Electrical Stimulation publications

Neuromodulation is widely employed to enhance neural activity and restore impaired circuitry, yet current methods suffer from invasiveness, limited depth, or poor spatial resolution. Temporal interference stimulation (TIS) has emerged as a non-invasive approach to modulate deep brain regions via interference of high-frequency electric fields, achieving spatial selectivity. Despite its potential, the physiological effects remain unexplored. Here, we present a customized liquid metal-based neural interface to record electrophysiological responses to TIS across diverse neural tissues, from brain organoids to mouse brains. The softness of the interface minimizes invasiveness while ensuring stable access to deep neural regions. Electrophysiological analyses reveal TIS-induced dynamics in neurodevelopment and functional connectivity. Furthermore, we investigated latent neural dynamics, presenting population-level neural activity, to compare responses across models of differing complexity and maturity. By combining soft neural interfaces with multi-scale analyses, this study uncovers how neuromodulation shapes neural dynamics and supports the development of future therapeutic strategies.

Current disease-sensing devices primarily focus on distinguishing between healthy and diseased states, effective for diagnosis but limited in guiding optimal intervention timing for prevention. We developed a tripartite framework identifying pre-disease state in depression, a reversible phase preceding irreversible onset. Using complex systems theory, we analyzed early-warning signals emerging as biological systems approach critical transitions. Continuous monitoring of nine multimodal biomarkers—spanning electrophysiological, behavioral, and biological—enabled classification into normal, pre-disease, and disease states by quantitatively defining critical points. An artificial intelligence agent classified disease states with 95.2% accuracy using multimodal data, enabled by ultrasoft neural probes for stable, low-damage recordings. Therapeutic validation with a skin-attachable wireless vagus nerve stimulator integrating soft three-dimensional electrodes demonstrated superior efficacy during pre-disease states. Subjects treated during pre-disease showed faster recovery and greater therapeutic responses, while those treated after disease onset failed to achieve full recovery. This framework provides evidence-based rationale for early intervention.

A hallmark of intelligence is proficiency in solving new problems, including those that substantially differ from previously seen problems. Problem solving in turn depends on the goal-directed generation of novel ideas and behaviours 1 , which has been proposed to involve internal representations of discrete units (or symbols) that can be recombined into numerous possible composite representations 1–7 . Although this view has been influential in cognitive-level explanations of behaviour, definitive evidence for a neuronal substrate of symbols has remained elusive. Here we identify a neural population that encodes action symbols—recombinable representations of discrete units of motor behaviour—in a specific area of the frontal cortex. In macaque monkeys performing a drawing-like task, we found behavioural evidence that action elements (strokes) exhibit three crucial features that indicate an underlying symbolic representation: (1) invariance over low-level motor parameters; (2) categorical structure, which reflects discrete action types; and (3) recombination into novel sequences. Based on simultaneous neural recordings across eight regions of the motor, premotor and prefrontal cortex, we identified population activity specifically in the ventral premotor cortex that encodes planned actions in a manner that also reflects invariance, categorical structure and recombination. These findings reveal a neural representation of action symbols localized to the ventral premotor cortex and a putative neural substrate for symbolic operations.

