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Targeting bladder function with network-specific epidural stimulation after chronic spinal cord injury.
April N Herrity1,2,3, Sevda C Aslan4,5, Samineh Mesbah4,5
1Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, The University of Louisville, 220 Abraham Flexner Way, Suite 1518, Louisville, KY, 40202, USA. april.herrity@louisville.edu.
Spinal cord epidural stimulation (scES) can improve bladder control and reduce incontinence in individuals with spinal cord injury (SCI). This neuromodulation approach targets bladder function, aiding in autonomic dysreflexia management and volitional voiding.
Area of Science:
- Neuroscience
- Urology
- Rehabilitation Medicine
Background:
- Spinal cord injury (SCI) causes significant autonomic dysfunction, including impaired bladder control.
- Spinal cord epidural stimulation (scES) shows promise in restoring some autonomic functions after SCI.
- Optimal scES parameters for lower urinary tract (LUT) function remain largely unexplored.
Purpose of the Study:
- To determine if specific scES parameters can improve bladder storage and emptying in individuals with motor-complete SCI.
- To identify neuroanatomical targets for scES to modulate LUT function.
Main Methods:
- Functional bladder mapping during filling cystometry to identify effective scES parameters.
- High-resolution magnetic resonance imaging (MRI) and finite element modeling to map neuroanatomical structures.
- Pilot clinical trial involving seven individuals with motor-complete SCI.
Main Results:
- Specific scES parameters improved bladder compliance and enabled voluntary voiding initiation.
- Stable blood pressure was maintained during stimulation.
- Reduced incidence of urinary incontinence and autonomic dysreflexia associated with bladder distention were observed.
Conclusions:
- Targeted scES neuromodulation can enhance bladder compliance and mitigate autonomic dysreflexia in SCI.
- Initiating voiding with scES represents a significant step towards regaining volitional LUT control.
- scES adaptability for autonomic function restoration in SCI is advancing.
