Computational study of subdural and epidural cortical stimulation of the motor cortex.

Cortical stimulation (CS) has gained wide attention for its use in augmenting neurological recovery in various conditions. Noninvasive cortical stimulations using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are less invasive when delivering the electrical current to the patient's brain, but have several limitations. Direct cortical stimulation (DCS) using an implantable stimulation system consisting of epidurally or subdurally placed electrodes and pulse generators, provides cortical stimulation and concurrent rehabilitative training in a stable fashion without limiting a patient's activities. The effectiveness of these two types of DCS--epidural cortical stimulation (ECS) and subdural cortical stimulation (SCS)--has not been compared. In this work, a computer simulation study was conducted to predict the current density distributions (CDD) through cortical stimulations using subdurally or epidurally placed electrodes. The simulation study is based on the human motor cortex model with a three-dimensional finite element model (FEM). The change in CDD depending on the shape of the electrode (disc or ring) is discussed. The output current induced by SCS was about four times larger than that of ECS when voltage stimulations with the same magnitude were regulated. Thus, SCS showed substantially better penetration of the current into gray or white matter. Further, the ring electrode performed comparably or slightly inferior to the disc electrode in both cortical stimulations.