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Duguay M, Mac-Thiong JM, Richard-Denis A. Bedside electromyography for clinical assessment of sacral motor and reflex activity adapted for patients hospitalized with acute neurological conditions: a pilot study. Spinal Cord Ser Cases 2024; 10:47. [PMID: 39003274 PMCID: PMC11246438 DOI: 10.1038/s41394-024-00657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/08/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
STUDY DESIGN Pilot cohort study. OBJECTIVE To develop and implement a sacral electromyographic (sEMG) technique at bedside to ascertain sparing of sacral motor activity and reflexes in patients hospitalized for acute neurological conditions. SETTING Hôpital du Sacré-Coeur de Montréal a Canadian Level-1 university trauma center specialized in SCI care. METHODS Nine patients underwent digital rectal examination (DRE) and sEMG, assessing voluntary anal contraction and sacral spinal reflexes (bulbocavernosus reflex and the anal wink). Our sEMG technique utilized surface recording electrodes and tactile elicitation of reflexes. EMG signal was acquired at bedside through the Noraxon MR3 system. RESULTS It was quick, well accepted and did no harm. We found that contrary to the DRE, sEMG detected subclinical sacral motor activity and reflexes in 20% of cases for voluntary anal contraction and 40% of cases for the anal wink. CONCLUSION We believe our sEMG technique is a powerful tool able to enhance management of patients suffering from acute neurological impairments and requiring sacral function assessment.
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Affiliation(s)
- Maude Duguay
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Jean-Marc Mac-Thiong
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
- Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Lindsay Pavillon of the Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montreal, QC, Canada.
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2
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Sachdeva R, Rietchel L, Lee M, Krassioukov-Enns D, Ditunno J, Krassioukov AV. The Babinski Sign in 'Perseus with the head of Medusa': revisiting art through a neurological lens. Spinal Cord Ser Cases 2024; 10:45. [PMID: 38992024 PMCID: PMC11239905 DOI: 10.1038/s41394-024-00661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024] Open
Affiliation(s)
- Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
| | - Lauren Rietchel
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Megan Lee
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Dmitri Krassioukov-Enns
- Section of Sports & Exercise Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - John Ditunno
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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3
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Bonsignore-Opp L, O'Donnell J, Agha O, Bach K, Metz L, Swarup I. Evaluation and Management of Thoracolumbar Spine Trauma in Pediatric Patients: A Critical Analysis Review. JBJS Rev 2024; 12:01874474-202406000-00002. [PMID: 38885326 DOI: 10.2106/jbjs.rvw.24.00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
» Pediatric thoracolumbar trauma, though rare, is an important cause of morbidity and mortality and necessitates early, accurate diagnosis and management.» Obtaining a detailed history and physical examination in the pediatric population can be difficult. Therefore, the threshold for advanced imaging, such as magnetic resonance imaging, is low and should be performed in patients with head injuries, altered mental status, inability to cooperate with examination, and fractures involving more than 1 column of the spine.» The classification of pediatric thoracolumbar trauma is based primarily on adult studies and there is little high-level evidence examining validity and accuracy in pediatric populations.» Injury pattern and neurologic status of the patient are the most important factors when determining whether to proceed with operative management.
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Affiliation(s)
- Lisa Bonsignore-Opp
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California
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4
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Moura MM, Monteiro A, Salgado AJ, Silva NA, Monteiro S. Disrupted autonomic pathways in spinal cord injury: Implications for the immune regulation. Neurobiol Dis 2024; 195:106500. [PMID: 38614275 DOI: 10.1016/j.nbd.2024.106500] [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: 11/21/2023] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024] Open
Abstract
Spinal Cord Injury (SCI) disrupts critical autonomic pathways responsible for the regulation of the immune function. Consequently, individuals with SCI often exhibit a spectrum of immune dysfunctions ranging from the development of damaging pro-inflammatory responses to severe immunosuppression. Thus, it is imperative to gain a more comprehensive understanding of the extent and mechanisms through which SCI-induced autonomic dysfunction influences the immune response. In this review, we provide an overview of the anatomical organization and physiology of the autonomic nervous system (ANS), elucidating how SCI impacts its function, with a particular focus on lymphoid organs and immune activity. We highlight recent advances in understanding how intraspinal plasticity that follows SCI may contribute to aberrant autonomic activity in lymphoid organs. Additionally, we discuss how sympathetic mediators released by these neuron terminals affect immune cell function. Finally, we discuss emerging innovative technologies and potential clinical interventions targeting the ANS as a strategy to restore the normal regulation of the immune response in individuals with SCI.
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Affiliation(s)
- Maria M Moura
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's Associate Lab, PT Government Associated Lab, 4710-057 Braga, Guimarães, Portugal
| | - Andreia Monteiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's Associate Lab, PT Government Associated Lab, 4710-057 Braga, Guimarães, Portugal
| | - António J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's Associate Lab, PT Government Associated Lab, 4710-057 Braga, Guimarães, Portugal
| | - Nuno A Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's Associate Lab, PT Government Associated Lab, 4710-057 Braga, Guimarães, Portugal
| | - Susana Monteiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; ICVS/3B's Associate Lab, PT Government Associated Lab, 4710-057 Braga, Guimarães, Portugal.
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5
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Hsueh YH, Li YW, Chen KP, Chen WL, Tu YK. Nerve Bypass Surgery for Spinal Cord Reconstruction. World Neurosurg 2024:S1878-8750(24)00775-7. [PMID: 38735563 DOI: 10.1016/j.wneu.2024.05.022] [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: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Spinal cord injury (SCI) is a devastating condition that significantly decreases the patient's quality of life. Therefore, treatments that can facilitate nerve regeneration, reduce complications, and increase quality of life are valuable for these patients. In this study, we aimed to assess nerve bypass surgery's feasibility and clinical outcomes by transferring the intercostal nerves into the spinal cord. METHODS Eight patients with complete thoracic SCI and delayed presentation more than a year after the injury were analyzed retrospectively. All patients underwent nerve bypass surgery with the transfer of 2 pairs of intercostal nerves from proximal to the injury site to the anterolateral spinal cord, followed by duraplasty with fascia grafting to close the dura. RESULTS Six of the 8 (75%) patients demonstrated motor and sensory improvements, based on the American SCI Association score. Three patients demonstrated a limited recovery of motor function that could be independently triggered without ICN initiation. Five patients demonstrated evidence of cerebrospinal fluid leakage after surgery; however, only 1 patient complained of a headache. CONCLUSIONS Spinal cord bypass surgery is a potential reconstruction method to treat chronic complete thoracic SCI with functional improvements, and is worth further investigation.
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Affiliation(s)
- Yu-Huan Hsueh
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yen-Wei Li
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuan-Po Chen
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wen-Liang Chen
- College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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6
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Thomas AX, Erklauer JC. Neurocritical care and neuromonitoring considerations in acute pediatric spinal cord injury. Semin Pediatr Neurol 2024; 49:101122. [PMID: 38677801 DOI: 10.1016/j.spen.2024.101122] [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: 11/20/2023] [Revised: 02/26/2024] [Accepted: 03/18/2024] [Indexed: 04/29/2024]
Abstract
Management of pediatric spinal cord injury (SCI) is an essential skill for all pediatric neurocritical care physicians. In this review, we focus on the evaluation and management of pediatric SCI, highlight a novel framework for the monitoring of such patients in the intensive care unit (ICU), and introduce advancements in critical care techniques in monitoring and management. The initial evaluation and characterization of SCI is crucial for improving outcomes as well as prognostication. While physical examination and imaging are the main stays of the work-up, we propose the use of somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS) for challenging clinical scenarios. SSEPs allow for functional evaluation of the dorsal columns consisting of tracts associated with hand function, ambulation, and bladder function. Meanwhile, TMS has the potential for informing prognostication as well as response to rehabilitation. Spine stabilization, and in some cases surgical decompression, along with respiratory and hemodynamic management are essential. Emerging research suggests that targeted spinal cerebral perfusion pressure may provide potential benefits. This review aims to increase the pediatric neurocritical care physician's comfort with SCI while providing a novel algorithm for monitoring spinal cord function in the ICU.
