Immediate Restoration of Voluntary Movement with Epidural Spinal Cord Stimulation in Two Patients with Paraplegia
A presentation at the 2018 American Association of Neurological Surgeons Annual Scientific Meeting
25-Apr-2018 5:00 PM EDT
Newswise — Winner of the Philip L. Gildenberg, MD, Resident Award, David Darrow, MD, presented his research, Immediate Restoration of Voluntary Movement with Epidural Spinal Cord Stimulation in Two Patients with Paraplegia, during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
In a small cohort of patients, spinal cord stimulation (SCS) has been shown to restore volitional movement in select paraplegic patients, after intensive therapy. The Epidural Stimulation After Neurologic Damage (E-STAND) study was designed to assess the effect of SCS on paraplegic patients, directly on movement and cardiovascular function, while undergoing intensive stimulator setting optimization 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 (as soon as 36 hours from surgery) of SCS revealed restoration of lower extremity volitional movement only during stimulation in both patients, despite being 11 and 5 years out from surgery. Quantitative surface EMG power was found to significantly improve for both patients within just the first five follow up visits.
SCS 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 our knowledge, these are the first women with radiographically-severe SCI who are the furthest from injury, where restoration of some volitional movement and autonomic function has been reported. This work provides evidence that even in the most severe forms of chronic SCI, some volitional movement and autonomic function can be restored in paraplegic patients with SCS neuromodulation without significant prehabilitation.
Author Block: David Balser, MD; Aaron Phillips, PhD; Andrei Krassioukov, MD, PhD; Uzma Samadani, MD, PhD
Disclosure: The author reported no conflicts of interest.
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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 11,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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