Epidural Spinal Cord Stimulation Facilitates Immediate Restoration of Dormant Motor and Autonomic Supraspinal Pathways after Chronic Neurologically Complete Spinal Cord Injury.

David Darrow,Theoden I Netoff,Ann Parr,David Balser,Uzma Samadani,Andrei Krassioukov,Aaron Phillips

doi:10.1089/neu.2018.6006

Abstract

Epidural Spinal Cord Stimulation (eSCS) in combination with extensive rehabilitation has been reported to restore volitional movement in a select group of subjects after motor-complete spinal cord injury (SCI). Numerous questions about the generalizability of these findings to patients with longer term SCI have arisen, especially regarding the possibility of restoring autonomic function. To better understand the effect of eSCS on volitional movement and autonomic function, two female participants five and 10 years after injury at ages 48 and 52, respectively, with minimal spinal cord preservation on magnetic resonance imaging were implanted with an eSCS system at the vertebral T12 level. We demonstrated that eSCS can restore volitional movement immediately in two female participants in their fifth and sixth decade of life with motor and sensory-complete SCI, five and 10 years after sustaining severe radiographic injuries, and without prescribed or significant pre-habilitation. Both patients experienced significant improvements in surface electromyography power during a volitional control task with eSCS on. Cardiovascular function was also restored with eSCS in one participant with cardiovascular dysautonomia using specific eSCS settings during tilt challenge while not affecting function in a participant with normal cardiovascular function. Orgasm was achieved for the first time since injury in one participant with and immediately after eSCS. Bowel-bladder synergy improved in both participants while restoring volitional urination in one with eSCS. While numerous questions remain, the ability to restore some supraspinal control over motor function below the level of injury, cardiovascular function, sexual function, and bowel and bladder function should promote intense efforts to investigate and develop optimization strategies to maximize recovery in all participants with chronic SCI.

Highlights

Despite more than five decades of clinical trials and research, there have been few major advancements in the clinical treatment of persons with chronic spinal cord injury (SCI)
Two sample t tests were performed on baseline, stimulation power, each Brain Motor Control Assessment (BMCA) maneuver, as well as for systolic blood pressure (BP) obtained at baseline, during symptomatic hypotension, and during stimulation
We corroborate that epidural Spinal cord stimulation (SCS) (eSCS) can restore volitional movement and muscle activity in participants after neurologically complete SCI

Summary

Introduction

Despite more than five decades of clinical trials and research, there have been few major advancements in the clinical treatment of persons with chronic spinal cord injury (SCI). Spinal cord stimulation (SCS)—and epidural SCS (eSCS)— involves the surgical implantation of a small array of electrodes into the epidural space, originally developed to manage chronic pain, and has been described since 1967.1 After more than 40 years of attempting to use eSCS for patients with SCI,[2] the possibility of restoring volitional movement below the level of injury in patients with motor-complete SCI was discovered nearly a decade ago.[3,4,5] It was serendipitously discovered that the restoration of volitional movement (supraspinal control) was possible after motor-complete SCI.[5].

Methods

Results

Conclusion