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Sysoev Y, Bazhenova E, Lyakhovetskii V, Kovalev G, Shkorbatova P, Islamova R, Pavlova N, Gorskii O, Merkulyeva N, Shkarupa D, Musienko P. Site-Specific Neuromodulation of Detrusor and External Urethral Sphincter by Epidural Spinal Cord Stimulation. Front Syst Neurosci 2020; 14:47. [PMID: 32774243 PMCID: PMC7387722 DOI: 10.3389/fnsys.2020.00047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Impairments of the lower urinary tract function including urine storage and voiding are widely spread among patients with spinal cord injuries. The management of such patients includes bladder catheterization, surgical and pharmacological approaches, which reduce the morbidity from urinary tract-related complications. However, to date, there is no effective treatment of neurogenic bladder and restoration of urinary function. In the present study, we examined neuromodulation of detrusor (Detr) and external urethral sphincter by epidural electrical stimulation (EES) of lumbar and sacral regions of the spinal cord in chronic rats. To our knowledge, it is the first chronic study where detrusor and external urethral sphincter signals were recorded simultaneously to monitor their neuromodulation by site-specific spinal cord stimulation (SCS). The data obtained demonstrate that activation of detrusor muscle mainly occurs during the stimulation of the upper lumbar (L1) and lower lumbar (L5-L6) spinal segments whereas external urethral sphincter was activated predominantly by sacral stimulation. These findings can be used for the development of neurorehabilitation strategies based on spinal cord epidural stimulation for autonomic function recovery after severe spinal cord injury (SCI).
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Affiliation(s)
- Yuriy Sysoev
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Department of Pharmacology and Clinical Pharmacology, Saint-Petersburg State Chemical Pharmaceutical University, Saint-Petersburg, Russia
| | - Elena Bazhenova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Vsevolod Lyakhovetskii
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Gleb Kovalev
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Polina Shkorbatova
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Regina Islamova
- Institute of Chemistry, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Natalia Pavlova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Oleg Gorskii
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Natalia Merkulyeva
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Dmitry Shkarupa
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Pavel Musienko
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia.,Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
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52
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Changes in spinal cord hemodynamics reflect modulation of spinal network with different parameters of epidural stimulation. Neuroimage 2020; 221:117183. [PMID: 32702485 PMCID: PMC7802109 DOI: 10.1016/j.neuroimage.2020.117183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022] Open
Abstract
In this study functional ultrasound (fUS) imaging has been implemented to explore the local hemodynamics response induced by electrical epidural stimulation and to study real-time in vivo functional changes of the spinal cord, taking advantage of the superior spatiotemporal resolution provided by fUS. By quantifying the hemodynamics and electromyographic response features, we tested the hypothesis that the temporal hemodynamics response of the spinal cord to electrical epidural stimulation could reflect modulation of the spinal circuitry and accordingly respond to the changes in parameters of electrical stimulation. The results of this study for the first time demonstrate that the hemodynamics response to electrical stimulation could reflect a neural-vascular coupling of the spinal cord. Response in the dorsal areas to epidural stimulation was significantly higher and faster compared to the response in ventral spinal cord. Positive relation between the hemodynamics and the EMG responses was observed at the lower frequencies of epidural stimulation (20 and 40 Hz), which according to our previous findings can facilitate spinal circuitry after spinal cord injury, compared to higher frequencies (200 and 500 Hz). These findings suggest that different mechanisms could be involved in spinal cord hemodynamics changes during different parameters of electrical stimulation and for the first time provide the evidence that neural-vascular coupling of the spinal cord circuitry could be related to specific organization of spinal cord vasculature and hemodynamics.
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53
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Taccola G, Salazar BH, Apicella R, Hogan MK, Horner PJ, Sayenko D. Selective Antagonism of A1 Adenosinergic Receptors Strengthens the Neuromodulation of the Sensorimotor Network During Epidural Spinal Stimulation. Front Syst Neurosci 2020; 14:44. [PMID: 32760254 PMCID: PMC7372902 DOI: 10.3389/fnsys.2020.00044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/16/2020] [Indexed: 01/02/2023] Open
Abstract
Although epidural spinal stimulation (ESS) results in promising therapeutic effects in individuals with spinal cord injury (SCI), its potential to generate functional motor recovery varies between individuals and remains largely unclear. However, both preclinical and clinical studies indicate the capacity of electrical and pharmacological interventions to synergistically increase the engagement of spinal sensorimotor networks and regain motor function after SCI. This study explored whether selective pharmacological antagonism of the adenosine A1 receptor subtype synergizes with ESS, thereby increasing motor response. We hypothesized that selective pharmacological antagonism of A1 receptors during ESS would produce facilitatory effects in spinal sensorimotor networks detected as an increased amplitude of spinally-evoked motor potentials and sustained duration of ESS induced activity. Terminal experiments were performed in adult rats using trains of stereotyped pulses at 40 Hz delivered at L5 with the local administration to the cord of 8-cyclopentyl-1,3-dipropylxanthine (DPCPX). We demonstrated that ESS combined with the blockage of A1 receptors increased the magnitude of the endogenous modulation and postponed the decay of responses that occur during ESS alone. Although DPCPX significantly increased the yield of repetitive stimulation in intact spinal cords, the effects of A1 antagonism on motor evoked responses after an acute spinal transection was not detected. These studies support the future investigation of the optimal dosage, methods of delivery, and systemic effects of the synergistic application of A1 antagonists and spinal stimulation in the intact and injured spinal cord.
