Stimulating the cervical spinal cord - combining clinical, classical and basic motor perspectives on epidural stimulation.
Stimulating the cervical spinal cord - combining clinical, classical and basic motor perspectives on epidural stimulation.
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DOI：
10.1113/jp281810
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发表时间：
2021-07
影响因子：
5.5
通讯作者：
Giszter, Simon F.
中科院分区：
文献类型：
--
作者：
Giszter, Simon F.
Sharma和Shah的论文“In Vivo Electrophysiological Mechanisms Underlying Cervical Epidural Stimulation in Adult”开辟了研究颈髓硬膜外刺激（ES）机制的多种途径。这些数据将有助于更深入地了解ES的脊柱机制和脊柱可塑性的未来。ES在脊髓损伤（SCI）中的巨大潜在临床影响，SCI康复和神经修复界开始更全面地分类和评估并与损伤相关（见Rejc等人，2020），但在机制上相对尚未探索。ES可以潜在地支持使脊髓和自主运动功能以及脊髓重组成为可能的许多方式。ES的临床效应是否仅依赖于特定传入神经的激活及其对运动池的单突触兴奋？或者，脊髓的多突触中间神经元系统有多重要？Sharma和Shah将ES反应延迟评估为代表运动轴突募集的早期反应（ER）、代表大纤维I型传入募集的单突触运动效应的中期反应（MR）和代表运动池的多突触神经元间募集的晚期反应（LR）。后者可以扩展到模式发生器电路效应。他们用双极ES和单极ES探索这些反应，除了阈值外几乎没有立即反应差异。双极ES目前受到许多研究者的青睐，因为它可以使ES效应更具特异性和针对性。Sharma和Shah测试了不同的颈椎水平、不同的肌肉、多种脊髓状态和运动任务。大鼠在清醒、休息或到达时以及在不同的麻醉方案下进行测试。最后，ES序列从单个脉冲通过成对脉冲变化到各种频率的脉冲序列。他们检查动力学，频率依赖性抑郁症，敏化和区分基于经典生理学的反应成分。从这个角度来看，这篇论文在完整大鼠的完整性方面是一个巡回演出，也是未来宫颈ES探索的有力基线。
Sharma and Shah’s paper ‘In Vivo Electrophysiological Mechanisms Underlying Cervical Epidural Stimulation in Adult’opens up multiple avenues of investigation of mechanisms of epidural stimulation (ES) in cervical spinal cord. The data will support deeper understanding of spinal mechanisms of ES and spinal plasticity in the future. The enormous potential clinical impacts of ES in spinal cord injury (SCI) that SCI rehab and neuroprosthetics communities are beginning to more fully catalog and evaluate and relate to injury (see Rejc et al. 2020) remain mechanistically relatively unexplored. ES can potentially support many ways to enable spinal and voluntary motor function and spinal cord reorganization. Do ES clinical effects depend only on the activation of specific afferents and their monosynaptic excitation of motor pools? Alternatively, how important are polysynaptic inteneuron systems of the spinal cord?Sharma and Shah evaluate ES response latencies as Early Response (ER) representing motor axon recruitment, Middle Response (MR) representing monosynaptic motor effects of large fiber type-I afferent recruitment, and Late Response (LR) representing polysynaptic interneuronal recruitment of motor pools. The latter could extend to pattern generator circuit effects. They explore these responses with both bipolar ES and monopolar ES, with little immediate response difference besides threshold. Bipolar ES is currently favored as allowing more specificity and focus of ES effects by many investigators. Sharma and Shah test different cervical levels, different muscles, multiple spinal cord states and motor tasks. Rats are tested while awake, at rest, or reaching, and under different anesthetic regimes. Finally, ES trains are varied from single pulse through paired pulse to pulse trains at various frequencies. They examine dynamics, frequency dependent depression, sensitization and distinguish response components based on classical physiology. From this perspective the paper is a tour de force in terms of completeness in intact rats, and a powerful baseline for future cervical ES exploration.