Presentation Authors: Evgeniy Kreydin*, Parag Gad, Hui Zhong, Kyle Latack, V. Reggie Edgerton, Los Angeles, CA
Introduction: Transcutaneous spinal cord stimulation (TSCS) is a neuromodulation modality that has been used to improve upper and lower extremity function after spinal cord injury (SCI) . In this study, we assessed whether TSCS affects lower urinary tract (LUT) function in SCI individuals.
Methods: Seven individuals (four males and three females) with SCI at T11 or above who used clean intermittent catheterization to manage the LUT were recruited. Each subject had a stable SCI that occurred at least one year prior to study initiation. Each subject underwent testing and stimulation over two days. On day 1, dose response curves for detrusor and external urethral sphincter (EUS) activation by TSCS were constructed by varying stimulation location (T11 or L1) and current intensity (10 mA - 200 mA). To examine the effects of stimulation on urine storage and voiding, on day 2 subjects underwent baseline urodynamics (UDS) and TSCS at settings found to produce maximal physiologic response in the LUT.
Results: To assess the effect on urine voiding, the bladder was filled to 80% urodynamic capacity and TSCS delivered at 1 Hz. As a result, voiding efficiency increased from 26.99 Â± 15.41 to 50.80 Â± 5.25 % (P < 0.05, n = 7). In addition, increased flow rate, decreased detrusor-sphincter dyssenergia and post-void residuals were noted. To assess the effect on urine storage, TSCS at 30 Hz was delivered during urodynamic bladder filling. As a result, bladder capacity increased from 170.54 Â± 15.86 to 252.59 Â± 18.91 ml (P < 0.05, n = 7). When UDS was repeated without stimulation, reversal to baseline was observed.
Conclusions: To our knowledge, this is the first demonstration that neural networks in the spinal cord can be activated with noninvasive stimulation to facilitate LUT activity after spinal cord injury in humans. We show that varying of the stimulation parameters has differential effects on the LUT. Future studies will assess long-term TSCS for correction of LUT dysfunction after SCI._x000D_
1. Gerasimenko, Y., R. Gorodnichev, T. Moshonkina, et al., Transcutaneous electrical spinal-cord stimulation in humans. Ann Phys Rehabil Med, 2015. 58(4): p. 225-31.
Source of Funding: International Foundation for Research in Paraplegia