Spinal Cord Stimulation Prevents the Effects of Combined Experimental Ischemic and Traumatic Brain Injury

Visocchi, Massimiliano; Tartaglione, Tommaso; Romani, Rossana; Meglio, Mario

doi:10.1159/000066731

Cited by 22 publications

(14 citation statements)

References 13 publications

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“…22 In a combined ischemic and traumatic model in the rabbit, spinal cord stimulation leads to a reduction in lesions and attenuation of the CBF decrease caused by the insult. 9 Direct electrical stimulation of the cerebellar fastigial nucleus before the ischemic insult dramatically reduces the volume of damage attributable to perma- …”

Section: Discussionmentioning

confidence: 99%

“…2,3 Nonpharmacological treatment techniques, such as hypothermia and hyperoxemia, have also been proposed, 4 but it remains to be seen how they transfer from laboratory to bedside. There are even studies suggesting that electrical stimulation of the cerebellar fastigial nucleus 5,6 before ischemia, or the spinal cord [7][8][9] weeks and months after the ischemic insult can reduce damage.…”

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confidence: 99%

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Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Burnett

Shimazu

Szabados

et al. 2006

Stroke

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Background and Purpose-Functional stimulation is accompanied by increases in regional cerebral blood flow which exceed metabolic demands under normal circumstances, but it is unknown whether functional stimulation is beneficial or detrimental in the setting of acute ischemia. The aim of this study was to determine the effect of forepaw stimulation during temporary focal ischemia on neurological and tissue outcome in a rat model of reversible focal forebrain ischemia. Methods-Sprague-Dawley rats were prepared for temporary occlusion of the right middle cerebral artery (MCA) using the filament model. Cerebral blood flow in the MCA territory was continuously monitored with a laser-Doppler flowmeter. Subdermal electrodes were inserted into the dorsal forepaw to stimulate either the forepaw ipsilateral or contralateral to the occlusion starting 1 minute into ischemia and continuing throughout the ischemic period. A neurological evaluation was undertaken after 24 hours of reperfusion, and animals were then euthanized and brain slices stained with 2,3,5-triphenyltetrazolium chloride. Cortical and striatal damage was measured separately. Results-The cortical and striatal infarct volumes were both significantly reduced in the contralateral stimulated group compared with the ipsilateral stimulated group (48% total reduction). There were no statistically significant differences in the neurobehavioral scores between the 2 groups, or in the laser-Doppler flow measurements from the MCA core. Conclusions-Functional stimulation of ischemic tissue may decrease tissue damage and improve outcome from stroke.Although the precise mechanism of this effect remains to be determined, functional stimulation could readily be translated to clinical practice. Key Words: cerebral ischemia, focal Ⅲ electrical stimulation therapy Ⅲ middle cerebral artery occlusion T here remains intense interest in discovering novel neuroprotective therapies for use in acute cerebral ischemia. Most recent research efforts have focused on compounds designed to interfere with the cascade of deleterious events that occur in tissue during and in the minutes and hours after cerebral ischemia. 1 Although many compounds have been investigated, to-date none have proven clinically useful in humans. 2,3 Nonpharmacological treatment techniques, such as hypothermia and hyperoxemia, have also been proposed, 4 but it remains to be seen how they transfer from laboratory to bedside. There are even studies suggesting that electrical stimulation of the cerebellar fastigial nucleus 5,6 before ischemia, or the spinal cord 7-9 weeks and months after the ischemic insult can reduce damage.Functional stimulation is accompanied by an increase in regional cerebral blood flow (CBF) in activated brain regions. We have shown previously in a rat model of graded cerebral ischemia that when CBF is reduced by as much as 90%, forepaw stimulation is still able to elicit an increase in blood flow in the somatosensory cortex, 10 and studies in stroke patients demonstrate that CBF can be activated...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Burnett

Shimazu

Szabados

et al. 2006

Stroke

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“…From 1994 to 2001, studies from our laboratories were performed on the effects of cervical SCS on experimental cerebral early spasm after SAH [15,28,37,[41][42][43] . In particular, cervical SCS was observed to be able to prevent early spasm in a 'protective' fashion when stimulation was started before SAH.…”

Section: Sah and Cerebral Vasospasmmentioning

confidence: 99%

Spinal Cord Stimulation and Cerebral Hemodynamics: Updated Mechanism and Therapeutic Implications

Visocchi

Pepa

Esposito

et al. 2011

Stereotact Funct Neurosurg

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The effects of spinal cord stimulation (SCS) on cerebral blood flow (CBF) are well known based on experimental investigations, and its vasodilator effect on peripheral arteries is widely used in clinical settings in the treatment of peripheral vascular disease. Since Hosobuchi’s [Appl Neurophysiol 1985;48:372–376] first observations on the effects of SCS on CBF were published 22 years ago, many advances have been made in understanding SCS-mediated effects on CBF. This paper reviews the main laboratory observations and analyzes the most significant neurophysiological theories on the SCS-mediated effect on CBF. Most significant experimental data have been discussed, with specific reference to possible mechanisms such as ‘functional reversible sympathectomy’, cerebral infarction and related ischemic edema, hemodynamic deterioration in experimental combined ischemic-traumatic brain injury and cerebral vasospasm. The authors revised the published experiences in humans with hypoperfusion syndromes and ‘adjuvant’ locoregional CBF increase in chemotherapy of brain tumors. SCS represents a new perspective in challenging neurosurgical clinical fields such as cerebral ischemia and vasospasm, and seems promising as a new trend of functional neurosurgery in cerebrovascular diseases.

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“…The projections from the reticular formation to the central thalamus to the cerebral cortex may constitute a critical pathway for maintaining a waking cortical state [41]. Cervical SCS might enhance this specific firing to the cerebral cortex by a direct effect on the reticular formation [42]. …”

Section: Discussionmentioning

confidence: 99%

Neuromodulation of Vegetative State through Spinal Cord Stimulation: Where Are We Now and Where Are We Going?

Pepa

Fukaya

Rocca

et al. 2013

Stereotact Funct Neurosurg

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Background: Vegetative state (VS) is a complex condition that represents a challenging frontier for medicine and neuroscience research. Nowadays there is no scientifically validated treatment for VS patients, and their chronic long-term assistance is very demanding for healthcare systems worldwide. Objectives: The present paper is a systematic review of the role of spinal cord stimulation (SCS) as a treatment of patients with VS. Methods: Published literature on this topic was analyzed systematically. Clinical and epidemiological characteristics of VS, present therapeutic options and social costs of VS were also evaluated. Results: Only 10 papers have been published since 1988, and overall 308 VS patients have been treated with SCS worldwide; 51.6% displayed a clinical improvement and an amelioration of the environmental interaction. These effects are probably mediated by the stimulation of the reticular formation-thalamus-cortex pathway and by cerebral blood flow augmentation induced by SCS. Conclusions: The experience on this topic is still very limited, and on this basis it is still hard to make any rigorous assessment. However, the most recent experiments represent significant progress in the research on this topic and display SCS as a possible therapeutic tool in the treatment of VS.

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Spinal Cord Stimulation Prevents the Effects of Combined Experimental Ischemic and Traumatic Brain Injury

Cited by 22 publications

References 13 publications

Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Electrical Forepaw Stimulation During Reversible Forebrain Ischemia Decreases Infarct Volume

Spinal Cord Stimulation and Cerebral Hemodynamics: Updated Mechanism and Therapeutic Implications

Neuromodulation of Vegetative State through Spinal Cord Stimulation: Where Are We Now and Where Are We Going?

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