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Bourguignon L, Lukas LP, Kondiles BR, Tong B, Lee JJ, Gomes T, Tetzlaff W, Kramer JLK, Walter M, Jutzeler CR. Impact of commonly administered drugs on the progression of spinal cord injury: a systematic review. COMMUNICATIONS MEDICINE 2024; 4:213. [PMID: 39448737 PMCID: PMC11502874 DOI: 10.1038/s43856-024-00638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 10/09/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Complications arising from acute traumatic spinal cord injury (SCI) are routinely managed by various pharmacological interventions. Despite decades of clinical application, the potential impact on neurological recovery has been largely overlooked. This study aims to highlight commonly administered drugs with potential disease-modifying effects. METHODS This systematic literature review included studies referenced in PubMed, Scopus and Web of Science from inception to March 31st, 2021, which assess disease-modifying properties on neurological and/or functional recovery of drugs routinely administered following spinal cord injury. Drug effects were classified as positive, negative, mixed, no effect, or not (statistically) reported. Risk of bias was assessed separately for animal, randomized clinical trials, and observational human studies. RESULTS We analyzed 394 studies conducting 486 experiments that evaluated 144 unique or combinations of drugs. 195 of the 464 experiments conducted on animals (42%) and one study in humans demonstrate positive disease-modifying properties on neurological and/or functional outcomes. Methylprednisolone, melatonin, estradiol, and atorvastatin are the most common drugs associated with positive effects. Two studies on morphine and ethanol report negative effects on recovery. CONCLUSION Despite a large heterogeneity observed in study protocols, research from bed to bench and back to bedside provides an alternative approach to identify new candidate drugs in the context of SCI. Future research in human populations is warranted to determine if introducing drugs like melatonin, estradiol, or atorvastatin would contribute to enhancing neurological outcomes after acute SCI.
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Affiliation(s)
- Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.
- Schulthess Klinik, Zurich, Switzerland.
| | - Louis P Lukas
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.
- Schulthess Klinik, Zurich, Switzerland.
| | - Bethany R Kondiles
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Jaimie J Lee
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Tomás Gomes
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - Wolfram Tetzlaff
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthias Walter
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Catherine R Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Schulthess Klinik, Zurich, Switzerland
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Dell'Osso L, Nardi B, Massoni L, Gravina D, Benedetti F, Cremone IM, Carpita B. Neuroprotective Properties of Antiepileptics: What are the Implications for Psychiatric Disorders? Curr Med Chem 2024; 31:3447-3472. [PMID: 37226791 DOI: 10.2174/0929867330666230523155728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/29/2023] [Accepted: 04/14/2023] [Indexed: 05/26/2023]
Abstract
Since the discovery of the first antiepileptic compound, increasing attention has been paid to antiepileptic drugs (AEDs), and recently, with the understanding of the molecular mechanism underlying cells death, a new interest has revolved around a potential neuroprotective effect of AEDs. While many neurobiological studies in this field have focused on the protection of neurons, growing data are reporting how exposure to AEDs can also affect glial cells and the plastic response underlying recovery; however, demonstrating the neuroprotective abilities of AEDs remains a changeling task. The present work aims to summarize and review the literature available on the neuroprotective properties of the most commonly used AEDs. Results highlighted how further studies should investigate the link between AEDs and neuroprotective properties; while many studies are available on valproate, results for other AEDs are very limited and the majority of the research has been carried out on animal models. Moreover, a better understanding of the biological basis underlying neuro-regenerative defects may pave the way for the investigation of further therapeutic targets and eventually lead to an improvement in the actual treatment strategies.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Leonardo Massoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
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Wang R, Bai J. Pharmacological interventions targeting the microcirculation following traumatic spinal cord injury. Neural Regen Res 2024; 19:35-42. [PMID: 37488841 PMCID: PMC10479866 DOI: 10.4103/1673-5374.375304] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/08/2023] [Accepted: 04/07/2023] [Indexed: 07/26/2023] Open
Abstract
Traumatic spinal cord injury is a devastating disorder characterized by sensory, motor, and autonomic dysfunction that severely compromises an individual's ability to perform activities of daily living. These adverse outcomes are closely related to the complex mechanism of spinal cord injury, the limited regenerative capacity of central neurons, and the inhibitory environment formed by traumatic injury. Disruption to the microcirculation is an important pathophysiological mechanism of spinal cord injury. A number of therapeutic agents have been shown to improve the injury environment, mitigate secondary damage, and/or promote regeneration and repair. Among them, the spinal cord microcirculation has become an important target for the treatment of spinal cord injury. Drug interventions targeting the microcirculation can improve the microenvironment and promote recovery following spinal cord injury. These drugs target the structure and function of the spinal cord microcirculation and are essential for maintaining the normal function of spinal neurons, axons, and glial cells. This review discusses the pathophysiological role of spinal cord microcirculation in spinal cord injury, including its structure and histopathological changes. Further, it summarizes the progress of drug therapies targeting the spinal cord microcirculation after spinal cord injury.
