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McIntosh JR, Joiner EF, Goldberg JL, Greenwald P, Dionne AC, Murray LM, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Chan AK, Riew KD, Harel NY, Virk MS, Mandigo C, Carmel JB. Timing-dependent synergies between motor cortex and posterior spinal stimulation in humans. J Physiol 2024; 602:2961-2983. [PMID: 38758005 PMCID: PMC11178459 DOI: 10.1113/jp286183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
Volitional movement requires descending input from the motor cortex and sensory feedback through the spinal cord. We previously developed a paired brain and spinal electrical stimulation approach in rats that relies on convergence of the descending motor and spinal sensory stimuli in the cervical cord. This approach strengthened sensorimotor circuits and improved volitional movement through associative plasticity. In humans, it is not known whether posterior epidural spinal cord stimulation targeted at the sensorimotor interface or anterior epidural spinal cord stimulation targeted within the motor system is effective at facilitating brain evoked responses. In 59 individuals undergoing elective cervical spine decompression surgery, the motor cortex was stimulated with scalp electrodes and the spinal cord was stimulated with epidural electrodes, with muscle responses being recorded in arm and leg muscles. Spinal electrodes were placed either posteriorly or anteriorly, and the interval between cortex and spinal cord stimulation was varied. Pairing stimulation between the motor cortex and spinal sensory (posterior) but not spinal motor (anterior) stimulation produced motor evoked potentials that were over five times larger than brain stimulation alone. This strong augmentation occurred only when descending motor and spinal afferent stimuli were timed to converge in the spinal cord. Paired stimulation also increased the selectivity of muscle responses relative to unpaired brain or spinal cord stimulation. Finally, clinical signs suggest that facilitation was observed in both injured and uninjured segments of the spinal cord. The large effect size of this paired stimulation makes it a promising candidate for therapeutic neuromodulation. KEY POINTS: Pairs of stimuli designed to alter nervous system function typically target the motor system, or one targets the sensory system and the other targets the motor system for convergence in cortex. In humans undergoing clinically indicated surgery, we tested paired brain and spinal cord stimulation that we developed in rats aiming to target sensorimotor convergence in the cervical cord. Arm and hand muscle responses to paired sensorimotor stimulation were more than five times larger than brain or spinal cord stimulation alone when applied to the posterior but not anterior spinal cord. Arm and hand muscle responses to paired stimulation were more selective for targeted muscles than the brain- or spinal-only conditions, especially at latencies that produced the strongest effects of paired stimulation. Measures of clinical evidence of compression were only weakly related to the paired stimulation effect, suggesting that it could be applied as therapy in people affected by disorders of the central nervous system.
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Affiliation(s)
- James R McIntosh
- Department of Neurology, Columbia University, New York, NY, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Evan F Joiner
- Department of Neurological Surgery, Columbia University, New York, NY, USA
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Phoebe Greenwald
- Department of Neurological Surgery, Columbia University, New York, NY, USA
| | - Alexandra C Dionne
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Lynda M Murray
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Med. Ctr., Bronx, NY, USA
| | - Earl Thuet
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Oleg Modik
- Department of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Evgeny Shelkov
- Department of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Joseph M Lombardi
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - K Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Noam Y Harel
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Med. Ctr., Bronx, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Christopher Mandigo
- Department of Neurological Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Jason B Carmel
- Department of Neurology, Columbia University, New York, NY, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
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2
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Malloy DC, Côté MP. Multi-session transcutaneous spinal cord stimulation prevents chloride homeostasis imbalance and the development of hyperreflexia after spinal cord injury in rat. Exp Neurol 2024; 376:114754. [PMID: 38493983 DOI: 10.1016/j.expneurol.2024.114754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.
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Affiliation(s)
- Dillon C Malloy
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
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3
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Grau JW, Hudson KE, Johnston DT, Partipilo SR. Updating perspectives on spinal cord function: motor coordination, timing, relational processing, and memory below the brain. Front Syst Neurosci 2024; 18:1184597. [PMID: 38444825 PMCID: PMC10912355 DOI: 10.3389/fnsys.2024.1184597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Those studying neural systems within the brain have historically assumed that lower-level processes in the spinal cord act in a mechanical manner, to relay afferent signals and execute motor commands. From this view, abstracting temporal and environmental relations is the province of the brain. Here we review work conducted over the last 50 years that challenges this perspective, demonstrating that mechanisms within the spinal cord can organize coordinated behavior (stepping), induce a lasting change in how pain (nociceptive) signals are processed, abstract stimulus-stimulus (Pavlovian) and response-outcome (instrumental) relations, and infer whether stimuli occur in a random or regular manner. The mechanisms that underlie these processes depend upon signal pathways (e.g., NMDA receptor mediated plasticity) analogous to those implicated in brain-dependent learning and memory. New data show that spinal cord injury (SCI) can enable plasticity within the spinal cord by reducing the inhibitory effect of GABA. It is suggested that the signals relayed to the brain may contain information about environmental relations and that spinal cord systems can coordinate action in response to descending signals from the brain. We further suggest that the study of stimulus processing, learning, memory, and cognitive-like processing in the spinal cord can inform our views of brain function, providing an attractive model system. Most importantly, the work has revealed new avenues of treatment for those that have suffered a SCI.
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Affiliation(s)
- James W. Grau
- Lab of Dr. James Grau, Department of Psychological and Brain Sciences, Cellular and Behavioral Neuroscience, Texas A&M University, College Station, TX, United States
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4
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Fang B, Wang L, Liu S, Zhou M, Ma H, Chang N, Ning G. Sarsasapogenin regulates the immune microenvironment through MAPK/NF-kB signaling pathway and promotes functional recovery after spinal cord injury. Heliyon 2024; 10:e25145. [PMID: 38322941 PMCID: PMC10844052 DOI: 10.1016/j.heliyon.2024.e25145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Spinal cord injury (SCI) occurs as a result of traumatic events that damage the spinal cord, leading to motor, sensory, or autonomic function impairment. Sarsasapogenin (SA), a natural steroidal compound, has been reported to have various pharmacological applications, including the treatment of inflammation, diabetic nephropathy, and neuroprotection. However, the therapeutic efficacy and underlying mechanisms of SA in the context of SCI are still unclear. This research aimed to investigate the therapeutic effects and mechanisms of SA against SCI by integrating network pharmacology analysis and experimental verification. Network pharmacology results suggested that SA may effectively treat SCI by targeting key targets such as TNF, RELA, JUN, MAPK14, and MAPK8. The underlying mechanism of this treatment may involve the MAPK (JNK) signaling pathway and inflammation-related signaling pathways such as TNF and Toll-like receptor signaling pathways. These findings highlight the therapeutic potential of SA in SCI treatment and provide valuable insights into its molecular mechanisms of action. In vivo experiments confirmed the reparative effect of SA on SCI in rats and suggested that SA could repair SCI by modulating the immune microenvironment. In vitro experiments further investigated how SA regulates the immune microenvironment by inhibiting the MAPK/NF-kB pathways. Overall, this study successfully utilized a combination of network pharmacology and experimental verification to establish that SA can regulate the immune microenvironment via the MAPK/NF-kB signaling pathway, ultimately facilitating functional recovery from SCI. Furthermore, these findings emphasize the potential of natural compounds from traditional Chinese medicine as a viable therapy for SCI treatment.
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Affiliation(s)
- Bing Fang
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- Department of Othopaedics, Affiliated Hospital of Qingdao Binhai University, Qingdao, China
| | - Liyue Wang
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Liu
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Mi Zhou
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongpeng Ma
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Nianwei Chang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guangzhi Ning
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
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5
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Zhou K, Wei W, Yang D, Zhang H, Yang W, Zhang Y, Nie Y, Hao M, Wang P, Ruan H, Zhang T, Wang S, Liu Y. Dual electrical stimulation at spinal-muscular interface reconstructs spinal sensorimotor circuits after spinal cord injury. Nat Commun 2024; 15:619. [PMID: 38242904 PMCID: PMC10799086 DOI: 10.1038/s41467-024-44898-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
The neural signals produced by varying electrical stimulation parameters lead to characteristic neural circuit responses. However, the characteristics of neural circuits reconstructed by electrical signals remain poorly understood, which greatly limits the application of such electrical neuromodulation techniques for the treatment of spinal cord injury. Here, we develop a dual electrical stimulation system that combines epidural electrical and muscle stimulation to mimic feedforward and feedback electrical signals in spinal sensorimotor circuits. We demonstrate that a stimulus frequency of 10-20 Hz under dual stimulation conditions is required for structural and functional reconstruction of spinal sensorimotor circuits, which not only activates genes associated with axonal regeneration of motoneurons, but also improves the excitability of spinal neurons. Overall, the results provide insights into neural signal decoding during spinal sensorimotor circuit reconstruction, suggesting that the combination of epidural electrical and muscle stimulation is a promising method for the treatment of spinal cord injury.
