1
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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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2
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Davidson B, Bhattacharya A, Sarica C, Darmani G, Raies N, Chen R, Lozano AM. Neuromodulation techniques - From non-invasive brain stimulation to deep brain stimulation. Neurotherapeutics 2024; 21:e00330. [PMID: 38340524 PMCID: PMC11103220 DOI: 10.1016/j.neurot.2024.e00330] [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: 10/11/2023] [Revised: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Over the past 30 years, the field of neuromodulation has witnessed remarkable advancements. These developments encompass a spectrum of techniques, both non-invasive and invasive, that possess the ability to both probe and influence the central nervous system. In many cases neuromodulation therapies have been adopted into standard care treatments. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial ultrasound stimulation (TUS) are the most common non-invasive methods in use today. Deep brain stimulation (DBS), spinal cord stimulation (SCS), and vagus nerve stimulation (VNS), are leading surgical methods for neuromodulation. Ongoing active clinical trials using are uncovering novel applications and paradigms for these interventions.
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Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Nasem Raies
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada.
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3
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Katic Secerovic N, Balaguer JM, Gorskii O, Pavlova N, Liang L, Ho J, Grigsby E, Gerszten PC, Karal-Ogly D, Bulgin D, Orlov S, Pirondini E, Musienko P, Raspopovic S, Capogrosso M. Neural population dynamics reveals disruption of spinal circuits' responses to proprioceptive input during electrical stimulation of sensory afferents. Cell Rep 2024; 43:113695. [PMID: 38245870 PMCID: PMC10962447 DOI: 10.1016/j.celrep.2024.113695] [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: 05/30/2023] [Revised: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
While neurostimulation technologies are rapidly approaching clinical applications for sensorimotor disorders, the impact of electrical stimulation on network dynamics is still unknown. Given the high degree of shared processing in neural structures, it is critical to understand if neurostimulation affects functions that are related to, but not targeted by, the intervention. Here, we approach this question by studying the effects of electrical stimulation of cutaneous afferents on unrelated processing of proprioceptive inputs. We recorded intraspinal neural activity in four monkeys while generating proprioceptive inputs from the radial nerve. We then applied continuous stimulation to the radial nerve cutaneous branch and quantified the impact of the stimulation on spinal processing of proprioceptive inputs via neural population dynamics. Proprioceptive pulses consistently produce neural trajectories that are disrupted by concurrent cutaneous stimulation. This disruption propagates to the somatosensory cortex, suggesting that electrical stimulation can perturb natural information processing across the neural axis.
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Affiliation(s)
- Natalija Katic Secerovic
- School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia; The Mihajlo Pupin Institute, University of Belgrade, 11060 Belgrade, Serbia; Laboratory for Neuroengineering, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Oleg Gorskii
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia; Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; National University of Science and Technology "MISIS," 4 Leninskiy Pr., 119049 Moscow, Russia
| | - Natalia Pavlova
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Lucy Liang
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Jonathan Ho
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Erinn Grigsby
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Dzhina Karal-Ogly
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia
| | - Dmitry Bulgin
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia; Sirius University of Science and Technology, 354340 Sochi, Russia
| | - Sergei Orlov
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Pavel Musienko
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia; Sirius University of Science and Technology, 354340 Sochi, Russia; Life Improvement by Future Technologies Center "LIFT," 143025 Moscow, Russia
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland.