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Affiliation(s)
- Rongrong Wang
- Department of Spine and Spinal Cord Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Jinzhu Bai
- Department of Spine and Spinal Cord Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
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Jutzeler CR, Bourguignon L, Tong B, Ronca E, Bailey E, Harel NY, Geisler F, Ferguson AR, Kwon BK, Cragg JJ, Grassner L, Kramer JLK. Pharmacological management of acute spinal cord injury: a longitudinal multi-cohort observational study. Sci Rep 2023; 13:5434. [PMID: 37012257 PMCID: PMC10070428 DOI: 10.1038/s41598-023-31773-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Multiple types and classes of medications are administered in the acute management of traumatic spinal cord injury. Prior clinical studies and evidence from animal models suggest that several of these medications could modify (i.e., enhance or impede) neurological recovery. We aimed to systematically determine the types of medications commonly administered, alone or in combination, in the transition from acute to subacute spinal cord injury. For that purpose, type, class, dosage, timing, and reason for administration were extracted from two large spinal cord injury datasets. Descriptive statistics were used to describe the medications administered within the first 60 days after spinal cord injury. Across 2040 individuals with spinal cord injury, 775 unique medications were administered within the two months after injury. On average, patients enrolled in a clinical trial were administered 9.9 ± 4.9 (range 0-34), 14.3 ± 6.3 (range 1-40), 18.6 ± 8.2 (range 0-58), and 21.5 ± 9.7 (range 0-59) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Those enrolled in an observational study were administered on average 1.7 ± 1.7 (range 0-11), 3.7 ± 3.7 (range 0-24), 8.5 ± 6.3 (range 0-42), and 13.5 ± 8.3 (range 0-52) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Polypharmacy was commonplace (up to 43 medications per day per patient). Approximately 10% of medications were administered acutely as prophylaxis (e.g., against the development of pain or infections). To our knowledge, this was the first time acute pharmacological practices have been comprehensively examined after spinal cord injury. Our study revealed a high degree of polypharmacy in the acute stages of spinal cord injury, raising the potential to impact neurological recovery. All results can be interactively explored on the RXSCI web site ( https://jutzelec.shinyapps.io/RxSCI/ ) and GitHub repository ( https://github.com/jutzca/Acute-Pharmacological-Treatment-in-SCI/ ).
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Affiliation(s)
- Catherine R Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Lengghalde 2, 8008, Zurich, Switzerland
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Elias Ronca
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Eric Bailey
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Noam Y Harel
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Weill Institute for Neurosciences, University of California San Francisco (UCSF), San Francisco, CA, USA
- San Francisco Veteran's Affairs Health Care System, San Francisco, CA, USA
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Hugill Centre for Anesthesia, University of British Columbia, Vancouver, Canada
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Davis JA, Grau JW. Protecting the injured central nervous system: Do anesthesia or hypothermia ameliorate secondary injury? Exp Neurol 2023; 363:114349. [PMID: 36775099 DOI: 10.1016/j.expneurol.2023.114349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Traumatic injury to the central nervous system (CNS) and stroke initiate a cascade of processes that expand the area of tissue loss. The current review considers recent studies demonstrating that the induction of an anesthetic state or cooling the affected tissue (hypothermia) soon after injury can have a therapeutic effect. We first provide an overview of the neurobiological processes that fuel tissue loss after traumatic brain injury (TBI), spinal cord injury (SCI) and stroke. We then examine the rehabilitative effectiveness of therapeutic anesthesia across a variety of drug categories through a systematic review of papers in the PubMed database. We also review the therapeutic benefits hypothermia, another treatment that quells neural activity. We conclude by considering factors related to the safety, efficacy and timing of treatment, as well as the mechanisms of action. Clinical implications are also discussed.
