Nature Medicine:奇迹!完全瘫痪者进行脊髓电刺激治疗,仅仅几小时就恢复了独立运动能力

2022-02-11 王聪 “生物世界”公众号

早在30年前,就有临床前和临床研究表明,在腰骶脊髓上进行硬膜外电刺激(ESS)可以恢复脊髓损伤患者的的行走能力。但这需要数名理疗师的协助,经过数月高强度训练才行,而且成功案例极其有限。

早在30年前,就有临床前和临床研究表明,在腰骶脊髓上进行硬膜外电刺激(ESS)可以恢复脊髓损伤患者的的行走能力。但这需要数名理疗师的协助,经过数月高强度训练才行,而且成功案例极其有限。如果将这些复杂的、罕见的案例转化为一种可普遍应用的治疗方法,是一个巨大的挑战。

2018年,瑞士洛桑联邦理工学院 Grégoire Courtine 博士和洛桑大学医院神经外科医生 Jocelyne Bloch 开发了一种靶向神经技术,使用电刺激重新激活脊髓神经元,让三名慢性截瘫患者重新获得了行走的能力,该研究以封面论文形式发表于 Nature 期刊

2022年2月8日,Grégoire Courtine 和 Jocelyne Bloch 在国际顶尖医学期刊 Nature Medicine 发表了题为:Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis 的研究论文。

这一次,他们开发了由人工智能软件控制的个性化脊髓电刺激电极,在植入后通过电刺激激活躯干和腿部肌肉的脊髓区域,三名完全瘫痪的脊髓损伤患者,在接受治疗后几小时,就恢复了独立运动能力,能够站立、行走、骑自行车、游泳和控制躯干运动。

脊髓电刺激是恢复脊髓损伤患者运动功能的一种很有前景的治疗选择。迄今为止,刺激方法通过使用最初设计用于治疗疼痛的重新用途的神经技术,为患者的脊髓提供了持续的电刺激。然而,这些重新使用的电刺激装置无法刺激脊髓中与腿部和躯干运动相关的所有神经,这可能会限制所有运动功能的恢复。

这一次,研究团队设计了一种新的电极,能靶向与脊髓中腿部和躯干运动相关的所有神经。通过使用更长、更宽的植入导线,其电极排列方式与脊神经根完全一致,从而能精确控制调节特定肌肉的神经元。

这项研究是一项临床试验(NCT02936453)的一部分,三名患者均为脊髓损伤导致的完全瘫痪,完全感觉运动麻痹,他们的年龄在29-41岁之间。

研究团队将该技术与人工智能(AI)相结合,为每种类型的活动编写对应的电刺激程序,患者可以在平板电脑上选择所需的活动,然后程序启动位于腹部的起搏器,刺激特定的肌肉神经元,帮助完成活动。

这三名完全瘫痪的患者,在接受治疗后仅仅几个小时,就能够实现独立自主的站立、行走、骑车、游泳和控制躯干运动

这种脊髓电刺激带来的神经恢复促进了足够的改善,让这些原本完全瘫痪的脊髓损伤患者能够恢复日常活动,这为严重脊髓损伤患者开辟了具体了临床意义的疗法,为帮助他们的康复开辟了一个现实的道路。

这项临床试验由洛桑联邦理工学院 、洛桑大学医院和 Onward Medical 公司合作进行,该公司于2014年成立,致力于开发用于恢复脊髓损伤患者运动、独立和健康的疗法。该公司目前已有三款治疗设备被FDA授予突破性设备称号,并在美国、加拿大、欧洲等地进行临床试验。这篇 Nature Medicine 论文的两位通讯作者 Grégoire Courtine 和 Jocelyne Bloch 是公司的联合创始人。该公司于2021年10月在荷兰阿姆斯特丹泛欧交易所上市。

Grégoire Courtine(右)和 Jocelyne Bloch(左)

原始出处:

Rowald, A., Komi, S., Demesmaeker, R. et al. Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis. Nat Med (2022). https://doi.org/10.1038/s41591-021-01663-5.

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    2022-04-08 jeanqiuqiu
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    2022-09-16 liye789132251
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GetPortalCommentsPageByObjectIdResponse(id=1500010, encodeId=f08b150001072, content=<a href='/topic/show?id=a40c9421969' target=_blank style='color:#2F92EE;'>#运动能力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94219, encryptionId=a40c9421969, topicName=运动能力)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=058e9400974, createdName=xzw116, createdTime=Sat Feb 12 13:10:40 CST 2022, time=2022-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1577874, encodeId=926f15e787402, content=<a href='/topic/show?id=cda91148004' target=_blank style='color:#2F92EE;'>#Medicine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11480, encryptionId=cda91148004, topicName=Medicine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54cd16396700, createdName=ms1692212821629096, createdTime=Sat Feb 12 13:10:40 CST 2022, time=2022-02-12, status=1, ipAttribution=)]
    2022-10-11 lifestar

    完全#瘫痪#者进行#脊髓电刺激#治疗,仅仅几小时就恢复了独立运动能力。未来在#脑瘫#治疗也是一样,还可以将脊髓电刺激与#人工智能##外骨骼#结合起来,真正实现完全正常化的人。

    0

  4. 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topicName=null, topicId=null, topicList=[TopicDto(id=70003, encryptionId=a054e00031c, topicName=电刺激)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqTLTjicBiccpdUyHMGZV43nOBI6QIQqxVcy2EzXz67E390Q5j0R7QWjym391HxsyiaYt7NzbrcojRDw/132, createdBy=64462500151, createdName=ms705947299214030, createdTime=Sat Feb 12 13:10:40 CST 2022, time=2022-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1443006, encodeId=6fbb1443006e3, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Sat Feb 12 13:10:40 CST 2022, time=2022-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500010, encodeId=f08b150001072, content=<a href='/topic/show?id=a40c9421969' target=_blank style='color:#2F92EE;'>#运动能力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94219, encryptionId=a40c9421969, topicName=运动能力)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=058e9400974, createdName=xzw116, createdTime=Sat Feb 12 13:10:40 CST 2022, time=2022-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1577874, encodeId=926f15e787402, content=<a href='/topic/show?id=cda91148004' target=_blank style='color:#2F92EE;'>#Medicine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11480, encryptionId=cda91148004, topicName=Medicine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54cd16396700, createdName=ms1692212821629096, createdTime=Sat Feb 12 13:10:40 CST 2022, time=2022-02-12, status=1, ipAttribution=)]
    2022-10-10 ms6000000011727137

    牛啊

    0

  5. 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createdBy=54cd16396700, createdName=ms1692212821629096, createdTime=Sat Feb 12 13:10:40 CST 2022, time=2022-02-12, status=1, ipAttribution=)]
    2022-04-23 kalseyzl
  6. 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    2022-02-13 ms1000002136354097

    脊髓刺激可使全瘫患者站立行走真是奇迹

    0

  7. 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  8. 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