Neuromodulatory hacking: a review of the technology and security risks of spinal cord stimulation
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REVIEW ARTICLE - FUNCTIONAL NEUROSURGERY - PAIN
Neuromodulatory hacking: a review of the technology and security risks of spinal cord stimulation Christopher Markosian 1 & Varun S. Taruvai 1 & Antonios Mammis 1 Received: 8 June 2020 / Accepted: 22 September 2020 / Published online: 3 October 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Spinal cord stimulation (SCS) is a neuromodulatory technique used to relieve chronic pain. Previous instances of malicious remote control of implantable medical devices, including insulin delivery pumps and implantable cardiac defibrillators, have been documented. Though no cases of neuromodulatory hacking have been recorded outside of the academic setting, an understanding of SCS technology and the possible consequences of manipulation is important in promoting safety. Methods We review the components and implantation protocol of a SCS system, the functionality and technological specifications for SCS systems in the global market based on their device manuals, and patient- and clinician-specific adjustable factors. Furthermore, we assess documented instances of implantable medical device hacking and speculate on the potential harms of targeting SCS systems. Results SCS systems from Abbott Laboratories, Boston Scientific, Medtronic, and Nevro have unique functionality and technological specifications. Six parameters in device control can potentially be targeted and elicit various harms, including loss of therapeutic effect, accelerated battery drainage, paresthesia in unintended locations, muscle weakness or dysfunction, tissue burn, and electrical shock. Conclusions Based on the history of implantable medical device hacking, SCS systems may also be susceptible to manipulation. As the prevalence of SCS use increases and SCS systems continuously evolve in the direction of wireless control and compatibility with mobile devices, appropriate measures should be taken by manufacturers and governmental agencies to ensure safety. Keywords Chronic pain . Cybersecurity . Hacking . Implantable pulse generator . Neuromodulation . Spinal cord stimulation
Abbreviations AES-CCM Advanced encryption standard– counter with cipher block chaining message authentication code FDA Food and Drug Administration IPG Implantable pulse generator RF Radiofrequency SCS Spinal cord stimulation SDR Software-defined radio
This article is part of the Topical Collection on Functional Neurosurgery - Pain * Christopher Markosian [email protected] 1
Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
Introduction Spinal cord stimulation (SCS) (i.e., dorsal column stimulation) therapy involves an implantable neuromodulatory device that generates and sends electrical currents to the dorsal columns for the treatment of chronic neuropathic pain [10, 26]. The most common indication for SCS therapy is failed back surgery syndrome (post-laminectomy syndrome), a neuropathic pain condition that somet
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