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Affiliation(s)
- Jacob A Davis
- Cellular and Behavioral Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA.
| | - James W Grau
- Cellular and Behavioral Neuroscience, Department of Psychology, Texas A&M University, College Station, TX 77843, USA
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Wilson JR, Doty S, Petitt JC, El-Abtah M, Francis JJ, Sharpe MG, Kelly ML, Anderson KD. Feasibility of gabapentin as an intervention for neurorecovery after an acute spinal cord injury: Protocol. Front Neurol 2022; 13:1033386. [PMID: 36419530 PMCID: PMC9676350 DOI: 10.3389/fneur.2022.1033386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction This protocol is describing the first ever prospective, mock-efficacy, dose exploration trial design testing the feasibility of administering gabapentin in the acute setting as an intervention for neurorecovery. Gabapentin is an FDA-approved medication for treating seizures and postherpetic neuralgia and is used broadly off-label for neuropathic pain management for many conditions, including spinal cord injury. Emerging data suggests that when given early after spinal cord injury onset and in low-medium doses, gabapentin may have properties that promote recovery of neurological function. The objective of this trial is to assess the feasibility of conducting an efficacy trial in which gabapentin is started early after injury, is restricted in its dose, and is not used for pain management. Methods and analysis Forty-two people aged 18 years or older with any level and any severity of spinal cord injury induced by a trauma will be enrolled, randomized, and have the first dose of study medication by 120 h post-injury onset. Participants will be randomly assigned to one of three groups: 600, 1,800 mg/day gabapentin, or placebo. Study medication will be given for a 90-day duration. Blinded assessments will be obtained at 7 days post-injury (baseline), 30 days post-injury (interim), after the 90-day treatment duration/approximately 3 months post-injury (end of treatment), and at 6 months post-injury (end of study). The key analysis parameters will evaluate feasibility of recruitment of target population, delivery of drug treatment protocol, maintenance of blinding, and retention of participants. Discussion Outputs from this trial will inform research and clinical practice on the effects of manipulating gabapentin for non-pain management purposes in the acute setting and will guide the development of a properly powered efficacy trial of gabapentin as an intervention for neurorecovery in spinal cord injury. Ethics and dissemination The study was approved by the MetroHealth Institutional Review Board (IRB21-00609) and registered at clinicaltrials.gov prior to enrolling any participants. Dissemination will include peer-reviewed publications, presentations at professional conferences and in the community, and through other healthcare and public venues. Clinical trial registration www.ClinicalTrials.gov, identifier: NCT05302999; protocol version 1.1 approved 05/23/2022. Trial funding National Institute on Disability, Independent Living and Rehabilitation Research.
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Affiliation(s)
- James R. Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, United States
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Samuel Doty
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Jordan C. Petitt
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Mohamed El-Abtah
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - John J. Francis
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Megan G. Sharpe
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Michael L. Kelly
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- MetroHealth Medical Center, MetroHealth System, Cleveland, OH, United States
| | - Kim D. Anderson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, United States
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- *Correspondence: Kim D. Anderson
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Mun S, Han K, Hyun JK. The Time Sequence of Gene Expression Changes after Spinal Cord Injury. Cells 2022; 11:cells11142236. [PMID: 35883679 PMCID: PMC9324287 DOI: 10.3390/cells11142236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 02/01/2023] Open
Abstract
Gene expression changes following spinal cord injury (SCI) are time-dependent, and an accurate understanding of these changes can be crucial in determining time-based treatment options in a clinical setting. We performed RNA sequencing of the contused spinal cord of rats at five different time points from the very acute to chronic stages (1 hour, 1 day, 1 week, 1 month, and 3 months) following SCI. We identified differentially expressed genes (DEGs) and Gene Ontology (GO) terms at each time point, and 14,257 genes were commonly expressed at all time points. The biological process of the inflammatory response was increased at 1 hour and 1 day, and the cellular component of the integral component of the synaptic membrane was increased at 1 day. DEGs associated with cell activation and the innate immune response were highly enriched at 1 week and 1 month, respectively. A total of 2841 DEGs were differentially expressed at any of the five time points, and 18 genes (17 upregulated and 1 downregulated) showed common expression differences at all time points. We found that interleukin signaling, neutrophil degranulation, eukaryotic translation, collagen degradation, LGI–ADAM interactions, GABA receptor, and L1CAM-ankyrin interactions were prominent after SCI depending on the time post injury. We also performed gene–drug network analysis and found several potential antagonists and agonists which can be used to treat SCI. We expect to discover effective treatments in the clinical field through further studies revealing the efficacy and safety of potential drugs.
