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Combined neuromodulatory approaches in the central nervous system for treatment of spinal cord injury
Open accessAbstract
Purpose of review: To report progress in neuromodulation following spinal cord injury (SCI) using combined brain and spinal neuromodulation. Neuromodulation refers to alterations in neuronal activity for therapeutic purposes. Beneficial effects are established in disease states such as Parkinson's Disease (PD), chronic pain, epilepsy, and SCI. The repertoire of neuromodulation and bioelectric medicine is rapidly expanding. After SCI, cohort studies have reported the benefits of epidural stimulation (ES) combined with training. Recently, we have explored combining ES with deep brain stimulation (DBS) to increase activation of descending motor systems to address limitations of ES in severe SCI. In this review, we describe the types of applied neuromodulation that could be combined in SCI to amplify efficacy to enable movement. These include ES, mesencephalic locomotor region (MLR) - DBS, noninvasive transcutaneous stimulation, transcranial magnetic stimulation, paired-pulse paradigms, and neuromodulatory drugs. We examine immediate and longer-term effects and what is known about: (1) induced neuroplastic changes, (2) potential safety concerns; (3) relevant outcome measures; (4) optimization of stimulation; (5) therapeutic limitations and prospects to overcome these. Recent findings: DBS of the mesencephalic locomotor region is emerging as a potential clinical target to amplify supraspinal command circuits for locomotion. Summary: Combinations of neuromodulatory methods may have additive value for restoration of function after spinal cord injury.
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“This cooperation probably plays an essential role in the reorganization of neuronal pathways that mediate neurological recovery in response to neurorehabilitation with the BSI.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [41]
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Self-citation
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Walking naturally after spinal cord injury using a brain–spine interface
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Metadata
- Authors
- Noga, B. R., & Guest, J. D.
- Affiliations
- University of Miami (US)
- Corresponding author
- Noga, Brian R.
- Venue
- Current Opinion in Neurology
- Published
- 2021-09-29
- Volume
- 34
- Issue
- 6
- Pages
- 804-811
- ISSN
- 1350-7540 (ISSN-L)
- 1473-6551
- PMC
- PMC8595808
- OpenAlex
- W3203430713
- Cited by
- 14
- References
- 108
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2023: 2 · 2022: 5
- FWCI
- 0.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (R21NS115185, R01NS089972)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Spinal Cord Injury Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Keywords
- spinal cord injury, neuromodulation, epidural stimulation, deep brain stimulation, mesencephalic locomotor region, transcranial magnetic stimulation, transcutaneous electrical stimulation, paired-pulse stimulation, neuroplasticity, locomotor recovery
- MeSH terms
- Brain, Humans, Locomotion, Neuronal Plasticity, Spinal Cord, Spinal Cord Injuries, Deep Brain Stimulation
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