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Affiliation(s)
- Ajay X Thomas
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA.
| | - Jennifer C Erklauer
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA
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7
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Vasudeva P, Kumar V, Yadav S, Prasad V, Kumar N, Kumar S, Kumar A. Urodynamic assessment of detrusor function in the very acute phase of traumatic spinal cord injury: A prospective cohort study. Indian J Urol 2024; 40:31-36. [PMID: 38314069 PMCID: PMC10836447 DOI: 10.4103/iju.iju_315_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction The bladder is believed to be acontractile due to the phase of spinal shock and there is a lack of data on the detrusor function within the first few days after spinal cord injury (SCI). This study intended to assess the detrusor function with invasive urodynamics (UDS) during the first 15 days of SCI. Methods This prospective observational study was carried out from January 2020 to June 2021 and consecutive stable patients older than 18 years of age who had a history of traumatic SCI within the past 15 days were screened for inclusion. For each patient, the International Standards for Neurological Classification of SCI Worksheet was filled. All patients underwent bedside invasive UDS within 15 days of injury. Results There were a total of 41 patients with a mean age of 35 years. The thoracic cord was most commonly involved (46.3%) with Type A AISA grade being the most common (68.2%). The mean duration of injury at the time of UDS was 6 days. Abnormality in the filling phase could be identified in six patients. Three patients had neurogenic detrusor overactivity (NDO), with one having a high-pressure phasic NDO and one having a sustained NDO. Two patients had poor compliance and one had borderline poor compliance. None of the patients generated any detrusor pressure during voiding cystometry. Conclusions In patients with SCI, 14.5% of the patients had abnormal findings during the filling phase on the UDS performed within 15 days of the injury. These findings are in stark contrast to the traditional understanding that the detrusor is acontractile during the early phase of the SCI and merit further evaluation.
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Affiliation(s)
- Pawan Vasudeva
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vinod Kumar
- Department of Urology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Siddharth Yadav
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vishnu Prasad
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Niraj Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sandeep Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amitabh Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Gouveia D, Carvalho C, Vong N, Pereira A, Cardoso A, Moisés M, Rijo I, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Spinal shock in severe SCI dogs and early implementation of intensive neurorehabilitation programs. Res Vet Sci 2023; 164:105018. [PMID: 37722219 DOI: 10.1016/j.rvsc.2023.105018] [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: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
Spinal shock is complex, paradoxical with sudden presentation, possibly leading to a guarded prognosis. Thus, it is suggested the need for early implementation of intensive neurorehabilitation. This prospective controlled blinded cohort study aims to understand the implication of spinal shock in neurorehabilitation of severe SCI dogs and the importance of its evaluation thought a spinal shock scale (SSS). 371 dogs were randomized by stratification according the presence of spinal shock in the SG (n = 245) or CG (n = 126). The SSS, a punctuation scale (0-7), was evaluated at admission and each 6 h for 3 days, each day for 15 days, each week for 6 weeks, each month until 3 months, followed by 3 monthly follow-ups. All dogs had similar land and underwater treadmill training with functional electrical stimulation. Observational dataset allowed an approximate level of power (1-β) of 0.90 and an α (Type I error) of 0.01, with a total of 11,088 SSS observations between two blinded observers and 18% of disagreement. 75% of the dogs were admitted in 24-48 h after injury, allowing early detection of spinal shock, and dogs admitted at 72 h with SSS ≥ 4 were not able to achieve ambulation. Regarding ambulation rate, there was a significant difference between groups, with 66.9% of ambulation in the SG and 97.6% in the CG. Also, there was a difference in regard to time until ambulation, with a mean of 31.57 days for the SG and 23.02 for the CG. The SSS estimated marginal means had an exponential decrease within the first 6 h, followed by a slower decrease, but always faster in spinal shock dogs diagnosed with non-compressive myelopathies. Thus, early intensive neurorehabilitation in dogs after severe SCI may benefit from SSS classifications at admission and during treatment to establish different therapeutic protocols according to each patient's needs, especially in deep pain negative dogs.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal; Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, Lisboa 1950-396, Portugal; Faculty of Veterinary Medicine, Lusófona University, Campo Grande, Lisboa 1749-024, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Natalina Vong
- Faculty of Veterinary Medicine, Évora University, Évora 94, 7002-554, Portugal
| | - Ana Pereira
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Ana Cardoso
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Marina Moisés
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - Inês Rijo
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, Lisboa 1300-477, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, Lisboa 1300-477, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, Lisboa 1300-477, Portugal; CIISA - Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, Lisboa 1300-477, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital - Arrábida Animal Rehabilitation Center, Setubal 2925-538, Portugal; Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, Lisboa 1950-396, Portugal; Faculty of Veterinary Medicine, Lusófona University, Campo Grande, Lisboa 1749-024, Portugal.
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Larrea A, Elexpe A, Díez-Martín E, Torrecilla M, Astigarraga E, Barreda-Gómez G. Neuroinflammation in the Evolution of Motor Function in Stroke and Trauma Patients: Treatment and Potential Biomarkers. Curr Issues Mol Biol 2023; 45:8552-8585. [PMID: 37998716 PMCID: PMC10670324 DOI: 10.3390/cimb45110539] [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: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Neuroinflammation has a significant impact on different pathologies, such as stroke or spinal cord injury, intervening in their pathophysiology: expansion, progression, and resolution. Neuroinflammation involves oxidative stress, damage, and cell death, playing an important role in neuroplasticity and motor dysfunction by affecting the neuronal connection responsible for motor control. The diagnosis of this pathology is performed using neuroimaging techniques and molecular diagnostics based on identifying and measuring signaling molecules or specific markers. In parallel, new therapeutic targets are being investigated via the use of bionanomaterials and electrostimulation to modulate the neuroinflammatory response. These novel diagnostic and therapeutic strategies have the potential to facilitate the development of anticipatory patterns and deliver the most beneficial treatment to improve patients' quality of life and directly impact their motor skills. However, important challenges remain to be solved. Hence, the goal of this study was to review the implication of neuroinflammation in the evolution of motor function in stroke and trauma patients, with a particular focus on novel methods and potential biomarkers to aid clinicians in diagnosis, treatment, and therapy. A specific analysis of the strengths, weaknesses, threats, and opportunities was conducted, highlighting the key challenges to be faced in the coming years.