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Affiliation(s)
- Giuliano Taccola
- Department of Neuroscience, International School for Advanced Studies (SISSA), Trieste, Italy
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Betsy Habeth Salazar
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Rosamaria Apicella
- Department of Neuroscience, International School for Advanced Studies (SISSA), Trieste, Italy
| | - Matthew Kevin Hogan
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Philip John Horner
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Dimitry Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
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54
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Jack AS, Hurd C, Martin J, Fouad K. Electrical Stimulation as a Tool to Promote Plasticity of the Injured Spinal Cord. J Neurotrauma 2020; 37:1933-1953. [PMID: 32438858 DOI: 10.1089/neu.2020.7033] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Unlike their peripheral nervous system counterparts, the capacity of central nervous system neurons and axons for regeneration after injury is minimal. Although a myriad of therapies (and different combinations thereof) to help promote repair and recovery after spinal cord injury (SCI) have been trialed, few have progressed from bench-top to bedside. One of the few such therapies that has been successfully translated from basic science to clinical applications is electrical stimulation (ES). Although the use and study of ES in peripheral nerve growth dates back nearly a century, only recently has it started to be used in a clinical setting. Since those initial experiments and seminal publications, the application of ES to restore function and promote healing have greatly expanded. In this review, we discuss the progression and use of ES over time as it pertains to promoting axonal outgrowth and functional recovery post-SCI. In doing so, we consider four major uses for the study of ES based on the proposed or documented underlying mechanism: (1) using ES to introduce an electric field at the site of injury to promote axonal outgrowth and plasticity; (2) using spinal cord ES to activate or to increase the excitability of neuronal networks below the injury; (3) using motor cortex ES to promote corticospinal tract axonal outgrowth and plasticity; and (4) leveraging the timing of paired stimuli to produce plasticity. Finally, the use of ES in its current state in the context of human SCI studies is discussed, in addition to ongoing research and current knowledge gaps, to highlight the direction of future studies for this therapeutic modality.
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Affiliation(s)
- Andrew S Jack
- Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Caitlin Hurd
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John Martin
- Department of Molecular, Cellular, and Biomedical Sciences, City University of New York School of Medicine, and City University of New York Graduate Center, New York, New York, USA
| | - Karim Fouad
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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55
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Steadman CJ, Grill WM. Spinal cord stimulation for the restoration of bladder function after spinal cord injury. Healthc Technol Lett 2020; 7:87-92. [PMID: 32754343 PMCID: PMC7353924 DOI: 10.1049/htl.2020.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
Spinal cord injury (SCI) results in the inability to empty the bladder voluntarily, and neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD) negatively impact both the health and quality of life of persons with SCI. Current approaches to treat bladder dysfunction in persons with SCI, including self-catheterisation and anticholinergic medications, are inadequate, and novel approaches are required to restore continence with increased bladder capacity, as well as to provide predictable and efficient on-demand voiding. Improvements in bladder function following SCI have been documented using a number of different modalities of spinal cord stimulation (SCS) in both persons with SCI and animal models, including SCS alone or SCS with concomitant activity-based training. Improvements include increased volitional voiding, voided volumes, bladder capacity, and quality of life, as well as decreases in NDO and DSD. Further, SCS is a well-developed therapy for chronic pain, and existing Food And Drug Administration (FDA)-approved devices provide a clear pathway to sustainable commercial availability and impact. However, the effective stimulation parameters and the appropriate timing and location of stimulation for SCS-mediated restoration of bladder function require further study, and studies are needed to determine underlying mechanisms of action.
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Affiliation(s)
- Casey J Steadman
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.,Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA.,Department of Neurobiology, Duke University, Durham, NC 27708, USA.,Department of Neurosurgery, Duke University, Durham, NC 27708, USA
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56
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Kaplan A, Murray TA. Batch Bayesian optimization design for optimizing a neurostimulator. Biometrics 2020; 77:661-674. [PMID: 32530495 DOI: 10.1111/biom.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
Recently, spinal epidural neurostimulation is being considered for rehabilitation of persons suffering from partial spinal-cord injury. The neurostimulator must be programmed by a neurosurgeon, yet little work has been done to develop rigorous methods for optimally programming the device. We propose an adaptive design to efficiently optimize programming of the neurostimulator based on specified interim evaluations of patient reported preferences. Preferences for the eligible device configurations are estimated after each interim analysis through a conditionally autoregressive model that assumes preference for one configuration is related to preferences for neighboring configurations. Using the adaptively updated preferences, a group of configurations is programmed into the device for the patient to evaluate during the next follow-up period. This selection is based on a balance of device exploration and preference maximization. We repeat this process until a specified stopping rule or the calibration end is reached. We show simulation studies to evaluate the overall quality of the adaptive calibration for various configuration selection strategies and the effects of stopping it early.
