中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (12): 2367-2375.doi: 10.4103/1673-5374.313017

• 综述:脊髓损伤修复保护与再生 • 上一篇    下一篇

硬膜外电刺激治疗脊髓损伤

  

  • 出版日期:2021-12-15 发布日期:2021-05-13

Epidural electrical stimulation for spinal cord injury

Elliot H. Choi1, 2, 3, Sandra Gattas3, Nolan J. Brown3, John D. Hong2, Joshua N. Limbo3, Alvin Y. Chan3, Michael Y. Oh3, *   

  1. 1Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 2Department of Ophthalmology, Gavin Herbert Eye Institute, School of Medicine, University of California, Irvine, CA, USA; 3Department of Neurosurgery, University of California, Irvine, CA, USA
  • Online:2021-12-15 Published:2021-05-13
  • Contact: Michael Y. Oh, MD, ohm2@hs.uci.edu.
  • Supported by:
    This work was supported by the Medical Scientist Training Program T32GM007250 and Predoctoral Training in Molecular Therapeutics Program T32GM008803 (to EHC).

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摘要：

Neural Regen Res： 硬膜外电刺激治疗脊髓损伤的潜力

脊髓损伤研究的一个长期目标是制定有效的修复策略，使运动和感觉功能恢复到接近正常水平。近年来，脊髓损伤的临床治疗进展显著改善了脊髓损伤患者的预后、生存率和生活质量。基础科学研究的重大进展揭示了脊髓损伤的潜在细胞和分子事件。这些努力促进了药物、生物材料和干细胞治疗的发展。在脊髓损伤的多种动物模型中，硬膜外电刺激脊髓显示运动功能恢复。有关硬膜外电刺激疗效的新证据进一步扩大了硬膜外电刺激治疗脊髓损伤患者的潜力。大多数临床研究是在极少数脊髓损伤范围广泛的患者身上进行的。因此，后续的研究对于评估硬膜外电刺激对脊髓损伤的治疗潜力和优化刺激参数至关重要。

来自美国加州大学尔湾分校的Michael Y. Oh团队认为在阐明脊髓损伤的病理生理学和应用硬膜外电刺激恢复运动功能方面取得了重大进展。通过调节脊髓神经网络，硬膜外电刺激能够恢复脊髓损伤动物模型和患者的迈步能力。值得注意的是，最近对人类受试者的研究表明，靶向本体感受器回路在残余下行通路的重组中起着至关重要的作用。硬膜外电刺激治疗脊髓损伤的未来方向需要克服几个挑战。例如，需要改进以建立最佳的硬膜外电刺激技术和刺激参数；改善电极的生物相容性对减少长期并发症的发生。尽管挑战依然存在，但证明硬膜外电刺激治疗脊髓损伤有效性的案例正在出现。因此，跨学科的合作将促进人们对硬膜外电刺激在神经回路恢复中机制的理解，并加速其在临床实践中的应用。

文章在《中国神经再生研究（英文版）》杂志2021年 12 月 12 期发表。

https://orcid.org/0000-0003-0477-6116 (Michael Y. Oh)

Abstract: A long-standing goal of spinal cord injury research is to develop effective repair strategies, which can restore motor and sensory functions to near-normal levels. Recent advances in clinical management of spinal cord injury have significantly improved the prognosis, survival rate and quality of life in patients with spinal cord injury. In addition, a significant progress in basic science research has unraveled the underlying cellular and molecular events of spinal cord injury. Such efforts enabled the development of pharmacologic agents, biomaterials and stem-cell based therapy. Despite these efforts, there is still no standard care to regenerate axons or restore function of silent axons in the injured spinal cord. These challenges led to an increased focus on another therapeutic approach, namely neuromodulation. In multiple animal models of spinal cord injury, epidural electrical stimulation of the spinal cord has demonstrated a recovery of motor function. Emerging evidence regarding the efficacy of epidural electrical stimulation has further expanded the potential of epidural electrical stimulation for treating patients with spinal cord injury. However, most clinical studies were conducted on a very small number of patients with a wide range of spinal cord injury. Thus, subsequent studies are essential to evaluate the therapeutic potential of epidural electrical stimulation for spinal cord injury and to optimize stimulation parameters. Here, we discuss cellular and molecular events that continue to damage the injured spinal cord and impede neurological recovery following spinal cord injury. We also discuss and summarize the animal and human studies that evaluated epidural electrical stimulation in spinal cord injury.

Key words: central nervous system, chondroitin sulfate proteoglycans, epidural electrical stimulation, glial scar, gliosis, neural activity, neuromodulation, oligodendrocyte, spinal cord injury