Grgoire Courtine and his colleagues developed an electrical stimulation treatment that restores voluntary leg mobility to people with paralysis following spinal cord injuries. This could be merely the first step towards transforming how we conceive these injuries.
In 2018, former athlete David MZee stood from his wheelchair, spoke into his smart watch, and started to walk with the support of a rollator. Several years before, he had suffered a spinal cord injury during a trampolining accident which left him paralysed from the waist down.
MZees convalescence came from decades of research, including 10 years of work on spinal cord dynamics by Professor Grgoire Courtine, a neuroscientist at the Swiss Federal Institute of Technology (EPFL) in Lausanne. Courtine who trained in mathematics and physics before transitioning to experimental medicine works on restoring function to people with paralysis following spinal cord injuries.
Even as of now, theres still no treatment for spinal cord injuries, he explained. You can go through rehabilitation, which means a robotic exoskeleton moving your leg, and sometimes there is spontaneous recovery and you can move around a little bit. But in 50 per cent of cases people are completely paralysed.
Courtine and his colleagues focused on the few centimetres of spinal cord within the lumbar region. This section, which controls walking, is left intact after the majority of spinal cord injuries. It had previously been shown that this could be reactivated with electrical stimulation; this was the starting point for the scientists.
At the beginning, we used a very simple approach; we stimulate the spinal cord, Courtine said. And through time we really understood what the structures are in the spinal cord which are recruited with the stimulation, meaning we gain a scientific understanding of the principles activated by the electrical stimulation in the spinal cord.
Rather than simply delivering a constant current, the researchers experimented with patterns of stimulation. They learned where and when to provide stimulation to enable locomotion, developing a pattern of stimulation to activate the relevant groups of leg muscles at the correct times in the step cycle. In 2012, Courtine and his colleagues administered this stimulation along with some pharmaceutical agents to paralysed rats, which were able to walk again.
This set in motion the long nightmare of moving from rats to humans.
According to Courtine, they encountered every possible challenge imaginable. In addition to the obvious engineering challenge, they wrangled with ethical committees, funding applications, recruitment, and finding a large dedicated space at Lausanne University Hospital. Courtine had always been aware that this was not a purely academic effort, and had started collaborating with neurosurgeon Jocelyn Bloch at an early stage to ensure that the treatment would work in patients. The two founded a start-up, GTX Medical (now Onward) in 2014 to develop the technology and manage the administrative side of the project.
In a crucial stepping stone between rats and humans, Courtine had to demonstrate that the treatment would work in non-human primates: The way we stimulate the human spinal cord is different to rats, its based on what we observed in monkeys, so this was a critical step to the translation to humans, he said.
This introduced many of the challenges they would encounter in human trials: a more complex central nervous system, high ethical standards, and intelligent subjects who could not be conveniently restrained, controlled, and euthanised as rats can. This was also the point at which Bloch surgically implanted the system (previously wired), meaning that it had to be medical-grade.
After a successful non-human primate trial, in 2018 they implanted the flexible electrodes in three human patients and applied the stimulation pattern.
The treatment not only allowed the unprecedented restoration of mobility in itself a scientific marvel but this activity also triggered the natural regeneration of nerve fibres. Nerves grew spontaneously, bypassing damaged tissue to carry electrical signals between the brain and spinal cord. This allowed the patients to regain control over previously paralysed muscles, even when the stimulation was switched off.
This was a surprise, Courtine said. You are able to stimulate the spinal cord in the way you reactivate this dormant site, which enables the immediate production of movement. It means you can train and generate activity.
That is a process where local activity depends on plasticity, meaning that when the system is active it triggers the growth of new connections: the reorganisation of neuronal pathways in a way that after this long period training with stimulation enables this very activity. You have the growth of new connections that enable the recovery of some function without stimulation.
After five months of training and physical therapy, all three patients were able to voluntarily control their leg muscles and walk for as long as an hour without muscle exhaustion, even leaving the laboratory and walking outdoors.Ten patients have now recovered voluntary leg mobility through this approach.
