High-Cervical Spinal Cord Electrical Stimulation in Brain Low Perfusion Syndromes: Experimental Basis and Preliminary Clinical Report

Abstract

Previous studies of our group showed that C₁-C₂ spinal cord stimulation increases carotid and brain blood flow in normal conditions in the goat and dog and it has a beneficial vasomotor effect in a model of vasospasm in the rat. For further clinical application it seemed rational to investigate the possible vascular changes mediated by this technique in experimental brain infarction. To this aim, 45 New Zealand rabbits were used. Brain infarction was produced by bilateral carotid ligation in 15, unilateral microcoagulation of the middle cerebral artery in 15 and by microcoagulation of the vertebral artery at the cranio-cervical junction in the other 15. One week later, following daily clinical scoring and cortical and posterior fossa blood flow readings by laser Doppler, a period of 120 min of right C₁-C₂ spinal cord electric stimulation was performed. A mean of 27% increase in previous blood flow recordings was obtained at the right hemisphere and a mean of 32% in the posterior fossa. This procedure was used in 10 patients presenting with various cerebral low perfusion syndromes. Though not constant, an increase in alertness, retention, speech, emotional lability and performance in skilled acts was achieved. No MR changes were observed, though SPECT readings showed an increase in blood flow in the penumbral perilesional area.

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

“…A similar experience was published by Broseta et al [36] in 1994. They observed the results of cervical SCS in three groups of rabbits with different stroke models (bilateral carotid ligation, unilateral microcoagulation of the MCA and microcoagulation of the vertebral artery).…”

Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: A review of experimental studies

“…2.3.3 Sympathetic mechanisms-Sagher was the first to assess the role of sympathetic tone in cSCS-induced cerebral vasodilation (Sagher et al, 2000), although the earlier studies suggested this mechanism (Broseta et al, 1994;Isono et al, 1994;Visocchi et al, 1994). Intravenous administration of hexamethonium (10 mg/Kg) prior to the initiation of cSCS in the rats abolished the cSCS-induced cerebral vasodilation (Sagher et al, 2000).…”

Roles of dorsal column pathway and transient receptor potential vanilloid type 1 in augmentation of cerebral blood flow by upper cervical spinal cord stimulation in rats

“…Some studies suggested the involvement of alterations in sympathetic tone in cSCS-induced cerebral vasodilation (Broseta et al, 1994;Isono et al, 1995;Visocchi et al, 1994). For example, intravenous administration of hexamethonium (a ganglionic blocker) and prazosin (a selective α-1 receptor blocker) prior to the initiation of cSCS in rats abolish the cSCS-induced cerebral vasodilation (Patel et al, 2003;Sagher et al, 2000).…”

“…Therefore, the promising results of SCSinduced CBF augmentation have led some clinicians to use this procedure to treat various cerebral vascular disorders. These cerebral diseases and/or pathological conditions include cerebral ischemia (Broseta et al, 1994;De Andres et al, 2007;Hosobuchi, 1991), ischemic spastic hemiparesis (Visocchi et al, 1994), focal cerebral ischemia (Meglio et al, 1991a, b;Ebel et al, 2001;Sagher et al, 2003;Sagher and Huang 2006;Robaina et al, 2004), cerebral vasospasm Karadag et al, 2005;Visocchi et al, 2001), stroke (Hosobuchi, 1991;Matsui and Hosobuchi, 1989;Visocchi et al, 1994Visocchi et al, , 2001, ischemic cerebral oedema (Gonzalez-Darder and Canadas-Rodriguez, 1991), postapoplectic spastic hemiplegia (Nakamura and Tsubokawa, 1985), prolonged coma (Fujii et al, 1998), persistent vegetative state (Funahashi et al 1989;Kanno et al, 1987;Kuwata, 1993), as well as migraine and posttraumatic cervicogenic headache (Dario et al, 2005). However, the underlying mechanisms of blood flow improvement are not well understood ).…”