ONWARD: Revolutionary Advances in Spinal Cord Injury Treatment: Insights from Grégoire Courtine, PhD

In a groundbreaking keynote talk at the 2021 American Spinal Injury Association (ASIA) Annual Scientific Meeting, two leading figures in neurological research, Grégoire Courtine, PhD, and Jocelyne Bloch, MD, shared their latest findings and research abstracts, offering new hope in the treatment of spinal cord injuries.

Understanding the Impact of Spinal Cord Injuries

Spinal cord injuries often result in severe, irreversible neurological deficits, including the loss of motor and autonomic functions. This is primarily due to the disrupted communication between the brain and the spinal cord. The work of Dr. Courtine and Dr. Bloch focuses on bridging this gap and restoring lost functions.

Epidural Electrical Stimulation (EES): A Gateway to Recovery

The crux of their research lies in the use of Epidural Electrical Stimulation (EES). EES utilizes large-diameter afferent fibers within the posterior roots as a gateway to specific neuron populations in the spinal cord. This innovative approach has enabled the design of implantable EES systems that precisely modulate neural circuits involved in motor and autonomic functions.

Epidural Electrical Stimulation (EES) is a promising therapeutic technique that has shown significant potential in helping individuals with paralysis, particularly those with spinal cord injuries (SCI). Here's an overview of how it works and why it is beneficial:

How Epidural Electrical Stimulation Works:

1. Placement of Electrodes: EES involves the surgical placement of a small array of electrodes along the lower part of the spinal cord, just above the dura mater (the outermost membrane covering the spinal cord). These electrodes are typically positioned over the spinal segments that control lower limb muscles.

2. Electrical Stimulation: The electrodes are connected to a pulse generator, which delivers controlled electrical currents to the spinal cord. This stimulation mimics the signals that the brain normally sends to initiate movement.

3. Activation of Neural Circuits: The electrical pulses activate the neural circuits in the spinal cord that are still intact after injury. These circuits are responsible for specific motor functions and, when stimulated, can facilitate controlled movement of the legs, even in the absence of direct brain signals.

4. Modulation of Signals: The stimulation can be modulated in terms of intensity, frequency, and timing to match the desired movement, such as standing, walking, or other specific motor tasks.

Why It Helps People with Paralysis:

1. Restoration of Movement: For individuals with complete or incomplete SCI, EES can enable movements like standing, stepping, and even walking. It essentially 'reawakens' the dormant neural pathways, allowing for voluntary control of muscles that were previously paralyzed.

2. Improvement in Autonomic Functions: Beyond motor control, EES has been shown to improve other bodily functions affected by SCI, such as bladder control, sexual function, and cardiovascular stability.

3. Neuroplasticity: EES can promote neuroplasticity, the brain's ability to reorganize itself by forming new neural connections. This can lead to long-term improvements in motor functions and a reduction in the severity of paralysis.

4. Combination with Rehabilitation Therapies: When combined with physical rehabilitation therapies, EES can significantly enhance the recovery process. Patients undergoing EES often participate in rigorous physical therapy to relearn movements and improve their strength and coordination.

5. Psychological and Quality of Life Improvement: The ability to regain some level of independence in movement can have profound psychological benefits, improving the overall quality of life for individuals with paralysis.

Ongoing Research and Future Prospects:

While EES shows great promise, it is still an area of active research. Ongoing studies aim to refine the technology, understand the optimal parameters for stimulation, and make it accessible and effective for a broader range of spinal cord injuries. As research progresses, EES could become a standard treatment for SCI, offering hope to many who face paralysis.

Promising Results and Future Applications

The application of these EES systems has shown remarkable results. Not only have they restored mobility, but they have also reinstated hemodynamic stability in patients with clinically complete spinal cord injuries. The scope of neurological functions that can be addressed with EES is continually expanding, opening new avenues for treatment.

Translating Research into Real-World Solutions

ONWARD, the organization behind this research, is dedicated to translating these scientific breakthroughs into commercially available products. Their team, comprising scientists, engineers, and physicians, is driven by the mission to create life-changing therapies for those living with spinal cord injuries.

A New Era in Neurological Treatment

The work of Dr. Courtine and Dr. Bloch represents a significant leap forward in the treatment of spinal cord injuries. Their research not only provides a deeper understanding of the underlying mechanisms but also paves the way for practical, effective treatments. As they continue their work, the future looks hopeful for millions affected by these injuries, marking the beginning of a new era in neurological rehabilitation.