Dr. Andrei Krassioukov

He turns out to be a burly able-bodied guy with a distinct Russian accent. His talk is called

Spinal Cord Neuromodulation for Restoration of Autonomic Cardiovascular Function in Individuals with Spinal Cord Injury

How’s that for a mouthful? What he’s going to give us is an update from the ESTAND trial — for those who don’t know, that’s the epistim work they’re doing in Minnesota that involves implanting stimulators into patients and then sending them home without even a nod at rehab. It’s a completely different way of investigating the potential of the stimulators.

Today I’m going to talk about restoration of autonomic function — like sexual function, breathing, and so on.

(He has some slides, which I’m not going to try to reproduce … )

There are two nervous systems: the sympathetic and the parasympathetic — I’ve studied these systems for 14 years. Disability can come in many different forms … what is the number one goal of people in chairs? What do they most want back?

(Ooooh, good quote on the screen: “It is autonomic functions that we take for granted when we have them and dominate our lives when we lost them.” Amen to that.)

The problem was that for many many years, scientists in their labs thought that walking was the goal.

He’s showing a slide at clinical trials.gov, where there are now 10 trials going on with epidural stimulation, and only 4 of them address autonomic dysfunction (as opposed to motor recovery).

There are also 11 trials looking at transcutaneous stimulation — and only one looking at autonomic return.

(Well, that seems backwards.)

Showing the EStand team …. the EStand trial is all about autonomic outcomes. People who get these stimulators don’t hang out and do rehab. They go home and live their lives as usual …

The study then measures changes in the cardiovascular system (meaning blood pressure, among other things). So in people with high injuries, as most of us know, getting dizzy is a big problem. If they get on a tilt table, they get dizzy when they’re moved upward a few degrees. This is true even for paralympic athletes.

EStand is also looking at brain blood supply in able-bodied people …. turns out — not surprisingly — that SCI that comes with deficits in cardiovascular funcion also can cause deficits in cognitive function.

Great. Also, not news. It’s why a lot of people feel sleepy and fuzzy-headed if they don’t get enough oxygen . If epidural stimulation can mitigate this, it would be huge.

So, what do they do? Place the epidural electrode at T1-L2, a set of 16 electrodes. Depending on which electrodes they fire up, they can get different muscles active. Showing a video of a guy with an ASIA A injury, voluntarily moving his legs. So, what about blood pressure?

Patients can be tilted way up, and with the stim on, they don’t get dizzy. The blood flows.

What about urinary tract function? Their patients in the ESTAND trial report much less leaking and better function …

Bowel? One patient how had a 60 minute program saw it reduced to 25 minutes.

Sexual function? We now know from our patients that there’s reason to be hopeful … one patient was able to reach orgasm for the first time, 5 years after injury.

All I can say is, halleluiah!

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