1
|
Mukhametova E, Militskova A, Biktimirov A, Kharin N, Semenova E, Sachenkov O, Baltina T, Lavrov I. Consecutive Transcutaneous and Epidural Spinal Cord Neuromodulation to Modify Clinical Complete Paralysis-the Proof of Concept. Mayo Clin Proc Innov Qual Outcomes 2024; 8:1-16. [PMID: 38186923 PMCID: PMC10770429 DOI: 10.1016/j.mayocpiqo.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective To evaluate the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) in facilitating volitional movements, balance, and nonmotor functions, in this observational study, tSCS and EES were consecutively tested in 2 participants with motor complete spinal cord injury (SCI). Participants and Methods Two participants (a 48-year-old woman and a 28-year-old man), both classified as motor complete spinal injury, were enrolled in the study. Both participants went through a unified protocol, such as an initial electrophysiological assessment of neural connectivity, consecutive tSCS and EES combined with 8 wks of motor training with electromyography (EMG) and kinematic evaluation. The study was conducted from May 1, 2019, to December 31, 2021. Results In both participants, tSCS reported a minimal improvement in voluntary movements still essential to start tSCS-enabled rehabilitation. Compared with tSCS, following EES showed immediate improvement in voluntary movements, whereas tSCS was more effective in improving balance and posture. Continuous improvement in nonmotor functions was found during tSCS-enabled and then during EES-enabled motor training. Conclusion Results report a significant difference in the effect of tSCS and EES on the recovery of neurologic functions and support consecutive tSCS and EES applications as a potential therapy for SCI. The proposed approach may help in selecting patients with SCI responsive to neuromodulation. It would also help initiate neuromodulation and rehabilitation therapy early, particularly for motor complete SCI with minimal effect from conventional rehabilitation.
Collapse
Affiliation(s)
- Elvira Mukhametova
- Department of Neurology, Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
- Laboratory of Neuromodulation, Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Russia
- Laboratory of Movement Physiology, Federal State Institution of Science Institute of Physiology, IP Pavlov, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Alena Militskova
- Department of Neurology, Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
- Laboratory of Neuromodulation, Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Russia
- Laboratory of Movement Physiology, Federal State Institution of Science Institute of Physiology, IP Pavlov, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Artur Biktimirov
- Center of Neurotechnologies, Virtual, and Augmented Reality Technologies, Department of Neurosurgery, Far Eastern Federal University, Russia
| | - Nikita Kharin
- Laboratory of Shell Mechanics, N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, Kazan, Russia
| | - Elena Semenova
- Laboratory of Shell Mechanics, N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, Kazan, Russia
| | - Oskar Sachenkov
- Laboratory of Shell Mechanics, N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, Kazan, Russia
| | - Tatiana Baltina
- Laboratory of Neuromodulation, Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Russia
| | - Igor Lavrov
- Department of Neurology, Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
| |
Collapse
|
2
|
Biktimirov A, Bryukhovetskiy I, Sharma A, Sharma HS. Neuromodulation and quality of life for patient with spasticity after spinal cord injury. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 172:79-99. [PMID: 37833019 DOI: 10.1016/bs.irn.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
RATIONALE Spasticity develops in 80% of spinal cord injury cases and negatively affects the patents' quality of life. The most common method of surgical treatment for severe spasticity is a long-term intrathecal baclofen therapy (ITB). Long-term spinal cord stimulation is another possible treatment technique. This paper aims to evaluate the changes in quality of life for patients with spasticity who have been treated with neuromodulation (SCS or ITB) in 12 months after the surgery, as well to compare the changes in quality of life for patients who have been treated with spinal cord stimulation and those who received long-term intrathecal baclofen therapy. MATERIALS AND METHODS The influence of spasticity, experienced by the patients with a spinal cord injury, on their quality of life was analyzed before the surgery and 12 months after it. The severity of the spinal cord damage was determined with the scale of the American Spinal Injury Association (ASIA); spasticity was evaluated with the modified Ashworth scale, Penn Spasm Frequency Scale; pain levels were determined with visual analogue scale (VAS), anxiety and depression levels - with HADS. Functional activity of the patients was evaluated with the help of the Functional Independence Measure (FIM). RESULTS The treatment results for 33 patients (25 men and 8 women), aged from 18 to 62, are presented. After the trial stimulation, the patients were randomly assigned to either SCS or ITB group (18 and 15 people respectively). The decrease of spasticity in both experimental groups caused lower levels of pain, less functional dependency on other people, lower stress and depression rates and, as a consequence, better quality of life and social adaptation. The obtained results for SCS and ITB groups are statistically similar.
Collapse
Affiliation(s)
- Artur Biktimirov
- Department of Neurosurgery, Far Eastern Federal University, Medical Center, Vladivostok, Russia.
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, Far Eastern Federal University, School of Biomedicine, Vladivostok, Russia
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
Putilina M, Teplova N. Drug synergism as a basis for rational neuroprotection. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:17-22. [DOI: 10.17116/jnevro202212205117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
4
|
Drug Synergism as the Basis of Rational Neuroprotection. NEUROSCIENCE AND BEHAVIORAL PHYSIOLOGY 2022; 52:1207-1211. [PMID: 36748019 PMCID: PMC9893192 DOI: 10.1007/s11055-023-01349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023]
Abstract
Optimization of the choice of neuroprotective therapy regimens in patients with cerebrovascular diseases (CVD), taking into account the synergism of drug interactions, is a basic approach in clinical practice. Unfortunately, modern pharmacology has no unified way of establishing synergistic spectra of drug actions, which would allow systematic investigation of the effects of combinations of drugs. An approach based on studying detailed mechanisms of action suggested combinations of drugs with the greatest possible synergism (by summation and potentiation of effects) for various directions in the treatment of neurological diseases. Examples of rational neuroprotection are considered, using Cortexin, citicoline, and antioxidants.
Collapse
|