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Affiliation(s)
- Seyoung Mun
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea;
- Center for Bio Medical Engineering Core Facility, Dankook University, Cheonan 31116, Korea;
| | - Kyudong Han
- Center for Bio Medical Engineering Core Facility, Dankook University, Cheonan 31116, Korea;
- Department of Microbiology, College of Science & Technology, Dankook University, Cheonan 31116, Korea
| | - Jung Keun Hyun
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea;
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea
- Correspondence: ; Tel.: +82-10-2293-3415
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Bourguignon L, Tong B, Geisler F, Schubert M, Röhrich F, Saur M, Weidner N, Rupp R, Kalke YBB, Abel R, Maier D, Grassner L, Chhabra HS, Liebscher T, Cragg JJ, Kramer J, Curt A, Jutzeler CR. International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials. BMC Med 2022; 20:225. [PMID: 35705947 PMCID: PMC9202190 DOI: 10.1186/s12916-022-02395-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The epidemiological international landscape of traumatic spinal cord injury (SCI) has evolved over the last decades along with given inherent differences in acute care and rehabilitation across countries and jurisdictions. However, to what extent these differences may influence neurological and functional recovery as well as the integrity of international trials is unclear. The latter also relates to historical clinical data that are exploited to inform clinical trial design and as potential comparative data. METHODS Epidemiological and clinical data of individuals with traumatic and ischemic SCI enrolled in the European Multi-Center Study about Spinal Cord Injury (EMSCI) were analyzed. Mixed-effect models were employed to account for the longitudinal nature of the data, efficiently handle missing data, and adjust for covariates. The primary outcomes comprised demographics/injury characteristics and standard scores to quantify neurological (i.e., motor and sensory scores examined according to the International Standards for the Neurological Classification of Spinal Cord Injury) and functional recovery (walking function). We externally validated our findings leveraging data from a completed North American landmark clinical trial. RESULTS A total of 4601 patients with acute SCI were included. Over the course of 20 years, the ratio of male to female patients remained stable at 3:1, while the distribution of age at injury significantly shifted from unimodal (2001/02) to bimodal distribution (2019). The proportional distribution of injury severities and levels remained stable with the largest percentages of motor complete injuries. Both, the rate and pattern of neurological and functional recovery, remained unchanged throughout the surveillance period despite the increasing age at injury. The findings related to recovery profiles were confirmed by an external validation cohort (n=791). Lastly, we built an open-access and online surveillance platform ("Neurosurveillance") to interactively exploit the study results and beyond. CONCLUSIONS Despite some epidemiological changes and considerable advances in clinical management and rehabilitation, the neurological and functional recovery following SCI has remained stable over the last two decades. Our study, including a newly created open-access and online surveillance tool, constitutes an unparalleled resource to inform clinical practice and implementation of forthcoming clinical trials targeting neural repair and plasticity in acute spinal cord injury.
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Affiliation(s)
- Lucie Bourguignon
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Martin Schubert
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Frank Röhrich
- Berufsgenossenschaftliche Klinik Bergmanstrost of Halle, Halle, Germany
| | - Marion Saur
- Orthopädische Klinik, Hessisch Lichtenau, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Rainer Abel
- Spinal Cord Injury Center, Bayreuth, Germany
| | - Doris Maier
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - Lukas Grassner
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Harvinder S Chhabra
- Spine Service, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, India
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | | | - John Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Catherine R Jutzeler
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland. .,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland. .,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland.
