A Review of Effects of Spinal Cord Stimulation on Spectral Features in Resting-State Electroencephalography

Bart Witjes*, Lucas A. Ottenheym, Frank J.P.M. Huygen, Cecile C. de Vos

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

4 Citations (Scopus)


Background: Spinal cord stimulation (SCS) is an effective therapy for patients with refractory chronic pain syndromes. Although studies have shown that SCS has both spinal and supraspinal effects, the current understanding of cortical effects is still limited. Neuroimaging techniques, such as magnetoencephalography (MEG) and electroencephalography (EEG), combined here as M/EEG, can reveal modulations in ongoing resting-state cortical activity. We aim to provide an overview of available literature on resting-state M/EEG in patients with chronic pain who have been treated with SCS. Materials and Methods: We searched multiple online data bases for studies on SCS, chronic pain, and resting-state M/EEG. Primary outcome measures were changes in spectral features, combined with brain regions in which these changes occurred. Results: We included eight studies reporting various SCS paradigms (tonic, burst, high-dose, and high-frequency stimulation) and revealing heterogeneity in outcome parameters. We summarized changes in cortical activity in various frequency bands: theta (4–7 Hz), alpha (7–12 Hz), beta (13–30 Hz), and gamma (30–44 Hz). In multiple studies, the somatosensory cortex showed modulation of cortical activity under tonic, burst, and high-frequency stimulation. Changes in connectivity were found in the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, and parahippocampus. Conclusions: The large heterogeneity observed in outcome measures is probably caused by the large variety in study designs, stimulation paradigms, and spectral features studied. Paresthesia-free paradigms have been compared with tonic stimulation in multiple studies. These studies suggest modulation of medial, lateral, and descending pathways for paresthesia-free stimulation, whereas tonic stimulation predominantly modulates lateral and descending pathways. Moreover, multiple studies have reported an increased alpha peak frequency, increased alpha power, and/or decreased theta power when SCS was compared with baseline, indicating modulation of thalamocortical pathways. Further studies with well-defined groups of responders and nonresponders to SCS are recommended to independently study the cortical effects of pain relief and SCS.

Original languageEnglish
Pages (from-to)35-42
Number of pages8
Issue number1
Early online date10 May 2022
Publication statusPublished - Jan 2023

Bibliographical note

Funding Information:
Conflict of Interest: Frank J.P.M. Huygen reports grants and consultancy fees from Abbott, Saluda Medical, Grünenthal, and Pfizer and independent support from The Netherlands Organisation for Health Research and Development. The remaining authors reported no conflict of interest. Source(s) of financial support: The authors reported no funding sources.

Publisher Copyright:
© 2022 International Neuromodulation Society


Dive into the research topics of 'A Review of Effects of Spinal Cord Stimulation on Spectral Features in Resting-State Electroencephalography'. Together they form a unique fingerprint.

Cite this