Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents
Background: Central post stroke pain (CPSP) is a highly refractory syndrome that can occur after stroke. Primary motor cortex (M1) brain stimulation using epidural brain stimulation (EBS), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS) have been explored...
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| Format: | Article |
| Language: | en_US |
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Frontiers Research Foundation
2017
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| Online Access: | http://hdl.handle.net/1721.1/107000 https://orcid.org/0000-0001-5835-4256 |
| _version_ | 1826206356726611968 |
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| author | O’Brien, Anthony T. Amorim, Rivadavio Rushmore, R. Jarrett Eden, Uri Afifi, Linda Dipietro, Laura Valero-Cabré, Antoni Wagner, Tim Andrew |
| author2 | Harvard University--MIT Division of Health Sciences and Technology |
| author_facet | Harvard University--MIT Division of Health Sciences and Technology O’Brien, Anthony T. Amorim, Rivadavio Rushmore, R. Jarrett Eden, Uri Afifi, Linda Dipietro, Laura Valero-Cabré, Antoni Wagner, Tim Andrew |
| author_sort | O’Brien, Anthony T. |
| collection | MIT |
| description | Background: Central post stroke pain (CPSP) is a highly refractory syndrome that can occur after stroke. Primary motor cortex (M1) brain stimulation using epidural brain stimulation (EBS), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS) have been explored as potential therapies for CPSP. These techniques have demonstrated variable clinical efficacy. It is hypothesized that changes in the stimulating currents that are caused by stroke-induced changes in brain tissue conductivity limit the efficacy of these techniques.
Methods: We generated MRI-guided finite element models of the current density distributions in the human head and brain with and without chronic focal cortical infarctions during EBS, TMS, and tDCS. We studied the change in the stimulating current density distributions’ magnitude, orientation, and maxima locations between the different models.
Results: Changes in electrical properties at stroke boundaries altered the distribution of stimulation currents in magnitude, location, and orientation. Current density magnitude alterations were larger for the non-invasive techniques (i.e., tDCS and TMS) than for EBS. Nonetheless, the lesion also altered currents during EBS. The spatial shift of peak current density, relative to the size of the stimulation source, was largest for EBS.
Conclusion: In order to maximize therapeutic efficiency, neurostimulation trials need to account for the impact of anatomically disrupted neural tissues on the location, orientation, and magnitude of exogenously applied currents. The relative current-neuronal structure should be considered when planning stimulation treatment, especially across techniques (e.g., using TMS to predict EBS response). We postulate that the effects of altered tissue properties in stroke regions may impact stimulation induced analgesic effects and/or lead to highly variable outcomes during brain stimulation treatments in CPSP. |
| first_indexed | 2024-09-23T13:28:12Z |
| format | Article |
| id | mit-1721.1/107000 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T13:28:12Z |
| publishDate | 2017 |
| publisher | Frontiers Research Foundation |
| record_format | dspace |
| spelling | mit-1721.1/1070002022-09-28T14:29:55Z Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents O’Brien, Anthony T. Amorim, Rivadavio Rushmore, R. Jarrett Eden, Uri Afifi, Linda Dipietro, Laura Valero-Cabré, Antoni Wagner, Tim Andrew Harvard University--MIT Division of Health Sciences and Technology Wagner, Tim Andrew Background: Central post stroke pain (CPSP) is a highly refractory syndrome that can occur after stroke. Primary motor cortex (M1) brain stimulation using epidural brain stimulation (EBS), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS) have been explored as potential therapies for CPSP. These techniques have demonstrated variable clinical efficacy. It is hypothesized that changes in the stimulating currents that are caused by stroke-induced changes in brain tissue conductivity limit the efficacy of these techniques. Methods: We generated MRI-guided finite element models of the current density distributions in the human head and brain with and without chronic focal cortical infarctions during EBS, TMS, and tDCS. We studied the change in the stimulating current density distributions’ magnitude, orientation, and maxima locations between the different models. Results: Changes in electrical properties at stroke boundaries altered the distribution of stimulation currents in magnitude, location, and orientation. Current density magnitude alterations were larger for the non-invasive techniques (i.e., tDCS and TMS) than for EBS. Nonetheless, the lesion also altered currents during EBS. The spatial shift of peak current density, relative to the size of the stimulation source, was largest for EBS. Conclusion: In order to maximize therapeutic efficiency, neurostimulation trials need to account for the impact of anatomically disrupted neural tissues on the location, orientation, and magnitude of exogenously applied currents. The relative current-neuronal structure should be considered when planning stimulation treatment, especially across techniques (e.g., using TMS to predict EBS response). We postulate that the effects of altered tissue properties in stroke regions may impact stimulation induced analgesic effects and/or lead to highly variable outcomes during brain stimulation treatments in CPSP. National Institutes of Health (U.S.) (Grants (R01-NS33975, R21-NS062317, R21-NS084022, R44-AT008637, and R44NS080632) National Institute of Neurological Disorders and Stroke (U.S.) (Award R44NS080632) National Center for Complementary and Integrative Health (U.S.) 2017-02-21T15:45:38Z 2017-02-21T15:45:38Z 2016-11 2016-10 Article http://purl.org/eprint/type/JournalArticle 1662-5161 http://hdl.handle.net/1721.1/107000 O’Brien, Anthony T. et al. “Motor Cortex Neurostimulation Technologies for Chronic Post-Stroke Pain: Implications of Tissue Damage on Stimulation Currents.” Frontiers in Human Neuroscience 10 (2016): n. pag. https://orcid.org/0000-0001-5835-4256 en_US http://dx.doi.org/10.3389/fnhum.2016.00545 Frontiers in Human Neuroscience Creative Commons Attribution 4.0 International License http://creativecommons.org/licenses/by/4.0/ application/pdf Frontiers Research Foundation Frontiers |
| spellingShingle | O’Brien, Anthony T. Amorim, Rivadavio Rushmore, R. Jarrett Eden, Uri Afifi, Linda Dipietro, Laura Valero-Cabré, Antoni Wagner, Tim Andrew Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents |
| title | Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents |
| title_full | Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents |
| title_fullStr | Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents |
| title_full_unstemmed | Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents |
| title_short | Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents |
| title_sort | motor cortex neurostimulation technologies for chronic post stroke pain implications of tissue damage on stimulation currents |
| url | http://hdl.handle.net/1721.1/107000 https://orcid.org/0000-0001-5835-4256 |
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