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Spinal Cord. 2019 Jul 23. doi: 10.1038/s41393-019-0331-z. [Epub ahead of print]

Application of electrophysiological measures in spinal cord injury clinical trials: a narrative review.

Author information

1
Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. Michele.Hubli@balgrist.ch.
2
International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
3
School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.
4
Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
5
Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland.
6
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
7
University of Toronto, Toronto, ON, Canada.
8
Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
9
Departments of Neurosurgery and Neurobiology, University of Mississippi Medical Center, Jackson, MS, USA.
10
NeuroRobotics Lab, Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA.
11
Spinal Cord Injury Medicine and Research Services, Veterans Administration Medical Center, Jackson, MS, USA.

Abstract

STUDY DESIGN:

Narrative review.

OBJECTIVES:

To discuss how electrophysiology may contribute to future clinical trials in spinal cord injury (SCI) in terms of: (1) improvement of SCI diagnosis, patient stratification and determination of exclusion criteria; (2) the assessment of adverse events; and (3) detection of therapeutic effects following an intervention.

METHODS:

An international expert panel for electrophysiological measures in SCI searched and discussed the literature focused on the topic.

RESULTS:

Electrophysiology represents a valid method to detect, track, and quantify readouts of nerve functions including signal conduction, e.g., evoked potentials testing long spinal tracts, and neural processing, e.g., reflex testing. Furthermore, electrophysiological measures can predict functional outcomes and thereby guide rehabilitation programs and therapeutic interventions for clinical studies.

CONCLUSION:

Objective and quantitative measures of sensory, motor, and autonomic function based on electrophysiological techniques are promising tools to inform and improve future SCI trials. Complementing clinical outcome measures, electrophysiological recordings can improve the SCI diagnosis and patient stratification, as well as the detection of both beneficial and adverse events. Specifically composed electrophysiological measures can be used to characterize the topography and completeness of SCI and reveal neuronal integrity below the lesion, a prerequisite for the success of any interventional trial. Further validation of electrophysiological tools with regard to their validity, reliability, and sensitivity are needed in order to become routinely applied in clinical SCI trials.

PMID:
31337870
DOI:
10.1038/s41393-019-0331-z

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