scholarly journals Sensory restoration by epidural stimulation of dorsal spinal cord in upper-limb amputees

2019 ◽  
Author(s):  
Santosh Chandrasekaran ◽  
Ameya C. Nanivadekar ◽  
Gina P. McKernan ◽  
Eric R. Helm ◽  
Michael L. Boninger ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Limb Amputation ◽  
Neural Pathways ◽  
Dorsal Spinal Cord ◽  
Epidural Stimulation ◽  
Epidural Spinal Cord Stimulation ◽  
Dorsal Spinal ◽  
Median Change ◽  
Stimulation Of

Restoring somatosensory feedback to people with limb amputations is crucial for improving prosthesis acceptance and function. Epidural spinal cord stimulation is a commonly used clinical procedure that targets sensory neural pathways in the dorsal spinal cord to treat pain conditions. A similar approach could be developed as a clinically translatable means to restore somatosensation in amputees. We show that epidural stimulation of the dorsal spinal cord evoked sensory percepts, perceived as emanating from the amputated arm and hand, in four people with upper-limb amputation. After an initial caudal movement immediately following the implantation, the leads stabilized, exhibiting a median migration of <5 mm (each electrode contact is 3 mm long) over the remainder of the study in all the subjects. This was reflected in the consistent locations of evoked percepts in the hand across four subjects throughout the period of implantation, which lasted up to 29 days. The median change in the centroid location was 1.2 to 35.3 mm and the median change in percept area was 0 to 40%. While most of the evoked percepts were paresthetic in nature, a subset was described as naturalistic (e.g. touch or pressure) in three subjects. Modulating the stimulus amplitude affected the perceived intensity of the sensation in all subjects. A variety of sensory percepts were evoked in all subjects irrespective of the level of amputation or the time since amputation, suggesting the approach is amenable to a diverse population of amputees.

scholarly journals Sensory restoration by epidural stimulation of the lateral spinal cord in upper-limb amputees

eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Santosh Chandrasekaran ◽  
Ameya C Nanivadekar ◽  
Gina McKernan ◽  
Eric R Helm ◽  
Michael L Boninger ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Sensory Feedback ◽  
Limb Amputation ◽  
Stimulus Amplitude ◽  
Major Barrier ◽  
Somatosensory Feedback ◽  
Upper Limb Amputation ◽  
Epidural Spinal Cord Stimulation ◽  
Stimulation Of

Restoring somatosensory feedback to people with limb amputations is crucial to improve prosthetic control. Multiple studies have demonstrated that peripheral nerve stimulation and targeted reinnervation can provide somatotopically relevant sensory feedback. While effective, the surgical procedures required for these techniques remain a major barrier to translatability. Here, we demonstrate in four people with upper-limb amputation that epidural spinal cord stimulation (SCS), a common clinical technique to treat pain, evoked somatosensory percepts that were perceived as emanating from the missing arm and hand. Over up to 29 days, stimulation evoked sensory percepts in consistent locations in the missing hand regardless of time since amputation or level of amputation. Evoked sensations were occasionally described as naturalistic (e.g. touch or pressure), but were often paresthesias. Increasing stimulus amplitude increased the perceived intensity linearly, without increasing area of the sensations. These results demonstrate the potential of SCS as a tool to restore somatosensation after amputations.

Epidural spinal cord stimulation as an intervention for motor recovery after motor complete spinal cord injury

2021 ◽  
Author(s):  
Jan T Hachmann ◽  
Andrew Yousak ◽  
Josephine J Wallner ◽  
Parag N. Gad ◽  
V. Reggie Edgerton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Stimulation ◽  
Large Diameter ◽  
Motor Units ◽  
Clinical Results ◽  
Neural Pathways ◽  
Epidural Stimulation ◽  
Cord Injury ◽  
Epidural Spinal Cord Stimulation

Spinal cord injury (SCI) commonly results in permanent loss of motor, sensory, and autonomic function. Recent clinical studies have shown that epidural spinal cord stimulation may provide a beneficial adjunct for restoring lower extremity and other neurological functions. Herein, we review the recent clinical advances of lumbosacral epidural stimulation for restoration of sensorimotor function in individuals with motor complete SCI and we discuss the putative neural pathways involved in this promising neurorehabilitative approach. We focus on three main sections: review recent clinical results for locomotor restoration in complete SCI; discuss the contemporary understanding of electrical neuromodulation and signal transduction pathways involved in spinal locomotor networks; review current challenges of motor system modulation and future directions towards integrative neurorestoration. The current understanding is that initial depolarization occurs at the level of large diameter dorsal root proprioceptive afferents that when integrated with interneuronal and latent residual supraspinal translesional connections can recruit locomotor centers and augment downstream motor units. Spinal epidural stimulation can initiate excitability changes in spinal networks and supraspinal networks. Different stimulation parameters can facilitate standing or stepping, and it may also have potential for augmenting myriad other sensorimotor and autonomic functions. More comprehensive investigation of the mechanisms that mediate the transformation of dysfunctional spinal networks to higher functional states with a greater focus on integrated systems based control system may reveal the key mechanisms underlying neurological augmentation and motor restoration after severe paralysis.

scholarly journals Author response: Sensory restoration by epidural stimulation of the lateral spinal cord in upper-limb amputees

2020 ◽  
Author(s):  
Santosh Chandrasekaran ◽  
Ameya C Nanivadekar ◽  
Gina McKernan ◽  
Eric R Helm ◽  
Michael L Boninger ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Author Response ◽  
Epidural Stimulation ◽  
Stimulation Of

scholarly journals Correction: Sensory restoration by epidural stimulation of the lateral spinal cord in upper-limb amputees

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Santosh Chandrasekaran ◽  
Ameya C Nanivadekar ◽  
Gina McKernan ◽  
Eric R Helm ◽  
Michael L Boninger ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Epidural Stimulation ◽  
Stimulation Of

Idiopathic dorsal spinal cord herniation perforating the lamina: a case report and review of the literature

2021 ◽  
Author(s):  
Haruki Funao ◽  
Satoshi Nakamura ◽  
Kenshi Daimon ◽  
Norihiro Isogai ◽  
Yutaka Sasao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Review Of The Literature ◽  
Dorsal Spinal Cord ◽  
Spinal Cord Herniation ◽  
Dorsal Spinal

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

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