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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4
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Capogrosso M, Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields D, Gonzalez-Martinez J, Gerszten P, Weber D, Pirondini E. Supraspinal control of motoneurons after paralysis enabled by spinal cord stimulation. RESEARCH SQUARE 2024:rs.3.rs-3650257. [PMID: 38260333 PMCID: PMC10802737 DOI: 10.21203/rs.3.rs-3650257/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
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Affiliation(s)
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
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5
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Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields DP, Gonzalez-Martinez JA, Gerszten PC, Fisher LE, Weber DJ, Pirondini E, Capogrosso M. SUPRASPINAL CONTROL OF MOTONEURONS AFTER PARALYSIS ENABLED BY SPINAL CORD STIMULATION. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.29.23298779. [PMID: 38076797 PMCID: PMC10705627 DOI: 10.1101/2023.11.29.23298779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
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Affiliation(s)
- Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Genis Prat-Ortega
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Nikhil Verma
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Prakarsh Yadav
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Erynn Sorensen
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Roberto de Freitas
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Scott Ensel
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Luigi Borda
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Serena Donadio
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
| | - Lucy Liang
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Jonathan Ho
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- School of Medicine, University of Pittsburgh, Pittsburgh, US
| | - Arianna Damiani
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Erinn Grigsby
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Daryl P. Fields
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | | | - Peter C. Gerszten
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Lee E. Fisher
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
- Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Douglas J. Weber
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, US
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
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6
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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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7
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Bryson N, Lombardi L, Hawthorn R, Fei J, Keesey R, Peiffer J, Seáñez I. Enhanced selectivity of transcutaneous spinal cord stimulation by multielectrode configuration. J Neural Eng 2023; 20:10.1088/1741-2552/ace552. [PMID: 37419109 PMCID: PMC10481387 DOI: 10.1088/1741-2552/ace552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 07/09/2023]
Abstract
Objective.Transcutaneous spinal cord stimulation (tSCS) has been gaining momentum as a non-invasive rehabilitation approach to restore movement to paralyzed muscles after spinal cord injury (SCI). However, its low selectivity limits the types of movements that can be enabled and, thus, its potential applications in rehabilitation.Approach.In this cross-over study design, we investigated whether muscle recruitment selectivity of individual muscles could be enhanced by multielectrode configurations of tSCS in 16 neurologically intact individuals. We hypothesized that due to the segmental innervation of lower limb muscles, we could identify muscle-specific optimal stimulation locations that would enable improved recruitment selectivity over conventional tSCS. We elicited leg muscle responses by delivering biphasic pulses of electrical stimulation to the lumbosacral enlargement using conventional and multielectrode tSCS.Results.Analysis of recruitment curve responses confirmed that multielectrode configurations could improve the rostrocaudal and lateral selectivity of tSCS. To investigate whether motor responses elicited by spatially selective tSCS were mediated by posterior root-muscle reflexes, each stimulation event was a paired pulse with a conditioning-test interval of 33.3 ms. Muscle responses to the second stimulation pulse were significantly suppressed, a characteristic of post-activation depression suggesting that spatially selective tSCS recruits proprioceptive fibers that reflexively activate muscle-specific motor neurons in the spinal cord. Moreover, the combination of leg muscle recruitment probability and segmental innervation maps revealed a stereotypical spinal activation map in congruence with each electrode's position.Significance. Improvements in muscle recruitment selectivity could be essential for the effective translation into stimulation protocols that selectively enhance single-joint movements in neurorehabilitation.
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Affiliation(s)
- Noah Bryson
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Lorenzo Lombardi
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Rachel Hawthorn
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Jie Fei
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Rodolfo Keesey
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - J.D. Peiffer
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
- Biomedical Engineering, Northwestern University
| | - Ismael Seáñez
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
- Neurosurgery, Washington University School of Medicine in St. Louis
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8
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ElSaban M, Kleppel DJ, Kubrova E, Martinez Alvarez GA, Hussain N, D'Souza RS. Physical functioning following spinal cord stimulation: a systematic review and meta-analysis. Reg Anesth Pain Med 2023; 48:302-311. [PMID: 37080578 DOI: 10.1136/rapm-2022-104295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking. OBJECTIVE The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain. EVIDENCE REVIEW PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence. FINDINGS A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type. CONCLUSION This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.
