Modulation of Cerebral Blood Flow With Transcutaneous Electrical Neurostimulation (TENS) in Patients With Cerebral Vasospasm After Subarachnoid Hemorrhage. Issue 5 (11th April 2014)

• Record Type: Journal Article
• Authors: ter Laan, Mark; van Dijk, J. Marc C.; Stewart, Roy; Staal, Michiel J.; Elting, Jan‐Willem J.
• Is Part Of: Neuromodulaton. Volume 17:Issue 5(2014)
• Page Start: 431
• Page End: 437
• Publication Date: 2014-04-11
• Subjects: Central nervous system -- Physiology -- Periodicals; Central nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ner.12177
• Languages: English
• ISSNs: 1094-7159

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ner12177-sec-0001" sec-type="section"> <title>Objectives</title> <p>Transcutaneous electrical neurostimulation (TENS) and spinal cord stimulation have been shown to increase peripheral and cerebral blood flow. We postulate that certain pathological conditions attenuate cerebral autoregulation, which may result in a relative increase of the importance of neurogenic regulation of cerebral blood flow, which could be decreased by electrical modulation. We therefore assess the effects of TENS on cerebral blood flow velocities (CBFVs) and cerebral saturation in patients with cerebral vasospasm after subarachnoid hemorrhage (SAH).</p> </sec> <sec id="ner12177-sec-0002" sec-type="section"> <title>Materials and Methods</title> <p>Cervical TENS was applied in 10 SAH patients with transcranial Doppler (TCD)‐proven cerebral vasospasm. Measurements included plethysmography, near‐infrared spectroscopy, capnography, and CBFVs by TCD. After determining the optimal frequency and current, patients were treated with cervical TENS for two periods of three days, with a pause of one day in between.</p> </sec> <sec id="ner12177-sec-0003" sec-type="section"> <title>Results</title> <p>The TENS electrodes were not always tolerated by the patients. Higher frequencies demonstrated the most prominent combined effects. ETCO<sub>2</sub> was 0.19% lower with TENS off than with TENS on (<italic>p</italic> = 0.05). Mean arterial blood pressure and pulse were not significantly different over time. CBFV in MCA was decreased (<italic>p</italic> = 0.07) while cerebral oxygen saturation was increased (<italic>p</italic> = 0.01) after the use of TENS.</p> </sec> <sec id="ner12177-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Our data suggest improved cerebral blood flow when using cervical TENS in patients with cerebral vasospasm. Several factors could have attenuated the effects: the electrodes were poorly tolerated, ETCO<sub>2</sub> increased during TENS, few vessels showed prolonged vasospasm, and overall flow velocities were low. Still, an on–off effect of TENS over time was detected.</p> </sec> </abstract>