Timing dependent synergies between motor cortex and posterior spinal stimulation in humans.

Autor:	McIntosh JR; Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; Dept. of Orthopedic Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065., Joiner EF; Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA., Goldberg JL; Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065., Greenwald P; Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA., Murray LM; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029.; James J. Peters VA Med. Ctr., 130 West Kingsbridge Road, Bronx, NY 10468., Thuet E; New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034., Modik O; Dept. of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065., Shelkov E; Dept. of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065., Lombardi JM; Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034., Sardar ZM; Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034., Lehman RA; Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034., Chan AK; Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034., Riew KD; Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065.; New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034., Harel NY; Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029.; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029.; James J. Peters VA Med. Ctr., 130 West Kingsbridge Road, Bronx, NY 10468., Virk MS; Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065., Mandigo C; Dept. of Neurological Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; New York Presbyterian, The Och Spine Hospital, 5141 Broadway, New York, NY 10034., Carmel JB; Dept. of Neurology, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; Dept. of Orthopedic Surgery, Columbia University, 650 W. 168th St, New York, NY, 10032, USA.; Dept. of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, 1300 York Ave, New York, NY 10065.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2023 Dec 21. Date of Electronic Publication: 2023 Dec 21.
DOI:	10.1101/2023.08.18.23294259
Abstrakt:	Volitional movement requires descending input from motor cortex and sensory feedback through the spinal cord. We previously developed a paired brain and spinal electrical stimulation approach in rats that relies on convergence of the descending motor and spinal sensory stimuli in the cervical cord. This approach strengthened sensorimotor circuits and improved volitional movement through associative plasticity. In humans it is not known whether dorsal epidural SCS targeted at the sensorimotor interface or anterior epidural SCS targeted within the motor system is effective at facilitating brain evoked responses. In 59 individuals undergoing elective cervical spine decompression surgery, the motor cortex was stimulated with scalp electrodes and the spinal cord with epidural electrodes while muscle responses were recorded in arm and leg muscles. Spinal electrodes were placed either posteriorly or anteriorly, and the interval between cortex and spinal cord stimulation was varied. Pairing stimulation between the motor cortex and spinal sensory (posterior) but not spinal motor (anterior) stimulation produced motor evoked potentials that were over five times larger than brain stimulation alone. This strong augmentation occurred only when descending motor and spinal afferent stimuli were timed to converge in the spinal cord. Paired stimulation also increased the selectivity of muscle responses relative to unpaired brain or spinal cord stimulation. Finally, paired stimulation effects were present regardless of the severity of myelopathy as measured by clinical signs or spinal cord imaging. The large effect size of this paired stimulation makes it a promising candidate for therapeutic neuromodulation. Competing Interests: 5.1Competing interests Jason B. Carmel is a Founder and stock holder in BackStop Neural and a scientific advisor and stockholder in SharperSense. He has received honoraria from Pacira, Motric Bio, and Restorative Therapeutics. Michael S. Virk has been a consultant and has received honorarium from Depuy Synthes and BrainLab Inc; he is on the Medical Advisory Board and owns stock with OnPoint Surgical. K. Daniel Riew: Consulting: Happe Spine (Nonfinancial), Nuvasive; Royalties: Biomet, Nuvasive; Speaking and/or Teaching Arrangements: Nuvasive (Travel Expense Reimbursement); Stock Ownership: Amedica, Axiomed, Benvenue, Expanding Orthopedics, Happe Spine, Paradigm Spine, Spinal Kinetics, Spineology, Vertiflex. Ronald A. Lehman: Consulting: Medtronic; Royalties: Medtronic, Stryker. Zeeshan M. Sardar: Consulting: Medtronic; Grant/Research support from the Department of Defense. Joseph M. Lombardi: Consulting: Medtronic, Stryker. The other authors have nothing to disclose.
Databáze:	MEDLINE
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