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Affiliation(s)
- Ane Larrea
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain;
| | - Ane Elexpe
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
| | - Eguzkiñe Díez-Martín
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
- Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - María Torrecilla
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain;
| | - Egoitz Astigarraga
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
| | - Gabriel Barreda-Gómez
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
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Mansoor Ali D, Sivaganesan A, Neal CJ, Thalheimer S, Ugiliweneza B, Toups EG, Abd-El-Barr M, Jimsheleishvili G, Kurpad SN, Aarabi B, Shaffrey CI, Fehlings MG, Tator CH, Grossman RG, Guest JD, Harrop JS. Bulbocavernosus Reflex Has No Prognostic Features During the Acute Evaluation of Spinal Cord Injuries. J Neurotrauma 2023; 40:1970-1975. [PMID: 36884291 DOI: 10.1089/neu.2022.0412] [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] [Indexed: 03/09/2023] Open
Abstract
The bulbocavernosus reflex (BCR) has been used during the initial evaluation of a spinal cord injury patient as a metric to determine prognosis and whether the patient is in "spinal shock." This reflex has been less utilized over the last decade, and therefore a review was performed to assess the value of BCR in patient prognosis. The North American Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that includes a prospective SCI registry. The NACTN registry data was analyzed to evaluate the prognostic implication of the BCR during the initial evaluation of a spinal cord injury patient. SCI patients were divided into those with an intact or absent BCR during their initial evaluation. Associations of participants' descriptors and neurological status on follow-up were performed, followed by associations with the presence of a BCR. A total of 769 registry patients with recorded BCRs were included in the study. The median age was 49 years (32-61 years), and the majority were male (n = 566, 77%) and white (n = 519, 73%). Among included patients, high blood pressure was the most common comorbidity (n = 230, 31%). Cervical spinal cord injury was the most common (n = 470, 76%) with fall (n = 320, 43%) being the most frequent mechanism of injury. BCR was present in 311 patients (40.4%), while 458 (59.6%) had a negative BCR within 7 days of injury or before surgery. At 6 months post-injury, 230 patients (29.9%) followed up, of which 145 had a positive BCR, while 85 had a negative BCR. The presence/absence of BCR was significantly different in patients with cervical (p = 0.0015) or thoracic SCI (p = 0.0089), or conus medullaris syndrome (p = 0.0035), and in those who were American Spinal Injury Association Impairment Scale grade A (p = 0.0313). No significant relationship was observed between BCR results and demographics, AIS grade conversion, motor score changes (p = 0.1669), and changes in pin prick (p = 0.3795) and light touch scores (p = 0.8178). In addition, cohorts were not different in surgery decision (p = 0.7762) and injury to surgery time (p = 0.0681). In our review of the NACTN spinal cord registry, the BCR did not provide prognostic utility in the acute evaluation of spinal cord injury patients. Therefore, it should not be used as a reliable marker for predicting neurological outcomes post-injury.
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Affiliation(s)
| | | | - Chris J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sara Thalheimer
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | | | - Shekar N Kurpad
- Neuroscience Institute, the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bizhan Aarabi
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles H Tator
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert G Grossman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | - James D Guest
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - James S Harrop
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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11
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Ortega MA, Fraile-Martinez O, García-Montero C, Haro S, Álvarez-Mon MÁ, De Leon-Oliva D, Gomez-Lahoz AM, Monserrat J, Atienza-Pérez M, Díaz D, Lopez-Dolado E, Álvarez-Mon M. A comprehensive look at the psychoneuroimmunoendocrinology of spinal cord injury and its progression: mechanisms and clinical opportunities. Mil Med Res 2023; 10:26. [PMID: 37291666 PMCID: PMC10251601 DOI: 10.1186/s40779-023-00461-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating and disabling medical condition generally caused by a traumatic event (primary injury). This initial trauma is accompanied by a set of biological mechanisms directed to ameliorate neural damage but also exacerbate initial damage (secondary injury). The alterations that occur in the spinal cord have not only local but also systemic consequences and virtually all organs and tissues of the body incur important changes after SCI, explaining the progression and detrimental consequences related to this condition. Psychoneuroimmunoendocrinology (PNIE) is a growing area of research aiming to integrate and explore the interactions among the different systems that compose the human organism, considering the mind and the body as a whole. The initial traumatic event and the consequent neurological disruption trigger immune, endocrine, and multisystem dysfunction, which in turn affect the patient's psyche and well-being. In the present review, we will explore the most important local and systemic consequences of SCI from a PNIE perspective, defining the changes occurring in each system and how all these mechanisms are interconnected. Finally, potential clinical approaches derived from this knowledge will also be collectively presented with the aim to develop integrative therapies to maximize the clinical management of these patients.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Sergio Haro
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel Ángel Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Diego De Leon-Oliva
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Ana M. Gomez-Lahoz
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Mar Atienza-Pérez
- Service of Rehabilitation, National Hospital for Paraplegic Patients, Carr. de la Peraleda, S/N, 45004 Toledo, Spain
| | - David Díaz
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Elisa Lopez-Dolado
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology Service and Internal Medicine, University Hospital Príncipe de Asturias (CIBEREHD), 28806 Alcala de Henares, Spain
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12
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Hunt A, McQuillan KA. Acute Management of Cervical Spinal Cord Injuries. Crit Care Nurs Clin North Am 2023; 35:119-128. [PMID: 37127369 DOI: 10.1016/j.cnc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Traumatic cervical spinal cord injury can cause significant neurologic disability. A cervical spine injury impacts not only the neurologic system but also numerous other organ systems of the body. This complex injury requires a systematic approach to assessment and care aimed at preventing, recognizing, and treating potentially devastating secondary spinal cord injury and multisystem complications. This article focuses on the pathophysiology, initial presentation, and treatment of cervical spinal cord injury by body system.
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Affiliation(s)
- Alexandra Hunt
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Karen A McQuillan
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
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13
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Gordon DM, Thakkar K. Serial Neurologic Examination in a Child With Acute Flaccid Weakness. Clin Pediatr (Phila) 2023; 62:180-183. [PMID: 35996321 DOI: 10.1177/00099228221118956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 5-month-old healthy infant presented with acute flaccid weakness, anisocoria, and urinary retention with clinical suspicion of acute flaccid myelitis versus acute transverse myelitis.
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Affiliation(s)
- Danielle M Gordon
- Department of Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Kavita Thakkar
- Department of Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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14
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Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci 2023; 17:999253. [PMID: 36925966 PMCID: PMC10011113 DOI: 10.3389/fncel.2023.999253] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.
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Affiliation(s)
| | - Veronica J. Tom
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
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15
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Vieira I, Cunha P, Pinto M, Ribeiro S, Sacramento S, Silva A, Almeida C, Guedes I. Anaesthetic management of tetraplegic pregnant patients during child delivery: A systematic review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:224-230. [PMID: 36842688 DOI: 10.1016/j.redare.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/30/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND Pregnancy in spinal cord injured patients has specific issues that must be carefully addressed. However, guidelines for their management are scarce. METHODS A systematic review of the literature regarding the anaesthetic management during delivery of pregnant patients with cervical spinal cord injury was performed on the electronic databases of PubMed (Medline) and Cochrane. RESULTS Twenty-two papers were included. A higher incidence of preterm birth and caesarean delivery were seen. Anaesthetic management was diverse, although most pregnant patients received epidural analgesia. Autonomic dysreflexia symptoms were present in 51% of pregnancies. CONCLUSION Timely management of these patients could possibly reduce caesarean and preterm delivery rates, avoid or minimize common complications, as well as reduce costs. An early reference to anaesthesiology consultation and a multidisciplinary approach is recommended.
