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Updated: Jul 14, 2026
Simultaneous EEG Monitoring During Transcranial Direct Current Stimulation
Published on: June 17, 2013
American Clinical Neurophysiology Society Technical Standards for Electrical Stimulation With Intracranial Electrodes
Ravindra Arya1, Fiona M Baumer2, Patrick Chauvel3
1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, and Departments of Neurology, Pediatrics, and Computer Science, University of Cincinnati, Cincinnati, Ohio, U.S.A.
Purpose:
These American Clinical Neurophysiology Society technical standards suggest best practices for electrical stimulation mapping (ESM) with subdural and stereotactic depth electrodes for seizure induction and mapping of brain function.
Methods:
A working group was convened from American Clinical Neurophysiology Society membership with expertise in ESM. PubMed searches were performed to identify pertinent peer-reviewed literature. Recurrent meetings reviewed progress, built consensus by discussion, and developed evidence-based recommendations to the extent possible.
Recommendations:
Stimulators used for ESM should have sufficient dynamic range, ability to interrupt a stimulus train, and ictal disrupt mechanism(s). Charge density should be calculated for the specific electrodes and ESM settings, the maximum safe limits being 52 to 57 μC/cm 2 /phase for subdural electrodes and not established for stereotactic depth electrodes. Subdural ESM for functional mapping is typically performed at 50-Hz pulse frequency, 200- to 300-µs pulse width, 2- to 8-s train duration, and 1- to 20-mA current strength. Stereo ESM is commonly performed using 2 different pulse frequencies: 1 Hz (300-500 µs pulse width, train duration up to 30 s, and often a constant current of 3-5 mA), and 50 Hz (100-500 µs pulse width, train duration 2-8 s, and 0.5-10 mA current intensity).
Conclusions:
This guideline provides technical standards for the performance of ESM, which will likely evolve over time with advances in technology and additional evidence (also see Graphical Abstract).