Since then, Courtine and Onward have been working towards commercialising their approach such that it can reach thousands of people. They improved the technology, replacing their previous electron array with a version better suited to facilitating movement and refining the stimulator. They realise that this technology needs to be convenient to use; they envision the user simply saying stim[ulation] on or stim[ulation] off to their smart watch to begin training.
Meanwhile, they are setting up clinical trials to try this treatment in people with fresh spinal cord injuries, as data from rats and non-human primates suggest there is a window of opportunity (with greater plasticity) following the injury. They hope to begin the two-year trial in 2022.
Courtine and his colleagues are also experimenting with applying electrical stimulation to other types of paralysis. As the recipient of the 2020 IET A F Harvey Prize, Courtine will have 350,000 to help broaden the scope of his research: The idea is to accelerate this understanding and technology to move this to a different location to target new function, in this case upper limb movement.
Over the next decade, Courtine hopes that Onward will be able to provide a range of treatments to improve the lives of people with spinal cord injuries in every way that matters to them. This transcends limb movement to include things like sexual function and bowel and bladder control. Asked whether he hopes to change how we conceive of spinal cord injuries as a life sentence of restricted function, Courtine chuckles.
Maybe thats a big statement, he said. But we are at least working towards that as a dream objective of our lives. Hopefully [that will happen] before I am constrained to retire.
Grgoire Courtine will present his work in a lecture hosted by the IET in London in spring 2021, broadcast live and followed by a Q&A session.
Sign up to the E&T News e-mail to get great stories like this delivered to your inbox every day.
More:
The neuroscientist changing the meaning of spinal cord injury - E&T Magazine
- Hungarian Spinal Cord Injury Patient - Stem Cell Treatment Experience - May 7th, 2011 [May 7th, 2011]
- Stem cell treatment for Spinal Cord Injury (SCI)-Osama - May 8th, 2011 [May 8th, 2011]
- Spinal Cord Injury Patient after Stem Cell Treatment - Juan Carlos Murillo - May 10th, 2011 [May 10th, 2011]
- Spinal Cord Injury patient 10 years after injury after Stem Cell Treatment - May 10th, 2011 [May 10th, 2011]
- Rap Toward a Cure for Spinal Cord Injury - May 11th, 2011 [May 11th, 2011]
- Christopher "Kit" Bond - Spinal Cord Injury Stem Cell Patient - May 20th, 2011 [May 20th, 2011]
- Stem Cell Treatment - Spinal Cord Injury (2) - May 21st, 2011 [May 21st, 2011]
- Spinal Cord Injury-After Treatment, Pt was completely paralyzed (2) - May 22nd, 2011 [May 22nd, 2011]
- Spinal Cord Injury-After Treatment, Pt was completely paralyzed (1) - May 23rd, 2011 [May 23rd, 2011]
- Dogs recover following new treatment for spinal cord injury - June 2nd, 2011 [June 2nd, 2011]
- Spinal Cord Injury Rehabiliation Success Story - June 3rd, 2011 [June 3rd, 2011]
- Stem Cells for Spinal Cord Injury: Community Outreach San Diego 2011 - Trish Stressman - June 7th, 2011 [June 7th, 2011]
- Stroke Client Gains Strength and Mobility in North Palm Beach Florida - June 9th, 2011 [June 9th, 2011]
- Spinal Cord Injury Chicago Rehabilitation Lokomat - June 10th, 2011 [June 10th, 2011]
