Journal Article

Optimizing transcutaneous spinal stimulation: excitability of evoked spinal reflexes is dependent on electrode montage

Thatcher, Kelly Lynn, Daliet, Oliver John, Sandler, Evan Blake, Iddings, Jennifer Ann, Nielsen, Karen Emily, Field-Fote, Edelle Carmen

2025

Overview

Background There is growing interest in use of transcutaneous spinal stimulation (TSS) for people with neurologic conditions both to augment volitional control (by facilitating motoneuron excitability), and to decrease spasticity (by activating inhibitory networks). Various electrode montages are used during TSS, with little understanding of how electrode position influences spinal circuit activation. We sought to identify the thoracolumbar electrode montage associated with the most robust activation of spinal circuits by comparing posterior root-muscle reflexes (PRM reflexes) elicited by 6 montages. Additionally, we assessed tolerability of the stimulation during PRM reflex testing. Methods Fifteen adults with intact neurological systems participated in this randomized crossover study. PRM reflexes were evoked transcutaneously using electrode montages with dorsal–ventral (DV) or dorsal-midline (DM) current flow. DV montages included: [1] cathode over T11/T12, anodes over iliac crests (DV-I), [2] cathode over T11/T12, anodes over umbilicus (DV-U), [3] dual paraspinal cathodes at T11/12, anodes over iliac crests (DV-PI), and [4] dual paraspinal cathodes at T11/12, anodes over umbilicus (DV-PU). DM montages included: [5] cathode over T11/12, anode 5 cm caudal (DM-C), and [6] cathode over T11/12, anode 5 cm rostral (DM-R). PRM reflex recruitment curves were obtained in the soleus muscle of both lower extremities. Results Lower reflex thresholds (mA) for dominant (D) and nondominant (ND) soleus muscles were elicited in DV-U (D: 46.7[33.9, 59.4], ND: 45.4[32.5, 58.2]) and DV-I (D: 48.1[35.3, 60.8], ND: 45.4[32.5, 58.2]) montages compared to DV-PU (D: 64.3[51.4, 77.1], ND:61.7[48.8, 74.6]), DV-PI (D:64.9[52.1, 77.7], ND:61.4[48.5, 75.5]), DM-C(D:60.0[46.9, 73.1], ND:63.6[50.8, 76.5]), and DM-R(D:63.1[50.3, 76.0], ND:62.6[49.8, 75.5]). DV-U and DV-I montages demonstrated larger recruitment curve area than other montages. There were no differences in response amplitude at 120% of RT(1.2xRT) or tolerability among montages. Conclusions Differences in spinal circuit recruitment are reflected in the response amplitude of the PRM reflexes. DV-I and DV-U montages were associated with lower reflex thresholds, indicating that motor responses can be evoked with lower stimulation intensity. DV-I and DV-U montages therefore have the potential for lower and more tolerable interventional stimulation intensities. Our findings optimize electrode placement for interventional TSS and PRM reflex assessments. Clinical Trial Number: NCT04243044.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Amplitudes / Anodes / Biomedical and Life Sciences / Biomedical Engineering and Bioengineering / Biomedicine / Care and treatment / Cathodes / Cross-Over Studies / Electrodes / Electromyography / Excitability / Extremities / Female / Health aspects / Humans / Male / Methods / Middle Aged / Muscle, Skeletal - physiology / Muscles / Nerves, Spinal / Nervous system diseases / Neural circuitry / Neurology / Neuromodulation / Neurosciences / Optimization / Recruitment / Reflex - physiology / Reflexes / Rehabilitation Medicine / Skin / Soleus muscle / Spasticity / Spinal cord / Spinal Cord - physiology / Spinal Cord Stimulation - instrumentation / Spinal Cord Stimulation - methods / Spinal excitability / Stimulation / Testing / Thresholds / Transcutaneous Electric Nerve Stimulation - instrumentation / Transcutaneous Electric Nerve Stimulation - methods / Transcutaneous electrical nerve stimulation / Transcutaneous spinal stimulation / Umbilicus / Young Adult