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Affiliation(s)
- I Vieira
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - P Cunha
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - M Pinto
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Ribeiro
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Sacramento
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - A Silva
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - C Almeida
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - I Guedes
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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16
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Ferreira A, Nascimento D, Cruz CD. Molecular Mechanism Operating in Animal Models of Neurogenic Detrusor Overactivity: A Systematic Review Focusing on Bladder Dysfunction of Neurogenic Origin. Int J Mol Sci 2023; 24:ijms24043273. [PMID: 36834694 PMCID: PMC9959149 DOI: 10.3390/ijms24043273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
Neurogenic detrusor overactivity (NDO) is a severe lower urinary tract disorder, characterized by urinary urgency, retention, and incontinence, as a result of a neurologic lesion that results in damage in neuronal pathways controlling micturition. The purpose of this review is to provide a comprehensive framework of the currently used animal models for the investigation of this disorder, focusing on the molecular mechanisms of NDO. An electronic search was performed with PubMed and Scopus for literature describing animal models of NDO used in the last 10 years. The search retrieved 648 articles, of which reviews and non-original articles were excluded. After careful selection, 51 studies were included for analysis. Spinal cord injury (SCI) was the most frequently used model to study NDO, followed by animal models of neurodegenerative disorders, meningomyelocele, and stroke. Rats were the most commonly used animal, particularly females. Most studies evaluated bladder function through urodynamic methods, with awake cystometry being particularly preferred. Several molecular mechanisms have been identified, including changes in inflammatory processes, regulation of cell survival, and neuronal receptors. In the NDO bladder, inflammatory markers, apoptosis-related factors, and ischemia- and fibrosis-related molecules were found to be upregulated. Purinergic, cholinergic, and adrenergic receptors were downregulated, as most neuronal markers. In neuronal tissue, neurotrophic factors, apoptosis-related factors, and ischemia-associated molecules are increased, as well as markers of microglial and astrocytes at lesion sites. Animal models of NDO have been crucial for understanding the pathophysiology of lower urinary tract (LUT) dysfunction. Despite the heterogeneity of animal models for NDO onset, most studies rely on traumatic SCI models rather than other NDO-driven pathologies, which may result in some issues when translating pre-clinical observations to clinical settings other than SCI.
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Affiliation(s)
- Ana Ferreira
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde-i3S and IBMC, Universidade do Porto, 4200-319 Porto, Portugal
| | - Diogo Nascimento
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal
| | - Célia Duarte Cruz
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde-i3S and IBMC, Universidade do Porto, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-220426740; Fax: +351-225513655
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17
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Hollis E, Li Y. Nicotinic acetylcholine signaling is required for motor learning but not for rehabilitation from spinal cord injury. Neural Regen Res 2023; 18:364-367. [PMID: 35900431 PMCID: PMC9396487 DOI: 10.4103/1673-5374.346544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Spinal Cord Injury Causes Marked Tissue Rearrangement in the Urethra-Experimental Study in the Rat. Int J Mol Sci 2022; 23:ijms232415951. [PMID: 36555592 PMCID: PMC9783636 DOI: 10.3390/ijms232415951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) results in the time-dependent development of urinary impairment due to neurogenic detrusor overactivity (NDO) and detrusor-sphincter-dyssynergia (DSD). This is known to be accompanied by massive changes in the bladder wall. It is presently less clear if the urethra wall also undergoes remodelling. To investigate this issue, female rats were submitted to complete spinal transection at the T8/T9 level and left to recover for 1 week and 4 weeks. To confirm the presence of SCI-induced NDO, bladder function was assessed by cystometry under urethane anesthesia before euthanasia. Spinal intact animals were used as controls. Urethras were collected and processed for further analysis. Following thoracic SCI, time-dependent changes in the urethra wall were observed. Histological assessment revealed marked urethral epithelium reorganization in response to SCI, as evidenced by an increase in epithelial thickness. At the muscular layer, SCI resulted in strong atrophy of the smooth muscle present in the urethral sphincter. Innervation was also affected, as evidenced by a pronounced decrease in the expression of markers of general innervation, particularly those present in sensory and sympathetic nerve fibres. The present data show an evident impact of SCI on the urethra, with significant histological rearrangement, accompanied by sensory and sympathetic denervation. It is likely that these changes will affect urethral function and contribute to SCI-induced urinary dysfunction, and they deserve further investigation.
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19
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Cui Z, Li Y, Huang S, Wu X, Fu X, Liu F, Wan X, Wang X, Zhang Y, Qiu H, Chen F, Yang P, Zhu S, Li J, Chen W. BCI system with lower-limb robot improves rehabilitation in spinal cord injury patients through short-term training: a pilot study. Cogn Neurodyn 2022; 16:1283-1301. [PMID: 36408074 PMCID: PMC9666612 DOI: 10.1007/s11571-022-09801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/27/2021] [Accepted: 11/04/2021] [Indexed: 12/27/2022] Open
Abstract
In the recent years, the increasing applications of brain-computer interface (BCI) in rehabilitation programs have enhanced the chances of functional recovery for patients with neurological disorders. We presented and validated a BCI system with a lower-limb robot for short-term training of patients with spinal cord injury (SCI). The cores of this system included: (1) electroencephalogram (EEG) features related to motor intention reported through experiments and used to drive the robot; (2) a decision tree to determine the training mode provided for patients with different degrees of injuries. Seven SCI patients (one American Spinal Injury Association Impairment Scale (AIS) A, three AIS B, and three AIS C) participated in the short-term training with this system. All patients could learn to use the system rapidly and maintained a high intensity during the training program. The strength of the lower limb key muscles of the patients was improved. Four AIS A/B patients were elevated to AIS C. The cumulative results indicate that clinical application of the BCI system with lower-limb robot is feasible and safe, and has potentially positive effects on SCI patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11571-022-09801-6.
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Affiliation(s)
- Zhengzhe Cui
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Yongqiang Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sisi Huang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xixi Wu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangxiang Fu
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Fei Liu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaojiao Wan
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Xue Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuting Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huaide Qiu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peijin Yang
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Shiqiang Zhu
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Jianan Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weidong Chen
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China
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20
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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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21
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Stem Cell Strategies in Promoting Neuronal Regeneration after Spinal Cord Injury: A Systematic Review. Int J Mol Sci 2022; 23:ijms232112996. [PMID: 36361786 PMCID: PMC9657320 DOI: 10.3390/ijms232112996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/09/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating condition with a significant medical and socioeconomic impact. To date, no effective treatment is available that can enable neuronal regeneration and recovery of function at the damaged level. This is thought to be due to scar formation, axonal degeneration and a strong inflammatory response inducing a loss of neurons followed by a cascade of events that leads to further spinal cord damage. Many experimental studies demonstrate the therapeutic effect of stem cells in SCI due to their ability to differentiate into neuronal cells and release neurotrophic factors. Therefore, it appears to be a valid strategy to use in the field of regenerative medicine. This review aims to provide an up-to-date summary of the current research status, challenges, and future directions for stem cell therapy in SCI models, providing an overview of this constantly evolving and promising field.
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22
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Gatskiy AA, Tretyak IB, Tsymbaliuk VI, Tsymbaliuk YV. Nerve transfers in a patient with asymmetrical neurological deficit following traumatic cervical spinal cord injury: simultaneous bilateral restoration of pinch grip and elbow extension. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22301. [PMID: 36193034 PMCID: PMC9552560 DOI: 10.3171/case22301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cervical spinal cord injury (CSCI) causes severe motor deficit in upper extremities. The mixed segmental CSCI pattern is reflected in the combination of time-sensitive (TS) and non-TS myotomes in the upper extremities. Nerve transfers (NTs) restore upper extremity function yet remain TS procedures. A combination of neurological, magnetic resonance imaging (MRI), and electromyography (EMG) studies allows the identification of TS and non-TS myotomes in the upper extremities. OBSERVATIONS Nineteen months after NTs, flexor pollicis longus (FPL) and deep flexor of the index finger (FDP2) recovered to M4 (right UE), FPL recovered to M3 and FDP2 to M2 (left EU). The long head of the triceps brachii muscle recovered to M4 bilaterally. The Capabilities of Upper Extremity Questionnaire (CUE-Q) score for unilateral arm functionality increased by 44% (right) and 112.5% (left) and for bilateral arm functionality by 400%; the CUE-Q score for unilateral hand and finger function increased by 283% (right) and 166% (left). LESSONS The combination of neurological, MRI, and EMG studies before surgery and data obtained during surgery provides reliable information on the CSCI pattern, specifically the availability of motor donor nerves. Simultaneous bilateral restoration is required in the event of CSCI and significantly improves the unilateral and bilateral function of the UEs.
