Abstract
Motor cortex stimulation (MCS) is a promising clinical technique used to treat chronic, otherwise intractable pain. However, the mechanisms by which the neural elements that are stimulated during MCS induce pain relief are not understood. Neither is it known which of the main neural elements, i.e. cell bodies, dendrites or fibers are immediately excited by the electrical pulses in MCS. Moreover, it is not known what are the effects of MCS on fibers which are parallel or perpendicular to the cortical layers, below or away from the electrode. The therapy and its efficacy are less likely to be improved until it is better understood how it may work.
In this chapter, we present our efforts to resolve this issue. Our computer model of MCS is introduced and some of its predictions are discussed. In particular, the influence of stimulus polarity and electrode position on the electrical field and excitation thresholds of different neural elements is addressed. Such predictions, supported with clinical evidence, should help to elucidate the immediate effects of an electrical stimulus applied over the motor cortex and may ultimately lead to optimizations of the therapy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Amassian VE, Stewart M, Quirk GJ, Rosenthal JL (1987) Physiological basis of motor effects of a transient stimulus to cerebral cortex. Neurosurgery 20: 74–93
Basser PJ, Roth BJ (2000) New currents in electrical stimulation of excitable tissues. Annu Rev Biomed Eng 2: 377–397
Brown JA, Barbaro NM (2003) Motor cortex stimulation for central and neuropathic pain: current status. Pain 104: 431–435
Brown JA, Lutsep H, Cramer SC, Weinand M (2003) Motor cortex stimulation for enhancement of recovery after stroke: case report. Neurol Res 25: 815–818
Garcia-Larrea L, Peyron R, Mertens P, Gregoire MC, Lavenne F, Le Bars D, Convers P, Mauguiere F, Sindou M, Laurent B (1999) Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 83: 259–273
Hanajima R, Ashby P, Lang AE, Lozano AM (2002) Effects of acute stimulation through contacts placed on the motor cortex for chronic stimulation. Clinical Neurophysiol 113: 635–641
Hern JEC, Landgren S, Phillips CG, Porter R (1962) Selective excitation of corticofugal neurons by surface anodal stimulation of the baboon’s motor cortex. J Physiol 161: 73–90
Holsheimer J (2002) Which neuronal elements are activated directly by spinal cord stimulation. Neuromodulation 5: 25–31
Holsheimer J, Wesselink WA (1997) Optimum electrode geometry for spinal cord stimulation: the narrow bipole and tripole. Med Biol Eng Comput 35: 493–497
Holsheimer J, Struijk JJ, Tas NR (1995) Effects of electrode geometry and combination on nerve fiber selectivity in spinal cord stimulation. Med Biol Eng Comput 33: 676–682
Holsheimer J, Nuttin B, King GW, Wesselink WA, Gybels JM, de Sutter P (1998) Clinical evaluation of paresthesia steering with a new system for spinal cord stimulation. Neurosurgery 42: 541–549
Manola L, Roelofsen BH, Holsheimer J, Marani E, Geelen J (2005) Modelling motor cortex stimulation for chronic pain control: characteristics of the electrical field, activating function and nerve fibre responses. Med Biol Eng Comput 43: 35–343
McIntyre CC, Grill WM (1999) Excitation of central nervous system neurons by nonuniform electric fields. Biophys J 76: 878–888
Meyerson B (2005) Motor cortex stimulation — effective for neuropathic pain but the mode of action remains illusive. Pain 118: 6–7
Nguyen J-P, Lefaucheur J-P, Decq P, Uchiyama T, Carpentier A, Fontaine D, Brugieres P, Pollin B, Feve A, Rostaing S, Cesaro P, Keravel Y (1999) Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data. Pain 82: 245–251
Nguyen J-P, Lefaucheur J-P, Keravel Y (2003) Motor cortex stimulation in Electrical stimulation and relief of pain. Pain research and clinical management, vol. 15. Elsevier Science
Nowak LG, Bullier J (1998) Axons but not cell bodies are activated by electrical stimulation in cortical gray matter. I. Evidence from chronaxie measurements. Exp Brain Res 118: 477–488
Pagni CA, Altibrandi MG, Bentivoglio A, Caruso G, Cioni B, Fiorella C, Insola A, Lavano A, Maina R, Mazzone P, Signorelli CD, Sturiale C, Valzania F, Zeme S, Zenga F (2005) Extradural motor cortex stimulation (EMCS) for Parkinson’s disease. History and first results by the study group of the Italian neurosurgical society. Acta Neurochir Suppl 93: 113–119
Patton HD, Amassian VE (1953) Single-and multiple-unit analysis of cortical stage of pyramidal tract activation. J Neurophysiol 17: 345–363
Phillips CG, Porter R (1962) Unifocal and bifocal stimulation of the motor cortex. J Physiol 162: 532–538
Rattay F (1998) Analysis of the electrical excitation of CNS neurons. IEEE Trans Biomed Eng 45: 766–772
Rivara C-B, Sherwood CC, Bouras C, Hof PR (2003) Stereologic characterization and spatial distribution patterns of Betz cells in the human primary motor cortex. Anat Rec A Discov Mol Cell Evol 270: 137–151
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S (1993) Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 78: 393–401
Turner D, Schwartzkroin PA (1980) Steady-state electrotonic analysis of intracellularly stained hippocampal neurons. J Neurophysiol 44: 184–199
Wesselink WA, Holsheimer J, Boom HBK (1999) A model of the electrical behaviour of myelinated sensory nerve fibres based on human data. Med Biol Eng Comput 37: 228–235
Woolsey CN, Erickson TC, Gilson WE (1979) Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg. 51: 476–506
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag
About this chapter
Cite this chapter
Manola, L., Holsheimer, J. (2007). Motor cortex stimulation: role of computer modeling. In: Sakas, D.E., Simpson, B.A. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/2. Springer, Vienna. https://doi.org/10.1007/978-3-211-33081-4_57
Download citation
DOI: https://doi.org/10.1007/978-3-211-33081-4_57
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-33080-7
Online ISBN: 978-3-211-33081-4
eBook Packages: MedicineMedicine (R0)