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Hori T, Imura T, Tanaka R. Development of a clinical prediction rule for patients with cervical spinal cord injury who have difficulty in obtaining independent living. Spine J 2022; 22:321-328. [PMID: 34487911 DOI: 10.1016/j.spinee.2021.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A simple and easy to use clinical prediction rule (CPR) to detect patients with a cervical spinal cord injury (SCI) who would have difficulty in obtaining independent living status is vital for providing the optimal rehabilitation and education in both care recipients and caregivers. A machine learning approach was recently applied to the field of rehabilitation and has the possibility to develop an accurate and useful CPR. PURPOSE The aim of this study was to develop and assess a CPR using a decision tree algorithm for predicting which patients with a cervical SCI would have difficulty in obtaining an independent living. STUDY DESIGN The present study was a cohort study. PATIENT SAMPLE In the present study, the data was obtained from the nationwide Japan Rehabilitation Database (JRD). The data on the SCIs was collected from 10 hospitals and the data was collected from the registries obtained between 2005 and 2015. The severity of SCI can vary, and patient prognosis differs depending on the damage site. In this study, the patients with cervical SCI were included. OUTCOME MEASURES In this study, the degree of the independent living at discharge was investigated. The degree of the independent living was classified and listed as below: independent in social, independent at home, need care at home, independent at facility, need care at facility. In this study, the independent in social and independent at home were defined as "independent," and the other situations were defined as "non-independent." METHODS We performed a classification and regression tree (CART) analysis to develop the CPR to predict whether the cervical SCI patients obtain an independent living at discharge. The area under the curve, the classification accuracy, sensitivity, specificity, and positive predictive value were used for model evaluation. RESULTS A total of 4181 patients with SCI were registered in the JRD and the CART analysis was performed for 1282 patients with the cervical SCI. The Functional Independence Measure (FIM) total score and the American Spinal Injury Association impairment scale were identified as the first and second discriminators for predicting the degree of the independence, respectively. Subsequently, the CART model identified FIM eating, the residual function level, and the FIM bed to chair transfer as next discriminators. Each parameter for evaluating the CART model were the area under the curve 0.813, the classification accuracy 78.6%, the sensitivity 80.7%, the specificity 75.1%, and the positive predictive value 84.5%. CONCLUSIONS In this study, we developed a clinically useful CPR with moderate accuracy to predict whether the cervical SCI patients obtain independent living at the discharge.
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Affiliation(s)
- Tomonari Hori
- Department of Rehabilitation, Fukuyama Rehabilitation Hospital, 2-15-41, Myojincho, Fukuyama 721-0961, Japan
| | - Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, 3-2-1, Otsuka-higashi, Hiroshima 731-3166, Japan; Graduate School of Humanities and Social Sciences, Hiroshima University, 1-3-2, Kagamiyama, Higashihiroshima 739-8511, Japan.
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, 1-3-2, Kagamiyama, Higashihiroshima 739-8511, Japan
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Grassner L, Garcia-Ovejero D, Mach O, Lopez-Dolado E, Vargas-Vaquero E, Alcobendas M, Esclarin A, Sanktjohanser L, Wutte C, Becker J, Lener S, Hartmann S, Girod PP, Koegl N, Griessenauer C, Papadopoulos MC, Geisler F, Thomé C, Molina-Holgado E, Vidal J, Curt A, Scivoletto G, Guest J, Maier D, Weidner N, Rupp R, Kramer JLK, Arevalo-Martin A. A NEW SCORE BASED ON THE INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY FOR INTEGRATIVE EVALUATION OF CHANGES IN SENSORIMOTOR FUNCTIONS. J Neurotrauma 2021; 39:613-626. [PMID: 34937399 DOI: 10.1089/neu.2021.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Sensorimotor function of patients with spinal cord injury (SCI) is commonly assessed according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). From the ISNCSCI segmental motor and sensory assessments, upper and lower extremity motor scores (UEMS and LEMS), sum scores of pin prick (PP) and light touch (LT) sensation, the neurological level of injury (NLI) and the classification of lesion severity according to the American Spinal Injury Association Impairment Scale (AIS) grade are derived. Changes of these parameters over time are widely used to evaluate neurological recovery. However, evaluating recovery based on a single ISNCSCI scoring or classification variable may misestimate overall recovery. Here, we propose an Integrated Neurological Change Score (INCS) based on the combination of normalized changes between two-time points of UEMS, LEMS, and total PP and LT scores. To assess the agreement of INCS with clinical judgement of meaningfulness of neurological changes, changes of ISNCSCI variables between two time-points of 88 patients from an independent cohort were rated by 20 clinical experts according to a 5-categories Likert Scale. As for individual ISNCSCI variables, neurological change measured by INCS is associated to severity (AIS grade), age and time since injury, but INCS better reflects clinical judgment about meaningfulness of neurological changes than individual ISNCSCI variables. In addition, INCS is related with changes in functional independence measured by the Spinal Cord Independence Measure (SCIM) in patients with tetraplegia. INCS may be a useful measure of overall neurological change in clinical studies.
