Spinal Cord Stimulation for Spasticity: Historical Approaches, Current Status, and Future Directions

Nagel, Sean J.; Wilson, Saul; Johnson, Michael D.; Machado, André G.; Frizon, Leonardo A.; Chardon, Matthieu K.; Reddy, Chandan G.; Gillies, G. T.; Howard, Matthew A.

doi:10.1111/ner.12591

Cited by 68 publications

(34 citation statements)

References 109 publications

(140 reference statements)

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“…For example, SCS was found to inhibit sensorimotor reflexes such as the H‐reflex in patients with lower limb pain caused by FBSS . This inhibition is thought to occur at least in part via direct effects on motor neurons, although more complex modulation of spinal cord sensorimotor circuits are likely . The effects of SCS on motor systems are robust and reliable, and SCS has been used to treat spasticity and improve motor function in patients with spinal cord injury and other movement disorders such as multiple sclerosis and Parkinson's disease .…”

Section: Conventional Waveformsmentioning

confidence: 99%

“…This inhibition is thought to occur at least in part via direct effects on motor neurons, although more complex modulation of spinal cord sensorimotor circuits are likely . The effects of SCS on motor systems are robust and reliable, and SCS has been used to treat spasticity and improve motor function in patients with spinal cord injury and other movement disorders such as multiple sclerosis and Parkinson's disease . The nociceptive sensorimotor reflex (RIII) is a polysynaptic spinal reflex considered to be an objective physiologic measure of nociception, and has been shown to correlate positively with perceived pain .…”

Section: Conventional Waveformsmentioning

confidence: 99%

“…69 The effects of SCS on motor systems are robust and reliable, and SCS has been used to treat spasticity and improve motor function in patients with spinal cord injury and other movement disorders such as multiple sclerosis and Parkinson's disease. 69,70 The nociceptive sensorimotor reflex (RIII) is a polysynaptic spinal reflex considered to be an objective physiologic measure of nociception, and has been shown to correlate positively with perceived pain. 71,72 SCS was shown to inhibit the RIII and correlate with efficacy of stimulation in 2 studies of patients with neuropathic pain.…”

Section: Burstmentioning

confidence: 99%

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Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

2018

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Spinal cord stimulation (SCS) is a minimally invasive therapy used for the treatment of chronic neuropathic pain. SCS is a safe and effective alternative to medications such as opioids, and multiple randomized controlled studies have demonstrated efficacy for difficult-to-treat neuropathic conditions such as failed back surgery syndrome. Conventional SCS is believed mediate pain relief via activation of dorsal column Aβ fibers, resulting in variable effects on sensory and pain thresholds, and measurable alterations in higher order cortical processing. Although potentiation of inhibition, as suggested by Wall and Melzack's gate control theory, continues to be the leading explanatory model, other segmental and supraspinal mechanisms have been described. Novel, non-standard, stimulation waveforms such as high-frequency and burst have been shown in some studies to be clinically superior to conventional SCS, however their mechanisms of action remain to be determined. Additional studies are needed, both mechanistic and clinical, to better understand optimal stimulation strategies for different neuropathic conditions, improve patient selection and optimize efficacy.

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Section: Conventional Waveformsmentioning

confidence: 99%

Section: Conventional Waveformsmentioning

confidence: 99%

Section: Burstmentioning

confidence: 99%

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Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

2018

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“…Repetitive stimulation leads to the depression of the H-reflex, potentially in order to avoid over-stimulation of the a motor neuron and the muscle [39]. The system is frequently disrupted because of spinal disinhibition in various pathologies, such as diabetic neuropathy [40], or after spinal cord injury (SCI) [41], leading to spasticity and pain. Despite the large amount of related studies, it was still unclear whether the inhibition steps in at the pre-or post-synaptic level.…”

Section: Major Tom To Motoneuron: H-reflex Depression Happens At the mentioning

confidence: 99%

Tumour travel tours – Why circulating cancer cells value company

Häfner

2020

Biomedical Journal

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Leptospirosis H-reflex depression a b s t r a c tWelcome to the New Year and a new issue of the Biomedical Journal, where we learn that travelling with company boosts the metastatic potential of circulating tumour cells, as well as that a worm could be an excellent model to study antidiabetic drugs. In addition, we discover another pair of molecular scissors for genetic engineering, how exactly Leptospira wreaks havoc on its run through the host organism, and that hyperparathyroidism brings its own risks, but does not worsen the outcome of papillary thyroid carcinoma. Furthermore, the importance of taking into account differing beauty ideals for aesthetic surgery surveys is discussed, alongside the question how bad isolated local recurrence is in the case of HR þ breast cancer. Finally, we find out that virtual colonoscopy deserves more credit, that the first medical experiment in space was all about the H-reflex, and that it is possible to survive advanced necrotising fasciitis of the face and neck.

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“…The clinical success obtained with these methods has stirred additional interest in developing a firm understanding of the neurophysiology mechanisms of action underlying spinal cord stimulation (107). This is especially important in the complex disruptions that arise in spinal cord injury (108), and efforts aimed at elucidating the neuronal therapeutic responses to spinal cord stimulation are underway (2,109). We anticipate that the same considerations will hold for leads delivered directly into the intrathecal space.…”

Section: Stimulation System Designsmentioning

confidence: 99%