Neuroelectrostimulation from Natural Electricity to Multifactorial

Systems: A Review

Vladimir Kublanov

, Konstantin Retyunskiy

, Timur Petrenko

and Mikhail Babich

Ural Federal University, Yekaterinburg, Russian Federation

Belgorod State University, Belgorod, Russian Federation

Keywords: Neuroelectrstimulation, Neuropsychiatric Diseases, Neurorehabilitation, Electrical Stimulation, Transcranial,

Cranial, Spinal, Cervical Nerve Formations, Polyfactorial, Homeostatic Regulation.

Abstract: The article discusses the problem of the neuropsychiatric health deterioration in the face of new challenges to

humanity: the complication of the scientific and technical environment and the technosphere, social relations

in society against the background of an increase in the duration of a person's active life, as well as the relevance

of the development of neurorehabilitation technologies for restoring human health in these conditions. The

paper presents a review of the evolution of the technology of transcutaneous neuroelectrostimulation from

ancient times to modern technologies, transcranial electrical stimulation, electrical stimulation of cranial

nerves, spinal cord and neck nerve structures. The prospects of a mobile hardware and software system for

polyfactorial neurostimulation and its potential for use in personalized medicine are considered. Possibilities

of promising medical technologies for homeostatic regulation, capable of modulating autonomic processes,

influencing motor control and cognitive functions are discussed.

1 INTRODUCTION

In the 21st century, a person lives in a dynamically

developing scientific and technical environment, the

complication of the technological sphere, social

relations in society against the background of an

increase in the duration of an active life. The

consequence of these processes are new global

problems and challenges that did not exist before -

overpopulation, globalization, hyper information

environment, man-made disasters, interethnic

conflicts, local wars. In such conditions, the load,

especially on the neurological and mental health of a

person, increases significantly, leading to its

exhaustion, chronic stress and, as a result, to

depressive disorder and personality deformation with

complete loss of ability to work and life guidelines.

According to the World Health Organization,

today diseases of the central nervous system have

come out on top among diseases leading to disability

among young people in developed countries. At the

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same time, all areas of human health suffer, limiting

his adaptive capabilities throughout his life. Increased

funding is required to restore health. health care

(WHO, 2016).

The global pandemic of the coronavirus infection

COVID-19 has raised these problems. According to a

WHO study, the COVID-19 pandemic has increased

the demand for neurological and mental health

services: bereavement, isolation, loss of income and

fear for the future disrupt mental health, exacerbate

existing problems. A high level of social stress pushes

people to abuse substances and alcohol. Meanwhile,

there is convincing evidence that the coronavirus has

a neurotoxic effect, leading to impaired perception,

delirium, asthenia, depression. People with pre-

existing mental, drug addiction and neurological

disorders are more vulnerable to coronavirus

infection - they are at high risk of severe outcomes

and even death (WHO Survey, 2020).

Under these conditions, there is a demand for non-

invasive medical technologies for

Kublanov, V., Retyunskiy, K., Petrenko, T. and Babich, M.

Neuroelectrostimulation from Natural Electricity to Multifactorial Systems: A Review.

DOI: 10.5220/0010394302210230

In Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2021) - Volume 1: BIODEVICES, pages 221-230

ISBN: 978-989-758-490-9

221

neurorehabilitation, capable of restoring psycho-

neurological disorders formed as a result of

depression, stroke, brain and spinal cord trauma or

progressive degenerative and hereditary diseases

(Parkinson's disease, motor neuron disease, etc.).

2 ORGANIZATION PRINCIPLES

OF NEUROPROTECTIVE

THERAPY

Modern approaches to the treatment of neurological

dysfunctions are based on neuroprotective therapy,

which enhances the activity of nervous tissue and its

structural restoration in response to emerging

pathogens. New neurostimulation techniques should

enhance the brain's natural ability to repair damage,

form new functional pathways, facilitate the recovery

process, as well as increase and accelerate functional

neurorehabilitation, improve and optimize the

treatment of acquired brain damage, as well as the

patient's ability to learn. Regardless of the nosological

form of the disease, modern technologies of

neurorehabilitation combine natural therapeutic

factors, drug and non-drug therapy, as well as other

methods aimed at restoring impaired functions

(Doidge, 2007).