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Affiliation(s)
- Lukas Grassner
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria.,Paracelsus Medical University Salzburg, 31507, Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Salzburg, Austria;
| | - Daniel Garcia-Ovejero
- Hospital Nacional de Parapléjicos, SESCAM, Laboratorio de Neuroinflamación, Finca La Peraleda, Toledo, Spain, 45071;
| | - Orpheus Mach
- Trauma Center Murnau, Center for Spinal Cord Injuries, Prof.-Kuentscher-Str. 8, Murnau, Germany, 82418;
| | - Elisa Lopez-Dolado
- Hospital Nacional de Paraplejicos, Physical Medicine and Rehabilitation, Toledo, Spain;
| | | | - Monica Alcobendas
- Hospital Nacional de Paraplejicos, Physical Medicine and Rehabilitation, Toledo, Spain;
| | - Ana Esclarin
- HOSPITAL NACIONAL DE PARAPLEJICOS, Physical Medicine and Rehabilitation, Finca de la Peraleda S/N, Toledo, Toledo, Spain, 45007.,Fund;
| | | | - Christof Wutte
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Johannes Becker
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Sara Lener
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Sebastian Hartmann
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Pierre-Pascal Girod
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Nikolaus Koegl
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Christoph Griessenauer
- Geisinger Health System, 2780, Neurosurgery, Danville, Pennsylvania, United States.,Harvard Medical School, 1811, Neurological Surgery, Boston, Massachusetts, United States;
| | - Marios C Papadopoulos
- St George's University of London, Academic Neurosurgery Unit, St George's, University of London, 1.122 Jenner Wing, Cranmer Terrace, London, United Kingdom of Great Britain and Northern Ireland, SW17 0RE;
| | - Fred Geisler
- University of Saskatchewan College of Medicine, 12371, Saskatoon, Saskatchewan, Canada;
| | - Claudius Thomé
- Medical University Innsbruck, Dept. of Neurosurgery, Anichstr. 35, Innsbruck, Austria, 6020;
| | - Eduardo Molina-Holgado
- Hospital Nacional de Parapléjicos, SESCAM, Laboratorio de Neuroinflamación, Finca La Peraleda s/n, Toledo, Spain, 45071;
| | - Joan Vidal
- Institut Guttmann, 83068, Badalona, Catalunya, Spain;
| | - Armin Curt
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland, 8008;
| | - Giorgio Scivoletto
- IRCCS Fondazioen S. Lucia, Spinal Cord Unit, via Ardeatina 306, Rome, Italy, 00179;
| | - James Guest
- University of Miami, Neurological Surgery, 1095 NW 14th Terrace, Miami, Florida, United States, 33136;
| | - Doris Maier
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Norbert Weidner
- University Hospital Heidelberg, Spinal Cord Injury Center, Schlierbacher Landstr, Heidelberg, Germany, 69118;
| | - Rüdiger Rupp
- University Hospital Heidelberg, Spinal Cord Injury Center, Schlierbacher Landstr. 200a, Heidelberg, BW, Germany, 69118;
| | - John L K Kramer
- University of British Columbia International Collaboration on Repair Discoveries, 507272, Vancouver, British Columbia, Canada;
| | - Angel Arevalo-Martin
- Hospital Nacional de Paraplejicos, Laboratory of Neuroinflammation, Finca la Peraleda, s/n, Toledo, Spain, 45071;
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11
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Warner FM, Cragg JJ, Jutzeler CR, Grassner L, Mach O, Maier DD, Mach B, Schwab JM, Kopp MA, Kramer JLK. Association of timing of gabapentinoid use with motor recovery after spinal cord injury. Neurology 2020; 95:e3412-e3419. [PMID: 32989101 DOI: 10.1212/wnl.0000000000010950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/12/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To explore the hypothesis that earlier administration of acute gabapentinoids is beneficial to motor recovery after spinal cord injury in humans. METHODS This is an observational study using a cohort from the European Multi-Centre Study about Spinal Cord Injury. Patient charts were reviewed to extract information regarding the administration and timing of gabapentinoid anticonvulsants. The primary outcome measure was motor scores, as measured by the International Standards for Neurological Classification of Spinal Cord Injury, collected longitudinally in the first year after injury. Sensory scores (light touch and pinprick) and functional measures (Spinal Cord Independence Measure) were secondary outcomes. Linear mixed effects regression models included a drug-by-time interaction to determine whether exposure to gabapentinoids altered recovery of muscle strength in the first year after injury. RESULTS A total of 201 participants were included in the study and had a median age of 46 and baseline motor score of 50. Participants were mostly men (85%) with sensory and motor complete injuries (50%). Seventy individuals (35%) were administered gabapentinoids within the first 30 days after injury, and presented with similar demographics. In the longitudinal model, the administration of gabapentinoids within 30 days after injury was associated with improved motor recovery when compared to those who did not receive gabapentinoids during this time (3.69 additional motor points from 4 to 48 weeks after injury; p = 0.03). This effect size increased as administration occurred earlier after injury (i.e., a benefit of 4.68 points when administered within 5 days). CONCLUSIONS This retrospective, observational study provided evidence of the beneficial effect of gabapentinoid anticonvulsants on motor recovery after spinal cord injury. More critically, it highlighted a potential time dependence, suggesting that earlier intervention is associated with better outcomes. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that gabapentinoids improve motor recovery for individuals with acute spinal cord injury.
