Restoration of Autonomic Cardiovascular Regulation in Spinal Cord Injury with Epidural Stimulation: A Case Series
Abstract
Cervical spinal cord injury can cause profound disruption to the nervous system, and impaired cardiovascular autonomic regulation adversely impacts cardiovascular function, which in turn increases morbidity and mortality [1]. Cardiovascular autonomic dysfunction significantly delays therapeutic interventions, limiting functional gains, and prolonging inpatient care, thereby diminishing independence and quality of life [2]. In chronic cases, cardiovascular dysregulation has been associated with cognitive deficits, poor general health, and chronic fatigue, and may contribute to significant adverse clinical outcomes, including syncope, stroke, seizure, or death [3]. Therapeutic interventions to mitigate the effects of cardiovascular autonomic dysregulation and increase quality of life should therefore be a high priority, but functional improvements are limited by damage to spinal sympathetic neurons. Few interventions have proven effective at improving cardiovascular function in chronic spinal cord injury, and individuals are encouraged to adapt to blood pressure instability—recovery is not possible [3]. However, we previously found that spinal cord epidural stimulation targeted for cardiovascular function (CV-scES) can alleviate chronic hypotension by immediately increasing and maintaining blood pressure. Moreover, active CV-scES during postural stress can mitigate orthostatic hypotension. After prolonged daily CV-scES to maintain blood pressure, individuals no longer needed…
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