Association of Epidural Stimulation With Cardiovascular Function in an Individual With Spinal Cord Injury

Association of Epidural Stimulation With Cardiovascular Function in an Individual With Spinal Cord Injury The application of epidural electrical stimulation to the lumbosacral spinal cord in individuals with a spinal cord injury (SCI) facilitates supraspinal control of paralyzed limbs.1 There is a growing interest in studying whether epidural stimulation can be leveraged to also abrogate cardiovascular dysfunction, as evidenced by ongoing randomized clinical trials on this topic (NCT02037620; NCT03026816). Here, we investigated whether lumbosacral epidural stimulation could be optimized to control cardiovascular functions in the short term, a top health priority and primary cause of death,2 in 1 individual with a motorcomplete cervical SCI. Methods | A man in his early 30s with a chronic C5 motorcomplete SCI (ASIA impairment scale B) who was previously (12 months prior) fitted with an epidural spinal cord stimulation unit and 16-electrode array (Restore-ADVANCED and Specify 5-6-5; Medtronic) at T11-L1 vertebral levels was assessed. The placement was confirmed via radiography (Figure 1A). The participant gave his written informed consent. This study was approved by the University of British Columbia Clinical Research Ethics Board. We first conducted a series of tests (over 2 weeks) to determine the optimum stimulation parameters to increase blood pressure (BP) in the seated position, ultimately selecting a widefield stimulation configuration (Figure 1A; frequency, 35 Hz; pulse width, 300 milliseconds; intensity, 3.5 V). On the main experimental day, we assessed beat-by-beat BP via finger photoplethysmography (Finometer PRO; Finapres Medical Sys-