A recent study demonstrates that the Medoc PATHWAY system (CHEPS Model) is able to generate a reliably recorded Cold Evoked Potential (CEP) – a non-invasive, painless objective measure for the assessment of A-delta fiber integrity
The Pathway Model CHEPS System is an advanced thermal stimulator capable of eliciting a recordable pain evoked potential – allowing the clinical researcher to measure and document an objective response to evoked-pain. Cold perception is an important indicator of A-delta fiber function, potentially damaged at an early stage of small-fiber disease. Recording of the Cold Evoked Potentials (CEP) can fill a diagnostic gap related to cutaneous cold receptors.
In this study, CEPs were recorded in 16 healthy subjects at baseline, during A-delta block and after the block. The purpose was to verify the reliability of CEPs and the ability to assess the loss and recovery of A-delta function. Stimulation was performed using the PATHWAY system going from the baseline of 30˚C to the destination of 25˚C with a 20˚C/sec rate. The stimulation was applied on the subject’s face, hand and foot. The A-delta block was applied to the hand and monitored by other testing modalities to assess CEPs during A-delta fiber loss of and after functional recovery.
The results demonstrated that CEPs were successfully recorded in all subjects from all tested body sites. During the A-delta block, CEPs were not detectable and were fully restored 10 minutes after the block removal.
The study concludes that recording CEPs is a reliable measure of A-delta fiber integrity, loss of function and restitution. The results illuminate the potential diagnostic value for early assessment of small-fiber disease.
Pathway Model CHEPS (Contact Heat-Evoked Potential Stimulator) is considered the most advanced device for objective pain assessment available today. It is capable of delivering rapid and accurate cold and heat stimuli. Pathway Model CHEPS provides exciting opportunities in the field of pain research and in development of evidence-base clinical diagnostic procedures. For further reading on click here
CEPs performed using Pathway Model CHEPS system requires extended software capabilities. Please contact your local partner for further information:
A conclusive multi-center study to be presented at the upcoming German Pain Meeting validates of the Q-Sense thermal testing device, confirming the applicability of existing normative data.
Thermal QST is a reliable method for small fiber assessment and an essential part of the DFNS protocol. While the TSA-II device has been the gold standard for thermal sensory testing for the last two decades, the Q-Sense, launched in 2012 is an easy-to-use, small, thermal QST device, designed for clinical setup.
This multi-center study aimed to compare the Q-Sense device to the well-established TSA-II thermal-testing device. Warm and cold detection thresholds were assessed in healthy subjects as well as in diabetes mellitus patients. The thermal testing was performed according to the DFNS protocol, for two consecutive days at the same time in the foot of the dominant side or the more affected side. The order of testing devices was randomized and blinded. In addition an agar hand phantom was used to compare the temperature profile of both devices.
The results of the study demonstrate similar results for both warm and cold detection thresholds in healthy subjects. For diabetic patients there was a significant correlation between the results of both devices. Testing on the agar hand phantom also revealed the similarity between the temperature change rates.
The study demonstrates that the Q-Sense device is comparable to the TSA-II and concludes that the normative data collected for TSA-II over the years is applicable for Q-Sense for the detection of sensory loss both for warm and for cold detection threshold modalities.
TSA-II – NeuroSensory Analyzer is a precise, computer-controlled device capable of generating and documenting response to highly repeatable thermal and vibratory stimuli, such as warmth, cold, heat-induced pain, cold-induced pain or vibration.
Q-Sense – Small-fiber Test is a portable, easy-to-use system, which offers a scientifically validated measure of warm, cool and heat-pain thermal sensory thresholds, all clinically useful determinants in the evaluation of neuropathic pain, diabetic neuropathy, chemotherapeutic and other small-fiber neuropathies.
“CHEPS is an emerging and promising objective technique in clinical neurophysiology” says the 4th edition of the prestigious Clinical Neurophysiology, published by Oxford University Press (March 2016). The book includes a very useful chapter dedicated to the CHEPS by Medoc. It gives a thorough overview of the available methodologies contact heat evoked potentials (CHEPS) presents and its advantages.
The author, Dr. Benn E. Smith, affirms that having been used in individuals with a wide variety of peripheral and central disorders affecting spinothalamic pathways, CHEPS is an encouraging objective technique in clinical neurophysiology.
He also states that “contact heat evoked potential (CHEPS) testing is a validated method to study A delta- and C-fiber spinothalamic pathways from cutaneous afferents through the spinal cord and thalamus to the postcentral gyrus. With a rigorously collected published multinational set of normal values, CHEPS promises to be a valuable clinical and research tool to investigate small diameter nociceptive pathways in the periphery such as diabetic small fiber neuropathy as well as in central nervous system disorders affecting spinal cord and brain. As further data accumulate, the applications of CHEPS in clinical and research neurophysiology laboratories across the globe are likely to increase.”
Pathway Model CHEPS (Contact Heat-Evoked Potential Stimulator) is an advanced thermal stimulator for pain evoked-potentials equipped with functional MRI (fMRI) capabilities.
CHEPS is considered the most advanced and sophisticated device for pain assessment available today, and opens exciting opportunities in pain research.
The department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, uses Diffuse Noxious Inhibitory Control Assessment (DNIC) among their pain testing protocols when researching the Paradigm for Prediction of Post-Operative Pain in order to identify patients at risk of developing chronical pain. The DNIC protocol is performed using Medoc Pathway device thermode to produce heat pain test stimulus and a hot-water bath as a conditioning stimulus. The DNIC procedure allows the researchers to evaluate the functionality of inhibitory pathway of the pain modulatory system.