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Affiliation(s)
- Kai Zhou
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University; Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215123, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China
| | - Wei Wei
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University; Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215123, China
| | - Dan Yang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University; Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215123, China
- Department of Anatomy, School of Basic Medical Science, Guizhou Medical University, Guiyang, 550025, China
| | - Hui Zhang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University; Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215123, China
| | - Wei Yang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University; Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215123, China
| | - Yunpeng Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, 215163, China
| | - Yingnan Nie
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Mingming Hao
- i-Lab, Key Laboratory of Multifunctional Nanomaterials and Smart Systems, Suzhou Institute of Nano-tech and Nano-bionics, Chinese Academy of Sciences, Suzhou, Jiangsu, 215123, China
- Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, 315048, China
| | - Pengcheng Wang
- Institutes of Biology and Medical Sciences, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Hang Ruan
- Institutes of Biology and Medical Sciences, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Ting Zhang
- i-Lab, Key Laboratory of Multifunctional Nanomaterials and Smart Systems, Suzhou Institute of Nano-tech and Nano-bionics, Chinese Academy of Sciences, Suzhou, Jiangsu, 215123, China
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Yaobo Liu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University; Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215123, China.
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China.
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6
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McIntosh JR, Joiner EF, Goldberg JL, Greenwald P, Murray LM, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Chan AK, Riew KD, Harel NY, Virk MS, Mandigo C, Carmel JB. Timing dependent synergies between motor cortex and posterior spinal stimulation in humans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.18.23294259. [PMID: 37645795 PMCID: PMC10462218 DOI: 10.1101/2023.08.18.23294259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Volitional movement requires descending input from motor cortex and sensory feedback through the spinal cord. We previously developed a paired brain and spinal electrical stimulation approach in rats that relies on convergence of the descending motor and spinal sensory stimuli in the cervical cord. This approach strengthened sensorimotor circuits and improved volitional movement through associative plasticity. In humans it is not known whether dorsal epidural SCS targeted at the sensorimotor interface or anterior epidural SCS targeted within the motor system is effective at facilitating brain evoked responses. In 59 individuals undergoing elective cervical spine decompression surgery, the motor cortex was stimulated with scalp electrodes and the spinal cord with epidural electrodes while muscle responses were recorded in arm and leg muscles. Spinal electrodes were placed either posteriorly or anteriorly, and the interval between cortex and spinal cord stimulation was varied. Pairing stimulation between the motor cortex and spinal sensory (posterior) but not spinal motor (anterior) stimulation produced motor evoked potentials that were over five times larger than brain stimulation alone. This strong augmentation occurred only when descending motor and spinal afferent stimuli were timed to converge in the spinal cord. Paired stimulation also increased the selectivity of muscle responses relative to unpaired brain or spinal cord stimulation. Finally, paired stimulation effects were present regardless of the severity of myelopathy as measured by clinical signs or spinal cord imaging. The large effect size of this paired stimulation makes it a promising candidate for therapeutic neuromodulation.
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Affiliation(s)
- James R McIntosh
- Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- Dept. of Orthopedic Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065
| | - Evan F Joiner
- Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
| | - Jacob L Goldberg
- Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065
| | - Phoebe Greenwald
- Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
| | - Lynda M Murray
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029
- James J. Peters VA Med. Ctr., 130 West Kingsbridge Road, Bronx, NY 10468
| | - Earl Thuet
- New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034
| | - Oleg Modik
- Dept. of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065
| | - Evgeny Shelkov
- Dept. of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065
| | - Joseph M Lombardi
- Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034
| | - Zeeshan M Sardar
- Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034
| | - Ronald A Lehman
- Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034
| | - Andrew K Chan
- Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034
| | - K Daniel Riew
- Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065
- New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034
| | - Noam Y Harel
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029
- James J. Peters VA Med. Ctr., 130 West Kingsbridge Road, Bronx, NY 10468
| | - Michael S Virk
- Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065
| | - Christopher Mandigo
- Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034
| | - Jason B Carmel
- Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- Dept. of Orthopedic Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA
- Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065
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Malloy DC, Côté MP. Multi-session transcutaneous spinal cord stimulation prevents chloridehomeostasis imbalance and the development of spasticity after spinal cordinjury in rat. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.24.563419. [PMID: 37961233 PMCID: PMC10634766 DOI: 10.1101/2023.10.24.563419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.
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Affiliation(s)
- Dillon C. Malloy
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129
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8
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Grover FM, Chen B, Perez MA. Increased paired stimuli enhance corticospinal-motoneuronal plasticity in humans with spinal cord injury. J Neurophysiol 2023; 129:1414-1422. [PMID: 36752493 PMCID: PMC10259851 DOI: 10.1152/jn.00499.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
Paired corticospinal-motoneuronal stimulation (PCMS) has been used to enhance corticospinal excitability and functional outcomes in humans with spinal cord injury (SCI). Here, we examined the effect of increasing the number of paired pulses on PCMS-induced plasticity. During PCMS, corticospinal volleys evoked by transcranial magnetic stimulation (TMS) over the hand motor cortex were timed to arrive at corticospinal-motoneuronal synapses of the first dorsal interosseous (FDI) muscle 1-2 ms before the arrival of antidromic potentials elicited in motoneurons by electrical stimulation of the ulnar nerve. We tested motor-evoked potentials (MEPs) elicited by TMS over the hand motor cortex and electrical stimulation at the cervicomedullary junction (CMEPs) in the FDI muscle before and after 180 paired pulses (PCMS-180) followed up by another 180 paired pulses (PCMS-360) in humans with and without chronic incomplete cervical SCI. The nine-hole-peg-test (9HPT) was measured before and after PCMS paired pulses in individuals with SCI. We found that the size of MEPs and CMEPs increased after PCMS-180 in both groups compared with baseline and further increased after PCMS-360 in participants with SCI, suggesting a spinal origin for these effects. Notably, in people with SCI, the time to complete the 9HPT decreased after PCMS-180 and further decreased after PCMS-360 compared with baseline but not when the 9HPT was repeated overtime. Our findings demonstrate that increasing the number of PCMS paired pulses potentiates corticospinal excitability and voluntary motor output after SCI, likely through spinal plasticity. This proof-of-principle study suggests that increasing the PCMS dose represents a strategy to boost voluntary motor output after SCI.NEW & NOTEWORTHY Paired corticospinal-motoneuronal stimulation (PCMS) has been used to enhance corticospinal excitability and functional outcomes in humans with spinal cord injury (SCI). Here, we demonstrate that 360 paired pulses resulted in larger increases in motor-evoked potential size in a hand muscle and in a better ability to complete the nine-hold-peg-test compared with 180 paired pulses in people with SCI. This proof-of-principle study suggests that increasing the PCMS dose represents a strategy to boost motor output after SCI.
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Affiliation(s)
- Francis M Grover
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
| | - Bing Chen
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Edward Hines Jr. VA Hospital, Chicago, Illinois, United States
| | - Monica A Perez
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
- Edward Hines Jr. VA Hospital, Chicago, Illinois, United States
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9
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Sasaki R, Tamura K, Kim TK, Takatani T, Nakagawa I, Park YS, Nakase H. Tetanic Stimulation of the Pudendal Nerve Amplifies Intraoperative Motor Evoked Potential in Pediatric Craniotomy. World Neurosurg 2023; 174:227-228. [PMID: 37037681 DOI: 10.1016/j.wneu.2023.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- Ryota Sasaki
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tae Kyun Kim
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tsunenori Takatani
- Department of Central Operation, Nara Medical University, Kashihara, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
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10
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McIntosh JR, Joiner EF, Goldberg JL, Murray LM, Yasin B, Mendiratta A, Karceski SC, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Mandigo C, Riew KD, Harel NY, Virk MS, Carmel JB. Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses. J Neurophysiol 2023; 129:66-82. [PMID: 36417309 PMCID: PMC9799146 DOI: 10.1152/jn.00235.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although epidural stimulation of the lumbar spinal cord has emerged as a powerful modality for recovery of movement, how it should be targeted to the cervical spinal cord to activate arm and hand muscles is not well understood, particularly in humans. We sought to map muscle responses to posterior epidural cervical spinal cord stimulation in humans. We hypothesized that lateral stimulation over the dorsal root entry zone would be most effective and responses would be strongest in the muscles innervated by the stimulated segment. Twenty-six people undergoing clinically indicated cervical spine surgery consented to mapping of motor responses. During surgery, stimulation was performed in midline and lateral positions at multiple exposed segments; six arm and three leg muscles were recorded on each side of the body. Across all segments and muscles tested, lateral stimulation produced stronger muscle responses than midline despite similar latency and shape of responses. Muscles innervated at a cervical segment had the largest responses from stimulation at that segment, but responses were also observed in muscles innervated at other cervical segments and in leg muscles. The cervical responses were clustered in rostral (C4-C6) and caudal (C7-T1) cervical segments. Strong responses to lateral stimulation are likely due to the proximity of stimulation to afferent axons. Small changes in response sizes to stimulation of adjacent cervical segments argue for local circuit integration, and distant muscle responses suggest activation of long propriospinal connections. This map can help guide cervical stimulation to improve arm and hand function.NEW & NOTEWORTHY A map of muscle responses to cervical epidural stimulation during clinically indicated surgery revealed strongest activation when stimulating laterally compared to midline and revealed differences to be weaker than expected across different segments. In contrast, waveform shapes and latencies were most similar when stimulating midline and laterally, indicating activation of overlapping circuitry. Thus, a map of the cervical spinal cord reveals organization and may help guide stimulation to activate arm and hand muscles strongly and selectively.
