Neurophysiological effects of dorsal column stimulation in man and monkey

Abstract

✓ In 18 patients with cancer and intractable pain, capacitatively coupled pulses of 0.25 msec duration were delivered transcutaneously at 100 Hz to sets of five in-line electrodes implanted subdurally over the dorsal columns. Averaged somatosensory-evoked potentials were recorded from scalp electrodes before, during, and after application of current. All but one patient experienced relief of pain during stimulation, persisting for as long as several hours afterward. Eleven patients developed hyperactive deep reflexes, pathological reflexes, and decreased perception of joint rotation, pain, and touch below the level of current application. Somatosensory-evoked potential amplitudes were markedly reduced. All neurological findings returned to control values within 1 hour after each of repeated applications of current. Histological examination of spinal cord sections from four cancer patients showed no changes secondary to long-term current application. Similar currents were applied to the spinal cord of 15 monkeys with chronically implanted bipolar recording or stimulating electrodes over the lower, middle, and upper thoracic cord, in nucleus ventralis posterior lateralis (VPL), and over the sensory motor cortex (SMC). With application of current, the responses in VPL and SMC to peripheral stimulation were abolished. Evoked potential responses were abolished between bipolar stimulating electrodes and bipolar recording electrodes separated by the five in-line electrodes used to supply the 100 Hz current. However, when both stimulating and recording electrodes were either above or below the five in-line electrode set, evoked responses were unaffected. The findings indicate that applied currents blocked neuronal transmission by producing local changes in the cord. The prolonged alteration of cerebral evoked potentials and relief of pain, however, could also be related to involvement of supraspinal neurons.