Of the specific neuroprotectors, the most studied

and have a strong evidence base are pharmacological

drugs. To date, a large group of drugs that were

effective in the experiment, in clinical therapy were

not so effective because of side effects, in their

severity commensurate with clinical (Tamburin et al.,

2019). The described situation is especially

unfavorable in those cases when the treatment, along

with the existing disease, "interferes" with the natural

course of the regulatory, adaptive processes of the

central nervous system, acting as stress factors.

With non-drug therapy, in which targeted

stimulation is provided by non-thermal physical

signals and fields, side effects problems can be

virtually eliminated (Nudo et al., 2001).

The key link in non-drug technologies for the

restoration of functional disorders of the brain is the

use of the brain's ability to significant functional

restructuring, which triggers the mechanisms of

neuroplasticity when restoring and compensating for

disturbed functions (Egiazaryan & Sudakov, 2007).

When creating modern medical devices and

technologies, the achievements of cybernetics,

medical physics, instrumentation, microelectronics

and information technologies are applied.

3 PERCUTANEOUS

NEUROELECTROSTIMULATI-

Since prehistoric times, people have tried to

understand natural phenomena and use their

capabilities. So, according to the evidence of

numerous artifacts and written sources, even in

ancient times, amber and some species of fish were

used for treatment, capable of generating electrical

discharges. Amber was used to prevent tonsillitis and

other diseases of the throat, and amber, crushed and

mixed with Attic honey, was used for low vision, in

the treatment of delusional conditions. For diseases of

the stomach, amber was recommended to be

consumed either in the form of a finely ground

powder, or with water and mastic. In many ancient

cultures, doctors recommended that their patients

wear stones in the form of amulets and talismans for

health, protection and good luck (von der Emde G,

1999). Persian philosopher and physician Avicenna

(Abu Ali Hussein ibn Abdallah ibn Sina, 980 - 1037).

in his encyclopedia of medical knowledge "Canon of

Medicine" mentions amber as a remedy for many

diseases at any age.

The Roman physician Scribonius Largus, who

lived from 1 to 50 AD, was the first to suggest using

the "strikes" of stingrays for medical purposes: he

advised standing on live rays to relieve headaches and

treat gout. Other physicians of that time also advised

to relieve pain with live rays in the treatment of

several diseases - from epilepsy to rectal prolapse.

There is also a description in the Russian chronicles

of the XIV century, which tells about outlandish fish

placed in a barrel, which, by their touch, caused a

healing effect in humans.

Scientists in medieval Europe studied the

phenomenon of electric fish ("animal electricity"). It

should be noted here the works of G. Cavendish, D.

Walsh, L. Galvani and A. Volta, the results of which

formed the applied direction in medicine - medical

physics, which became an integral part of medical

science. Today we know that electric current is one of

the key phenomena in medical physics, primarily

because the functioning of the human nervous system

is provided by neurons that can generate and transmit

electrical impulses. Therefore, for a living organism,

electric current is a "familiar" physical phenomenon,

and it is widely used in the treatment process.

If we restrict ourselves only to non-invasive

percutaneous solutions, then the following groups are

known from an extensive variety of medical devices

used for neuroelectrostimulation.:

NDNSNT 2021 - Special Session on Non-invasive Diagnosis and Neuro-stimulation in Neurorehabilitation Tasks

222

1. Transcranial electrical stimulation - provides

regulation of the cerebral blood supply system and

stimulation of the cerebral cortex. The therapeutic

effects in this case are associated with selective ionic

conductivity and systemic-selective biochemical

transformations in the brain tissues. Depending on the

characteristics of the current used in this case, the

following stimulation methods are distinguished

(Mutz et al., 2019):

1.1. Anode transcranial electrical stimulation

(known as "Transcranial direct current stimulation,

tDCS") uses direct electrical current to stimulate. The

function of the active electrode in this case is

performed by the anode, which is located in the

projection of the cortical region to be stimulated,

while the reference electrode is usually located in the

area not associated with the studied brain processes

(forehead, crown, or not on the head). This is a purely

neuromodulation method: the current generated

during tDCS does not induce an action potential but

is maintained at subthreshold levels in order to affect

only cortical excitability. tDCS alters the spontaneous

activity of neural networks without causing

suprathreshold membrane depolarization and

generation of neuronal electrical impulses (Nitsche et

al., 2008). tDCS induces long-term effects that persist

after the end of stimulation due to modulation of

inhibitory intracortical and corticospinal neurons

(Liebetanz et al., 2002). Since a constant electric field

affects all polar molecules, and most

neurotransmitters and receptors in the brain have

electrical properties, tDCS can also affect neuronal

function, causing long-term neurochemical changes.