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Affiliation(s)
- James R. McIntosh
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Evan F. Joiner
- 2Department of Neurological Surgery, Columbia University, New York, New York
| | - Jacob L. Goldberg
- 4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Lynda M. Murray
- 8Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York,9James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Bushra Yasin
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Anil Mendiratta
- 3Department of Neurology, Columbia University, New York, New York
| | - Steven C. Karceski
- 5Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Earl Thuet
- 6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Oleg Modik
- 5Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Evgeny Shelkov
- 5Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Joseph M. Lombardi
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Zeeshan M. Sardar
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Ronald A. Lehman
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Christopher Mandigo
- 2Department of Neurological Surgery, Columbia University, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - K. Daniel Riew
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York,6New York Presbyterian, Och Spine Hospital, New York, New York
| | - Noam Y. Harel
- 7Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York,8Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York,9James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Michael S. Virk
- 4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Jason B. Carmel
- 1Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York,3Department of Neurology, Columbia University, New York, New York,4Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
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11
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Pal A, Park H, Ramamurthy A, Asan AS, Bethea T, Johnkutty M, Carmel JB. Spinal cord associative plasticity improves forelimb sensorimotor function after cervical injury. Brain 2022; 145:4531-4544. [PMID: 36063483 PMCID: PMC10200304 DOI: 10.1093/brain/awac235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 01/06/2023] Open
Abstract
Associative plasticity occurs when two stimuli converge on a common neural target. Previous efforts to promote associative plasticity have targeted cortex, with variable and moderate effects. In addition, the targeted circuits are inferred, rather than tested directly. In contrast, we sought to target the strong convergence between motor and sensory systems in the spinal cord. We developed spinal cord associative plasticity, precisely timed pairing of motor cortex and dorsal spinal cord stimulations, to target this interaction. We tested the hypothesis that properly timed paired stimulation would strengthen the sensorimotor connections in the spinal cord and improve recovery after spinal cord injury. We tested physiological effects of paired stimulation, the pathways that mediate it, and its function in a preclinical trial. Subthreshold spinal cord stimulation strongly augmented motor cortex evoked muscle potentials at the time they were paired, but only when they arrived synchronously in the spinal cord. This paired stimulation effect depended on both cortical descending motor and spinal cord proprioceptive afferents; selective inactivation of either of these pathways fully abrogated the paired stimulation effect. Spinal cord associative plasticity, repetitive pairing of these pathways for 5 or 30 min in awake rats, increased spinal excitability for hours after pairing ended. To apply spinal cord associative plasticity as therapy, we optimized the parameters to promote strong and long-lasting effects. This effect was just as strong in rats with cervical spinal cord injury as in uninjured rats, demonstrating that spared connections after moderate spinal cord injury were sufficient to support plasticity. In a blinded trial, rats received a moderate C4 contusive spinal cord injury. Ten days after injury, they were randomized to 30 min of spinal cord associative plasticity each day for 10 days or sham stimulation. Rats with spinal cord associative plasticity had significantly improved function on the primary outcome measure, a test of dexterity during manipulation of food, at 50 days after spinal cord injury. In addition, rats with spinal cord associative plasticity had persistently stronger responses to cortical and spinal stimulation than sham stimulation rats, indicating a spinal locus of plasticity. After spinal cord associative plasticity, rats had near normalization of H-reflex modulation. The groups had no difference in the rat grimace scale, a measure of pain. We conclude that spinal cord associative plasticity strengthens sensorimotor connections within the spinal cord, resulting in partial recovery of reflex modulation and forelimb function after moderate spinal cord injury. Since both motor cortex and spinal cord stimulation are performed routinely in humans, this approach can be trialled in people with spinal cord injury or other disorders that damage sensorimotor connections and impair dexterity.
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Affiliation(s)
- Ajay Pal
- Department of Orthopedics, Columbia University, New York, NY 10032, USA
| | - HongGeun Park
- Department of Orthopedics, Columbia University, New York, NY 10032, USA
| | - Aditya Ramamurthy
- Department of Orthopedics, Columbia University, New York, NY 10032, USA
| | - Ahmet S Asan
- Department of Orthopedics, Columbia University, New York, NY 10032, USA
| | - Thelma Bethea
- Department of Orthopedics, Columbia University, New York, NY 10032, USA
| | - Meenu Johnkutty
- Department of Orthopedics, Columbia University, New York, NY 10032, USA
| | - Jason B Carmel
- Department of Orthopedics, Columbia University, New York, NY 10032, USA
- Department of Neurology, Columbia University, New York, NY 10032, USA
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12
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Adeel M, Lin BS, Chen HC, Lai CH, Liou JC, Wu CW, Chan WP, Peng CW. Motor Neuroplastic Effects of a Novel Paired Stimulation Technology in an Incomplete Spinal Cord Injury Animal Model. Int J Mol Sci 2022; 23:ijms23169447. [PMID: 36012710 PMCID: PMC9409074 DOI: 10.3390/ijms23169447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Paired stimulation of the brain and spinal cord can remodel the central nervous tissue circuitry in an animal model to induce motor neuroplasticity. The effects of simultaneous stimulation vary according to the extent and severity of spinal cord injury. Therefore, our study aimed to determine the significant effects on an incomplete SCI rat brain and spinal cord through 3 min and 20 min stimulations after 4 weeks of intervention. Thirty-three Sprague Dawley rats were classified into six groups: (1) normal, (2) sham, (3) iTBS/tsDCS, (4) iTBS/ts-iTBS, (5) rTMS/tsDCS, and (6) rTMS/ts-iTBS. Paired stimulation of the brain cortex and spinal cord thoracic (T10) level was applied simultaneously for 3−20 min. The motor evoked potential (MEP) and Basso, Beattie, and Bresnahan (BBB) scores were recorded after every week of intervention for four weeks along with wheel training for 20 min. Three-minute stimulation with the iTBS/tsDCS intervention induced a significant (p < 0.050 *) increase in MEP after week 2 and week 4 treatments, while 3 min iTBS/ts-iTBS significantly improved MEP (p < 0.050 *) only after the week 3 intervention. The 20 min rTMS/ts-iTBS intervention showed a significant change only in post_5 min after week 4. The BBB score also changed significantly in all groups except for the 20 min rTMS/tsDCS intervention. iTBS/tsDCS and rTMS/ts-iTBS interventions induce neuroplasticity in an incomplete SCI animal model by significantly changing electrophysiological (MEP) and locomotion (BBB) outcomes.
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Affiliation(s)
- Muhammad Adeel
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City 237, Taiwan
| | - Bor-Shing Lin
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City 237, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Jian-Chiun Liou
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Wei Wu
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Research Center of Biomedical Device, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: ; Tel./Fax: +886-2-2736-1661 (ext. 3070)
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13
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Mesquida-Veny F, Martínez-Torres S, Del Río JA, Hervera A. Genetic control of neuronal activity enhances axonal growth only on permissive substrates. Mol Med 2022; 28:97. [PMID: 35978278 PMCID: PMC9387030 DOI: 10.1186/s10020-022-00524-2] [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: 04/26/2022] [Accepted: 08/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Neural tissue has limited regenerative ability. To cope with that, in recent years a diverse set of novel tools has been used to tailor neurostimulation therapies and promote functional regeneration after axonal injuries. Method In this report, we explore cell-specific methods to modulate neuronal activity, including opto- and chemogenetics to assess the effect of specific neuronal stimulation in the promotion of axonal regeneration after injury. Results Opto- and chemogenetic stimulations of neuronal activity elicited increased in vitro neurite outgrowth in both sensory and cortical neurons, as well as in vivo regeneration in the sciatic nerve, but not after spinal cord injury. Mechanistically, inhibitory substrates such as chondroitin sulfate proteoglycans block the activity induced increase in axonal growth. Conclusions We found that genetic modulations of neuronal activity on both dorsal root ganglia and corticospinal motor neurons increase their axonal growth capacity but only on permissive environments. Supplementary Information The online version contains supplementary material available at 10.1186/s10020-022-00524-2.
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Affiliation(s)
- Francina Mesquida-Veny
- Molecular and Cellular Neurobiotechnology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona, Spain.,Network Centre of Biomedical Research of Neurodegenerative Diseases (CIBERNED), Institute of Health Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Sara Martínez-Torres
- Molecular and Cellular Neurobiotechnology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona, Spain.,Network Centre of Biomedical Research of Neurodegenerative Diseases (CIBERNED), Institute of Health Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - José Antonio Del Río
- Molecular and Cellular Neurobiotechnology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona, Spain.,Network Centre of Biomedical Research of Neurodegenerative Diseases (CIBERNED), Institute of Health Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Arnau Hervera
- Molecular and Cellular Neurobiotechnology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain. .,Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona, Spain. .,Network Centre of Biomedical Research of Neurodegenerative Diseases (CIBERNED), Institute of Health Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain. .,Institute of Neuroscience, University of Barcelona, Barcelona, Spain.
