Beyond treatment of chronic pain: a scoping review about epidural electrical spinal cord stimulation to restore sensorimotor and autonomic function after spinal cord injury

Neurological Research and Practice, 2023 · DOI: https://doi.org/10.1186/s42466-023-00241-z · Published: March 30, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Epidural electrical spinal cord stimulation (ESCS) is a treatment used for chronic pain. Recent studies show ESCS, along with rehabilitation, can help restore movement and neurological function after spinal cord injury (SCI). Besides improving arm and leg function, ESCS is being studied for autonomic dysfunction after SCI, like orthostatic hypotension.

Study Duration

Not specified

Participants

Clinical studies with varying participant numbers (1-20) and SCI conditions

Evidence Level

Level 3b to 4, Case series, Case reports, Case control study;cohort study

Key Findings

1
ESCS can partially restore lower extremity function such as standing and stepping, even in sensorimotor complete and chronic SCI.
2
In individuals with some preserved motor function below the injury, ESCS combined with intensive rehabilitation may improve voluntary motor function beyond what training alone can achieve.
3
ESCS might be a successful therapy option for orthostatic hypotension.

Research Summary

ESCS is an established therapeutic option for chronic pain conditions. ESCS shows promise in restoring sensorimotor and autonomic function in people with SCI. Future trials are needed to prove the efficacy and generalizability of ESCS outcomes, requiring controlled clinical trials.

Practical Implications

Restorative Therapy Potential

ESCS, combined with rehabilitation, may offer a way to restore motor and autonomic functions after SCI, especially for those with incomplete injuries.

Home-Based Training Systems

Developing ESCS systems that can be operated by the end user could allow for home-based training, increasing accessibility and convenience.

Targeted Autonomic Improvement

ESCS has potential for improving autonomic function like orthostatic hypotension, pending further research on its benefits and acceptance by SCI patients.

Study Limitations

1
The studies are primarily non-controlled case series.
2
Efficacy and generalizability of ESCS outcomes need to be proven in larger, controlled trials.
3
Long-term acceptance of this invasive therapy for autonomic function improvement remains to be determined.

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