Epidural electrical stimulation for spinal cord injury

Abstract

A long-standing goal of spinal cord injury research is to develop effective repair strategies, which can restore motor and sensory functions to near-normal levels. Recent advances in clinical management of spinal cord injury have significantly improved the prognosis, survival rate and quality of life in patients with spinal cord injury. In addition, a significant progress in basic science research has unraveled the underlying cellular and molecular events of spinal cord injury. Such efforts enabled the development of pharmacologic agents, biomaterials and stem-cell based therapy. Despite these efforts, there is still no standard care to regenerate axons or restore function of silent axons in the injured spinal cord. These challenges led to an increased focus on another therapeutic approach, namely neuromodulation. In multiple animal models of spinal cord injury, epidural electrical stimulation of the spinal cord has demonstrated a recovery of motor function. Emerging evidence regarding the efficacy of epidural electrical stimulation has further expanded the potential of epidural electrical stimulation for treating patients with spinal cord injury. However, most clinical studies were conducted on a very small number of patients with a wide range of spinal cord injury. Thus, subsequent studies are essential to evaluate the therapeutic potential of epidural electrical stimulation for spinal cord injury and to optimize stimulation parameters. Here, we discuss cellular and molecular events that continue to damage the injured spinal cord and impede neurological recovery following spinal cord injury. We also discuss and summarize the animal and human studies that evaluated epidural electrical stimulation in spinal cord injury.

Partial restoration of spinal cord neural continuity via vascular pedicle hemisected spinal cord transplantation using spinal cord fusion technique

“…We will optimize the fusogen (PEG) and apply electrical stimulation to improve surgical outcomes. 35,36 In addition, mental imagery (MI) therapy will be added to our postoperative rehabilitation program.…”

“…Based on the results of this clinical trial, we plan to try to optimize the experimental protocol before expansion of the clinical trial. We will optimize the fusogen (PEG) and apply electrical stimulation to improve surgical outcomes 35,36 . In addition, mental imagery (MI) therapy will be added to our postoperative rehabilitation program.…”

Effect of Transcutaneous Spinal Cord Stimulation on Balance and Neurophysiological Characteristics in Young Healthy Adults

“…Transcutaneous spinal cord stimulation (TSCS) is a non-invasive neuromodulation technique that can be used to excite sensory neurons in the posterior root of the spinal column. The effects of TSCS are similar to epidural stimulation (ES) that targets the same spinal structures Hofstoetter et al (2018); García et al (2019) and has been shown to be effective in restoring motor function in spinal cord injury (SCI) patients Eisdorfer et al (2020); Rejc et al (2015); Oh et al (2021). However, electrode implantation in ES comes with the risks and expenses of invasive surgery and possible infection after surgery.…”

“…There is still much to be understood about the mechanisms by which electrical stimulation affects the nervous system and the interaction of the many stimulation parameters, such as stimulation frequency, current amplitude, etc. which affect the outcomes of the interventions Oh et al (2021). We investigate in this study the effects on balance and neurophysiological measures when TSCS is applied to participants performing a functional balance task.…”

Effect of Epidural Pulsed Radiofrequency with Neuro-Stimulation in Management of Thoracic Spinal Cord Injury

“…Spinal cord injury is a devastating neurological disorder that is associated with life-long neurological condition with motor, sensory, and autonomic deficits (1). Up to 90% of SCI cases are caused by trauma including vehicle crashes, sports injuries, falls or violence (2).The overall global incidence of traumatic spinal cord injury is 10.5 cases per 100,000 person, resulting in an estimated 768,473 new cases annually worldwide , traumatic SCI is one of the major source of morbidity and mortality throughout the world (3). Spinal cord injury (SCI) is a traumatic lifechanging event that has a significant impact on the affected individual as well as the health system.…”