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Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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9
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Tharu NS, Wong AYL, Zheng YP. Neuromodulation for recovery of trunk and sitting functions following spinal cord injury: a comprehensive review of the literature. Bioelectron Med 2023; 9:11. [PMID: 37246214 DOI: 10.1186/s42234-023-00113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023] Open
Abstract
Trunk stability is crucial for people with trunk paralysis resulting from spinal cord injuries (SCI), as it plays a significant role in performing daily life activities and preventing from fall-related accidents. Traditional therapy used assistive methods or seating modifications to provide passive assistance while restricting their daily functionality. The recent emergence of neuromodulation techniques has been reported as an alternative therapy that could improve trunk and sitting functions following SCI. The aim of this review was to provide a broad perspective on the existing studies using neuromodulation techniques and identify their potentials in terms of trunk recovery for people with SCI. Five databases were searched (PubMed, Embase, Science Direct, Medline-Ovid, and Web of Science) from inception to December 31, 2022 to identify relevant studies. A total of 21 studies, involving 117 participants with SCI, were included in this review. According to these studies, neuromodulation significantly improved the reaching ability, restored trunk stability and seated posture, increased sitting balance, as well as elevated activity of trunk and back muscles, which were considered early predictors of trunk recovery after SCI. However, there is limited evidence regarding neuromodulation techniques on the improvement of trunk and sitting functions. Therefore, future large-scale randomized controlled trials are warranted to validate these preliminary findings.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China.
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Bryson N, Lombardi L, Hawthorn R, Fei J, Keesey R, Peiffer JD, Seáñez I. Enhanced selectivity of transcutaneous spinal cord stimulation by multielectrode configuration. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.30.534835. [PMID: 37034788 PMCID: PMC10081184 DOI: 10.1101/2023.03.30.534835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Objective Transcutaneous spinal cord stimulation (tSCS) has been gaining momentum as a non-invasive rehabilitation approach to restore movement to paralyzed muscles after spinal cord injury (SCI). However, its low selectivity limits the types of movements that can be enabled and, thus, its potential applications in rehabilitation. Approach In this cross-over study design, we investigated whether muscle recruitment selectivity of individual muscles could be enhanced by multielectrode configurations of tSCS in 16 neurologically intact individuals. We hypothesized that due to the segmental innervation of lower limb muscles, we could identify muscle-specific optimal stimulation locations that would enable improved recruitment selectivity over conventional tSCS. We elicited leg muscle responses by delivering biphasic pulses of electrical stimulation to the lumbosacral enlargement using conventional and multielectrode tSCS. Results Analysis of recruitment curve responses confirmed that multielectrode configurations could improve the rostrocaudal and lateral selectivity of tSCS. To investigate whether motor responses elicited by spatially selective tSCS were mediated by posterior root-muscle reflexes, each stimulation event was a paired pulse with a conditioning-test interval of 33.3 ms. Muscle responses to the second stimulation pulse were significantly suppressed, a characteristic of post-activation depression suggesting that spatially selective tSCS recruits proprioceptive fibers that reflexively activate muscle-specific motor neurons in the spinal cord. Moreover, the combination of leg muscle recruitment probability and segmental innervation maps revealed a stereotypical spinal activation map in congruence with each electrode's position. Significance Improvements in muscle recruitment selectivity could be essential for the effective translation into stimulation protocols that selectively enhance single-joint movements in neurorehabilitation.