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Affiliation(s)
- Alexander A. Gatskiy
- Restorative Neurosurgery Department, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine
| | - Ihor B. Tretyak
- Restorative Neurosurgery Department, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine
| | | | - Yaroslav V. Tsymbaliuk
- Group of Chronic Pain Treatment, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine
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23
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Drotleff N, Jansen O, Weckwerth C, Aach M, Schildhauer TA, Waydhas C, Hamsen U. Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up? BMC Anesthesiol 2022; 22:277. [PMID: 36050640 PMCID: PMC9434085 DOI: 10.1186/s12871-022-01806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the use of vasopressors to maintain haemodynamic goals after acute spinal cord injury (SCI) is still recommended, evidence regarding the target values and possible risks of this practice is limited, and data on haemodynamic parameters unaffected by catecholamines are rare. In this pilot study, we show the haemodynamic profile of patients with acute SCI mainly unaffected by vasopressor use and other factors that influence the cardiovascular system. METHODS From March 2018 to March 2020, we conducted a prospective, single-centre pilot study of 30 patients with acute SCI. Factors that could affect the cardiocirculatory system other than SCI (sepsis, pre-existing heart disease or multiple trauma) led to exclusion. A total of 417 measurements were performed using the PiCCO™ system. RESULTS The mean systemic vascular resistance index (SVRI, 1447.23 ± 324.71 dyn*s*cm-5*m2), mean central venous pressure (CVP, 10.69 ± 3.16) and mean global end-diastolic volume index (GEDVI, 801.79 ± 158.95 ml/m2) deviated from the reference range, while the mean cardiac index (CI), mean stroke volume index (SVI), mean arterial pressure (MAP), and mean heart rate (HR) were within the reference range, as indicated in the literature. A mixed model analysis showed a significant negative relationship between norepinephrine treatment and MAP (83.97 vs. 73.69 mmHg, p < 0.001), SVRI (1463.40 vs. 1332.14 dyn*s*cm-5*m2, p = 0.001) and GEDVI (808.89 vs. 759.39 ml/m2, p = 0.001). CONCLUSION These findings could lead to an adaptation of the target range for SVRI and MAP in patients with acute SCI and therefore reduce the use of vasopressors.
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Affiliation(s)
- Niklas Drotleff
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany.
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | | | - Mirko Aach
- Department of Spinal Cord Injury, BG University Hospital Bergmannsheil, Bochum, Germany
| | | | - Christian Waydhas
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany.,Medical Faculty of the University of Duisburg-Essen, Essen, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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24
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Sangari S, Perez MA. Prevalence of spasticity in humans with spinal cord injury with different injury severity. J Neurophysiol 2022; 128:470-479. [PMID: 35507475 PMCID: PMC9423778 DOI: 10.1152/jn.00126.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022] Open
Abstract
Spasticity is one of the most common symptoms manifested following spinal cord injury (SCI). The aim of this study was to assess spasticity in individuals with subacute and chronic SCI with different injury severity, standardizing the time and assessments of spasticity. We tested 110 individuals with SCI classified by the American Spinal Injury Association Impairment Scale (AIS) as either motor complete (AIS A and B; subacute, n = 25; chronic, n = 33) or motor incomplete (AIS C and D; subacute, n = 23; chronic, n = 29) at a similar time after injury (subacute, ∼1 mo after injury during inpatient rehabilitation and chronic, ≥1 yr after injury) using clinical (modified Ashworth scale) and kinematic (pendulum test) outcomes to assess spasticity in the quadriceps femoris muscle. Using both methodologies, we found that among individuals with subacute motor complete injuries, only a minority showed spasticity, whereas the majority exhibited no spasticity. This finding stands in contrast to individuals with subacute motor incomplete injury, where both methodologies revealed that a majority exhibited spasticity, whereas a minority exhibited no spasticity. In chronic injuries, most individuals showed spasticity regardless of injury severity. Notably, when spasticity was present, its magnitude was similar across injury severity in both subacute and chronic injuries. Our results suggest that the prevalence, not the magnitude, of spasticity differs between individuals with motor complete and incomplete SCI in the subacute and chronic stages of the injury. We thus argue that considering the "presence of spasticity" might help the stratification of participants with motor complete injuries for clinical trials.NEW & NOTEWORTHY The prevalence of spasticity in humans with SCI remains poorly understood. Using kinematic and clinical outcomes, we examined spasticity in individuals with subacute and chronic injuries of different severity. We found that spasticity in the quadriceps femoris muscle was more prevalent among individuals with subacute motor incomplete than in those with motor complete injuries. However, in a different group of individuals with chronic injuries, no differences were found in the prevalence of spasticity across injury severity.
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Affiliation(s)
| | - Monica A Perez
- Shirley Ryan AbilityLab, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
- Edward Hines Jr., VA Hospital, Hines, Illinois
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Freyermuth-Trujillo X, Segura-Uribe JJ, Salgado-Ceballos H, Orozco-Barrios CE, Coyoy-Salgado A. Inflammation: A Target for Treatment in Spinal Cord Injury. Cells 2022; 11:cells11172692. [PMID: 36078099 PMCID: PMC9454769 DOI: 10.3390/cells11172692] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) is a significant cause of disability, and treatment alternatives that generate beneficial outcomes and have no side effects are urgently needed. SCI may be treatable if intervention is initiated promptly. Therefore, several treatment proposals are currently being evaluated. Inflammation is part of a complex physiological response to injury or harmful stimuli induced by mechanical, chemical, or immunological agents. Neuroinflammation is one of the principal secondary changes following SCI and plays a crucial role in modulating the pathological progression of acute and chronic SCI. This review describes the main inflammatory events occurring after SCI and discusses recently proposed potential treatments and therapeutic agents that regulate inflammation after insult in animal models.
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Affiliation(s)
- Ximena Freyermuth-Trujillo
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico
| | - Julia J. Segura-Uribe
- Subdirección de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City CP 06720, Mexico
| | - Hermelinda Salgado-Ceballos
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
| | - Carlos E. Orozco-Barrios
- CONACyT-Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
| | - Angélica Coyoy-Salgado
- CONACyT-Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
- Correspondence: ; Tel.: +52-55-2498-5223
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Michel-Flutot P, Efthimiadi L, Djerbal L, Deramaudt TB, Bonay M, Vinit S. AMPK-Nrf2 Signaling Pathway in Phrenic Motoneurons following Cervical Spinal Cord Injury. Antioxidants (Basel) 2022; 11:antiox11091665. [PMID: 36139739 PMCID: PMC9495920 DOI: 10.3390/antiox11091665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
High spinal cord injuries (SCI) induce the deafferentation of phrenic motoneurons, leading to permanent diaphragm paralysis. This involves secondary injury associated with pathologic and inflammatory processes at the site of injury, and at the level of phrenic motoneurons. In the present study, we evaluated the antioxidant response in phrenic motoneurons involving the AMPK-Nrf2 signaling pathway following C2 spinal cord lateral hemi-section in rats. We showed that there is an abrupt reduction in the expression of phosphorylated AMPK and Nrf2 at one hour post-injury in phrenic motoneurons. A rebound is then observed at one day post-injury, reflecting a return to homeostasis condition. In the total spinal cord around phrenic motoneurons, the increase in phosphorylated AMPK and Nrf2 occurred at three days post-injury, showing the differential antioxidant response between phrenic motoneurons and other cell types. Taken together, our results display the implication of the AMPK-Nrf2 signaling pathway in phrenic motoneurons’ response to oxidative stress following high SCI. Harnessing this AMPK-Nrf2 signaling pathway could improve the antioxidant response and help in spinal rewiring to these deafferented phrenic motoneurons to improve diaphragm activity in patients suffering high SCI.
