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Two-years of home based functional electrical stimulation recovers epidermis from atrophy and flattening after years of complete Conus-Cauda Syndrome.
Medicine (Baltimore) 2019; 98(52):e18509M

Abstract

To evaluate progression of skin atrophy during 8 years of complete Conus-Cauda Syndrome and its recovery after 2 years of surface Functional Electrical Stimulation a cohort study was organized and implemented.Functional assessments, tissue biopsies, and follow-up were performed at the Wilhelminenspital, Vienna, Austria; skin histology and immunohistochemistry at the University of Padova, Italy on 13 spinal cord injury persons suffering up to 10 years of complete conus/cauda syndrome. Skin biopsies (n. 52) of both legs were analyzed before and after 2 years of home-based Functional Electrical Stimulation delivered by large anatomically shaped surface electrodes placed on the skin of the anterior thigh. Using quantitative histology we analyzed: 1. Epidermis atrophy by thickness and by area; 2. Skin flattening by computing papillae per mm and Interdigitation Index of dermal-epidermal junctions; 3. Presence of Langerhans cells.Linear regression analyses show that epidermal atrophy and flattening worsen with increasing years post- spinal cord injury and that 2 years of skin electrostimulation by large anatomically shaped electrodes reverses skin changes (pre-functional Electrical Stimulation vs post-functional Electrical Stimulation: thickness 39%, P < .0001; area 41%, P < .0001; papillae n/mm 35%, P < 0.0014; Interdigitation index 11%, P < 0.018), producing a significant recovery to almost normal levels of epidermis thickness and of dermal papillae, with minor changes of Langerhans cells, despite 2 additional years of complete Conus-Cauda Syndrome.In complete Conus-Cauda Syndrome patients, the well documented beneficial effects of 2 years of surface h-b Functional Electrical Stimulation on strength, bulk, and muscle fiber size of thigh muscles are extended to skin, suggesting that electrical stimulation by anatomically shaped electrodes fixed to the skin is also clinically relevant to counteract atrophy and flattening of the stimulated skin. Mechanisms, pros and cons are discussed.

Authors+Show Affiliations

Department of Neuroscience, Section of Human Anatomy.Interdepartmental Research Center of Myology, Department of Biomedical Sciences, University of Padova. A&C M-C Foundation for Translational Myology, Padova, Italy.Physiko- und Rheumatherapie, St. Poelten. Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten.Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten.Physiko- und Rheumatherapie, St. Poelten. Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten.Wilhelminenspital, Vienna, Austria.Department of Neuroscience, Section of Human Anatomy.Department of Neuroscience, Section of Human Anatomy.Department of Neuroscience, Section of Human Anatomy.Department of Neuroscience, Section of Human Anatomy.Interdepartmental Research Center of Myology, Department of Biomedical Sciences, University of Padova. A&C M-C Foundation for Translational Myology, Padova, Italy. Physiko- und Rheumatherapie, St. Poelten.Anatomy Department, Southern Illinois University School of Medicine, Carbondale, IL.Department of Medicine, Section of Dermatology Clinic, University of Padova, Italy.Interdepartmental Research Center of Myology, Department of Biomedical Sciences, University of Padova. A&C M-C Foundation for Translational Myology, Padova, Italy.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

31876739

Citation

Albertin, Giovanna, et al. "Two-years of Home Based Functional Electrical Stimulation Recovers Epidermis From Atrophy and Flattening After Years of Complete Conus-Cauda Syndrome." Medicine, vol. 98, no. 52, 2019, pp. e18509.
Albertin G, Ravara B, Kern H, et al. Two-years of home based functional electrical stimulation recovers epidermis from atrophy and flattening after years of complete Conus-Cauda Syndrome. Medicine (Baltimore). 2019;98(52):e18509.
Albertin, G., Ravara, B., Kern, H., Hofer, C., Loefler, S., Jurecka, W., ... Carraro, U. (2019). Two-years of home based functional electrical stimulation recovers epidermis from atrophy and flattening after years of complete Conus-Cauda Syndrome. Medicine, 98(52), pp. e18509. doi:10.1097/MD.0000000000018509.
Albertin G, et al. Two-years of Home Based Functional Electrical Stimulation Recovers Epidermis From Atrophy and Flattening After Years of Complete Conus-Cauda Syndrome. Medicine (Baltimore). 2019;98(52):e18509. PubMed PMID: 31876739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two-years of home based functional electrical stimulation recovers epidermis from atrophy and flattening after years of complete Conus-Cauda Syndrome. AU - Albertin,Giovanna, AU - Ravara,Barbara, AU - Kern,Helmut, AU - Hofer,Christian, AU - Loefler,Stefan, AU - Jurecka,Wolfgang, AU - Guidolin,Diego, AU - Rambaldo,Anna, AU - Porzionato,Andrea, AU - De Caro,Raffaele, AU - Zampieri,Sandra, AU - Pond,Amber, AU - Alaibac,Mauro, AU - Carraro,Ugo, PY - 2019/12/27/entrez PY - 2019/12/27/pubmed PY - 2020/1/15/medline SP - e18509 EP - e18509 JF - Medicine JO - Medicine (Baltimore) VL - 98 IS - 52 N2 - To evaluate progression of skin atrophy during 8 years of complete Conus-Cauda Syndrome and its recovery after 2 years of surface Functional Electrical Stimulation a cohort study was organized and implemented.Functional assessments, tissue biopsies, and follow-up were performed at the Wilhelminenspital, Vienna, Austria; skin histology and immunohistochemistry at the University of Padova, Italy on 13 spinal cord injury persons suffering up to 10 years of complete conus/cauda syndrome. Skin biopsies (n. 52) of both legs were analyzed before and after 2 years of home-based Functional Electrical Stimulation delivered by large anatomically shaped surface electrodes placed on the skin of the anterior thigh. Using quantitative histology we analyzed: 1. Epidermis atrophy by thickness and by area; 2. Skin flattening by computing papillae per mm and Interdigitation Index of dermal-epidermal junctions; 3. Presence of Langerhans cells.Linear regression analyses show that epidermal atrophy and flattening worsen with increasing years post- spinal cord injury and that 2 years of skin electrostimulation by large anatomically shaped electrodes reverses skin changes (pre-functional Electrical Stimulation vs post-functional Electrical Stimulation: thickness 39%, P < .0001; area 41%, P < .0001; papillae n/mm 35%, P < 0.0014; Interdigitation index 11%, P < 0.018), producing a significant recovery to almost normal levels of epidermis thickness and of dermal papillae, with minor changes of Langerhans cells, despite 2 additional years of complete Conus-Cauda Syndrome.In complete Conus-Cauda Syndrome patients, the well documented beneficial effects of 2 years of surface h-b Functional Electrical Stimulation on strength, bulk, and muscle fiber size of thigh muscles are extended to skin, suggesting that electrical stimulation by anatomically shaped electrodes fixed to the skin is also clinically relevant to counteract atrophy and flattening of the stimulated skin. Mechanisms, pros and cons are discussed. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/31876739/Two-years_of_home_based_functional_electrical_stimulation_recovers_epidermis_from_atrophy_and_flattening_after_years_of_complete_Conus-Cauda_Syndrome L2 - http://dx.doi.org/10.1097/MD.0000000000018509 DB - PRIME DP - Unbound Medicine ER -