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11
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Combined Transcutaneous Electrical Spinal Cord Stimulation and Task-Specific Rehabilitation Improves Trunk and Sitting Functions in People with Chronic Tetraplegia. Biomedicines 2022; 11:biomedicines11010034. [PMID: 36672542 PMCID: PMC9855778 DOI: 10.3390/biomedicines11010034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to examine the effects of transcutaneous electrical spinal cord stimulation (TSCS) and conventional task-specific rehabilitation (TSR) on trunk control and sitting stability in people with chronic tetraplegia secondary to a spinal cord injury (SCI). Five individuals with complete cervical (C4-C7) cord injury participated in 24-week therapy that combined TSCS and TSR in the first 12 weeks, followed by TSR alone for another 12 weeks. The TSCS was delivered simultaneously at T11 and L1 spinal levels, at a frequency ranging from 20-30 Hz with 0.1-1.0 ms. pulse width biphasically. Although the neurological prognosis did not manifest after either treatment, the results show that there were significant increases in forward reach distance (10.3 ± 4.5 cm), right lateral reach distance (3.7 ± 1.8 cm), and left lateral reach distance (3.0 ± 0.9 cm) after the combinational treatment (TSCS+TSR). The stimulation also significantly improved the participants' trunk control and function in sitting. Additionally, the trunk range of motion and the electromyographic response of the trunk muscles were significantly elevated after TSCS+TSR. The TSCS+TSR intervention improved independent trunk control with significantly increased static and dynamic sitting balance, which were maintained throughout the TSR period and the follow-up period, indicating long-term sustainable recovery.
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12
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Pavlov VA, Tracey KJ. Bioelectronic medicine: Preclinical insights and clinical advances. Neuron 2022; 110:3627-3644. [PMID: 36174571 PMCID: PMC10155266 DOI: 10.1016/j.neuron.2022.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/28/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
The nervous system maintains homeostasis and health. Homeostatic disruptions underlying the pathobiology of many diseases can be controlled by bioelectronic devices targeting CNS and peripheral neural circuits. New insights into the regulatory functions of the nervous system and technological developments in bioelectronics drive progress in the emerging field of bioelectronic medicine. Here, we provide an overview of key aspects of preclinical research, translation, and clinical advances in bioelectronic medicine.
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Affiliation(s)
- Valentin A Pavlov
- Institute of Bioelectronic Medicine, the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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13
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Insausti-Delgado A, López-Larraz E, Nishimura Y, Ziemann U, Ramos-Murguialday A. Non-invasive brain-spine interface: Continuous control of trans-spinal magnetic stimulation using EEG. Front Bioeng Biotechnol 2022; 10:975037. [PMID: 36394044 PMCID: PMC9659618 DOI: 10.3389/fbioe.2022.975037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/23/2022] [Indexed: 08/22/2023] Open
Abstract
Brain-controlled neuromodulation has emerged as a promising tool to promote functional recovery in patients with motor disorders. Brain-machine interfaces exploit this neuromodulatory strategy and could be used for restoring voluntary control of lower limbs. In this work, we propose a non-invasive brain-spine interface (BSI) that processes electroencephalographic (EEG) activity to volitionally control trans-spinal magnetic stimulation (ts-MS), as an approach for lower-limb neurorehabilitation. This novel platform allows to contingently connect motor cortical activation during leg motor imagery with the activation of leg muscles via ts-MS. We tested this closed-loop system in 10 healthy participants using different stimulation conditions. This BSI efficiently removed stimulation artifacts from EEG regardless of ts-MS intensity used, allowing continuous monitoring of cortical activity and real-time closed-loop control of ts-MS. Our BSI induced afferent and efferent evoked responses, being this activation ts-MS intensity-dependent. We demonstrated the feasibility, safety and usability of this non-invasive BSI. The presented system represents a novel non-invasive means of brain-controlled neuromodulation and opens the door towards its integration as a therapeutic tool for lower-limb rehabilitation.
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Affiliation(s)
- Ainhoa Insausti-Delgado
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- International Max Planck Research School (IMPRS) for Cognitive and Systems Neuroscience, Tübingen, Germany
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | - Yukio Nishimura
- Neural Prosthetics Project, Department of Brain and Neuroscience, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
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14
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Pirondini E, Carranza E, Balaguer JM, Sorensen E, Weber DJ, Krakauer JW, Capogrosso M. Poststroke arm and hand paresis: should we target the cervical spinal cord? Trends Neurosci 2022; 45:568-578. [PMID: 35659414 DOI: 10.1016/j.tins.2022.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/18/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have limited efficacy at the level of impairment. To address this problem, we make the conceptual case for a new treatment approach. We first summarize current understanding of motor control deficits in the arm and hand after stroke and their shared physiological mechanisms with spinal cord injury (SCI). We then review studies of spinal cord stimulation (SCS) for recovery of locomotion after SCI, which provide convincing evidence for enhancement of residual corticospinal function. By extrapolation, we argue for using cervical SCS to restore upper limb motor control after stroke.