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Affiliation(s)
- Adam Kaplan
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Thomas A Murray
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
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57
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Taccola G, Barber S, Horner PJ, Bazo HAC, Sayenko D. Complications of epidural spinal stimulation: lessons from the past and alternatives for the future. Spinal Cord 2020; 58:1049-1059. [DOI: 10.1038/s41393-020-0505-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
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58
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Neurogenic Bowel: Traditional Approaches and Clinical Pearls. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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59
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Kreydin E, Zhong H, Latack K, Ye S, Edgerton VR, Gad P. Transcutaneous Electrical Spinal Cord Neuromodulator (TESCoN) Improves Symptoms of Overactive Bladder. Front Syst Neurosci 2020; 14:1. [PMID: 32116576 PMCID: PMC7017715 DOI: 10.3389/fnsys.2020.00001] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/06/2020] [Indexed: 12/22/2022] Open
Abstract
Neuromodulation is a therapeutic technique that is well-established in the treatment of idiopathic Lower urinary tract (LUT) dysfunction such as overactive bladder (OAB). We have recently developed a novel neuromodulation approach, Transcutaneous Electrical Spinal Cord Neuromodulation (TESCoN) and demonstrated its acute effects on LUT dysfunction after spinal cord injury (SCI) during urodynamic studies. We found that TESCoN can promote urinary storage and induce urinary voiding when delivered during urodynamic studies. The objective of this study was to determine whether TESCoN can retrain the spinal neural networks to induce chronic improvement in the LUT, such that positive changes can persist even in the absence of stimulation. In addition, we wished to examine the effect of TESCoN on LUT dysfunction due to multiple pathologies. To achieve this objective, 14 patients [SCI = 5, stroke = 5, multiple sclerosis (MS) = 3, and idiopathic OAB (iOAB) = 1] completed 24 sessions of TESCoN over the course of 8 weeks. Patients completed urodynamic studies before and after undergoing TESCoN therapy. Additionally, each subject completed a voiding diary and the Neurogenic Bladder Symptom Score questionnaire before and after receiving TESCoN therapy. We found that TESCoN led to decreased detrusor overactivity, improved continence, and enhanced LUT sensation across the different pathologies underlying LUT dysfunction. This study serves as a pilot in preparation for a rigorous randomized placebo-controlled trial designed to demonstrate the effect of TESCoN on LUT function in neurogenic and non-neurogenic conditions. NEW AND NOTEWORTHY Non-Surgical modality to reduce incidence of urinary incontinence and improve neurogenic bladder symptom scores (NBSS) in individuals with neurogenic bladder due to spinal cord injury or stroke.
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Affiliation(s)
- Evgeniy Kreydin
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Hui Zhong
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kyle Latack
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - Shirley Ye
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
| | - V. Reggie Edgerton
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- The Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - Parag Gad
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States
- The Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
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60
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Shah J, Smith RH, Al-Gharaibeh A. A Novel Electromagnetic-Neurobiologic Interface for Functional Animation of Dormant Motor Nerve Roots in Spinal Cord Injury via Neuromodulation. Front Surg 2020; 6:73. [PMID: 31998742 PMCID: PMC6970190 DOI: 10.3389/fsurg.2019.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022] Open
Abstract
Complete spinal cord injury is a devastating occurrence afflicting millions of people worldwide with no available treatment for functional motor recovery. In this report, we describe a procedure in which we used parts of a device available for chronic pain treatment to provide a neuromodulation of motor nerve roots in a case with complete motor and sensory paraplegia. By using a retrograde trans-foraminal approach to implant electrodes close to L2-S1 motor nerve roots bilaterally, we were able to stimulate those nerves and induce precise movements at the joints of lower extremity in a T5 complete spinal cord injury case. We believe that our approach shows potential of the device as a rehabilitation system with the possibility of a parallel electric circuitry that can bridge a damaged spinal cord.
