Cardiovascular Effects of Spinal Cord Stimulation: The Highs, the Lows, and the Don't Knows

Marco Law; Rahul Sachdeva; David Darrow; Andrei Krassioukov

doi:10.1016/j.neurom.2023.07.010

Cardiovascular Effects of Spinal Cord Stimulation: The Highs, the Lows, and the Don't Knows

Marco Law, Rahul Sachdeva, David Darrow, Andrei Krassioukov

Rehabilitation Medicine

Research output: Contribution to journal › Review article › peer-review

9 Scopus citations

Abstract

Background and Objectives: There are many potential etiologies of impaired cardiovascular control, from chronic stress to neurodegenerative conditions or central nervous system lesions. Since 1959, spinal cord stimulation (SCS) has been reported to modulate blood pressure (BP), heart rate (HR), and HR variability (HRV), yet the specific stimulation sites and parameters to induce a targeted cardiovascular (CV) change for mitigating abnormal hemodynamics remain unclear. To investigate the ability and parameters of SCS to modulate the CV, we reviewed clinical studies using SCS with reported HR, BP, or HRV findings. Materials and Methods: A keyword-based electronic search was conducted through MEDLINE, Embase, and PubMed data bases, last searched on February 3, 2023. Inclusion criteria were studies with human participants receiving SCS with comparison with SCS turned off, with reporting of either HR, HRV, or BP findings. Non-English studies, conference abstracts, and studies not reporting standalone effects of SCS when comparing SCS with non-SCS interventions were excluded. Results were plotted for visual analysis. When available, participant-specific stimulation parameters and effects were extracted and quantitatively analyzed using ordinary least squares regression. Results: A total of 59 studies were included in this review; 51 studies delivered SCS invasively through implanted/percutaneous leads. Eight studies used noninvasive, transcutaneous electrodes. We found numerous reports of cervical, high thoracic, and mid-to-low thoracolumbar SCS increasing resting BP, and cervical/mid-to-low thoracolumbar SCS decreasing BP. The effect of SCS location on HR and HRV was equivocal. We were unable to analyze stimulation parameters owing to inadequate parameter reporting in many publications. Conclusions: Our findings suggest CV neuromodulation, particularly BP modulation, with SCS to be a promising frontier. Further research with larger randomized controlled trials and detailed reporting of SCS parameters will be necessary for appropriate evaluation of SCS as a CV therapy.

Original language	English
Pages (from-to)	1164-1176
Number of pages	13
Journal	Neuromodulation
Volume	27
Issue number	7
DOIs	https://doi.org/10.1016/j.neurom.2023.07.010
State	Published - Oct 2024

Bibliographical note

Publisher Copyright:
© 2023 International Neuromodulation Society

Funding

Andrei V. Krassioukov holds an endowed chair in rehabilitation medicine, International Collaboration on Repair Discoveries/University of British Columbia (UBC), and his laboratory is supported by funds from the Canadian Institute for Health Research, Rick Hansen Foundation, and Canadian Foundation for Innovation, US Department of Defense, and BC Knowledge Development Fund. Rahul Sachdeva is supported by Wings for Life Spinal Cord Research Foundation and US Department of Defense. Marco Law acknowledges support and guidance from the UBC Faculty of Medicine FLEX program. Marco Law was responsible for conceptualizing the project, developing the methods, literature search and review, data collection, analyses, creating visualizations, and drafting the original manuscript. Rahul Sachdeva performed literature review and assisted with writing and editing the final version of the paper. David Darrow provided feedback on multiple drafts of the manuscript. Finally, Andrei V. Krassioukov managed project administration, allocated necessary resources, and helped to finalize the written work. All four authors have carefully reviewed and approved the final manuscript, which reflects their collective efforts and insights on this important topic. Source(s) of financial support: The authors reported no funding sources.

