One Small Step for Paralysis…

The ongoing struggle to develop new therapies to treat spinal cord injury and other forms of paralysis took a significant step forward this month. As we report in our article on page 1 of this issue, investigators at three U.S. institutions—Mayo Clinic, UCLA, and University of Louisville—published encouraging findings supporting the viability of epidural stimulation as a key therapeutic component for treating SCI.

The Mayo-UCLA team reported in Nature Medicine that a 26-year old subject with complete paralysis was able to produce bilateral independent stepping after 43 weeks of epidural stimulation teamed with training. The Louisville team, writing in JAMA Neurology, reported significant improvements in autonomic function in four subjects with complete paralysis.

The two new studies represent good news for two commercial firms in the space, NeuroRecovery Technologies Inc., based on Reggie Edgerton’s research at UCLA, and GTX Medical, based on Gregoire Courtine’s research at EPFL in Switzerland. But the studies represent even better news for individuals with SCI, particularly those with complete injuries. Since the first reports of using epidural stimulation to treat SCI surfaced a few years ago, investigators in that field were met with a degree of skepticism by some of their colleagues in the neural engineering community and a mix of hope and caution in the SCI patient population. People living with paralysis have seen more than a few promises of “miracle” cures for paralysis over the years and some patient advocates sought to temper claims coming from early investigators in this field with a large dose of realism and fact-checking, lest users be once again wheeled down a primrose path.

But the new data—still relatively sparse—seems to lend support to Edgerton’s claims that the spinal cord is capable of much more plasticity and reorganization than originally thought. (Edgerton once referred to the spinal cord as the “Rodney Dangerfield of the CNS,” since so many neuroscientists showed more respect for brain phenomena like cortical plasticity.)

While the gains in autonomic function resulting from epidural stimulation are now widely accepted in the neural engineering community and welcomed in the SCI community, the report of independent stepping is revolutionary, almost of Neil Armstrong proportions. A video of the achievement shows the subject taking steps on his own, though trunk stability remains an issue. We continue to believe that a personalized therapy combining the best aspects of epidural stimulation/training, FES, and robotic exoskeletons could well be the cocktail that gets many people with SCI out of their wheelchairs and on their feet again.

James Cavuoto
Editor and Publisher