Epidural spinal cord stimulation (ESCS) is widely used for chronic pain treatment, and is also a promising tool for restoring motor function after spinal cord injury. Despite significant positive impact of ESCS, currently available protocols provide limited specificity and efficiency partially due to the limited number of contacts of the leads and to the limited flexibility to vary the spatial distribution of the stimulation field in respect to the spinal cord. Recently, we introduced Orientation Selective (OS) stimulation strategies for deep brain stimulation, and demonstrated their selectivity in rats using functional MRI (fMRI). The method achieves orientation selectivity by controlling the main direction of the electric field gradients using individually driven channels. Here, we introduced a similar OS approach for ESCS, and demonstrated orientation dependent brain activations as detected by brain fMRI. The fMRI activation patterns during spinal cord stimulation demonstrated the complexity of brain networks stimulated by OS-ESCS paradigms, involving brain areas responsible for the transmission of the motor and sensory information. The OS approach may allow targeting ESCS to spinal fibers of different orientations, ultimately making stimulation less dependent on the precision of the electrode implantation.

A 1 Virtanen Institute for Molecular Sciences University of Eastern Finland Kuopio Finland

Center for Magnetic Resonance Research Department of Radiology University of Minnesota 2021 6th St SE Minneapolis MN 55455 USA

Department of Advanced Medical and Surgical Sciences University of Campania Luigi Vanvitelli Naples Italy

Department of Neurology Charles University and General University Hospital Prague Prague Czech Republic

Department of Neurology Mayo Clinic Rochester MN USA

Department of Neurosurgery University of Minnesota Minneapolis MN USA

Department of Physiology and Biomedical Engineering Mayo Clinic Rochester MN USA

Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN USA

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