Table Of ContentNeural
Stimulation
Volume I
Editors
Joel B. Myklebust, Ph.D.
Associate Professor
Department of Neurosurgery
Medical College of Wisconsin
Milwaukee, Wisconsin
Joseph F. Cusick, M.D.
Professor
Department of Neurosurgery
Medical College of Wisconsin
Milwaukee, Wisconsin
Anthony Sanees, Jr., Ph.D.
Professor and Chairman
Biomedical Engineering Department
Medical College of Wisconsin
Milwaukee, Wisconsin
Sanford J. Larson, M.D., Ph.D.
Professor and Chairman
Department of Neurosurgery
Medical College of Wisconsin
Milwaukee, Wisconsin
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PREFACE
Neural stimulation encompasses a large and diverse body of experimental and clinical
investigation. It is the goal of this text to coalesce the current concepts and clinical imple-
mentations of electrical stimulation of the nervous system. The first six chapters deal with
theoretical and laboratory studies while the latter chapters discuss particular applications of
neural stimulation.
Theoretical considerations regarding the distribution of electric fields in biologic media
are dealt with by Plonsey. Jarzembski discusses the theoretical foundation for the measure-
ment of current distribution secondary to electrical stimulation. Swiontek and Sanees present
experimentally derived current density plots and indicate the necessary adaptations and
practical considerations for making these measurements. The use of the evoked potential as
a means of investigating the mechanisms of neural stimulation is discussed by Myklebust
and Cusick. Zuperku illustrates the laboratory use of electrical stimulation for the study of
the central nervous system.
Perhaps the most common application for neural stimulation is the amelioration of pain.
This stimulation may be applied at peripheral, spinal or central levels. Spinal stimulation
for pain relief is reviewed by Maiman, Larson, and Sanees, while Abram discusses peripheral
stimulation (TNK), and Groth presents the findings with deep brain stimulation. Movement
disorders have similarly been treated with stimulation at various levels of the central nervous
system. Spinal stimulation for spasticity is extensively reveiwed by Sherwood. Gottlieb and
Myklebust present the findings regarding the effect of cerebellar stimulation upon spinal
reflexes. Harris discusses methods of assessing in spasticity with particular attention to
changes with cerebellar stimulation.
It is well known that electrical stimulation of brain structures can modify hehavior. One
of the pioneers in this area and his colleagues present a relatively new aspect of stimulation
for behavioral disorders (Heath, Walker, Dempesy, and Franklin). Cranial electrotherapy
stimulation is discussed by Smith.
One of the most exciting areas of investigation is in peripheral neuromuscular stimulation.
The restoration of function to paralyzed limbs has become a realizable goal. McNeal and
Bowman review the state of this important work. If any application of electrical stimulation
can be termed clinically established, it is the use of electric fields for bone growth and
healing. The current methods in this area are presented by Esterhai.
These volumes provide a significant overview of the current state of neural stimulation
which we hope will be of considerable value to interested researchers and clinicians.
Joel B. Myklebust
Joseph F. Cusick
Anthony Sanees, Jr.
Sanford J. Larson
THE EDITORS
Joel B. Myklebust, Ph.D. is a biomedical engineer in the Neuroscience Laboratory of
the Veterans Administration Medical Center at Wood, Wisconsin. He received his B.S.
degree from the University of Iowa in 1971 and his M.S. degree from the University of
Rochester in 1972, both in electrical engineering. He received his Ph.D. degree in Biomedical
Engineering from Marquette University of Milwaukee, Wisconsin, in June 1981. In July,
1981, he was appointed Assistant Clinical Professor of Biomedical Engineering in the
Department of Neurosurgery at the Medical College of Wisconsin as well as Adjunct Assistant
Professor of Biomedical Engineering at Marquette University, Milwaukee. In 1984, he was
appointed Associate Professor of Biomedical Engineering in the Department of Neurosurgery
at the Medical College of Wisconsin. His research interests include the therapeutic appli-
cations of electrical current to the nervous system and the recording of neuroelectric potentials
for diagnostic purposes, and biomechanics.
