New treatment helps patients with spinal cord injury

An international team of scientists led by Grégoire Courtine at EPFL and CHUV and Aaron Phillips from the University of Calgary has developed a treatment that can dramatically improve the lives of patients with spinal cord injury.

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“A serious and unrecognized result of these injuries is unstable blood pressure, which can have devastating consequences that reduce quality of life and put life at risk. Unfortunately, there are no effective therapies for unstable blood pressure afterwards. a spinal cord injury “. said Dr Aaron Phillips, co-lead author of the study (see affiliations below). “We have created the first platform to understand the mechanisms underlying blood pressure instability after spinal cord injury.

Their findings, published today in Nature, is based on research that has already enabled several paraplegics to walk again thanks to epidural electrical stimulation (EES). But instead of targeting the region of the spinal cord that produces leg movement, they delivered EES to the region containing the neural circuits that regulate blood pressure. In addition, they adapted the real-time stimulation protocol according to the measurements taken by a blood pressure monitor implanted in an artery. The monitor continuously measures blood pressure and adapts the instructions sent to a pacemaker which in turn delivers electrical impulses to the spinal cord. The stimulation is biomimetic, as it recapitulates the natural activation of the hemodynamic system of the body. “The stimulation compensates for the break in the communication line between the patient’s central nervous system and the sympathetic nervous system,” explains Courtine.

The research team first tested their method on preclinical rodent and non-human primate models to understand the mechanisms that disrupt blood pressure modulation after spinal cord injury and to identify where and how stimulation regimens must be applied to obtain the desired hemodynamic responses. Jocelyne Bloch, the neurosurgeon who runs the .NeuroRestore research center with Courtine and who carried out the surgical implants, was amazed at how quickly the stimulation protocol worked. “It was impressive to see the blood pressure hit the target level immediately after the stimulation was applied,” she says.

After these first tests, the scientists tried their method on a human patient.

“I suffered from daily episodes of hypotension, especially in the morning and evening,” says Richi, 38. “But since I have the implant, it happens a lot less often – maybe once every two weeks.” A surgeon himself, Richi lost the use of all four limbs after a sports accident. “These daily episodes of hypotension were a real burden. They also disrupted my vision and prevented me from performing even simple daily tasks. The electrical stimulation treatment provided enormous relief – much more effective than the medication. “

One of the doctors working with Richi, Dr Sean Dukelow, says: “Since using this system, Richi has been able to completely stop all the drugs he was using to manage the instability in blood pressure. This has been transformative and, reducing Richi’s risk of cardiovascular disease. ”

The team intends to continue its research thanks to a large grant received from the US Defense Advanced Research Projects Agency (DARPA). At the same time, Onward (formerly GTX Medical) – a startup based at EPFL Innovation Park and in the Netherlands – will develop and market clinical devices based on the team’s findings.

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