Hope for paraplegics in the horizon

By Dr. Ananya Mandal, MDSep 26 2018

According to a new study from the University of Louisville, four paraplegics have found hope. Paraplegia is complete paralysis of the lower limbs due to damage or injury to the spinal cord. The team of researchers have published their success story in a study in the latest issue of the New England Journal of Medicine.

The four patients had a surgical implant on their spinal cords. This implant stimulates electrical activity. These patients also underwent months of regular physiotherapy. At the end of the study the researchers noted that two of the four patients could take a few limited steps after the therapy and the other two could walk independently. This novel device is manufactured by Medtronic. The study was supported by the University of Louisville Hospital.

Another simultaneous case report was published recently in the journal Nature Medicine. This also reported the success of electrical stimulation device in paraplegia along with intensive physiotherapy. Experts have warned that these studies have been conducted in a handful of patients and the causes of paraplegia may be different in different patients and the spinal injuries may also vary among the patients. They suggest larger studies with varied patients to establish the success of this device.

This technique was pioneered by the team led by Susan Harkema, associate scientific director of the Kentucky Spinal Cord Injury Research Center at the University of Louisville. She said that the device was implanted below the site of the injury. She said that there have been studies that have worked on regrowth of the injured spine cells and this new device works by electrical stimulation. She explained this is a gradual shift in the focus. Harkema said, “The basis of this work is that the spinal circuitry is sophisticated and really has the same properties that the brain does in many ways, and in the context of this study, really what is shown is it has the capability of relearning to walk in the right conditions.” “Combined with all the sensory information you get from moving the legs in a steplike pattern, and that tiny little whisper of an intent signal that they still have coming down, that all comes together,” Harkema explained.

For this study the team gave the study subjects around two months of intense physical therapy and training. This was to ensure that the therapy was not responsible alone for restoring function of the spinal cord. Thereafter the device was implanted and the daily physiotherapy was continued. The case report earlier too showed similar results. Both sets of researchers proved that the device was necessary for the paraplegics to work and it was not due to recovery of the patient.

Kendall Lee, a neurosurgeon at the Mayo Clinic said, “The important point is this technology may be able to give back functional control, to stand and take independent steps. So it really gives hope to people who are faced with paralysis.”

Researchers hope that the device would be improved and bettered in future so that it is more effective. The patients in these studies were in their 20s or 30s and their injuries were within two to three years prior to the treatment. Larger studies with older patients and those who have suffered the injuries many years back would provide insights into the actual efficacy of this device say experts.