Spinal cord stimulator

A spinal cord stimulator (SCS) or dorsal column stimulator (DCS) is a type of implantable neuromodulation device (sometimes called a "pain pacemaker") that is used to send electrical signals to select areas of the spinal cord (dorsal columns) for the treatment of certain pain conditions. SCS is a consideration for people who have a pain condition that has not responded to more conservative therapy. There are also spinal cord stimulators under research and development that could enable patients with spinal cord injury to walk again via epidural electrical stimulation (EES). Medical uses The most common use of SCS is failed back surgery syndrome (FBSS) in the United States and peripheral ischemic pain in Europe. As of 2014 the FDA had approved SCS as a treatment for FBSS, chronic pain, complex regional pain syndrome, intractable angina, as well as visceral abdominal and perineal pain and pain in the extremities from nerve damage. Once a person has had

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Neuromodulation in the restoration of function after spinal cord injury

Nicholas David James

Neuromodulation, the use of electrical interfaces to alter neuronal activity, has been successful as a treatment approach in several neurological disorders, including deep brain stimulation for Parkinson's disease and epidural spinal stimulation for chronic pain. Neuromodulation can also be beneficial for spinal cord injury, from assisting basic functions such as respiratory pacing and bladder control, through to restoring volitional movements and skilled hand function. Approaches range from electrical stimulation of peripheral muscles, either directly or via brain-controlled bypass devices, to stimulation of the spinal cord and brain. Limitations to widespread clinical application include durability of neuromodulation devices, affordability and accessibility of some approaches, and poor understanding of the underlying mechanisms. Efforts to overcome these challenges through advances in technology, together with pragmatic knowledge gained from clinical trials and basic research, could lead to personalised neuromodulatory interventions to meet the specific needs of individuals with spinal cord injury.

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Automatic clustering of spinal reflexes evoked by epidural electrical stimulation of the cervical spinal cord in non-human primates

Beatrice Barra, Jocelyne Bloch, Marco Capogrosso, Sara Conti, Grégoire Courtine, Stéphanie Lacour, Giuseppe Schiavone, Katie Zhi Zhuang

Epidural electrical stimulation of the spinal cord elicits motor responses by recruiting large sensory afferents in the posterior roots. Divergence of excitatory inputs provided by these fibers generates a variety of shapes, latencies and amplitudes in the electrical responses recorded from skeletal muscles. Interpretation of these signals is pivotal to the tuning and optimization of stimulation parameters. Here we present an automatic approach to identify and sort different arm muscle responses elicited by epidural stimulation of the cervical spinal cord in nonhuman primates. We tested the efficiency of our algorithm both under anesthesia and during behavior.

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Selective Recruitment of Arm Motoneurons in Nonhuman Primates Using Epidural Electrical Stimulation of the Cervical Spinal Cord

Beatrice Barra, Jocelyne Bloch, Marco Capogrosso, Grégoire Courtine, Stéphanie Lacour, Camille Roux, Giuseppe Schiavone

Recovery of reaching and grasping ability is the priority for people with cervical spinal cord injury (SCI). Epidural electrical stimulation (EES) has shown promising results in improving motor control after SCI in various animal models and in humans. Notably, the application of stimulation bursts with spatiotemporal sequences that reproduce the natural activation of motoneurons restored skilled leg movements in rodent and nonhuman primate models of SCI. Here, we studied whether this conceptual framework could be transferred to the design of cervical EES protocols for the recovery of reaching and grasping in nonhuman primates. We recorded muscle activity during a reaching and grasping task in a macaque monkey and found that this task involves a stereotypical spatiotemporal map of motoneuron activation. We then characterized the specificity of a spinal implant for the delivery of EES to cervical spinal segments in the same animal. Finally, we combined these results to design a simple stimulation protocol that may reproduce natural motoneuron activation and thus facilitate upper limb movements after injury.

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