Research press release


Nature Medicine

Neuroscience: Personalized spinal cord treatment rapidly restores motor function after complete paralysis



G Courtine、J Blochたちは、脊髄中にあって脚と体幹の動きに関係する神経全てを標的にできる新しいへら状の電極を設計した。この技術をコンピューターによる個別化治療の枠組みと組み合わせることで、このへら型電極の位置を患者ごとに正確に配置し、活動に応じた刺激プログラムを個別化することが可能になった。完全な感覚運動麻痺の患者3人(全員男性、年齢は29~41歳)で最適化されたこの脊髄刺激法を使うと、自力歩行や自転車走行、水泳などの運動活動性がわずか1日の間に急速に回復した。神経リハビリテーションはさらに回復を助け、患者たちはこれらの活動を実生活の中で行えるようになった。


Personalized spinal cord electrical stimulation — using electrode paddles designed specifically for spinal cord injuries — has been shown to restore independent motor movements within a few hours of the onset of therapy in three patients with complete sensorimotor paralysis. These findings — presented in Nature Medicine — demonstrate that purpose-built stimulation approaches result in superior efficacy and more-diverse motor activities after the most severe spinal cord injury.

Electrical stimulation of the spinal cord is a promising therapeutic option for restoring motor function in people with spinal cord injury. Stimulation approaches so far have provided continuous electrical stimulation of the spinal cord in patients through the use of re-purposed neurotechnologies that were originally designed to treat pain. However, these re-purposed electrical stimulation devices fail to stimulate all the nerves in the spinal cord associated with leg and trunk movements, which may limit the recovery of all motor functions.

Grégoire Courtine, Jocelyne Bloch and colleagues designed a new electrode paddle that targets all nerves associated with leg and trunk movements in the spinal cord. The team combined this technology with a personalized computational framework which allowed for the precise positioning of the electrode paddle for each patient and the personalization of activity-dependent stimulation programs. This optimized spinal cord–stimulation approach was then shown to rapidly restore independent walking and other motor activities, such as cycling and swimming, in three patients (all men, between 29 and 41 years of age) with complete sensorimotor paralysis, within a single day. Neurorehabilitation further helped the patients to be able to conduct these activities within their communities.

These findings — which form part of an ongoing trial — highlight the superior efficacy of purpose-built, personalized spinal cord–stimulation approaches, presenting a therapy that could mediate clinically meaningful improvements in people with a broad range of spinal cord injury severities.

doi: 10.1038/s41591-021-01663-5

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