Choi Elliot H, Gattas Sandra, Brown Nolan J, Hong John D, Limbo Joshua N, Chan Alvin Y, Oh Michael Y
Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Ophthalmology, Gavin Herbert Eye Institute, School of Medicine; Department of Neurosurgery, University of California, Irvine, CA, USA.
Department of Neurosurgery, University of California, Irvine, CA, USA.
Neural Regen Res. 2021 Dec;16(12):2367-2375. doi: 10.4103/1673-5374.313017.
A long-standing goal of spinal cord injury research is to develop effective repair strategies, which can restore motor and sensory functions to near-normal levels. Recent advances in clinical management of spinal cord injury have significantly improved the prognosis, survival rate and quality of life in patients with spinal cord injury. In addition, a significant progress in basic science research has unraveled the underlying cellular and molecular events of spinal cord injury. Such efforts enabled the development of pharmacologic agents, biomaterials and stem-cell based therapy. Despite these efforts, there is still no standard care to regenerate axons or restore function of silent axons in the injured spinal cord. These challenges led to an increased focus on another therapeutic approach, namely neuromodulation. In multiple animal models of spinal cord injury, epidural electrical stimulation of the spinal cord has demonstrated a recovery of motor function. Emerging evidence regarding the efficacy of epidural electrical stimulation has further expanded the potential of epidural electrical stimulation for treating patients with spinal cord injury. However, most clinical studies were conducted on a very small number of patients with a wide range of spinal cord injury. Thus, subsequent studies are essential to evaluate the therapeutic potential of epidural electrical stimulation for spinal cord injury and to optimize stimulation parameters. Here, we discuss cellular and molecular events that continue to damage the injured spinal cord and impede neurological recovery following spinal cord injury. We also discuss and summarize the animal and human studies that evaluated epidural electrical stimulation in spinal cord injury.
脊髓损伤研究的一个长期目标是制定有效的修复策略，使运动和感觉功能恢复到接近正常水平。脊髓损伤临床管理的最新进展显著改善了脊髓损伤患者的预后、生存率和生活质量。此外，基础科学研究取得的重大进展揭示了脊髓损伤潜在的细胞和分子事件。这些努力推动了药物、生物材料和基于干细胞的疗法的发展。尽管做出了这些努力，但仍没有标准的治疗方法来使受损脊髓中的轴突再生或恢复沉默轴突的功能。这些挑战导致人们更加关注另一种治疗方法，即神经调节。在多个脊髓损伤动物模型中，脊髓硬膜外电刺激已证明运动功能有所恢复。关于硬膜外电刺激疗效的新证据进一步拓展了其治疗脊髓损伤患者的潜力。然而，大多数临床研究是在极少数脊髓损伤范围广泛的患者身上进行的。因此，后续研究对于评估硬膜外电刺激对脊髓损伤的治疗潜力以及优化刺激参数至关重要。在此，我们讨论了持续损害受损脊髓并阻碍脊髓损伤后神经功能恢复的细胞和分子事件。我们还讨论并总结了评估脊髓损伤硬膜外电刺激的动物和人体研究。
