Summary: Researchers report they have successfully and immediately restored volitional movement in two paralyzed people with the help of spinal cord stimulation. Additionally, the stimulation helped to reduce hypotension in the patients.
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.
he author reported no conflicts of interest.
Source: Alice I. Kelsey – AANS
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is for illustrative purposes only.
Original Research: The study was presented at the AANS Annual Scientific Meeting 2018.
Less immune activation following social stress in rural vs. urban participants raised with regular or no animal contact, respectively
Urbanization is on the rise, and environments offering a narrow range of microbial exposures are linked to an increased prevalence of both physical and mental disorders. Human and animal studies suggest that an overreactive immune system not only accompanies stress-associated disorders but might even be causally involved in their pathogenesis. Here, we show in young [mean age, years (SD): rural, 25.1 (0.78); urban, 24.5 (0.88)] healthy human volunteers that urban upbringing in the absence of pets (n = 20), relative to rural upbringing in the presence of farm animals (n = 20), was associated with a more pronounced increase in the number of peripheral blood mononuclear cells (PBMCs) and plasma interleukin 6 (IL-6) concentrations following acute psychosocial stress induced by the Trier social stress test (TSST). Moreover, ex vivo-cultured PBMCs from urban participants raised in the absence of animals secreted more IL-6 in response to the T cell-specific mitogen Con A. In turn, antiinflammatory IL-10 secretion was suppressed following TSST in urban participants raised in the absence of animals, suggesting immunoregulatory deficits, relative to rural participants raised in the presence of animals. Questionnaires, plasma cortisol, and salivary α-amylase, however, indicated the experimental protocol was more stressful and anxiogenic for rural participants raised in the presence of animals. Together, our findings support the hypothesis that urban vs. rural upbringing in the absence or presence of animals, respectively, increases vulnerability to stress-associated physical and mental disorders by compromising adequate resolution of systemic immune activation following social stress and, in turn, aggravating stress-associated systemic immune activation.