spinal pathways

Noninvasive Neuromodulation to Improve Hand Motor Function in Multiple Sclerosis

Project Summary/Abstract Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, and degenerative disease that affects nearly one million Americans. Although more than 75% of persons with MS (PwMS) experience hand motor impairments that reduce independence and quality of life, current treatments primarily aim to slow disease progression through pharmacological approaches and rehabilitation and often do not improve motor function. Recent evidence shows that reduced corticospinal transmission is strongly associated with motor impairment severity in PwMS, highlighting the need for targeted strategies to strengthen residual corticospinal pathways. Therefore, this project aims to evaluate the therapeutic potential of paired corticospinal-motoneuronal stimulation (PCMS) in improving hand dexterity in PwMS. PCMS, a noninvasive mechanism-driven neuromodulation approach, enhances corticospinal transmission by producing long-term potentiation-like effects at the corticospinal-motoneuronal synapse by precisely pairing transcranial magnetic stimulation (TMS) with peripheral nerve stimulation (PNS). This project first aims to examine the effects of a single PCMS session on corticospinal transmission and hand motor function in PwMS. Using a randomized, crossover design, 25 PwMS will complete two sessions: (1) PCMS and (2) sham-PCMS. Each session will deliver 180 paired TMS-PNS stimuli over 30 minutes. The primary outcome is performance on the 9-Hole Peg Test (9HPT). Secondary outcomes include pinch grip force, maximal voluntary contraction (MVC), MEP amplitude and latency, F-wave parameters, and M- max amplitude. It is hypothesized that PCMS will enhance corticospinal transmission and improve hand motor performance compared to sham stimulation. Second, this project will examine the effects of PCMS combined with hand motor training in PwMS. Forty-eight PwMS will be randomized to receive either PCMS or sham-PCMS combined with motor training over 10 sessions in 3–4 weeks. Outcomes will be assessed at baseline, post- intervention, and one-month follow-up. It is hypothesized that PCMS participants receiving PCMS with motor training to show greater functional gains than those receiving sham-PCMS with motor training and the functional gains will be better maintained in the PCMS with motor training group at follow-up. This project is the first to apply PCMS in PwMS, leveraging a noninvasive neuromodulation strategy to specifically enhance corticospinal output for improving manual dexterity. Findings will establish proof-of-concept for this intervention in PwMS and guide future studies optimizing stimulation protocols and evaluating clinical efficacy on a larger scale. Ultimately, this work may lead to a new therapeutic approach to improve dexterity, independence, and quality of life for people living with MS.

The neural basis of pain experience and its modulation by opioids

How the brain creates a painful experience remains a mystery. Solving this mystery is crucial to understanding the fundamental biological processes that underlie the perception of body integrity, and to creating better, non-addictive pain treatments. My laboratory’s goal is to resolve the neural basis of pain. We aim to understand the mechanisms by which our nervous system produces and assembles the sensory-discriminative, affective-motivational, and cognitive-evaluative dimensions of pain to create this unique and critically important experience. To capture every component of the pain experience, we examine the entirety of the pain circuitry, from sensory and spinal ascending pathways to cortical/subcortical circuits and brainstem descending pain modulation systems, at the molecular, cellular, circuit and whole-animal levels. For these studies, we have invented novel behavioral paradigms to interrogate the affective and cognitive dimensions of pain in mice while simultaneously imaging and manipulating nociceptive circuits. My laboratory also investigates how opioids suppress pain. Remarkably, despite their medical and societal significance, how opium poppy alkaloids such as morphine produce profound analgesia remains largely unexplained. By identifying where and how opioids act in neural circuits, we not only establish the mechanisms of action of one of the oldest drugs known to humans, but also reveal the critical elements of the pain circuitry for developing of novel analgesics and bringing an end to the opioid epidemic.

Parallel ascending spinal pathways for affective touch and pain

Each day we experience myriad somatosensory stimuli: hugs from loved ones, warm showers, a mosquito bite, and sore muscles after a workout. These tactile, thermal, itch, and nociceptive signals are detected by peripheral sensory neuron terminals distributed throughout our body, propagated into the spinal cord, and then transmitted to the brain through ascending spinal pathways. Primary sensory neurons that detect a wide range of somatosensory stimuli have been identified and characterized. In contrast, very little is known about how peripheral signals are integrated and processed within the spinal cord and conveyed to the brain to generate somatosensory perception and behavioral responses. We tackled this question by developing new mouse genetic tools to define projection neuron (PN) subsets of the anterolateral pathway, a major ascending spinal cord pathway, and combining these new tools with advanced anatomical, physiological, and behavioral approaches. We found that Gpr83+ PNs, a newly identified subset of spinal cord output neurons, and Tacr1+ PNs are largely non-overlapping populations that innervate distinct sets of subnuclei within the lateral parabrachial nucleus (PBNL) of the pons in a zonally segregated manner. In addition, Gpr83+ PNs are highly sensitive to cutaneous mechanical stimuli, receive strong synaptic inputs from primary mechanosensory neurons, and convey tactile information bilaterally to the PBNL in a non-topographically organized manner. Remarkably, Gpr83+ mechanosensory limb of the anterolateral pathway controls behaviors associated with different hedonic values (appetitive or aversive) in a scalable manner. This is the first study to identify a dedicated spinal cord output pathway that conveys affective touch signals to the brain and to define parallel ascending circuit modules that cooperate to convey tactile, thermal and noxious cutaneous signals from the spinal cord to the brain. This study has also revealed exciting new therapeutic opportunities for developing treatments for neurological disorders associated with pain and affective touch.

Characterization of anatomical and functional vestibulospinal pathways in larval Xenopus laevis

Modulation of brain commands and spinal pathways in human upper limb control in various gravity conditions; insights from neuromusculoskeletal simulation

FENS Forum 2024