New strategies of pelvic nerves stimulation for recovery of pelvic visceral functions and locomotion in paraplegics

Possover, Marc; Schurch, Brigitte; Henle, Klaus-Peter

doi:10.1002/nau.20897

Cited by 52 publications

(41 citation statements)

References 19 publications

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“…Operative technique After the patient signed informed consent form for surgery and permissions (for case details, personal information and images), he underwent the LION procedure in June 2011 in accordance with the technique described previously: 4 The procedure consisted of the implantation, by laparoscopy, of fine wire (designed for spinal cord stimulation or for sacral nerve root stimulation) in direct contact to the endopelvic portion of the somatic pelvic nerves for electrical stimulation or neuromodulation. An epidural spinal cord stimulation unit (Restore ADVANCED, Medtronic, Minneapolis, MN, USA) and four 4-arrays fine wire electrodes were implanted to the sciatic, pudendal and femoral nerves according to our surgical technique described previously.…”

Section: Methodsmentioning

confidence: 99%

Recovery of supraspinal control of leg movement in a chronic complete flaccid paraplegic man after continuous low-frequency pelvic nerve stimulation and FES-assisted training

Possover

Forman

2017

Spinal Cord Ser Cases

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INTRODUCTION:More than 30 years ago, functional electrical stimulation (FES) was developed as an orthotic system to be used for rehabilitation for SCI patients. In the present case report, FES-assisted training was combined with continuous low-frequency stimulation of the pelvic somatic nerves in a SCI patient. CASE PRESENTATION: We report on unexpected findings in a 41-year-old man with chronic complete flaccid paraplegia, since he was 18 years old, who underwent spinal stem cell therapy and a laparoscopic implantation of neuroprosthesis (LION procedure) in the pelvic lumbosacral nerves. The patient had complete flaccid sensomotoric paraplegia T12 as a result of a motor vehicle accident in 1998. In June 2011, he underwent a laparoscopic implantation of stimulation electrodes to the sciatic and femoral nerves for continuous low-frequency electrical stimulation and functional electrical stimulation of the pelvic nerves. Neither intraoperative direct stimulation of the pelvic nerves nor postoperative stimulation induced any sensation or muscle reactions. After 2 years of passive continuous low-frequency stimulation, the patient developed progressive recovery of electrically assisted voluntary motor functions below the lesions: he was first able to extend the right knee and 6 months later, the left. He is currently capable of voluntary weight-bearing standing and walking (with voluntary knee movements) about 50 m with open cuff crutches and drop foot braces. DISCUSSION: Our findings suggest that continuous low-frequency pelvic nerve stimulation in combination with FES-assisted training might induce changes that affect both the upper and the lower motor neuron and allow supra-and infra-spinal inputs to engage residual spinal and peripheral pathways.

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Section: Methodsmentioning

confidence: 99%

Recovery of supraspinal control of leg movement in a chronic complete flaccid paraplegic man after continuous low-frequency pelvic nerve stimulation and FES-assisted training

Possover

Forman

2017

Spinal Cord Ser Cases

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“…laparoscopic implantation of neural electrode (implant below the level of the injury) to restore the motor or autonomic function (37,38).…”

Section: Sexual Dysfunctionsmentioning

confidence: 99%

Nerve-Sparing radical hysterectomy - An old Japanese concept

Bacalbaşa¹,

Lintoiu²

2016

JTMR

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Conventional radical hysterectomy, the main part of the standard surgical treatment in cervical cancer, causes damage to the pelvic autonomic nerves, thus leading to urinary, anorectal and sexual dysfunctions. Many researches have focused on surgical approaches that protect the pelvic nerves in order to decrease postoperative related morbidity. Nervesparing radical hysterectomy is a safe technique that improves the quality of life of patients who undergo cervical cancer surgery without compromising oncologic outcomes.

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“…One problem is an overactive bladder causing urinary incontinence and this is managed through bladder inhibition. Possover et al, [28], using a bladder control system, showed in three SCI patients that pudendal nerve stimulation at 20 Hz could inhibit the bladder producing bladder filling volumes of 500 ml. Another problem for SCI patients is high urethral resistance; Possover et al, [28] demonstrated in one patient that a 1.2 KHz high-frequency blocking of the pudendal nerve could be used to decrease urethral resistance.…”

Section: Implantable Bladder Stimulators and Proposed Development Workmentioning

confidence: 99%

“…Possover et al, [28], using a bladder control system, showed in three SCI patients that pudendal nerve stimulation at 20 Hz could inhibit the bladder producing bladder filling volumes of 500 ml. Another problem for SCI patients is high urethral resistance; Possover et al, [28] demonstrated in one patient that a 1.2 KHz high-frequency blocking of the pudendal nerve could be used to decrease urethral resistance. In this study, we tested high-frequency blocking methods on the pudendal nerve, the results are reported in a parallel study publication [29].…”

Section: Implantable Bladder Stimulators and Proposed Development Workmentioning

confidence: 99%

Evaluation of Bipolar Permaloc™ Electrodes for Direct Bladder Stimulation

Walter¹,

Allen²,

Sayers³

et al. 2012

TOREHJ

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Abstract:Purpose: A bladder control system for spinal cord injured (SCI) patients is needed that can be implanted with minimally invasive methods. New Permaloc bipolar electrodes consisting of 6 mm helical, wire, stimulating surfaces separated by 3 mm and a polypropylene securing barb (Synapse Biomedical Inc) were developed for this application. They are implanted on the bladder wall with a 16 gauge needle, a minimally invasive method.Methods: Seven swines were anesthetized, the lower urinary tract exposed and instrumented with pressure transducers. Four Permaloc TM electrodes were implanted following identification of effective bladder wall stimulation sites next to the ureters and dorsal neurovascular bundle. Bladder stimulation to induce high pressures was conducted at 40 Hz, 400 s pulses, 5 s stimulation periods and a high stimulating current of 40 mA.Results: At the high stimulating current peak bladder pressures were low, ranging from 12±2 to15±3 cm H 2 0, insufficient to induce urination. Urethral sphincter contractions occurred during high bladder pressure. A spinal reflex role for high sphincter pressures during stimulation was shown by similar high pressures recorded during a bladder squeeze test without stimulation. Conclusions:Stimulation with Permaloc TM bipolar electrodes at high currents produced insufficient bladder pressures for urination. Further modifications of the electrode such as greater separation of the bipolar stimulating surfaces or changes in the testing methods such as alternative animal models are needed to induce high bladder pressures without side effects.

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New strategies of pelvic nerves stimulation for recovery of pelvic visceral functions and locomotion in paraplegics

Abstract: This short series indicated that laparoscopic implantation of neuroprothesis to the pelvic nerves offers absolutely new strategies based on new combinations of various reported methods to enhance bladder functions and to recover some locomotion in paraplegics.

Cited by 52 publications

References 19 publications

Recovery of supraspinal control of leg movement in a chronic complete flaccid paraplegic man after continuous low-frequency pelvic nerve stimulation and FES-assisted training

Recovery of supraspinal control of leg movement in a chronic complete flaccid paraplegic man after continuous low-frequency pelvic nerve stimulation and FES-assisted training

Nerve-Sparing radical hysterectomy - An old Japanese concept

Evaluation of Bipolar Permaloc™ Electrodes for Direct Bladder Stimulation

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