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Affiliation(s)
- Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Erick Carranza
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erynn Sorensen
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA; Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; The Santa Fe Institute, Santa Fe, CA, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA.
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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15
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Barra B, Conti S, Perich MG, Zhuang K, Schiavone G, Fallegger F, Galan K, James ND, Barraud Q, Delacombaz M, Kaeser M, Rouiller EM, Milekovic T, Lacour S, Bloch J, Courtine G, Capogrosso M. Epidural electrical stimulation of the cervical dorsal roots restores voluntary upper limb control in paralyzed monkeys. Nat Neurosci 2022; 25:924-934. [PMID: 35773543 DOI: 10.1038/s41593-022-01106-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022]
Abstract
Regaining arm control is a top priority for people with paralysis. Unfortunately, the complexity of the neural mechanisms underlying arm control has limited the effectiveness of neurotechnology approaches. Here, we exploited the neural function of surviving spinal circuits to restore voluntary arm and hand control in three monkeys with spinal cord injury, using spinal cord stimulation. Our neural interface leverages the functional organization of the dorsal roots to convey artificial excitation via electrical stimulation to relevant spinal segments at appropriate movement phases. Stimulation bursts targeting specific spinal segments produced sustained arm movements, enabling monkeys with arm paralysis to perform an unconstrained reach-and-grasp task. Stimulation specifically improved strength, task performances and movement quality. Electrophysiology suggested that residual descending inputs were necessary to produce coordinated movements. The efficacy and reliability of our approach hold realistic promises of clinical translation.
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Affiliation(s)
- Beatrice Barra
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara Conti
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Matthew G Perich
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Katie Zhuang
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Katia Galan
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicholas D James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maude Delacombaz
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mélanie Kaeser
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Eric M Rouiller
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Tomislav Milekovic
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stephanie Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Marco Capogrosso
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland. .,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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16
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Hofer AS, Scheuber MI, Sartori AM, Good N, Stalder SA, Hammer N, Fricke K, Schalbetter SM, Engmann AK, Weber RZ, Rust R, Schneider MP, Russi N, Favre G, Schwab ME. Stimulation of the cuneiform nucleus enables training and boosts recovery after spinal cord injury. Brain 2022; 145:3681-3697. [PMID: 35583160 PMCID: PMC9586551 DOI: 10.1093/brain/awac184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Severe spinal cord injuries result in permanent paraparesis in spite of the frequent sparing of small portions of white matter. Spared fibre tracts are often incapable of maintaining and modulating the activity of lower spinal motor centres. Effects of rehabilitative training thus remain limited. Here, we activated spared descending brainstem fibres by electrical deep brain stimulation of the cuneiform nucleus of the mesencephalic locomotor region, the main control centre for locomotion in the brainstem, in adult female Lewis rats. We show that deep brain stimulation of the cuneiform nucleus enhances the weak remaining motor drive in highly paraparetic rats with severe, incomplete spinal cord injuries and enables high-intensity locomotor training. Stimulation of the cuneiform nucleus during rehabilitative aquatraining after subchronic (n = 8 stimulated versus n = 7 unstimulated versus n = 7 untrained rats) and chronic (n = 14 stimulated versus n = 9 unstimulated versus n = 9 untrained rats) spinal cord injury re-established substantial locomotion and improved long-term recovery of motor function. We additionally identified a safety window of stimulation parameters ensuring context-specific locomotor control in intact rats (n = 18) and illustrate the importance of timing of treatment initiation after spinal cord injury (n = 14). This study highlights stimulation of the cuneiform nucleus as a highly promising therapeutic strategy to enhance motor recovery after subchronic and chronic incomplete spinal cord injury with direct clinical applicability.