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Affiliation(s)
- Jawad Shah
- Department of Neurosurgery, Insight Institute of Neurosurgery & Neuroscience, Flint, MI, United States.,Department of Research, Insight Institute of Neurosurgery & Neuroscience, Flint, MI, United States.,Center for Cognition and Neuroethics, University of Michigan-Flint - IINN, Flint, MI, United States.,Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Richard H Smith
- Department of Research, Insight Institute of Neurosurgery & Neuroscience, Flint, MI, United States
| | - Abeer Al-Gharaibeh
- Department of Research, Insight Institute of Neurosurgery & Neuroscience, Flint, MI, United States.,Center for Cognition and Neuroethics, University of Michigan-Flint - IINN, Flint, MI, United States
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61
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Doherty S, Vanhoestenberghe A, Duffell L, Hamid R, Knight S. A Urodynamic Comparison of Neural Targets for Transcutaneous Electrical Stimulation to Acutely Suppress Detrusor Contractions Following Spinal Cord Injury. Front Neurosci 2019; 13:1360. [PMID: 31956301 PMCID: PMC6951414 DOI: 10.3389/fnins.2019.01360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/02/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives To assess and compare the effect of transcutaneous Dorsal Genital Nerve Stimulation (DGNS), Tibial Nerve Stimulation (TNS), Sacral Nerve Stimulation (SNS), and Spinal Stimulation (SS) on Neurogenic Detrusor Overactivity (NDO) and bladder capacity in people with Spinal Cord Injuries (SCI). Materials and Methods Seven male participants with supra-sacral SCI were tested. Standard cystometry (CMG) was performed to assess bladder activity at baseline and with stimulation applied at each site. This was conducted over four separate sessions. All stimulation was monophasic, 15 Hz, 200 μS pulses and applied at maximum tolerable amplitude. Results were analysed against individual control results from within the same session. Results Dorsal Genital Nerve Stimulation increased bladder capacity by 153 ± 146 ml (p = 0.016) or 117 ± 201%. DGNS, TNS and SNS all increased the volume held following the first reflex contraction, by 161 ± 175, 46 ± 62, and 34 ± 33 ml (p = 0.016, p = 0.031, p = 0.016), respectively. SS results showed small reduction of 33 ± 26 ml (p = 0.063) from baseline bladder capacity in five participants. Maximum Detrusor Pressure before leakage was increased during TNS, by 10 ± 13 cmH2O (p = 0.031) but was unchanged during stimulation of other sites. DGNS only was able to suppress at least one detrusor contraction in five participants and reduced first peak detrusor pressure below 40 cmH2O in these 5. Continuous TNS, SNS, and SS produced non-significant changes in bladder capacity from baseline, comparable to conditional stimulation. Increase in bladder capacity correlated with stimulation amplitude for DGNS but not TNS, SNS or SS. Conclusion In this pilot study DGNS acutely suppressed detrusor contractions and increased bladder capacity whereas TNS, SNS, and SS did not. This is the first within individual comparison of surface stimulation sites for management of NDO in SCI individuals.
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Affiliation(s)
- Sean Doherty
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom.,London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom
| | - Lynsey Duffell
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom
| | - Rizwan Hamid
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Sarah Knight
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
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62
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Propriospinal Neurons of L3-L4 Segments Involved in Control of the Rat External Urethral Sphincter. Neuroscience 2019; 425:12-28. [PMID: 31785359 DOI: 10.1016/j.neuroscience.2019.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022]
Abstract
Coordination of activity of external urethral sphincter (EUS) striated muscle and bladder (BL) smooth muscle is essential for efficient voiding. In this study we examined the morphological and electrophysiological properties of neurons in the L3/L4 spinal cord (SC) that are likely to have an important role in EUS-BL coordination in rats. EUS-related SC neurons were identified by retrograde transsynaptic tracing following injection of pseudorabies virus (PRV) co-expressing fluorescent markers into the EUS of P18-P20 male rats. Tracing revealed not only EUS motoneurons in L6/S1 but also interneurons in lamina X of the L6/S1 and L3/L4 SC. Physiological properties of fluorescently labeled neurons were assessed during whole-cell recordings in SC slices followed by reconstruction of biocytin-filled neurons. Reconstructions of neuronal processes from transverse or longitudinal slices showed that some L3/L4 neurons have axons projecting toward and into the ventro-medial funiculus (VMf) where axons extended caudally. Other neurons had axons projecting within laminae X and VII. Dendrites of L3/L4 neurons were distributed within laminae X and VII. The majority of L3/L4 neurons exhibited tonic firing in response to depolarizing currents. In transverse slices focal electrical stimulation (FES) in the VMf or in laminae X and VII elicited antidromic axonal spikes and/or excitatory synaptic responses in L3/L4 neurons; while in longitudinal slices FES elicited excitatory synaptic inputs from sites up to 400 μm along the central canal. Inhibitory inputs were rarely observed. These data suggest that L3/L4 EUS-related circuitry consists of at least two neuronal populations: segmental interneurons and propriospinal neurons projecting to L6/S1.
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63
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Huang H, Young W, Skaper S, Chen L, Moviglia G, Saberi H, Al-Zoubi Z, Sharma HS, Muresanu D, Sharma A, El Masry W, Feng S. Clinical Neurorestorative Therapeutic Guidelines for Spinal Cord Injury (IANR/CANR version 2019). J Orthop Translat 2019; 20:14-24. [PMID: 31908929 PMCID: PMC6939117 DOI: 10.1016/j.jot.2019.10.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/13/2019] [Indexed: 12/11/2022] Open
Abstract
Functional restoration after spinal cord injury (SCI) is one of the most challenging tasks in neurological clinical practice. With a view to exploring effective neurorestorative methods in the acute, subacute, and chronic phases of SCI, “Clinical Therapeutic Guidelines of Neurorestoration for Spinal Cord Injury (China Version 2016)” was first proposed in 2016 by the Chinese Association of Neurorestoratology (CANR). Given the rapid advances in this field in recent years, the International Association of Neurorestoratology (IANR) and CANR formed and approved the “Clinical Neurorestorative Therapeutic Guidelines for Spinal Cord Injury (IANR/CANR version 2019)”. These guidelines mainly introduce restoring damaged neurological structure and functions by varying neurorestorative strategies in acute, subacute, and chronic phases of SCI. These guidelines can provide a neurorestorative therapeutic standard or reference for clinicians and researchers in clinical practice to maximally restore functions of patients with SCI and improve their quality of life. The translational potential of this article This guideline provided comprehensive management strategies for SCI, which contains the evaluation and diagnosis, pre-hospital first aid, treatments, rehabilitation training, and complications management. Nowadays, amounts of neurorestorative strategies have been demonstrated to be benefit in promoting the functional recovery and improving the quality of life for SCI patients by clinical trials. Also, the positive results of preclinical research provided lots of new neurorestorative strategies for SCI treatment. These promising neurorestorative strategies are worthy of translation in the future and can promote the advancement of SCI treatments.
