Immediate restoration of voluntary movement with epidural spinal cord stimulation in two patients with paraplegia

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Study assessing the effect of spinal cord stimulation on paraplegic patients finds voluntary movement restored

In a small cohort of patients, spinal cord stimulation has been shown to restore volitional movement in select patients with paraplegia, after intensive therapy. This was the result presented by winner of the Philip L Gildenberg Resident Award, David Darrow (Neurosurgery Department, University of Minnesota, Minneapolis, USA), during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting (28 April–2 May, New Orleans, USA).

The presentation was entitled “Immediate Restoration of Voluntary Movement with Epidural Spinal Cord Stimulation in Two Patients with Paraplegia.”

The Epidural Stimulation After Neurologic Damage (E-STAND) study was designed to assess the effect of spinal cord stimulation on paraplegic patients, focusing directly on movement and cardiovascular function, while patients undergo intensive stimulator setting optimisation from home.

Participants were selected from a cohort of AIS A/B chronic spinal cord injury patients with a motor level between C6 and T10 greater than one year from injury. Patients were required to have full strength in their upper extremities and have discrete spinal cord lesions on MRI. The first two E-STAND patients underwent enrollment, surgical implantation of the stimulator and paddle electrode and follow-up. Preoperative and postoperative tilt table assessments and neurological assessments were performed.

The first two patients were female and in their fifth and sixth decade of life, with complete motor and sensory paraplegia (AIS A). Initial assessment (36 hours from surgery) of spinal cord stimulation revealed restoration of lower extremity volitional movement only during stimulation in both patients, despite being 11 and five years out from surgery. Quantitative surface EMG power was found to improve significantly for both patients within just the first five follow up visits.

Spinal cord stimulation was also found to restore normal blood pressure from severe hypotension during tilt table testing in the second patient, who had exhibited dysautonomia on screening assessments, while having no effect on the normal blood pressure of the first patient. Bowel and bladder changes were also found with restoration of volitional urination and restoration of bowel and bladder synergy.

To the authors’ knowledge, these are the first women with radiographically severe spinal cord injury this far from injury where restoration of some volitional movement and autonomic function has been reported. The authors claim that this work provides evidence that even in the most severe forms of chronic spinal cord injury, some volitional movement and autonomic function can be restored in paraplegic patients with spinal cord stimulation neuromodulation without significant prehabilitation.

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