Joseph F. Cusick, M.D., was born on May 10, 1939, in Binghamton, N.Y. He received
the B.S. degree from Fordham University, Bronx, N.Y., in 1961 and the M.D. degree from
Georgetown University School of Medicine, Washington, D.C., in 1965. He completed his
residency in neurosurgery at the University of Illinois, Chicago, 111., in 1972. He is presently
Professor of Neurosurgery at the Medical College of Wisconsin, Milwaukee, Wisconsin,
and Staff Neurosurgeon at the Veterans Administration Medical Center, Wood, Wisconsin.
He is a member of the American Association of Neurological Surgeons, American College
of Surgeons, Congress of Neurological Surgeons, International Society of Pituitary Surgeons,
Research Society of Neurological Surgeons, and Cervical Spine Research Society. He re-
ceived certification from the American Board of Neurological Surgeons in April, 1975.
Anthony Sanees, Jr., Ph.D., has been Professor and Chairman of Biomedical Engi-
neering at Marquette University and the Medical College of Wisconsin, Milwaukee, Wis-
consin, since 1964. He is also Professor of Electrical Engineering and Professor in the
Department of Neurosurgery. For the last 20 years he has been involved in the investigation
of the effects of electrical currents upon animals and humans, and reconstruction of electrical
injuries. Dr. Sanees is also conducting studies to evaluate the biomechanical mechanisms
of head and spinal cord injury. He has published 4 books and more than 200 scientific
articles. He serves as a consultant to the National Institutes of Health, the National Science
Foundation, and various industrial organizations. He is a registered professional engineer,
a certified clinical engineer, and belongs to 24 national or international medical and engi-
neering societies.
Sanford J. Larson, M.D., Ph.D., was born in Chicago, Illinois, on April 9, 1929. He
received the B.A. degree from Wheaton College, Wheaton, Illinois, in 1950 and both the
M.D. and Ph.D. degrees from Northwestern University, Evanston, Illinois, in 1954 and
1962, respectively.
After serving as an intern at Passavant Memorial Hospital, Chicago, Illinois, from 1954
to 1955, he took his residency in the Northwestern University Neurosurgical Residency
Program from 1955 to 1957, and from 1959 to 1961, a period interrupted by 2 years of
service in the Air Force. In 1961, he was awarded a Postdoctoral Research Fellowship and
also served as Clinical Assistant in Surgery at the Northwestern University School of Med-
icine. In 1962, he was appointed Director of Neurosurgical Education at Cook County
Hospital, Chicago, Illinois. In 1963, he was appointed Associate Professor and Chairman
of the Department of Neurosurgery, Marquette School of Medicine (now Medical College
of Wisconsin), Milwaukee, and is currently Professor and Chairman of that Department.
CONTRIBUTORS
Stephen E. Abram, M.D. Francis A. Hopp, Ph.D., M.S.
Professor of Anesthesiology Department of Anesthesiology
Medical College of Wisconsin Medical College of Wisconsin
Milwaukee, Wisconsin Biomedical Engineer
V.A. Medical Center
Bruce R. Bowman, Ph.D. Milwaukee, Wisconsin
Vice President
Med Tel, Inc. W. B. Jarzembski, Ph.D., P.E.
Edina, Minnesota Professor of Biomedical Engineering
Texas Tech University School of
Medicine
Colby W. Dempesy, Ph.D.
Lubbock, Texas
Research Professor in Neurosurgery
Tulane University School of Medicine
Dennis J. Maiman, M.D.
New Orleans, Louisiana
Assistant Professor of Neurosurgery
Medical College of Wisconsin
John L. Esterhai, Jr., M.D.
Milwaukee, Wisconsin
Assistant Professor
Department of Orthopaedic Surgery
Donald R. McNeal, Ph.D.
