Analysing the performance of KHFAC nerve block stimulation parameters

Developing design considerations for blocking the pudendal nerve using a new gate-dependent block determination model

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A major cause for voiding dysfunction is the inability to relax the urethral sphincter. KiloHertz Frequency Alternating Current (KHFAC) stimulation can block signals that are travelling through the body; applying this type of stimulation at the pudendal nerve could inhibit the pulses that lead to contraction of the urethral sphincter, and restore voiding ability. In order to design a successful KHFAC block therapy for the pudendal nerve, it is necessary to understand what impact different stimulation parameters have on efficacy, safety and power-efficiency. This thesis will therefore test earlier researched KHFAC stimulation parameters against a new quality measure, study the impact of new waveform alterations, and study how bipolar electrode design can improve KHFAC therapy. By utilizing the theory behind the mechanism of the KHFAC nerve block, a new block-determination model was developed that is over thirty times faster than the classic model. The McIntyre-Richardson-Grill model was chosen as the implementation of the axon model, and the bipolar electrode was modelled as an electric dipole. The simulation experiments revealed that the charge per phase of the KHFAC signal at block threshold could be reduced, without increasing the amplitude of the signal, by introducing interphase delays to the waveforms and by creating asymmetric charge-balanced waveforms. Triangular waveforms were shown to also require less charge per phase than a regular square wave to block, albeit with a higher amplitude. A correctly aligned bipolar electrode set-up with an interpolar distance that was about the same as the electrode-to-axon distance was shown to result in reduced block thresholds. Overall, this thesis has shown how stimulation parameters can be chosen to develop an effective KHFAC block therapy for the pudendal nerve.