Abstract
Deficits in urologic function after spinal cord injury (SCI) manifest both as a failure to store and empty, greatly impacting daily life. While current management strategies are necessary for urological maintenance, they oftentimes are associated with life-long side effects. Our objective was to investigate the efficacy of spinal cord epidural stimulation (scES) as a promising therapy to improve bladder control after SCI. A bladder mapping study was undertaken for sixteen sessions over the course of four months in an individual with chronic, motor complete SCI. Varying combinations of stimulating cathode electrodes were initially tested during filling cystometry resulting in the identification of an effective configuration for reflexive bladder emptying at the caudal end of the electrode array. Subsequent systematic testing of different frequencies at a fixed stimulus intensity and pulse width yielded lowest post-void residual volumes at 30 Hz. These stimulation parameters were then tested in four additional research participants and found to also improve reflexive voiding efficiency. Taken together with SCI studies on step, stand, voluntary motor control and cardiovascular regulation, these findings further corroborate that scES has an all-encompassing potential to increase the central state of excitability, allowing for the control of multiple body functions, including the urological system.
Highlights
Following spinal cord injury (SCI), volitional control to all or a portion of the lower urinary tract is impaired
We have previously shown that locomotor training alone was sufficient to induce significant improvements in multiple bladder parameters, such as increased capacity, voiding efficiency, detrusor contraction duration as well as decreased detrusor leak point pressure[15]
A potential limitation with spinal cord epidural stimulation (scES) is that the stimulation configuration we found effective for voiding efficiency may not be as effective for the other phase of micturition
Summary
Following spinal cord injury (SCI), volitional control to all or a portion of the lower urinary tract is impaired. A recent finding of improved voiding efficiency and low-pressure voiding was obtained following injection of Botulinum toxin into the sphincter[5] This method is gaining acceptance as an effective way to conduct reflex or spontaneous bladder voiding following SCI. Mapping using different anode/cathode configurations, spinal cord locations, and stimulation frequencies for bladder effects during repeated cystometry evaluation revealed an effective lumbosacral scES electrode configuration that improved reflexive voiding efficiency in this individual. This configuration was re-tested in four additional individuals (3 AIS A, 1 AIS B), already implanted with spinal cord epidural stimulators. Our goal was to demonstrate efficacy of scES to excite the spinal cord circuitry at the lower lumbosacral region and facilitate neural output to the bladder to improve storage and/or elimination
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