Single Lead Epidural Spinal Cord Stimulation Targeted Trunk Control and Standing in Complete Paraplegia

Abstract

A 25-year-old male with T3 complete AIS A was implanted with percutaneous spinal cord epidural stimulation (scES; eight contacts each) leads and a Medtronic Prime advance internal pulse generator. The two leads were placed at the midline level to cover the region of the T11–T12 vertebrae. Five days after implantation, X-ray showed complete migration of the left lead outside the epidural space. Two weeks after implantation, reprogramming of the single right lead (20 Hz and 240 µs) after setting the cathode at 0 and the anode at 3 resulted in target activation of the abdominal muscles and allowed for the immediate restoration of trunk control during a seated position, even with upper extremity perturbation. This was followed by achieving immediate standing after setting the single lead at −3 for the cathode and +6 for the anode using stimulation configurations of 20 Hz and 240 µs. The results were confirmed with electromyography (EMG) of the rectus abdominus and lower extremity muscles. Targeted stimulation of the lumbosacral segment using a single lead with a midline approach immediately restored the trunk control and standing in a person with complete paraplegia.

A case study of percutaneous epidural stimulation to enable motor control in two men after spinal cord injury

“…Next, the leads were navigated in the epidural space and the configuration (i.e. stimulation parameters), in the presence of Medtronic representative, necessary to evoke motor potentials was tested as indicated by visible motor contractions of the paralyzed muscles 26 . The leads were steered to the left and right of midline on live AP fluoroscopy confirming posterior epidural placement on lateral fluoroscopy.…”

Effects of percutaneously-implanted epidural stimulation on cardiovascular autonomic function and spasticity after complete spinal cord injury: A case report

“…The SCES mapping was approximately conducted after 6 months from permanent implantation. The detailed process of establishing rhythmic, locomotor-like activity was previously described by our laboratory ( Gorgey and Gouda, 2022 ). We attempted to identify the cathodal-anodal locations that yield electromyography (EMG) activities of the rectus femoris and then followed by medial gastrocnemius (GM) muscles as previously described ( Minassian et al, 2004 ; Gorgey and Gouda, 2022 ).…”

“…The detailed process of establishing rhythmic, locomotor-like activity was previously described by our laboratory ( Gorgey and Gouda, 2022 ). We attempted to identify the cathodal-anodal locations that yield electromyography (EMG) activities of the rectus femoris and then followed by medial gastrocnemius (GM) muscles as previously described ( Minassian et al, 2004 ; Gorgey and Gouda, 2022 ). These configurations were tested at 2 Hz at three different pulse durations (250, 500, and 1,000 μs) and after ramping the current from 1 to 10 mA.…”

“…Identifying optimal person-specific and function-specific SCES configurations is labor-intensive and time-consuming ( Angeli et al, 2014 ; Sayenko et al, 2014 ; Rejc et al, 2015 ). Pursuant to this, the increasing occurrence of doctors performing off-label implantations ( Gorgey and Gouda, 2022 ) or persons with SCI electing to self-pay for a SCES system implantation has yielded more variable results than those from research laboratories dedicated to optimizing SCES for persons with SCI ( Gorgey et al, 2020 ). One potential clinically feasible strategy to maximize functional benefits from SCES would be determining if SCES configurations intended for one function yield benefits for other functions or bodily systems.…”

A Fully Implantable and Programmable Epidural Spinal Cord Stimulation System for Rats With Spinal Cord Injury

“…Epidural spinal cord stimulation (ESCS) has been proven to be beneficial to the recovery of motor function in animal experiments and clinical experiments [3]- [9]. In ESCS, the stimulating electrodes are placed on the surface of the spinal dura below the injured site of the spinal cord.…”