Neurorestorative interventions involving bioelectronic implants after spinal cord injury

Bioelectronic Medicine, 2019 · DOI: https://doi.org/10.1186/s42234-019-0027-x · Published: June 13, 2019

Simple Explanation

Recent advances in bioelectronic medicine are changing the landscape of treatments for spinal cord injury (SCI). Multiple neuromodulation therapies targeting circuits in the brain, midbrain, or spinal cord have shown promise in improving motor and autonomic functions. Implantable brain-computer interface technologies are rapidly evolving and being integrated into rehabilitation programs to enhance the plasticity of spared circuits and residual projections through training. Functional neurosurgeons are taking on a new role in neurorestorative interventional medicine, which combines neurosurgery, neuro-engineering, and neurorehabilitation to restore neurological functions after SCI.

Study Duration

Not specified

Participants

Chronic SCI patients (AIS A/B), Chronic SCI patients (AIS C/D), Chronic tetraplegia secondary to SCI

Evidence Level

Review

Key Findings

1
Epidural electrical stimulation (EES) applied over the dorsal aspect of the spinal cord has been the most promising paradigm to engage lumbosacral circuits, enabling complex motor behaviors even in the complete absence of supraspinal input.
2
Spatiotemporal neuromodulation strategies, which involve the delivery of spatially-selective trains of EES with a timing reproducing task-dependent activation of motor neuron pools, have restored full weight bearing locomotion in rats with complete SCI.
3
Brain-computer interfaces (BCIs) have enabled individuals with severe SCI to operate biomimetic robotic arms and restore the ability to distinguish pressure-like sensations in each finger of the robotic hand.

Research Summary

This review summarizes the emerging role of bioelectronic medicine in treating spinal cord injury (SCI). Neuromodulation therapies and brain-computer interfaces are showing promise in improving motor and autonomic functions. Functional neurosurgeons are playing a crucial role in this new field, implanting bioelectronic devices and collaborating with multidisciplinary teams to deploy these treatments. The review discusses various bioelectronic treatments, including infralesional neuromodulation therapies targeting spinal circuits, supralesional neuromodulation therapies engaging hindbrain circuits, and brain-computer interface technologies.

Practical Implications

Enhanced Motor Recovery

Spatiotemporal neuromodulation protocols and brain-computer interfaces can improve motor function and coordination in SCI patients, potentially leading to increased independence and mobility.

Improved Autonomic Function

Epidural spinal cord stimulation can stabilize blood pressure and improve cardiovascular regulation in individuals with SCI, addressing a major health priority for this population.

Personalized Treatment Approaches

Computational models and real-time control infrastructures can enable personalized bioelectronic therapies tailored to the specific needs and neurological status of each patient.

Study Limitations

1
The clinical dissemination of BCIs may be limited by the difficulty to coordinate the direct recruitment of so many muscles in order to stabilize the posture of the arm and realize the tasks with fluidity.
2
More work is necessary to dissect the underlying mechanisms, and thus justify the surgical implantation of brain-spine interfaces in human patients. The computational complexity and skilled technological support may also need to be factored in prior to envisioning the clinical deployment of these neuroprostheses.
3
Studies investigating SCI-related changes in brain circuit dynamics, and how specific circuits contribute to steering recovery after SCI are limited.

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