Biomedical engineering specifications for epidural spinal cord stimulation to augment motor performance

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• Upper motor neuron disorders present significant challenges in patient management.
• Epidural spinal cord stimulation (SCS) is an emerging therapeutic modality.
• Previous research has explored SCS for various neurological conditions.

Purpose of the Study:

• To evaluate the feasibility and application of epidural spinal cord stimulation in the upper thoracic region for patients with upper motor neuron disorders.
• To describe the technical aspects of electrode placement and stimulation parameters used.
• To present an overview of available systems, challenges encountered, and future research directions.

Main Methods:

• 28 patients with upper motor neuron disorders underwent implantation of stimulating electrodes in the posterior epidural space of the upper thoracic region.
• Standard chronic stimulation parameters were utilized: 200 microsecond pulse width, 22 Hz repetition rate, and 5 mA amplitude.
• Platinum electrodes were inserted via a 16-gauge Touhy needle, and passive implanted receivers powered by external devices delivered the stimulus current.

Main Results:

• The study details the surgical placement of electrodes and the chronic stimulation parameters employed.
• An analysis of available stimulation systems, including problem diagnosis and troubleshooting, is provided.
• The findings are based on patient data from systems implanted for over six months.

Conclusions:

• Epidural spinal cord stimulation in the upper thoracic region is technically feasible for patients with upper motor neuron disorders.
• The study provides insights into the practical application, challenges, and potential future developments of this therapeutic approach.
• Long-term implantation data informs the understanding of chronic SCS in this patient population.