In this case, tDCS modulates not only the activity of

single neurons, the induced activity of neurons, but

also spontaneous oscillations of neurons, causes not

only long-term changes in the evoked motor

potentials, but also affects the somatosensory and

visual evoked potentials and can affect the state of the

cerebellum (Ardolino et al., 2005). In a study using

functional magnetic resonance imaging, it was found

that tDCS of the primary motor cortex in healthy

volunteers leads to a significant increase in resting-

state cerebral blood flow during and after stimulation.

In this case, cerebral blood flow increases linearly

with increasing current strength (Shigematsu et al.,

2013). tDCS leads to significant changes in the

regional connections of the brain in the default mode

network, frontal-parietal neural networks in the

stimulation and associative areas. Similar changes

were observed in studies involving patients with

Parkinson's disease: strengthening of connections in

neural networks by default is associated with

improved working and semantic memory, and

activation of the frontal and parietal regions is

associated with attention and working memory.

Strengthening of connections in frontal-parietal

neural networks was observed after cognitive training

(Pereira et al., 2012; Wirth et al., 2011). It was found

that tDCS can restore disturbed functional

connections in regulatory systems, which is due to an

improvement in interneuronal, interstructural and

intersystem interactions. The restructuring of the

central functional mechanisms continues after the end

of stimulation, which indicates the activation of self-

regulation mechanisms and, consequently, an

improvement in homeostasis (Lewis et al., 2009). The

effectiveness of using tDCS in medical practice

primarily depends on the choice of current parameters

and the correct positioning of the electrodes on the

head, depending on the type of restored cognitive

function.

1.2. Cathode transcranial electrical stimulation,

Cathode CS, uses direct or alternating electric current

for stimulation, and the cathode acts as an active

electrode. It has been experimentally established that

СathtCS activates the protective mechanisms of the

brain. Only sagittally directed current (location of the

electrodes forehead - occiput or forehead - mastoid

processes) can reach the structures of the protective

mechanisms of the brain. With this position of the

electrodes, the current to the structures of the

protective mechanisms of the brain (the ventral nuclei

of the hypothalamus, the central gray matter of the

midbrain, the nucleus of the suture) flows through the

cisternal and intraventricular pathways. With the

bilateral arrangement of the electrodes (mastoid

process - mastoid process), no current flows to the

structures of the protective mechanisms of the brain.

СathtCS influences endorphinergic mechanisms,

which leads to a significant increase in the

concentration of beta-endorphin in the structures of

the brain stem, dorsal horns of the spinal cord, in the

cerebrospinal fluid and blood, as well as met-

enkephalin in the cerebrospinal fluid. The maximum

increase in the concentration of beta-endorphin is

observed when using rectangular current pulses with

a duration of 3.5 ms and a frequency in the range from

60 to 80 Hz. At the same time, the level of serotonin

in the cerebrospinal fluid also increases (Gabis et al.,

2003).

1.3. Transcranial alternating current stimulation,

tACS, uses amplitude modulated alternating current,

usually sinusoidal, to stimulate. It was found that in

the case of tACS, frequency, intensity and phase are

the main factors influencing the effectiveness of

stimulation. In contrast to tDCS, tACS does not

change the excitability of neurons, but their

Neuroelectrostimulation from Natural Electricity to Multifactorial Systems: A Review

223

transmembrane potential and polarization change.

This leads to an increase in the number of neurons

participating in the formation of the exogenous

frequency: it is assumed that this is due to the fact that

the alternating current participating in the stimulation

process excites endogenous neuronal oscillations,

possibly by increasing the oscillation power or the

index of phase synchronization between excitatory

and endogenous oscillations (Neuling et al., 2012).

