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Samejima S, Shackleton C, Miller T, Moritz CT, Kessler TM, Krogh K, Sachdeva R, Krassioukov AV. Mapping the Iceberg of Autonomic Recovery: Mechanistic Underpinnings of Neuromodulation following Spinal Cord Injury. Neuroscientist 2024; 30:378-389. [PMID: 36631741 PMCID: PMC11107126 DOI: 10.1177/10738584221145570] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Spinal cord injury leads to disruption in autonomic control resulting in cardiovascular, bowel, and lower urinary tract dysfunctions, all of which significantly reduce health-related quality of life. Although spinal cord stimulation shows promise for promoting autonomic recovery, the underlying mechanisms are unclear. Based on current preclinical and clinical evidence, this narrative review provides the most plausible mechanisms underlying the effects of spinal cord stimulation for autonomic recovery, including activation of the somatoautonomic reflex and induction of neuroplastic changes in the spinal cord. Areas where evidence is limited are highlighted in an effort to guide the scientific community to further explore these mechanisms and advance the clinical translation of spinal cord stimulation for autonomic recovery.
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Affiliation(s)
- Soshi Samejima
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Tiev Miller
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Chet T. Moritz
- Departments of Electrical and Computer Engineering, Rehabilitation Medicine, and Physiology and Biophysics and the Center for Neurotechnology, University of Washington, Seattle, WA, USA
| | - Thomas M. Kessler
- Department of Neuro-urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Klaus Krogh
- Department of Clinical Medicine and Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
- Spinal Cord Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
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2
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Moreno Romero GN, Twyman AR, Bandres MF, McPherson JG. Unintentionally intentional: unintended effects of spinal stimulation as a platform for multi-modal neurorehabilitation after spinal cord injury. Bioelectron Med 2024; 10:12. [PMID: 38745334 PMCID: PMC11094943 DOI: 10.1186/s42234-024-00144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
Electrical stimulation of spinal neurons has emerged as a valuable tool to enhance rehabilitation after spinal cord injury. In separate parameterizations, it has shown promise for improving voluntary movement, reducing symptoms of autonomic dysreflexia, improving functions mediated by muscles of the pelvic floor (e.g., bowel, bladder, and sexual function), reducing spasms and spasticity, and decreasing neuropathic pain, among others. This diverse set of actions is related both to the density of sensorimotor neural networks in the spinal cord and to the intrinsic ability of electrical stimulation to modulate neural transmission in multiple spinal networks simultaneously. It also suggests that certain spinal stimulation parameterizations may be capable of providing multi-modal therapeutic benefits, which would directly address the complex, multi-faceted rehabilitation goals of people living with spinal cord injury. This review is intended to identify and characterize reports of spinal stimulation-based therapies specifically designed to provide multi-modal benefits and those that report relevant unintended effects of spinal stimulation paradigms parameterized to enhance a single consequence of spinal cord injury.
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Affiliation(s)
- Gerson N Moreno Romero
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Avery R Twyman
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Maria F Bandres
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacob Graves McPherson
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO, USA.
- Program in Neurosciences, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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3
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Medina-Aguiñaga D, Hoey RF, Wilkins NL, Ugiliweneza B, Fell J, Harkema SJ, Hubscher CH. Mid-lumbar (L3) epidural stimulation effects on bladder and external urethral sphincter in non-injured and chronically transected urethane-anesthetized rats. Sci Rep 2023; 13:12258. [PMID: 37507456 PMCID: PMC10382500 DOI: 10.1038/s41598-023-39388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Recent pre-clinical and clinical spinal cord epidural stimulation (scES) experiments specifically targeting the thoracolumbar and lumbosacral circuitries mediating lower urinary tract (LUT) function have shown improvements in storage, detrusor pressure, and emptying. With the existence of a lumbar spinal coordinating center in rats that is involved with external urethral sphincter (EUS) functionality during micturition, the mid-lumbar spinal cord (specifically L3) was targeted in the current study with scES to determine if the EUS and thus the void pattern could be modulated, using both intact and chronic complete spinal cord injured female rats under urethane anesthesia. L3 scES at select frequencies and intensities of stimulation produced a reduction in void volumes and EUS burst duration in intact rats. After chronic transection, three different subgroups of LUT dysfunction were identified and the response to L3 scES promoted different cystometry outcomes, including changes in EUS bursting. The current findings suggest that scES at the L3 level can generate functional neuromodulation of both the urinary bladder and the EUS in intact and SCI rats to enhance voiding in a variety of clinical scenarios.
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Affiliation(s)
- Daniel Medina-Aguiñaga
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, 511 S. Floyd St., MDR, Room 111, Louisville, KY, 40202, USA
| | - Robert F Hoey
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, 511 S. Floyd St., MDR, Room 111, Louisville, KY, 40202, USA
- Physical Medicine and Rehabilitation Department, MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, USA
- Physical Medicine and Rehabilitiation Department, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Natasha L Wilkins
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, 511 S. Floyd St., MDR, Room 111, Louisville, KY, 40202, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
- Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY, USA
| | - Jason Fell
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, 511 S. Floyd St., MDR, Room 111, Louisville, KY, 40202, USA
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, 511 S. Floyd St., MDR, Room 111, Louisville, KY, 40202, USA.