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Affiliation(s)
- Freda M Warner
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Jacquelyn J Cragg
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Catherine R Jutzeler
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Lukas Grassner
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Orpheus Mach
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Doris D Maier
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Benedikt Mach
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Jan M Schwab
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Marcel A Kopp
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - John L K Kramer
- From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada.
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12
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Valproic Acid: A Potential Therapeutic for Spinal Cord Injury. Cell Mol Neurobiol 2020; 41:1441-1452. [DOI: 10.1007/s10571-020-00929-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
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13
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Cragg JJ, Jutzeler CR, Grassner L, Ramer M, Bradke F, Kramer JLK. Beneficial "Pharmaceutical Pleiotropy" of Gabapentinoids in Spinal Cord Injury: A Case for Refining Standard-of-Care. Neurorehabil Neural Repair 2020; 34:686-689. [PMID: 32508248 DOI: 10.1177/1545968320931516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spinal cord injury results in devastating neurological deficits accompanied by lifelong disability and significant economic burden. While the development of novel compounds or cell-based interventions for spinal cord injury is unquestionably worthwhile, a complementary approach examines current standards of care and the degree to which these can be optimized to benefit long-term neurological function. Numerous classes of drugs, already in use in the acute phase of spinal cord injury, are intriguing because they (1) readily cross the blood-spinal cord barrier to modulate activity in the central nervous system and (2) are administered during a window of time in which neuroprotection, and even some repair, are feasible. Here, we review a rare case of convergent lines of evidence from both preclinical and human studies to support the early administration of a class of drug (ie, gabapentinoids) to both foster motor recovery and reduce the severity of neuropathic pain.
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Affiliation(s)
- Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lukas Grassner
- Paracelsus Medical University, Salzburg, Austria.,Medical University Innsbruck, Innsbruck, Austria
| | - Matt Ramer
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
| | - Frank Bradke
- German Centre for Neurodegenerative Disease (DZNE), Bonn, Germany
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
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14
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Griffin JM, Bradke F. Therapeutic repair for spinal cord injury: combinatory approaches to address a multifaceted problem. EMBO Mol Med 2020; 12:e11505. [PMID: 32090481 PMCID: PMC7059014 DOI: 10.15252/emmm.201911505] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/07/2020] [Accepted: 01/31/2020] [Indexed: 12/21/2022] Open
Abstract
The recent years saw the advent of promising preclinical strategies that combat the devastating effects of a spinal cord injury (SCI) that are progressing towards clinical trials. However, individually, these treatments produce only modest levels of recovery in animal models of SCI that could hamper their implementation into therapeutic strategies in spinal cord injured humans. Combinational strategies have demonstrated greater beneficial outcomes than their individual components alone by addressing multiple aspects of SCI pathology. Clinical trial designs in the future will eventually also need to align with this notion. The scenario will become increasingly complex as this happens and conversations between basic researchers and clinicians are required to ensure accurate study designs and functional readouts.
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Affiliation(s)
- Jarred M Griffin
- Laboratory for Axonal Growth and Regeneration, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Frank Bradke
- Laboratory for Axonal Growth and Regeneration, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
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