Spinal Cord Stimulation for the Control of Spasticity in Patients with Chronic Spinal Cord Injury: I. Clinical Observations

Abstract

The effectiveness of spinal cord stimulation for control of spasticity was studied in 59 spinal cord injury patients. SCS was markedly or moderately effective in reducing spasticity in 63% of the patients. We found that control of spasticity by SCS was not correlated with the severity of spasticity, the type of spasticity (flexor or extensor), or the ability to ambulate. However, stimulation was more effective in patients with incomplete cervical lesions than in complete cervical lesions. Stimulation below the lesion was more effective than above. We conclude that SCS was effective when electrodes were properly positioned below the lesion over the posterior aspect of the spinal cord in patients with some residual spinal cord function. We hypothesize that SCS controls spasticity by modification of activity of spinal-brainstem-spinal loops and by suppression of segmental excitation through antidromic activation of propriospinal pathways.

Epidural electrical stimulation of posterior structures of the human lumbosacral cord: 3. Control of spasticity

“…8 In an eort to clarify the precise impact of the site of stimulation, Dimitrijevic et al used SCS in a sample of 58 SCI patients and found spasticity to be more eectively controlled when the electrode was placed below, rather than above, the lesion. 9 This ®nding was again con®rmed by Barolat et al who, based on a total of 48 patients, concluded that SCS applied below the level of the lesion was an eective and safe approach to controlling SCI-related spasms. 10 The 1990s saw the interest in this approach declining, mainly due to technical problems and the realization that SCS as a method to control spasticity was less eective in patients with severe spasms of the lower limbs.…”

“…33 It has been shown repeatedly that mild forms of spasticity can be eectively controlled by placing the electrode below the level of the spinal cord lesion. 2,5,9,10 Why this approach has failed in cases of severe spasticity becomes clear when we realize how heavily the antispastic eect of SCS depends on the site of stimulation (Figures 3 and 4). Rather than just placing the electrode below the level of the lesion, it is essential that the stimulation site targets the dorsal roots of the upper lumbar cord segment.…”

Activity and participation after spinal cord injury: State-of-the-art report

“…BMCA has been used to demonstrate the ability to modify EMG reflex excitability in many persons clinically classified as complete SCI [49]. Applications include documentation of treatment effects for returning motor control [50], assessment of spasticity and cocontraction [51], and provision of objective criteria for the selection of intervention strategies [52].…”

Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury

“…In patients with motor-complete and incomplete SCI, epidural SCS was applied below and above the lesion at vertebral levels ranging from C2 to T10 and at stimulation frequencies of 30-1500 Hz, with variable results. [18][19][20][21][22] Dimitrijevic et al 23,24 suggested that the diversity of physiological conditions after SCI and the placement of the epidural electrodes determined the efficacy of SCS in spasticity control. While interest in this technique declined in the 1990s, Pinter et al 25 revisited its use in individuals with chronic SCI.…”