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Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis
Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower ext...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Mary Ann Liebert, Inc., publishers
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482916/ https://www.ncbi.nlm.nih.gov/pubmed/30430902 http://dx.doi.org/10.1089/neu.2018.5921 |
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author | Calvert, Jonathan S. Grahn, Peter J. Strommen, Jeffrey A. Lavrov, Igor A. Beck, Lisa A. Gill, Megan L. Linde, Margaux B. Brown, Desmond A. Van Straaten, Meegan G. Veith, Daniel D. Lopez, Cesar Sayenko, Dimitry G. Gerasimenko, Yury P. Edgerton, V. Reggie Zhao, Kristin D. Lee, Kendall H. |
author_facet | Calvert, Jonathan S. Grahn, Peter J. Strommen, Jeffrey A. Lavrov, Igor A. Beck, Lisa A. Gill, Megan L. Linde, Margaux B. Brown, Desmond A. Van Straaten, Meegan G. Veith, Daniel D. Lopez, Cesar Sayenko, Dimitry G. Gerasimenko, Yury P. Edgerton, V. Reggie Zhao, Kristin D. Lee, Kendall H. |
author_sort | Calvert, Jonathan S. |
collection | PubMed |
description | Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower extremities. However, the use of EES-evoked motor responses to guide EES system implantation over the spinal cord and their relation to post-operative EES-enabled function in humans with chronic paralysis attributed to SCI has yet to be described. Herein, we describe the surgical and intraoperative electrophysiological approach used, followed by initial EES-enabled results observed in 2 human subjects with motor complete paralysis who were enrolled in a clinical trial investigating the use of EES to enable motor functions after SCI. The 16-contact electrode array was initially positioned under fluoroscopic guidance. Then, EES-evoked motor responses were recorded from select leg muscles and displayed in real time to determine electrode array proximity to spinal cord regions associated with motor activity of the lower extremities. Acceptable array positioning was determined based on achievement of selective proximal or distal leg muscle activity, as well as bilateral muscle activation. Motor response latencies were not significantly different between intraoperative recordings and post-operative recordings, indicating that array positioning remained stable. Additionally, EES enabled intentional control of step-like activity in both subjects within the first 5 days of testing. These results suggest that the use of EES-evoked motor responses may guide intraoperative positioning of epidural electrodes to target spinal cord circuitry to enable motor functions after SCI. |
format | Online Article Text |
id | pubmed-6482916 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Mary Ann Liebert, Inc., publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-64829162019-04-26 Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis Calvert, Jonathan S. Grahn, Peter J. Strommen, Jeffrey A. Lavrov, Igor A. Beck, Lisa A. Gill, Megan L. Linde, Margaux B. Brown, Desmond A. Van Straaten, Meegan G. Veith, Daniel D. Lopez, Cesar Sayenko, Dimitry G. Gerasimenko, Yury P. Edgerton, V. Reggie Zhao, Kristin D. Lee, Kendall H. J Neurotrauma Original Articles Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower extremities. However, the use of EES-evoked motor responses to guide EES system implantation over the spinal cord and their relation to post-operative EES-enabled function in humans with chronic paralysis attributed to SCI has yet to be described. Herein, we describe the surgical and intraoperative electrophysiological approach used, followed by initial EES-enabled results observed in 2 human subjects with motor complete paralysis who were enrolled in a clinical trial investigating the use of EES to enable motor functions after SCI. The 16-contact electrode array was initially positioned under fluoroscopic guidance. Then, EES-evoked motor responses were recorded from select leg muscles and displayed in real time to determine electrode array proximity to spinal cord regions associated with motor activity of the lower extremities. Acceptable array positioning was determined based on achievement of selective proximal or distal leg muscle activity, as well as bilateral muscle activation. Motor response latencies were not significantly different between intraoperative recordings and post-operative recordings, indicating that array positioning remained stable. Additionally, EES enabled intentional control of step-like activity in both subjects within the first 5 days of testing. These results suggest that the use of EES-evoked motor responses may guide intraoperative positioning of epidural electrodes to target spinal cord circuitry to enable motor functions after SCI. Mary Ann Liebert, Inc., publishers 2019-05-01 2019-04-12 /pmc/articles/PMC6482916/ /pubmed/30430902 http://dx.doi.org/10.1089/neu.2018.5921 Text en © Jonathan S. Calvert et al., 2018; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. |
spellingShingle | Original Articles Calvert, Jonathan S. Grahn, Peter J. Strommen, Jeffrey A. Lavrov, Igor A. Beck, Lisa A. Gill, Megan L. Linde, Margaux B. Brown, Desmond A. Van Straaten, Meegan G. Veith, Daniel D. Lopez, Cesar Sayenko, Dimitry G. Gerasimenko, Yury P. Edgerton, V. Reggie Zhao, Kristin D. Lee, Kendall H. Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis |
title | Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis |
title_full | Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis |
title_fullStr | Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis |
title_full_unstemmed | Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis |
title_short | Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis |
title_sort | electrophysiological guidance of epidural electrode array implantation over the human lumbosacral spinal cord to enable motor function after chronic paralysis |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482916/ https://www.ncbi.nlm.nih.gov/pubmed/30430902 http://dx.doi.org/10.1089/neu.2018.5921 |
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