Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis.
Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis.
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硬膜外刺激颈髓治疗中风后上肢瘫痪。
DOI：
10.1038/s41591-022-02202-6
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发表时间：
2023-03
期刊：
影响因子：
82.9
通讯作者：
Capogrosso, Marco
中科院分区：
文献类型：
--
作者：
Powell, Marc P. P.;Verma, Nikhil;Sorensen, Erynn;Carranza, Erick;Boos, Amy;Fields, Daryl P. P.;Roy, Souvik;Ensel, Scott;Barra, Beatrice;Balzer, Jeffrey;Goldsmith, Jeff;Friedlander, Robert M. M.;Wittenberg, George F. F.;Fisher, Lee E. E.;Krakauer, John W. W.;Gerszten, Peter C. C.;Pirondini, Elvira;Weber, Douglas J. J.;Capogrosso, Marco
脑中风会扰乱从运动皮质区域到脊髓的下行指令，这可能会导致手臂和手的永久性运动缺陷。然而，在损伤下方，控制运动的脊髓回路保持完好，可能成为神经技术恢复运动的靶点。在这里，我们报告了两名参与者的研究结果，这是人类第一次使用电刺激颈脊髓回路来促进慢性中风后偏瘫患者的手臂和手的运动控制(NCT04512690)。受试者在硬膜外背侧间隙植入两根直线导联29天，靶向C3至T1脊神经根，以增加手臂和手部运动神经元的兴奋。我们发现，通过选定触点的持续刺激可以改善力量(例如握力+40%SCS01；+108%SCS02)、运动学(例如+30%到+40%速度)和功能性动作，从而使参与者能够执行他们在没有SCS的情况下无法执行的动作。两位参与者即使在没有刺激的情况下也保留了其中的一些改善，并且没有报告严重的不良事件。虽然我们不能从两个参与者身上对安全性和有效性进行决定性的评估，但我们的数据提供了有希望的证据，尽管是初步的，SCS可能是中风后上肢康复的一种辅助和恢复性方法。
Cerebral strokes can disrupt descending commands from motor cortical areas to the spinal cord, which can result in permanent motor deficits of the arm and hand. However, below the lesion, the spinal circuits that control movement remain intact and could be targeted by neurotechnologies to restore movement. Here we report results from two participants in a first-in-human study using electrical stimulation of cervical spinal circuits to facilitate arm and hand motor control in chronic post-stroke hemiparesis (NCT04512690). Participants were implanted for 29 days with two linear leads in the dorsolateral epidural space targeting spinal roots C3 to T1 to increase excitation of arm and hand motoneurons. We found that continuous stimulation through selected contacts improved strength (e.g. grip force +40% SCS01; +108% SCS02), kinematics (e.g. +30% to +40% speed), and functional movements, thereby enabling participants to perform movements that they could not perform without SCS. Both participants retained some of these improvements even without stimulation and no serious adverse events were reported. While we cannot conclusively evaluate safety and efficacy from two participants, our data provides promising, albeit preliminary, evidence that SCS could be an assistive as well as a restorative approach for upper limb recovery after stroke.
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影响因子：
3.2
作者：
Israely S;Leisman G;Machluf CC;Carmeli E
通讯作者：
Carmeli E
影响因子：
158.5
作者：
Feigin, Valery L.;Nguyen, Grant;Roth, Gregory A.
通讯作者：
Roth, Gregory A.
DOI：
10.1109/tnsre.2021.3049133
发表时间：
2021-01-01
影响因子：
4.9
作者：
Inanici, Fatma;Brighton, Lorie N.;Moritz, Chet T.
通讯作者：
Moritz, Chet T.
影响因子：
7.7
作者：
Chandrasekaran, Santosh;Nanivadekar, Ameya C.;Fisher, Lee E.
通讯作者：
Fisher, Lee E.
影响因子：
5.3
作者：
Capogrosso, Marco;Wenger, Nikolaus;Micera, Silvestro
通讯作者：
Micera, Silvestro