A Scoping Review of Epidural Spinal Cord Stimulation for Improving Motor and Voiding Function Following Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2023 · DOI: 10.46292/sci22-00061 · Published: July 1, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Spinal cord injury (SCI) can disrupt sensory and motor control, affecting daily life and bladder function. Even partial recovery of these functions greatly improves quality of life. After SCI, the nervous system can reorganize itself, a process called neuroplasticity, to compensate for lost function by forming new pathways and connections. Epidural spinal cord stimulation (SCS) shows promise in enhancing motor neuron excitability and aiding recovery post-SCI. It may improve responsiveness to local input and supraspinal input, even when not clinically apparent.

Study Duration

Not specified

Participants

88 individuals with complete or incomplete SCI (AIS grade A to D)

Evidence Level

Scoping Review

Key Findings

1
Epidural SCS can lead to variable improvements in volitional motor function in individuals with SCI.
2
Some studies have shown significant reductions in spasticity with the use of SCS.
3
Small studies suggest that epidural SCS may improve supraspinal control of volitional micturition.

Research Summary

This scoping review synthesizes evidence on epidural SCS for improving motor control, neurological recovery, and voiding in individuals with chronic SCI. Epidural SCS, originally for chronic pain, has shown potential in enhancing volitional motor control post-SCI, with various proposed mechanisms including afferent activation and segmental disinhibition. Future research should focus on identifying optimal epidural SCS targets and parameters to improve locomotion, spasticity, and voiding, and assess the long-term sustenance of effects.

Practical Implications

Motor Function Improvement

Epidural SCS can be considered as a potential intervention to enhance volitional motor control in individuals with SCI, though further research is needed to optimize parameters.

Spasticity Reduction

SCS may offer a way to reduce spasticity in SCI patients, potentially reducing the need for antispastic medications.

Voiding Function Enhancement

Epidural SCS could be explored to improve bladder control and voiding efficiency in individuals with SCI.

Study Limitations

1
Small cohort sizes in the identified studies
2
High risk of publication bias due to the nature of case reports and case series
3
Lack of large, good quality prospective controlled trials

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