This ability to engage neurons in a specific area of the

brain to excite them at a predetermined frequency

allows researchers to identify key frequencies

associated with different types of behavior, and to

identify causal relationships between them. The

specific parameters of these changes depend on the

task, area and state of the brain and are believed to

reflect the structural and functional characteristics of

the activity of neural networks that mediate local and

distributed cortical functions and their cognitive

manifestations. Currently, the most problematic issue

of tACS is the choice of stimulating current

parameters: amplitude and frequency.

1.4. Transcranial random noise stimulation, tRNS,

uses an alternating electrical current with noise-like

amplitude modulation to stimulate. The method was

developed relatively recently. Compared to tDCS,

CattCS and tACS, tRNS is the most effective method

for increasing the excitability of the motor cortex

(Battleday et al., 2014). Based on the results of

physiological and pharmacological studies, several

theories have been proposed to explain the

mechanisms underlying tRNS. According to one of

the proposed theories, broadband amplitude

modulation, formed according to a pseudo-random

law in the tRNS signal, provides a quasi-resonant

effect in target neurons, which increases the

sensitivity of neurons to external influences.

However, it is suggested that the mechanism of action

of tRNS is based on repeated subthreshold

stimulations, which can prevent homeostasis of the

system and potentiate task-related neural activity (van

der Groen & Wenderoth, 2016). To date, relatively

few studies have been published on the effect of tRNS

on functional processes in brain tissues. But the

available evidence shows that tRNS can modulate

cognitive processes, including connectivity. And this

testifies to the great prospects of this direction in

solving problems using neuroelectrostimulation in

neurology and psychiatry.

2. Electrical stimulation of the cranial nerves,

which are input channels directly to the brain. The

effect of neurostimulation in this case is determined

by the effect on the structures of the brain stem, which

leads to the activation of the reticular formation, the

release of neurotransmitters and the suppression of

epileptiform patterns of the cerebral cortex. The most

elaborated solutions in this direction are realized with

the help of translingual neurostimulation and

electrical stimulation of the trigeminal nerve (Bach-

y-Rita, 2004). Medical devices for translingual

Neurostimulation, TLNS, and medical techniques for

their use, known as Cranial Electrical Stimulation

(Cranial Nerve NonInvasive NeuroModulation, CN-

NINM), were developed by a group of scientists from

the University of Wisconsin-Madison (USA). The

ideologist of this trend was the outstanding American

neurophysiologist Paul Bach-y-Rita, known for his

pioneering work in the field of neuroplasticity. Using

the tongue as a target for stimulation can be beneficial

for many applications. The anterior dorsal surface of

the tongue is an area of human skin with a unique

pattern of innervation. Relatively thin, in comparison

with other areas of the skin, the epithelium of the oral

cavity is saturated with mechanical and taste

receptors, as well as free nerve endings. It is uniquely

suited for electrotactile stimulation because, in the

protected environment of the mouth, on the dorsal

surface of the tongue, there is no stratum corneum or

protective layer of skin, such as on the hands and feet,

and sensory receptors are located either on the surface

or close to it. The tongue is constantly washed with

an electrolyte solution (saliva), which has a constant

acidity and temperature. Two main nerves from the

tongue deliver information flows directly to the

brainstem: the lingual nerve, which is a branch of the

mandibular section of the trigeminal nerve (CN-V),

and the chorda tympani, the terminal branch of the

intermediate nerve extending from the facial nerve

(facial nerve, CN-VII). Currently, several

modifications of the PoNS ™ (Portable

Neurostimulator) device have been developed, which

implements the TLNS technology. TLNS technology

was originally developed for modulating neural

networks in neurorehabilitation tasks. Further studies

have shown the possibility of its use for restoring

balance and posture in patients after peripheral

vestibular disorders, as well as for the treatment of

infantile cerebral palsy, imbalance in patients with

multiple sclerosis, restoration of gait in patients with

Parkinson's disease, multiple sclerosis, after TBI and

stroke, restoration of some parameters of cognitive

functioning, such as the ability of a person to quickly

switch attention from one task to another (multi-

tasking), concentration of attention, memory (Paltin

et al., 2017).

