Lumbosacral spinal cord epidural stimulation improves voiding function after human spinal cord injury

Scientific Reports, 2018 · DOI: 10.1038/s41598-018-26602-2 · Published: June 8, 2018

Simple Explanation

This study investigates the use of spinal cord epidural stimulation (scES) to improve bladder control in individuals with spinal cord injury (SCI). The research involved bladder mapping to identify effective stimulation parameters for reflexive bladder emptying. The study found that specific combinations of stimulating electrodes and frequencies (30 Hz) resulted in lower post-void residual volumes, indicating improved voiding efficiency. These parameters were effective in multiple research participants. These findings suggest that scES has the potential to enhance the central state of excitability, allowing for the control of urological functions in addition to motor and cardiovascular functions.

Study Duration

4 Months

Participants

5 (1 primary, 4 additional) individuals with chronic, motor complete SCI

Evidence Level

Level IV, Case Series

Key Findings

1
Spinal cord epidural stimulation (scES) targeting the lower lumbosacral region improves reflexive voiding efficiency in individuals with spinal cord injury (SCI).
2
A stimulation frequency of 30 Hz was found to be the most effective for voiding efficiency, while maintaining safe detrusor leak point and maximum detrusor pressures.
3
An effective electrode configuration was identified at the lower end of the stimulator array (L5/S1 region), demonstrating improved bladder emptying in multiple participants.

Research Summary

This study evaluated the efficacy of spinal cord epidural stimulation (scES) in improving bladder control after spinal cord injury (SCI). The research involved bladder mapping to identify effective electrode configurations and stimulation parameters for enhancing reflexive voiding efficiency. The findings demonstrated that scES targeting the lower lumbosacral region, particularly with a frequency of 30 Hz, significantly improved voiding efficiency while maintaining safe bladder pressures, offering a promising therapy for bladder dysfunction after SCI.

Practical Implications

Therapeutic Potential

scES can be a therapeutic intervention to improve bladder function in individuals with SCI.

Personalized Treatment

Optimal electrode configurations and stimulation parameters may vary from individual to individual, necessitating mapping.

Multisystem Benefits

scES may offer benefits to other autonomic systems, such as cardiovascular, respiratory, bowel, and sexual function.

Study Limitations

1
The sample size is small, with only five participants.
2
The study primarily focused on improving voiding efficiency and did not consistently improve bladder capacity.
3
Long-term effects of stimulation, including sustainability and impact on overlapping systems, are not yet known.

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