Temporal Pattern of Stimulation as a New Dimension of Therapeutic Innovation

Electrical stimulation for treatment of neurological disorders, diseases, or injuries has relied on controlling the effects of stimulation through selection of stimulation amplitude, pulse duration, and pulse repetition frequency. I introduce a new parameter dimension—the temporal pattern of stimulation—and demonstrate how model-based design of temporal patterns of stimulation increases the efficacy and energy efficiency of neural stimulation therapies. Our finding that the effects of deep brain stimulation (DBS) were dependent on the temporal pattern of stimulation [Dorval et al. 2010], in addition to the frequency of stimulation, inspired the design of novel temporal patterns of DBS. Patterns were developed that treat the symptoms of PD more effectively than conventional regularly patterned DBS [Brocker et al. 2013a] or enable equivalent treatment of symptoms but with a substantial reduction in the required energy [Brocker 2013b]. This latter innovation is an important consideration for the size, recharge frequency, and battery life of implanted pulse generators. This concept was then extended to develop novel temporal patterns of epidural spinal cord stimulation for the treatment of chronic pain. Collectively, the results demonstrate the utility of a new dimension of neural stimulation parameters—the timing between stimulation pulses—to increase the efficacy and efficiency of neural stimulation therapies.