The trigeminocervical complex (TCC) is a critical structure involved in headache disorders and a promising target for neuromodulation therapies. While cervical spinal cord stimulation (SCS) aiming to stimulate the TCC using invasive electrodes has shown clinical efficacy, non-invasive alternatives are sought to reduce surgical risks. Electrical neuromodulation delivers controlled currents to specific neural structures to alter their activity. This study aims to evaluate the feasibility of non-invasive electrical stimulation of the TCC using electrodes placed on the skin, optimized through computational modeling, and to compare its performance to invasive SCS. Using the highly realistic anatomical head model “MIDA”, three transcutaneous spinal cord stimulation (tSCS) strategies were simulated (clinically guided, exploratory, and reciprocity-based optimization) and compared to an invasive SCS reference case, using 2 mA in all cases. Metrics analyzed included mean and maximum electric field values, and equivalent-to-invasive-stimulation current injection strength. Reciprocity-based optimization tSCS achieved mean electric field intensities only 4.5 times lower than invasive stimulation, with clinically acceptable equivalent-to-invasive current levels (9 mA). This optimization improved the electric field intensity at the region of interest by approximately one order of magnitude, while reducing the equivalent-to-invasive current required by factors between 11 and 69 compared to clinically guided tSCS. Optimized tSCS produced sufficiently intense stimulation, comparable in some cases to invasive techniques. Computational optimization of tSCS configurations offers a promising non-invasive alternative for targeting the TCC, supporting the development of personalized and safer therapies for refractory headache patients. Future validation in clinical settings is planned to confirm these findings.

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Computational Optimization of Transcutaneous Spinal Cord Stimulation (tSCS) Targeting the Trigeminocervical Complex

  • Sofía A. Díaz,
  • Mariano Fernández-Corazza,
  • Fiorella Martin Bertuzzi

摘要

The trigeminocervical complex (TCC) is a critical structure involved in headache disorders and a promising target for neuromodulation therapies. While cervical spinal cord stimulation (SCS) aiming to stimulate the TCC using invasive electrodes has shown clinical efficacy, non-invasive alternatives are sought to reduce surgical risks. Electrical neuromodulation delivers controlled currents to specific neural structures to alter their activity. This study aims to evaluate the feasibility of non-invasive electrical stimulation of the TCC using electrodes placed on the skin, optimized through computational modeling, and to compare its performance to invasive SCS. Using the highly realistic anatomical head model “MIDA”, three transcutaneous spinal cord stimulation (tSCS) strategies were simulated (clinically guided, exploratory, and reciprocity-based optimization) and compared to an invasive SCS reference case, using 2 mA in all cases. Metrics analyzed included mean and maximum electric field values, and equivalent-to-invasive-stimulation current injection strength. Reciprocity-based optimization tSCS achieved mean electric field intensities only 4.5 times lower than invasive stimulation, with clinically acceptable equivalent-to-invasive current levels (9 mA). This optimization improved the electric field intensity at the region of interest by approximately one order of magnitude, while reducing the equivalent-to-invasive current required by factors between 11 and 69 compared to clinically guided tSCS. Optimized tSCS produced sufficiently intense stimulation, comparable in some cases to invasive techniques. Computational optimization of tSCS configurations offers a promising non-invasive alternative for targeting the TCC, supporting the development of personalized and safer therapies for refractory headache patients. Future validation in clinical settings is planned to confirm these findings.