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Affiliation(s)
- Hongyun Huang
- Institute of Neurorestoratology, Third Medical Center of PLA General Hospital, Beijing, People's Republic of China.,Hongtianji Neuroscience Academy, Lingxiu Building, No.1 at Gucheng Street, Beijing, People's Republic of China
| | - Wise Young
- W. M. Keck Center for Collaborative Neuroscience, Rutgers, State University of New Jersey, Piscataway, NJ, USA
| | - Stephen Skaper
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Lin Chen
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, People's Republic of China
| | - Gustavo Moviglia
- Center of Research and Engineer of Tissues and Cellular Therapy, Maimonides University, Buenos Aires, Argentina
| | - Hooshang Saberi
- Department of Neurosurgery, Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ziad Al-Zoubi
- Jordan Ortho and Spinal Centre, Al-Saif Medical Center, Amman, Jordan
| | - Hari Shanker Sharma
- Intensive Experimental CNS Injury and Repair, University Hospital, Uppsala University, Uppsala, Sweden
| | - Dafin Muresanu
- Department of Neurosciences "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alok Sharma
- Department of Neurosurgery, LTM Medical College, LTMG Hospital, Mumbai, Mumbai, India
| | - Wagih El Masry
- Spinal Injuries Unit, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Shiqing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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64
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Holmes GM, Blanke EN. Gastrointestinal dysfunction after spinal cord injury. Exp Neurol 2019; 320:113009. [PMID: 31299180 PMCID: PMC6716787 DOI: 10.1016/j.expneurol.2019.113009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/13/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
The gastrointestinal tract of vertebrates is a heterogeneous organ system innervated to varying degrees by a local enteric neural network as well as extrinsic parasympathetic and sympathetic neural circuits located along the brainstem and spinal axis. This diverse organ system serves to regulate the secretory and propulsive reflexes integral to the digestion and absorption of nutrients. The quasi-segmental distribution of the neural circuits innervating the gastrointestinal (GI) tract produces varying degrees of dysfunction depending upon the level of spinal cord injury (SCI). At all levels of SCI, GI dysfunction frequently presents life-long challenges to individuals coping with injury. Growing attention to the profound changes that occur across the entire physiology of individuals with SCI reveals profound knowledge gaps in our understanding of the temporal dimensions and magnitude of organ-specific co-morbidities following SCI. It is essential to understand and identify these broad pathophysiological changes in order to develop appropriate evidence-based strategies for management by clinicians, caregivers and individuals living with SCI. This review summarizes the neurophysiology of the GI tract in the uninjured state and the pathophysiology associated with the systemic effects of SCI.
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Affiliation(s)
- Gregory M Holmes
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, United states of America.
| | - Emily N Blanke
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, United states of America
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65
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Calvert JS, Manson GA, Grahn PJ, Sayenko DG. Preferential activation of spinal sensorimotor networks via lateralized transcutaneous spinal stimulation in neurologically intact humans. J Neurophysiol 2019; 122:2111-2118. [PMID: 31553681 DOI: 10.1152/jn.00454.2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcutaneous spinal stimulation (TSS), a noninvasive technique to modulate sensorimotor circuitry within the spinal cord, has been shown to enable a wide range of functions that were thought to be permanently impaired in humans with spinal cord injury. However, the extent to which TSS can be used to target specific mediolateral spinal cord circuitry remains undefined. We tested the hypothesis that TSS applied unilaterally to the skin ~2 cm lateral to the midline of the lumbosacral spine selectively activates ipsilateral spinal sensorimotor circuitry, resulting in ipsilateral activation of downstream lower extremity neuromusculature. TSS cathodes and anodes were positioned lateral from the midline of the spine in 15 healthy subjects while supine, and the timing of TSS pulses was synchronized to recordings of lower extremity muscle activity and force. At motor threshold, left and right TSS-evoked muscle activity was significantly higher in the ipsilateral leg compared with contralateral recordings from the same muscles. Similarly, we observed a significant increase in force production in the ipsilateral leg compared with the contralateral leg. Delivery of paired TSS pulses, during which an initial stimulus was applied to one side of the spinal cord and 50 ms later a second stimulus was applied to the contralateral side, revealed that ipsilateral leg muscle responses decreased following the initial stimulus, whereas contralateral muscle responses did not decrease, indicating side-specific activation of lateral spinal sensorimotor circuitry. Our results indicate TSS can selectively engage ipsilateral neuromusculature via lumbosacral sensorimotor networks responsible for lower extremity function in healthy humans.NEW & NOTEWORTHY We demonstrate the selectivity of transcutaneous spinal stimulation (TSS), which has been shown to enable function in humans with chronic paralysis. Specifically, we demonstrate that TSS applied to locations lateral to the spinal cord can selectively activate ipsilateral spinal sensorimotor networks. We quantified lumbosacral spinal network activity by recording lower extremity muscle electromyography and force. Our results suggest lumbosacral TSS engages side-specific spinal sensorimotor networks associated with ipsilateral lower extremity function in humans.
