An Open-source Computational Model of Neurostimulation of the Spinal Pudendo-Vesical Reflex for the Recovery of Bladder Control After Spinal Cord Injury.

Spinal cord stimulation (SCS) could be used to restore control of the bladder after spinal cord injury, but substantial development is still required to tailor this technology for bladder function. Computational models could be utilized to accelerate these efforts enabling in-silico optimization of stimulation parameters. However, no model of the spinal pudendo-vesical reflex can simulate the effect of stimulation amplitude on neuron recruitment. This limitation hinders accurate prediction of bladder pressure changes for different stimulation configurations. Here., we implemented an open-source realistic spiking neural network model of the pudendo-vesical reflex enabling exploration of the impact of stimulation amplitude and frequency on bladder pressure changes. We used the oS PARC platform to design a parallel implementation of the bladder reflex circuits with NEURON. Our model successfully reproduced and expanded previous studies., producing a decrease in bladder pressure at low stimulation frequency (10 Hz) and excitation at high stimulation frequency (≥33 Hz) in isovolumetric experiments. We then explored the effect of mixed nerve recruitment., simulating a common case of poorly selective spinal cord stimulation. We found that high recruitments of pudendal nerve axons are necessary to maintain this bi-modal behavior., regardless of stimulation specificity. Our framework is fully open-source and can be used to simulate any type of axon stimulations such as SCS and peripheral nerve stimulation.