Spinal Cord Stimulation as a Tool f or Physiological Research

Dimitrijevič, Milan R.; Faganel, J.; Sherwood, Arthur M.

doi:10.1159/000101270

Cited by 11 publications

(11 citation statements)

References 11 publications

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“…The most widely utilized effects of SCS have been its inhibitory action on in creased muscle tone of various etiologies [1,5,9,10]. This case shows the potential of SCS to augment motor strength and voluntary control.…”

Section: Resultsmentioning

confidence: 85%

“…Only a few studies have focused on the ef fects of SCS on specific motor disabilities rather than diseases charac terized by miscellaneous motor problems. Various motor disorders have been claimed to be affected by SCS, such as spasms and spasticity of spinal origin [1,5,[7][8][9], ataxia due to spinocerebellar degeneration and multiple sclerosis [3,4], and neurogenic bladder dysfunction [2,3,7]. Some authors have reported improvement in motor strength and vol untary motor control following SCS [2,4,6,10].…”

Section: Resultsmentioning

confidence: 99%

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Enhancement of Voluntary Motor Function Following Spinal Cord Stimulation - Case Study

Barolat

Myklebust

Wenninger³

1986

Stereotact Funct Neurosurg

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One patient with an incomplete traumatic myelopathy underwent epidural spinal cord stimulation for the management of severe intractable spasms, which were abolished by the stimulation. After several months of stimulation, the patient regained some voluntary motor function in the lower extremities. Voluntary motor control of the Ieft quadriceps was present only when spinal cord stimulation was activated and stopped immediately after it was turned off. The effects could be consistently reproduced. EMG polygraphic recordings confirmed the results.

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Section: Resultsmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Enhancement of Voluntary Motor Function Following Spinal Cord Stimulation - Case Study

Barolat

Myklebust

Wenninger³

1986

Stereotact Funct Neurosurg

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“…This train yields a stimulus/response ratio of 1 : 1 when applied to anterior roots and a reduced ratio when applied to dorsal roots. 23 In the present study we have not explicitly addressed these neurophysiological parameters, but the test was performed in all studied subjects. Thus the posterior positions of the cathode were documented by neurophysiological as well as radiological means as part of our routine approach.…”

Section: Discussionmentioning

confidence: 99%

Epidural electric stimulation of posterior structures of the human lumbar spinal cord: 1. muscle twitches – a functional method to define the site of stimulation

Murg¹,

Binder

2000

Spinal Cord

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Objectives: To describe an electrophysiological method for determining the relation between lumbar cord dorsal roots and cathode of epidural electrode for spinal cord stimulation (SCS). Materials and methods: Data has been collected from 13 subjects who have been under evaluation of eectiveness of SCS for control of spasticity. Induced muscle twitches from both quadriceps (Q), adductors (A), hamstrings (H), tibial anterior muscles (TA) and triceps surae muscles (TS) were simultaneously recorded with surface-electrode polyelectromyography (pEMG) and analyzed for amplitudes, latency times and recruitment order. Results: Stimulation of dorsal lumbar cord structures evoked characteristic EMG events during muscle twitch responses. Their amplitudes varied with stimulus strength. Latency times were rather invariable regardless of stimulus strength. Two distinct recruitment orders were demonstrated depending on whether the stimulating cathode was placed over the upper (=response from quadriceps and/or adductor muscles) or the lower (=response from tibialis anterior and triceps surae) lumbar cord segments. The chances to stimulate upper lumbar cord segments are best around the 12th thoracic vertebra. Conclusions: pEMG recording of muscle twitches enables us to accurately dierentiate between upper and lower lumbar cord segments. Furthermore, our ®ndings regarding amplitude, latency and recruitment order strongly suggest that we stimulate posterior roots not posterior columns of the lumbar spinal cord. Spinal Cord (2000) 38, 394 ± 402

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“…This regime may be supplemented by extra-dural electrical stimulation and other methods of restorative neurology if available. 69 Electrical stimulation is known to facilitate well-being in incomplete SCI. 70 It is also important to avoid pressure palsies of peripheral nerves so that the skeletal muscles do not undergo atrophy.…”

Section: The Futurementioning

confidence: 99%

“…This phenomenon also underlines the importance of recognizing the discomplete SCI individuals who may benefit from treatment within the repertoire of restorative neurology. 69 This standard clinical regime for SCI is the treatment platform from which the stem cell therapy when developed may be mounted.…”

Section: The Futurementioning

confidence: 99%

Neuropathology: the foundation for new treatments in spinal cord injury

2004

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The first step essential in the search for a cure of human spinal cord injury (SCI) is to appreciate the complexity of the disorder. In this regard, it is not only the loss of ambulation but the sensory and autonomic changes that are equally important in recovery. In addition, there are the serious social emotional psychological and lifestyle effects of SCI which should also be taken into account. It is also true that no two SCI lesions are alike as each is the result of a SCI unique to that individual. Clinically of utmost importance is the segmental level of injury and whether it is complete, incomplete or discomplete (loss of all neurological functions below the injury but with physiological or anatomical continuity of Central nervous system tracts across the lesion). We are not concerned here with primary and secondary prevention or methods designed to limit the severity of the lesion after the event, important as they are, but with the requirements for a cure. Clearly, the greater the number of nerve fibers that can be preserved in the acute stage, the better will be the end result. Our focus at present is on the end-stage lesion with the aim of showing that a cure for SCI will depend upon establishing functionally useful central axonal regeneration and reestablishing physiological reconnections. Existing experimental methods are based on stimulating axonal regeneration by neutralizing inhibitory factors, adding positive trophisms and creating a permissive environment. Better results are obtained by bridging the gap with grafts of peripheral nerves or transplants of Schwann cells and genetically engineered fibroblasts. Recently, the potential for stem cells to enhance this process has created great interest. This is because of the ability of pluripotential cells to differentiate into neural tissue. A cure based on the physiopathology of SCI requires pyramidal, extrapyramidal, sensory, cerebellar and autonomic pathways to be regenerated with their appropriate neurotransmitters restored and reflexes integrated physiologically and in synchrony. In human SCI, there is a very long distance anatomically for axonal regrowth to occur in order to reach their relevant nuclei. This is because of continuing Wallerian degeneration. It also presumes that the target neurons are intact and that there has been no transneuronal degeneration above or below the lesion. Alternatively, in place of regenerated long axons, a multisynaptic pathway may be constructed from stem cells that have developed into neurons. Whether such a pathway would restore useful neurological functions is unknown. At present, the transplant and grafting research teams are exploring these possibilities in experimental animals. Moderate success in gaining axonal regeneration has been reported; however, it must be appreciated that the human lesion differs considerably from that of the experimental animal. In order to be successful, the neuropathology and neurophysiology of human SCI must be taken into account. The purpose of this review is to place the req...

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Spinal Cord Stimulation as a Tool f or Physiological Research

Cited by 11 publications

References 11 publications

Enhancement of Voluntary Motor Function Following Spinal Cord Stimulation - Case Study

Enhancement of Voluntary Motor Function Following Spinal Cord Stimulation - Case Study

Epidural electric stimulation of posterior structures of the human lumbar spinal cord: 1. muscle twitches – a functional method to define the site of stimulation

Neuropathology: the foundation for new treatments in spinal cord injury

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