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Affiliation(s)
- Jonathan S Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota
| | - Gerome A Manson
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
| | - Peter J Grahn
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
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66
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Cho N, Squair JW, Bloch J, Courtine G. Neurorestorative interventions involving bioelectronic implants after spinal cord injury. Bioelectron Med 2019; 5:10. [PMID: 32232100 PMCID: PMC7098222 DOI: 10.1186/s42234-019-0027-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/13/2019] [Indexed: 12/15/2022] Open
Abstract
In the absence of approved treatments to repair damage to the central nervous system, the role of neurosurgeons after spinal cord injury (SCI) often remains confined to spinal cord decompression and vertebral fracture stabilization. However, recent advances in bioelectronic medicine are changing this landscape. Multiple neuromodulation therapies that target circuits located in the brain, midbrain, or spinal cord have been able to improve motor and autonomic functions. The spectrum of implantable brain-computer interface technologies is also expanding at a fast pace, and all these neurotechnologies are being progressively embedded within rehabilitation programs in order to augment plasticity of spared circuits and residual projections with training. Here, we summarize the impending arrival of bioelectronic medicine in the field of SCI. We also discuss the new role of functional neurosurgeons in neurorestorative interventional medicine, a new discipline at the intersection of neurosurgery, neuro-engineering, and neurorehabilitation.
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Affiliation(s)
- Newton Cho
- École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Center for Neuroprosthetics and Brain Mind Institute, 1202 Genève, Switzerland.,2Department of Neurosurgery, University of Toronto, Toronto, Ontario Canada
| | - Jordan W Squair
- École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Center for Neuroprosthetics and Brain Mind Institute, 1202 Genève, Switzerland.,3Cumming School of Medicine, University of Calgary, Calgary, Canada.,4MD/PhD Training Program, University of British Columbia, Vancouver, Canada
| | - Jocelyne Bloch
- 5Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,6Defitech Center for Interventional Neurotherapies, EPFL / CHUV, Lausanne, Switzerland
| | - Grégoire Courtine
- École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Center for Neuroprosthetics and Brain Mind Institute, 1202 Genève, Switzerland.,5Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,6Defitech Center for Interventional Neurotherapies, EPFL / CHUV, Lausanne, Switzerland
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67
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Calvert JS, Grahn PJ, Zhao KD, Lee KH. Emergence of Epidural Electrical Stimulation to Facilitate Sensorimotor Network Functionality After Spinal Cord Injury. Neuromodulation 2019; 22:244-252. [PMID: 30840354 DOI: 10.1111/ner.12938] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) disrupts signaling pathways between the brain and spinal networks below the level of injury. In cases of severe SCI, permanent loss of sensorimotor and autonomic function can occur. The standard of care for severe SCI uses compensation strategies to maximize independence during activities of daily living while living with chronic SCI-related dysfunctions. Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES). METHODS This review provides a historical account of the translational research efforts that led to the emergence of EES of the spinal cord to enable intentional control of motor functions that were lost after SCI. We also highlight the major limitations associated with EES after SCI and propose future directions of spinal neuromodulation research. RESULTS Multiple, independent studies have demonstrated return of motor function via EES in individuals with chronic SCI. These enabled motor functions include intentional, controlled movement of previously paralyzed extremities, independent standing and stepping, and increased grip strength. In addition, improvements in cardiovascular health, respiratory function, body composition, and urologic function have been reported. CONCLUSIONS EES holds promise to enable functions thought to be permanently lost due to SCI. However, EES is currently restricted to scientific investigation in humans with SCI and requires further validation of factors such as safety and efficacy before clinical translation.
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Affiliation(s)
| | - Peter J Grahn
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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68
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Huang H, Sharma HS, Chen L, Saberi H, Mao G. 2018 Yearbook of Neurorestoratology. JOURNAL OF NEURORESTORATOLOGY 2019. [DOI: 10.26599/jnr.2019.9040003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The Neurorestoratology discipline is getting worldwide attention from the clinicians, basic scientists, students and policy makers alike. Accordingly, this year too, the discipline has made profound advances and great achievements for the benefit of the mankind. In this report, of the 2018 Neurorestoratology Yearbook, salient features of new developments are summarized. This Yearbook consists 3 key themes namely (i) the new findings on pathogenesis of neurological diseases or degeneration; (ii) the new mechanisms of neurorestorative aspects; and (iii) the achievements and progresses made in the clinical field of neurorestorative therapies. The new trend has emerged in clinical studies that are based on greater levels of evidence-based medical practices both in clinical therapies and clinical trials based on standard designs.
