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Tuesday, April 8, 2014

Experimental Paralysis Treatment Hailed As ‘Groundbreaking’

From left, Andrew Meas, Dustin Shillcox, Kent Stephenson and Rob Summers, who are the first four to undergo task-specific training with epidural stimulation at the Human Locomotion Research Center laboratory, Frazier Rehab Institute, as part of the University of Louisville's Kentucky Spinal Cord Injury Research Center in Louisville, Kentucky. (University of Louisville)

From left, Andrew Meas, Dustin Shillcox, Kent Stephenson and Rob Summers, who were the first four to undergo task-specific training with epidural stimulation at the Human Locomotion Research Center laboratory, Frazier Rehab Institute, as part of the University of Louisville’s Kentucky Spinal Cord Injury Research Center in Louisville, Kentucky. (University of Louisville)

Four paralyzed men who underwent an experimental treatment involving electric current were able to move their limbs and regain some control of their bowel and bladder function.

The revolutionary new treatment is being hailed as “groundbreaking” by experts. They say the results of the study, which will be published today in the journal Brain, are an important first step toward an eventual cure for spinal cord injury.

Researchers say the electrical device’s “zapping” of the spinal cord helps it receive simple commands from the brain — even though doctors had long assumed those connections were beyond repair.

While the patients in the study still use wheelchairs and are only able to move their limbs while the electrical current is in place, they say that the ability to once again make voluntary movements has changed their lives.

Cladia Angeli, who is lead author of the study and a senior researcher at the Human Locomotion Research Center at Frazier Rehab, discusses the new treatment with Here & Now’s Robin Young.

Interview Highlights: Cladia Angeli

On her colleague’s surprise seeing the very first patient move his toes

“It was actually extremely surprising because initially the study was to see if we could follow some of the successes that were shown in the animal model where rats were able to generate some independent steps and able to stand as well. So we never thought about asking these individuals if they could move their legs through any of the process that was involved in the research. So it was actually extremely surprising because it was that first participant that actually found out on his own that he had regained some voluntary activity.”

Why stimulating the spinal cord, not the brain, is allowing the patent to move

“It’s a little bit of a change in the thinking that the brain has to put together all the details of the movement. But what we’re doing with the stimulation is we’re stimulating the spinal cord and getting it ready — awakening it, if you would — to receive a simple command from the brain to intend to move. So we believe that all that is needed from the brain perspective is a very simple intent to move a leg, and then the spinal cord will take over all the details of how to reorganize the neurons and the inner neurons to generate the movement itself.”

Is this changing the thinking on spinal cords damaged ‘beyond repair’?

“Absolutely. So when the injury happens, it’s located in a very small portion of the spinal cord, but the rest of the spinal cord is intact. So when we actually place the electrode, we place it over the lower aspect of the spinal cord which is intact, and by stimulating we can actually access those inner neurons and neurons that are still healthy and make them kind of remember what it was that they needed to do, in terms of generation of a specific movement.”

How soon before this can get to more people?

“We’re hoping to move this to clinical translation in the near future. The technology is our current limitation and we’re working in terms of trying to improve that as well, but we do have that objective in mind, to move this to the clinic as quickly as possible so other individuals can benefit from this type of therapy.”

Guest

Transcript

ROBIN YOUNG, HOST:

From NPR and WBUR Boston, I'm Robin Young.

MEGHNA CHAKRABARTI, HOST:

I'm Meghna Chakrabarti. It's HERE AND NOW. Coming up, a look at two neighboring states, one that expanded Medicaid under the Affordable Care Act and one that did not.

YOUNG: But first to potentially spectacular, what some researchers say is staggering, news in the world of spinal cord research. Four paralyzed men who underwent an experimental treatment involving electric current were able to move their limbs and regain some control of their bowel, bladder and sexual function when their damaged spinal cords were stimulated.

