Cuneiform Nucleus Stimulation Can Assist Gait Training to Promote Locomotor Recovery in Individuals With Incomplete...

Area of Science:

• Neuroscience
• Neurology
• Rehabilitation Medicine

Background:

• Incomplete spinal cord injury (SCI) often impairs stepping ability, limiting locomotor training efficacy and leading to wheelchair dependence.
• The cuneiform nucleus (CNF) is a crucial mesencephalic center for locomotor control, modulating spinal centers via the reticulospinal tract.
• Unilateral CNF deep brain stimulation (DBS) has shown potential in rodent models to induce stepping and improve gait after SCI.

Purpose of the Study:

• To investigate the therapeutic potential of unilateral CNF-DBS in augmenting training and improving gait in human patients with incomplete SCI.
• To translate findings from animal models to clinical application in non-ambulatory individuals with chronic tetraplegia.

Main Methods:

• A clinical trial (NCT03053791) involving unilateral CNF-DBS in conjunction with 6 months of locomotor training.
• Assessment of 2 individuals with chronic tetraplegia, evaluating effects with and without stimulation.
• Primary endpoint: change in walking distance during the 6-Minute Walking Test (6MWT) after 6 months.

Main Results:

• Patient 1 achieved the primary endpoint in the off-stimulation condition.
• Patient 2 achieved the primary endpoint in both off- and on-stimulation conditions.
• No serious adverse events were reported during the study.

Conclusions:

• Unilateral CNF-DBS was well-tolerated in the first two patients with chronic tetraplegia.
• The findings suggest CNF-DBS has therapeutic potential for improving gait in SCI.
• Lessons learned are being implemented for future patient cohorts.