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The Impact of Transcutaneous Spinal Cord Stimulation on Autonomic Regulation after Spinal Cord Injury: A randomized crossover trial

medRxiv preprint, 2023 · DOI: https://doi.org/10.1101/2023.07.18.23292676 · Published: July 23, 2023

Spinal Cord InjuryNeurology

Simple Explanation

Individuals with spinal cord injury (SCI) often experience blood pressure instability due to disrupted communication between the brain and the spinal cord. This study investigates whether transcutaneous spinal cord stimulation, a non-invasive method of stimulating the spinal cord, can improve autonomic regulation in individuals with SCI. The study found that while spinal cord stimulation can generate sympathetic activation, it does not improve overall autonomic regulation and may increase the risk of autonomic dysreflexia, a dangerous condition involving sudden, severe high blood pressure.

Study Duration
February to November 2022
Participants
Two pairs of well-matched individuals with and without high-thoracic, complete SCI
Evidence Level
Level 2: Randomized crossover trial

Key Findings

  • 1
    Transcutaneous spinal cord stimulation generates tonic, frequency-dependent sympathetic activation below the level of injury.
  • 2
    Spinal cord stimulation enhanced sympathoexcitatory responses, normalizing previously impaired Valsalva’s maneuvers.
  • 3
    Spinal cord stimulation exacerbated already impaired sympathoinhibitory responses, resulting in significantly greater mean arterial pressure increases with the same phenylephrine doses compared to baseline.

Research Summary

This study aimed to determine if transcutaneous spinal cord stimulation improves autonomic regulation after spinal cord injury (SCI). The results indicated that spinal cord stimulation does not improve autonomic regulation after SCI and may generate tonic sympathoexcitation, potentially lowering the threshold for autonomic dysreflexia. The study compared different stimulation frequencies and found that 120Hz stimulation had the greatest degree of sympathetic activation.

Practical Implications

Clinical Monitoring

Future studies should adequately monitor for autonomic dysreflexia (AD) with stimulation due to the risk of potentially dangerous hypertension.

Frequency-Dependent Effects

The choice of stimulation frequency significantly impacts sympathetic activation, with 120Hz showing the greatest effect.

Limited Therapeutic Benefit

Transcutaneous spinal cord stimulation may not provide the anticipated improvements in overall autonomic regulation for individuals with SCI and could exacerbate certain autonomic imbalances.

Study Limitations

  • 1
    Limited generalizability due to small cohort size.
  • 2
    Potential limitations in fully characterizing the autonomic regulatory effects due to the specific tests used.
  • 3
    Not specified

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