Neuromodulation and restoration of motor responses after severe spinal cord injury

Sayenko, Dimitry G.; Bazo, Humberto Antonio Cerrel; Horner, Philip J.; Taccola, Giuliano

doi:10.1016/b978-0-12-822427-4.00005-8

Cited by 2 publications

(3 citation statements)

References 63 publications

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“…Indeed, a recent study that combined biophysical modeling with animal and human (individuals with SCI and stroke) electrophysiological experiments indicated that in the presence of supraspinal inputs, subthreshold excitatory postsynaptic potentials induced by spinal stimulation can be transformed into action potentials that increase motor output ( Balaguer et al, 2023 ). Although a more detailed understanding of the neural mechanisms associated with spinal stimulation comes from preclinical and neurophysiological studies with epidural spinal cord stimulation, we believe that TSCS can also re-activate functionally silent pathways by enhancing the general level of excitability and bringing interneurons and motor neurons closer to the threshold of firing, thereby making the spinal circuits more likely to respond to both descending drives and ascending sensory information ( Taylor et al, 2021 ; Barss et al, 2022 ; Lin et al, 2022 ; Sayenko et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, no studies have yet compared whether different pulse widths can alter the recruitment of neurons differently. Regarding the frequency, two studies reported the effects of different frequencies on motor recovery ( Shapkova et al, 2020 ; Sayenko et al, 2022 ). Shapkova et al (2020) compared the effects of different frequencies of 1 Hz, 3 Hz, and 67 Hz and reported that the application of 67 Hz had the greatest impact on spasticity and walking performance.…”

Section: Discussionmentioning

confidence: 99%

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Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review

Tajali,

Balbinot,

Pakosh

et al. 2024

Front. Neurosci.

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IntroductionTranscutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level.MethodsThe following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included.ResultsNineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor.DiscussionThis review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review

Tajali,

Balbinot,

Pakosh

et al. 2024

Front. Neurosci.

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“…A hot topic in motor neurorehabilitation is the different strategies to stimulate the spinal cord to facilitate recovery of different motor and autonomic functions. This intervention was initially targeted to the spinal cord following spinal injury (Harkema et al, 2011;Gerasimenko et al 2015;Sayenko et al, 2022) to reactivate and train spinal locomotor circuits disconnected from brain commands (Taccola et al, 2018).…”

Section: Spinal Cord Stimulation For Supraspinal Motor Disordersmentioning

confidence: 99%

Spinal facilitation of descending motor input

Taccola

Kissane

Culaclii

et al. 2023

Preprint

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Highly varying patterns of electrostimulation (Dynamic Stimulation, DS) delivered to the dorsal cord through an epidural array with 18 independent electrodes transiently facilitate corticospinal motor responses, even after spinal injury. To partly unravel how corticospinal input are affected by DS, we introduced a corticospinal platform that allows selective cortical stimulation during the multisite acquisition of cord dorsum potentials (CDPs) and the simultaneous supply of DS. Firstly, the epidural interface was validated by the acquisition of the classical multisite distribution of CDPs on the dorsal cord and their input-output profile elicited by pulses delivered to peripheral nerves. Apart from increased EMGs, DS selectively increased excitability of the spinal interneurons that first process corticospinal input, without changing the magnitude of commands descending from the motor cortex, suggesting a novel correlation between muscle recruitment and components of cortically-evoked CDPs. Finally, DS increases excitability of post-synaptic spinal interneurons at the stimulation site and their responsiveness to any residual supraspinal control, thus supporting the use of electrical neuromodulation whenever the motor output is jeopardized by a weak volitional input, due to a partial disconnection from supraspinal structures and/or neuronal brain dysfunctions.

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Neuromodulation and restoration of motor responses after severe spinal cord injury

Cited by 2 publications

References 63 publications

Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review

Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review

Spinal facilitation of descending motor input

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