scholarly journals Exploration of the Supraspinal Hypotheses about Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation: A Systematic Review

2021 ◽  
Vol 10 (13) ◽  
pp. 2766
Author(s):  
Lisa Goudman ◽  
Sander De Groote ◽  
Bengt Linderoth ◽  
Ann De Smedt ◽  
Sam Eldabe ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Animal Studies ◽  
Review Process ◽  
Web Of Science ◽  
Mechanisms Of Action ◽  
The Body ◽  
Descending Pathways ◽  
Inhibitory Pathways ◽  
Motivational Influences

Despite the established efficacy and effectiveness of Spinal Cord Stimulation (SCS), there is still no consensus on the supraspinal mechanisms of action of this therapy. The purpose of this study was to systematically review previously raised hypotheses concerning supraspinal mechanisms of action of SCS based on human, animal and computational studies. Searches were conducted using four electronic databases (PubMed, EMBASE, SCOPUS and Web of Science), backward reference searching and consultation with experts. The study protocol was registered prior to initiation of the review process (PROSPERO CRD42020161531). A total of 54 publications were included, 21 of which were animal studies, and 33 were human studies. The supraspinal hypotheses (n = 69) identified from the included studies could be categorized into six groups concerning the proposed supraspinal hypothesis, namely descending pathways (n = 24); ascending medial pathway (n = 13); ascending lateral pathway (n = 10); affective/motivational influences (n = 8); spinal–cerebral (thalamic)-loop (n = 3) and miscellaneous (n = 11). Scientific support is provided for the hypotheses identified. Modulation of the descending nociceptive inhibitory pathways, medial and lateral pathways were the most frequently reported hypotheses about the supraspinal mechanisms of action of SCS. These hypotheses were mainly supported by studies with a high or moderate confidence in the body of evidence.

Microcirculatory Responses to Electrical Spinal Cord Stimulation in Humans: Implications to Potential Mechanisms of Action

2000 ◽  
Vol 98 (s42) ◽  
pp. 13P-13P
Author(s):  
SEM Eaton ◽  
ND Harris ◽  
F Selmi ◽  
L Brady ◽  
S Tesfaye ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Mechanisms Of Action

Modifications of Locomotor Pattern Underlying Escape Behavior in the Lamprey

2008 ◽  
Vol 99 (1) ◽  
pp. 297-307 ◽  
Author(s):  
Salma S. Islam ◽  
Pavel V. Zelenin
Keyword(s):  
Spinal Cord ◽  
Escape Behavior ◽  
Sensory Information ◽  
The Body ◽  
Descending Pathways ◽  
Long Distance ◽  
Lower Vertebrate ◽  
Dorsal Roots ◽  
Tactile Stimuli ◽  
Undulatory Locomotion

Two forms of undulatory locomotion in the lamprey (a lower vertebrate) have been described earlier: fast forward swimming (FFS) used for long distance migrations and slow backward swimming (SBS) used for escape from adverse tactile stimuli. In the present study, we describe another form of escape behavior: slow forward swimming (SFS). We characterize the kinematic and electromyographic patterns of SFS and compare them with SBS and FFS. The most striking feature of SFS is nonuniformity of shape and speed of the locomotor waves propagating along the body: close to the site of stimulation, the waves slow down and the body curvature increases several-fold due to enhanced muscle activity. Lesions of afferents showed that sensory information critical for elicitation of SFS is transmitted through the dorsal roots. In contrast, sensory signals that induce SBS are transmitted through the dorsal roots, lateral line nerves, and trigeminal nerves. Persistence of SFS and SBS after different lesions of the spinal cord suggests that the ascending and descending pathways, necessary for induction of SBS and SFS, are dispersed over the cross section of the spinal cord. As shown previously, during FFS (but not SBS) the lamprey maintains the dorsal-side-up body orientation due to vestibular postural reflexes. In this study we have found that the orientation control is absent during SFS. The role of the spinal cord and the brain stem in generation of different forms of undulatory locomotion is discussed.

scholarly journals Plasticity: Implications for opioid and other pharmacological interventions in specific pain states

1997 ◽  
Vol 20 (3) ◽  
pp. 392-403 ◽  
Author(s):  
Anthony H. Dickenson
Keyword(s):  
Spinal Cord ◽  
Combination Therapy ◽  
Experimental Verification ◽  
Clinical Setting ◽  
Side Effect ◽  
Mechanisms Of Action ◽  
Delta Opioid Receptor ◽  
Descending Pathways ◽  
Pharmacological Interventions ◽  
Opioid Receptor Agonists

The spinal mechanisms of action of opioids under normal conditions are reasonably well understood. The spinal effects of opioids can be enhanced or reduced depending on pathology and activity in other segmental and nonsegmental pathways. This plasticity will be considered in relation to the control of different pain states using opioids. The complex and contradictory findings on the supraspinal actions of opioids are explicable in terms of heterogeneous descending pathways to different spinal targets using multiple transmitters and receptors – therefore opioids can both increase and decrease activity in descending pathways. These pathways could exhibit considerable plasticity. There is increasing evidence that delta opioid receptor agonists have the potential to replace morphine as major analgesics with reduced side-effect profiles. The concept of preemptive analgesia, based on preventing the induction of some of the negative plastic influences on opioid controls and the detrimental effects of pain, is sound, but experimental verification in the clinical setting is difficult. For example, a delayed compensatory upregulation of inhibitory systems, particularly in inflammation, may counter persistent painful inputs. Combination therapy with opioids may be beneficial in many pain states where either negative influences are blocked or inhibitory controls are enhanced. Finally, developmental aspects of these systems are discussed in connection with the treatment of pain in young children, where inhibitory systems in the spinal cord are immature.

scholarly journals Somatosensory control of balance during locomotion in decerebrated cat

2012 ◽  
Vol 107 (8) ◽  
pp. 2072-2082 ◽  
Author(s):  
Pavel Musienko ◽  
Gregoire Courtine ◽  
Jameson E. Tibbs ◽  
Vyacheslav Kilimnik ◽  
Alexandr Savochin ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brain Stem ◽  
Spinal Cord Stimulation ◽  
Balance Control ◽  
Dynamic Balance ◽  
Weight Bearing ◽  
The Body ◽  
Emg Activity ◽  
Somatosensory Information ◽  
The Brain

Postmammillary decerebrated cats can generate stepping on a moving treadmill belt when the brain stem or spinal cord is stimulated tonically and the hindquarters are supported both vertically and laterally. While adequate propulsion seems to be generated by the hindlimbs under these conditions, the ability to sustain equilibrium during locomotion has not been examined extensively. We found that tonic epidural spinal cord stimulation (5 Hz at L5) of decerebrated cats initiated and sustained unrestrained weight-bearing hindlimb stepping for extended periods. Detailed analyses of the relationships among hindlimb muscle EMG activity and trunk and limb kinematics and kinetics indicated that the motor circuitries in decerebrated cats actively maintain equilibrium during walking, similar to that observed in intact animals. Because of the suppression of vestibular, visual, and head-neck-trunk sensory input, balance-related adjustments relied entirely on the integration of somatosensory information arising from the moving hindquarters. In addition to dynamic balance control during unperturbed locomotion, sustained stepping could be reestablished rapidly after a collapse or stumble when the hindquarters switched from a restrained to an unrestrained condition. Deflecting the body by pulling the tail laterally induced adaptive modulations in the EMG activity, step cycle features, and left-right ground reaction forces that were sufficient to maintain lateral stability. Thus the brain stem-spinal cord circuitry of decerebrated cats in response to tonic spinal cord stimulation can control dynamic balance during locomotion using only somatosensory input.

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