restoring hemodynamic stability using targeted epidural spinal stimulation following spinal cord injury

Conditions: Spinal Cord Injuries

Summary: the purpose of this study is to stimulate the circuits in the spinal cord that are directly responsible for hemodynamic control to restore hemodynamic stability in patients with chronic cervical or high-thoracic spinal cord injury. the ultimate objective of this feasibility study is to provide preliminary safety and efficacy measures on the ability of the hemodynamic targeted epidural spinal stimulation (tess) to ensure the long-term management of hemodynamic instability and reduce the incidence and severity of orthostatic hypotension and autonomic dysreflexia episodes in humans with chronic cervical or high-thoracic spinal cord injury. in addition, the long-term safety and efficacy of tess on cardiovascular health, respiratory function, spasticity, trunk stability and quality of life in patients with chronic spinal cord injury will be evaluated.

the investigators hypothesize that targeted epidural spinal stimulation (tess) foreshadows a new era in the hemodynamic management of both acute and chronic sci. it is envisioned that tess will become the first-line treatment for hemodynamic instability in people with chronic sci, where vasopressor agents and compression garments will become second-line treatments behind the precise control of blood pressure achieved with tess. in this study, the investigators propose to investigate the preliminary safety of hemodynamic tess to modulate pressor responses and manage blood pressure instability in 4 patients with chronic sci located between c3 and t6 and who suffer from severe orthostatic hypotension. the study intervention consists of 8 phases preceded by pre-screening: * screening and enrolment * baseline and pre-implantation assessments * surgery * intensive tess configuration phase * daily supervised at-home tess phase * long-term at-home phase * configuration of additional tess programs phase * end of study measures will be performed before surgical intervention and at regular intervals during the study. the study will take place at the chuv (lausanne, switzerland). a total of 4 participants will be enrolled in the study and implanted with two lead electrodes (specify surescan 5-6-5 leads, model 977c190 medtronic) and two implantable pulse generators (intellis™ with adaptivestim™, model 97715 medtronic). all participants will undergo the same treatment and procedures. the total duration of the study will be approximately 2 months (up to 10 months/participant).

Eligibility criteria:
inclusion criteria: * age 18 to 70 years old * able to undergo the informed consent/assent process * radiologically confirmed spinal cord injury * spinal cord injury between c3 and t6 * classified with ais a or b spinal cord injury * stable medical, physical and psychological condition as considered by investigators * greater than 1 year since initial injury and at least 6 months from any required spinal instrumentation * confirmed orthostatic hypotension and autonomic dysreflexia * willing to attend all scheduled appointments exclusion criteria: * patients in an emergency situation * diseases and conditions that would increase the morbidity and mortality of spinal cord injury surgery * the inability to withhold antiplatelet/anticoagulation agents perioperatively * history of myocardial infarction or cerebrovascular event * other conditions that would make the subject unable to participate in testing in the judgment of the investigators * current and anticipated need for opioid pain medications or pain that would prevent full participation in the rehabilitation program in the judgement of the investigators * clinically significant mental illness in the judgment of the investigators * botulinum toxin injections in the previous 6 months * presence of significant pressure ulcers * recurrent urinary tract infection refractory to antibiotics * current pregnancy * current breastfeeding * known or suspected drug or alcohol abuse * unhealed spinal fractures * presence of indwelling baclofen or insulin pump

Keywords: sci spinal cord injury epidural spinal stimulation