Cochlear implants (CIs) have successfully restored hearing in more than one million patients with severe to profound hearing loss worldwide. Although CIs effectively restore speech perception in quiet environments, sound localization remains challenging for bilateral CI users, particularly their ability to utilize interaural time differences (ITDs). The majority of clinical CI processors use a coding strategy that encodes ITD information only in the envelope of electrical pulse trains rather than their pulse timing, which may contribute to the poorer spatial hearing perception of CI users. We recently demonstrated in a behavioural study on early deafened, bilaterally CI‐implanted rats that pulse timing ITDs completely dominate ITD perception, whereas sensitivity to envelope ITDs is almost negligible in comparison. Building on this, we here investigated the neurophysiological sensitivity of the inferior colliculus (IC) to envelope and pulse timing ITDs at two different pulse rates (900 and 4500 pulses/s) and three different stimulation modulations (5, 20 and 100 Hz) in CI rats with different hearing experiences. Our results indicate that IC neurons exhibit far greater sensitivity to pulse timing ITD than envelope ITD independent of pulse rate, modulation rate or hearing experience. These findings suggest that to improve binaural hearing outcomes in bilateral CI users, clinical stimulation strategies should provide informative pulse timing ITDs. image Key points Current bilateral cochlear implants mostly provide time cues of arriving sound in the envelope of stimulation rather than in the timing of pulses. A behavioural study on cochlear implanted rats has shown that pulse timing dominates binaural hearing. Here we examined the neural sensitivity to independent changes in time cues presented on the envelope or pulse timing, respectively, in rats with bilateral cochlear implants and different hearing experiences. Auditory midbrain neurons were consistently more sensitive to changes in pulse timing rather than envelope, irrespective of stimulus pulse rate, modulation rate or an animal's hearing experience.

Magnetogenetic deep brain stimulation (MG‐DBS) represents a wireless neuromodulation that has demonstrated long‐lasting behavioral benefits in Parkinson's disease models. However, the circuit‐level mechanisms underlying these therapeutic effects have remained uncharacterized due to limitations of conventional neural interfaces. We present a bio‐integrable soft neural interface featuring ultrasoft liquid‐metal probes with bioresorbable stiffeners and customizable interconnects directly printed onto cranial surfaces to match individual skull anatomy and nanoparticle injection sites. This platform enables stable multi‐regional recordings from deep brain structures without chronic tissue damage. We systematically investigate MG‐DBS therapeutic mechanisms in a Parkinson's disease mouse model. Circuit‐level analysis reveals that MG‐DBS modulates pathological beta‐band oscillations and inter‐regional synchrony across the cortico‐basal ganglia‐thalamic circuit. Direct comparison with conventional electrical DBS demonstrates that MG‐DBS effects persisted approximately fifteen‐fold longer after stimulation cessation. Our electrophysiological recordings elucidate the mechanistic basis for this sustained therapeutic effect, providing unprecedented insights into magnetogenetic neuromodulation dynamics.

Human vision relies on photoreceptor cells in the outer retina that are sensitive to visible light. However, many people suffer from blindness due to retinal diseases that cause photoreceptor degeneration. Electrical stimulation of retinal neurons can recreate the action potentials associated with seeing that are generated by these cells. Here we report a thin artificial retina that can be adhered to the epiretinal surface and can convert near-infrared (NIR) light into electrical stimuli that selectively stimulate ganglion cells. The artificial retina consists of a NIR-sensitive phototransistor array and three-dimensional liquid metal micropillar electrodes. The liquid metal electrodes enhance proximity to retinal ganglion cells, providing effective charge injection while minimizing tissue damage, owing to their low Young’s modulus. Ex vivo studies demonstrate its biocompatibility, and in vivo studies using healthy and blind mice demonstrate perception of both visible and NIR light, as indicated by cortical recordings and behavioural tests. The retina could, in the future, be used to create a NIR visual channel in patients with photoreceptor degenerative blindness without interfering with their remaining natural vision.

Neural interfaces for monitoring and modulating spinal nerve activity are increasingly being designed to be flexible and stretchable to enhance their biomechanical compatibility and integration. However, excessive flexibility introduces practical limitations such as difficulty in insertion into narrow spinal spaces and long-term electrical instability, hindering real-world applications. In this study, we developed a spinal nerve interface by incorporating a liquid-metal conductor and dynamic stiffness-based variable-compliance structure, which can address the challenges of current flexible neural interface technologies. During insertion, the dynamic stiffness enhancer minimizes unintended buckling and ensures minimally invasive implantation into the intended target. The proximity of the proposed device to the spinal cord increases as it flexes automatically and rapidly in a humid environment. The liquid-metal conductor maintained stable electrical properties in freely moving rats, ensuring reliable and sustained functionality. This study lays the foundation for practical, fully implantable spinal bioelectronics designed with a focus on ease of implantation and long-term functionality.

