A new technique for sacral nerve stimulation: a percutaneous method for urinary incontinence caused by spinal cord injury

Ishigooka,; Сузуки,; Hashimoto, Y.; Sasagawa,; Nakada,; Handa,

doi:10.1046/j.1464-410x.1998.00569.x

Cited by 38 publications

(18 citation statements)

References 14 publications

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“…These conditions have not been present in previous studies of sacral root neuromodulation. 11,12 We used conditional stimulation in the two patients who responded well to continuous stimulation, and found it to be highly eective, consistent with a previous ®nding that conditional stimulation via the dorsal penile nerve is probably at least as eective as continuous. 9 It suggests that current research to develop a device for conditional neuromodulation ± capable of detecting bladder pressure rises by recording from the sacral roots, and then suppressing them by stimulation ± is justi®ed.…”

Section: Discussionsupporting

confidence: 83%

“…The trigger of 10 cm water chosen in this study is similar to the smallest rises in bladder pressure that can be detected by recording from the cat sacral roots. 26 In previous studies with implanted stimulators for long-term neuromodulation in SCI 12,13 cystometry was performed at prede®ned intervals after implantation to assess the eect of neuromodulation. Especially with the ®lling rates used (50 ml/min or greater), this does not necessarily re¯ect the bladder capacity that the patient experiences at home.…”

Section: Discussionmentioning

confidence: 99%

“…3,7 ± 9 Stimulation of the sacral roots, whether magnetically 10 or by percutaneous 11 or implanted electrode, 12 is probably at least as eective. However, although there is now a large quantity of data about the short term eects of neuromodulation, it has been more dicult to apply it in the long term.…”

Section: Introductionmentioning

confidence: 99%

“…However, although there is now a large quantity of data about the short term eects of neuromodulation, it has been more dicult to apply it in the long term. Two groups have shown that application of sacral root stimulation via implanted electrodes can increase capacity to a functionally useful degree, 12,13 but the situation in spinal cord injury lags behind the treatment of the urinary urge group, where the Medtronic Interstim is an accepted and eective implant. 2 The Finetech-Brindley Sacral Anterior Root Stimulator (SARS or Vocare, Neurocontrol, USA) is an established and successful device for bladder and bowel emptying in Spinal Cord Injury, and is usually accompanied by a rhizotomy of the posterior (sensory) sacral roots.…”

Section: Introductionmentioning

confidence: 99%

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Neuromodulation through sacral nerve roots 2 to 4 with a Finetech-Brindley sacral posterior and anterior root stimulator

et al. 2002

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Study design: Investigation of ®ve patients receiving an implant, using laboratory cystometry and self-catheterisation at home. Objectives: To use the established Finetech-Brindley sacral root stimulator to increase bladder capacity by neuromodulation, eliminating the need for posterior rhizotomy, as well as achieving bladder emptying by neurostimulation. Setting: Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. Methods: Five patients underwent implantation of a Finetech-Brindley stimulator without rhizotomy of the posterior roots. This was either a two channel extradural device (four cases) or a three channel intrathecal device (one case). In each patient, the implant was con®gured as a Sacral Posterior and Anterior Root Stimulator (SPARS). Postoperatively, repeated provocations using rapid instillation of 60 ml saline were used to determine the relative thresholds for neuromodulation using each channel. The eect of continuous neuromodulation was examined in the laboratory using slow ®ll cystometrograms, and conditional stimulation was also studied (neuromodulation for 1 min to suppress hyperre¯exic contractions as they occurred). In one patient, neuromodulation was applied continuously at home, and volumes at self catheterisation recorded in a diary. Results: Re¯ex erections were preserved in each patient. In three patients, detrusor hyperre¯exia persisted postoperatively and neuromodulation via the implant was studied. In these three patients, the con®guration was: S2 mixed roots bilaterally (channel B), and S34 bilaterally (channel A). Both channels could be used to suppress provoked hyperre¯exic contractions, with the S2 channel eective at a shorter pulse width than S34 in a majority of cases. Continuous stimulation more than doubled bladder capacity in two out of three patients during slow ®ll cystometry. Conditional stimulation was highly eective. In the one patient who used continuous stimulation at home, bladder capacity was more than doubled and the eect was comparable with anticholinergic medication. Bladder pressures 470 cm water could be achieved with intense stimulation in three patients, but detrusor-external urethral sphincter dyssynergia (DSD) prevented complete emptying. Conclusions: Neuromodulation via a SPARS was eective and may replace the need for posterior rhizotomy. However, persisting DSD may prevent complete bladder emptying and warrants further investigation.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neuromodulation through sacral nerve roots 2 to 4 with a Finetech-Brindley sacral posterior and anterior root stimulator

et al. 2002

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“…Sacral nerve stimulation (SNS) has been used since 1967 to activate bladder voiding (91,132,182,241), to treat bladder incontinence (20,34,44,59,78,108,119,120,122,221,229), to alleviate pelvic pain (1,38,190,279), to prevent fecal incontinence (50,(72)(73)(74)103,153), and to relieve constipation (56,128,133,134,161,166,167,186,189,248,252,272 (87,112,138,147,198,199,219) led to many devices (152,201) for improving walking (81,237), activating hand function (24) through voice commands (94), enhancing coughing (154), and even relieving seating pressures (65). Called neuroprostheses (25,193), these devices often are designed to correct specific deficits, such as foot drop (27,217,245) and hand grasp weakness (47,249,267).…”

Section: Peripheral Nerve Stimulationmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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