For which patients would you consider offering a spinal cord stimulator for management of autonomic dysfunction?

The use of SCS for its effects on the autonomic nervous system is one of the more interesting applications of neurostimulation. We’ve known for years that SCS has a potent sympatholytic effect, and it has been used for peripheral and cardiac ischemia extensively. This use has been more prevalent in Europe than it has been in the United States for a number of reasons.

Using SCS to treat SCI-related autonomic dysfunction is one of the more interesting novel applications of SCS. It is currently investigational, but the data are quite interesting. Dr. Harkema’s group has done some very interesting work in this area, and I remain hopeful that it will eventually clear regulatory hurdles to become clinically utilized.