Stimulation of sensory vagal pathways is typically delivered via invasive, cervical vagus nerve stimulation (cVNS) or noninvasive, trans-auricular nerve stimulation (taNS). While both methods are investigated therapeutically, their effects on brain physiology remain poorly understood, hindering mechanistic insights and stimulus optimization. In 6 awake nonhuman primates, we recorded cortical vagal-evoked potentials (VEPs) from subdural electrodes placed in prefrontal, sensorimotor and parietal cortical areas, in response to cVNS or taNS. Across 478 different taNS and cVNS protocols, we varied stimulation side, intensity, frequency, pulse count, and pulse width and assessed independent effects on amplitude and latency of early (EC; 30-100 ms), intermediate (IC; 101-200 ms) and late components (LC; 201-500 ms) of VEPs. Fixed and random effects of stimulation parameters and subjects, respectively, on VEPs were assessed using a linear mixed-effects model. Overall, cVNS elicits more robust VEPs than taNS, with larger EC, IC and LC amplitudes, in both hemispheres. cVNS-elicited ECs and LCs are largest in PFC and PC areas, whereas ICs are largest in SM areas. On the other hand, taNS generally does not elicit area-specific responses. cVNS-elicited ECs have slower latency than ta-NS elicited ECs. Higher stimulation frequencies and intensities and a longer pulse width elicit larger ECs and ICs for cVNS, and to some extent for taNS. Both short and long cVNS trains elicit stronger ECs, and long trains elicit slower ICs. Earlobe stimulation elicits VEPs that partially overlap with those from taNS. In conclusion, cVNS and taNS elicit cortical VEPs in a manner consistent with distinct engagement of ascending vagal pathways, with both similarities and differences in the effects of stimulation parameters on evoked responses.

The clinical use of alternating current stimulation (ACS) has been confounded by heterogeneity in patient responses. Optimization of this treatment requires understanding the dependence of neuronal responses on ACS parameters. We sought to characterize neuronal responses across varying ACS frequencies and amplitudes and assess the extent to which changes in neuronal activity persist beyond the cessation of the stimulation, thereby informing ACS optimization pathways and evaluating the potential for sustained neuromodulation. We delivered subcutaneous ACS while recording intracortical electrophysiological activity in adult rats. We applied ACS for 1 or 20 minutes and analyzed ensuing spiking activity, power spectra, and low-frequency to high-frequency phase–amplitude coupling (LF-HF PAC). Both durations of ACS elicited a modulation of firing patterns (either in rate or entrainment) in most neurons, in a stimulation frequency- and amplitude-dependent manner. Changes in firing rate were more frequent, albeit modest, whereas changes in entrainment were rarer, but pronounced. Increasing ACS amplitude or frequency increased the degree of entrainment. Further, entrainment changes persisted beyond the 20-minute ACS, at half their online level. Neuronal power and LF-HF PAC increased proximal to excited, but decreased near suppressed neurons. Neuronal entrainment was observed alongside decreased power and LF-HF PAC. The prominent entrainment response to prolonged high-frequency ACS observed here supports the potential of ACS for facilitating signal integration and promoting functional reorganization via spike timing-dependent plasticity. In turn, we found broader temporal windows of excitation under low ACS frequencies engendered greater variability in spike timing, which may be utilized to reduce hypersynchronous or task-irrelevant activity.

