Bidirectional Nerve Refractory Characteristics in Simulations of Direct and Remote Stimulation

The effects of remote stimulation on the refractory characteristics of myelinated nerve fibers were investigated using computer simulations of nerve action potentials, in response to spatially separated conditioning and test stimuli. The behavior of the test action potential was strongly influenced by its direction of propagation relative to that of the conditioning action potential. Under certain conditions, the variation of relative refractory period with conduction velocity (CV) changed from inverse, for propagation in opposing directions, to direct, for propagation in the same direction. A similar directionally dependent result occurred in the study of relative refractory period as a function of stimulus intensity. At certain interstimulus intervals, the test stimulus elicited action potentials which would conduct in the direction opposite to the conditioning action potential, but would not conduct in the wake of that conditioning action potential. These results are explained in terms of the spatial spread of stimulus current resulting from distant placement of the stimulating electrode in a volume conductor. Clinical repercussions of these results for correction of refractory period in collision neurography are discussed.