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da Cruz Tobelem D, Silva T, Araujo T, Andreo L, Malavazzi TCDS, Horliana ACRT, Fernandes KPS, Bussadori SK, Mesquita-Ferrari RA. Effects of photobiomodulation in experimental spinal cord injury models: A systematic review. JOURNAL OF BIOPHOTONICS 2022; 15:e202200059. [PMID: 35484784 DOI: 10.1002/jbio.202200059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
This systematic review investigated the repercussions of photobiomodulation using low-level laser therapy (LLLT) for the treatment of spinal cord injury (SCI) in experimental models. Studies were identified from relevant databases published between January 2009 and December 2021. Nineteen original articles were selected and 68.4% used light at an infrared wavelength. There was a considerable variation of the power used (from 25 to 200 mW), total application time (8-3000 s) and total energy (0.3-450 J). In 79% of the studies, irradiation was initiated immediately after or within 2 h of the SCI, and treatment time ranged continuously from 5 to 21 days. In conclusion, LLLT can be an auxiliary therapy in the treatment of SCI, playing a neuroprotective role, enabling functional recovery, increasing the concentration of nerve connections around the injury site and reducing pro-inflammatory cytokines. However, there is a need for standardization in the dosimetric parameters.
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Affiliation(s)
- Daysi da Cruz Tobelem
- Postgraduate Program in Biophotonics Applied to the Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Tamiris Silva
- Postgraduate Program in Rehabilitation Sciences, UNINOVE, São Paulo, SP, Brazil
| | - Tamires Araujo
- Postgraduate Program in Biophotonics Applied to the Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Lucas Andreo
- Postgraduate Program in Biophotonics Applied to the Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | | | | | | | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to the Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, UNINOVE, São Paulo, SP, Brazil
| | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to the Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, UNINOVE, São Paulo, SP, Brazil
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Panisset MG, El-Ansary D, Dunlop SA, Marshall R, Clark J, Churilov L, Galea MP. Factors influencing thigh muscle volume change with cycling exercises in acute spinal cord injury - a secondary analysis of a randomized controlled trial. J Spinal Cord Med 2022; 45:510-521. [PMID: 32970970 PMCID: PMC9246176 DOI: 10.1080/10790268.2020.1815480] [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] [Indexed: 01/16/2023] Open
Abstract
Objective: To conduct a per-protocol analysis on thigh muscle volume outcomes from the Spinal Cord Injury and Physical Activity (SCIPA) Switch-On Trial.Design: Secondary analysis from an assessor-blind randomized, controlled trial.Setting: Four acute/sub-acute hospitals in Australia and New Zealand.Participants: 24 adults (1 female) within four weeks of motor complete or incomplete spinal cord injury (SCI)Intervention: Functional electrical stimulation-assisted cycling (FESC) or passive cycling (PC) 4x/week for 12 weeks.Outcome Measures: Whole thigh and muscle group volumes calculated from manually segmented MR images.Results: 19/24 participants completed ≥ twelve weeks of the intervention. Five participants experienced hypertrophy (4 FESC; 1 PC) and eight attenuation of atrophy (<20% volume loss) (3 FESC; 5 PC) in thigh muscle volume. Six participants were non-responders, exhibiting atrophy >20% (3 FESC; 3 PC). Mean (SD) change for FESC was -2.3% (25.3%) and PC was -14.0% (12.3%). After controlling for baseline muscle volumes, a strong significant correlation was found between mean weekly exercise frequency and quadriceps and hamstring volumes (r=6.25, P=0.006), regardless of mode. Average watts was highly correlated to quadriceps volumes only (r=5.92, P=0.01), while total number of sessions was strongly correlated with hamstring volumes only (r=5.91, P=0.01).Conclusion: This per-protocol analysis of FESC and PC early after SCI reports a partial response in 42% and a beneficial response in 25% of patients who completed 12 weeks intervention, regardless of mode. Strong correlations show a dose-response according to exercise frequency. Characteristics of non-responders are discussed to inform clinical decision-making.
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Affiliation(s)
- Maya G. Panisset
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Australia,Correspondence to: Maya G. Panisset, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC3052, Australia; Ph: (+61) 0405 027 127.
| | - Doa El-Ansary
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorne, Australia,Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Sarah Alison Dunlop
- School of Biological Sciences, The University of Western Australia, Perth, Australia
| | - Ruth Marshall
- Hampstead Rehabilitation Centre, Northfield, Australia
| | - Jillian Clark
- Hampstead Rehabilitation Centre, Lightsview, Australia
| | | | - Mary P. Galea
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Australia
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Tauroursodeoxycholic Acid Reduces Neuroinflammation but Does Not Support Long Term Functional Recovery of Rats with Spinal Cord Injury. Biomedicines 2022; 10:biomedicines10071501. [PMID: 35884805 PMCID: PMC9313003 DOI: 10.3390/biomedicines10071501] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
The bile acid tauroursodeoxycholic acid (TUDCA) reduces cell death under oxidative stress and inflammation. Implants of bone marrow-derived stromal cells (bmSC) are currently under investigation in clinical trials of spinal cord injury (SCI). Since cell death of injected bmSC limits the efficacy of this treatment, the cytoprotective effect of TUDCA may enhance its benefit. We therefore studied the therapeutic effect of TUDCA and its use as a combinatorial treatment with human bmSC in a rat model of SCI. A spinal cord contusion injury was induced at thoracic level T9. Treatment consisted of i.p. injections of TUDCA alone or in combination with one injection of human bmSC into the cisterna magna. The recovery of motor functions was assessed during a surveillance period of six weeks. Biochemical and histological analysis of spinal cord tissue confirmed the anti-inflammatory activity of TUDCA. Treatment improved the recovery of autonomic bladder control and had a positive effect on motor functions in the subacute phase, however, benefits were only transient, such that no significant differences between vehicle and TUDCA-treated animals were observed 1–6 weeks after the lesion. Combinatorial treatment with TUDCA and bmSC failed to have an additional effect compared to treatment with bmSC only. Our data do not support the use of TUDCA as a treatment of SCI.
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Thomas AX, Riviello JJ, Davila-Williams D, Thomas SP, Erklauer JC, Bauer DF, Cokley JA. Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children. Curr Treat Options Neurol 2022; 24:285-304. [PMID: 35702419 PMCID: PMC9184374 DOI: 10.1007/s11940-022-00720-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review This review provides guidance for acute spinal cord injury (SCI) management through an analytical assessment of the most recent evidence on therapies available for treating SCI, including newer therapies under investigation. We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognostication, with additional emphasis on the pediatric population when evidence is available. Recent Findings Further studies since the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) demonstrated a potential functional outcome benefit with ultra-early surgical intervention ≤ 8 h post-SCI. Subsequent analysis of the National Acute Spinal Cord Injury Study (NASCIS) II and NASCIS III trials have demonstrated potentially serious complications from intravenous methylprednisolone with limited benefit. Newer therapies actively being studied have demonstrated limited or no benefit in preclinical and clinical trials with insufficient evidence to support use in acute SCI treatment. Summary Care for SCI patients requires a multi-disciplinary team. Immediate evaluation and management are focused on preventing additional injury and restoring perfusion to the affected cord. Rapid assessment and intervention involve focused neurological examination, targeted imaging, and surgical intervention when indicated. There are currently no evidence-based recommendations for pathomechanistically targeted therapies.
