Epidural Spinal Cord Stimulation for Spasticity: a Systematic Review of the Literature

Jung, Youngkyung; Breitbart, Sara; Malvea, Anahita; Bhatia, Anuj; Ibrahim, George M.; Gorodetsky, Carolina

doi:10.1016/j.wneu.2023.12.158

Cited by 2 publications

(3 citation statements)

References 48 publications

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“…According to this study, spinal cord excitability, as measured by the Hmax/Max ratio, significantly decreased during tSCS applied at one or two segments and with multisegmental tSCS, including in the final condition. By targeting specific neural pathways, the SCS can inhibit hyperexcitable spinal reflexes [30][31][32], including the H-reflex, thereby reducing spasticity and improving motor control [14]. The previous literature suggests that spinal cord stimulation (SCS) has the potential to engage local inhibitory spinal circuits [31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

“…By targeting specific neural pathways, the SCS can inhibit hyperexcitable spinal reflexes [30][31][32], including the H-reflex, thereby reducing spasticity and improving motor control [14]. The previous literature suggests that spinal cord stimulation (SCS) has the potential to engage local inhibitory spinal circuits [31][32][33][34]. By stimulating afferent fibers, the SCS may trigger the release of inhibitory neurotransmitters in both humans and animals, likely by enhancing pre-and postsynaptic spinal inhibitory mechanisms [14,33,34].…”

Section: Discussionmentioning

confidence: 99%

“…By stimulating afferent fibers, the SCS may trigger the release of inhibitory neurotransmitters in both humans and animals, likely by enhancing pre-and postsynaptic spinal inhibitory mechanisms [14,33,34]. The reduction in spinal cord excitability by tSCS could suggest a potential application for the normalization of spinal reflex excitability after SCI [30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

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Improvement in Motor and Walking Capacity during Multisegmental Transcutaneous Spinal Stimulation in Individuals with Incomplete Spinal Cord Injury

Kumru,

Ros-Alsina,

García Alén

et al. 2024

IJMS

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Transcutaneous multisegmental spinal cord stimulation (tSCS) has shown superior efficacy in modulating spinal locomotor circuits compared to single-site stimulation in individuals with spinal cord injury (SCI). Building on these findings, we hypothesized that administering a single session of tSCS at multiple spinal segments may yield greater enhancements in muscle strength and gait function during stimulation compared to tSCS at only one or two segments. In our study, tSCS was applied at single segments (C5, L1, and Coc1), two segments (C5-L1, C5-Coc1, and L1-Coc1), or multisegments (C5-L1-Coc1) in a randomized order. We evaluated the 6-m walking test (6MWT) and maximum voluntary contraction (MVC) and assessed the Hmax/Mmax ratio during stimulation in ten individuals with incomplete motor SCI. Our findings indicate that multisegmental tSCS improved walking time and reduced spinal cord excitability, as measured by the Hmax/Mmax ratio, similar to some single or two-site tSCS interventions. However, only multisegmental tSCS resulted in increased tibialis anterior (TA) muscle strength. These results suggest that multisegmental tSCS holds promise for enhancing walking capacity, increasing muscle strength, and altering spinal cord excitability in individuals with incomplete SCI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Improvement in Motor and Walking Capacity during Multisegmental Transcutaneous Spinal Stimulation in Individuals with Incomplete Spinal Cord Injury

Kumru,

Ros-Alsina,

García Alén

et al. 2024

IJMS

View full text Add to dashboard Cite

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Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injury

Vorobyev,

Burmistrova,

Puzin

et al. 2024

Cureus

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Introduction: Epidural spinal cord stimulation is a minimally invasive procedure with a growing list of indications. It has a good safety profile and analgesic effect, reduces the severity of spasticity, and activates various brain regions. The purpose of this study is to evaluate the clinical outcome of epidural spinal cord stimulation in patients with spastic syndrome and chronic disorders of consciousness resulting from severe traumatic brain injury (sTBI).Methods: Between 2021 and 2023, an epidural spinal cord stimulation test was performed in 34 patients with central paresis, severe hypertonia, and chronically altered consciousness following sTBI. The severity of spastic syndrome was assessed using a modified Ashworth scale. All patients underwent implantation of a cylindrical eight-contact test epidural electrode at C3-C5 cervical level, followed by neurostimulation and selection of individual modes. Tonic stimulation at a frequency of 60 Hz, "burst" mode, or a combination of the two was used.Results: Epidural spinal cord stimulation was administered for an average of 4 ± 1.5 days, with tonic stimulation mode applied in 15 (44.1%) patients, "burst" mode in 10 (29.4%), and a combination of two in nine (26.5%) patients. A reduction in spasticity with clinical improvement was observed in 21 patients (61.8%). The Ashworth scale scores for distal and proximal upper extremities decreased from 3 points to 2.5 points and from 3 points to 2 points, respectively. This was significant in the right upper limbs (p = 0.0152 distally and p = 0.0164 proximally). Significant improvements were also seen in the lower extremities. Active movements in paretic limbs increased or appeared in 12 patients (35.3%), while a heightened level of consciousness was observed in six patients (17.6%). Permanent neurostimulator implantation was performed in 12 patients (35.3%), with no reported surgical complications.Conclusion: Epidural spinal cord stimulation shows promise as an invasive rehabilitation method for patients with sTBI sequelae. Its use reduced the severity of spastic syndrome in over half of patients and increased active movements in paretic limbs in over a third. Notably, neuromodulation at the cervical level yielded pronounced effects on the upper extremities, both proximally and distally. Findings regarding consciousness level improvement are particularly intriguing but warrant further validation through randomized trials.

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Epidural Spinal Cord Stimulation for Spasticity: a Systematic Review of the Literature

Cited by 2 publications

References 48 publications

Improvement in Motor and Walking Capacity during Multisegmental Transcutaneous Spinal Stimulation in Individuals with Incomplete Spinal Cord Injury

Improvement in Motor and Walking Capacity during Multisegmental Transcutaneous Spinal Stimulation in Individuals with Incomplete Spinal Cord Injury

Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injury

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