- Spinal Cord Injury Treatment With Stem Cells - June 11th, 2011 [June 11th, 2011]
- Spinal Cord Injury Patient after Stem Cell Treatment - Wesley Hixen - June 12th, 2011 [June 12th, 2011]
- Stem Cell Therapy for Spinal Cord Injury - Injured Airline Pilot Flies Again - June 13th, 2011 [June 13th, 2011]
- David Chen: How would stem-cell therapies work in the treatment of spinal cord injuries? - June 17th, 2011 [June 17th, 2011]
- William Rader MD - Paralyzed Spinal Cord Injury Patient Walks Again - June 29th, 2011 [June 29th, 2011]
- The Spinal Cord Injury Treatment Team - July 4th, 2011 [July 4th, 2011]
- Introduction to the Bioness H200 Hand Rehabilitation System - July 14th, 2011 [July 14th, 2011]
- Organ repair using own stem cells -- brain, heart - Future Health keynote speaker - July 15th, 2011 [July 15th, 2011]
- 2011 Shriners Ride for Kids, Salt Lake City Utah. - July 17th, 2011 [July 17th, 2011]
- Degenerative Disc Disease: C5-C6 c6-C7 Treatment - July 18th, 2011 [July 18th, 2011]
- Rehabilitation Institute of Michigan's 60 Anniversary TV Commercial - July 18th, 2011 [July 18th, 2011]
- California Spinal Cord Injury Attorney: Obtaining damages for lifetime care. - July 19th, 2011 [July 19th, 2011]
- Physical and Mental Adjustments After a Spinal Cord Injury - July 19th, 2011 [July 19th, 2011]
- Comprehensive Inpatient Rehabilitation - July 28th, 2011 [July 28th, 2011]
- SCI Treatment Center at the Claremont Club - July 30th, 2011 [July 30th, 2011]
- Spinal Cord Inury Patient at XCell-Center- M. Hasan - August 5th, 2011 [August 5th, 2011]
- Spinal Cord Inury Patient at XCell-Center- K. Potts - August 6th, 2011 [August 6th, 2011]
- Magee Rehabilitation Hospital Foundation and Toyota 100 Cars for Good - August 13th, 2011 [August 13th, 2011]
- SCI_Celine_French_ifting_her_arms.wmv - September 1st, 2011 [September 1st, 2011]
- New Treatment May Help Paralyzed Patients Move Again By Dr.Zaghloul ahmed - September 1st, 2011 [September 1st, 2011]
- Claire Marsh - Spinal Cord Injury Part One - September 6th, 2011 [September 6th, 2011]
- Coping with spinal cord and traumatic brain injuries - September 10th, 2011 [September 10th, 2011]
- Stem Cell Treatment - Spinal Cord Injury (3) - September 15th, 2011 [September 15th, 2011]
- Stem Cell Treatment - Spinal Cord Injury (1) - September 20th, 2011 [September 20th, 2011]
- Stem cell treatment by Adiva Health Care India after Spinal Cord Injury - September 22nd, 2011 [September 22nd, 2011]
- Spinal Cord Injury Documentary: You Will Never Walk Again, Part 1 - September 24th, 2011 [September 24th, 2011]
- Claire Marsh Returns - Spinal Cord Injury Patient - September 25th, 2011 [September 25th, 2011]
- Spinal Cord Injury: Raising awareness about research and treatment for spinal cord injury - September 26th, 2011 [September 26th, 2011]
- Walking after Spinal Cord injury and Stem Cells - September 27th, 2011 [September 27th, 2011]
- New Treatments for Spinal Cord Injuries - October 10th, 2011 [October 10th, 2011]
- Claire Marsh - Spinal Cord Injury Part Two - Video - October 18th, 2011 [October 18th, 2011]
- Stem Cell Treatment for Spinal Cord Injury - Video - November 2nd, 2011 [November 2nd, 2011]
- Stem Cells - Treatment for Spinal Cord Injury - Video - November 2nd, 2011 [November 2nd, 2011]
- (Film Trailer) - The Spinal Cord Journey: Stem Cell Therapy Stories of Recovery - Video - November 27th, 2011 [November 27th, 2011]
- Stem Cell Treatment for T-6 Spinal Cord Injury - Video - December 7th, 2011 [December 7th, 2011]
