Deep Brain Stimulation in Patients With Incomplete Spinal Cord Injury for Improvement of Gait

Summary

Spinal cord injuries are anatomically mostly incomplete, showing tissue bridges of the spinal cord at the injury site. Of the 60% functionally incomplete patients, about half face a life in the wheelchair. Besides conventional rehabilitation, no prominsing further treatment options exist. One of the most plastic systems involved in locomotion is the pontomedullary reticulospinal tract, which is the oldest locomotor command system existing in most vertebrates, including primates. Muscle activation patterns for limb movements are programmed in the spinal cord and have to be activated and coordinated through commands from the so called mesencephalic locomotor region (MLR). The MLR consists of nerve cells in the lower mesencephalic tegmentum sending uni- and bilateral signals through the medullary reticulospinal tracts. Classical physiological studies showed that electrical stimulation of the MLR induce locomotion. For the first time this approach was transferred and recently published in a model of induced incomplete spinal cord injury by the Schwab group. Rats severly impaired in motor hindlimb control with only 10-20% spared white matter, recovered with fully functional weight bearing locomotion under MLR deep brain stimulation (DBS). Even rats with only 2-10% spared white matter regained weight supporting stepping. DBS is a clinical standard treatment option in patients with movement disorders but does not relieve all symptoms. Therefore, small studies of MLR stimulations have been safely used in Parkinsonian patients showing freezing of gait and frequent falls with variable results. In a translational approach, we aim at performing a multidisciplinary phase one clinical trial with 5 patients and incomplete spinal cord injury. With the means of our established universitary setup for DBS treatments the operations will be performed unilaterally under local anaesthesia in the Division of Neurosurgery, USZ, with perioperative electrophysiological recordings, clinical assessments and gait analysis under test stimulation in the Spinal Cord Injury Center Balgrist.

Conditions

• Spinal Cord Injury

Interventions

PROCEDURE

Deep brain stimulation in mesencephalic locomotor region

Implantation of Electrodes in the Mesencephalic Locomotor Region for improvement of Locomotion and Gait

DEVICE

Implantation of a Deep brain stimulation system

Implantation of a Medtronic Percept PC Impulse Generator for chronic Stimulation of the selected target.

Sponsors & Collaborators

• Balgrist University Hospital

  collaborator OTHER

• ETH Zurich

  collaborator OTHER

• Wings for Life

  collaborator OTHER

• University of Zurich

  lead OTHER

Principal Investigators

• Lennart H Stieglitz, MD · University Hospital Zurich, Neurosurgery

Study Design

Allocation

NA

Purpose

TREATMENT

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Max Age

75 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-03-15

Primary Completion

2026-12-31

Completion

2027-12-31

Countries

• Switzerland

Study Locations