Chronic Studies of Spinal Cord Stimulation for Restoration of Bladder Function
Abstract
Loss of bladder function is a substantial challenge for persons with spinal cord injury (SCI), and impaired bladder function results in medical complications, decreased quality of life, lower life satisfaction, and can limit social contact. Not surprisingly, restoration of bladder function is consistently identified as a high priority for persons with SCI. Clean intermittent self-catheterization, often in combination with medications, is presently the most effective method to treat the loss of bladder function resulting from SCI. However, catheterization is challenging for persons with decreased hand function, and this treatment can be limited by intolerance or lack of effectiveness of drugs, persistent incontinence, and is still associated with frequent urinary tract infections. Thus, adequate and effective treatment of bladder dysfunction in persons with SCI remains a significant unmet need. Our objective is to conduct preclinical studies in an animal model (rat) to advance a novel approach using electrical stimulation of the spinal cord to restore bladder function. Restoration of bladder function is intended to include restored continence with increased bladder capacity and predictable and efficient on-demand bladder emptying. Electrical stimulation of the spinal cord is well-developed and commercially available for treating chronic pain, and this will greatly facilitate clinical translation of this innovative approach to restore bladder function. Electrical stimulation of the spinal cord (termed spinal cord stimulation) includes an electrode array placed inside the spine (but outside the protective dural sack surrounding the spinal cord) connected by a wire beneath the skin to a battery-powered implanted stimulator, similar to a cardiac pacemaker. Thus, the entire device is implanted within the body and can be programmed remotely by a clinician to set the appropriate dose of stimulation. Importantly, the effects of spinal cord stimulation can be determined using a temporary electrode placed through the skin during a trial phase (a “test drive”), and effects on bladder function can be determined prior to committing to a surgically implanted device. The goal is to develop a successful approach to restore bladder function to persons with SCI. The outcome will contribute to the medical and social rehabilitation of individuals with SCI, particularly those whose health or activities are limited by bladder dysfunction. The total number of individuals with SCI is approximately 300,000, with an estimated 12,500 new injuries occurring every year (www.sci-info-pages.com). Restoration of bladder function in persons with SCI is of particular relevance to the U.S. Veteran population, as more than 20% of persons with SCI in the U.S. are Veterans, and more than 40% of all Veterans with SCI were injured during their military Service. More than half of persons with SCI are between the ages of 16 and 30 years, and thus have many years of life over which the medical, social, and economic benefits of even initially costly technology can accumulate. We anticipate that spinal cord stimulation will emerge as a treatment option for persons with SCI above the sacral region, whether the injury is complete or incomplete. The type of spinal cord stimulation proposed in this project uses stimulation intensities that cannot be felt and thus, this therapy is likely to be well-tolerated even in persons with incomplete SCI who retain some sensation, as has been documented in persons using spinal cord stimulation to treat chronic pain. In addition to restoring bladder function after SCI, this approach may also be beneficial in individuals with brainstem stroke or multiple sclerosis, who often have bladder dysfunction similar to persons with spinal injury. We will establish the chronic functionality and confirm the appropriate stimulation parameters for this therapy, and we anticipate pursuing subsequent studies in persons with SCI. Since
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110541
Entities
People
- Warren M Grill
Organizations
- Duke University
- United States Army