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Affiliation(s)
- Anna-Sophie Hofer
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Myriam I Scheuber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Andrea M Sartori
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicolas Good
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Stephanie A Stalder
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicole Hammer
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Kai Fricke
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Sina M Schalbetter
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Anne K Engmann
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Rebecca Z Weber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Ruslan Rust
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Marc P Schneider
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Natalie Russi
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Giacomin Favre
- Department of Economics, University of Zurich, 8032 Zurich, Switzerland
| | - Martin E Schwab
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
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17
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de Freitas RM, Capogrosso M, Nomura T, Milosevic M. Preferential activation of proprioceptive and cutaneous sensory fibers compared to motor fibers during cervical transcutaneous spinal cord stimulation: A computational study. J Neural Eng 2022; 19. [PMID: 35472720 DOI: 10.1088/1741-2552/ac6a7c] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Cervical transcutaneous spinal cord stimulation (tSCS) is a promising technology that can support motor function recovery of upper-limbs after spinal cord injury. Its efficacy may depend on the ability to recruit sensory afferents, conveying excitatory inputs onto motoneurons. Therefore, understanding its physiological mechanisms is critical to accelerate its development towards clinical applications. In this study, we used an anatomically realistic cervical tSCS computational model to compare α-motor, Aα-sensory, and Aβ-sensory fiber activation thresholds and activation sites. APPROACH We developed a 3D geometry of the cervical body and tSCS electrodes with a cathode centred at the C7 spinous process and an anode placed over the anterior neck. The geometrical model was used to estimate the electric potential distributions along motor and sensory fiber trajectories at the C7 spinal level using a finite element method. We implemented dedicated motor and sensory fiber models to simulate the α-motor and Aα-sensory fibers using 12, 16, and 20 µm diameter fibers, and Aβ-sensory fibers using 6, 9, and 12 µm diameter fibers. We estimated nerve fiber activation thresholds and sites for a 2 ms monophasic stimulating pulse and compared them across the fiber groups. MAIN RESULTS Our results showed lower activation thresholds of Aα- and Aβ-sensory fibers compared with α-motor fibers, suggesting preferential sensory fiber activation. We also found no differences between activation thresholds of Aα-sensory and large Aβ-sensory fibers, implying their co-activation. The activation sites were located at the dorsal and ventral root levels. SIGNIFICANCE Using a realistic computational model, we demonstrated preferential activation of dorsal root Aα- and Aβ-sensory fibers compared with ventral root α-motor fibers during cervical tSCS. These findings suggest high proprioceptive and cutaneous contributions to neural activations during cervical tSCS, which inform the underlying mechanisms of upper-limb functional motor recovery.
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Affiliation(s)
- Roberto M de Freitas
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, 560-8531, JAPAN
| | - Marco Capogrosso
- University of Pittsburgh, 3520, Fifth Av., Pittsburgh, Pennsylvania, 15261, UNITED STATES
| | - Taishin Nomura
- Department of Mechanical Science and Bioengineering, Osaka University, Machikaneyama 1-3, Toyonaka City, Osaka 560- 8531, Toyonaka, 5608531, JAPAN
| | - Matija Milosevic
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama-cho, J520, Toyonaka, Osaka, 560-8531, JAPAN
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18
