Abstract
Regaining control of autonomic functions such as those of the cardiovascular system, lower urinary tract and bowel, rank among the most important health priorities for individuals living with spinal cord injury (SCI). Recently our research provided evidence that epidural spinal cord stimulation (ESCS) could acutely modulate autonomic circuits responsible for cardiovascular function after SCI. This finding raised the question of whether ESCS can be used to modulate autonomic circuits involved in lower urinary tract and bowel control after SCI. We present the case of a 32-year-old man with a chronic motor-complete SCI (American Spinal injury Association Impairment Scale B) at the 5th cervical spinal segment. He sustained his injury during a diving accident in 2012. He was suffering from neurogenic lower urinary tract and bowel dysfunction. Epidural stimulation of the lumbosacral spinal cord immediately modulated both functions without negatively affecting the cardiovascular system. Specifically, the individual’s bowel function was assessed using different pre-set configurations and stimulation parameters in a randomized order. Compared to the individual’s conventional bowel management approach, ESCS significantly reduced the time needed for bowel management (p = 0.039). Furthermore, depending on electrode configuration and stimulation parameters (i.e., amplitude, frequency, and pulse width), ESCS modulated detrusor pressure and external anal sphincter/pelvic floor muscle tone to various degrees during urodynamic investigation. Although, ESCS is currently being explored primarily for restoring ambulation, our data suggest that application of this neuroprosthetic intervention may provide benefit to lower urinary tract and bowel function in individuals with SCI. To fully capitalize on the potential of improving lower urinary tract and bowel function, further research is needed to better understand the neuronal pathways and identify optimal stimulation configurations and parameters.
Highlights
When individuals living with spinal cord injury (SCI) rank their health priorities, regaining autonomic functions such as those of the lower urinary tract and bowel, are consistently considered more important than walking again (Anderson, 2004)
While one case series recently reported on improved voiding function (Herrity et al, 2018), the effects of epidural spinal cord stimulation (ESCS) on bowel function in individuals following SCI have not been explored in humans
Following SCI, the majority of individuals experience partial or complete loss of their supraspinal bowel and bladder control. These conditions are known as neurogenic lower urinary tract and bowel dysfunction
Summary
When individuals living with spinal cord injury (SCI) rank their health priorities, regaining autonomic functions such as those of the lower urinary tract and bowel, are consistently considered more important than walking again (Anderson, 2004). The majority of individuals following SCI rely on additional measures such as suppositories, laxatives, and/or digital stimulation to facilitate bowel evacuation (Krassioukov et al, 2010) Improving these functions will improve quality of life (Patel et al, 2016), and will reduce the duration of care (bowel routines are often more than 1 h) (Rosito et al, 2002) and the prevalence of artificial bladder emptying strategies including intermittent or indwelling catheterization (Cameron et al, 2010; Jeong et al, 2010). The latter is associated with high risk of urinary tract infection (Linsenmeyer, 2018) and bladder cancer (Welk et al, 2013), and is a considerable economic health care burden (White et al, 2017; Welk et al, 2018)
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