The target of trigeminal nerve stimulation

technology, TNS, is the supraorbital nerve, which is

the superior ophthalmic branch of the trigeminal

NDNSNT 2021 - Special Session on Non-invasive Diagnosis and Neuro-stimulation in Neurorehabilitation Tasks

224

nerve. TNS increases blood flow to areas of the brain

that are associated with the regulation of attention,

emotion, and behavior (Generoso et al., 2019). It has

been found that this stimulation also has an

anticonvulsant effect. These results and data from

pilot clinical trials provide an optimistic view of this

technology in the treatment of epilepsy, depression,

post-traumatic stress disorder and attention deficit

hyperactivity disorder (ADHD).

3. Electrostimulation of the spinal cord - ensures

the restoration of the functioning of the descending

and ascending neural networks of the spinal cord,

which control postural and locomotor functions: this

effect stimulates the primary sympathetic neurons

and interneurons of the spinal cord involved in the

regulation of autonomic functions (Gerasimenko et

al., 2015a). A breakthrough in the development of

spinal cord electrical stimulation technology was

created by fundamental research carried out by

scientists at the I.P. Pavlov Institute of Physiology of

the Russian Academy of Sciences under the

leadership of Yu. P. Gerasimenko. In these studies,

direct experimental evidence was presented for the

existence of a neural spinal network in humans, a

generator of stepping movements, which forms a

locomotor activity program and provides stereotyped

rhythmic coordinated activity of the muscles of each

limb, interlimb coordination, as well as coordination

of the activity of the muscles of the limbs and trunk

for movement in space. The possibility of replacing

activating and controlling supraspinal influences on

stepping generators by means of electrical stimulation

of the spinal cord and pharmacological effects has

been shown. The knowledge gained made it possible

to develop an original electrical stimulator BioStim-5

(Gerasimenko et al., 2015b), as well as a technique

for transcutaneous electrical stimulation of the spinal

cord, which combines the ability to determine the

place of installation of stimulating electrodes through

which single pulses of a rectangular shape are

supplied, and directly stimulate the spinal cord with

modulated impulses of different frequencies and

shapes simultaneously several segments and roots of

the spinal cord. The most important difference of this

device from others is that it implements the

technology of multisegmental stimulation. The

BioStim-5 electrostimulation device allows you to

speed up the rehabilitation process, increase the

amplitude and improve the coordination of the

evoked movements, which is achieved through

synchronous stimulation of various parts of the spinal

cord, carried out simultaneously with natural

physiological stimulation.

4. Electrostimulation of the neck nerve structures

- provides correction of the activity of the

suprasegmental and segmental parts of the autonomic

nervous system by means of exposure to the

projection of the cervical ganglia of the sympathetic

part of this system (V. S. Kublanov, 2008). The

principles of organizing technical means for

stimulating the cervical ganglia of the sympathetic

division of the autonomic nervous system were

proposed in the early 90s of the last centuries and

implemented in the device "Corrector of the activity

of the sympathetic nervous system

SYMPATHOCOR-01" (V. Kublanov et al., 2018).

The SYMPATHOCOR-01 device is structurally

made in the form of a monoblock, consisting of two

multi-element electrodes (ME) and an electronic unit,

and has a mass of 1500 g. 13 electrodes are placed on

the cuff of each ME. The appearance of the device

and the layout of its electrodes on the patient's neck

during the treatment are shown in Fig. 1. Between two

MEs, a spatially distributed field of monopolar

positive current pulses is formed, the vector of which

is projected into the target area for stimulation - the

cervical region of the sympathetic trunk, represented

mainly by the upper and middle nodes (ganglia) and

the inter-nodal branches connecting them (Kublanov

et al., 2017).

Figure 1: The appearance of the SYMPATHOCOR-01

device (a) and the layout of its electrodes on the patient's

neck during the treatment procedure are shown (b).

For implementing the algorithm for correction of

the activity of the sympathetic nervous system,

alternation of modes of stimulation and its absence is

used. A typical version of the cyclogram of such an

algorithm looks like this: the patient's functional rest

Neuroelectrostimulation from Natural Electricity to Multifactorial Systems: A Review

225

for 5 minutes. - stimulation in the projection of the

left cervical ganglia of the sympathetic nervous

system - no stimulation for 5 minutes. - stimulation in

the projection of the right ganglia of the sympathetic

nervous system - functional rest of the patient for 5

minutes.