As part of a deep brain stimulation (DBS) procedure, direct electrophysiological recordings from thalamic and basal ganglia circuits were obtained from a pediatric participant with secondary dystonia to examine the neural mechanisms of motor timing. The participant performed a two-phase repetitive timing task that began with synchronization to a series of externally presented auditory cues, followed by a continuation phase in which the participant maintained the movement rhythm without external guidance. Simultaneous recordings from stereoelectroencephalography (sEEG) leads implanted in the globus pallidus internus (GPi), subthalamic nucleus (STN), ventral oralis (Vo), centromedian nucleus (CM), and thalamic nuclei receiving projections from the cerebellum (ventral intermediate nucleus (VIM) and centrolateral nucleus (CL)) revealed behaviorally relevant neural dynamics. Local field potentials (LFPs) from recorded nuclei exhibited strong, time-locked responses during the synchronization phase, with reduced amplitudes during the continuation phase. Time-frequency analysis showed consistent power increases around the corresponding mean of the inter-response intervals (IRIs) in both behavioral output and neural signals, suggesting frequency-specific entrainment across circuits. These findings suggest of cerebellar-thalamic and basal ganglia contributions to temporal coordination.

Background: Optimizing deep brain stimulation (DBS) parameter settings requires postoperative adjustments through a time-consuming trial-and-error process. As such, researchers have been developing computational models to guide DBS programming. Despite growing interest in image-guided DBS technology, and recent adoption into clinical practice, the direct validation of the prediction accuracy remains limited. Objective: The objective of this study was to establish a comparative framework for validating the accuracy of various DBS computational modeling methodologies in predicting the activation of clinically relevant pathways using in vivo measurements from PD patients undergoing subthalamic (STN) DBS surgery. Methods: In this study, we compared the accuracy of six computational modeling variations for predicting the activation of the corticospinal/bulbar tract (CSBT) and cortico-subthalamic hyperdirect pathway (HDP) using very short- (<2 ms) and short-latency (2-4 ms) cortical evoked potentials (cEPs). We constructed the variations using three key factors: modeling method (Driving Force [DF] vs. Volume of Tissue Activated [VTA]), imaging space (native vs. normative), and anatomical representation (pathway vs. structure). The model performances were quantified using the coefficient of determination (R2) between the cEP amplitudes and percent pathway or structure activation. Results: We compared model accuracy for 11 PD patients. The DF-Native-Pathway model was the most accurate method for quantitatively predicting experimental subcortical pathway activations. Additionally, our analysis showed that using normative brain space significantly diminished the accuracy of model predictions. Conclusion: The choice of methodology should depend on the specific application and the required level of precision for the intended analysis. However, model parameters should be optimized to accurately predict known experimental activation measures.

Purpose: We aim to develop a robust method to improve the estimation accuracy of motor-evoked potential (MEP) recruitment curves (RCs), including motor threshold, in small-sample settings which typically involve fewer than 40 stimuli. Methods: We present a hierarchical Bayesian (HB) method to model MEP size as a rectified-logistic function of stimulation intensity. This method is designed to account for small samples, handle outliers without discarding data, quantify estimation uncertainty, and simulate synthetic data that closely matches real observations, useful for optimizing experimental design. We validate its performance on transcranial magnetic stimulation (TMS), epidural spinal cord stimulation (SCS), and synthetic TMS datasets, and provide an open-source library for Python, called hbMEP, for diverse applications. Results: The rectified-logistic outperformed sigmoidal functions in predictive accuracy on TMS and SCS datasets, as demonstrated through cross-validation. A mixture extension of the HB model improved robustness to outliers by further increasing its predictive accuracy. The HB model reduced threshold estimation error by up to 70% on sparse synthetic TMS data compared to non-hierarchical models. Bayesian estimation with the HB model reduced the required number of participants by at least 23% to detect a shift in threshold with 80% power, compared to frequentist testing. Empirical results on human SCS data further validated its applicability to real data. Conclusion: By improving accuracy on sparse data, our method minimizes the number of stimuli needed to probe each individual's neuromuscular parameters across multiple muscles simultaneously, thereby reducing session duration and the risk of inadvertent neuromodulation. Our approach provides a more statistically powerful and conclusive framework for inferring changes in threshold, and therefore corticospinal excitability. The hbMEP library streamlines and unifies the analysis of RCs across stimulation modalities and experimental paradigms.

