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Tonic, Burst, and Burst Cycle Spinal Cord Stimulation Lead to Differential Brain Activation Patterns as Detected by Functional Magnetic Resonance Imaging. Neuromodulation 2021 Jun 02



Pubmed ID




Scopus ID

2-s2.0-85106996924 (requires institutional sign-in at Scopus site)   4 Citations


OBJECTIVE: The objective of this preclinical study was to examine the responses of the brain to noxious stimulation in the presence and absence of different modes of spinal cord stimulation (SCS) using blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD-fMRI).

MATERIALS AND METHODS: Sprague-Dawley rats were randomized to groups based on the mode of SCS delivered which included tonic stimulation (n = 27), burst stimulation (n = 30), and burst-cycle stimulation (n = 29). The control (sham) group (n = 28) received no SCS. The SCS electrode was inserted between T10 and T12 spinal levels prior to fMRI session. The experimental protocol for fMRI acquisition consisted of an initial noxious stimulation phase, a treatment phase wherein the SCS was turned on concurrently with noxious stimulation and a residual effect phase wherein the noxious stimulation alone was turned on. The responses were statistically analyzed through paired t-test and the results were presented as z-scores for the quantitative analysis of the fMRI data.

RESULTS: The treatment with different SCS modes attenuated the BOLD brain responses to noxious hindlimb stimulation. The tonic, burst, and burst-cycle SCS treatment attenuated BOLD responses in caudate putamen (CPu), insula (In), and secondary somatosensory cortex (S2). There were little to no corresponding change in sham control in these three regions. The burst and burst-cycle SCS demonstrated greater attenuation of BOLD signals in CPu, In, and S2 compared to tonic stimulation.

CONCLUSION: The high-resolution fMRI study using rat model demonstrated the potential of different SCS modes to act on several pain-matrix related regions of the brain in response to noxious stimulation. The burst and burst-cycle SCS exhibited greater brain activity reduction in response to noxious hindlimb stimulation in caudate putamen, insula, and secondary somatosensory cortex compared to tonic stimulation.

Author List

Saber M, Schwabe D, Park HJ, Tessmer J, Khan Z, Ding Y, Robinson M, Hogan QH, Pawela CP


Quinn H. Hogan MD Vice Chair, Professor in the Anesthesiology department at Medical College of Wisconsin
Christopher Pawela PhD Associate Professor in the Biomedical Engineering department at Medical College of Wisconsin