Spinal Cord Stimulation for Spinal Cord Injury

(SCAP Trial)

Recruiting at 3 trial locations

Overseen By Chris E Mandigo, M.D.

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: Columbia University

Must not be taking: Amphetamines, Neuroleptics, Dalfampridine, Bupropion

Disqualifiers: Seizures, Stroke, Heart disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 6-8 weeks

92 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new technique called "Intraoperative pairing of cortical and spinal stimulation," which uses electrical stimulation to help people with spinal cord injuries regain arm and hand movement. The study aims to determine if this method can enhance signals between the spinal cord and muscles, improving movement and function. Individuals with a spinal cord injury who have difficulty moving their hands or are scheduled for cervical spine surgery might be suitable candidates for this study. As an Early Phase 1 trial, this research focuses on understanding how this new technique works in people, offering participants the opportunity to be among the first to receive this innovative treatment.

Will I have to stop taking my current medications?

The trial requires that your prescription medications remain stable for 30 days before screening, so you should not change your current medications during this time.

What prior data suggests that this technique is safe for spinal cord injury patients?

Research shows that the spinal cord associative plasticity (SCAP) technique, which stimulates both the brain and spinal cord, has shown promise in other studies. In past research, a non-invasive paired stimulation method was used on people with spinal cord injuries, and it rarely caused side effects, meaning most participants did not experience significant issues.

During surgery, this stimulation has been safely used in neck spine surgeries to better understand spinal cord functions. The equipment for this stimulation is designed to be safe for use during these operations.

Overall, these studies suggest that the treatment is generally well-tolerated. However, since this research remains in the early stages, information on long-term safety is limited. Participants should consider discussing potential risks and benefits with their healthcare provider. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these spinal cord stimulation techniques because they have the potential to enhance recovery for spinal cord injury patients in a new way. Unlike traditional treatments that might rely on physical therapy or medications, these methods use a combination of cortical and spinal stimulation to directly influence neural pathways. This approach could lead to more immediate and lasting improvements in motor function. Additionally, the trial includes both invasive and non-invasive methods, which could offer more flexible treatment options tailored to individual patient needs. By targeting the injury site more precisely, these techniques aim to stimulate nerve regeneration and functional recovery, offering hope for better outcomes than currently available treatments.

What evidence suggests that this trial's treatments could be effective for spinal cord injury?

Research has shown that a technique called spinal cord associative plasticity (SCAP) might improve arm and hand movement after a spinal cord injury. This trial will explore different SCAP methods, including non-invasive and intraoperative approaches. Studies have found that combining brain and spinal cord stimulation enhances hand muscle function more effectively than brain stimulation alone. This method strengthens the connection between the brain and spinal cord, aiding movement improvement. For individuals with spinal injuries, this could lead to better muscle control. Early evidence suggests that repeated stimulation increases spinal cord activity, allowing it to send signals to muscles more effectively. Although still under study, early results are promising for enhancing movement abilities. ^{1 2 5 6 7}

Who Is on the Research Team?

Jason B Carmel, MD, PhD

Principal Investigator

Columbia University

Are You a Good Fit for This Trial?

This trial is for adults aged 18-80 with spinal cord injuries or cervical myelopathy who may undergo surgery. Able-bodied participants without neurological diseases can join too. Participants must not use certain drugs, have a history of seizures, metal implants in the head (except dental), stimulators, or severe cardiovascular issues.

Inclusion Criteria

Must be able to abstain from alcohol, smoking and caffeine consumption on the day of each experiment

Must be able to abstain from recreational drugs for the entirety of the study

I am scheduled for surgery on my neck's spine.

Exclusion Criteria

I or my family have a history of seizures.

You have had major hearing issues in the past.

I have a serious heart condition.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo non-invasive and intraoperative paired cortical and spinal stimulation to study immediate and lasting effects of SCAP

6-8 weeks

Multiple visits for stimulation sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, including muscle response measurements

4 weeks

2 visits (in-person)

Extension

Optional continuation of SCAP treatment to assess long-term effects

Long-term

What Are the Treatments Tested in This Trial?

Interventions

• Intraoperative pairing of cortical and spinal stimulation
• Intraoperative repeated pairing of cortical and spinal stimulation (SCAP)
• Intraoperative repeated pairing of cortical and spinal stimulation (SCAP) at or below myelopathic region
• Non-invasive pairing of cortical and spinal stimulation
• Non-invasive repeated pairing of cortical and spinal stimulation (SCAP)

Trial Overview The study tests SCAP—a technique using electrical stimulation on the brain and spine to improve arm and hand function after spinal injury. It explores if this can strengthen muscle signaling and enhance movement production by the spinal cord before or during surgery.