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14
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Progression in translational research on spinal cord injury based on microenvironment imbalance. Bone Res 2022; 10:35. [PMID: 35396505 PMCID: PMC8993811 DOI: 10.1038/s41413-022-00199-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/14/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023] Open
Abstract
Spinal cord injury (SCI) leads to loss of motor and sensory function below the injury level and imposes a considerable burden on patients, families, and society. Repair of the injured spinal cord has been recognized as a global medical challenge for many years. Significant progress has been made in research on the pathological mechanism of spinal cord injury. In particular, with the development of gene regulation, cell sequencing, and cell tracing technologies, in-depth explorations of the SCI microenvironment have become more feasible. However, translational studies related to repair of the injured spinal cord have not yielded significant results. This review summarizes the latest research progress on two aspects of SCI pathology: intraneuronal microenvironment imbalance and regenerative microenvironment imbalance. We also review repair strategies for the injured spinal cord based on microenvironment imbalance, including medications, cell transplantation, exosomes, tissue engineering, cell reprogramming, and rehabilitation. The current state of translational research on SCI and future directions are also discussed. The development of a combined, precise, and multitemporal strategy for repairing the injured spinal cord is a potential future direction.
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15
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Adapting Human-Based Transcutaneous Spinal Cord Stimulation to Develop a Clinically Relevant Animal Model. J Clin Med 2022; 11:jcm11072023. [PMID: 35407636 PMCID: PMC8999945 DOI: 10.3390/jcm11072023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 02/01/2023] Open
Abstract
Transcutaneous spinal cord stimulation (tSCS) as a neuromodulatory strategy has received great attention as a method to promote functional recovery after spinal cord injury (SCI). However, due to the noninvasive nature of tSCS, investigations have primarily focused on human applications. This leaves a critical need for the development of a suitable animal model to further our understanding of this therapeutic intervention in terms of functional and neuroanatomical plasticity and to optimize stimulation protocols. The objective of this study is to establish a new animal model of thoracolumbar tSCS that (1) can accurately recapitulate studies in healthy humans and (2) can receive a repeated and stable tSCS treatment after SCI with minimal restraint, while the electrode remains consistently positioned. We show that our model displays bilateral evoked potentials in multisegmental leg muscles characteristically comparable to humans. Our data also suggest that tSCS mainly activates dorsal root structures like in humans, thereby accounting for the different electrode-to-body-size ratio between the two species. Finally, a repeated tSCS treatment protocol in the awake rat after a complete spinal cord transection is feasible, tolerable, and safe, even with minimal body restraint. Additionally, repeated tSCS was capable of modulating motor output after SCI, providing an avenue to further investigate stimulation-based neuroplasticity and optimize treatment.
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16
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Effects of paired stimulation with specific waveforms on cortical and spinal plasticity in subjects with a chronic spinal cord injury. J Formos Med Assoc 2022; 121:2044-2056. [DOI: 10.1016/j.jfma.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/13/2021] [Accepted: 02/17/2022] [Indexed: 12/16/2022] Open
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17
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Asan AS, McIntosh JR, Carmel JB. Targeting Sensory and Motor Integration for Recovery of Movement After CNS Injury. Front Neurosci 2022; 15:791824. [PMID: 35126040 PMCID: PMC8813971 DOI: 10.3389/fnins.2021.791824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/27/2021] [Indexed: 12/18/2022] Open
Abstract
The central nervous system (CNS) integrates sensory and motor information to acquire skilled movements, known as sensory-motor integration (SMI). The reciprocal interaction of the sensory and motor systems is a prerequisite for learning and performing skilled movement. Injury to various nodes of the sensorimotor network causes impairment in movement execution and learning. Stimulation methods have been developed to directly recruit the sensorimotor system and modulate neural networks to restore movement after CNS injury. Part 1 reviews the main processes and anatomical interactions responsible for SMI in health. Part 2 details the effects of injury on sites critical for SMI, including the spinal cord, cerebellum, and cerebral cortex. Finally, Part 3 reviews the application of activity-dependent plasticity in ways that specifically target integration of sensory and motor systems. Understanding of each of these components is needed to advance strategies targeting SMI to improve rehabilitation in humans after injury.
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Affiliation(s)
| | | | - Jason B. Carmel
- Departments of Neurology and Orthopedics, Columbia University, New York, NY, United States
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18
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Spinal cord imaging markers and recovery of standing with epidural stimulation in individuals with clinically motor complete spinal cord injury. Exp Brain Res 2021; 240:279-288. [PMID: 34854934 DOI: 10.1007/s00221-021-06272-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 02/04/2023]
Abstract
Spinal cord epidural stimulation (scES) is an intervention to restore motor function in those with severe spinal cord injury (SCI). Spinal cord lesion characteristics assessed via magnetic resonance imaging (MRI) may contribute to understand motor recovery. This study assessed relationships between standing ability with scES and spared spinal cord tissue characteristics at the lesion site. We hypothesized that the amount of lateral spared cord tissue would be related to independent extension in the ipsilateral lower limb. Eleven individuals with chronic, clinically motor complete SCI underwent spinal cord MRI, and were subsequently implanted with scES. Standing ability and lower limb activation patterns were assessed during an overground standing experiment with scES. This assessment occurred prior to any activity-based intervention with scES. Lesion hyperintensity was segmented from T2 axial images, and template-based analysis was used to estimate spared tissue in anterior, posterior, right, and left spinal cord regions. Regression analysis was used to assess relationships between imaging and standing outcomes. Total volume of spared tissue was related to left (p = 0.007), right (p = 0.005), and bilateral (p = 0.011) lower limb extension. Spared tissue in the left cord region was related to left lower limb extension (p = 0.019). A positive trend (p = 0.138) was also observed between right spared cord tissue and right lower limb extension. In this study, MRI measures of spared spinal cord tissue were significantly related to standing outcomes with scES. These preliminary results warrant future investigation of roles of supraspinal input and MRI-detected spared spinal cord tissue on lower limb motor responsiveness to scES.
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19
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Wecht JR, Savage WM, Famodimu GO, Mendez GA, Levine JM, Maher MT, Weir JP, Wecht JM, Carmel JB, Wu YK, Harel NY. Posteroanterior Cervical Transcutaneous Spinal Cord Stimulation: Interactions with Cortical and Peripheral Nerve Stimulation. J Clin Med 2021; 10:jcm10225304. [PMID: 34830584 PMCID: PMC8623612 DOI: 10.3390/jcm10225304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022] Open
Abstract
Transcutaneous spinal cord stimulation (TSCS) has demonstrated potential to beneficially modulate spinal cord motor and autonomic circuitry. We are interested in pairing cervical TSCS with other forms of nervous system stimulation to enhance synaptic plasticity in circuits serving hand function. We use a novel configuration for cervical TSCS in which the anode is placed anteriorly over ~C4–C5 and the cathode posteriorly over ~T2–T4. We measured the effects of single pulses of TSCS paired with single pulses of motor cortex or median nerve stimulation timed to arrive at the cervical spinal cord at varying intervals. In 13 participants with and 15 participants without chronic cervical spinal cord injury, we observed that subthreshold TSCS facilitates hand muscle responses to motor cortex stimulation, with a tendency toward greater facilitation when TSCS is timed to arrive at cervical synapses simultaneously or up to 10 milliseconds after cortical stimulus arrival. Single pulses of subthreshold TSCS had no effect on the amplitudes of median H-reflex responses or F-wave responses. These findings support a model in which TSCS paired with appropriately timed cortical stimulation has the potential to facilitate convergent transmission between descending motor circuits, segmental afferents, and spinal motor neurons serving the hand. Studies with larger numbers of participants and repetitively paired cortical and spinal stimulation are needed.
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Affiliation(s)
- Jaclyn R. Wecht
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - William M. Savage
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Grace O. Famodimu
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Gregory A. Mendez
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Jonah M. Levine
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Matthew T. Maher
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
| | - Joseph P. Weir
- Department of Health, Sport & Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA;
| | - Jill M. Wecht
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jason B. Carmel
- Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA;
| | - Yu-Kuang Wu
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noam Y. Harel
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; (J.R.W.); (W.M.S.); (G.O.F.); (G.A.M.); (J.M.L.); (M.T.M.); (J.M.W.); (Y.-K.W.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence:
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20
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Al'joboori Y, Hannah R, Lenham F, Borgas P, Kremers CJP, Bunday KL, Rothwell J, Duffell LD. The Immediate and Short-Term Effects of Transcutaneous Spinal Cord Stimulation and Peripheral Nerve Stimulation on Corticospinal Excitability. Front Neurosci 2021; 15:749042. [PMID: 34744614 PMCID: PMC8566815 DOI: 10.3389/fnins.2021.749042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Rehabilitative interventions involving electrical stimulation show promise for neuroplastic recovery in people living with Spinal Cord Injury (SCI). However, the understanding of how stimulation interacts with descending and spinal excitability remain unclear. In this study we compared the immediate and short-term (within a few minutes) effects of pairing Transcranial Magnetic Stimulation (TMS) with transcutaneous Spinal Cord stimulation (tSCS) and Peripheral Nerve Stimulation (PNS) on Corticospinal excitability in healthy subjects. Three separate experimental conditions were assessed. In Experiment I, paired associative stimulation (PAS) was applied, involving repeated pairing of single pulses of TMS and tSCS, either arriving simultaneously at the spinal motoneurones (PAS0ms) or slightly delayed (PAS5ms). Corticospinal and spinal excitability, and motor performance, were assessed before and after the PAS interventions in 24 subjects. Experiment II compared the immediate effects of tSCS and PNS on corticospinal excitability in 20 subjects. Experiment III compared the immediate effects of tSCS with tSCS delivered at the same stimulation amplitude but modulated with a carrier frequency (in the kHz range) on corticospinal excitability in 10 subjects. Electromyography (EMG) electrodes were placed over the Tibialis Anterior (TA) soleus (SOL) and vastus medialis (VM) muscles and stimulation electrodes (cathodes) were placed on the lumbar spine (tSCS) and lateral to the popliteal fossa (PNS). TMS over the primary motor cortex (M1) was paired with tSCS or PNS to produce Motor Evoked Potentials (MEPs) in the TA and SOL muscles. Simultaneous delivery of repetitive PAS (PAS0ms) increased corticospinal excitability and H-reflex amplitude at least 5 min after the intervention, and dorsiflexion force was increased in a force-matching task. When comparing effects on descending excitability between tSCS and PNS, a subsequent facilitation in MEPs was observed following tSCS at 30-50 ms which was not present following PNS. To a lesser extent this facilitatory effect was also observed with HF- tSCS at subthreshold currents. Here we have shown that repeated pairing of TMS and tSCS can increase corticospinal excitability when timed to arrive simultaneously at the alpha-motoneurone and can influence functional motor output. These results may be useful in optimizing stimulation parameters for neuroplasticity in people living with SCI.
