Scientific Basis of Auriculotherapy: State of the Art.

Background: Using a modern scientific basis, this article examines clinical findings and experimentally reproducible data that demonstrate reliably the objective reality of the auriculotherapy procedures initiated by Paul Nogier, MD, of Lyon, France. Objective: The aims of this review are to: (1) identify the Chinese acupoints and all relevant related subjects; (2) offer a critical analysis of different auricle cartographies or ear maps; and (3) evaluate evidence for auriculotherapy with respect to the constant progress of our knowledge of nervous-system organization. Discussion: Acupuncture points have lower electrical impedance than nonacupoints. This was demonstrated by Niboyet and Terral, utilizing a sinusoidal current with the technical arrangements of different equivalent circuits made at Unit 103 of the French National Institute of Health and Medical Research (INSERM), Montpellier, France. This work demonstrated that physical behavior associated with acupuncture corresponds to a specific histologic structure located within the dermis termed the neurovascular complex (NVC). The concept of using sham points for testing acupuncture needs to be criticized. A reproducible experimental model of analgesia has been produced using the hind limb of a rabbit; this model is a proven demonstration of the positive action of acupuncture on pain. Acupuncture analgesia is a technique that has been used effectively by Chinese researchers in the 1970s for surgical applications. The different ear maps may have to be significantly modified because of the paucity of scientific validation of most of the localizations of organs or functions and, particularly, of nervous structures. Increased knowledge about complex nervous interactions should facilitate formulation of some scientifically acceptable hypothesis to explain the action of auriculotherapy. Conclusions: More scientific research should be performed to improve the scientific credibility of auriculotherapy.

[The BAB project (Big Artificial Brain)]. / Le projet BAB (Big Artificial Brain).

Recent advances in neuroscience allow us to envisage the creation of an artificial brain (BAB, for Big Artificial Brain) in order to reproduce cerebral functions without having to copy individual neurons, the complex properties of which are largely beyond our present technological capabilities. As in the human brain, we intend to combine inputs, a black box ("mentipulator") and expressive outputs. The ZISC and NeuroMem neuronal chips designed by Guy Paillet, Anne Ménendez and IBM have been used to built a BAB of 1 million transversally and vertically interconnected neurons with a parallel architecture, as in the human cerebral cortex. Potential applications are multiple and highly promising.

Laparoscopic implantation of neural electrodes on pelvic nerves: an experimental study on the obturator nerve in a chronic minipig model.

BACKGROUND: Laparoscopic exposure of pelvic nerves has opened a new area in the field of neuromodulation. However, electrode design and material deterioration remain issues that limit clinical application. The objective of this study was to evaluate experimentally the laparoscopic implantation of different types of neural electrodes in order to achieve functional and selective electrical stimulation of pelvic nerves. METHODS: This was a prospective comparative study of the laparoscopic implantation and tolerance and efficacy of three monopolar cuff electrodes implanted on the obturator nerve in ten Göttingen minipigs (18-20 months old; 14.5-24 kg body weight). Animals were allocated to two groups. A 3-mm-diameter laparoscopic instrument was used during dissection of paravesical fossa and obturator nerve on both sides in order to minimize nerve damage. In all animals, a "split-cylinder" cuff electrode was implanted around the left obturator nerve. On the right side, a "lasso" cuff electrode was implanted in the first group and a "closed-cylinder" cuff was implanted in the second group. Electrical stimulation (0-5 V, 20 Hz) was performed for implanted electrodes on days 0, 7, 15, 30, 45, 60, and 90. Current intensity thresholds were identified by palpation of muscle contraction. Strength developed according to stimulation level and was measured using weight transducers. RESULTS: All procedures were performed by laparoscopy. Mean operative times differed significantly among groups, the shortest being for split-cylinder electrodes (P = 0.0002). No electrical spread phenomena were observed. Initial thresholds were below 1.5 V (range = 0.5-1.3); however, a significant rise was observed, with time to a maximum of 2.7 V (P < 0.0001). Only split-cylinder electrodes remained functional after 3 months. The mean value of maximum strength remained stable during the study period (P = 0.21, NS). CONCLUSIONS: The laparoscopic approach to implanting neuroprostheses seems to be very attractive. Furthermore, this approach could allow highly selective nerve stimulation to be achieved using simpler devices such as split-cylinder monopolar electrodes.

An implantable neuroprosthesis for standing and walking in paraplegia: 5-year patient follow-up.

We present the results of a 5-year patient follow-up after implantation of an original neuroprosthesis. The system is able to stimulate both epimysial and neural electrodes in such a way that the complete flexor-extensor chain of the lower limb can be activated without using the withdrawal reflex. We demonstrate that standing and assisted walking are possible, and the results have remained stable for 5 years. Nevertheless, some problems were noted, particularly regarding the muscle response on the epimysial channels. Analysis of the electrical behaviour and thresholds indicated that the surgical phase is crucial because of the sensitivity of the functional responses to electrode placement. Neural stimulation proved to be more efficient and more stable over time. This mode requires less energy and provides more selective stimulation. This FES system can be improved to enable balanced standing and less fatiguing gait, but this will require feedback on event detection to trigger transitions between stimulation sequences, as well as feedback to the patient about the state of his lower limbs.