How Is the Trial Designed?

Group I: 5. Intraoperative participants - Lasting effects of SCAP at or below myelopathic region Experimental Treatment 2 Interventions

Participants will take part in the following if they have been scheduled for a clinically indicated cervical surgery, to examine the lasting effects of repeated cortical and spinal stimulation: A) Non-invasive repeated pairing of cortical and spinal stimulation (SCAP); B) Intraoperative repeated pairing of cortical and spinal stimulation (SCAP) at or below myelopathic region.

Group II: 4. Chronic cervical SCI participants - Lasting effects of non-invasive SCAP Experimental Treatment 1 Intervention

Participants with chronic cervical SCI will take part in the following, to examine the lasting effects of repeated cortical and spinal stimulation: A) Non-invasive repeated pairing of cortical and spinal stimulation (SCAP).

Group III: 3. Intraoperative participants - Lasting effects of SCAP Experimental Treatment 2 Interventions

Participants will take part in the following if they have been scheduled for a clinically indicated cervical surgery, to examine the lasting effects of repeated cortical and spinal stimulation: A) Non-invasive repeated pairing of cortical and spinal stimulation (SCAP); B) Intraoperative repeated pairing of cortical and spinal stimulation (SCAP).

Group IV: 2. Intraoperative participants - Immediate effects of paired stimulation Experimental Treatment 2 Interventions

Participants will take part in the following if they have been scheduled for a clinically indicated cervical surgery to examine the immediate effects of combining cortical and spinal stimulation: A) Non-invasive pairing of cortical and spinal stimulation; B) Intraoperative pairing of cortical and spinal stimulation.

Group V: 1. Uninjured participants - Immediate and lasting effects of non-invasive paired stimulation Experimental Treatment 2 Interventions

Participants will take part in the following to examine the immediate effects of combining cortical and spinal stimulation: A) Non-invasive pairing of cortical and spinal stimulation; B) Non-invasive repeated pairing of cortical and spinal stimulation (SCAP).

Intraoperative pairing of cortical and spinal stimulation is already approved in United States for the following indications:

Approved in United States as Spinal Cord Associative Plasticity (SCAP) for:

• Spinal cord injury
• Amyotrophic lateral sclerosis (ALS)

Who Is Running the Clinical Trial?

Columbia University

Lead Sponsor

Trials

1,529

Recruited

2,832,000+

Bronx Veterans Medical Research Foundation, Inc

Collaborator

Trials

10

Recruited

750+

Weill Medical College of Cornell University

Collaborator

Trials

1,103

Recruited

1,157,000+

National Institute of Neurological Disorders and Stroke (NINDS)

Collaborator

Trials

1,403

Recruited

655,000+

Published Research Related to This Trial

The study compared different frequencies of paired associative stimulation (PAS) applied to the spinal cord, including 0.1 Hz, 1 Hz, and 5 Hz bursts, but none were effective in consistently inducing neuroplasticity.

High variability in responses among participants indicates that spinal PAS may not be universally effective, suggesting that its therapeutic potential could depend on individual differences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Failure of spinal paired associative stimulation to induce neuroplasticity in the human corticospinal tract. McGie, SC., Masani, K., Popovic, MR.[2021]

In a study of 19 patients undergoing spinal cord stimulation (SCS) lead placement under general anesthesia, 84.2% experienced adequate stimulation coverage and significant pain relief postoperatively, demonstrating the efficacy of this approach for patients unable to undergo awake procedures.

Using compound muscle action potentials (CMAPs) for lead placement guidance proved effective, as consistent results were achieved in 17 out of 19 procedures, indicating that this method can successfully compensate for the lack of patient feedback during surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electrophysiologic monitoring for placement of laminectomy leads for spinal cord stimulation under general anesthesia. Air, EL., Toczyl, GR., Mandybur, GT.[2022]

In a study of 68 patients who had spinal cord stimulation paddle electrodes removed, the most common reason for removal was loss of coverage or effect (75%), indicating that while SCS is effective, it may not always provide lasting relief.

Postoperative complications occurred in 11.75% of patients, with two major complications requiring reoperation, highlighting that while SCS removal is generally safe, it does carry some risks that patients should be aware of.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rate of Complications Following Spinal Cord Stimulation Paddle Electrode Removal. Maldonado-Naranjo, AL., Frizon, LA., Sabharwal, NC., et al.[2022]

In a study involving 59 individuals undergoing cervical spine surgery, paired stimulation of the motor cortex and spinal cord significantly enhanced muscle responses, producing motor evoked potentials over five times larger than brain stimulation alone.