Funders	Funder number
Rick Hansen Foundation
Canada Foundation for Innovation
Univ. of Northern British Columbia
International Collaboration on Repair Discoveries
Wings for Life Spinal Cord Research Foundation
Canadian Institutes of Health Research
U.S. Department of Defense

Keywords

Blood pressure
heart rate
heart rate variability
review
spinal cord stimulation

ASJC Scopus subject areas

Neurology
Clinical Neurology
Anesthesiology and Pain Medicine

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10.1016/j.neurom.2023.07.010

Cite this

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title = "Cardiovascular Effects of Spinal Cord Stimulation: The Highs, the Lows, and the Don't Knows",

abstract = "Background and Objectives: There are many potential etiologies of impaired cardiovascular control, from chronic stress to neurodegenerative conditions or central nervous system lesions. Since 1959, spinal cord stimulation (SCS) has been reported to modulate blood pressure (BP), heart rate (HR), and HR variability (HRV), yet the specific stimulation sites and parameters to induce a targeted cardiovascular (CV) change for mitigating abnormal hemodynamics remain unclear. To investigate the ability and parameters of SCS to modulate the CV, we reviewed clinical studies using SCS with reported HR, BP, or HRV findings. Materials and Methods: A keyword-based electronic search was conducted through MEDLINE, Embase, and PubMed data bases, last searched on February 3, 2023. Inclusion criteria were studies with human participants receiving SCS with comparison with SCS turned off, with reporting of either HR, HRV, or BP findings. Non-English studies, conference abstracts, and studies not reporting standalone effects of SCS when comparing SCS with non-SCS interventions were excluded. Results were plotted for visual analysis. When available, participant-specific stimulation parameters and effects were extracted and quantitatively analyzed using ordinary least squares regression. Results: A total of 59 studies were included in this review; 51 studies delivered SCS invasively through implanted/percutaneous leads. Eight studies used noninvasive, transcutaneous electrodes. We found numerous reports of cervical, high thoracic, and mid-to-low thoracolumbar SCS increasing resting BP, and cervical/mid-to-low thoracolumbar SCS decreasing BP. The effect of SCS location on HR and HRV was equivocal. We were unable to analyze stimulation parameters owing to inadequate parameter reporting in many publications. Conclusions: Our findings suggest CV neuromodulation, particularly BP modulation, with SCS to be a promising frontier. Further research with larger randomized controlled trials and detailed reporting of SCS parameters will be necessary for appropriate evaluation of SCS as a CV therapy.",

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AB - Background and Objectives: There are many potential etiologies of impaired cardiovascular control, from chronic stress to neurodegenerative conditions or central nervous system lesions. Since 1959, spinal cord stimulation (SCS) has been reported to modulate blood pressure (BP), heart rate (HR), and HR variability (HRV), yet the specific stimulation sites and parameters to induce a targeted cardiovascular (CV) change for mitigating abnormal hemodynamics remain unclear. To investigate the ability and parameters of SCS to modulate the CV, we reviewed clinical studies using SCS with reported HR, BP, or HRV findings. Materials and Methods: A keyword-based electronic search was conducted through MEDLINE, Embase, and PubMed data bases, last searched on February 3, 2023. Inclusion criteria were studies with human participants receiving SCS with comparison with SCS turned off, with reporting of either HR, HRV, or BP findings. Non-English studies, conference abstracts, and studies not reporting standalone effects of SCS when comparing SCS with non-SCS interventions were excluded. Results were plotted for visual analysis. When available, participant-specific stimulation parameters and effects were extracted and quantitatively analyzed using ordinary least squares regression. Results: A total of 59 studies were included in this review; 51 studies delivered SCS invasively through implanted/percutaneous leads. Eight studies used noninvasive, transcutaneous electrodes. We found numerous reports of cervical, high thoracic, and mid-to-low thoracolumbar SCS increasing resting BP, and cervical/mid-to-low thoracolumbar SCS decreasing BP. The effect of SCS location on HR and HRV was equivocal. We were unable to analyze stimulation parameters owing to inadequate parameter reporting in many publications. Conclusions: Our findings suggest CV neuromodulation, particularly BP modulation, with SCS to be a promising frontier. Further research with larger randomized controlled trials and detailed reporting of SCS parameters will be necessary for appropriate evaluation of SCS as a CV therapy.

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Cardiovascular Effects of Spinal Cord Stimulation: The Highs, the Lows, and the Don't Knows

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

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