“I have my life back,” says Julie, a participant in the clinical study. After a spinal cord injury left her with chronic bouts of dizziness and fatigue, she had little energy to pursue even basic daily tasks. “Now I can go back to school and finish my PhD.” Daniel, another participant, has spent decades navigating life in a wheelchair after a skiing accident. Thanks to a new type of implant, he was able to pursue his love of para-alpine sit skiing with greater confidence and stability this past winter.
These personal stories, though striking, reflect a lesser-known reality for people living with spinal cord injuries (SCI): the inability to regulate blood pressure. While much of the focus in SCI care has been on restoring movement, a majority of patients—over 70%, according to a survey in 1’479 people conducted for the study—live with chronic hypotension, a condition that leaves them exhausted, cognitively dulled, and prone to fainting.
This is because the projections from the brainstem to the region of the spinal cord that regulates blood pressure are disrupted, leaving the body unable to adjust vascular tone and heart rate in response to daily activities. And if hypotension was not debilitating enough, this deregulation can also lead to life-threatening peaks in blood pressure, known as autonomic dysreflexia.
A major discovery to stabilize blood pressure
In a rare double publication in both Nature and Nature Medicine, a pair of landmark studies led by Grégoire Courtine (professor of neurosciences at EPFL), Jocelyne Bloch (neurosurgeon at Lausanne University Hospital and professor at University of Lausanne) and Aaron Phillips (University of Calgary) describe the development of a targeted therapy to address blood pressure regulation in SCI patients. Working with the EPFL spin-off ONWARD Medical, the team has demonstrated how an implanted neurostimulation system successfully restored blood pressure stability.
“First, in the study we’ve published in Nature, we were able to identify the entire neuronal architecture of the spinal cord that is responsible for uncontrolled, life-threatening elevation of blood pressure, called autonomic dysreflexia. We also showed that spinal cord stimulation can compete with this neuronal architecture to safely and precisely regulate blood pressure. This competition occurs over a specific region of the spinal cord that we call the hemodynamic hotspot,” says Professor Grégoire Courtine, director of .NeuroRestore along with Professor Jocelyne Bloch. He goes on to say, “in the Nature Medicine study, we leveraged this understanding to engineer an implantable system capable of targeting this hemodynamic hotspot with electrical stimulation in order to prevent chronic low blood pressure.”
Over the past decade, a series of patents on this technology were filed by the Swiss and Canadian teams as their discoveries and development progressed. Developed by ONWARD Medical, this implantable system, known commercially as ARC-IM, consists of a new class of electrode arrays, carefully shaped and spaced to target the hemodynamic hotspot. These arrays connect to a purpose-built pulse generator—similar to a cardiac pacemaker—that delivers finely tuned electrical stimulation, calibrated to each patient’s needs. The result is a compact, adaptable system capable of restoring blood pressure stability through targeted neuromodulation.
Safe and effective deployment across multiple clinical studies
The therapy for hypotension involved 14 patients and was validated across four clinical studies in Switzerland, the Netherlands, and Canada, each treated by independent clinical teams. “The international deployment shows that the surgery and therapy are safe and effective regardless of local practices. It’s a key milestone toward making this technology widely available,” says Professor Jocelyne Bloch.
“Our mechanistic discoveries in Nature were crucial in bridging the gap from foundational neuronal mapping to clinical application and allowed us to move quickly from theory to therapy. The Nature Medicine study demonstrates that low blood pressure after a spinal cord injury has serious medical consequences that must not be clinically ignored and that our neuromodulation therapy for blood pressure instability after SCI can be deployed effectively in diverse clinical settings,” says Dr. Aaron Phillips, neuroscientist and director of the RESTORE Network at the University of Calgary.
The results were consistent: once activated, the system restored blood pressure to a functional range, often within minutes. “Based on our experiences with this novel treatment, participants report experiencing less brain fog, having more energy, being able to speak louder, and suffering less from a postprandial dip. In addition, once the surgery was performed by neurosurgeon Erkan Kurt at Radboudumc, this system proved relatively easy to use in their home environment,' says Dr. Ilse van Nes, who successfully deployed the system at the rehabilitation center Sint Maartenskliniek in Nijmegen, Netherlands. “Its impact extends beyond physical health: by stabilizing blood pressure, the therapy improves mood and independence—elements of daily life that are often compromised after spinal cord injury,” adds Professor Jocelyne Bloch.
“The goal now is to move toward widespread clinical adoption,” says Professor Grégoire Courtine. “ONWARD Medical has recently received Investigational Device Exemption (FDA IDE) approval to initiate a pivotal trial of this therapy, which is expected to involve approximately 20 leading neurorehabilitation and neurosurgical research centers across the United States, Canada, and Europe. This multicenter study will be crucial to demonstrating the safety and efficacy of the system at scale. If successful, it will pave the way for regulatory approval and reimbursement—bringing this therapy within reach for the broader SCI community.”
Contacts for journalists
CHUV (Lausanne University Hospital) : medias(at)chuv.ch / +41 79 556 60 00
EPFL: michael.mitchell(at)epfl.ch / +41 21 693 92 52
UCalgary: kelly.johnston2(at)ucalgary.ca / +1 403 617 8691
ONWARD: sebastien.cros(at)onwd.com / +41 78 343 86 40
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