PMID- 33367527
OWN - NLM
STAT- MEDLINE
DCOM- 20210419
LR  - 20210419
IS  - 1460-2156 (Electronic)
IS  - 0006-8950 (Linking)
VI  - 144
IP  - 2
DP  - 2021 Mar 3
TI  - Predictors of volitional motor recovery with epidural stimulation in individuals 
      with chronic spinal cord injury.
PG  - 420-433
LID - 10.1093/brain/awaa423 [doi]
AB  - Spinal cord epidural stimulation (scES) has enabled volitional lower extremity 
      movements in individuals with chronic and clinically motor complete spinal cord 
      injury and no clinically detectable brain influence. The aim of this study was to 
      understand whether the individuals' neuroanatomical characteristics or 
      positioning of the scES electrode were important factors influencing the extent 
      of initial recovery of lower limb voluntary movements in those with clinically 
      motor complete paralysis. We hypothesized that there would be significant 
      correlations between the number of joints moved during attempts with scES prior 
      to any training interventions and the amount of cervical cord atrophy above the 
      injury, length of post-traumatic myelomalacia and the amount of volume coverage 
      of lumbosacral enlargement by the stimulation electrode array. The clinical and 
      imaging records of 20 individuals with chronic and clinically motor complete 
      spinal cord injury who underwent scES implantation were reviewed and analysed 
      using MRI and X-ray integration, image segmentation and spinal cord volumetric 
      reconstruction techniques. All individuals that participated in the scES study 
      (n = 20) achieved, to some extent, lower extremity voluntary movements post scES 
      implant and prior to any locomotor, voluntary movement or cardiovascular 
      training. The correlation results showed that neither the cross-section area of 
      spinal cord at C3 (n = 19, r = 0.33, P = 0.16) nor the length of severe 
      myelomalacia (n = 18, r = -0.02, P = 0.93) correlated significantly with 
      volitional lower limb movement ability. However, there was a significant, 
      moderate correlation (n = 20, r = 0.59, P = 0.006) between the estimated 
      percentage of the lumbosacral enlargement coverage by the paddle electrode as 
      well as the position of the paddle relative to the maximal lumbosacral 
      enlargement and the conus tip (n = 20, r = 0.50, P = 0.026) with the number of 
      joints moved volitionally. These results suggest that greater coverage of the 
      lumbosacral enlargement by scES may improve motor recovery prior to any training, 
      possibly because of direct modulatory effects on the spinal networks that control 
      lower extremity movements indicating the significant role of motor control at the 
      level of the spinal cord.
CI  - (c) The Author(s) (2020). Published by Oxford University Press on behalf of the 
      Guarantors of Brain. All rights reserved. For permissions, please email: 
      journals.permissions@oup.com.
FAU - Mesbah, Samineh
AU  - Mesbah S
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, USA.
FAU - Ball, Tyler
AU  - Ball T
AD  - Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
FAU - Angeli, Claudia
AU  - Angeli C
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, USA.
AD  - Department of Bioengineering, University of Louisville, Louisville, KY, USA.
AD  - Frazier Rehab Institute, University of Louisville Health, Louisville, KY, USA.
FAU - Rejc, Enrico
AU  - Rejc E
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, USA.
AD  - Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
FAU - Dietz, Nicholas
AU  - Dietz N
AD  - Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
FAU - Ugiliweneza, Beatrice
AU  - Ugiliweneza B
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, USA.
AD  - Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
FAU - Harkema, Susan
AU  - Harkema S
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, USA.
AD  - Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
AD  - Frazier Rehab Institute, University of Louisville Health, Louisville, KY, USA.
FAU - Boakye, Maxwell
AU  - Boakye M
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, USA.
AD  - Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Brain
JT  - Brain : a journal of neurology
JID - 0372537
SB  - IM
MH  - Adult
MH  - Epidural Space
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Movement
MH  - Prognosis
MH  - Spinal Cord Injuries/*diagnosis/*rehabilitation
MH  - Spinal Cord Stimulation/*methods
MH  - Treatment Outcome
MH  - *Volition
MH  - Young Adult
OTO - NOTNLM
OT  - magnetic resonance imaging
OT  - neuromodulation
OT  - spinal cord epidural stimulation
OT  - spinal cord injury
EDAT- 2020/12/29 06:00
MHDA- 2021/04/20 06:00
CRDT- 2020/12/28 12:15
PHST- 2020/02/24 00:00 [received]
PHST- 2020/05/25 00:00 [revised]
PHST- 2020/09/30 00:00 [accepted]
PHST- 2020/12/29 06:00 [pubmed]
PHST- 2021/04/20 06:00 [medline]
PHST- 2020/12/28 12:15 [entrez]
AID - 6046571 [pii]
AID - 10.1093/brain/awaa423 [doi]
PST - ppublish
SO  - Brain. 2021 Mar 3;144(2):420-433. doi: 10.1093/brain/awaa423.