Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord Injury

<b>Background/Objectives</b>: Spinal cord injury (SCI) presents significant challenges in restoring motor function, with limited therapeutic options available. Recent advancements in neuromodulation technologies, such as brain-spine interface (BSI), epidural electrical stimulation (EES),...

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Main Authors: Barnabas T. Shiferaw, Max Y. Jin, Milan Patel, Lukas J. Henjum, Alaa Abd-Elsayed
Format: Article
Language:English
Published: MDPI AG 2025-03-01
Series:Biomedicines
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Online Access:https://www.mdpi.com/2227-9059/13/3/631
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author Barnabas T. Shiferaw
Max Y. Jin
Milan Patel
Lukas J. Henjum
Alaa Abd-Elsayed
author_facet Barnabas T. Shiferaw
Max Y. Jin
Milan Patel
Lukas J. Henjum
Alaa Abd-Elsayed
author_sort Barnabas T. Shiferaw
collection DOAJ
description <b>Background/Objectives</b>: Spinal cord injury (SCI) presents significant challenges in restoring motor function, with limited therapeutic options available. Recent advancements in neuromodulation technologies, such as brain-spine interface (BSI), epidural electrical stimulation (EES), and deep brain stimulation (DBS), offer promising solutions. This review article explores the integration of these approaches, focusing on their potential to restore function in SCI patients. <b>Findings</b>: DBS has shown efficacy in SCI treatment with several stimulation sites identified, including the nucleus raphe magnus (NRM) and periaqueductal gray (PAG). However, transitioning from animal to human studies highlights challenges, including the technical risks of targeting the NRM in humans instead of rodent models. Additionally, several other regions have shown potential for motor rehabilitation, including the midbrain locomotor region (MLR) pathways, cuneiform nucleus (CnF), pedunculopontine nucleus (PPN), and lateral hypothalamic. DBS with EES further supports motor recovery in SCI; however, this approach requires high-DBS amplitude, serotonergic pharmacotherapy, and cortical activity decoding to attenuate stress-associated locomotion. BSI combined with EES has recently emerged as a promising novel therapy. Although human studies are limited, animal models have provided evidence supporting its potential. Despite these advancements, the effectiveness of DBS and combined systems remains limited in cases of complete central denervation. <b>Conclusions</b>: The integration and combination of DBS, BSI, and EES represent a transformational approach to treating and restoring function in patients with SCI. While further research is needed to optimize these strategies, these advancements hold immense potential for improving the quality of life in SCI patients and advancing the field of neuromodulation.
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spelling doaj-art-b6faec0285b541de83e2008abf00a8382025-08-20T03:43:11ZengMDPI AGBiomedicines2227-90592025-03-0113363110.3390/biomedicines13030631Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord InjuryBarnabas T. Shiferaw0Max Y. Jin1Milan Patel2Lukas J. Henjum3Alaa Abd-Elsayed4Department of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792, USADepartment of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792, USADepartment of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792, USADepartment of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792, USADepartment of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792, USA<b>Background/Objectives</b>: Spinal cord injury (SCI) presents significant challenges in restoring motor function, with limited therapeutic options available. Recent advancements in neuromodulation technologies, such as brain-spine interface (BSI), epidural electrical stimulation (EES), and deep brain stimulation (DBS), offer promising solutions. This review article explores the integration of these approaches, focusing on their potential to restore function in SCI patients. <b>Findings</b>: DBS has shown efficacy in SCI treatment with several stimulation sites identified, including the nucleus raphe magnus (NRM) and periaqueductal gray (PAG). However, transitioning from animal to human studies highlights challenges, including the technical risks of targeting the NRM in humans instead of rodent models. Additionally, several other regions have shown potential for motor rehabilitation, including the midbrain locomotor region (MLR) pathways, cuneiform nucleus (CnF), pedunculopontine nucleus (PPN), and lateral hypothalamic. DBS with EES further supports motor recovery in SCI; however, this approach requires high-DBS amplitude, serotonergic pharmacotherapy, and cortical activity decoding to attenuate stress-associated locomotion. BSI combined with EES has recently emerged as a promising novel therapy. Although human studies are limited, animal models have provided evidence supporting its potential. Despite these advancements, the effectiveness of DBS and combined systems remains limited in cases of complete central denervation. <b>Conclusions</b>: The integration and combination of DBS, BSI, and EES represent a transformational approach to treating and restoring function in patients with SCI. While further research is needed to optimize these strategies, these advancements hold immense potential for improving the quality of life in SCI patients and advancing the field of neuromodulation.https://www.mdpi.com/2227-9059/13/3/631spinal cord injury (SCI)neuromodulationdeep brain stimulation (DBS)brain–spine interface (BSI)epidural electrical stimulation (EES)neurorehabilitation
spellingShingle Barnabas T. Shiferaw
Max Y. Jin
Milan Patel
Lukas J. Henjum
Alaa Abd-Elsayed
Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord Injury
Biomedicines
spinal cord injury (SCI)
neuromodulation
deep brain stimulation (DBS)
brain–spine interface (BSI)
epidural electrical stimulation (EES)
neurorehabilitation
title Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord Injury
title_full Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord Injury
title_fullStr Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord Injury
title_full_unstemmed Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord Injury
title_short Deep Brain Stimulation and Brain–Spine Interface for Functional Restoration in Spinal Cord Injury
title_sort deep brain stimulation and brain spine interface for functional restoration in spinal cord injury
topic spinal cord injury (SCI)
neuromodulation
deep brain stimulation (DBS)
brain–spine interface (BSI)
epidural electrical stimulation (EES)
neurorehabilitation
url https://www.mdpi.com/2227-9059/13/3/631
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