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Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis

Publication date:

  • 07 February 2022

Authors:

Andreas Rowald
Salif Komi
Robin Demesmaeker
Edeny Baaklini
Sergio Daniel Hernandez-Charpak
Edoardo Paoles
Hazael Montanaro
Antonino Cassara
Fabio Becce
Bryn Lloyd
Taylor Newton
Jimmy Ravier
Nawal Kinany
Marina D’Ercole
Aurélie Paley
Nicolas Hankov
Camille Varescon
Laura McCracken
Molywan Vat
Miroslav Caban
Anne Watrin
Charlotte Jacquet
Léa Bole-Feysot
Cathal Harte
Henri Lorach
Andrea Galvez
Manon Tschopp
Natacha Herrmann
Moïra Wacker
Lionel Geernaert
Isabelle Fodor
Valentin Radevich
Katrien Van Den Keybus
Grégoire Eberle
Etienne Pralong
Maxime Roulet
Jean-Baptiste Ledoux
Eleonora Fornari
Stefano Mandija
Loan Mattera
Roberto Martuzzi
Bruno Nazarian
Stefan Benkler
Simone Callegari
Nathan Greiner
Benjamin Fuhrer
Martijn Froeling
Nik Buse
Tim Denison
Rik Buschman
Christian Wende
Damien Ganty
Jurriaan Bakker
Vincent Delattre
Hendrik Lambert
Karen Minassian
Cornelis A. T. van den Berg
Anne Kavounoudias
Silvestro Micera
Dimitri Van De Ville
Quentin Barraud
Erkan Kurt
Niels Kuster
Esra Neufeld
Marco Capogrosso
Leonie Asboth
Fabien B. Wagner
Jocelyne Bloch
Grégoire Courtine

Abstract

Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial (www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI.

Reference
Doi: 10.1038/s41591-021-01663-5
Published in: Nature Medicine,
Read the paper
Version: Published
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