The Closed Loop stimulation paradigm requires the use of both the Neuralynx and Blackrock recording systems.

Prior to beginning the set up, we must ensure that a neurologist is available to supervise the stimulation testing in order to approve the session. As of 2/21/2025, Dr. Dawn Eliashiv oversees stimulation studies conducted by Fried Lab. Once Dr. Eliashiv has confirmed her availability, we must inform Dr. Fried and he will send which electrodes he thinks we should Stim from and where we should sense from.

Neuralynx: #

The Neuralynx system is the primary recording device, with the acquisition and stimulation being viewed on Pegasus. The NK cables originating from the neuralynx headboxes connect to the EEG monitor per the typical set up. If the Neuralynx has already been set up as the recording device for this patient, then during the set up, the clinical cables which connect the patient’s T-Bar (blue pouch) to the NLX headboxes should be removed as the Blackrock cables will take its place.

Blackrock: #

The blackrock systems primary purpose is to send the stimulation signal from the Macrostim box via Central. In order to connect the Blackrock to the neuralynx, the Blackrock NK cables will connect the NLX headboxes to the patients blue pouch, and the grey connectors will serve as Blackrocks connection to the set up. If Blackrock has already been set up as the recording device for this patient, then the blue pouch should already be connected via the Blackrock cables. In this case, the other end of the Blackrock NK cables will be disconnected from the EEG monitor and plugged into the NLX headboxes. While connecting the Blackrock cables to the patient’s T-Bar, ensure that the correct cable is connected to each box (A to A, B to B).

Stimulation: #

In order to determine which AD channel should be used for the Closed loop software and which Blackrock macro splitter bank should be connected to the Macrostimulator, we can use the Closed Loop Codex, found on the NAS Server. It serves as an easy way to understand how the AD channels correspond to the clinical montage, and which Neuralynx/Blackrock channels we should see the stim signals on. In order to use it, you must have access to the Clinical Montage. In the case it is not available, the EEG technicians in the Telemetry room should have it.

In order to take the impedances of the Macros, we can use the monitors in the Telemetry room. After locating the correct screen for the patient, there is an omega symbol in the tool bar near the top. Holding it will take the impedances of each Macro contact. Record this in the Blue Book on the impedances section.

Connect the Blue ribbon cable from the appropriate splitter bank to the Macrostimulator only when you are ready to stimulate under Neurologist Supervision. If Dr. Eliashiv is in, she will observe a test stim on Pegasus, and if she is out, she is open to FaceTiming someone in the room and observing over the phone. After Dr. Eliashiv approves the stim, we can start the session and continue without her.