Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation

Background: Novel patterns of electrical stimulation of the brain and spinal cord hold tremendous promise to improve neuromodulation therapies for diverse disorders, including tremor and pain. To date, there are limited numbers of experimental studies in human subjects to help explain how stimulatio...

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Main Authors:	Matthew S. Willsey, Charles W Lu, Sam R. Nason, Karlo A. Malaga, Scott F. Lempka, Cynthia A. Chestek, Parag G. Patil
Format:	Article
Language:	English
Published:	Elsevier 2020-09-01
Series:	Brain Stimulation
Subjects:	Thalamus Deep brain stimulation Movement disorders Burst Perception
Online Access:	http://www.sciencedirect.com/science/article/pii/S1935861X20302059

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spelling	doaj-bd581067450449d4bda5cda56fa91c882021-03-19T07:22:45ZengElsevierBrain Stimulation1935-861X2020-09-0113514361445Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulationMatthew S. Willsey0Charles W Lu1Sam R. Nason2Karlo A. Malaga3Scott F. Lempka4Cynthia A. Chestek5Parag G. Patil6Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Corresponding author. Neurosurgery, 3470 TC SPC 5338, University Hospital, Ann Arbor, MI, 48109-5048, USA.Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USADepartment of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USADepartment of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, Bucknell University, Lewisburg, PA, USADepartment of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USADepartment of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Electrical Engineering, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USADepartment of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Corresponding author. Neurosurgery, 3470 TC SPC 5338, University Hospital, Ann Arbor, MI, 48109-5048, USA.Background: Novel patterns of electrical stimulation of the brain and spinal cord hold tremendous promise to improve neuromodulation therapies for diverse disorders, including tremor and pain. To date, there are limited numbers of experimental studies in human subjects to help explain how stimulation patterns impact the clinical response, especially with deep brain stimulation.We propose using novel stimulation patterns during electrical stimulation of somatosensory thalamus in awake deep brain stimulation surgeries and hypothesize that stimulation patterns will influence the sensory percept without moving the electrode. Methods: In this study of 15 fully awake patients, the threshold of perception as well as perceptual characteristics were compared for tonic (trains of regularly-repeated pulses) and bursting stimulation patterns. Results: In a majority of subjects, tonic and burst percepts were located in separate, non-overlapping body regions (i.e., face vs. hand) without moving the stimulating electrode (p < 0.001; binomial test). The qualitative features of burst percepts also differed from those of tonic-evoked percepts as burst patterns were less likely to evoke percepts described as tingling (p = 0.013; Fisher’s exact test). Conclusions: Because somatosensory thalamus is somatotopically organized, percept location can be related to anatomic thalamocortical pathways. Thus, stimulation pattern may provide a mechanism to select for different thalamocortical pathways. This added control could lead to improvements in neuromodulation - such as improved efficacy and side effect attenuation - and may also improve localization for sensory prostheses.http://www.sciencedirect.com/science/article/pii/S1935861X20302059ThalamusDeep brain stimulationMovement disordersBurstPerception
collection	DOAJ
language	English
format	Article
sources	DOAJ
author	Matthew S. Willsey Charles W Lu Sam R. Nason Karlo A. Malaga Scott F. Lempka Cynthia A. Chestek Parag G. Patil
spellingShingle	Matthew S. Willsey Charles W Lu Sam R. Nason Karlo A. Malaga Scott F. Lempka Cynthia A. Chestek Parag G. Patil Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation Brain Stimulation Thalamus Deep brain stimulation Movement disorders Burst Perception
author_facet	Matthew S. Willsey Charles W Lu Sam R. Nason Karlo A. Malaga Scott F. Lempka Cynthia A. Chestek Parag G. Patil
author_sort	Matthew S. Willsey
title	Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation
title_short	Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation
title_full	Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation
title_fullStr	Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation
title_full_unstemmed	Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation
title_sort	distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation
publisher	Elsevier
series	Brain Stimulation
issn	1935-861X
publishDate	2020-09-01
description	Background: Novel patterns of electrical stimulation of the brain and spinal cord hold tremendous promise to improve neuromodulation therapies for diverse disorders, including tremor and pain. To date, there are limited numbers of experimental studies in human subjects to help explain how stimulation patterns impact the clinical response, especially with deep brain stimulation.We propose using novel stimulation patterns during electrical stimulation of somatosensory thalamus in awake deep brain stimulation surgeries and hypothesize that stimulation patterns will influence the sensory percept without moving the electrode. Methods: In this study of 15 fully awake patients, the threshold of perception as well as perceptual characteristics were compared for tonic (trains of regularly-repeated pulses) and bursting stimulation patterns. Results: In a majority of subjects, tonic and burst percepts were located in separate, non-overlapping body regions (i.e., face vs. hand) without moving the stimulating electrode (p < 0.001; binomial test). The qualitative features of burst percepts also differed from those of tonic-evoked percepts as burst patterns were less likely to evoke percepts described as tingling (p = 0.013; Fisher’s exact test). Conclusions: Because somatosensory thalamus is somatotopically organized, percept location can be related to anatomic thalamocortical pathways. Thus, stimulation pattern may provide a mechanism to select for different thalamocortical pathways. This added control could lead to improvements in neuromodulation - such as improved efficacy and side effect attenuation - and may also improve localization for sensory prostheses.
topic	Thalamus Deep brain stimulation Movement disorders Burst Perception
url	http://www.sciencedirect.com/science/article/pii/S1935861X20302059
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Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation

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