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

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, su...

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Bibliographic Details
Published in:Scientific reports 2022-07, Vol.12 (1), p.11179-15, Article 11179
Main Authors: Herrity, April N., Aslan, Sevda C., Mesbah, Samineh, Siu, Ricardo, Kalvakuri, Karthik, Ugiliweneza, Beatrice, Mohamed, Ahmad, Hubscher, Charles H., Harkema, Susan J.
Format: Article
Language:English
Subjects:
631/378
631/378/1689
Adaptability
Anatomy
Autonomic nervous system
Bladder
Blood pressure
Epidural
Epidural Space
Humanities and Social Sciences
Humans
Magnetic resonance imaging
multidisciplinary
Neuromodulation
Science
Science (multidisciplinary)
Spinal Cord Injuries
Spinal Cord Stimulation - methods
Urinary Bladder
Urinary incontinence
Urinary tract
Urination
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Summary: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.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-022-15315-2