The Lancet Paper on "Spinal Cord Damage" -some improvement in Movements of Paralyzed Patients

The patient seems to have had the following type of spinal cord damage:
 The Lancet Quote "An individual three years post C7-T1 subluxation presented with a complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment" end of Quote.

In this interesting Lancet paper on neuronal recovery/functional recovery, the authors claims they have noticed significant improvement of Paralyzed patients after implant and electrical stimulation. This new positive results was not achieved by the same group in their own earlier clinical studies,  authors say "we have not seen such a result in their earlier research studies". 

Spinal cord stimulation studies been done both in lab rats as well as paralyzed patients. This is the latest report on paralyzed patients responding to stimulation with visible movements, it is interesting but we have long way to go to have a wholesome or meaningful treatment of spinal cord damages, it all comes to the extent of damage, and severity of neural paths that are severed by accidents......if the integrity of both afferent and efferent pathways are preserved with mild or minor damages, the recovery can be significant, in cases were more than 50% percent damages or even more severe, that determines the possibility of any recovery. In either case, it is good to read some results. And, when it is published in The Lancet, got to be little credible to listen to the news?..

-------------------------------------------------------------------------------------------------------

Lancet. 2011 June 4; 377(9781): 1938–1947.

Published online 2011 May 19. doi:  10.1016/S0140-6736(11)60547-3

Effect of Epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study

Findings

Epidural stimulation enabled the human lumbosacral spinal circuitry to dynamically elicit full weight-bearing standing with assistance provided only for balance for 4·25 minutes in a subject with a clinically motor complete SCI. This occurred when using stimulation at parameters optimized for standing while providing bilateral load-bearing proprioceptive input. Locomotor-like patterns were also observed when stimulation parameters were optimized for stepping. In addition, seven months after implantation, the subject recovered supraspinal control of certain leg movements, but only during epidural stimulation.

Median Nerve SSEP:- Is there a relationship between Median Nerve SSEP & Level of Spinal Cord Injury?

This case study was conducted by the American Spinal Cord Injury Association (ASIA) on patients with Quadriplegia. The question asked was is there a relationship between median nerve SSEP changes and level of spinal cord injury?.

The answer is yes, neuromonitoring of median nerve SSEPs conducted on 14 quadriplegic patients and 8 normal individuals. Amplitude and latency analysis of waveforms N9, N13 and N20 was conducted. N9 responses were present in all the patients and normal subjects, both amplitude and latency were similar in both groups.

On the other hand, N13 was absent in Quadriplegia patients?
N20 was absent in C5 patients with Quadriplegia? but it was present in C6-7 patients, though the amplitudes were decreased with normal latency. Did you notice these waveform changes in your recording?.

Read further:

Original Article

Spinal Cord (2009) 47, 372–378; doi:10.1038/sc.2008.147; published online 20 January 2009

Relationship between median nerve somatosensory evoked potentials and spinal cord injury levels in patients with quadriplegia

M I F de Arruda Serra Gaspar¹, A Cliquet Jr^2,3, V M Fernandes Lima⁴ and D C C de Abreu¹

Methods:

Fourteen individuals with quadriplegia and 8 healthy individuals were evaluated. Electrophysiological assessment of the median nerve was performed by evoked potential equipment. The injury level was obtained by ASIA. N₉, N₁₃ and N₂₀ were analyzed based on the presence or absence of responses. The parameters used for analyzing these responses were the latency and the amplitude. Data were analyzed using mixed-effect models.