The effectiveness of this paired stimulation was dependent on the timing of the stimuli converging in the spinal cord, suggesting a promising approach for therapeutic neuromodulation that could benefit patients with varying degrees of spinal cord injury.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Timing dependent synergies between motor cortex and posterior spinal stimulation in humans. McIntosh, JR., Joiner, EF., Goldberg, JL., et al.[2023]

A new method for spinal paired associative stimulation (PAS) in lower limbs effectively enhances corticospinal transmission by individually estimating interstimulus intervals (ISIs) based on F-response and motor-evoked potential (MEP) latencies, achieving a significant 186% increase in MEP amplitude in healthy subjects.

This approach improves the precision of spinal PAS by ensuring accurate placement of peripheral nerve stimulation electrodes and using navigation in transcranial magnetic stimulation, making it a promising technique for clinical applications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of F-response in defining interstimulus intervals appropriate for LTP-like plasticity induction in lower limb spinal paired associative stimulation. Shulga, A., Lioumis, P., Kirveskari, E., et al.[2015]

Pairing motor cortex stimulation with spinal cord epidural stimulation significantly enhances motor responses, particularly when the timing of the stimuli is optimized, leading to more than double the motor evoked potentials (MEPs).

Repeated stimulation of both areas not only produced immediate effects but also resulted in lasting increases in spinal excitability and MEPs, suggesting a potential therapeutic approach for improving sensorimotor function after central nervous system injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Paired motor cortex and cervical epidural electrical stimulation timed to converge in the spinal cord promotes lasting increases in motor responses. Mishra, AM., Pal, A., Gupta, D., et al.[2018]

A novel surgical technique was developed for the safe placement of paddle-type spinal cord stimulation (SCS) electrodes in patients with epidural scar tissue, successfully applied in eight patients without complications.

This technique involves creating a laminotomy trough to facilitate dissection of scar tissue, ensuring safe electrode placement and adequate coverage, addressing challenges that can lead to spinal cord injury during conventional placement methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New technique for open placement of paddle-type spinal cord stimulator electrode in presence of epidural scar tissue. Pabaney, AH., Robin, AM., Schwalb, JM.[2022]

In a proof-of-principle study involving two patients with chronic spinal cord injuries, long-term paired associative stimulation (20-24 weeks) led to significant recovery of voluntary movements, including ankle movement in one patient and grasping ability in another.

The improvements in motor function persisted for at least one month after the last stimulation session, suggesting that paired associative stimulation can strengthen neural connections in a clinically relevant way, warranting further research into its potential as a rehabilitation strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term paired associative stimulation can restore voluntary control over paralyzed muscles in incomplete chronic spinal cord injury patients. Shulga, A., Lioumis, P., Zubareva, A., et al.[2019]

Citations

1. binausa.org binausa.org/research-clinical-trials/motor/individual-trial/spinal-cord-associative-plasticity-study-scap/

Spinal Cord Associative Plasticity Study (SCAP) This study seeks to improve arm and hand function in individuals with spinal cord injury. Noninvasive stimulation to both the brain and spinal cord.

2. ninds.nih.gov ninds.nih.gov/health-information/clinical-trials/spinal-cord-associative-plasticity-study

Spinal Cord Associative Plasticity Study The goal of this project is to translate a promising therapy for improving arm and hand function after partial spinal cord injury to humans. The approach ...

3. labs.icahn.mssm.edu labs.icahn.mssm.edu/harellab/spinal-cord-associative-plasticity-scap/

Spinal Cord Associative Plasticity (SCAP) Preliminary results demonstrate that precisely pairing TSCS and TMS has the potential to facilitate upper extremity responses to cortical stimulation. Note ...

4. clinicaltrials.gov clinicaltrials.gov/ct2/show/NCT06104735

Finding the Best Combination of Brain and Spinal Cord ... When one pulse of brain stimulation is synchronized with one pulse of cervical spinal stimulation, hand muscle responses are larger than with brain stimulation ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/36063483/

Spinal cord associative plasticity improves forelimb ... - PubMed We tested the hypothesis that properly timed paired stimulation would strengthen the sensorimotor connections in the spinal cord and improve ...

6. withpower.com withpower.com/trial/phase-quadriplegia-8-2021-80bc9

Spinal Cord Stimulation for Spinal Cord Injury (SCAP Trial) Spinal cord associative plasticity (SCAP) is a combined cortical and spinal electrical stimulation technique developed to induce recovery of arm and hand ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9799146/

Intraoperative electrical stimulation of the human dorsal spinal ... The present study used electrical stimulation during clinically indicated cervical spine surgery to improve understanding of cervical spinal cord circuits. Some ...