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69
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Walter M, Lee AHX, Kavanagh A, Phillips AA, Krassioukov AV. Epidural Spinal Cord Stimulation Acutely Modulates Lower Urinary Tract and Bowel Function Following Spinal Cord Injury: A Case Report. Front Physiol 2018; 9:1816. [PMID: 30618826 PMCID: PMC6305431 DOI: 10.3389/fphys.2018.01816] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022] Open
Abstract
Regaining control of autonomic functions such as those of the cardiovascular system, lower urinary tract and bowel, rank among the most important health priorities for individuals living with spinal cord injury (SCI). Recently our research provided evidence that epidural spinal cord stimulation (ESCS) could acutely modulate autonomic circuits responsible for cardiovascular function after SCI. This finding raised the question of whether ESCS can be used to modulate autonomic circuits involved in lower urinary tract and bowel control after SCI. We present the case of a 32-year-old man with a chronic motor-complete SCI (American Spinal injury Association Impairment Scale B) at the 5th cervical spinal segment. He sustained his injury during a diving accident in 2012. He was suffering from neurogenic lower urinary tract and bowel dysfunction. Epidural stimulation of the lumbosacral spinal cord immediately modulated both functions without negatively affecting the cardiovascular system. Specifically, the individual's bowel function was assessed using different pre-set configurations and stimulation parameters in a randomized order. Compared to the individual's conventional bowel management approach, ESCS significantly reduced the time needed for bowel management (p = 0.039). Furthermore, depending on electrode configuration and stimulation parameters (i.e., amplitude, frequency, and pulse width), ESCS modulated detrusor pressure and external anal sphincter/pelvic floor muscle tone to various degrees during urodynamic investigation. Although, ESCS is currently being explored primarily for restoring ambulation, our data suggest that application of this neuroprosthetic intervention may provide benefit to lower urinary tract and bowel function in individuals with SCI. To fully capitalize on the potential of improving lower urinary tract and bowel function, further research is needed to better understand the neuronal pathways and identify optimal stimulation configurations and parameters.
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Affiliation(s)
- Matthias Walter
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Amanda H X Lee
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Aaron A Phillips
- Department of Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada
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70
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Spinal Cord Stimulation for Pain Treatment After Spinal Cord Injury. Neurosci Bull 2018; 35:527-539. [PMID: 30560438 DOI: 10.1007/s12264-018-0320-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022] Open
Abstract
In addition to restoration of bladder, bowel, and motor functions, alleviating the accompanying debilitating pain is equally important for improving the quality of life of patients with spinal cord injury (SCI). Currently, however, the treatment of chronic pain after SCI remains a largely unmet need. Electrical spinal cord stimulation (SCS) has been used to manage a variety of chronic pain conditions that are refractory to pharmacotherapy. Yet, its efficacy, benefit profiles, and mechanisms of action in SCI pain remain elusive, due to limited research, methodological weaknesses in previous clinical studies, and a lack of mechanistic exploration of SCS for SCI pain control. We aim to review recent studies and outline the therapeutic potential of different SCS paradigms for traumatic SCI pain. We begin with an overview of its manifestations, classification, potential underlying etiology, and current challenges for its treatment. The clinical evidence for using SCS in SCI pain is then reviewed. Finally, future perspectives of pre-clinical research and clinical study of SCS for SCI pain treatment are discussed.
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71
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Peng X, Hickman JL, Bowles SG, Donegan DC, Welle CG. Innovations in electrical stimulation harness neural plasticity to restore motor function. BIOELECTRONICS IN MEDICINE 2018; 1:251-263. [PMID: 33859830 PMCID: PMC8046169 DOI: 10.2217/bem-2019-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/21/2019] [Indexed: 12/28/2022]
Abstract
Novel technology and innovative stimulation paradigms allow for unprecedented spatiotemporal precision and closed-loop implementation of neurostimulation systems. In turn, precise, closed-loop neurostimulation appears to preferentially drive neural plasticity in motor networks, promoting neural repair. Recent clinical studies demonstrate that electrical stimulation can drive neural plasticity in damaged motor circuits, leading to meaningful improvement in users. Future advances in these areas hold promise for the treatment of a wide range of motor systems disorders.