An information indicator of the processes

corrected with such a dynamic correction of the

activity of the sympathetic nervous system is the

index of vagosympathetic interaction (autonomic

balance), defined as the ratio LF / HF, where LF is the

activity of the low-frequency component of the heart

rate variability spectrum in the frequency range from

0.15 to 0.04 Hz, HF - activity of the high-frequency

component of this spectrum in the frequency range

from 0.4 to 0.15 Hz.

The device is effectively used in the treatment of

vegetative-vascular dystonia, migraine, headache,

tension pain, autonomic dysregulation syndrome,

headache, hyperhidrosis syndrome, orthostatic

hypotension syndrome and postural tachycardia,

neurosis-like syndromes and neuropathies of various

origins, vestibulopathic syndrome, for effective

replacement of invasive insults, treatment of

depression, tic disorders, attention deficit

hyperactivity disorder, hypertension, sensorineural

hearing loss, vasomotor rhinitis, degenerative

diseases of vision and atrophy of the optic nerve,

glaucoma, computer vision syndrome and asthenopia,

incurable epilepsy with attention deficit hyperactivity

disorder in children disorders, Korsakov's (amnestic)

psychosis, panic attacks, anxiety disorders (Petrenko

et al., 2020).

4 POLYFACTOR ELECTRIC

STIMULATION

The technology of polyfactorial electrical stimulation

should provide an effect on three levels of human

nervous regulation: peripheral, autonomic and

central, and be able to combine it with other

technologies. To do this, it is necessary to implement

in a medical device:

1. Possibility of choosing for

neuroelectrostimulation of several local zones of the

neck (targets), the projections of which correspond

not only to the cervical ganglia of the sympathetic

nervous system, but also to targets anatomically

associated with various parts of the brain.

2. Control of the structure of the field of current

pulses and its biotropic parameters is adequate to

pathophysiological changes in the central and

autonomic nervous systems.

3. Compactness and mobility of its

implementation due to the use of new circuit and

technical solutions using microcontrollers and

electrical radio products of a high level of system

integration, as well as modern materials and

technologies that made it possible to implement it in

a compact and mobile device.

4. New hardware and software solutions for

neuroelectrostimulation both for individual and group

use in the treatment process using one control unit.

5. The functions of modern information

technology that will allow it to be used in

personalized medicine.

Modern capabilities of electronic instrumentation

and information technology allow these requirements

to be implemented using a mobile hardware and

software system, consisting of three autonomous

functionally complete modules, which must perform

the following tasks:

• the first module provides the formation of a field

of monopolar rectangular voltage pulses between two

MEs, the installation of stimulation targets, field

structure and biotropic parameters of spatially

distributed pulses of this field;

• the second module is a specialized patient

interface and provides data transmission for the first

module, which are necessary for selecting a

stimulation target, changing the structure of the

voltage pulse field and setting the values of biotropic

parameters of pulses, as well as collecting

information about the patient, his clinical data and

functional parameters of the central and vegetative

nervous systems, as well as control data of the

neurorehabilitation process and transfers them to the

third module;

• the third module is a specialized interface of the

doctor and provides analysis of data about the patient,

his clinical state and functional parameters of the

central and autonomic nervous systems, as well as

data from the control of the neurorehabilitation

process; transmitting data to the second module for

selecting the stimulation target, the structure of the

voltage pulse field and the values of the biotropic

parameters of the pulses; provides the second module

with information for managing the treatment process

(turning on / off the first module, changing the

parameters of the stimulation procedure cyclogram),

as well as comments about the patient and the course

of the treatment process.

To implement the functions of the second module,

it is required to perform certain computational

procedures when generating commands and the

NDNSNT 2021 - Special Session on Non-invasive Diagnosis and Neuro-stimulation in Neurorehabilitation Tasks

226

structure of a spatially distributed field of current

pulses and parameters of pulses of this field. These

tasks can be solved using a mobile wearable computer

(smartphone, tablet or personal computer), which will

perform the functions of a specialized interface of a

polyfactorial electrostimulation device.

The third module can be implemented as a web

application located on a server with access to the

Internet.

Information between the first and second modules

is transmitted via a telemetric communication

channel Bluetooth Low Energy (BLE): for this

purpose, transceivers built into the first and second

modules are used. Information between the second

and third modules is transmitted via the Internet. The

block diagram of the polyfactorial electrostimulation

device is shown in Fig. 2. General view of the first

module of the polyfactorial electrostimulation device

is shown in Fig. 3.

