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• W2324294169 abstract "Event Abstract Back to Event Computational and Evidence-based Medicine in Neuromodulation Christopher Butson1, 2*, Brian H. Kopell2, K Driesslein1 and S Jain1 1 Medical College of Wisconsin, Department of Neurology, United States 2 Medical College of Wisconsin, Department of Neurosurgery, United States Background/Aims Cortical stimulation (CS) has been used diagnostically as a mapping tool prior to surgery, as well as therapeutically as a chronic treatment for a variety of disorders including epilepsy, depression, tinnitus, pain and other conditions. Therapeutic CS is delivered through a chronically implanted system that is composed of an implantable pulse generator (IPG) and one or more stimulating electrodes. After surgical implantation the IPG must be programmed with a stimulation protocol that provides good therapeutic response with minimal side effects. The fundamental principle behind this approach is that current injected through epidural or subdural electrodes impinges on nearby anatomical areas, which leads to a functional response. For example, during CS for treatment of chronic pain the objective is to provide symptomatic relief without any stimulation-induced side effects such as muscle twitches, speech arrest or changes in cognitive/sensory state. However, the therapeutic effectiveness of this approach is quite variable, and few tools have been available to quantify the interactions between the stimulation system and the surrounding tissue. Therefore, the first step to understanding the effects of CS is to determine how much current is entering the cortical tissue, where this is occurring and how these two factors are affected by the stimulation protocol. Methods/Statistics We used patient-specific, multi-scale computational models to quantify the interaction between the stimulation system and the brain tissue. Finite element models of cortex were constructed from pre-operative MRI for anatomical segmentation and post-operative CT for electrode localization. Conductivities were assigned for the brain tissue, dura, electrodes and insulating material, and boundary conditions were applied based on the stimulation protocol. The system was solved to determine the voltage in the tissue medium, which was subsequently applied to pyramidal cell neuron models which fired spontaneously. Hence, the model system allowed us to examine the modulatory effects of stimulation, which could include excitation or inhibition, on an individual cell basis as a function of the electrode location and stimulation protocol (current amplitude, pulse width, frequency and configuration of anodes and cathodes). Finally, we combined model outcomes with clinical measures of CS effectiveness for tinnitus to identify cortical regions where stimulation provided the best therapeutic response with minimal side effects. Results We observed complex interactions between the stimulation protocol, the location of the electrodes and the detailed morphology of the brain: (i) The amount of current entering the cortical tissue was strongly dependent on the thickness of the dura under the electrode, as well as the position of the electrode with regard to the sulcal/gyral pattern. (ii) The voltage distribution in the cortical tissue was strongly dependent on the configuration of anodes and cathodes (e.g. monopolar, bipolar or multiple anodes/cathodes). (iii) The modulatory effects of CS were a function of the stimulation protocol and the amount of current entering the cortical tissue (as opposed to current that was shunted away by dura or cerebrospinal fluid). (iv) In a cohort of 8 patients receiving CS for tinnitus, we observed that both anodic or cathodic stimulation could provide good therapeutic response as long as the areas of strongest modulation were well aligned with target cortical regions identified via fMRI. In addition, we observed that the effects of stimulation were not immediate: average time for onset was about 4 weeks, and average time for offset was about 2 weeks. Conclusion/Summary In this study we demonstrate how patient-specific computational models can be combined with clinical outcome measures to facilitate evidence-based decision making in neuromodulation. With this approach we were able to compare the modulatory effects of CS in areas of effective versus ineffective stimulation. This approach facilitates comparison across all patients via an atlas brain. Keywords: neuroengineering Conference: The Monte Verita' Workshop on the Frontiers in Neuroengineering, Ascona, Switzerland, 5 Sep - 9 Sep, 2010. Presentation Type: Oral Presentation Topic: Frontiers in Neuroengineering Citation: Butson C, Kopell BH, Driesslein K and Jain S (2010). Computational and Evidence-based Medicine in Neuromodulation. Front. Neuroeng. Conference Abstract: The Monte Verita' Workshop on the Frontiers in Neuroengineering. doi: 10.3389/conf.fneng.2010.10.00012 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 19 Aug 2010; Published Online: 10 Sep 2010. * Correspondence: Dr. Christopher Butson, Medical College of Wisconsin, Department of Neurology, Milwaukee, United States, butsonc@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Christopher Butson Brian H Kopell K Driesslein S Jain Google Christopher Butson Brian H Kopell K Driesslein S Jain Google Scholar Christopher Butson Brian H Kopell K Driesslein S Jain PubMed Christopher Butson Brian H Kopell K Driesslein S Jain Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page." @default.
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• W2324294169 title "Computational and Evidence-based Medicine in Neuromodulation" @default.
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