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
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Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci 2023; 17:999253. [PMID: 36925966 PMCID: PMC10011113 DOI: 10.3389/fncel.2023.999253] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.
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Affiliation(s)
| | - Veronica J. Tom
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
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Zhong H, Liu E, Kohli P, Perez L, Edgerton VR, Ginsberg D, Gad P, Kreydin E. Noninvasive spinal neuromodulation mitigates symptoms of idiopathic overactive bladder. Bioelectron Med 2022; 8:5. [PMID: 35317851 PMCID: PMC8941742 DOI: 10.1186/s42234-022-00087-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Overactive bladder (OAB) affects 12 to 30% of the world’s population. The accompanying urinary urgency, frequency and incontinence can have a profound effect on quality of life, leading to depression, social isolation, avoidance of sexual activity and loss of productivity. Conservative measures such as lifestyle modification and pelvic floor physical therapy are the first line of treatment for overactive bladder. Patients who fail these may go on to take medications, undergo neuromodulation or receive injection of botulinum toxin into the bladder wall. While effective, medications have side effects and suffer from poor adherence. Neuromodulation and botulinum toxin injection are also effective but are invasive and not acceptable to some patients. Methods We have developed a novel transcutaneous spinal cord neuromodulator (SCONE™,) that delivers multifrequency electrical stimulation to the spinal cord without the need for insertion or implantation of stimulating electrodes. Previously, multifrequency transcutaneous stimulation has been demonstrated to penetrate to the spinal cord and lead to motor activation of detrusor and external urethral sphincter muscles. Here, we report on eight patients with idiopathic overactive bladder, who underwent 12 weeks of SCONE™ therapy. Results All patients reported statistically significant clinical improvement in multiple symptoms of overactive bladder, such as urinary urgency, frequency and urge incontinence. In addition, patients reported significant symptomatic improvements as captured by validated clinical surveys. Conclusion SCONE™ therapy represents the first of its kind therapy to treat symptoms of urgency, frequency and urge urinary incontinence in patients with OAB. Trial registration The study was listed on clinicaltrials.gov (NCT03753750).
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Affiliation(s)
- Hui Zhong
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA.,Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA
| | - Emilie Liu
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA.,Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,SpineX Inc., 19509 Astor Pl, Northridge, Los Angeles, CA, 91324, USA
| | - Priya Kohli
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Laura Perez
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - V Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA.,Department of Neurosurgery, University of California, Los Angeles, CA, 90095, USA.,Brain Research Institute, University of California, Los Angeles, CA, 90095, USA.,Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, 08916, Badalona, Barcelona, Spain
| | - David Ginsberg
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Parag Gad
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA. .,Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA. .,SpineX Inc., 19509 Astor Pl, Northridge, Los Angeles, CA, 91324, USA.
| | - Evgeniy Kreydin
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
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Hoey RF, Medina-Aguiñaga D, Khalifa F, Ugiliweneza B, Wang D, Zdunowski S, Fell J, Naglah A, El-Baz AS, Herrity AN, Harkema SJ, Hubscher CH. Thoracolumbar epidural stimulation effects on bladder and bowel function in uninjured and chronic transected anesthetized rats. Sci Rep 2022; 12:2137. [PMID: 35136100 PMCID: PMC8826941 DOI: 10.1038/s41598-022-06011-2] [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] [Received: 09/17/2021] [Accepted: 01/18/2022] [Indexed: 11/09/2022] Open
Abstract
Pre-clinical studies have shown that spinal cord epidural stimulation (scES) at the level of pelvic and pudendal nerve inputs/outputs (L5-S1) alters storage and/or emptying functions of both the bladder and bowel. The current mapping experiments were conducted to investigate scES efficacy at the level of hypogastric nerve inputs/outputs (T13-L2) in male and female rats under urethane anesthesia. As found with L5-S1 scES, T13-L2 scES at select frequencies and intensities of stimulation produced an increase in inter-contraction interval (ICI) in non-injured female rats but a short-latency void in chronic T9 transected rats, as well as reduced rectal activity in all groups. However, the detrusor pressure during the lengthened ICI (i.e., urinary hold) remained at a low pressure and was not elevated as seen with L5-S1 scES, an effect that's critical for translation to the clinic as high fill pressures can damage the kidneys. Furthermore, T13-L2 scES was shown to stimulate voiding post-transection by increasing bladder activity while also directly inhibiting the external urethral sphincter, a pattern necessary to overcome detrusor-sphincter dyssynergia. Additionally, select scES parameters at T13-L2 also increased distal colon activity in all groups. Together, the current findings suggest that optimization of scES for bladder and bowel will likely require multiple electrode cohorts at different locations that target circuitries coordinating sympathetic, parasympathetic and somatic outputs.
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Affiliation(s)
- Robert F Hoey
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA.,Physical Medicine and Rehabilitation Department, MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, USA
| | - Daniel Medina-Aguiñaga
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Fahmi Khalifa
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY, USA
| | - Dengzhi Wang
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Sharon Zdunowski
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Jason Fell
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ahmed Naglah
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - Ayman S El-Baz
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - April N Herrity
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA. .,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
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Sheetz T, Clemens JQ, Crescenze I. Neuroanatomy of Bladder Pain. CURRENT BLADDER DYSFUNCTION REPORTS 2021. [DOI: 10.1007/s11884-021-00629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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