Paralyzed patients regain movement in first-of-its-kind, noninvasive trial

By John Murphy, MDLinx
Published January 5, 2016

Key Takeaways

Researchers used a novel, noninvasive stimulation method on completely paralyzed patients that allowed them to voluntarily move their legs for the first time since paralysis. This reawakened dormant neural connections and re-established functional connectivity between the brain and spinal cord, according to the study published in the Journal of Neurotrauma.

Last year, the same researchers demonstrated similar results but with a surgically invasive method of electromagnetic stimulationa device implanted on the spinal cord.

“Many people thought just a few years ago we might be able to achieve these results in perhaps 1 out of 100 subjects, but now we have 9 of 9,” said senior author V. Reggie Edgerton, PhD, distinguished professor of integrative biology and physiology, neurobiology, and neurosurgery at University of California Los Angeles (UCLA). “I think it’s a big deal, and when the subjects see their legs moving for the first time after paralysis, they say it’s a big deal.”

In this study, 5 men who had been completely paralyzed for more than 2 years were given one 45-minute training session per week for 18 weeks. They performed the training lying on their sides and using an apparatus designed to minimize gravitational effects. Researchers placed electrodes on their skin at their lower back (at T11) and tailbone (at Co1), and then administered a unique pattern of electrical currents.

For the first 4 weeks, the men were also given twice daily doses of buspirone—a drug often used to treat anxiety disorders, but used in this experiment to pharmacologically stimulate motor control.

After 4 training sessions with both electrical and pharmacological stimulation, the subjects had recovered a significantly greater level of voluntary knee movement and range of motion. By the end of the study, the men were able to move their legs with no stimulation at all and their range of movement was, on average, the same as when they were moving while receiving stimulation.

“The key message derived from these observations is that some combination of electrical stimulation, pharmacological intervention, and training can open new functional connections among brain-spinal cord networks and that these functional connections are highly dynamic and interactive,” the researchers wrote.

“These findings tell us we have to look at spinal cord injury in a new way,” Dr. Edgerton said. “The fact that they regained voluntary control so quickly must mean that they had neural connections that were dormant, which we reawakened. It was remarkable.”

He added that most expertsincluding himselfhad assumed that people who were completely paralyzed would no longer have neural connections across the area of the spinal cord injury.

“People who are paralyzed are often told very early on, ‘Don’t have any hope because you’re not going to recover function below the lesion,’” Dr. Edgerton said. “They have been told that for decades, and still are today. But this was ridiculous before, and it’s even more ridiculous now.”

He said these new approaches won't likely be widely available for years, although he now believes that treatment can significantly improve quality of life for patients with severe spinal cord injuries and help them recover multiple body functions. The researchers don't know yet whether patients who are completely paralyzed can be trained to fully bear their weight and walk.

Dr. Edgerton also wants to test noninvasive stimulation on individuals with partial paralysis. “We have focused on individuals with complete paralysis throughout this whole process because we knew that was going to be the toughest patient population to see changes in. We’ve always thought, and we have every reason to believe, that those individuals with partial injuries have even more room for improvement,” he said.

“These encouraging results provide continued evidence that spinal cord injury may no longer mean a life-long sentence of paralysis and support the need for more research,” said Roderic Pettigrew, PhD, MD, director of the National Institute of Biomedical Imaging and Bioengineering, in Bethesda MD. “The potential to offer a life-changing therapy to patients without requiring surgery would be a major advance; it could greatly expand the number of individuals who might benefit from spinal stimulation. It’s a wonderful example of the power that comes from combining advances in basic biological research with technological innovation.”

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