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Affiliation(s)
- Xiaoyu Peng
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Jordan L. Hickman
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Spencer G. Bowles
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Dane C. Donegan
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
- ETH Zurich, Department Health Science and Technology, Institute for Neuroscience. Schorenstrasse 16, 8603 Schwerzenbach, Switzerland
| | - Cristin G. Welle
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
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Taylor MJ, Fornusek C, Ruys AJ. The duty cycle in Functional Electrical Stimulation research. Part II: Duty cycle multiplicity and domain reporting. Eur J Transl Myol 2018; 28:7733. [PMID: 30662696 PMCID: PMC6317134 DOI: 10.4081/ejtm.2018.7733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022] Open
Abstract
In part I of this review, we introduced the duty cycle as a fundamental parameter in controlling the effect of electrical stimulation pulse trains on muscle structural and functional properties with special emphasis on fatigue. Following on from a survey of the literature, we discuss here the relative ability of intermittent and continuous stimulation to fatigue muscle. In addition, pertinent literature is explored on a more deeper level, highlighting contentions regarding the duty cycle across studies. In response to literature inconsistencies, we propose frameworks upon which the duty cycle parameter may be specified. We present the idea of domain reporting for the duty cycle, and illustrate with practical examples. In addition we dig further into the literature and present a set of notations that have been used by different researchers to report the duty cycle. We also propose the idea of the duty cycle multiple, which together with domain reporting, will help researchers understand more precisely duty cycles of electrical stimulation. As a case study, we also show how the duty cycle has been looked at by researchers in the context of pressure sore attenuation in patients. Together with part I, it is hoped that the frameworks suggested provide a complete picture of how duty cycle has been discussed across the literature, and gives researchers a more trans-theoretical basis upon which they may report the duty cycle in their studies. This may also lead to a more precise specification of electrical stimulation protocols used in patients.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, Australia
| | - Ché Fornusek
- Faculty of Medicine and Health, University of Sydney, Lidcombe, Australia
| | - Andrew J. Ruys
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
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73
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Taylor MJ, Fornusek C, Ruys AJ. Reporting for Duty: The duty cycle in Functional Electrical Stimulation research. Part I: Critical commentaries of the literature. Eur J Transl Myol 2018; 28:7732. [PMID: 30662695 PMCID: PMC6317136 DOI: 10.4081/ejtm.2018.7732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/21/2018] [Indexed: 02/07/2023] Open
Abstract
There are several parameters that can be modulated during electrical stimulation-induced muscle contraction to obtain external work, i.e., Functional Electrical Stimulation (FES). The literature has several reports of the relationships of parameters such as frequency, pulse width, amplitude and physiological or biomechanical outcomes (i.e., torque) when these parameters are changed. While these relationships are well-described, lesser known across the literature is how changing the duty cycle (time ON and time OFF) of stimulation affects the outcomes. This review provides an analysis of the literature pertaining to the duty cycle in electrical stimulation experiments. There are two distinct sections of this review - an introduction to the duty cycle and definitions from literature (part I); and contentions from the literature and proposed frameworks upon which duty cycle can be interpreted (part II). It is envisaged that the two reviews will highlight the importance of modulating the duty cycle in terms of muscle fatigue in mimicking physiological activities. The frameworks provided will ideally assist in unifying how researchers consider the duty cycle in electrical stimulation (ES) of muscles.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, Australia
| | - Ché Fornusek
- Faculty of Medicine and Health, University of Sydney, Lidcombe, Australia
| | - Andrew J. Ruys
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
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74
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Sajer S, Guardiero GS, Scicchitano BM. Myokines in Home-Based Functional Electrical Stimulation-Induced Recovery of Skeletal Muscle in Elderly and Permanent Denervation. Eur J Transl Myol 2018; 28:7905. [PMID: 30662701 PMCID: PMC6317133 DOI: 10.4081/ejtm.2018.7905] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromuscular disorders, disuse, inadequate nutrition, metabolic diseases, cancer and aging produce muscle atrophy and this implies that there are different types of molecular triggers and signaling pathways for muscle wasting. Exercise and muscle contractions may counteract muscle atrophy by releasing a group of peptides, termed myokines, to protect the functionality and to enhance the exercise capacity of skeletal muscle. In this review, we are looking at the role of myokines in the recovery of permanent denervated and elderly skeletal muscle tissue. Since sub-clinical denervation events contribute to both atrophy and the decreased contractile speed of aged muscle, we saw a parallel to spinal cord injury and decided to look at both groups together. The muscle from lifelong active seniors has more muscle bulk and more slow fiber-type groupings than those of sedentary seniors, demonstrating that physical activity maintains slow motoneurons that reinnervate the transiently denervated muscle fibers. Furthermore, we summarized the evidence that muscle degeneration occur with irreversible Conus and Cauda Equina syndrome, a spinal cord injury in which the human leg muscles may be permanently disconnected from the peripheral nervous system. In these patients, suffering with an estreme case of muscle disuse, a complete loss of muscle fibers occurs within five to ten years after injury. Their recovered tetanic contractility, induced by home-based Functional Electrical Stimulation, can restore the muscle size and function in compliant Spinal Cord Injury patients, allowing them to perform electrical stimulation-supported stand-up training. Myokines are produced and released by muscle fibers under contraction and exert both local and systemic effects. Changes in patterns of myokine secretion, particularly of IGF-1 isoforms, occur in long-term Spinal Cord Injury persons and also in very aged people. Their modulation in Spinal Cord Injury and late aging are also key factors of home-based Functional Electrical Stimulation - mediated muscle recovery. Thus, Functional Electrical Stimulation should be prescribed in critical care units and nursing facilities, if persons are unable or reluctant to exercise. This will result in less frequent hospitalizations and a reduced burden on patients' families and public health services.
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Affiliation(s)
- Sascha Sajer
- Department of Physiko&Rheuma-Therapie, Institute for Physical Medicine, St. Pölten, Austria
| | - Giulio Sauro Guardiero
- A&C M-C Foundation for Translational Myology, Padova, Italy
- Interdepartmental Research Centre of Myology, University of Padova, Italy
| | - Bianca Maria Scicchitano
- Istituto di Istologia ed Embriologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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75
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Targeted neurotechnology restores walking in humans with spinal cord injury. Nature 2018; 563:65-71. [DOI: 10.1038/s41586-018-0649-2] [Citation(s) in RCA: 469] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
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