Electrical Spinal Cord Stimulation for Spastic Movement Disorders

Siegfried, J.; Krainick, J.-U.; Haas, Hans-Josef; Adorjani, C.; Meyer, Mylène; Thoden, U.

doi:10.1159/000102409

Cited by 41 publications

(35 citation statements)

References 4 publications

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“…25 Another potential source of the effects observed here can be drawn from the reports that stimulation of the long tracts of the spinal cord reduces responsiveness to muscle spindle afferent input after spinal cord lesioning in cat models and SCI in humans. 23,24,43,44 Here, we applied tSCS with adequate intensity to produce paraesthesias that are generally associated with posteriorcolumn depolarization during epidural SCS. [45][46][47] Modeling of tSCS-induced currents, however, has shown that posterior column fibers have considerably higher thresholds than the posterior root fibers.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Hofstoetter

McKay

Tansey³

et al. 2013

The Journal of Spinal Cord Medicine

150

172

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Participants: Three subjects with chronic motor-incomplete spinal cord injury (SCI) who could walk ≥10 m. Interventions: Two interconnected stimulating skin electrodes (Ø 5 cm) were placed paraspinally at the T11/T12 vertebral levels, and two rectangular electrodes (8 × 13 cm) on the abdomen for the reference. Biphasic 2 mswidth pulses were delivered at 50 Hz for 30 minutes at intensities producing paraesthesias but no motor responses in the lower limbs. Outcome measures: The Wartenberg pendulum test and neurological recordings of surface-electromyography (EMG) were used to assess effects on exaggerated reflex excitability. Non-functional co-activation during volitional movement was evaluated. The timed 10-m walk test provided measures of clinical function. Results: The index of spasticity derived from the pendulum test changed from 0.8 ± 0.4 pre-to 0.9 ± 0.3 poststimulation, with an improvement in the subject with the lowest pre-stimulation index. Exaggerated reflex responsiveness was decreased after tSCS across all subjects, with the most profound effect on passive lower-limb movement (pre-to post-tSCS EMG ratio: 0.2 ± 0.1), as was non-functional co-activation during voluntary movement. Gait speed values increased in two subjects by 39%. Conclusion: These preliminary results suggest that tSCS, similar to epidurally delivered stimulation, may be used for spasticity control, without negatively impacting residual motor control in incomplete SCI. Further study in a larger population is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hofstoetter

McKay

Tansey³

et al. 2013

The Journal of Spinal Cord Medicine

150

172

View full text Add to dashboard Cite

show abstract

“…7 Siegfried et al, who treated 15 chronic SCI patients by placing the electrode above the lesion, failed to con®rm this ®nding. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Pinter¹,

2000

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Objectives: The purpose of this study was to evaluate the eect of spinal cord stimulation (SCS) on severe spasticity of the lower limbs in patients with traumatic spinal cord injury (SCI) under close scrutiny of the site and parameters of stimulation. Materials and methods: Eight SCI patients (four women, four men) were included in the study. Levels of spasticity before and during stimulation were compared according to a clinical rating scale and by surface electrode polyelectromyography (pEMG) during passive¯exion and extension of the knee, supplemented by a pendulum test with the stimulating device switched either on or o over an appropriate period. Results: Both the clinical and the experimental parameters clearly demonstrated that SCS, when correctly handled, is a highly eective approach to controlling spasticity in spinal cord injury subjects. The success of this type of treatment hinges on four factors: (1) the epidural electrode must be located over the upper lumbar cord segment (L1, L2, L3); (2) the train frequency of stimulation must be in the range of 50 ± 100 Hz, the amplitude within 2 ± 7 V and the stimulus width of 210 ms; (3) the stimulus parameters must be optimized by clinically assessing the eect of arbitrary combinations of the four contacts of the quadripolar electrode; and (4) amplitudes of stimulation must be adjusted to dierent body positions. Conclusions: Severe muscle hypertonia aecting the lower extremities of patients with chronic spinal cord injuries can be eectively suppressed via stimulation of the upper lumbar cord segment. Spinal Cord (2000) 38, 524 ± 531

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“…Recent advances in spinal cord stim ulation (SCS) for modification of im paired m otor activity have presented an opportunity for the clini cal researcher to observe [1, 4-7, 9, 12, 13, 15, 21-23], to record [13,17,21], and to study changes in abnorm al m otor activity in patients with upper m otor neuron dysfunctions [8]. However, from an experimental design point of view, the situation is rather complicated, due to the fact that the currently used stim ulation param eters require continuous ap plication o f the stimulus.…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Stimulation as a Tool f or Physiological Research

Dimitrijevič¹,

Faganel²,

Sherwood³

1983

Stereotact Funct Neurosurg

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The use of spinal cord stimulation for alleviation of disabilities due to motor neuron lesions has provided the opportunity to explore a new approach to measurement of spinal cord physiology. Externalized leads of epidural electrodes provide the possibility of recording evoked spinal cord activity, while both externalized or implanted leads can be used to study cortical evoked responses and twitches induced by spinal cord stimulation. The use of such electrophysiological techniques can be expected to expand greatly the applicaolmy of the technique for alleviating motor disabilities, through a better definition of the degree, nature and extent of the lesion.

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Electrical Spinal Cord Stimulation for Spastic Movement Disorders

Cited by 41 publications

References 4 publications

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

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

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

Spinal Cord Stimulation as a Tool f or Physiological Research

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