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Laskin JJ, Waheed Z, Thorogood NP, Nightingale TE, Noonan VK. Spinal cord stimulation research in the restoration of motor, sensory and autonomic function for individuals living with spinal cord injuries: A scoping review. Arch Phys Med Rehabil 2022; 103:1387-1397. [PMID: 35202581 DOI: 10.1016/j.apmr.2022.01.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the status of spinal cord stimulation (SCS) research for the improvement of motor, sensory and autonomic function for individuals living with a spinal cord injury (SCI). DATA SOURCES This scoping review identified original research published prior to March 31, 2021, via literature searches using Medline, EMBASE, PubMed, Science Direct, CINAHL, Sport Discus, Web of Science, as well as a targeted search for well-known principal investigators. Search terms included permutations of "spinal cord stimulation", "epidural spinal cord stimulation", "transcutaneous spinal cord stimulation", "magnetic spinal cord stimulation" and "neuromodulation". STUDY SELECTION Studies were included if they: 1) were in English, 2) presented original research on humans living with a SCI, and 3) investigated at least one of the three forms of SCS. DATA EXTRACTION Extracted data included: authors, publication year, participant characteristics, purpose, study design, stimulation (device, location, parameters,) primary outcomes, and adverse events. DATA SYNTHESIS As a scoping review the extracted data was tabulated and presented descriptively. Themes and gaps in the literature were identified and reported. Of the 5,754 articles screened, 103 articles were included (55 epidural, 36 transcutaneous and 12 magnetic). The primary research design was a case study or series with only a single randomized clinical trial. Motor recovery was the most common primary outcome for epidural and transcutaneous SCS studies whereas bowel and bladder outcomes were most common for magnetic. Seventy percent of the studies included 10 or fewer participants, and 18 articles documented at least one adverse event. Incomplete stimulation parameter descriptions were noted across many studies. No articles mentioned direct engagement of consumers or advocacy groups. CONCLUSION This review identified a need for more robust study designs, larger sample sizes, comparative studies, improved reporting of stimulation parameters, adverse event data, and alignment of outcomes with the priorities of the SCI community.
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Affiliation(s)
- James J Laskin
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada; School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana.
| | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | - Tom E Nightingale
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Treatment with Pulsed Extremely Low Frequency Electromagnetic Field (PELF-EMF) Exhibit Anti-Inflammatory and Neuroprotective Effect in Compression Spinal Cord Injury Model. Biomedicines 2022; 10:biomedicines10020325. [PMID: 35203533 PMCID: PMC8869291 DOI: 10.3390/biomedicines10020325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Spinal cord injury (SCI) pathology includes both primary and secondary events. The primary injury includes the original traumatic event, and the secondary injury, beginning immediately after the initial injury, involves progressive neuroinflammation, neuronal excitotoxicity, gliosis, and degeneration. Currently, there is no effective neuroprotective treatment for SCI. However, an accumulating body of data suggests that PELF-EMF has beneficial therapeutic effects on neurotrauma. The purpose of this study was to test the efficacy of the PELF-EMF SEQEX device using a compression SCI mouse model. Methods: C57BL/6 mice were exposed to PELF-EMF for 4 h on a daily basis for two months, beginning 2 h after a mild-moderate compression SCI. Results: The PELF-EMF treatment significantly diminished inflammatory cell infiltration and astrocyte activation by reducing Iba1, F4/80, CD68+ cells, and GAFP at the lesion borders, and increased pro-survival signaling, such as BDNF, on the neuronal cells. Moreover, the treatment exhibited a neuroprotective effect by reducing the demyelination of the axons of the white matter at the lesion’s center. Conclusions: Treatment with SEQEX demonstrated significant anti-inflammatory and neuroprotective effects. Considering our results, this safe and effective rehabilitative device, already available on the market, may provide a major therapeutic asset in the treatment of SCI.
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20
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Carrera RM, Omofuma I, Yasin B, Agrawal SK. The Effect of Transcutaneous Spinal Cord Stimulation on Standing Postural Control in Healthy Adults. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3185370] [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]
Affiliation(s)
- Robert M. Carrera
- Department of Biomedical Engineering, Columbia University,, New York, NY, USA
| | - Isirame Omofuma
- Department of Biomedical Engineering, Columbia University,, New York, NY, USA
| | - Bushra Yasin
- Mechanical Engineering Department, Columbia University, New York, NY, USA
| | - Sunil K. Agrawal
- Departments of Mechanical Engineering and Rehabilitation and, Regenerative Medicine, New York, NY, USA
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