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Affiliation(s)
- Ajay X. Thomas
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX USA
| | - James J. Riviello
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Daniel Davila-Williams
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Sruthi P. Thomas
- Division of Pediatric Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX USA
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Jennifer C. Erklauer
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - David F. Bauer
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Jon A. Cokley
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Department of Pharmacy, Baylor College of Medicine, Houston, TX USA
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Gouveia D, Cardoso A, Carvalho C, Gonçalves AR, Gamboa Ó, Canejo-Teixeira R, Ferreira A, Martins Â. Influence of Spinal Shock on the Neurorehabilitation of ANNPE Dogs. Animals (Basel) 2022; 12:ani12121557. [PMID: 35739893 PMCID: PMC9219513 DOI: 10.3390/ani12121557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Acute noncompressive nucleus pulposus extrusion (ANNPE) is related to contusive spinal cord injuries, and dogs usually appear to be exercising vigorously at the time of onset. ANNPE has a characteristic peracute onset of clinical signs during exercise or following trauma, with non-progressive signs during the first 24 h and possibly signs of spinal shock. The main aim was to assess if the presence of spinal shock affects the neurorehabilitation outcomes of ANNPE dogs. This prospective controlled cohort clinical study was conducted at the Arrábida Rehabilitation Center. All of the dogs had T3−L3 injuries and were paraplegic/monoplegic with/without nociception, the study group (n = 14) included dogs with ANNPE spinal shock dogs, and the control group (n = 19) included ANNPE dogs without spinal shock. The study group was also evaluated using a new scale—the Spinal Shock Scale (SSS)—and both groups were under the same intensive neurorehabilitation protocol. Spinal shock was a negative factor for a successful outcome within less time. SSS scores > 4 required additional hospitalization days. The protocol was safe, tolerable, and feasible and accomplished 32% ambulation within 7 days, 29% in 14 days, and 29% in 30 days. The results were better than those obtained in previous studies—94% at 60 days—and 75% of the dogs without nociception recovered ambulation. Long-term follows-ups carried out 4 years later revealed a positive evolution.
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Affiliation(s)
- Débora Gouveia
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Correspondence:
| | - Ana Cardoso
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
| | - Carla Carvalho
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
| | - Ana Rita Gonçalves
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal; (A.R.G.); (R.C.-T.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal; (Ó.G.); (A.F.)
| | - Rute Canejo-Teixeira
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal; (A.R.G.); (R.C.-T.)
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal; (Ó.G.); (A.F.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-538 Setúbal, Portugal; (A.C.); (C.C.); (Â.M.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal; (A.R.G.); (R.C.-T.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal
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32
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Kaneyama H, Kawano O, Morishita Y, Yamamoto T, Maeda T. Predicting motor function recovery in cervical spinal cord injury-induced complete paralysis with reflex response. Spinal Cord 2022; 60:1020-1022. [PMID: 35662288 DOI: 10.1038/s41393-022-00821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A retrospective clinical study. OBJECTIVE To elucidate the usefulness of the patellar tendon reflex (PTR), bulbocavernosus reflex (BCR), and plantar response (PR) as factors in the prognostic prediction of motor function in complete paralysis due to cervical spinal cord injuries (CSCIs) at the acute phase. SETTING Department of Orthopedic Surgery, Spinal Injuries Center, Japan. METHODS 99 patients assessed as the American Spinal Injury Association Impairment Scale (AIS) grade A (AIS A) were included in this study. The PTR, BCR, and PR were evaluated respectively as positive or negative at the time of injury. We classified the patients into two groups based on their neurological recovery at 3 months after injury: "recovered" group was defined as AIS C, D, or E; "non-recovered" group was defined as AIS A or B. RESULTS Eight patients demonstrated positive PTR, while 91 demonstrated negative. Three out of eight patients with positive PTR (37.5%) were R group, while 83 out of 91 patients with negative PTR (91.2%) were N group. A significant difference was observed (p = 0.043). For BCR, no significant difference was observed (p > 0.05). Twenty-six patients demonstrated positive PTR, while 73 demonstrated negative. Nine out of twenty-six patients with positive PR (34.6%) were R group, while 71 out of 73 patients with negative PR (97.3%) were N group. A significant difference was observed (p = 0.000068). CONCLUSION The PTR and PR are useful for poor prognostic prediction of motor function in CSCI at the acute phase.
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Affiliation(s)
- Hironari Kaneyama
- Department of Orthopedic Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan. .,Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
| | - Osamu Kawano
- Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan
| | | | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan
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Hofer AS, Scheuber MI, Sartori AM, Good N, Stalder SA, Hammer N, Fricke K, Schalbetter SM, Engmann AK, Weber RZ, Rust R, Schneider MP, Russi N, Favre G, Schwab ME. Stimulation of the cuneiform nucleus enables training and boosts recovery after spinal cord injury. Brain 2022; 145:3681-3697. [PMID: 35583160 PMCID: PMC9586551 DOI: 10.1093/brain/awac184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Severe spinal cord injuries result in permanent paraparesis in spite of the frequent sparing of small portions of white matter. Spared fibre tracts are often incapable of maintaining and modulating the activity of lower spinal motor centres. Effects of rehabilitative training thus remain limited. Here, we activated spared descending brainstem fibres by electrical deep brain stimulation of the cuneiform nucleus of the mesencephalic locomotor region, the main control centre for locomotion in the brainstem, in adult female Lewis rats. We show that deep brain stimulation of the cuneiform nucleus enhances the weak remaining motor drive in highly paraparetic rats with severe, incomplete spinal cord injuries and enables high-intensity locomotor training. Stimulation of the cuneiform nucleus during rehabilitative aquatraining after subchronic (n = 8 stimulated versus n = 7 unstimulated versus n = 7 untrained rats) and chronic (n = 14 stimulated versus n = 9 unstimulated versus n = 9 untrained rats) spinal cord injury re-established substantial locomotion and improved long-term recovery of motor function. We additionally identified a safety window of stimulation parameters ensuring context-specific locomotor control in intact rats (n = 18) and illustrate the importance of timing of treatment initiation after spinal cord injury (n = 14). This study highlights stimulation of the cuneiform nucleus as a highly promising therapeutic strategy to enhance motor recovery after subchronic and chronic incomplete spinal cord injury with direct clinical applicability.
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Affiliation(s)
- Anna-Sophie Hofer
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Myriam I Scheuber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Andrea M Sartori
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicolas Good
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Stephanie A Stalder
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicole Hammer
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Kai Fricke
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Sina M Schalbetter
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Anne K Engmann
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Rebecca Z Weber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Ruslan Rust
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Marc P Schneider
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Natalie Russi
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Giacomin Favre
- Department of Economics, University of Zurich, 8032 Zurich, Switzerland
| | - Martin E Schwab
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland.,Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
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Frers F, Hellige M, Franke S, Puff C, Delling U, Feige K. Schiff‐Sherrington syndrome
in a 7‐year‐old zebra mare (
Equus quagga
). EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F. Frers
- Clinic for Horses University of Veterinary Medicine Hannover, Foundation Hannover Germany
| | - M. Hellige
- Clinic for Horses University of Veterinary Medicine Hannover, Foundation Hannover Germany
| | - S. Franke
- Department of Pathology University of Veterinary Medicine Hannover, Foundation Hannover Germany
| | - C. Puff
- Department of Pathology University of Veterinary Medicine Hannover, Foundation Hannover Germany
| | - U. Delling
- Clinic for Horses University of Veterinary Medicine Hannover, Foundation Hannover Germany
| | - K. Feige
- Clinic for Horses University of Veterinary Medicine Hannover, Foundation Hannover Germany
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Temporal and spatial cellular and molecular pathological alterations with single-cell resolution in the adult spinal cord after injury. Signal Transduct Target Ther 2022; 7:65. [PMID: 35232960 PMCID: PMC8888618 DOI: 10.1038/s41392-022-00885-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) involves diverse injury responses in different cell types in a temporally and spatially specific manner. Here, using single-cell transcriptomic analyses combined with classic anatomical, behavioral, electrophysiological analyses, we report, with single-cell resolution, temporal molecular and cellular changes in crush-injured adult mouse spinal cord. Data revealed pathological changes of 12 different major cell types, three of which infiltrated into the spinal cord at distinct times post-injury. We discovered novel microglia and astrocyte subtypes in the uninjured spinal cord, and their dynamic conversions into additional stage-specific subtypes/states. Most dynamic changes occur at 3-days post-injury and by day-14 the second wave of microglial activation emerged, accompanied with changes in various cell types including neurons, indicative of the second round of attacks. By day-38, major cell types are still substantially deviated from uninjured states, demonstrating prolonged alterations. This study provides a comprehensive mapping of cellular/molecular pathological changes along the temporal axis after SCI, which may facilitate the development of novel therapeutic strategies, including those targeting microglia.
