Spinal Cord Injury Epidural Stimulation

NCT ID: NCT02592668

Last Updated: 2020-04-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-04

Study Completion Date

2019-02-11

Brief Summary

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This is a feasibility study to test the use of epidural stimulation to restore volitional function previously lost due to spinal cord injury.

Previous studies conducted in animal models, performed elsewhere and here at Mayo Clinic, have shown that direct electrical stimulation of the spinal cord increases the excitability of spared neuronal connections within the site of injury, thereby enhancing signal transmission and allowing recovery of previously lost volitional function. Recently, epidural electrical stimulation of the lumbosacral spinal cord in four individuals with spinal cord injury (SCI) has restored motor and autonomic function below the level of injury. Despite positive results, further translational research is needed to validate these findings. The goal of this proposal is to perform epidural stimulation to restore volitional function in patients with SCI. In two patients, we will implant an epidural stimulator onto the dorsal aspect of the lumbosacral spinal cord dura mater. Patients will undergo a structured program of daily physical rehabilitation, treadmill step training, and epidural stimulation to recover motor, sensory, and autonomic function.

Detailed Description

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Conditions

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Spinal Cord Injury

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DEVICE_FEASIBILITY

Blinding Strategy

NONE

Study Groups

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Active stimulation

Subjects will be implanted with an epidural stimulator onto the dorsal aspect of the lumbosacral spinal cord dura mater. Patients will undergo a structured program of daily physical rehabilitation, treadmill step training, and epidural stimulation to recover motor, sensory, and autonomic function. The total estimated time for the intervention is 66 weeks.

Group Type EXPERIMENTAL

Epidural Stimulator

Intervention Type DEVICE

Subjects will be implanted with an epidural stimulator onto the dorsal aspect of the lumbosacral spinal cord dura mater. Patients will undergo a structured program of daily physical rehabilitation, treadmill step training, and epidural stimulation to recover motor, sensory, and autonomic function.

Interventions

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Epidural Stimulator

Subjects will be implanted with an epidural stimulator onto the dorsal aspect of the lumbosacral spinal cord dura mater. Patients will undergo a structured program of daily physical rehabilitation, treadmill step training, and epidural stimulation to recover motor, sensory, and autonomic function.

Intervention Type DEVICE

Other Intervention Names

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Medtronic Restore ULTRA 97712

Eligibility Criteria

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Inclusion Criteria

* Stable medical condition without \*cardiopulmonary disease or \*dysautonomia that would contraindicate standing or stepping with body weight support training
* No current anti-spasticity medication regimen
* Non-progressive spinal cord injury between the vertebral levels of C7 \& T10
* American Spinal Injury Association grading scale of A or B
* Sensory evoked potentials are either not present or have a bilateral delay
* Segmental reflexes remain functional below the lesion
* At least 2-years post-injury.

Exclusion Criteria

* Pregnancy at time of enrollment
* Failure to obtain consent
* Prisoners
* Children (age less than 21)
* Any patient identified as unsuitable for this protocol by the Mayo study team
* Skeletal fracture
* Osteoporosis with Dual-energy X-ray absorptiometry (DEXA) t score ≤-3.5
* Uncontrolled urinary tract infections
* Presence or history of frequent decubitus ulcers
* Clinical depression
* Drug abuse
* Painful musculoskeletal dysfunction, unhealed fracture, contracture, pressure sore, or urinary tract infection that might interfere with stand or step training
* Current anti-spasticity medication regimen
* Voluntary motor response present in leg muscles
* Volitional control during voluntary movement attempts in leg muscles as measured by electromyography (EMG) activity
* Brain influence on spinal reflexes as measured by EMG activity
* Recordable motor evoked potential in the lower limbs with transcranial magnetic stimulation
* Implanted cardiac pacemaker
* Implanted defibrillator
* Other implanted metallic or active body worn medical electronic device such as an insulin pump
* \*Cardiopulmonary disease that would result in exclusion from the study will be defined as clinically diagnosed chronic obstructive pulmonary disease, cardiac failure, and heart arrhythmia that would contraindicate sudden changes in body position such as sit-to-stand and stepping
* \*Excessive and uncontrolled autonomic dysreflexia characterized by symptomatic hypotension, light headedness and hypertension, flushing and bradycardia. Additionally blood pressure monitoring will be available at all times during rehabilitation and assessment times.
Minimum Eligible Age

21 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of California, Los Angeles

OTHER

Sponsor Role collaborator

Reneu Health Inc.

OTHER

Sponsor Role collaborator

Bel13ve in Miracles Foundation

OTHER

Sponsor Role collaborator

The Craig H. Neilsen Foundation

OTHER

Sponsor Role collaborator

National Center for Advancing Translational Sciences (NCATS)

NIH

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Kristin Zhao, PhD

Kristin D. Zhao, Ph.D.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Kristin D. Zhao, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

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Mayo Clinic in Rochester

Rochester, Minnesota, United States

Site Status

Countries

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United States

References

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Grahn PJ, Lavrov IA, Sayenko DG, Van Straaten MG, Gill ML, Strommen JA, Calvert JS, Drubach DI, Beck LA, Linde MB, Thoreson AR, Lopez C, Mendez AA, Gad PN, Gerasimenko YP, Edgerton VR, Zhao KD, Lee KH. Enabling Task-Specific Volitional Motor Functions via Spinal Cord Neuromodulation in a Human With Paraplegia. Mayo Clin Proc. 2017 Apr;92(4):544-554. doi: 10.1016/j.mayocp.2017.02.014.

Reference Type BACKGROUND
PMID: 28385196 (View on PubMed)

Gill ML, Grahn PJ, Calvert JS, Linde MB, Lavrov IA, Strommen JA, Beck LA, Sayenko DG, Van Straaten MG, Drubach DI, Veith DD, Thoreson AR, Lopez C, Gerasimenko YP, Edgerton VR, Lee KH, Zhao KD. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat Med. 2018 Nov;24(11):1677-1682. doi: 10.1038/s41591-018-0175-7. Epub 2018 Sep 24.

Reference Type BACKGROUND
PMID: 30250140 (View on PubMed)

Calvert JS, Grahn PJ, Strommen JA, Lavrov IA, Beck LA, Gill ML, Linde MB, Brown DA, Van Straaten MG, Veith DD, Lopez C, Sayenko DG, Gerasimenko YP, Edgerton VR, Zhao KD, Lee KH. Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis. J Neurotrauma. 2019 May 1;36(9):1451-1460. doi: 10.1089/neu.2018.5921. Epub 2018 Dec 15.

Reference Type BACKGROUND
PMID: 30430902 (View on PubMed)

Gill ML, Linde MB, Hale RF, Lopez C, Fautsch KJ, Calvert JS, Veith DD, Beck LA, Garlanger KL, Sayenko DG, Lavrov IA, Thoreson AR, Grahn PJ, Zhao KD. Alterations of Spinal Epidural Stimulation-Enabled Stepping by Descending Intentional Motor Commands and Proprioceptive Inputs in Humans With Spinal Cord Injury. Front Syst Neurosci. 2021 Jan 28;14:590231. doi: 10.3389/fnsys.2020.590231. eCollection 2020.

Reference Type DERIVED
PMID: 33584209 (View on PubMed)

Related Links

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Other Identifiers

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UL1TR000135

Identifier Type: NIH

Identifier Source: secondary_id

View Link

15-000510

Identifier Type: -

Identifier Source: org_study_id

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