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In another study, Wagner and colleagues re-established adaptive control of paralyzed muscles during walking by modulating the stimulation in both space and time 8.Īreas of growing research involve the optimization and advancement of ESCS strategies beyond the conventional paradigms that use low frequency, high amplitude, and 300–600 μs pulse widths. For example, with different contact combinations, Gill and colleagues 7 were able to restore independence of motor function after complete loss of lower sensorimotor functions after SCI.
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In addition to pain treatment, ESCS is a promising tool for restoring motor function after spinal cord injury (SCI) in patients. Hence, these challenges can lead to the failure of ESCS therapy for patients reporting distributions of pain in regions that are difficult to cover with paresthesia 3. Despite the significant positive impact of ESCS, current protocols are generally hampered by the limited number of contacts in the available leads and by their spatial distribution along the spinal cord 1. The success of traditional ESCS is largely based on the ability of the clinician to provide an adequate coverage over the patients’ distribution of pain and furthermore the willingness of the patient to tolerate the induced paresthesia 3. In clinical practice, conventional low frequency ESCS induces paresthesia in a distribution overlapping with the painful area, thus reducing the perception of pain 3, 6. ESCS was introduced after the introduction of the gate control hypothesis 4 according to which stimulating the low-threshold myelinated fibers in the dorsal columns of the spinal cord with electrical impulses at specific frequencies might lead to pain reduction 5. Similar content being viewed by othersĬonventional epidural spinal cord stimulation (ESCS) is commonly used for several diseases mostly associated with chronic pain conditions, complex regional pain syndrome, neuropathic and ischemic pain and painful diabetic peripheral neuropathy 1, 2, 3. The OS approach may allow targeting ESCS to spinal fibers of different orientations, ultimately making stimulation less dependent on the precision of the electrode implantation.
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The fMRI activation patterns during spinal cord stimulation demonstrated the complexity of brain networks stimulated by OS-ESCS paradigms, involving brain areas responsible for the transmission of the motor and sensory information. Here, we introduced a similar OS approach for ESCS, and demonstrated orientation dependent brain activations as detected by brain fMRI. The method achieves orientation selectivity by controlling the main direction of the electric field gradients using individually driven channels. Recently, we introduced Orientation Selective (OS) stimulation strategies for deep brain stimulation, and demonstrated their selectivity in rats using functional MRI (fMRI). Despite significant positive impact of ESCS, currently available protocols provide limited specificity and efficiency partially due to the limited number of contacts of the leads and to the limited flexibility to vary the spatial distribution of the stimulation field in respect to the spinal cord.
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Epidural spinal cord stimulation (ESCS) is widely used for chronic pain treatment, and is also a promising tool for restoring motor function after spinal cord injury.