Abstract
Objective
To reveal the possible mechanisms underlying poststimulation block induced by high-frequency
biphasic stimulation (HFBS).
Materials and Methods
A new axonal conduction model is developed for unmyelinated axons. This new model
is different from the classical axonal conduction model by including both ion concentrations
and membrane ion pumps to allow analysis of axonal responses to long-duration stimulation.
Using the new model, the post-HFBS block phenomenon reported in animal studies is
simulated and analyzed for a wide range of stimulation frequencies (100 Hz–10 kHz).
Results
HFBS can significantly change the Na+ and K+ concentrations inside and outside the axon to produce a post-HFBS block of either
short-duration (<500 msec) or long-duration (>3 sec) depending on the duration of
HFBS. The short-duration block is due to the fast recovery of the Na+ and K+ concentrations outside the axon in periaxonal space by diffusion of ions into and
from the large extracellular space, while the long-duration block is due to the slow
restoration of the normal Na+ concentration inside the axon by membrane ion pumps. The 100 Hz HFBS requires the
minimal electrical energy to achieve the post-HFBS block, while the 10 kHz stimulation
is the least effective frequency requiring high intensity and long duration to achieve
the block.
Conclusion
This study reveals two possible ionic mechanisms underlying post-HFBS block of axonal
conduction. Understanding these mechanisms is important for improving clinical applications
of HFBS block and for developing new nerve block methods employing HFBS.
Keywords
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Article info
Publication history
Published online: July 19, 2021
Accepted:
June 21,
2021
Received in revised form:
May 30,
2021
Received:
February 11,
2021
Footnotes
Source(s) of financial support: This study was funded by the National Institute of Neurological Disorders and Stroke under grants R01NS109198 and R41NS115460.
Conflict of Interest: Dr Changfeng Tai is an inventor of a patent application related to this study. The other authors have no conflicts of interest.
Identification
Copyright
© 2022 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
