Brain , May 2022

Stimulation of the cuneiform nucleus enables training and boosts recovery after spinal cord injury

Anna-Sophie Hofer, Myriam I Scheuber, Andrea M Sartori, Nicolas Good, Stephanie A Stalder, Nicole Hammer, Kai Fricke, Sina M Schalbetter, Anne K Engmann, Rebecca Z Weber, Ruslan Rust, Marc P Schneider, Natalie Russi, Giacomin Favre, Martin E Schwab

Severe spinal cord injuries result in permanent paraparesis in spite of the frequent sparing of small portions of white matter. Spared fiber tracts are often incapable of maintaining and modulating the activity of lower spinal motor centers. Effects of rehabilitative training thus remain limited. Here, we activated spared descending brainstem fibers by electrical deep brain stimulation of the cuneiform nucleus of the mesencephalic locomotor region, the main control center for locomotion in the brainstem, in adult female Lewis rats. We show that deep brain stimulation of the cuneiform nucleus enhances the weak remaining motor drive in highly paraparetic rats with severe, incomplete spinal cord injuries and enables high-intensity locomotor training. Stimulation of the cuneiform nucleus during rehabilitative aquatraining after subchronic (n = 8 stimulated vs. n = 7 unstimulated vs. n = 7 untrained rats) and chronic (n = 14 stimulated vs. n = 9 unstimulated vs. n = 9 untrained rats) spinal cord injury re-established substantial locomotion and improved long-term recovery of motor function. We additionally identified a safety window of stimulation parameters ensuring context-specific locomotor control in intact rats (n = 18) and illustrate the importance of timing of treatment initiation after spinal cord injury (n = 14). This study highlights stimulation of the cuneiform nucleus as a highly promising therapeutic strategy to enhance motor recovery after subchronic and chronic incomplete spinal cord injury with direct clinical applicability.


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