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. OBJECTIVE/HYPOTHESIS 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.

中文翻译：

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根据丘脑刺激的强直和爆发模式选择不同的感知通路


背景技术大脑和脊髓的电刺激的新颖模式对于改善包括震颤和疼痛在内的多种疾病的神经调节疗法具有巨大的希望。迄今为止，针对人类受试者的实验研究数量有限，无法帮助解释刺激模式如何影响临床反应，尤其是深部脑刺激。目的/假设我们建议在清醒深部脑刺激手术中对体感丘脑进行电刺激时使用新颖的刺激模式，并假设刺激模式将在不移动电极的情况下影响感官知觉。方法 在这项对 15 名完全清醒的患者进行的研究中，比较了强直（定期重复的脉冲串）和突发刺激模式的知觉阈值和知觉特征。结果 在大多数受试者中，强直和爆发知觉位于独立的、不重叠的身体区域（即面部与手部），无需移动刺激电极（p < 0.001；二项式检验）。爆发感知的定性特征也不同于强直诱发的感知，因为爆发模式不太可能唤起被描述为刺痛的感知（p=0.013；费舍尔精确检验）。结论 由于体感丘脑是按体位组织的，感知位置可能与解剖丘脑皮质通路相关。因此，刺激模式可以提供选择不同丘脑皮质通路的机制。这种额外的控制可以改善神经调节——例如提高功效和减弱副作用——并且还可以改善感觉假体的定位。