Key result
FES-training is linked to ~65% fewer regenerative events versus long-term denervation alone.
Why the study?
Long-term denervated muscles show fiber loss and regeneration cycles, but the safety and effectiveness of FES-training in inducing muscle recovery in SCI patients needed evaluation.
Does FES-training affect muscle fiber regeneration in patients with permanent lower motoneuron denervation post-spinal cord injury?
Observational
Does FES-training affect muscle fiber regeneration in patients with permanent lower motoneuron denervation post-spinal cord injury?
FES-training in patients with long-term lower motoneuron denervation is safe and associated with fewer regenerative events than denervation alone, supporting its effectiveness.
Supports FES safety in chronic denervation; hypothesis-generating and requires randomized trials before practice change.
Morphologic characteristics of the long-term denervated muscle in animals suggest that some original fibers are lost and some of those seen are the result of repeated cycles of fiber regeneration. Muscle biopsies from lower motoneuron denervated patients enrolled in the EU Project RISE show the characteristics of long-term denervation. They present a few atrophic or severely atrophic myofibers dispersed among adipocytes and connective tissue (denervated degenerated muscle, DDM). Monoclonal antibody for embryonic myosin shows that regenerative events are present from 1- to 37-years postspinal cord injury (SCI). After 2- to 10-years FES-training the muscle cryosections present mainly large round myofibers. In the FES-trained muscles the regenerative events are present, but at a lower rate than long-term denervated muscles (myofiber per mm2 of cryosection area: 0.8 +/- 1.3 in FES vs. 2.3 +/- 2.3 in DDM, mean +/- SD, P = 0.011). In our opinion this is a sound additional evidence of effectiveness of the Kern's electrical stimulation protocol for FES of DDM. In any case, the overall results demonstrate that the FES-training is safe: at least it does not induce more myofiber damage/regeneration than denervation per se.
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Carraro et al. (2005) conducted an observational in Lower motoneuron denervation following spinal cord injury. FES-training vs. Long-term denervated degenerated muscle (DDM) without FES was evaluated on Regenerative events (myofiber per mm2 of cryosection area) (p=0.011). FES-training in patients with spinal cord injury was associated with fewer regenerative events than long-term denervation alone (0.8 vs 2.3 myofibers/mm2; P=0.011), indicating the training is safe.
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