Nagel Sean J, Wilson Saul, Johnson Michael D, Machado Andre, Frizon Leonardo, Chardon Matthieu K, Reddy Chandan G, Gillies George T, Howard Matthew A
Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Neuromodulation. 2017 Jun;20(4):307-321. doi: 10.1111/ner.12591. Epub 2017 Apr 2.
Millions of people worldwide suffer with spasticity related to irreversible damage to the brain or spinal cord. Typical antecedent events include stroke, traumatic brain injury, and spinal cord injury, although insidious onset is also common. Regardless of the cause, the resulting spasticity leads to years of disability and reduced quality of life. Many treatments are available to manage spasticity; yet each is fraught with drawbacks including incomplete response, high cost, limited duration, dose-limiting side effects, and periodic maintenance. Spinal cord stimulation (SCS), a once promising therapy for spasticity, has largely been relegated to permanent experimental status.
In this review, our goal is to document and critique the history and assess the development of SCS as a treatment of lower limb spasticity. By incorporating recent discoveries with the insights gained from the early pioneers in this field, we intend to lay the groundwork needed to propose testable hypotheses for future studies.
SCS has been tested in over 25 different conditions since a potentially beneficial effect was first reported in 1973. However, the lack of a fully formed understanding of the pathophysiology of spasticity, archaic study methodology, and the early technological limitations of implantable hardware limit the validity of many studies. SCS offers a measure of control for spasticity that cannot be duplicated with other interventions.
With improved energy-source miniaturization, tailored control algorithms, novel implant design, and a clearer picture of the pathophysiology of spasticity, we are poised to reintroduce and test SCS in this population.
全球数百万人患有与脑或脊髓不可逆损伤相关的痉挛。典型的前驱事件包括中风、创伤性脑损伤和脊髓损伤，不过隐匿性起病也很常见。无论病因如何，由此导致的痉挛都会造成多年的残疾并降低生活质量。有多种治疗方法可用于管理痉挛；然而，每种方法都存在诸多缺点，包括反应不完全、成本高、持续时间有限、剂量限制性副作用以及需要定期维持治疗。脊髓刺激（SCS），一种曾被寄予厚望用于治疗痉挛的疗法，在很大程度上已沦为永久性实验状态。
在本综述中，我们的目标是记录和批判SCS作为治疗下肢痉挛的历史，并评估其发展情况。通过将近期的发现与该领域早期先驱者的见解相结合，我们打算为未来研究提出可检验假设奠定基础。
自1973年首次报道其潜在有益效果以来，SCS已在超过25种不同情况下进行了测试。然而，对痉挛病理生理学缺乏全面的理解、陈旧的研究方法以及植入式硬件早期的技术限制，限制了许多研究的有效性。SCS为痉挛提供了一种其他干预措施无法复制的控制手段。
随着能源小型化的改进、定制的控制算法、新颖的植入设计以及对痉挛病理生理学更清晰的认识，我们准备在这一人群中重新引入并测试SCS。