Figure 2: Block diagram of a polyfactorial

electrostimulation device.

The proposed approach for the implementation of

a polyfactorial electrostimulation device made it

possible to make it compact and mobile with the mass

of the first module less than 200 g.

Figure 3: General view of the first module of polyfactorial

electrostimulation device.

The projections of the cervical ganglia of the

sympathetic nervous system (target 1), the vagus

nerve (target 2), the carotid plexus (target 3), the

cervical spinal plexus (target 4), the accessory nerve

(target 5) and branches of the glossopharyngeal nerve

(target 6).

It is known that several interconnected systems

are involved in ensuring the functional processes of

the brain: neural networks, neuroglia, cerebral

membranes, the cerebrospinal fluid system and the

blood supply system. The latter is a complex

multiparameter biophysical structure with cross-

links, the control of which is provided by neurogenic,

humoral, metabolic and myogenic regulatory circuits.

These circuits are in dynamic interaction and their

activity is aimed at providing physical homeostasis,

determined by the balance of the process of filtration

of water from the blood into the brain tissue under the

action of hydrostatic pressure in the arterial segment

of the capillary and its absorption in the venous

segment of the capillary under the action of oncotic

pressure of blood plasma, and chemical homeostasis

internal environment of the brain.

To implement homeostatic regulation during

polyfactorial neuroelectrostimulation in an

electrostimulation device, it is possible to correct not

only the vegetative balance, but also the very low-

frequency component of the VLF of the heart rate in

the frequency range from 0.04 to 0.003 Hz. VLF

reflects the functional state of the brain in

psychogenic and organic pathology and is also a

sensitive indicator of metabolic processes control and

reflects well the energy deficit states of the brain.

One of the possible algorithms for the

implementation of this task is shown in Fig. 4.

Neuroelectrostimulation from Natural Electricity to Multifactorial Systems: A Review

227

Figure 4: Algorithm for the implementation of

polyfactorism.

The algorithm consists of two stages:

1. At the first stage, target 1 is selected for

stimulation and the LF / HF vegetative balance

indicator is adjusted using the dynamic correction of

the activity of the sympathetic nervous system

technology.

2. At the second stage, one of the targets (2, 3, 4,

5 or 6) or their combination is selected for

stimulation, depending on the leading pathological

process of the central nervous system. In this case,

stimulation occurs through the reticular formation,

thalamic structures and cerebral cortex, and affects

both the vascular tone of the cerebral arteries and the

autonomic nuclei of the spinal cord. The low-

frequency component of the VLF spectrum is an

indicator of changes in the activity of the

suprasegmental cerebral pathways.

The proposed system of neuroelectrostimulation

is capable of fully modulating autonomic processes,

influencing motor control and cognitive functions.

5 CONCLUSIONS

An analysis of the electrostimulation technologies

considered in this work shows that, since ancient

times, the criteria for the formation of these

technologies were based on knowledge about the

processes occurring in the human body. Our

understanding of physiological regulation has

evolved over time from the Greek idea of the balance

of fluids in the body to the concept of homeostasis

and the theory of controlling regulatory processes at

the cellular, tissue and organ levels. Homeostasis has

become the central unifying concept of physiology

and is defined as a self-regulating process through

which a living organism can maintain internal

stability while adapting to changing external

conditions. The health and vitality of the body is the

result of homeostatic regulation of the internal

environment.

When creating new technologies for

neurorehabilitation, other approaches are possible

today, but their foundation should remain the

homeostatic mechanisms of the whole organism,

determined by the coordinated interaction of the

autonomic, immune and endocrine systems, which

support most of the stable states of the organism.

We must proceed from the fact that it is

impossible to create one technology, a panacea for

treatment: the human body is too complex, and its

regulatory mechanisms are diverse. Further research

and testing are needed. And, of course, the results of

the implementation of polyfactorial

neuroelectrostimulation considered in the work are

another step in the movement from natural electricity

to multifactorial systems.

ACKNOWLEDGEMENTS

The reported study was funded by RFBR according

to the research project № 18-29-02052.

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