The study was partly funded by the Christopher and Dana Reeve Foundation. It'll be published today in the journal Brain. One of the researchers involved in the work at the University of Louisville is Dr. Claudia Angeli, senior researcher at the Human Locomotion Research Center at Frazier Rehab Institute at the school. And Dr. Angeli, we understand that one of your colleagues was there when this first patient unexpectedly moved his toes, and she uttered a phrase we can't say on air. Let's just say it was proceeded by the word holy - holy blank.

How surprising was this?

CLAUDIA ANGELI: It was actually extremely surprising because initially the study was to see if we could follow some of the successes that were shown in the animal model, where rats were able to generate some independent steps and able to stand, as well. So we never thought about asking these individuals if they could move their legs through any of the process that was involved in the research.

So it was extremely surprising because it was that first participant that actually found out on his own that he had regained some voluntary activity.

YOUNG: Yeah, because the original research was just to try to trace nerve pathways. It wasn't to actually get patients to move, and then suddenly he's saying I can move my toe. And now we understand patients are moving legs, toes, some doing sit-ups. What is happening here? Because we hear researchers saying, again with this shock, they are not stimulating the brain, which would send the signal to the leg to move. They're stimulating the spinal cord. So why is that giving someone the ability to move?

ANGELI: Yes, so it's a little bit of a change in the thinking that the brain has to put together all the details of the movement. But what we're doing with the stimulation is we're stimulating the spinal cord and getting it ready, awaken it if you would, to receive a simple command from the brain to - or intent to move.

So we believe that all that is needed from the brain perspective is a very simple intent to move a leg, and then the spinal cord will take over all the details of how to reorganize the neurons and the interneurons to generate the movement itself.

YOUNG: Is this meaning that their - the assumption has been that when the spinal cord is injured, it's damaged in some cases beyond repair. Is this changing that thinking, that this electric stimulation is finding that there is some viable spinal cord underneath all that injury?

ANGELI: Yeah, absolutely, so when the injury happens, it's located in a very small portion of the spinal cord, but the rest of the spinal cord is intact. So when we actually place the electrode, we place it over the lower aspect of the spinal cord, which is intact, and by stimulating, we can actually access those interneurons and neurons that are still healthy and make them kind of remember what it was that they needed to do in terms of generation of a specific movement.

YOUNG: Well, we're assuming this won't apply to everyone, you know, some people have more devastating injuries than others, and that it doesn't yet mean that people can walk because a stimulator has to be moved to different places to do each movement, you know, a leg moving here or a toe moving there.

ANGELI: Correct. We have different programs for different things, and the complexity of walking, it's a little bit beyond what we're able to functionally do with the stimulator right now.

YOUNG: But that, who knows, might come. And in the meantime, how important is it for paralyzed people to be able to move? How important - you know, at all, to move a leg or to have bowel function? You know, we are reading and being reminded that Christopher Reeve died not as much because of the paralysis but because of the immobility it causes.

ANGELI: Right, and mobility itself gets other systems going. And like you mentioned, they've shown return in some bowel, bladder, cardiovascular function. Muscle mass has improved significantly. And they feel better overall. Their quality of life has significantly changed. So even though, you know, sometimes everybody focuses on walking as the ultimate goal, all these other changes are even greater for them because it just improves their quality of life.

YOUNG: Well, I'm sure today you're being inundated with people who want to know more. How soon before this becomes widespread and more than the - I think you're looking at up to eight patients at some point here. But how soon before this can get to more people?

ANGELI: Yes, so we're hoping to move this to clinical translation in the near future. The technology is our current limitation, and we're working in terms of trying to improve that, as well. But we do have that objective in mind, to move this to the clinic as quickly as possible so other individuals can benefit from this type of therapy.

YOUNG: Quite something. We'll link people up at hereandnow.org. Dr. Claudia Angeli of the University of Louisville, which is publishing new research today from their spinal cord research center in the publication Brain. Dr. Angeli, congratulations to your team, and thank you for talking to us.

ANGELI: Thank you very much, and thank you for the interest. Transcript provided by NPR, Copyright NPR.


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