Nine paralyzed patients walk again thanks to the stimulation of neurons that restore locomotor capacity

• Paraplegia This is how Jered walked again five years after becoming a paraplegic

Nine people have

thanks to epidural electrostimulation.

The identification of 'locomotor' neurons that promote recovery after paralysis has helped patients with chronic spinal cord injury regain the ability to walk.

This important advance has been presented today in an article in Nature today, and is a step towards improving knowledge of how mobility can be recovered in those who have lost it for different reasons.

The work is a door to hope for many patients who have seen their situation diminished by the paralysis they suffer in the lower body.

In the publication, Grégoire Courtine's team has found that

in people with paralysis, although the underlying mechanism of this treatment is still not entirely clear.

In this sense, Juan de los Reyes Aguilar, researcher in charge of the Experimental Neurophysiology and Neural Circuits Group of the National Hospital for Paraplegics in Toledo, in statements collected by

, values ​​this advance: "The study has a high scientific quality. It demonstrates the positive effects that epidural electrostimulation therapy has on patients with spinal cord injury. It also resorts to the use of animal models to reveal the cellular and physiological mechanism by which the expected effect is achieved".

Courtine has investigated

that become necessary for patients to walk after paralysis.

To this end, nine people with severe or complete paralysis caused by spinal cord injury were enrolled in a clinical trial and received epidural electrical stimulation (ESS) treatment.

Two patients walking with the aid of a walker.JIMMY RAVIERNEURORESTORE

All volunteers immediately recovered or improved their ability to walk during treatment and

and rehabilitation using this electrostimulation technique.

De los Reyes Aguilar reviews the most interesting points of this work: "In the article,

but also, for example, the individual evolution of each patient treated, from their previous state to the therapy until the final result obtained. This offers a real vision of the effectiveness of the therapy in the best cases and the possibility that in others (the least) it does not provide benefits".

In this sense, the head of the Experimental Neurophysiology and Neural Circuits Group at the National Hospital for Paraplegics also explains that the researchers show that in people with incomplete spinal cord injury (who preserve some connections between the spinal cord and the brain)

.

"In these patients, it is important to highlight that the continuous application of the therapy for five months manages to recover the voluntary action of walking without the need to apply stimulation during the execution of the march (in four of six patients).

."

In this work, which emphasizes Science at the service of clinical needs, De los Reyes Aguilar also highlights the fact that people with complete spinal cord injury only managed to recover their gait during the application of stimulation therapy.

"The difference between patients who recover function autonomously and those who can only walk when receiving epidural stimulation indicates the

. Also the need to implement or combine other therapies that optimize outcomes in people with complete spinal cord injury."

How and why has epidural electrostimulation worked?

To explore the mechanism underlying this improvement, the authors

in humans.

Furthermore, they established a single-cell map of gene expression in various neurons of the mouse spinal cord.

Combining the model and the molecular map, the authors identified a specific type of excitatory neuron that plays an important role in restoration of gait after spinal cord injury, but is not required for walking in people without spinal cord injury. spinal cord.

Here, the head of the Experimental Neurophysiology and Neural Circuits Group at the National Hospital for Paraplegics puts on the table that "it must be taken into account that, in humans, experiments to identify neuronal types cannot be carried out. Therefore, the authors resort to to a model of spinal cord injury similar to that suffered by people, but applied to mice.

and for the manipulation of neuronal activity using genetic techniques".

And he continues with the explanation about the need to replicate the experiment in murine models to collect more information about the process: "The authors use

to characterize the molecular and spatial profile of the RNA expression of all the cell types that make up the spinal cord under normal conditions and after spinal cord damage. An artificial intelligence computer procedure, developed by the authors and called "

", which makes it possible to identify whether a cell type responds with greater RNA production to a stimulus that alters cell physiology. The combination of both approaches, molecular biology and bioinformatics, makes it possible to identify the region of intermediate laminae in the spinal cord as the location of neurons of interest,

the identification of the neuronal type that responds to therapy, the activity of these neurons can be manipulated by using optogenetic and pharmacogenetic techniques, which allow selectively activate or deactivate the target cells during the application of therapy and without application of therapy, all this confirms that

in response to the application of epidural electrostimulation in animal models and in humans".

These results bring us one step closer to understanding the mechanisms of rehabilitation using epidural electrical stimulation.

However, the authors point to the existence that other neurons in the brain and spinal cord contribute to gait recovery and therefore further study is needed.

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