Brief ES for recovery of autonomic function in CES.
Research type
Research Study
Full title
Can brief perioperative epidural electrical stimulation improve recovery of autonomic function in cauda equina syndrome? A feasibility study.
IRAS ID
325971
Contact name
Andrew Marshall
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
1 years, 8 months, 30 days
Research summary
Cauda equina syndrome (CES), defined as a compression of nerves controlling bowel, bladder and sexual function due to lumbar disc prolapse has a prevalence of 2 per 100000 UK population per year. It mostly affects individuals 30-49 years of age. Emergency surgery to decompress the nerves is the mainstay of treatment. Despite adequate decompression, 17% patients are left incontinent and 50% experience persistent autonomic dysfunction needing long term supportive symptomatic management and compromising their social cohesion and economic productivity.
Theoretically, there are two possible ways of improving their function – improving regeneration of damaged cells and improving conduction in partially damaged/residual cells. Use of perioperative electrical stimulation (ES) has shown significant promise in facilitating recovery in peripheral nerve compression syndromes. Epidural stimulation is routinely used for treating neuropathic pain and there is anecdotal evidence of improved bladder and bowel function in patients with CES who have received epidural spinal cord stimulation for chronic pain.
The objective of this feasibility study is to see if it is possible to timely and safely deliver epidural stimulation in patients presenting with autonomic dysfunction due to cauda equina compression, undergoing emergency lumbar decompression, assess the effect size of brief post-decompression ES proximal to level of compression in facilitating axonal regeneration and see if brief ES can improve conduction in residual neurons.
We aim to enrol 40 patients presenting with CES. At the time of decompression surgery, consenting patients shall receive ES. With standard care, patients who still have symptoms after decompression, remain symptomatic at 1 year. Comparison of functional outcomes post-surgery and at 3, 6 and 12 months will enable assessment of recovery due to axonal regeneration.
Results shall assess safety and feasibility of doing the study in emergency settings – enrolment and consent issues and assess effect size, expected to lead to an RCT.REC name
North West - Greater Manchester South Research Ethics Committee
REC reference
23/NW/0303
Date of REC Opinion
19 Oct 2023
REC opinion
Favourable Opinion