Sympathetic hyperactivity is a common feature observed in both primary and secondary hypertension, and neuromodulation-based therapies targeting this overactivity are under active investigation. The intermediolateral nucleus (IML) in the spinal cord plays a central role in sympathetic regulation, and its direct stimulation induces a transient, frequency-dependent reduction in blood pressure. However, this effect gradually diminishes as the baroreflex restores blood pressure to baseline. Therefore, this study aims to develop a closed-loop (CL) stimulation system that adjusts parameters in real-time based on neural activity recorded from the IML and to enhance and prolong the transient antihypertensive effect. This strategy was evaluated in normotensive and angiotensin II-induced hypertensive rat models and compared to open-loop (OL) stimulation of equal intensity. In both models, CL stimulation produced a more sustained blood pressure reduction than that of OL stimulation. These findings suggest that CL spinal cord stimulation offers a more effective and durable therapeutic option for treating hypertension.

Introduction The posterior tail of the striatum receives dense inputs from sensory regions of cortex and thalamus, as well as midbrain dopaminergic innervation, providing a neural substrate for associative sensory learning. Previously, we have demonstrated that developmental hearing loss is associated with aberrant physiological states in striatal medium spiny neurons (MSNs). Methods Here we directly investigated auditory associative learning impairments in the striatum of adult Mongolian gerbils that underwent transient developmental hearing loss or sham hearing loss during the critical period of auditory development. We used electrophysiology to reveal significant changes to neuronal population responses in vivo and intrinsic and synaptic properties to medium spiny neurons in vitro as animals learned an appetitive “Go/No-Go” auditory discrimination task. For in vivo experiments a 64-channel electrode was implanted in the auditory region of the posterior tail of the striatum and neuronal recordings were carried out as animals learned the task. For in vitro experiments, corticostriatal slice preparations were made from animals on each day of training. Results In naïve animals from both groups there was limited to no phase locking to either auditory stimulus in vivo , and long term depression resulted from theta burst stimulation in vitro . Furthermore, intrinsic and synaptic properties in normal hearing animals were unaffected; however, the hearing loss group continued to show lowered synaptic inhibition, synaptic hyperexcitation, and suppressed intrinsic excitability in the hearing loss group. Starting around day 3–4 in both groups, the emergence of striatal medium spiny neuron phase locking to the auditory conditioning stimuli was observed in vivo . This occurred contemporaneous to an increased probability of theta burst induced LTP during MSN whole cell recording in vitro , and acquisition of the task as the correct rejection response significantly increased in the behaving animals. During the acquisition phase MSNs in the normal hearing group showed a significant decrease in synaptic inhibition and increase in synaptic excitation with no change to intrinsic excitability, while the MSNs in the hearing loss group showed a significant increase in synaptic inhibition, reduction of synaptic hyper excitability, and compensatory changes to intrinsic excitability that supported normal action potential generation. In both groups, synaptic properties were resolved to similar level of E/I balance that could be part of a conserved learning state. Discussion These changes to the intrinsic and synaptic properties likely support LTP induction in vivo and the strengthening of synapses between auditory inputs and MSNs that facilitate neuronal phase locking. These findings have significant implications for our understanding of striatal resilience to sensory impairments in early life, in addition to establishing a granular understanding of the striatal circuit changes that support reward driven stimulus–response learning.

