481 Spinal Cord Stimulator Promotes Neuroplasticity in Patients With Severe Spinal Cord Injury

INTRODUCTION: Traumatic spinal cord injury (SCI) is one of the leading causes of morbidity and mortality worldwide. Recently, epidural electrical stimulation (EES) has been shown to restore voluntary motor control in patients with severe SCI. METHODS: To this date, three patients with SCI have been implanted with 5-6-5-Specify-Medtronic electrodes and Medtronic-Intellis pulse generator. All procedures were approved by the local Ethics Committee. The age of the patients ranged from 38-69 y, and the levels of the SCI were C6-D5. Clinically, they were classified ASIA A (2) or B (1). The time frame after injury was 2-7 y. Intraoperative electrophysiological mapping was performed to ensure correct location of the lead at the levels involved in the control of L3-S2 nerve roots. Clinical assessments were performed every 3 m. Additionally, we measured superficial EMG each month, through sensors equipped with accelerometers and gyroscopes. RESULTS: One patient completed 12 m of intense rehabilitation program. The other two patients are currently on training and to this date they completed respectively 6 and 3 months of the program. All 3 patients were able to perform walking activities on a treadmill and stationary bicycle with stimulation turned on. There was an important improvement in the scales related to motor skills and balance, at expense of worsening in pain scores. After 8 months the first patient started to present voluntary movements even with stimulation turned off. CONCLUSIONS: EES allows restoration of voluntary motor control of the legs after severe traumatic SCI. Moreover, after 8 months, a plastic effect could be observed, and a patient was able to control movements even with off stimulation. The observed improvement in overall patient’s performance occurred at expense of more pain, which need to be addressed carefully.