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Walking naturally after spinal cord injury using a brain-spine interface

Léonie Asboth, Edeny Baaklini, Jocelyne Bloch, Thibault Jean Etienne Collin, Laure Coquoz, Grégoire Courtine, Robin Jonathan Demesmaeker, Grégory Didier Dumont, Carmina Andrea Galvez Solano, Cathal John Harte, Sergio Daniel Hernandez, Salif Axel Komi, Henri Charles Alexandre Lorach, Félix Antoine Martel, Jimmy James Ravier, Icare Sakr, Valeria Spagnolo, Molywan Vat, Anne Marie Lucienne Watrin

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis(1,2). Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals(3) and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking(4-6). A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.

NATURE PORTFOLIO2023

Implanted System for Orthostatic Hypotension in Multiple-System Atrophy

Suje Amir, Léonie Asboth, Maxime Berney, Jocelyne Bloch, Grégoire Courtine, Robin Jonathan Demesmaeker, Grégory Didier Dumont, Nicolas Hankov, Sergio Daniel Hernandez, Jordan Squair

Orthostatic hypotension is a cardinal feature of multiple-system atrophy. The upright posture provokes syncopal episodes that prevent patients from standing and walking for more than brief periods. We implanted a system to restore regulation of blood pressure and enable a patient with multiple-system atrophy to stand and walk after having lost these abilities because of orthostatic hypotension. This system involved epidural electrical stimulation delivered over the thoracic spinal cord with accelerometers that detected changes in body position.

MASSACHUSETTS MEDICAL SOC2022

Targeted dorsal root entry zone stimulation alleviates pain due to meralgia paresthetica

Léonie Asboth, Jocelyne Bloch, Grégoire Courtine, Robin Jonathan Demesmaeker, Nicolas Hankov, Jimmy James Ravier, Molywan Vat

Objective. Meralgia paresthetica (MP) is a mononeuropathy of the exclusively sensory lateral femoral cutaneous nerve (LFCN) that is difficult to treat with conservative treatments. Afferents from the LFCN enter the spinal cord through the dorsal root entry zones (DREZs) innervating L2 and L3 spinal segments. We previously showed that epidural electrical stimulation of the spinal cord can be configured to steer electrical currents laterally in order to target afferents within individual DREZs. Therefore, we hypothesized that this neuromodulation strategy is suitable to target the L2 and L3 DREZs that convey afferents from the painful territory, and thus alleviates MP related pain. Approach. A patient in her mid-30s presented with a four year history of dysesthesia and burning pain in the anterolateral aspect of the left thigh due to MP that was refractory to medical treatments. We combined neuroimaging and intraoperative neuromonitoring to guide the surgical placement of a paddle lead over the left DREZs innervating L2 and L3 spinal segments. Main results. Optimized electrode configurations targeting the left L2 and L3 DREZs mediated immediate and sustained alleviation of pain. The patient ceased all other medical management, reported improved quality of life, and resumed recreational physical activities. Significance. We introduced a new treatment option to alleviate pain due to MP, and demonstrated how neuromodulation strategies targeting specific DREZs is effective to reduce pain confined to specific regions of the body while avoiding disconfort.

IOP Publishing Ltd2022