stimulation for chronic low back pain a systematic literature synthesis Neurosurgery. 1995 37 1088 1096, 2 Kumar K et al The effects of spinal cord stimulation in neuropathic pain are sustained a 24 month follow up of the. prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation Neurosurgery. 2008 63 762 770, 3 Kapural L et al Novel 10 kHz high frequency therapy HF10 therapy is superior to traditional low frequency spinal cord. stimulation for the treatment of chronic back and leg pain the SENZA RCT randomized controlled trial Anesthesiology. 2015 123 851 860, 4 Deer TR et al The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment.
of chronic pain and ischemic diseases the Neuromodulation Appropriateness Consensus Committee Neuromodulation. 2014 17 515 550, 5 Mekhail NA et al Cost benefit analysis of neurostimulation for chronic pain Clin J Pain 2004 20 462 468. 6 Turner JA et al Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome. a systematic review of effectiveness and complications Pain 2004 108 137 147. 7 Mekhail NA et al Retrospective review of 707 cases of spinal cord stimulation indications and complications Pain. Practice 2011 11 148 153, 8 Cameron T Safety and efficacy of spinal cord stimulation for the treatment of chronic pain a 20 year literature review J. Neurosurg 2004 100 254 267, 9 Krishna Kumar et al Complications of spinal cord stimulation suggestions to improve outcome and financial impact J. Neurosurg 2006 5 191 203, 10 Kumar K et al Spinal cord stimulation in treatment of chronic benign pain challenges in treatment planning and present. status a 22 year experience Neurosurgery 2006 58 481 496. 11 North RB et al Spinal cord stimulation for chronic intractable pain experience over two decades Neurosurgery. 1993 32 384 394, 12 Pineda A Complications of dorsal column stimulation J Neurosurg 1978 48 64 68.
13 Slavin KV Spinal stimulations for pain future applications Neurotherapeutics 2014 11 535 542. 14 Yearwood TL and Perryman LT Peripheral neurostimulation with a microsize wireless stimulator Prog Neurol Surg. 2016 29 168 191, 15 Feynman RP There s plenty of room at the bottom Presentation to the American Physical Society 1959. 16 Poon AS Optimal operating frequency in wireless power transmission for implantable devices Conf Proc IEEE Eng Med Biol. Soc 2007 5674 5679,RRJET Volume 6 Issue 4 December 2017 49. Research Reviews Journal of Engineering and Technology e ISSN 2319 9873. 17 Poon A et al Optimal frequency for wireless power transmission in to dispersive tissue IEEE Trans Antennas Propagation. 2010 58 1739 1750, 18 Perryman LT et al Tissue depth study for a fully implantable remotely powered and programmable wireless neural. stimulator International Journal of Nano Studies Technology 2016. 19 Weiner RL et al Treatment of FBSS low back pain with a novel percutaneous DRG wireless stimulator Pilot and feasibility. study Pain Med 2016 17 1911 1916, 20 Billet B et al Wireless neuromodulation by a minimally invasive technique for chronic refractory pain Report of preliminary. observations Med Res Arch 2017 5 1 8, 21 Billet B et al A novel minimally invasive wireless technology for neuromodulation via percutaneous intercostal nerve.
stimulation PNS for post herpetic neuralgia A case report with short term follows up Pain Pract 2017. 22 Weiner RL et al A novel miniature wireless neurostimulator in the management of chronic craniofacial pain preliminary. results from a prospective pilot study Scand J Pain 2017. 23 Perryman LT et al A novel wireless minimally invasive neuromodulation device for the treatment of chronic intractable. occipital neuralgia case illustrations Journal of Neurological Stroke 2017 6. Novel Minimally Invasive Wireless Nanotechnology Neuromodulation System in the Management of Chronic Pain Syndromes Laura Tyler Perryman Stimwave Technologies Inc 1310 Park Central Blvd South Pompano Beach Florida USA Review Article INTRODUCTION Spinal cord stimulation has been utilized for over 40 years and has been proven to provide therapeutically effective pain relief from chronic

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