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research article

Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury

Formento, Emanuele  
•
Minassian, Karen  
•
Wagner, Fabien  
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October 31, 2018
Nature Neuroscience

Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury but is less effective in humans. Here we hypothesized that this interspecies discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations and preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position. Consequently, continuous EES can only facilitate locomotion within a narrow range of stimulation parameters and is unable to provide meaningful locomotor improvements in humans without rehabilitation. Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motor neuron activity. This demonstrates the importance of stimulation protocols that preserve proprioceptive information to facilitate walking with EES.

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Type
research article
DOI
10.1038/s41593-018-0262-6
Author(s)
Formento, Emanuele  
Minassian, Karen  
Wagner, Fabien  
Mignardot, Jean-Baptiste  
Le Goff-Mignardot, Camille Georgette Marie
Rowald, Andreas  
Bloch, Jocelyne
Micera, Silvestro
Capogrosso, Marco  
Courtine, Grégoire  
Date Issued

2018-10-31

Published in
Nature Neuroscience
Volume

21

Start page

1728

End page

1741

Subjects

Spinal Cord Injury

•

Spinal Cord Stimulation

•

Computational Neuroscience

•

Electrical Stimulation

•

Proprioception

•

Locomotion

Editorial or Peer reviewed

REVIEWED

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Available on Infoscience
November 5, 2018
Use this identifier to reference this record
https://infoscience.epfl.ch/handle/20.500.14299/149630
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