Spinal Cord Stimulation Prevents Autonomic Dysreﬂexia in Individuals with Spinal Cord Injury: A Case Series

J. Clin. Med., 2023 · DOI: 10.3390/jcm12082897 · Published: April 16, 2023

Simple Explanation

Spinal cord injury (SCI) can lead to severe cardiovascular issues due to a disruption in the brain's control over the body. One such issue is autonomic dysreflexia (AD), where blood pressure spikes dangerously in response to normal stimuli. Spinal cord stimulation (SCS), a treatment already used for pain, is being explored as a way to manage unstable blood pressure after SCI. This study looks at how SCS, applied to the lower spinal cord, affects AD in people with SCI. The case series provides evidence to support the use of eSCS to prevent AD episodes during routine bowel procedures, improving the quality of life for individuals with SCI and potentially reducing cardiovascular risks.

Study Duration

Not specified

Participants

Three individuals with cervical and upper thoracic motor-complete SCI

Evidence Level

Level 4: Case Series

Key Findings

1
Epidural spinal cord stimulation (eSCS) can reduce the elevation in blood pressure and prevent digital anorectal stimulation (DARS)-induced autonomic dysreflexia (AD) in individuals with spinal cord injury (SCI).
2
Blood pressure variability analysis suggests that eSCS potentially reduces vascular sympathetic nervous system activity during DARS, compared to periods without eSCS.
3
Real-time eSCS during DARS decreased the elevation of LF wavelet power in BP variability, indicating reduced vasculature sympathetic nerve activity

Research Summary

This case series investigated the real-time effect of epidural spinal cord stimulation (eSCS) on mitigating autonomic dysreflexia (AD) in individuals with spinal cord injury (SCI). The study demonstrated that eSCS can reduce the elevation in blood pressure and prevent digital anorectal stimulation (DARS)-induced AD. The blood pressure variability analysis indicated that eSCS potentially reduced vascular sympathetic nervous system activity during DARS, compared to without eSCS. The findings support the use of eSCS to prevent AD episodes during routine bowel procedures, potentially improving the quality of life for individuals with SCI and reducing cardiovascular risks.

Practical Implications

Clinical Application

Epidural SCS may be a fast-acting alternative to pharmacological management of AD.

Improved Quality of Life

Preventing AD episodes during routine bowel procedures can improve the health-related quality of life for individuals with SCI.

Reduced Cardiovascular Risk

Mitigating uncontrolled blood pressure fluctuations with eSCS could decrease the risk of associated cardiovascular consequences.

Study Limitations

1
Small sample size of only three participants
2
Experimental AD assessment under controlled laboratory conditions
3
Potential risks associated with eSCS implantation, including surgical complications and battery life

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