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Predicted effects of pulse width programming in spinal cord stimulation: a mathematical modeling study.

Dongchul Lee1, Brad Hershey, Kerry Bradley

  • 1Boston Scientific Neuromodulation, 25155 Rye Canyon Blvd, Valencia, CA 91355, USA. Dongchul.Lee@bsci.com

Medical & Biological Engineering & Computing
|April 30, 2011
PubMed
Summary

Spinal cord stimulation (SCS) programming with varying pulse widths (PW) can precisely target nerve fibers. This computational model shows PW adjustments enhance control over dorsal column activation for better therapeutic outcomes.

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Area of Science:

  • Biomedical Engineering
  • Computational Neuroscience
  • Neurosurgery

Background:

  • Spinal cord stimulation (SCS) is a neuromodulation technique used for pain management.
  • Optimizing SCS parameters like pulse width (PW) is crucial for effective and selective neural activation.
  • Understanding the theoretical underpinnings of PW programming can improve SCS therapy.

Purpose of the Study:

  • To investigate the theoretical effects of pulse width (PW) programming in spinal cord stimulation (SCS) using computational modeling.
  • To gain insight into how PW programming influences electrical fields and neural activation patterns.
  • To explore the potential for PW programming to modulate the spatial selectivity of neural recruitment.

Main Methods:

  • Implementation of a mathematical model combining finite element analysis for electrical properties and a nonlinear double-cable axon model for neural excitation.

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  • Simulation of nerve excitation across different myelinated fiber sizes under various SCS parameters.
  • Validation of computational modeling results through a companion clinical study.

    • Main Results:

    • Mathematical modeling indicated that mediolateral lead position influences chronaxie and rheobase values.
    • Increased PW was predicted to enhance the activation of medial dorsal column fibers.
    • Modeling results were corroborated by a companion clinical study, confirming the theoretical predictions.

    Conclusions:

    • Variable PW programming in SCS offers theoretical advantages for increasing and steering the spatial selectivity of dorsal column fiber recruitment.
    • The developed computational SCS model serves as a valuable tool for elucidating the fundamental mechanisms of nerve fiber excitation.
    • This research highlights the importance of stimulation parameters, such as PW and electric fields, in modulating neural responses during SCS.