Mayr Winfried, Krenn Matthias, Dimitrijevic Milan R
aCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna bInstitute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria cFoundation for Movement Recovery, Oslo, Norway dBaylor College of Medicine, Houston, Texas, USA.
Curr Opin Neurol. 2016 Dec;29(6):721-726. doi: 10.1097/WCO.0000000000000382.
The Purpose of this review is to outline and explain the therapeutic use of electrical spinal cord stimulation (SCS) for modification of spinal motor output. Central functional stimulation provides afferent input to posterior root neurons and is applied to improve volitional movements, posture and their endurance, control spasticity, and improve bladder function or perfusion in the lower limbs. Clinical accomplishments strongly depend on each individual's physiological state and specific methodical adaptation to that physiological state.
Effectiveness of this neuromodulory technique for changing motor control after spinal cord injury (SCI) continues to be explored along with the underlying mechanisms of its effect in people with complete and incomplete spinal cord injuries. There are extensive studies of tonic and rhythmical activity elicited from the lumbar cord as well as data demonstrating augmentation of residual volitional activity. Recent studies have focused on verifying if and how SCS can modify features of neurocontrol in ambulatory spinal cord patients.
In this review, we emphasize recent publications of research revealing that SCS can substitute for the reduced brain drive for control of excitability in people with SCI. Artificially replacing diminished or lost brain control over the spinal cord has limitations. A fundamental requirement for successful SCS application is analysis of each individual's residual postinjury neural function. This will allow a better understanding of the physiological interactions between SCS and spinal cord motor control below injury and provide criteria for its application. Finally, the publication of both successful and failed applications of SCS will be crucial for gaining future progress.
本综述旨在概述并解释脊髓电刺激（SCS）在改变脊髓运动输出方面的治疗用途。中枢功能刺激为后根神经元提供传入输入，用于改善自主运动、姿势及其耐力，控制痉挛，并改善下肢的膀胱功能或灌注。临床成效很大程度上取决于个体的生理状态以及针对该生理状态的具体方法调整。
这种神经调节技术在脊髓损伤（SCI）后改变运动控制的有效性仍在持续探索中，同时也在研究其对完全性和不完全性脊髓损伤患者产生作用的潜在机制。针对从腰髓引出的强直性和节律性活动已有广泛研究，还有数据表明残余自主活动有所增强。近期研究聚焦于验证SCS能否以及如何改变能行走的脊髓损伤患者的神经控制特征。
在本综述中，我们强调了近期的研究出版物，这些研究表明SCS可替代因脑驱动减弱而导致的脊髓兴奋性控制不足。人为替代大脑对脊髓减少或丧失的控制存在局限性。成功应用SCS的一项基本要求是分析每个个体损伤后的残余神经功能。这将有助于更好地理解SCS与损伤以下脊髓运动控制之间的生理相互作用，并为其应用提供标准。最后，SCS成功与失败应用案例的公布对于未来取得进展至关重要。
