Why All Neuromodulation Is Sub-Threshold Neuromodulation (Marom Bikson)

All neuromodulation approaches, including Deep Brain Stimulation (DBS), Spinal Cord Stimulation (SCS), Transcranial Magnetic Stimulation (TMS) activate "sub-threshold" mechanisms, even though these techniques are traditionally considered "supra-threshold".
In simple and clear terms, this talk by Dr. Marom Bikson explains what supra-threshold and sub-threshold neuromodulation are, and outlines these types of sub-threshold neuromodulation. 1) Stimulation of non-neuronal cells such as glia and the blood-brain-barrier (BBB); 2) Modulation of oscillations; and 3) Modulation of synaptic function. These mechanisms are active even in supra-threshold techniques.
This talk also considers how neuromodulation is broadly dose controlled, and specifically how dose is controlled in pain control. Pain control neuromodulation is related to closed-loop SCS with eCAPS and then to eSAPS, which are finally related back to sub-threshold mechanisms.
( A version of this talk was given by Dr. Marom Bikson at the International Neuromodulation Society 2024 meeting in Vancouver, Canada. )
All the papers cited in this talk and others by Dr. Marom Bikson can be found here: www.neuralengr...
For additional related talks on neuromodulation by Dr. Bikson see also:
1: "A simple introduction to technical concepts in neuromodulation devices.
For clinicians, scientists & engineers" • Simple introduction to...
2: "How neuromodulation for pain works." • How Neuromodulation fo...
3: "Seven rules for sub-threshold neuromodulation." • Seven Rules for Subthr...

[@jamesdinneenjr5622]

I know John's Hopkins is doing trials on Stroke patients using the Scrambler Therapy machine on the patients' head/brain. Here is a summary that I read of the Scrambler Therapy Machine: The active principle with scrambler therapy is that artificial strings of action potentials calibrated to synchronize C-fiber surface receptors may replace endogenous pain information with synthetic "non-pain" information. Another words, Scrambler simulates actions potentials. I think this is just an fyi but maybe something more significant.