针对慢性脊髓损伤后基于网络特异性的硬膜外刺激的膀胱功能。

Targeting bladder function with network-specific epidural stimulation after chronic spinal cord injury.

机构信息

Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, The University of Louisville, 220 Abraham Flexner Way, Suite 1518, Louisville, KY, 40202, USA.

Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.

出版信息

Sci Rep. 2022 Jul 1;12(1):11179. doi: 10.1038/s41598-022-15315-2.

Abstract

Profound dysfunctional reorganization of spinal networks and extensive loss of functional continuity after spinal cord injury (SCI) has not precluded individuals from achieving coordinated voluntary activity and gaining multi-systemic autonomic control. Bladder function is enhanced by approaches, such as spinal cord epidural stimulation (scES) that modulates and strengthens spared circuitry, even in cases of clinically complete SCI. It is unknown whether scES parameters specifically configured for modulating the activity of the lower urinary tract (LUT) could improve both bladder storage and emptying. Functional bladder mapping studies, conducted during filling cystometry, identified specific scES parameters that improved bladder compliance, while maintaining stable blood pressure, and enabled the initiation of voiding in seven individuals with motor complete SCI. Using high-resolution magnetic resonance imaging and finite element modeling, specific neuroanatomical structures responsible for modulating bladder function were identified and plotted as heat maps. Data from this pilot clinical trial indicate that scES neuromodulation that targets bladder compliance reduces incidences of urinary incontinence and provides a means for mitigating autonomic dysreflexia associated with bladder distention. The ability to initiate voiding with targeted scES is a key step towards regaining volitional control of LUT function, advancing the application and adaptability of scES for autonomic function.

摘要

脊髓损伤 (SCI) 后,脊髓网络出现严重功能障碍和广泛的功能连续性丧失,但这并未阻止个体实现协调的自主活动和获得多系统自主控制。通过脊髓硬膜外刺激 (scES) 等方法可以调节和增强剩余的神经回路,从而增强膀胱功能,即使在临床上完全性 SCI 的情况下也是如此。目前尚不清楚专门用于调节下尿路 (LUT) 活动的 scES 参数是否可以改善膀胱储存和排空功能。在充盈膀胱测压期间进行的功能性膀胱映射研究确定了特定的 scES 参数,这些参数可改善膀胱顺应性,同时保持血压稳定,并使 7 名运动完全性 SCI 患者能够开始排尿。使用高分辨率磁共振成像和有限元建模,确定了负责调节膀胱功能的特定神经解剖结构,并将其绘制为热图。这项初步临床试验的数据表明,针对膀胱顺应性的 scES 神经调节可降低尿失禁的发生率,并为缓解与膀胱扩张相关的自主反射异常提供了一种方法。通过靶向 scES 开始排尿是恢复对 LUT 功能的自主控制的关键一步,这推进了 scES 在自主功能中的应用和适应性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d931/9249897/f0a943623144/41598_2022_15315_Fig1_HTML.jpg

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