- What is Project Walk Atlanta - Video - December 13th, 2011 [December 13th, 2011]
- Stem Cells Treatment for Spinal Cord Injuries, Successfully Results, Stem Therapy - Video - December 28th, 2011 [December 28th, 2011]
- Stem Cell Therapy for Spinal Cord Injury, India Mumbai - Video - January 6th, 2012 [January 6th, 2012]
- "April Crave", "Project Walk Spinal Cord Injury Recovery" - Video - January 10th, 2012 [January 10th, 2012]
- "Lori Hammond", "Project Walk Spinal Cord Injury Recovery" - Video - January 23rd, 2012 [January 23rd, 2012]
- "Chad C.""spinal cord Injury treatment" "spinal cord injury" "spinal cord injury recovery" - Video - January 23rd, 2012 [January 23rd, 2012]
- "Hugo Rodovalho", "Client Spotlight Project Walk Spinal Cord Injury Recovery" - Video - January 27th, 2012 [January 27th, 2012]
- "Cecilia V.", "Project Walk Spinal Cord Injury Recovery" - Video - January 27th, 2012 [January 27th, 2012]
- "Roy R.", "Project Walk Spinal Cord Injury Recovery" - Video - January 27th, 2012 [January 27th, 2012]
- "Angela", "Project Walk Spinal Cord Injury Recovery" - Video - January 27th, 2012 [January 27th, 2012]
- "Joey's Story", "Project Walk Spinal Cord Injury Recovery" - Video - January 27th, 2012 [January 27th, 2012]
- "Spinal Cord Injury", "A Story Of One" - Video - January 27th, 2012 [January 27th, 2012]
- Spinal Cord Injuries - The Healing Center Project! - Video - January 28th, 2012 [January 28th, 2012]
- "Crystal H.", "Project Walk Spinal Cord Injury Recovery" - Video - February 3rd, 2012 [February 3rd, 2012]
- "Dave D.", "Project Walk Spinal Cord Injury Recovery" - Video - February 5th, 2012 [February 5th, 2012]
- "Brook", "Project Walk Spinal Cord Injury Recovery" - Video - February 5th, 2012 [February 5th, 2012]
- "Ashley Vargas", "Project Walk Spinal Cord Injury Recovery" - Video - February 6th, 2012 [February 6th, 2012]
- "Nathan Bayer", "Project Walk Spinal Cord Injury Recovery" - Video - February 8th, 2012 [February 8th, 2012]
- "Annette Ross", "Project Walk Spinal Cord Injury Recovery" - Video - February 8th, 2012 [February 8th, 2012]
- "Joe Guintu", "Project Walk Spinal Cord Injury Recovery" - Video - February 8th, 2012 [February 8th, 2012]
- "Trevor Comeau,"Project Walk Spinal Cord Injury Recovery" - Video - February 9th, 2012 [February 9th, 2012]
- "Kyle Eade, "Project Walk Spinal Cord Injury Recovery" - Video - February 11th, 2012 [February 11th, 2012]
- Velomedix Receives IDE Approval to Evaluate the Use of Rapid Therapeutic Hypothermia in the Management of AMI Patients - February 14th, 2012 [February 14th, 2012]
- Neuralstem Announces Closing of $5.2-Million Registered Direct Offering - February 14th, 2012 [February 14th, 2012]
- Chamber May Open Window for Treating Spine - February 15th, 2012 [February 15th, 2012]
- InVivo Therapeutics’ CEO Frank Reynolds Scheduled to Appear on Fox News First and San Antonio Living - February 17th, 2012 [February 17th, 2012]
- High doses of 'load' slows loss of bone in spinal cord injury - February 17th, 2012 [February 17th, 2012]
- InVivo Therapeutics Announces Pricing of Public Offering of Common Stock - February 17th, 2012 [February 17th, 2012]
- High Doses of Load Slows Bone Loss in Spinal Cord Injury - February 21st, 2012 [February 21st, 2012]
- InVivo Therapeutics Announces Full Exercise of Over-Allotment Option - February 22nd, 2012 [February 22nd, 2012]
- InVivo Therapeutics Announces Net $18.1M In Offering - February 22nd, 2012 [February 22nd, 2012]