Effect of epidural stimulation of the lumbosacral spinal cord after paraplegia

January 01, 0001

Effect of epidural stimulation of the lumbosacral spinal cord after paraplegia

The researchers from the USA, Russia and India hypothesised that tonic epidural spinal cord stimulation can modulate spinal circuitry in human beings into a physiological state that enables sensory input from standing and stepping movements to serve as a source of neural control to undertake these tasks. A 23-year-old man who had paraplegia from a C7—T1 subluxation as a result of a motor vehicle accident in July 2006, presented with complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. After 170 locomotor training sessions over 26 months, a 16-electrode array was surgically placed on the dura (L1—S1 cord segments) in December 2009, to allow for chronic electrical stimulation. Spinal cord stimulation was done during sessions that lasted up to 250 min.

Epidural stimulation enabled the man to achieve full weight-bearing standing with assistance provided only for balance for 4.25 min. The patient achieved this standing during stimulation using parameters identified as specific for standing while providing bilateral load-bearing proprioceptive input. We also noted locomotor-like patterns when stimulation parameters were optimised for stepping. Additionally, 7 months after implantation, the patient recovered supraspinal control of some leg movements, but only during epidural stimulation.

The researchers concluded: "Task-specific training with epidural stimulation might reactivate previously silent spared neural circuits or promote plasticity. These interventions could be a viable clinical approach for functional recovery after severe paralysis."

Interesting findings is such a potentially helpful area.

For the full abstract, click here.

The Lancet published online 20 May 2011
© 2011 Elsevier Limited
Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Susan Harkema, Yury Gerasimenko, Jonathan Hodes et al. Correspondence to V Reggie Edgerton: [email protected]

Category: N. Neurological. Keywords: epidural, stimulation, lumbosacral spine, spinal cord, voluntary, moving, standing, assisted stepping, paraplegia, case study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 3 June 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.