Target engagement determines therapeutic efficacy. In spinal cord stimulation (SCS), efficacy depends on the attributes of the electrodes used to deliver stimulation, particularly their position, interelectrode distance, size, and current orientation. We tested the effects of these electrode parameters using cervical stimulation to elicit forelimb muscle responses in the rat. We implanted devices over the C6 dorsal root entry zone (DREZ) in eight rats and measured responses in six forelimb muscles. We used custom designed electrode arrays to systematically vary position, distance, and size with linear arrays, and current orientation with circular arrays. Stimulation consisted of biphasic and pseudomonophasic pulse shapes with bipolar or distant return, and a high-definition montage with four returns surrounding a central contact to increase local current density. Efficacy was calculated from the motor thresholds of recruitment curves, and parameters were compared using linear mixed models. For position, stimulation over the DREZ was most effective, reducing thresholds by 25.9% ( p = 0.0002) relative to the midline; efficacy decreased as the electrode was positioned medial or lateral to the DREZ. For distance, placing the electrodes farther apart significantly improved efficacy ( p = 0.0022). For size, large electrodes increased SCS efficacy, reducing thresholds by 21.5% ( p = 0.0026) relative to small electrodes. After accounting for position and distance, current orientation did not affect SCS efficacy. Lastly, the high-definition montage decreased efficacy, increasing thresholds by 16.7% ( p = 0.003) relative to monopolar stimulation with a distant return. In conclusion, electrode position, distance, and size had the greatest effect on SCS efficacy, with the optimal parameters combining large electrodes at the DREZ position with a distant return. These results have the potential to lower the current needed to engage cervical spinal circuitry and to inform the design of SCS systems to improve dexterity in people with neurological injury or disease.

Gastrointestinal (GI) dysmotility and associated conditions affect over 20% of population, yet pharmacological, behavioural, and surgical interventions offer limited therapeutic efficacy. Targeted electrical stimulation addressing underlying neuromuscular pathology stands to transform our ability to treat dysmotility. Here, we developed a closed-loop GI neuroprosthesis which activates or relaxes GI tract musculature through electrochemical stimulation in response to sensed food stimuli. We additionally describe a tool supporting minimally invasive endoscopically guided implantation that can penetrate the mucosa, accurately localize the submucosa, and safely deploy this device to directly interface with the enteric nervous system. The neuroprosthesis enables generation of coordinated peristaltic waves, significantly increasing the motility rate in a swine model of oesophageal and stomach dysmotility (p < 0.05, student's t-test). Further, by directly modulating the myenteric plexus and thus mimicking meal ingestion, we induce peristalsis in a fasted state and achieve a metabolic response commensurate with a fed or satiated state. This neuroprosthesis and implantation platform expand opportunities in fundamental studies and treatments of metabolic and neuromuscular pathologies affecting the GI tract.

Introduction Deep brain stimulation (DBS) is a neuromodulation method for treatment of various neurological disorders. Research on DBS has often focused on local inhibition or excitation effects, at the site of stimulation. However, it is well-known that DBS can lead to robust evoked potentials (EP) not only at the stimulation site, representing the local effect, but also in distant brain regions, representing the effects on distant targets. While the significance of these EPs for therapeutic outcomes is not known, it appears that the electrical effects of DBS have a partial modulatory impact on downstream targets. Nonetheless, it partly remains unclear through what mechanism DBS pulses travel to the distant targets or what portion of the pulses travel along the normal pathways from the stimulation site. The possible scenarios include orthodromic or antidromic pathways, accessory pathways, normally inhibited pathways, and direct electromagnetic activation of distant sites. We hypothesize that the pathways that transmit DBS pulses include the pathways that transmit intrinsic neural signals. Methods To test this, we performed a transfer function analysis on deep brain recordings from children with dystonia, during DBS-off condition and compared its impulse response with the transmission of signals from electrical stimulation during DBS-on condition. We compared impulse responses derived from intrinsic neural signals during voluntary movement (DBS-off) to evoked potentials (EPs) recorded during electrical stimulation (DBS-on), focusing on directional transmission (orthodromic vs. antidromic). Results DBS EPs were more accurately predicted by impulse responses corresponding to direct axonal activation rather than somatic relay. Significant correlations between intrinsic signal transfer functions and EPs, particularly in orthodromic directions ( p -value < 0.01) from pallidum to thalamus and subthalamic nucleus, support our hypothesis that DBS travels along physiological pathways. Discussion These results suggest that DBS engages existing motor pathways to reach distant targets, offering mechanistic insight into its network effects. This supports future approaches that could tailor treatment plans based on individual connectivity maps to improve clinical efficacy of DBS.

