Effects of percutaneously-implanted epidural stimulation on cardiovascular autonomic function and spasticity after complete spinal cord injury: A case report.
Effects of percutaneously-implanted epidural stimulation on cardiovascular autonomic function and spasticity after complete spinal cord injury: A case report.
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DOI：
10.3389/fnins.2023.1112853
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发表时间：
2023
影响因子：
4.3
通讯作者：
Trainer, Robert
中科院分区：
文献类型：
--
作者：
Gorgey, Ashraf S.;Goldsmith, Jacob;Alazzam, Ahmad;Trainer, Robert
关键词：
人们重新燃起了探索脊髓硬膜外刺激（SCES）以改善脊髓损伤（SCI）后身体功能的兴趣。本案例报告强调了通过单一 SCES 配置引发多项功能改进的潜力，这是一种可以改善临床转化的策略。旨在确定 SCES 旨在促进步行是否也能显着改善心血管自主调节和痉挛。病例报告来自 2022 年 3 月至 6 月相隔 15 周的两个时间点收集的数据，作为更大规模临床试验的一部分。亨特霍姆斯麦奎尔退伍军人医疗中心的研究实验室。 27 岁男性，C8 运动完全性脊髓损伤后 7 年。 SCES 配置旨在增强外骨骼辅助步行训练，应用于自主神经和痉挛管理。主要结果是心血管自主神经对 45 度仰角测试的反应。在有或没有 SCES 的情况下，在仰卧和倾斜状态下收集收缩压 (SBP)、心率 (HR) 以及心率变异性分析的低频 (LF) 和高频 (HF) 分量的绝对功率。通过使用和不使用 SCES 的等速测力法评估右膝屈肌和膝伸肌的痉挛状态。在 SCES 关闭的情况下进行的两次评估中，从仰卧转变为倾斜会降低 SBP（评估一：101.8 至 70 mmHg；评估二：98.9 至 66.4 mmHg）。在评估一中，仰卧位 SCES (3 mA) 增加 SBP（平均 117 mmHg）；在倾斜状态下，5 mA 使 SBP 稳定在基线值附近（平均 111.5 mmHg）。在评估二时，仰卧位 SCES (3 mA) 增加 SBP（第一分钟平均 140 mmHg）；将幅度减小至 2 mA 会降低 SBP（第五分钟平均为 119 mmHg）。在倾斜时，3 mA 将 SBP 稳定在基线值附近（平均 93.2 mmHg）。右膝的扭矩时间积分在膝屈肌（范围：-1.9 至 -7.8%）和膝伸肌（范围：-1 至 -11.4%）的所有角速度下均减少。这些结果表明，旨在促进步行的 SCES 还可以增强心血管自主控制并减轻痉挛。 SCI 后使用一种配置增强多种功能可能会加速临床转化。 https://clinicaltrials.gov/ct2/show/，标识符 NCT04782947。
There is a revived interest to explore spinal cord epidural stimulation (SCES) to improve physical function after spinal cord injury (SCI). This case report highlights the potential of eliciting multiple functional improvements with a single SCES configuration, a strategy which could improve clinical translation. To determine whether SCES intended to facilitate walking also acutely yields benefits in cardiovascular autonomic regulation and spasticity. Case report from data collected at two timepoints 15 weeks apart from March to June 2022 as part of a larger clinical trial. Research lab at Hunter Holmes McGuire VA Medical Center. 27-year-old male, 7 years post a C8 motor complete spinal cord injury. A SCES configuration intended to enhance exoskeleton-assisted walking training applied for autonomic and spasticity management. The primary outcome was cardiovascular autonomic response to a 45-degree head-up-tilt test. Systolic blood pressure (SBP), heart rate (HR), and absolute power of the low-frequency (LF) and high-frequency (HF) components of a heart-rate variability analysis were collected in supine and tilt with and without the presence of SCES. Right knee flexor and knee extensor spasticity was assessed via isokinetic dynamometry with and without SCES. At both assessments with SCES off, transitioning from supine to tilt decreased SBP (assessment one: 101.8 to 70 mmHg; assessment two: 98.9 to 66.4 mmHg). At assessment one, SCES on in supine (3 mA) increased SBP (average 117 mmHg); in tilt, 5 mA stabilized SBP near baseline values (average 111.5 mmHg). At assessment two, SCES on in supine (3 mA) increased SBP (average 140 mmHg in minute one); decreasing amplitude to 2 mA decreased SBP (average 119 mmHg in minute five). In tilt, 3 mA stabilized SBP near baseline values (average 93.2 mmHg). Torque-time integrals at the right knee were reduced at all angular velocities for knee flexors (range: −1.9 to −7.8%) and knee extensors (range: −1 to −11.4%). These results demonstrate that SCES intended to facilitate walking may also enhance cardiovascular autonomic control and attenuate spasticity. Using one configuration to enhance multiple functions after SCI may accelerate clinical translation. https://clinicaltrials.gov/ct2/show/, identifier NCT04782947.
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