Pittsburgh – In a pilot study, epidural implantation with electrodes stimulating the spinal cord at the level of the cervical spine improved partially paralyzed hand function of two patients undergoing rehabilitation treatment after stroke. The effect was after publication in nature midiCinema (2023; DOI: 10.1038 / s41591-022-02202-6) remains detectable even after planned removal of the electrodes.
Most strokes occur in the brain, with the spinal cord usually unaffected. Paresis and paralysis occur because the motor neurons no longer receive specific instructions from the damaged brain areas or are reduced to the point where they only perform weak muscle movements.
One of the goals of rehabilitation treatment is to improve residual motion. Over time, it is often possible to recruit other undamaged brain regions to perform motor tasks. However, in many patients, the paresis partially resolves over time.
Team led by Marco Capogrosso of University of Pittsburgh Would like to support rehabilitation treatment by stimulating the spinal cord. In one operation, two epidural tape-shaped implants are placed directly on the spinal cord in the C3 to Th1 vertebrae region. It is equipped with electrodes that stimulate sensory nerves.
Epidural spinal cord stimulators have been used in the treatment of various pain syndromes for a number of years also in Germany. In motor disorders, its effectiveness has not yet been proven.
The aim of the treatment is to strengthen the activity of the motor nerves by means of reflexes at the level of the spinal cord. The signals coming from the brain must be supported.
The treatment appears to have worked well in the first two patients in an ongoing study (as far as can be judged without a comparison group). A patient suffered a hemorrhagic stroke 10 years ago at the age of 23 after a brain aneurysm ruptured. The second patient, aged 47, had a stroke years ago.
Epidural spinal cord stimulation has been used as part of rehabilitation treatment. The devices were operated for 4 hours, 5 days a week.
The two patients were asked to perform certain exercises after activating the devices. At first glance, they seem to have worked out pretty well. According to Capogrosso, grip strength improved by 40% in one patient and as much as 108% in the other. Movement speed increased by 30% to 40%.
The patients were able to perform some daily movements that they were unable to do previously. This ranged from moving a hollow metal cylinder or gripping common household items such as a soup can to opening a padlock.
Interestingly, the effect persisted even after removal of the epidural electrodes, which was scheduled at 4 weeks in the study. A temporary implant could therefore be suitable to support rehabilitation treatment, although efficacy must be verified in other randomized studies before approval. The treatment appears to have few side effects. One patient reported a slight “shaking” sensation in her arms.
The study was funded by brain initiative Sponsored by the US National Institutes of Health. The researchers have already founded a startup, Reach Neuro, with which they want to conduct more clinical studies. © rme/aerzteblatt.de