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Affiliation(s)
- Yazi Al'joboori
- Department of Medical Physics & Biomedical Engineering, University College London, London, United Kingdom
| | - Ricci Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Francesca Lenham
- Department of Medical Physics & Biomedical Engineering, University College London, London, United Kingdom
| | - Pia Borgas
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Charlotte J P Kremers
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Karen L Bunday
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom.,Psychology, School of Social Sciences, University of Westminster, London, United Kingdom
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Lynsey D Duffell
- Department of Medical Physics & Biomedical Engineering, University College London, London, United Kingdom
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21
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Zhang Z, Lin BS, Peng CW, Chan WP, Lin BS, Lai CH. Design of a Novel Paired Associative Nerve Stimulation System and Treatment Strategy for Incomplete Spinal Cord Injury: A Preliminary Study. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1341-1349. [PMID: 34242169 DOI: 10.1109/tnsre.2021.3095842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Paired associative nerve stimulation (PANS) was proposed as a potential nerve rehabilitation treatment strategy. However, few relevant documents are available regarding the strategy, and only a few clinical studies have involved healthy people. To determine the feasibility of the neurorehabilitation treatment and to estimate the effect of PANS on nerve plasticity for individuals with incomplete spinal cord injury (iSCI), a design combining repetitive transcranial magnetic stimulation (rTMS) with trans-spinal electrical stimulation was developed for treating individuals with iSCI in this pilot case study. First, a novel PANS system with multiple stimulation modes was designed and verified with resistors and a metal coil as load. Then, the system was applied to three individuals with iSCI, and five types of paired associative stimulation was performed to confirm the feasibility of the system and determine the most effective treatment strategy. The preliminary result showed that 20-Hz rTMS combined with cathodal trans-spinal direct current stimulation (tsDCS) had the greatest effect on corticospinal excitability. Next, stimulations of 20-Hz rTMS (brain) and sham (spine) as well as sham (brain) and cathode tsDCS (spine) were administered to individuals with iSCI, and the results revealed that paired associative stimulation of brain and spine was more effective than only 20-Hz rTMS brain stimulation or cathodal tsDCS stimulation for corticospinal plasticity.
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22
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Sharma P, Shah PK. In vivo electrophysiological mechanisms underlying cervical epidural stimulation in adult rats. J Physiol 2021; 599:3121-3150. [PMID: 33894695 DOI: 10.1113/jp281146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS To electrophysiologically determine the predominant neural structures activated with cervical epidural stimulation (ES), well-established electrophysiological protocols (single-pulse, paired-pulse and multiple frequency stimulation) were delivered at rest, during motor activity and under anaesthesia in adult rats. Cervical ES resulted in spinal evoked motor responses with three different waveforms - early response (ER), middle response (MR) and late response (LR). ERs remained unmodulated by repeated stimulation protocols. In contrast, MRs and LRs were modulated by repeated stimulation protocols and volitional motor activity. ERs are consequential to the direct activation of motor efferents; MRs are secondary to type-I sensory afferent activation and LRs result from the engagement of wider spinal interneuronal circuitry with potential influence from supraspinal pathways. Evidence from this work is fundamental in enhancing our understanding of cervical ES, and critical in refining the design of neuromodulation-based rehabilitative strategies and in the construction of neuroprosthetics. ABSTRACT Epidural stimulation (ES) of the lumbar spinal cord has demonstrated significant improvements in various physiological functions after a traumatic spinal cord injury in humans. Electrophysiological evidence from rodent, human and computational studies collectively suggest that the functional recovery following lumbar ES is mediated via direct activation of sensory afferent fibres. However, the mechanisms underlying cervical ES have not been comprehensively studied, which greatly limits our understanding of its effectiveness in restoring upper limb function. In this work, we determined the predominant neural structures that are activated with cervical ES using in vivo cervical spinal evoked motor responses (SEMRs). Standard electrophysiological protocols (single-pulse, paired-pulse and multiple frequency stimulation) were implemented in 11 awake and anaesthetized rats in four experimental stages. Three distinct types of cervical SEMRs were identified based on latency of their appearance: early response (ER), middle response (MR) and late response (LR). ERs remained unmodulated by repeated stimulation protocols. MRs and LRs were modulated by repeated stimulation protocols and volitional motor activity. Except for LRs being completely abolished under urethane, ketamine or urethane anaesthesia did not affect the appearance of cervical SEMRs. Our data, backed by literature, suggest that ERs are secondary to the direct activation of motor efferents, MRs are elicited by activation of type-I sensory afferents and LRs result from the engagement of interneuronal circuitry with potential influence from supraspinal pathways. The gathered information paves the way to designing motor rehabilitation strategies that can utilize cervical ES to recover upper limb function following neurological deficits.
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Affiliation(s)
- Pawan Sharma
- Division of Rehabilitation Sciences, Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, Stony Brook, NY, 11727, USA
| | - Prithvi K Shah
- Division of Rehabilitation Sciences, Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, Stony Brook, NY, 11727, USA
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23
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Ting WKC, Fadul FAR, Fecteau S, Ethier C. Neurostimulation for Stroke Rehabilitation. Front Neurosci 2021; 15:649459. [PMID: 34054410 PMCID: PMC8160247 DOI: 10.3389/fnins.2021.649459] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Neurological injuries such as strokes can lead to important loss in motor function. Thanks to neuronal plasticity, some of the lost functionality may be recovered over time. However, the recovery process is often slow and incomplete, despite the most effective conventional rehabilitation therapies. As we improve our understanding of the rules governing activity-dependent plasticity, neuromodulation interventions are being developed to harness neural plasticity to achieve faster and more complete recovery. Here, we review the principles underlying stimulation-driven plasticity as well as the most commonly used stimulation techniques and approaches. We argue that increased spatiotemporal precision is an important factor to improve the efficacy of neurostimulation and drive a more useful neuronal reorganization. Consequently, closed-loop systems and optogenetic stimulation hold theoretical promise as interventions to promote brain repair after stroke.
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Affiliation(s)
- Windsor Kwan-Chun Ting
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Faïza Abdou-Rahaman Fadul
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Shirley Fecteau
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
| | - Christian Ethier
- Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec City, QC, Canada
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24
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Fujiki M, Kuga K, Ozaki H, Kawasaki Y, Fudaba H. Blockade of Motor Cortical Long-Term Potentiation Induction by Glutamatergic Dysfunction Causes Abnormal Neurobehavior in an Experimental Subarachnoid Hemorrhage Model. Front Neural Circuits 2021; 15:670189. [PMID: 33897380 PMCID: PMC8063030 DOI: 10.3389/fncir.2021.670189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/17/2021] [Indexed: 01/11/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) is a life-threatening condition that can also lead to permanent paralysis. However, the mechanisms that underlying neurobehavioral deficits after SAH have not been fully elucidated. As theta burst stimulation (TBS) can induce long-term potentiation (LTP) in the motor cortex, we tested its potential as a functional evaluation tool after experimentally induced SAH. Motor cortical inter-neuronal excitability was evaluated in anesthetized rats after 200 Hz-quadripulse TBS (QTS5), 200 Hz-quadripulse stimulation (QPS5), and 400 Hz-octapulse stimulation (OPS2.5). Furthermore, correlation between motor cortical LTP and N-methyl-D-aspartate-receptor activation was evaluated using MK-801, a NMDA-receptor antagonist. We evaluated inhibition-facilitation configurations [interstimulus interval: 3 ms; short-latency intracortical inhibition (SICI) and 11 ms; intracortical facilitation (ICF)] with paired electrical stimulation protocols and the effect of TBS paradigm on continuous recording of motor-evoked potentials (MEPs) for quantitative parameters. SAH and MK-801 completely blocked ICF, while SICI was preserved. QTS5, QPS5, and OPS2.5 facilitated continuous MEPs, persisting for 180 min. Both SAH and MK-801 completely blocked MEP facilitations after QPS5 and OPS2.5, while MEP facilitations after QTS5 were preserved. Significant correlations were found among neurological scores and 3 ms-SICI rates, 11 ms-ICF rates, and MEP facilitation rates after 200 Hz-QTS5, 7 days after SAH (R2 = 0.6236; r = −0.79, R2 = 0.6053; r = −0.77 and R2 = 0.9071; r = 0.95, p < 0.05, respectively). Although these findings need to be verified in humans, our study demonstrates that the neurophysiological parameters 3 ms-SICI, 11 ms-ICF, and 200 Hz-QTS5-MEPs may be useful surrogate quantitative biomarkers for assessing inter-neuronal function after SAH.
