Gad Parag N, Roy Roland R, Zhong Hui, Lu Daniel C, Gerasimenko Yury P, Edgerton V Reggie
Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, California, United States of America.
Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, California, United States of America; Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America.
PLoS One. 2014 Sep 29;9(9):e108184. doi: 10.1371/journal.pone.0108184. eCollection 2014.
The inability to control timely bladder emptying is one of the most serious challenges among the several functional deficits that occur after a complete spinal cord injury. Having demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis, we hypothesized that a similar approach could be used to recover bladder function after paralysis. Also knowing that posture and locomotion can be initiated immediately with a specific frequency-dependent stimulation pattern and that with repeated stimulation-training sessions these functions can improve even further, we reasoned that the same two strategies could be used to regain bladder function. Recent evidence suggests that rats with severe paralysis can be rehabilitated with a multisystem neuroprosthetic training regime that counteracts the development of neurogenic bladder dysfunction. No data regarding the acute effects of locomotion on bladder function, however, were reported. In this study we show that enabling of locomotor-related spinal neuronal circuits by epidural stimulation also influences neural networks controlling bladder function and can play a vital role in recovering bladder function after complete paralysis. We have identified specific spinal cord stimulation parameters that initiate bladder emptying within seconds of the initiation of epidural stimulation. The clinical implications of these results are substantial in that this strategy could have a major impact in improving the quality of life and longevity of patients while simultaneously dramatically reducing ongoing health maintenance after a spinal cord injury.
无法及时控制膀胱排空是完全性脊髓损伤后出现的多种功能缺陷中最严重的挑战之一。我们已经证明，硬膜外放置在脊髓背侧的电极可用于动物和人类，以恢复完全瘫痪后的姿势和运动功能。我们推测，类似的方法可用于恢复瘫痪后的膀胱功能。此外，我们知道特定的频率依赖性刺激模式可立即启动姿势和运动，并且通过重复刺激训练，这些功能可进一步改善。因此，我们推断同样的两种策略可用于恢复膀胱功能。最近的证据表明，严重瘫痪的大鼠可通过多系统神经假体训练方案进行康复，该方案可对抗神经源性膀胱功能障碍的发展。然而，尚未有关于运动对膀胱功能急性影响的数据报道。在本研究中，我们表明硬膜外刺激激活与运动相关的脊髓神经元回路，也会影响控制膀胱功能的神经网络，并在完全瘫痪后恢复膀胱功能中发挥重要作用。我们已经确定了特定的脊髓刺激参数，可在硬膜外刺激开始后的几秒钟内引发膀胱排空。这些结果的临床意义重大，因为该策略可能对改善患者的生活质量和寿命产生重大影响，同时显著减少脊髓损伤后的持续健康维护。