Pathway Model CHEPS (Contact Heat-Evoked Potential Stimulator) is considered the most advanced and sophisticated device for pain assessment available today. It is an advanced thermal stimulator for pain evoked-potentials able to deliver rapid and accurate heat. Pathway Model CHEPS provides exciting opportunities in the field of pain research. For further reading on, click here
I’m pleased to announce the appointment of Mr. Amir Katz to the position of R&D Manager, effective June 6th, 2016.
Amir brings extensive experience in the medical device field, with over 17 years of developing and managing different R&D groups at multi-disciplinary medical device companies. Amir took part in several patents, to include TMS – Neural stimulation methods, Deep transcranial stimulation coil and mechanical solutions.
In his role, Amir will lead Medoc’s R&D team in meeting the market challenges and opportunities toward enhancing and expanding our portfolio of products and services.
Please join me in wishing Amir the very best in his new important position.
Amir Haiman, General Manager
Medoc Ltd, Advanced Medical Systems Division
New set of normative data for Contact Heat Evoked Potentials (CHEPS) provided by a multicenter study
The prestigious journal PAIN has recently published an extensive set of reference values for A-Delta mediated evoked potentials using Contact Heat stimulation, a technology patented by Medoc, using Pathway Model CHEPS platform.
Nociceptive evoked potentials have been widely recommend for the diagnosis of neuropathic pain conditions and the evaluation of sensory pathways. This comprehensive set of reference data provides the necessary foundation for the implementation of CHEPS as a non-invasive and objective diagnostic method for a range of neurological and chronic pain conditions, including small fiber neuropathies.
This ambitious multicenter study is the result of the cooperation between leading researchers from Spain, Israel, Japan, Brazil, United States and the United Kingdom. The valuable data was collected using Medoc’s Pathway model CHEPS and Nihon Kohden’s EMG/EP measuring system from 226 healthy individuals, male and female between in the ages 20 – 79 years, from multiple body sites including the lower and upper limbs, lower and upper back and face.
In addition to providing normal reference values for a wide range of age and gender specific groups, the study also demonstrates that there is no significant difference between the right and left sides in healthy individuals. This, in concordance with previously published data, strengthens the utility of CHEPS for the diagnosis of focal or unilateral sensory nerve damage.
Pathway Model CHEPS (Contact Heat-Evoked Potential Stimulator) is an advanced thermal stimulator for pain evoked-potentials capable of delivering fast and accurate heat and is considered the most advanced and sophisticated device for pain assessment available today, providing exciting opportunities in the field of pain research. For further reading on Pathway model CHEPS
New study demonstrates long term relation between decline of peripheral nerve function and cumulative glycemic control
This prospective observational study, conducted for 24 years on patients with diabetes type 1, demonstrated for the first time that peripheral and autonomic nerve dysfunction can be completely prevented by long-term near-normoglycemia, maintained from the diagnosis of type 1 diabetes.
I am pleased to announce the appointment of Mrs. Yardena Belenstein to the position of Marketing Communications Manager, effective March 13th, 2016.
Yardena brings extensive experience in marketing for medical devices companies. Over the past 3 years, Yardena has managed the marketing and branding for Alma Lasers (a global company of medical aesthetic platforms). Among her duties, Yardena managed exhibitions and events worldwide, created the B2B collateral, as well as B2C approached collateral.
Prior to Alma Lasers, Yardena worked for Fortune 500 company Johnson & Johnson (medical devices) for 7 years. In her role at J&J, Yardena specialized in marketing for the Surgical franchise, with responsibility for management of websites (content, SEO and PPC), training and professional events, along with the implementation of global collateral to the local market.
Please join me in wishing Yardena the very best in her new important position.
Amir Haiman, General Manager
Medoc Ltd, Advanced Medical Systems Division
Oxaliplatin is a chemotherapeutic agent widely used in cases of colorectal cancer. Together with its therapeutical effect there are various side effects oxaliplatine may cause, one of the most common of them is peripheral neuropathy. The aim of this study was to find a way to predict who will develop a chronic oxaliplatin-induced neuropathy, using simple and short measurement with a potential to be used in clinical routine in oncology clinic. QST is suggested to serve as such measurement, since this is a noninvasive testing which can assess the functionality of both small and large fibers.
In this study cutaneous sensation threshold, vibration perception threshold, heat and cold perception and pain thresholds were measured before, during and 1 year after the treatment with oxaliplatin. The results of the study demonstrated that some of pretreatment QST measurements can serve as early biomarkers for the development of chronic neuropathy – heat detection threshold at baseline and during the first oxaliplatin infusion, cold detection threshold and cutaneous detection threshold during the first infusion, etc.
In conclusion, this study suggest using noninvasive and feasible QST testing to identify patients in high risk to develop chronic oxaliplatin-induced neuropathy before the treatment. The identification will potentially allow treatment and dose adjustment to reduce this life-altering complication occurrence.
TSA II Neuro Sensory Analyzer
The department of Anesthesia at Stanford University School of Medicine carries out its experiments using the following pain test paradigms: mechanical pain threshold tested with von Frey filaments and heat pain threshold evaluated using TSA II Neuro Sensory Analyzer. These tests together with microdialysis procedures allows the identification of the biochemical responsible of generating and propagating pain signals.
For more details, please watch the movie from the research presented at JoVE