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Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury

Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury (SCI) but is less effective in humans. Here, we hypothesized that this inter-species discrepancy is due to interference between EES and proprioceptive information in humans. Computatio...

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Autores principales: Formento, E., Minassian, K., Wagner, F., Mignardot, JB., Le Goff, C. G., Rowald, A., Bloch, J., Micera, S., Capogrosso, M., Courtine, G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6268129/
https://www.ncbi.nlm.nih.gov/pubmed/30382196
http://dx.doi.org/10.1038/s41593-018-0262-6
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author Formento, E.
Minassian, K.
Wagner, F.
Mignardot, JB.
Le Goff, C. G.
Rowald, A.
Bloch, J.
Micera, S.
Capogrosso, M.
Courtine, G.
author_facet Formento, E.
Minassian, K.
Wagner, F.
Mignardot, JB.
Le Goff, C. G.
Rowald, A.
Bloch, J.
Micera, S.
Capogrosso, M.
Courtine, G.
author_sort Formento, E.
collection PubMed
description Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury (SCI) but is less effective in humans. Here, we hypothesized that this inter-species discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations, preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents the modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position. Consequently, continuous EES can only facilitate locomotion within a narrow range of stimulation parameters and is unable to provide meaningful locomotor improvements in humans without rehabilitation. Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motoneuron activity. This demonstrates the importance of stimulation protocols that preserve proprioceptive information to facilitate walking with EES.
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spelling pubmed-62681292019-04-30 Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury Formento, E. Minassian, K. Wagner, F. Mignardot, JB. Le Goff, C. G. Rowald, A. Bloch, J. Micera, S. Capogrosso, M. Courtine, G. Nat Neurosci Article Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury (SCI) but is less effective in humans. Here, we hypothesized that this inter-species discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations, preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents the modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position. Consequently, continuous EES can only facilitate locomotion within a narrow range of stimulation parameters and is unable to provide meaningful locomotor improvements in humans without rehabilitation. Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motoneuron activity. This demonstrates the importance of stimulation protocols that preserve proprioceptive information to facilitate walking with EES. 2018-10-31 2018-12 /pmc/articles/PMC6268129/ /pubmed/30382196 http://dx.doi.org/10.1038/s41593-018-0262-6 Text en Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:http://www.nature.com/authors/editorial_policies/license.html#terms
spellingShingle Article
Formento, E.
Minassian, K.
Wagner, F.
Mignardot, JB.
Le Goff, C. G.
Rowald, A.
Bloch, J.
Micera, S.
Capogrosso, M.
Courtine, G.
Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury
title Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury
title_full Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury
title_fullStr Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury
title_full_unstemmed Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury
title_short Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury
title_sort electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6268129/
https://www.ncbi.nlm.nih.gov/pubmed/30382196
http://dx.doi.org/10.1038/s41593-018-0262-6
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