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Affiliation(s)
- Minoru Fujiki
- Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan
| | - Kazuhiro Kuga
- Drug Safety Research and Evaluation, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Harushige Ozaki
- Drug Safety Research and Evaluation, Takeda Pharmaceutical Company Limited, Fujisawa, Japan
| | - Yukari Kawasaki
- Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan
| | - Hirotaka Fudaba
- Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan
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25
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Huot-Lavoie M, Ethier C, Ting W, Burns D. Assessment of Corticospinal Excitability in Awake Rodents Using EMG-Controlled Intracortical Stimulation. Bio Protoc 2021; 11:e4267. [DOI: 10.21769/bioprotoc.4267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 11/02/2022] Open
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26
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Rejc E, Smith AC, Weber KA, Ugiliweneza B, Bert RJ, Negahdar M, Boakye M, Harkema SJ, Angeli CA. Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury. Front Syst Neurosci 2020; 14:559313. [PMID: 33192348 PMCID: PMC7654217 DOI: 10.3389/fnsys.2020.559313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/28/2020] [Indexed: 01/07/2023] Open
Abstract
Previous studies have shown that epidural stimulation of the lumbosacral spinal cord (scES) can re-enable lower limb volitional motor control in individuals with chronic, clinically motor complete spinal cord injury (SCI). This observation entails that residual supraspinal connectivity to the lumbosacral spinal circuitry still persisted after SCI, although it was non-detectable when scES was not provided. In the present study, we aimed at exploring further the mechanisms underlying scES-promoted recovery of volitional lower limb motor control by investigating neuroimaging markers at the spinal cord lesion site via magnetic resonance imaging (MRI). Spinal cord MRI was collected prior to epidural stimulator implantation in 13 individuals with chronic, clinically motor complete SCI, and the spared tissue of specific regions of the spinal cord (anterior, posterior, right, left, and total cord) was assessed. After epidural stimulator implantation, and prior to any training, volitional motor control was evaluated during left and right lower limb flexion and ankle dorsiflexion attempts. The ability to generate force exertion and movement was not correlated to any neuroimaging marker. On the other hand, spared tissue of specific cord regions significantly and importantly correlated with some aspects of motor control that include activation amplitude of antagonist (negative correlation) muscles during left ankle dorsiflexion, and electromyographic coordination patterns during right lower limb flexion. The fact that amount and location of spared spinal cord tissue at the lesion site were not related to the ability to generate volitional lower limb movements may suggest that supraspinal inputs through spared spinal cord regions that differ across individuals can result in the generation of lower limb volitional motor output prior to any training when epidural stimulation is provided.
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Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Andrew C Smith
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, United States
| | - Kenneth A Weber
- Department of Anethesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Robert J Bert
- Department of Radiology, University of Louisville, Louisville, KY, United States
| | | | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States.,Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States.,Department of Bioengineering, University of Louisville, Louisville, KY, United States
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27
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Lo MC, Younk R, Widge AS. Paired Electrical Pulse Trains for Controlling Connectivity in Emotion-Related Brain Circuitry. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2721-2730. [PMID: 33048668 DOI: 10.1109/tnsre.2020.3030714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neurostimulation therapies for psychiatric disorders often have limited clinical efficacy. The limited efficacy might arise from a mismatch between therapy and disease mechanisms. Mental disorders are believed to arise from communication breakdown in distributed brain circuits, and thus altering connectivity between brain regions might be an effective way to restore normal brain communication. Synchronized neural oscillations (coherence) and synaptic strength are two common measures of brain connectivity. In this work, we developed an electrical stimulation method for altering narrow-frequency-band (theta, 5-8 Hz) coherence and synaptic strength. We tested this method in a circuit between infralimbic cortex (IL) and basolateral amygdala (BLA), which is broadly implicated in fear regulation. 6 Hz pulse trains were delivered into IL and BLA with various inter-train lags. These paired trains induced long-lasting synaptic strength change and a brief coherence enhancement in the IL-BLA circuit. This enhancement was specific to the "top-down" (IL-to-BLA) direction, and only occurred when the IL and BLA pulse trains had a relative lag of 180° (83 ms). Since the IL-BLA connection is known to be highly relevant to fear regulation, this method provides a tool to study the relationship between brain connectivity and fear behaviors. Further, it may be a new approach to study the relative roles of synaptic strength and oscillatory synchrony in brain network communication.
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28
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Fujiki M, Kawasaki Y, Fudaba H. Continuous Theta-Burst Stimulation Intensity Dependently Facilitates Motor-Evoked Potentials Following Focal Electrical Stimulation of the Rat Motor Cortex. Front Neural Circuits 2020; 14:585624. [PMID: 33117132 PMCID: PMC7553073 DOI: 10.3389/fncir.2020.585624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 01/28/2023] Open
Abstract
Although theta-burst stimulation (TBS) is known to differentially modify motor cortical excitability according to stimulus conditions in humans, whether similar effects can be seen in animals, in particular rats, remains to be defined. Given the importance of experimental rat models for humans, this study explored this stimulation paradigm in rats. Specifically, this study aimed to explore corticospinal excitability after TBS in anesthetized animals to confirm its comparability with human results. Both inhibition-facilitation configurations using paired electrical stimulation protocols and the effects of the TBS paradigm on motor-evoked potentials (MEPs) in rat descending motor pathways were assessed. Paired-stimulation MEPs showed inhibition [interstimulus interval (ISI): 3 ms] and facilitation (11 ms) patterns under medetomidine/midazolam/butorphanol (MMB) anesthesia. Furthermore, while ketamine and xylazine (K/X) anesthesia completely blocked facilitation at 11-ms ISI, inhibition at a 3-ms ISI was preserved. Continuous and intermittent TBS strongly facilitated MEPs depending on stimulus intensity, persisting for up to 25 min under both MMB and K/X anesthesia. These findings are similar to the intracortical inhibition and facilitation observed in the human motor cortex using paired-pulse magnetic stimulation, particularly the glutamate-mediated facilitation phase. However, different TBS facilitatory mechanisms occur in the rat motor cortex. These different TBS facilitatory mechanisms affect the comparability and interpretations of TBS between rat and human models.
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Affiliation(s)
- Minoru Fujiki
- Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan
| | - Yukari Kawasaki
- Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan
| | - Hirotaka Fudaba
- Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan
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29
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Jara JS, Agger S, Hollis ER. Functional Electrical Stimulation and the Modulation of the Axon Regeneration Program. Front Cell Dev Biol 2020; 8:736. [PMID: 33015031 PMCID: PMC7462022 DOI: 10.3389/fcell.2020.00736] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/15/2020] [Indexed: 01/07/2023] Open
Abstract
Neural injury in mammals often leads to persistent functional deficits as spontaneous repair in the peripheral nervous system (PNS) is often incomplete, while endogenous repair mechanisms in the central nervous system (CNS) are negligible. Peripheral axotomy elicits growth-associated gene programs in sensory and motor neurons that can support reinnervation of peripheral targets given sufficient levels of debris clearance and proximity to nerve targets. In contrast, while damaged CNS circuitry can undergo a limited amount of sprouting and reorganization, this innate plasticity does not re-establish the original connectivity. The utility of novel CNS circuitry will depend on effective connectivity and appropriate training to strengthen these circuits. One method of enhancing novel circuit connectivity is through the use of electrical stimulation, which supports axon growth in both central and peripheral neurons. This review will focus on the effects of CNS and PNS electrical stimulation in activating axon growth-associated gene programs and supporting the recovery of motor and sensory circuits. Electrical stimulation-mediated neuroplasticity represents a therapeutically viable approach to support neural repair and recovery. Development of appropriate clinical strategies employing electrical stimulation will depend upon determining the underlying mechanisms of activity-dependent axon regeneration and the heterogeneity of neuronal subtype responses to stimulation.
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Affiliation(s)
| | - Sydney Agger
- Burke Neurological Institute, White Plains, NY, United States
| | - Edmund R Hollis
- Burke Neurological Institute, White Plains, NY, United States.,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
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30
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Grau JW, Baine RE, Bean PA, Davis JA, Fauss GN, Henwood MK, Hudson KE, Johnston DT, Tarbet MM, Strain MM. Learning to promote recovery after spinal cord injury. Exp Neurol 2020; 330:113334. [PMID: 32353465 PMCID: PMC7282951 DOI: 10.1016/j.expneurol.2020.113334] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/19/2020] [Accepted: 04/26/2020] [Indexed: 02/06/2023]
Abstract
The present review explores the concept of learning within the context of neurorehabilitation after spinal cord injury (SCI). The aim of physical therapy and neurorehabilitation is to bring about a lasting change in function-to encourage learning. Traditionally, it was assumed that the adult spinal cord is hardwired-immutable and incapable of learning. Research has shown that neurons within the lower (lumbosacral) spinal cord can support learning after communication with the brain has been disrupted by means of a thoracic transection. Noxious stimulation can sensitize nociceptive circuits within the spinal cord, engaging signal pathways analogous to those implicated in brain-dependent learning and memory. After a spinal contusion injury, pain input can fuel hemorrhage, increase the area of tissue loss (secondary injury), and undermine long-term recovery. Neurons within the spinal cord are sensitive to environmental relations. This learning has a metaplastic effect that counters neural over-excitation and promotes adaptive learning through an up-regulation of brain-derived neurotrophic factor (BDNF). Exposure to rhythmic stimulation, treadmill training, and cycling also enhances the expression of BDNF and counters the development of nociceptive sensitization. SCI appears to enable plastic potential within the spinal cord by down-regulating the Cl- co-transporter KCC2, which reduces GABAergic inhibition. This enables learning, but also fuels over-excitation and nociceptive sensitization. Pairing epidural stimulation with activation of motor pathways also promotes recovery after SCI. Stimulating motoneurons in response to activity within the motor cortex, or a targeted muscle, has a similar effect. It is suggested that a neurofunctionalist approach can foster the discovery of processes that impact spinal function and how they may be harnessed to foster recovery after SCI.
