Targeting urological improvements with spinal cord epidural stimulation after spinal cord injury
1Herrity A, 2Hubscher C, 3Angeli C, 1Rejc E, 1Ferreira C, 1Harkema S
1University of Louisville, Department of Neurological Surgery, Louisville, KY, U.s.a.; 2University of Louisville, Department of Anatomical Sciences and Neurobiology, Louisville, KY, U.s.a.; 3University of Louisville, Frazier Rehab Institute, Louisville, KY, U.s.a.
Objective: Spinal cord injury (SCI) eliminates voluntary control of urination resulting in inefficient bladder storage and emptying (1). There is a need for novel therapeutic interventions to improve bladder function after injury, as urological deficits profoundly impact quality of life and continue to rank as top priority issues in the SCI population (2). The objective of this study was to investigate the use of spinal cord epidural stimulation of the lumbosacral region on bladder outcomes in clinically complete motor SCI individuals.
Design/Method: This study included AIS A and B participants (n=8) receiving spinal cord epidural stimulation at L1-S1 spinal levels in combination with activity-based therapy: locomotor and/or stand training, cardiovascular and voluntary motor training. Urodynamic assessments, with and without the use of spinal cord epidural stimulation, were performed at pre- and post-training time-points and the Spinal Cord Injury Data Set questionnaires for bladder management accompanied each urodynamic procedure.
Results: We identified specific configurations and stimulation parameters optimal for continence and micturition in several subjects during filling cystometry. While activity-based therapies resulted in improvements in bladder capacity and voiding efficiency, the use of spinal cord epidural stimulation further enhanced these parameters and in a frequency-dependent manner. Importantly, as capacity increased in these participants, bladder pressures continued to remain low, indicating better overall bladder compliance.
Conclusion: Spinal cord epidural stimulation, along with activity-based training, may help provide an appropriate level of excitation to the spinal cord (3), targeting the neural circuitry involved in bladder control.
Support: NICHHD (R01HD080205), the Leona M. and Harry B. Helmsley Charitable Trust, the Christopher & Dana Reeve Foundation and the Craig H. Neilsen Foundation.
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