Pulse Width Modulation Dynamics in Anterior Cingulate Cortex Stimulation in Epilepsy Patients
Abstract number :
3.216
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2025
Submission ID :
444
Source :
www.aesnet.org
Presentation date :
12/8/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Isabel Danstrom, BS – Baylor College of Medicine
Josh Adkinson, PhD – Baylor College of Medicine
Meghan Robinson, PhD – KBR, Inc.
Denise Oswalt, PhD – University of Pennsylvania
Garrett Banks, MD – Baylor College of Medicine
Atul Maheshwari, MD – Baylor College of Medicine
Lu Lin, MD, PhD – Baylor College of Medicine
Ben Shofty, MD, PhD – University of Utah Health
Mohammed Hasen, MD, MSc, MSc – Imam Abdulrahman bin Faisal University
Alica Goldman, MD, PhD – Baylor University
Eleonora Bartoli, PhD – Baylor College of Medicine
Sarah Heilbronner, PhD – Baylor College of Medicine
Kelly Bijanki, PhD – Baylor College of Medicine
Rationale: Single pulse electrical stimulation (SPES) is increasingly being used to probe functional effective brain connectivity in epilepsy patients and is integral for pinpointing critical nodes of patient-specific seizure networks. Varying components of the SPES waveform can influence neural selectivity and output. Modulating pulse duration (pulse width) alters the total charge delivered to neural tissue and is thought to selectively activate fibers with different diameters, potentially shifting therapeutic thresholds. The anterior cingulate cortex (ACC) is of great clinical importance due to its prevalence in epilepsy etiology for many patients. However, empirical evidence for the impact of pulse width on circuit engagement in the ACC is missing from the literature, limiting our ability to modify cingulate circuits.
Methods: Here, we evaluated the influence of pulse width modulation in ACC stimulation on evoked connectivity in 20 patients undergoing intracranial monitoring for treatment-refractory epilepsy with stereo-electroencephalography. Three charge-balanced SPES conditions with varying pulse width and amplitude parameters were tested. The magnitude of evoked responses was recorded from 6,388 electrode contacts and compared across conditions.
Results: Results demonstrated a nonlinear relationship between pulse width and evoked potential robustness (p < 0.0001). Pulse width modulation was further shown to be distance-dependent, with distant connections responding optimally to a shorter pulse width (p < 0.0001).
Neurophysiology