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Affiliation(s)
- James W Grau
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA.
| | - Rachel E Baine
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Paris A Bean
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Jacob A Davis
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Gizelle N Fauss
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Melissa K Henwood
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Kelsey E Hudson
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - David T Johnston
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Megan M Tarbet
- Behavioral and Cellular Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Misty M Strain
- Battlefield Pain Research, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, BHT-1, BSA Fort Sam Houston, TX 78234, USA
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31
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Paired Associative Stimulation Fails to Induce Plasticity in Freely Behaving Intact Rats. eNeuro 2020; 7:ENEURO.0396-19.2020. [PMID: 32139377 PMCID: PMC7113557 DOI: 10.1523/eneuro.0396-19.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 12/21/2022] Open
Abstract
Paired associative stimulation (PAS) has been explored in humans as a noninvasive tool to drive plasticity and promote recovery after neurologic insult. A more thorough understanding of PAS-induced plasticity is needed to fully harness it as a clinical tool. Here, we tested the efficacy of PAS with multiple interstimulus intervals in an awake rat model to study the principles of associative plasticity. Using chronically implanted electrodes in motor cortex and forelimb, we explored PAS parameters to effectively drive plasticity. We assessed changes in corticomotor excitability using a closed-loop, EMG-controlled cortical stimulation paradigm. We tested 11 PAS intervals, chosen to force the coincidence of neuronal activity in the motor cortex and spinal cord of rats with timings relevant to the principles of Hebbian spike timing-dependent plasticity. However, despite a relatively large number of stimulus pairings (300), none of the tested intervals reliably changed corticospinal excitability relative to control conditions. Our results question PAS effectiveness under these conditions.
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Ling YT, Alam M, Zheng YP. Spinal Cord Injury: Lessons about Neuroplasticity from Paired Associative Stimulation. Neuroscientist 2019; 26:266-277. [DOI: 10.1177/1073858419895461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Paired associative stimulation (PAS) is a noninvasive neuromodulation method with rare cases of adverse effects for the patients with neurological injuries such as spinal cord injury (SCI). PAS is based on the principles of associative long-term potentiation and depression where the activation of presynaptic and postsynaptic neurons correlated in time is artificially induced. Statistically significant improvement in motor functions after applying PAS has been reported by several research groups. With further standardization of the technique, PAS could be an effective treatment for functional rehabilitation of SCI patients. In this review, we have summarized the methods and findings of PAS on SCI rehabilitation to facilitate the readers to understand the potentials and limitations of PAS for its future clinical use.
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Affiliation(s)
- Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Yang Q, Ramamurthy A, Lall S, Santos J, Ratnadurai-Giridharan S, Lopane M, Zareen N, Alexander H, Ryan D, Martin JH, Carmel JB. Independent replication of motor cortex and cervical spinal cord electrical stimulation to promote forelimb motor function after spinal cord injury in rats. Exp Neurol 2019; 320:112962. [PMID: 31125548 PMCID: PMC7035596 DOI: 10.1016/j.expneurol.2019.112962] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 12/24/2022]
Abstract
Cervical spinal cord injury (SCI) impairs arm and hand function largely by interrupting descending tracts. Most SCI spare some axons at the lesion, including the corticospinal tract (CST), which is critical for voluntary movement. We targeted descending motor connections with paired electrical stimulation of motor cortex and cervical spinal cord in the rat. We sought to replicate the previously published effects of intermittent theta burst stimulation of forelimb motor cortex combined with trans-spinal direct current stimulation placed on the skin over the neck to target the cervical enlargement. We hypothesized that paired stimulation would improve performance in skilled walking and food manipulation (IBB) tasks. Rats received a moderate C4 spinal cord contusion injury (200 kDynes), which ablates the main CST. They were randomized to receive paired stimulation for 10 consecutive days starting 11 days after injury, or no stimulation. Behavior was assessed weekly from weeks 4-7 after injury, and then CST axons were traced. Rats with paired cortical and spinal stimulation achieved significantly better forelimb motor function recovery, as measured by fewer stepping errors on the horizontal ladder task (34 ± 9% in stimulation group vs. 51 ± 18% in control, p = .013) and higher scores on the food manipulation task (IBB, 0-9 score; 7.2 ± 0.8 in stimulated rats vs. 5.2 ± 2.6 in controls, p = .025). The effect size for both tasks was large (Cohen's d = 1.0 and 0.92, respectively). The CST axon length in the cervical spinal cord did not differ significantly between the groups, but there was denser and broader ipsilateral axons distribution distal to the spinal cord injury. The large behavioral effect and replication in an independent laboratory validate this approach, which will be trialed in cats before being tested in people using non-invasive methods.
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Affiliation(s)
- Qi Yang
- Departments of Neurology and Orthopedics, Columbia University, New York, NY 10031, USA
| | - Aditya Ramamurthy
- Departments of Neurology and Orthopedics, Columbia University, New York, NY 10031, USA
| | - Sophia Lall
- Burke Neurological Institute, Weill Cornell Medicine, White Plains, NY 10605, USA
| | - Joshua Santos
- Burke Neurological Institute, Weill Cornell Medicine, White Plains, NY 10605, USA
| | | | - Madeleine Lopane
- Burke Neurological Institute, Weill Cornell Medicine, White Plains, NY 10605, USA
| | - Neela Zareen
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - Heather Alexander
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - Daniel Ryan
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - John H Martin
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA; CUNY Graduate Center, New York, NY 10031, USA
| | - Jason B Carmel
- Departments of Neurology and Orthopedics, Columbia University, New York, NY 10031, USA.
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Taccola G, Gad P, Culaclii S, Ichiyama RM, Liu W, Edgerton VR. Using EMG to deliver lumbar dynamic electrical stimulation to facilitate cortico-spinal excitability. Brain Stimul 2019; 13:20-34. [PMID: 31585723 DOI: 10.1016/j.brs.2019.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 08/06/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Potentiation of synaptic activity in spinal networks is reflected in the magnitude of modulation of motor responses evoked by spinal and cortical input. After spinal cord injury, motor evoked responses can be facilitated by pairing cortical and peripheral nerve stimuli. OBJECTIVE To facilitate synaptic potentiation of cortico-spinal input with epidural electrical stimulation, we designed a novel neuromodulation method called dynamic stimulation (DS), using patterns derived from hind limb EMG signal during stepping. METHODS DS was applied dorsally to the lumbar enlargement through a high-density epidural array composed of independent platinum-based micro-electrodes. RESULTS In fully anesthetized intact adult rats, at the interface array/spinal cord, the temporal and spatial features of DS neuromodulation affected the entire lumbosacral network, particularly the most rostral and caudal segments covered by the array. DS induced a transient (at least 1 min) increase in spinal cord excitability and, compared to tonic stimulation, generated a more robust potentiation of the motor output evoked by single pulses applied to the spinal cord. When sub-threshold pulses were selectively applied to a cortical motor area, EMG responses from the contralateral leg were facilitated by the delivery of DS to the lumbosacral cord. Finally, based on motor-evoked responses, DS was linked to a greater amplitude of motor output shortly after a calibrated spinal cord contusion. CONCLUSION Compared to traditional tonic waveforms, DS amplifies both spinal and cortico-spinal input aimed at spinal networks, thus significantly increasing the potential and accelerating the rate of functional recovery after a severe spinal lesion.
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Affiliation(s)
- Giuliano Taccola
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, 90095, USA; Neuroscience Department, International School for Advanced Studies (SISSA), Bonomea 265, Trieste, Italy; School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Parag Gad
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, 90095, USA
| | - Stanislav Culaclii
- Department of Bioengineering, University of California, Los Angeles, CA, 90095, USA
| | | | - Wentai Liu
- Department of Bioengineering, University of California, Los Angeles, CA, 90095, USA; Brain Research Institute, University of California, Los Angeles, CA, 90095, USA
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, 90095, USA; 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; The Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, 2007, NSW, Australia; Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari Adscrit a La Universitat Autònoma de Barcelona, Barcelona, 08916, Badalona, Spain.