Neurostimulation for cardiovascular control faces challenges due to the lack of predictive modeling for stimulus-driven dynamic responses, which is crucial for precise neuromodulation via quality feedback. We address this by employing a digital twin approach that leverages computational mechanisms underlying neuro-hemodynamic responses during neurostimulation. Our results emphasize the computational role of the nucleus tractus solitarius (NTS) in the brainstem in determining these responses. The intrinsic neural circuit within the NTS harbors collective dynamics residing in a low-dimensional latent space, which effectively captures stimulus-driven hemodynamic perturbations. Building on this, we developed a digital twin framework for individually optimized predictive modeling of neuromodulatory outcomes. This framework potentially enables the design of closed-loop neurostimulation systems for precise hemodynamic control. Consequently, our digital twin based on neural computation mechanisms marks an advancement in the artificial regulation of internal organs, paving the way for precise translational medicine to treat chronic diseases.

In this paper we aim to examine the correlation between diffusion tensor imaging parameters of anatomical connectivity and characteristics of signal transmission obtained from patient-specific transfer function models. Here, we focused on elucidating the correlation between structural and functional neural connectivity within a cohort of pediatric patients diagnosed with dystonia. Diffusion tractography images were obtained from 12 patients with dystonia prior to the deep brain stimulation surgery. For each patient, we processed the imaging data to estimate anatomical measures including fractional anisotropy, axial diffusivity, number of fibre tracts per unit area, and fibre tract length. After the implantation of temporary depth leads for each patient as part of their treatment plan, intracranial signals were recorded. Transfer function models of local field potential recordings and the corresponding measures of functional connectivity were computed for each patient. Linear mixed effect analysis was then employed to determine the relationship between transfer function measures and diffusion tractography parameters. Our results illustrate a positive correlation between fractional anisotropy, AD, and intrinsic neural transmission measures, representing amplification and spread of intrinsic neural oscillations, obtained from the transfer functions models. However, no significant correlation was found between the functional connectivity and number of fibre tracts or fibre lengths. Our findings suggest that white matter integrity, as measured by fractional anisotropy and AD, can potentially reflect the amplification and spread of intrinsic brain signals throughout the network. This study underscores the significant relationship between structural and functional connectivity, offering valuable insights into propagation of neural activity in the brain network and potential implications for optimizing non-invasive treatments and planning for neurological disorders.

Objective This study investigated the relationship between DBS evoked potentials (EPs) and diffusion tensor imaging (DTI) in a group of patients with dystonia who underwent DBS treatment. EPs and DTI are both useful methods for studying neural connectivity in the brain but measure different aspects of brain function. EPs provide information on electrical connectivity, while DTI provides information on anatomical pathways connecting regions. Methods This study focused on the pallidum and motor thalamus nuclei, which are common targets for DBS in dystonia. Prior to DBS implantation, DTI images were acquired for each patient, and were processed to obtain DTI coefficients such as length (L), volume (V), and fractional anisotropy (FA) of the fiber tracts. The relationship between the fiber tracts and electrophysiology was examined using a generalized linear model (GLM). Results We showed that the amplitude of EPs correlated with FA and tract volume, while delay correlated with tract length. These findings suggest that DBS signals travel across tracts to affect both local and distant brain regions, and the magnitude of the effect of DBS is determined by the integrity of the white matter tract, while DBS signal delay is affected by the tract length. Our results further suggest that the magnitude and delay of the spread of the DBS signal may be predicted by the DTI connectivity. This provides strong supporting evidence for other studies that have assumed, but have been unable to test, such a relationship. Conclusion Overall, this study suggests that the electrical effects of DBS can be at least partially predicted by noninvasive DTI imaging in patients with dystonia. By combining EPs with DTI, we could investigate the propagation of stimulation pulses through brain regions. While this relationship has been previously hypothesized by the neuroscience community, this is the first study in humans to demonstrate this relationship between DBS EPs and DTI, thereby advancing the field of human brain mapping and enhancing the precision of neurosurgical targeting.