Targeting bladder function with network‑specific epidural stimulation after chronic spinal cord injury

Scientific Reports, 2022 · DOI: https://doi.org/10.1038/s41598-022-15315-2 · Published: July 12, 2022

Simple Explanation

This study explores how epidural stimulation of the spinal cord (scES) can improve bladder function in individuals with spinal cord injury (SCI). It focuses on identifying specific scES parameters that enhance bladder storage and emptying. The researchers mapped bladder function during filling cystometry, discovering scES parameters that improved bladder compliance while maintaining stable blood pressure, and also enabled the initiation of voiding in participants with motor complete SCI. By using high-resolution magnetic resonance imaging and finite element modeling, the study identified specific neuroanatomical structures responsible for modulating bladder function, providing insights into how targeted scES can mitigate urinary incontinence and autonomic dysreflexia.

Study Duration

2018-2021

Participants

7 individuals with motor complete SCI

Evidence Level

Not specified

Key Findings

1
Targeted scES improved bladder compliance, reduced urinary incontinence, and mitigated autonomic dysreflexia associated with bladder distention.
2
The ability to initiate voiding with targeted scES was demonstrated, marking a significant step towards regaining volitional control of lower urinary tract function.
3
Specific neuroanatomical structures responsible for modulating bladder function were identified using high-resolution MRI and finite element modeling.

Research Summary

This study investigated the effects of scES on bladder function through targeted mapping during filling cystometry, using high-resolution MRI and computational modeling to understand the neuroanatomical regions responsible for improvements in LUT function. The study found that neuromodulation of bladder compliance was primarily effective when scES targeted spinal cord regions L3–L4, while initiation of voiding was enhanced at caudal regions of the lumbosacral spinal cord (L4–S1). The results demonstrate that scES can be used to simultaneously and safely modulate urinary continence and the initiation of voiding while managing distention-associated dysregulation of blood pressure.

Practical Implications

Clinical Application

Targeted scES neuromodulation can be used to improve bladder function in individuals with SCI, potentially reducing the need for catheterization and improving quality of life.

Personalized Therapy

The study highlights the importance of identifying individual-specific spinal networks to optimize scES parameters for bladder continence and micturition reflexes.

Further Research

Future studies should focus on integrating BC-scES and BV-scES in home settings to understand the natural transition from storage to voiding.

Study Limitations

1
Two participants did not receive high-resolution MR imaging, precluding the ability to generate a 3D model of the spinal cord and subsequent scES simulations.
2
Anatomical variability in the size of the lumbosacral spinal cord across individuals may also result in differing mechanisms of action of scES.
3
The extent, severity, mechanism of the injury, number of residual fibers as well as clinical and demographic factors may also influence the neuromodulatory effects of spinal cord stimulation.

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