Neural Prosthetic Control of Continence and Micturition

描述(由申请人提供)：由于神经系统疾病或损伤，如脊髓损伤(SCI)而导致的膀胱控制丧失，具有毁灭性的影响。脊髓损伤导致失去对膀胱排空的自主控制，膀胱反射亢进和膀胱括约肌协同障碍。这些因素通常导致输尿管返流和梗阻、肾脏感染、长期肾脏损伤、自主神经反射障碍伴随危险的血压升高、导致皮肤破裂的大小便失禁，以及频繁的尿路感染。失去对膀胱的控制也有深远的社会影响，导致生活质量下降，以及程序、用品和药物带来的巨额直接医疗成本。这项研究的长期目标是开发一种神经假体，以恢复神经疾病患者的膀胱功能(控制和排尿)，特别是脊髓损伤。在脊髓损伤患者中，通过电刺激骶神经根和手术切断骶神经根(背根切断术)来恢复膀胱排空和可控性，已经产生了有据可查的医疗、生活质量和经济利益。然而，现有技术的广泛应用受到潜在候选者反对不可逆背根切断术和复杂的外科种植过程的限制。我们提出了一种创新的方法，通过将单个多电极神经袖带植入阴部神经上，通过电记录来检测高反射性膀胱收缩的开始，通过电刺激阴部生殖器传入神经纤维来阻止新生的高反射性膀胱收缩，并通过电刺激阴部尿道传入神经纤维来按需进行膀胱排空。这种创新的方法与现有的使用脊神经根电刺激的方法有很大的不同，因为它不需要脊柱椎板切除，不需要不可逆转的手术横断骶骨感觉神经根，并且刺激系统的传入而不是传出侧。预计这将增加可以从神经假体技术中受益的个人人口，同时保持已记录的好处。这项拟议工作的目的是通过在动物模型和脊髓损伤患者身上进行补充实验来证明这种方法的可行性。该项目的成功完成将导致开发一种有效的神经假体系统来恢复膀胱功能。

DESCRIPTION (provided by applicant): Loss of bladder control as a result of neurological disease or injury such as spinal cord injury (SCI) has devastating effects. SCI results in loss of voluntary control of bladder evacuation, bladder hyper-reflexia, and bladder sphincter dysynergia. These factors often lead to ureteric reflux and obstruction, infection of the kidneys, long-term renal damage, episodes of autonomic dysreflexia with dangerous rises in blood pressure, incontinence which contributes to skin breakdown, as well as frequent urinary tract infections. Loss of bladder control also has profound social impact and leads to decreased quality of life, as well as large direct medical costs from procedures, supplies, and medication. The long-term goal of this research is to develop a neural prosthesis to restore bladder function (continence and micturition) in persons with neurological disorders, particularly spinal cord injury. Restoration of bladder evacuation and continence in individuals with SCI by electrical stimulation of the sacral nerve roots and surgical transection of sacral sensory nerve roots (dorsal rhizotomy) has resulted in documented medical, quality of life, and financial benefits. However, the widespread application of existing technology is limited by the objection of potential candidates to the irreversible dorsal rhizotomy and the complex surgical implant procedure. We propose an innovative approach to restoration of bladder function using a single multi-electrode nerve cuff implanted on the pudendal nerve to detect the onset of hyper-reflexive bladder contractions by electrical recording, to arrest nascent hyper-reflexive bladder contractions by electrical stimulation of pudendal genital afferent nerve fibers, and to produce on-demand bladder evacuation by electrical stimulation of pudendal urethral afferent nerve fibers. This innovative approach differs substantially from existing approaches using electrical stimulation of the spinal roots in that it does not require a spinal laminectomy, does not require irreversible surgical transection of the sacral sensory nerve roots, and stimulates the afferent rather than the efferent side of the system. This is expected to increase the population of individuals who can benefit from neural prosthetic technology, while maintaining the documented benefits. The objective of the proposed work is to demonstrate the feasibility of this approach using complementary experiments in an animal model and in persons with spinal cord injury. Successful completion of this project will lead to the development of an effective neural prosthetic system for restoration of bladder function.