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Review
. 2019 Jul 11:5:10.
doi: 10.1186/s42234-019-0027-x. eCollection 2019.

Neurorestorative interventions involving bioelectronic implants after spinal cord injury

Newton Cho  1   2 , Jordan W Squair  1   3   4 , Jocelyne Bloch  5   6 , Grégoire Courtine  1   5   6
Affiliations
Review

Neurorestorative interventions involving bioelectronic implants after spinal cord injury

Newton Cho et al. Bioelectron Med. .

Abstract

In the absence of approved treatments to repair damage to the central nervous system, the role of neurosurgeons after spinal cord injury (SCI) often remains confined to spinal cord decompression and vertebral fracture stabilization. However, recent advances in bioelectronic medicine are changing this landscape. Multiple neuromodulation therapies that target circuits located in the brain, midbrain, or spinal cord have been able to improve motor and autonomic functions. The spectrum of implantable brain-computer interface technologies is also expanding at a fast pace, and all these neurotechnologies are being progressively embedded within rehabilitation programs in order to augment plasticity of spared circuits and residual projections with training. Here, we summarize the impending arrival of bioelectronic medicine in the field of SCI. We also discuss the new role of functional neurosurgeons in neurorestorative interventional medicine, a new discipline at the intersection of neurosurgery, neuro-engineering, and neurorehabilitation.

Keywords: Brain-computer interface; Electrical stimulation; Neuromodulation; Neurosurgery; Spinal cord injury.

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Conflict of interest statement

Competing interestsJB and GC hold various patents in bioelectronics and are founders and shareholders of GTX medical, a company developing bioelectronic implants in direct relationships with the reviewed work.

Figures

Fig. 1
Fig. 1
Neuromodulation strategies to engage circuits below the lesion after SCI. The reactivation or modulation of spinal circuits for locomotion has been demonstrated with the use of epidural electrical stimulation (EES) combined with the oral or intrathecal administration of serotonergic and dopaminergic agonists. EES can also be used to optimize autonomic function post-SCI (i.e., blood pressure management). Brain-spine interfaces (BSIs) also provide an alternative strategy for locomotion through bypassing the injury
Fig. 2
Fig. 2
Neuromodulation strategies to engage circuits above the lesion after SCI. Neuromodulation therapies have been delivered to the mesencephalic locomotor region (MLR) using deep brain stimulation (DBS) in order to facilitate locomotion. Motor cortex stimulation (MCS) has been applied for extensive periods of time daily to promote the growth and sprouting of corticospinal tract fibers. Finally, vagus nerve stimulation (VNS) has been applied to augment motor learning and plasticity during motor rehabilitation
Fig. 3
Fig. 3
Spatiotemporal EES reproduces the natural activation of the spinal cord. Delivery of EES bursts matching the spatial and temporal dynamics of natural motor neuron activation immediately enables locomotion after SCI. Decoding algorithms detect foot movements in order to adjust the location and timing of the spatiotemporal stimulation sequences to the current needs of the patient. The spinal cord activation map is reconstructed based on the projection of electromyographic recordings onto the theoretical location of motor neurons in the spinal cord
Fig. 4
Fig. 4
Chronophotography illustrating the recovery of locomotion during targeted EES. The patient is receiving targeted EES while suspended in a cutting-edge body-weight support system. EES is switched on and off, showing that the recovery of overground locomotion only occurs during EES
Fig. 5
Fig. 5
Ecological principles should guide the development of bioelectronic technology for SCI. Making the technology useable in the patient’s natural setting is paramount to its utility. This photograph illustrates the technological framework that enables real-time control of EES outside the laboratory environment. Developing technology based on these ecological principles will require the input and collaborative effort of multiple specialties including neurosurgeons, neurologists, rehabilitation specialists, physiotherapists, engineers, and scientists in order to make bioelectronic technology for patients with SCI safe and user-friendly
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