Differential excitation of the inner capsule by hemispheric and trans-hemispheric electrical stimulation: Clinical and mathematical evidence

Lorena Vega Zelaya, Jesús Pastor

Abstract


Objective: To evaluate the differences in inner capsule (IC) excitability for trans-hemispheric and hemispheric trans-cranial electrical stimulation (thTES and hTES).

Methods: We performed thTES and hTES in the intact motor systems of 18 patients. We measured motor evoked potential (MEP) voltage thresholds (Vth, V) at the extensor digitorum and tibialis anterior, latencies (ms) and thresholds of movement (Vth_mov, V). We developed an analytical 2D model of the electric field ( ) of the brain.

Results: The stimulation pattern was similar for both methods, although the thTES Vth was lower; however, the Vth_mov was higher for hTES. Latency for upper limb muscles was lower for thTES. The mathematical model predicted excitability onset at a more caudal region for thTES. The model correctly predicted that excitability in lower limbs during hTES should be lower.

Conclusions: Clinical and analytical results showed that excitability with small step voltages occurs in relatively small length increments of the IC. In addition, the  induced by hTES is more cranial than that induced by thTES and is also a less perturbing technique for surgeons.


Keywords


analytical model, corticospinal tract, intraoperative neurophysiological monitoring, motor evoked potentials, semioval centre.

Full Text:

 Subscribers Only

References


Pastor J. Neurofisiología Intraoperatoria. In: Neurocirugía Funcional y Estereotáxica. Eds: E.G. Navarrete y R. G. Sola. Viguera Editores, 2011; Barcelona; pp: 589-604. ISBN 978-84-92931-00-2.

MacDonald DB. Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol. 2002;19(5):416-29.

MacDonald DB. Intraoperative motor evoked potential monitoring: overview and update. J. Clin. Monit. Comput 2006; 20(5): 347-377.

Kothbauer KF. Intraoperative neurophysiologic monitoring for intramedullary spinal-cord tumour surgery. Neurophysiol Clin. 2007; 37(6): 407–414.

Sala F, Manganotti P, Tramontano V, Bricolo A, Gerosa M Monitoring of motor pathways during brain stem surgery: what we have achieved and what we still miss? Neurophysiol Clin. 2007; 37 (6):399–406.

Pastor J, Vega-Zelaya L, Pulido P, Abreu A, Garnés O, Sola RG. J. Role of intraoperative neurophysiological monitoring during fluorescence-guided resection surgery. Acta Neurochirurg. 2013; 155:2201–2213.

Rothwell J, Burke D, Hicks R, Stephen J, Woodforth I, Crawford M. Transcranial electrical stimulation of the motor cortex in man: further evidence for the site of activation. J. Physiol. 1994; 481: 243-250.

Pastor J, Pulido P, A López, Sola RG. Monitoring of motor and somatosensory systems in a 26-weeks pregnant woman. ActaNeurochir (Wien). 2010; 152:1231–1234.

Pastor J, Perla y Perla P, Pulido P, Sola RG. Hemispheric transcranial electrical stimulation: clinical results. Rev. Neurol. 2010; 51(2):65-71.

Vega-Zelaya L, Pastor J. Intraoperative Neurophysiological Monitoring Techniques for the Resection of Malignant Brain Tumors Located in Eloquent Cortical Areas. Austin Journal of Neurosurgery; 2015; 2(4): 1038.

Vega-Zelaya L, Sola RG, Pastor J. Intraoperative Neurophysiological Monitoring in Neurooncology. In: Neurooncology. Edited by: A. Agarwal. InTech, 2016; pp: 207-249. ISBN 978-953-51-2425-2.

Szelényi A, Journée HL, Herrlich S, Galistu GM, van den Berg J, van Dijk JM. Experimental study of the course of threshold current, voltage and electrode impedance during stepwise stimulation from the skin surface to the human cortex. Brain Stimul. 2013;6(4):482-9.

Saypol JM, Roth BJ, Cohen LG, Hallet M. A theoretical comparison of electric and magnetic stimulation of the brain. Annals of Biomedical Engineering. 1991; 19: 317-328.

Nathan SS, Sinha SR, Gordon B, Lesser RP, Thakor NV. Determination of current density distributions generated by electrical stimulation of the human cerebral cortex. Electroencephalogr Clin Neurophysiol. 1993; 86: 183-192.

Li DL, Journee HL, van Hultzen A, Rath WE, Sclabassi RJ, Sum M. Computer simulation of corticospinal activity during transcranial electrical stimulation in neurosurgery. Stud Health Technol Inform 2007; 125: 292-297.

Holsheimer J, Lefaucher JP, Buitenweg JR, Goujon C, Nineb A, Nguyen JP. The role of intra-operative motor evoked potentials in the optimization of chronic cortical stimulation for the treatment of neuropathic pain. Clin. Neurophysiol, 2007; 118: 2287-2296.

Möller AR. Anatomy and physiology of sensory systems. Intraoperative neurophysiological monitoring. 2 ed. New Jersey: HumanaPress; 2006. p 55-84.

Skucas AP, Artru AA. Anesthetic complications of awake craniotomies for epilepsy surgery. Anesth Analg. 2006; 102: 882-7.

Oostendorp TF; Delbeke J; Stegeman DF. The conductivity of the human skull: results of in vivo and in vitro measurements. IEEE Transactions on Biomedical Engineering, 2000; 47(11): 1487 – 1492.

Yousif, N.; Bayford, R.; Liu, X. The influence of reactivity of the electrode-brain interface on the crossing electric current in therapeutic deep brain stimulation. Neuroscience 2008, 156, 597–606.

Alonso, F.; Hemm-Ode, S.; Wårdell, K. Influence on deep brain stimulation from lead design, operating mode and tissue impedance changes—A simulation study. Brain Disord. Ther. 2015, 4.

Wangsness RK. Electromagnetic Fields, 2nd ed, 1986, Wiley & Son, Hoboken, Canada.

Plonsey R, Barr RC. Bioelectricity. A quantitative approach. 3rd Ed. Springer, New York, 2007.

Rattay F. Analysis of models for external stimulation of axons. IEEE Trans Biomed Eng. 1986; 33: 974-977.

Nieuwenhuys R, Voogd J, van Huijzen C. The Human Central Nervous System. Ed. Springer-Verlag Berlin Heidelberg, New York. 2008.

Journée HL, Polak HE, de Kleuver M. Influence of electrode impedance on threshold voltage for transcranial electrical stimulation in motor evoked potential monitoring. Med Biol Eng Comput. 2004; 42(4):557-61.

Burke D, Hicks RG, Stephen JP. Corticospinal volleys evoked by anodal and cathodal stimulation of the human motor cortex. Journal of Neurophysiology, 1990; 425: 283-299.

Di Lazzaro V, Oliviero A, Pilato F, Saturno E, Dileone M Mazzone P, et al, The physiological basis of transcranial motor cortex stimulation in conscious humans. Clin. Neurophysiol. 2004; 115(2): 255-266.

Manola L, Holsheimer J, Veltink P, Buitenweg JR. Anodal vs cathodal stimulation of motor cortex: A modeling study. Clinical Neurophysiology. 2007; 118: 464–474.




DOI: http://dx.doi.org/10.18103/imr.v4i6.726

Refbacks

  • There are currently no refbacks.
Copyright 2016. All rights reserved.