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

Abstract

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.

Training with brain-machine interfaces, visuo-tactile feedback and assisted locomotion improves sensorimotor, visceral, and psychological signs in chronic paraplegic patients

“…Indeed, whereas a number of neurorehabilitation protocols have induced some level of neurological recovery in motor incomplete SCI patients (AIS C/D) (including stepping training [22,23], operant conditioning [24,25] or functional electrical stimulation [26]), improvement in motor complete SCI has been principally observed through compensatory mechanisms [15]. Only recently, a few studies in rats [27] and humans [28] have shown partial motor recovery (neurological and functional) in severe cases of SCI, following training with invasive epidural stimulation (see [29] for a review) or invasive pelvic nerve stimulation [30]. Notably, clinical improvement was noticed when such invasive stimulation was paired with direct patient control of the stimulating system, via a brain-machine interface [31] (see [32] for a review).…”

Endometriosis involving the sciatic nerve: A case report of isolated endometriosis of the sciatic nerve and review of the literature

“…Neuropelveology has a wide scope of application to pelvic conditions including neuropelveological evaluation to chronic pelvic pain, vascular entrapment syndrome as well as the use of implantation of electrode for pelvic visceral dysfunction and even implantation of electrodes to pelvic nerve for assisting ambulation in patient with spinal cord injury. [ 16 ] In addition to this specialized knowledge, it also requires a high degree of laparoscopic surgical skill.…”

Neuropelveology: An Emerging Discipline for the Management of Pelvic Neuropathies and Bladder Dysfunctions through to Spinal Cord Injury, Anti-Ageing and the Mars Mission

“…The crucial discovery we made with the LION procedure in people with SCI was undoubtedly the fact that some patients experienced enough recovery of supra-spinal control for some leg movement or even standing and walking [ 26 , 29 ]. In the most recent study of 29 patients with SCI 10 years after a LION procedure, 20 of them (71.4%) were able to demonstrate an electrically assisted, voluntary extension of the knee [ 30 ] ( Figure 10 ).…”