Transcutaneous Spinal Neuromodulation Reorganizes Neural Networks in Patients with Cerebral Palsy

Parag Gad,Susan Hastings,Hui Zhong,V Reggie Edgerton,Gaurav Seth,Sachin Kandhari

doi:10.1007/s13311-021-01087-6

Abstract

Spinal neuromodulation and activity-based rehabilitation triggers neural network reorganization and enhances sensory-motor performances involving the lower limbs, the trunk, and the upper limbs. This study reports the acute effects of Transcutaneous Electrical Spinal Cord Neuromodulation (SCONE™, SpineX Inc.) on 12 individuals (ages 2 to 50) diagnosed with cerebral palsy (CP) with Gross Motor Function Classification Scale (GMFCS) levels ranging from I to V. Acute spinal neuromodulation improved the postural and locomotor abilities in 11 out of the 12 patients including the ability to generate bilateral weight bearing stepping in a 2-year-old (GMFCS level IV) who was unable to step. In addition, we observed independent head-control and weight bearing standing with stimulation in a 10-year-old and a 4-year old (GMFCS level V) who were unable to hold their head up or stand without support in the absence of stimulation. All patients significantly improved in coordination of flexor and extensor motor pools and inter and intralimb joint angles while stepping on a treadmill. While it is assumed that the etiologies of the disruptive functions of CP are associated with an injury to the supraspinal networks, these data are consistent with the hypothesis that spinal neuromodulation and functionally focused activity-based therapies can form a functionally improved chronic state of reorganization of the spinal-supraspinal connectivity. We further suggest that the level of reorganization of spinal-supraspinal connectivity with neuromodulation contributed to improved locomotion by improving the coordination patterns of flexor and extensor muscles by modulating the amplitude and firing patterns of EMG burst during stepping.

Highlights

Cerebral palsy (CP) is one of the most common childhood motor disorders in the USA with an estimated 1.5 to 4 out of 1000 individuals born with cerebral palsy (CP) [1,2,3] and over 10,000 new cases diagnosed each year
It is generally assumed that the primary pathology of the nervous system that leads to CP is located within and among different combinations of supraspinal networks, and these pathologies can be due to multiple etiologies
The present data suggest that the supraspinal connectivity to the spinal neural networks in individuals with CP has developed into an incomplete and/or abnormal physiological state [33, 34]

Summary

Introduction

Cerebral palsy (CP) is one of the most common childhood motor disorders in the USA with an estimated 1.5 to 4 out of 1000 individuals born with CP [1,2,3] and over 10,000 new cases diagnosed each year. There are approximately 500,000 children under the age of 18 in USA and approximately 17 million globally currently living with CP. The total lifetime care costs currently exceed $1 million [4]. It is generally assumed that the primary pathology of the nervous system that leads to CP is located within and among different combinations of supraspinal networks, and these pathologies can be due to multiple etiologies. It appears that these supraspinal pathologies will be necessarily manifested as spinally mediated dysfunctions, affecting multiple peripheral sensory-motor

Objectives

Methods

Results

Conclusion