Abstract
Objective
The mechanisms of action of high-frequency stimulation (HFS) are unknown. We investigated
the possible mechanism of subthreshold superexcitability of HFS on the excitability
of the peripheral nerve.
Materials and Methods
The ulnar nerve was stimulated at the wrist in six healthy participants with a single
(control) stimulus, and the responses were compared with the responses to a continuous
train of 5 seconds at frequencies of 500 Hz, 2.5 kHz, 5 kHz, and 10 kHz. Threshold
intensity for compound muscle action potential (CMAP) was defined as intensity producing
a 100-μV amplitude in ten sequential trials and “subthreshold” as 10% below the CMAP
threshold. HFS threshold was defined as stimulation intensity eliciting visible tetanic
contraction.
Results
Comparing the threshold of single pulse stimulation for eliciting CMAP vs threshold
for HFS response and pooling data at different frequencies (500 Hz–10 kHz) revealed
a significant difference (p = 0.00015). This difference was most obvious at 10 kHz, with a mean value for threshold
reduction of 42.2%.
Conclusions
HFS with a stimulation intensity below the threshold for a single pulse induces axonal
superexcitability if applied in a train. It can activate the peripheral nerve and
produce a tetanic muscle response. Subthreshold superexcitability may allow new insights
into the mechanism of HFS.
Keywords
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Comment
Article info
Publication history
Published online: June 14, 2022
Accepted:
April 28,
2022
Received in revised form:
April 2,
2022
Received:
February 6,
2022
Footnotes
Source(s) of financial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest: The authors reported no conflict of interest.
Identification
Copyright
© 2022 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
