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Article

Posteroanterior Cervical Transcutaneous Spinal Cord Stimulation: Interactions with Cortical and Peripheral Nerve Stimulation

by
Jaclyn R. Wecht
1,†,
William M. Savage
1,†,
Grace O. Famodimu
1,
Gregory A. Mendez
1,
Jonah M. Levine
1,
Matthew T. Maher
1,
Joseph P. Weir
2,
Jill M. Wecht
1,3,
Jason B. Carmel
4,
Yu-Kuang Wu
1,3 and
Noam Y. Harel
1,3,5,*
1
James J. Peters VA Medical Center, Bronx, NY 10468, USA
2
Department of Health, Sport & Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA
3
Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
4
Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA
5
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
*
Author to whom correspondence should be addressed.
†
Contributed equally.
J. Clin. Med. 2021, 10(22), 5304; https://doi.org/10.3390/jcm10225304
Submission received: 4 October 2021 / Revised: 6 November 2021 / Accepted: 9 November 2021 / Published: 15 November 2021
(This article belongs to the Special Issue Spinal Cord Injury and Transcutaneous Spinal Cord Stimulation)
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Abstract

Transcutaneous spinal cord stimulation (TSCS) has demonstrated potential to beneficially modulate spinal cord motor and autonomic circuitry. We are interested in pairing cervical TSCS with other forms of nervous system stimulation to enhance synaptic plasticity in circuits serving hand function. We use a novel configuration for cervical TSCS in which the anode is placed anteriorly over ~C4–C5 and the cathode posteriorly over ~T2–T4. We measured the effects of single pulses of TSCS paired with single pulses of motor cortex or median nerve stimulation timed to arrive at the cervical spinal cord at varying intervals. In 13 participants with and 15 participants without chronic cervical spinal cord injury, we observed that subthreshold TSCS facilitates hand muscle responses to motor cortex stimulation, with a tendency toward greater facilitation when TSCS is timed to arrive at cervical synapses simultaneously or up to 10 milliseconds after cortical stimulus arrival. Single pulses of subthreshold TSCS had no effect on the amplitudes of median H-reflex responses or F-wave responses. These findings support a model in which TSCS paired with appropriately timed cortical stimulation has the potential to facilitate convergent transmission between descending motor circuits, segmental afferents, and spinal motor neurons serving the hand. Studies with larger numbers of participants and repetitively paired cortical and spinal stimulation are needed.
Keywords: spinal cord stimulation; cervical spinal cord injury; motor evoked potentials spinal cord stimulation; cervical spinal cord injury; motor evoked potentials

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MDPI and ACS Style

Wecht, J.R.; Savage, W.M.; Famodimu, G.O.; Mendez, G.A.; Levine, J.M.; Maher, M.T.; Weir, J.P.; Wecht, J.M.; Carmel, J.B.; Wu, Y.-K.; et al. Posteroanterior Cervical Transcutaneous Spinal Cord Stimulation: Interactions with Cortical and Peripheral Nerve Stimulation. J. Clin. Med. 2021, 10, 5304. https://doi.org/10.3390/jcm10225304

AMA Style

Wecht JR, Savage WM, Famodimu GO, Mendez GA, Levine JM, Maher MT, Weir JP, Wecht JM, Carmel JB, Wu Y-K, et al. Posteroanterior Cervical Transcutaneous Spinal Cord Stimulation: Interactions with Cortical and Peripheral Nerve Stimulation. Journal of Clinical Medicine. 2021; 10(22):5304. https://doi.org/10.3390/jcm10225304

Chicago/Turabian Style

Wecht, Jaclyn R., William M. Savage, Grace O. Famodimu, Gregory A. Mendez, Jonah M. Levine, Matthew T. Maher, Joseph P. Weir, Jill M. Wecht, Jason B. Carmel, Yu-Kuang Wu, and et al. 2021. "Posteroanterior Cervical Transcutaneous Spinal Cord Stimulation: Interactions with Cortical and Peripheral Nerve Stimulation" Journal of Clinical Medicine 10, no. 22: 5304. https://doi.org/10.3390/jcm10225304

APA Style

Wecht, J. R., Savage, W. M., Famodimu, G. O., Mendez, G. A., Levine, J. M., Maher, M. T., Weir, J. P., Wecht, J. M., Carmel, J. B., Wu, Y.-K., & Harel, N. Y. (2021). Posteroanterior Cervical Transcutaneous Spinal Cord Stimulation: Interactions with Cortical and Peripheral Nerve Stimulation. Journal of Clinical Medicine, 10(22), 5304. https://doi.org/10.3390/jcm10225304

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