Pioneering epidural treatment offers hope for paraplegic patients

A paraplegic man who was completely paralysed below the chest in a car accident is now able to stand independently, to walk with assistance and move his legs voluntarily, thanks to pioneering epidural treatment.

Rob Summers, 25, who sustained the injuries in 2006, has also regained some sexual and bladder function following the treatment – which was made possible, in part, by funding from the Christopher and Dana Reeve Foundation, named after and supported by the late Superman actor and his wife. Doctors are cautioning that much more work needs to take place before the treatment becomes standard practice, but nevertheless they are hailing it as a remarkable breakthrough. The treatment involved continual direct electrical stimulation of Mr Summers’ lower spinal cord, mimicking signals that the brain normally transmits to make us move. Once the signal is received, the spinal cord’s own neural network – combined with sensory input from the legs to the spinal cord – is able to direct the muscle and joint movements needed to stand, and to step with assistance on a treadmill. The treatment also involved retraining the spinal cord neural networks to produce the muscle movements needed to stand and take supported steps. The training process took more than two years to complete, after which the electrostimulation device was surgically implanted in the patient’s back. Before the device was implanted, Mr Summers had no voluntary control – but now, as well as standing and taking assisted steps, he can move his hips, knees, ankles and toes.

A set of five downloadable videos provided by The Lancet show various stages of Mr Summers' treatment: * Standing with bodyweight support and epidural stimulation (4–8V, 15Hz). Bodyweight support was reduced to 5 per cent without the need of manual facilitation. * Sit to stand with caudal stimulation (7·5V, 15Hz). * Full weight-bearing standing with epidural stimulation (9V, 25Hz) without manual facilitation. * Voluntary movements (leg, ankle and toe) with epidural stimulation (4V, 30Hz) in the supine position. * Attempts of voluntary movements (leg, ankle and toe) without epidural stimulation in the supine position.

The case is described today in The Lancet by Professor Susan Harkema of the Kentucky Spinal Cord Research Center at the University of Louisville, and Professor Reggie Edgerton of the Department of Integrative Biology and Comparative Physiology, University of California, Los Angeles. “This is a breakthrough,” said Professor Harkema. “It opens up a huge opportunity to improve the daily functioning of these individuals … but we have a long road ahead.” Professor Edgerton said: “The spinal cord is smart. The neural networks in the lumbosacral spinal cord are capable of initiating full weight bearing and relatively coordinated stepping without any input from the brain. This is possible, in part, due to information that is sent back from the legs directly to the spinal cord.” He added that sensory feedback from the feet and legs to the spinal cord facilitated the individual’s potential to balance and step over a range of speeds, directions and level of weight bearing. “The spinal cord can independently interpret these data and send movement instructions back to the legs – all without cortical involvement.” The authors caution that although the patient was completely paralysed below the chest, he did retain some feeling below the level of the injury. It is not known how the intervention would work with patients who have no feeling below the injury. There is also an issue with the stimulation equipment itself, as – to date – the researchers have only had access to standard off-the-shelf stimulation units designed for pain relief. Further work needs to be done on drug therapy to work alongside the stimulation and training, they added. As for Mr Summers, who was injured when a car mounted the pavement and hit him, he is delighted at the success of the treatment so far – and is optimistic that it might lead to even better things. “This procedure has completely changed my life," he said. "For someone who for four years was unable to even move a toe, to have the freedom and ability to stand on my own is the most amazing feeling. To be able to pick up my foot and step down again was unbelievable, but beyond all of that, my sense of wellbeing has changed. My physique and muscle tone has improved greatly, so much that most people don’t even believe I am paralysed. “I believe that epidural stimulation will get me out of this chair.” The research was funded by the US National Institutes of Health and the Christopher and Dana Reeve Foundation. Previously called the American Paralysis Association, the organisation was formed by individuals who refused to accept that spinal cord injuries could not be repaired. Christopher Reeve, who was paralysed in a riding accident, started working with the organisation following his injury in 1995. He died in 2004, aged 52.

Want to discuss other issues? Join the debate on our new Scottish Voices forum

Related posts:

1. Drug that could reverse Alzheimer’s to be tested on patients
2. Patients to get guaranteed waiting times
3. Patients prefer pills to chocolate to treat high blood pressure