chapter  11
34 Pages

Can Applied Voltages Be Used to Produce Spinal Cord Regeneration and Recovery in Humans?

Introduction ....................................................................................................... 234 To Regenerate or Not to Regenerate? ............................................................... 234 Anatomical Evidence for Voltage-Mediated Regeneration ............................... 236

Identišed Tracts, Axons, or Pathways .......................................................... 236 Marking the Plane of Transection ................................................................ 237

Anatomical Evidence for Voltage-Mediated Regeneration ............................... 239 The Bridge Experiment ................................................................................ 239

Behavioral Evidence for Voltage-Mediated Regeneration ................................ 242 Can We Effectively Study the Recovery of Walking in Experimental Animals? ...................................................................................................... 243 The Cutantous Trunci Muscle Re’ex ........................................................... 244 What Constitutes a CTM Recovery? ............................................................ 246 Applied Voltages Induce Regeneration and Behavioral Recovery in Laboratory Animals ...................................................................................... 246 Supportive Evidence from Neurons In Vitro ................................................ 247

Clinical Utility Relative to SCI ......................................................................... 248 An Applied DC Voltage as a Therapy for Human Spinal Cord Injury ......... 248 Unidirectional, Steady DC Voltages Have Little Clinical SignišcanceWhat Might Be The Remedy? ...................................................................... 249 A Jump to the Clinic: The Paraplegic Dog .................................................. 250

It is now clear that the use of an applied voltage gradient can signišcantly, and benešcially, alter the course of human spinal cord injury (SCI). This opinion is based on the results of the šrst published Food and Drug Administration (FDA)– sanctioned phase 1 human trials (Shapiro et al. 2005) and a new analysis of efšcacy provided by comparison to expectant levels of recovery and a published control group. These data come from recent guidelines establishing a framework for both planning human clinical trials in SCI and post hoc analysis (Fawcett et al. 2007; Lammertse et al. 2007). These issues will be discussed below. I will šrst discuss the basis for understanding how the mechanism of this therapy works. It is likely due to white matter regeneration in compromised spinal cords, even though one cannot test this directly in humans. Next I will only brie’y review the supportive in vitro data-covered extensively in Chapter 10. I will end on a new evaluation of the clinical data and what the future holds for this form of therapy.