Two-years of home based functional electrical stimulation recovers epidermis from atrophy and ﬂattening after years of complete Conus-Cauda Syndrome

Medicine, 2019 · DOI: http://dx.doi.org/10.1097/MD.0000000000018509 · Published: December 27, 2019

Simple Explanation

This study investigates the impact of home-based Functional Electrical Stimulation (h-bFES) on skin health in patients with complete Conus-Cauda Syndrome, a condition causing permanent muscle denervation. Researchers analyzed skin biopsies from the thighs of 13 participants before and after a two-year h-bFES program, focusing on epidermal thickness, skin flattening, and the presence of Langerhans cells. The study found that h-bFES significantly improved skin thickness and reduced flattening, suggesting that electrical stimulation can counteract skin atrophy in individuals with long-term denervation.

Study Duration

2 years

Participants

13 spinal cord injury persons suffering up to 10 years of complete conus/cauda syndrome

Evidence Level

Observational Study

Key Findings

1
Epidermal atrophy and flattening worsen with increasing years post-spinal cord injury (SCI).
2
Two years of skin electrostimulation by anatomically shaped electrodes reverses skin changes.
3
Home-based FES (h-bFES) produces a significant recovery to almost normal levels of epidermis thickness and of dermal papillae.

Research Summary

The study evaluated skin atrophy progression in complete Conus-Cauda Syndrome over 8 years and its recovery after 2 years of surface Functional Electrical Stimulation. Quantitative histology showed that epidermal atrophy and flattening worsen with increasing years post-spinal cord injury, but 2 years of skin electrostimulation reverses these changes. The findings suggest that electrical stimulation by anatomically shaped electrodes fixed to the skin is clinically relevant to counteract atrophy and flattening of stimulated skin.

Practical Implications

Counteracting Skin Atrophy

Home-based FES can be used to counteract skin atrophy and flattening in patients with complete Conus-Cauda Syndrome.

Improving Skin Health

Electrical stimulation can improve epidermal thickness and dermal papillae, enhancing skin resistance to physical, chemical, and biological insults.

Managing Skin Disorders

Further testing of electrical stimulation is justified as a contributory mechanism to manage skin disorders, particularly pressure sores in SCI, metabolic diseases, and late aging.

Study Limitations

1
The study does not know how long the effect of electrical stimulation on skin atrophy would last after the end of the treatment.
2
It is unknown if the effect is extended to skin areas that are subject to chronic pressure and chronic ischemia where pressure sores usually develop.
3
The study cannot rule out that the manipulation of the skin necessary for electric stimulation induces enough reaction of the skin to produce the changes seen.

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