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Song S, Luo L, Sun B, Sun D. Roles of glial ion transporters in brain diseases. Glia 2019; 68:472-494. [PMID: 31418931 DOI: 10.1002/glia.23699] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022]
Abstract
Glial ion transporters are important in regulation of ionic homeostasis, cell volume, and cellular signal transduction under physiological conditions of the central nervous system (CNS). In response to acute or chronic brain injuries, these ion transporters can be activated and differentially regulate glial functions, which has subsequent impact on brain injury or tissue repair and functional recovery. In this review, we summarized the current knowledge about major glial ion transporters, including Na+ /H+ exchangers (NHE), Na+ /Ca2+ exchangers (NCX), Na+ -K+ -Cl- cotransporters (NKCC), and Na+ -HCO3 - cotransporters (NBC). In acute neurological diseases, such as ischemic stroke and traumatic brain injury (TBI), these ion transporters are rapidly activated and play significant roles in regulation of the intra- and extracellular pH, Na+ , K+ , and Ca2+ homeostasis, synaptic plasticity, and myelin formation. However, overstimulation of these ion transporters can contribute to glial apoptosis, demyelination, inflammation, and excitotoxicity. In chronic brain diseases, such as glioma, Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS), glial ion transporters are involved in the glioma Warburg effect, glial activation, neuroinflammation, and neuronal damages. These findings suggest that glial ion transporters are involved in tissue structural and functional restoration, or brain injury and neurological disease development and progression. A better understanding of these ion transporters in acute and chronic neurological diseases will provide insights for their potential as therapeutic targets.
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Affiliation(s)
- Shanshan Song
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lanxin Luo
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania.,School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang, China.,School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang, China
| | - Baoshan Sun
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang, China.,Pólo Dois Portos, Instituto National de Investigação Agrária e Veterinária, Dois Portos, Portugal
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania.,Veterans Affairs Pittsburgh Health Care System, Geriatric Research, Educational and Clinical Center, Pittsburgh, Pennsylvania
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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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Courtine G, Sofroniew MV. Spinal cord repair: advances in biology and technology. Nat Med 2019; 25:898-908. [PMID: 31160817 DOI: 10.1038/s41591-019-0475-6] [Citation(s) in RCA: 256] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/01/2019] [Indexed: 02/06/2023]
Abstract
Individuals with spinal cord injury (SCI) can face decades with permanent disabilities. Advances in clinical management have decreased morbidity and improved outcomes, but no randomized clinical trial has demonstrated the efficacy of a repair strategy for improving recovery from SCI. Here, we summarize recent advances in biological and engineering strategies to augment neuroplasticity and/or functional recovery in animal models of SCI that are pushing toward clinical translation.
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Affiliation(s)
- Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland. .,Department of Neurosurgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland.
| | - Michael V Sofroniew
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Spinal Cord Epidural Stimulation for Lower Limb Motor Function Recovery in Individuals with Motor Complete Spinal Cord Injury. Phys Med Rehabil Clin N Am 2019; 30:337-354. [DOI: 10.1016/j.pmr.2018.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ratnadurai Giridharan S, Gupta D, Pal A, Mishra AM, Hill NJ, Carmel JB. Motometrics: A Toolbox for Annotation and Efficient Analysis of Motor Evoked Potentials. Front Neuroinform 2019; 13:8. [PMID: 30971908 PMCID: PMC6444173 DOI: 10.3389/fninf.2019.00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 02/05/2019] [Indexed: 12/16/2022] Open
Abstract
Stimulating the nervous system and measuring muscle response offers a unique opportunity to interrogate motor system function. Often, this is performed by stimulating motor cortex and recording muscle activity with electromyography; the evoked response is called the motor evoked potential (MEP). To understand system dynamics, MEPs are typically recorded through a range of motor cortex stimulation intensities. The MEPs increase with increasing stimulation intensities, and these typically produce a sigmoidal response curve. Analysis of MEPs is often complex and analysis of response curves is time-consuming. We created an MEP analysis software, called Motometrics, to facilitate analysis of MEPs and response curves. The goal is to combine robust signal processing algorithms with a simple user interface. Motometrics first enables the user to annotate data files acquired from the recording system so that the responses can be extracted and labeled with the correct subject and experimental condition. The software enables quick visual representations of entire datasets, to ensure uniform quality of the signal. It then enables the user to choose a variety of response curve analyses and to perform near real time quantification of the MEPs for quick feedback during experimental procedures. This is a modular open source tool that is compatible with several popular electrophysiological systems. Initial use indicates that Motometrics enables rapid, robust, and intuitive analysis of MEP response curves by neuroscientists without programming or signal processing expertise.
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Affiliation(s)
| | - Disha Gupta
- Department of Neurology, New York University School of Medicine, New York, NY, United States.,Comprehensive Epilepsy Center, NYU Langone Health, New York, NY, United States
| | - Ajay Pal
- Motor Recovery Lab, Burke Neurological Institute, White Plains, NY, United States
| | - Asht M Mishra
- Motor Recovery Lab, Burke Neurological Institute, White Plains, NY, United States
| | - N Jeremy Hill
- Motor Recovery Lab, Burke Neurological Institute, White Plains, NY, United States.,Brain Mind Research Inst., Weill Cornell Medicine Medical College, New York, NY, United States
| | - Jason B Carmel
- Motor Recovery Lab, Burke Neurological Institute, White Plains, NY, United States.,Brain Mind Research Inst., Weill Cornell Medicine Medical College, New York, NY, United States
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A novel simplistic fabrication technique for cranial epidural electrodes for chronic recording and stimulation in rats. J Neurosci Methods 2019; 311:239-242. [PMID: 30389487 DOI: 10.1016/j.jneumeth.2018.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/18/2018] [Accepted: 10/29/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The demand for neuromodulatory and recording tools has resulted in a surge of publications describing techniques for fabricating devices and accessories in-house suitable for neurological recordings. However, many of these fabrication protocols use equipment which are not common to biological laboratories, thus limiting researchers to the use of commercial alternatives. New method:We have developed a simple yet robust implantable stimulating surface electrode which can be fabricated in all wet-bench laboratories. RESULTS Female Sprague-Dawley rats received epidural implantation of the electrodes over the fore and hind limb areas of their motor cortex. Stimulation of the motor cortex successfully evoked fore- and hind limb motor outputs. The device was also able to record surface potentials of the motor cortex following epidural stimulation of the spinal cord. Comparisons with existing methods:For stimulation of the motor cortex, often stiff stainless or copper wires are roughly tucked underneath the skull, with little accuracy of localization. While, commercially available devices utilize burr holes and screw electrodes. Our new electrode design provides us stereotaxic accuracy that was not previously available. CONCLUSION We developed a chronic implantable electrode capable of being fabricated in all wet-labs, are robust, versatile and electrically sensitive enough for long-term chronic use. The simple and versatile electrode design provides scientific, economical and ethical benefits.
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Asci F. Spinal associative plasticity in depth: evidence from animal model. J Physiol 2018; 596:1793-1794. [DOI: 10.1113/jp275916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Francesco Asci
- Department of Human Neuroscience; Sapienza University of Rome; Rome Italy
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Garcia-Sandoval A, Pal A, Mishra AM, Sherman S, Parikh AR, Joshi-Imre A, Arreaga-Salas D, Gutierrez-Heredia G, Duran-Martinez AC, Nathan J, Hosseini SM, Carmel JB, Voit W. Chronic softening spinal cord stimulation arrays. J Neural Eng 2018; 15:045002. [PMID: 29569573 DOI: 10.1088/1741-2552/aab90d] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We sought to develop a cervical spinal cord stimulator for the rat that is durable, stable, and does not perturb the underlying spinal cord. APPROACH We created a softening spinal cord stimulation (SCS) array made from shape memory polymer (SMP)-based flexible electronics. We developed a new photolithographic process to pattern high surface area titanium nitride (TiN) electrodes onto gold (Au) interconnects. The thiol-ene acrylate polymers are stiff at room temperature and soften following implantation into the body. Durability was measured by the duration the devices produced effective stimulation and by accelerated aging in vitro. Stability was measured by the threshold to provoke an electromyogram (EMG) muscle response and by measuring impedance using electrochemical impedance spectroscopy (EIS). In addition, spinal cord modulation of motor cortex potentials was measured. The spinal column and implanted arrays were imaged with MRI ex vivo, and histology for astrogliosis and immune reaction was performed. MAIN RESULTS For durability, the design of the arrays was modified over three generations to create an array that demonstrated activity up to 29 weeks. SCS arrays showed no significant degradation over a simulated 29 week period of accelerated aging. For stability, the threshold for provoking an EMG rose in the first few weeks and then remained stable out to 16 weeks; the impedance showed a similar rise early with stability thereafter. Spinal cord stimulation strongly enhanced motor cortex potentials throughout. Upon explantation, device performance returned to pre-implant levels, indicating that biotic rather than abiotic processes were the cause of changing metrics. MRI and histology showed that softening SCS produced less tissue deformation than Parylene-C arrays. There was no significant astrogliosis or immune reaction to either type of array. SIGNIFICANCE Softening SCS arrays meet the needs for research-grade devices in rats and could be developed into human devices in the future.
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Affiliation(s)
- Aldo Garcia-Sandoval
- Department of Mechanical Engineering, The University of Texas at Dallas, Richardson, TX 75080, United States of America
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Affiliation(s)
- Dirk Czesnik
- Department of Clinical Neurophysiology, Robert-Koch-Straße 40, 37073, Göttingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, Robert-Koch-Straße 40, 37073, Göttingen, Germany
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