University of Pennsylvania School of
Co-Director
Medicine
Rancho Los Amigos Rehabilitation
Philadelphia, Pennsylvania
Engineering Center
Downey, California
Dennis E. Franklin, M.D.
Assistant Professor of Psychiatry and Barbara M. Myklebust, M.S.
Neurology Department of Physiology
Tulane University School of Medicine Rush Medical Center
New Orleans, Louisiana Chicago, Illinois
Robert Plonsey, Ph.D.
Gerald L. Gottlieb, Ph.D.
Professor of Biomedical Engineering
Professor of Physiology
Duke University
Rush Medical College
Durham, North Carolina
Chicago, Illinois
Arthur Sherwood, Ph.D.
Karl Groth, Ph.D.
Department of Clinical Neurophysiology
Product Planning Manager
Institute of Rehabilitation and Research
Metronics, Inc. Houston, Texas
Minneapolis, Minnesota
Ray B. Smith, Ph.D.
Gerald F. Harris, Ph.D. Vice President for Science Affairs
Director, Biomedical Engineering Neuro Systems, Inc.
Shriners Hospital Garland, Texas
Chicago, Illinois
Thomas J. Swiontek, Ph.D.
Robert G. Heath, M.D. Assistant Professor of Electrical
Professor of Psychiatry and Neurology Engineering
Tulane University School of Medicine Milwaukee School of Engineering
New Orleans, Louisiana Milwaukee, Wisconsin
Cedric F. Walker, Ph.D. Edward J. Zuperku, Ph.D.
Associate Professor of Biomedical Associate Professor of Biomedical
Engineering Engineering
Tulane University School of Medicine Department of Anesthesiology
New Orleans, Louisiana Medical College of Wisconsin
Biomedical Engineer/Research Service
V.A. Medical Center
Milwaukee, Wisconsin
TABLE OF CONTENTS
Volume I
Chapter 1
Introduction 1
J. Cusiek and J. Myklebust
Chapter 2
Electrical Field Modeling 13
Robert Plonsey
Chapter 3
Current Density Measurement in Living Tissue 33
W. B. Jarzembski
Chapter 4
Experimental Current Density Measurement 47
Thomas Swiontek and Anthony Sanees, Jr.
Chapter 5
Somatosensory Evoked Potentials in Experimental Neural Stimulation 69
J. Myklebust and J. Cusiek
Chapter 6
Selective Electrical Activation of Afférents: A Tool to Investigate Neural Integration... 93
Edward J. Zuperku and Francis A. Hopp
Chapter 7
Electrical Stimulation of the Spinal Cord in Movement Disorders Ill
Arthur M. Sherwood
Chapter 8
Spinal Cord Stimulation for Pain 147
Dennis J. Maiman, Sanford J. Larson, and Anthony Sanees, Jr.
Index 155
Volume II
Chapter 1
Transcutaneous Electrical Nerve Stimulation 1
Stephen E. Abram
Chapter 2
Deep Brain Stimulation 11
Karl Groth
Chapter 3
Quantitative Assessment of Cerebellar Stimulation in Cerebral Palsy 23
Gerald F. Harris and Dennis J. Maiman
Chapter 4
Some Effects of Cerebellar Stimulation of Cerebral Palsy Patients: Changes in Spinal
Reflexes and Ankle Joint Compliance 49
Gerald L. Gottlieb and Barbara M. Myklebust
Chapter 5
Cerebellar Stimulation for Treatment of Intractable Behavioral Disorders and
Epilepsy 77
Robert G. Heath, Cedric F. Walker, Colby W. Dempesy, and Dennis E. Franklin
Chapter 6
Peripheral Neuromuscular Stimulation 95
Donald R. McNeal and Bruce R. Bowman
Chapter 7
The Electrical Stimulation of Osteogenesis 119
J. L. Esterhai
Chapter 8
Cranial Electrotherapy Stimulation 129
Ray B. Smith
Index 151