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36
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Zhang JK, Botterbush KS, del Valle AJ, Mattei TA. Political Rivalry during the American Founding Fathers’ Era and the Bullet that ended up in Alexander Hamilton’s Upper Lumbar Spine. World Neurosurg 2022; 163:123-131.e2. [DOI: 10.1016/j.wneu.2022.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
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37
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Minic Z, O’Leary DS, Reynolds CA. Spinal Reflex Control of Arterial Blood Pressure: The Role of TRP Channels and Their Endogenous Eicosanoid Modulators. Front Physiol 2022; 13:838175. [PMID: 35283783 PMCID: PMC8904930 DOI: 10.3389/fphys.2022.838175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/26/2022] [Indexed: 01/14/2023] Open
Abstract
The spinal cord is an important integrative center for blood pressure control. Spinal sensory fibers send projections to sympathetic preganglionic neurons of the thoracic spinal cord and drive sympathetically-mediated increases in blood pressure. While these reflexes responses occur in able-bodied individuals, they are exaggerated following interruption of descending control - such as occurs following spinal cord injury. Similar reflex control of blood pressure may exist in disease states, other than spinal cord injury, where there is altered input to sympathetic preganglionic neurons. This review primarily focuses on mechanisms wherein visceral afferent information traveling via spinal nerves influences sympathetic nerve activity and blood pressure. There is an abundance of evidence for the widespread presence of this spinal reflex arch originating from virtually every visceral organ and thus having a substantial role in blood pressure control. Additionally, this review highlights specific endogenous eicosanoid species, which modulate the activity of afferent fibers involved in this reflex, through their interactions with transient receptor potential (TRP) cation channels.
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Affiliation(s)
- Zeljka Minic
- Department of Emergency Medicine Wayne State University School of Medicine, Detroit, MI, United States
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Donal S. O’Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Christian A. Reynolds
- Department of Emergency Medicine Wayne State University School of Medicine, Detroit, MI, United States
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
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38
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McBride R, Parker E, Garabed RB, Olby NJ, Tipold A, Stein VM, Granger N, Hechler AC, Yaxley PE, Moore SA. Developing a predictive model for spinal shock in dogs with spinal cord injury. J Vet Intern Med 2022; 36:663-671. [PMID: 35001437 PMCID: PMC8965241 DOI: 10.1111/jvim.16352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4-S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3-L3 myelopathy and concurrent spinal shock. HYPOTHESIS/OBJECTIVES We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries. ANIMALS Cohort of 59 dogs with T3-L3 myelopathies and spinal shock and 13 dogs with L4-S3 myelopathies. METHODS Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤ .1) on the odds of spinal shock in univariable logistic regression. RESULTS The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P = .09; confidence interval [CI] 0.07-1.2), increasing duration (OR = 0.44, P = .02; CI 0.21-0.9), decreased pelvic limb tone (OR = 0.04, P = .003; CI 0.01-0.36), and increased in the presence of paraplegia (OR = 7.87, P = .04; CI 1.1-56.62). CONCLUSIONS AND CLINICAL IMPORTANCE A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning.
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Affiliation(s)
- Rebecca McBride
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Elizabeth Parker
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Rebecca B Garabed
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Veronika Maria Stein
- Department of Clinical Veterinary Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Nicolas Granger
- Department of Small Animal Clinical Sciences, School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - Ashley C Hechler
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Page E Yaxley
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
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39
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Taran S, McCredie VA, Goligher EC. Noninvasive and invasive mechanical ventilation for neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:361-386. [PMID: 36031314 DOI: 10.1016/b978-0-323-91532-8.00015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with acute neurologic injuries frequently require mechanical ventilation due to diminished airway protective reflexes, cardiopulmonary failure secondary to neurologic insults, or to facilitate gas exchange to precise targets. Mechanical ventilation enables tight control of oxygenation and carbon dioxide levels, enabling clinicians to modulate cerebral hemodynamics and intracranial pressure with the goal of minimizing secondary brain injury. In patients with acute spinal cord injuries, neuromuscular conditions, or diseases of the peripheral nerve, mechanical ventilation enables respiratory support under conditions of impending or established respiratory failure. Noninvasive ventilatory approaches may be carefully considered for certain disease conditions, including myasthenia gravis and amyotrophic lateral sclerosis, but may be inappropriate in patients with Guillain-Barré syndrome or when relevant contra-indications exist. With regard to discontinuing mechanical ventilation, considerable uncertainty persists about the best approach to wean patients, how to identify patients ready for extubation, and when to consider primary tracheostomy. Recent consensus guidelines highlight these and other knowledge gaps that are the focus of active research efforts. This chapter outlines important general principles to consider when initiating, titrating, and discontinuing mechanical ventilation in patients with acute neurologic injuries. Important disease-specific considerations are also reviewed where appropriate.
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Affiliation(s)
- Shaurya Taran
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada.
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40
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Foran SJ, Taran S, Singh JM, Kutsogiannis DJ, McCredie V. Timing of tracheostomy in acute traumatic spinal cord injury: A systematic review and meta-analysis. J Trauma Acute Care Surg 2022; 92:223-231. [PMID: 34508010 PMCID: PMC8677619 DOI: 10.1097/ta.0000000000003394] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute traumatic cervical or high thoracic level spinal cord injury (SCI) typically require mechanical ventilation (MV) during their acute admission. Placement of a tracheostomy is preferred when prolonged weaning from MV is anticipated. However, the optimal timing of tracheostomy placement in patients with acute traumatic SCI remains uncertain. We systematically reviewed the literature to determine the effects of early versus late tracheostomy or prolonged intubation in patients with acute traumatic SCI on important clinical outcomes. METHODS Six databases were searched from their inception to January 2020. Conference abstracts from relevant proceedings and the gray literature were searched to identify additional studies. Data were obtained by two independent reviewers to ensure accuracy and completeness. The quality of observational studies was evaluated using the Newcastle Ottawa Scale. RESULTS Seventeen studies (2,804 patients) met selection criteria, 14 of which were published after 2009. Meta-analysis showed that early tracheostomy was not associated with decreased short-term mortality (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.39-1.79; p = 0.65; n = 2,072), but was associated with a reduction in MV duration (mean difference [MD], 13.1 days; 95% CI, -6.70 to -21.11; p = 0.0002; n = 855), intensive care unit length of stay (MD, -10.20 days; 95% CI, -4.66 to -15.74; p = 0.0003; n = 855), and hospital length of stay (MD, -7.39 days; 95% CI, -3.74 to -11.03; p < 0.0001; n = 423). Early tracheostomy was also associated with a decreased incidence of ventilator-associated pneumonia and tracheostomy-related complications (RR, 0.86; 95% CI, 0.75-0.98; p = 0.02; n = 2,043 and RR, 0.64; 95% CI, 0.48-0.84; p = 0.001; n = 812 respectively). The majority of studies ranked as good methodologic quality on the Newcastle Ottawa Scale. CONCLUSION Early tracheostomy in patients with acute traumatic SCI may reduce duration of mechanical entilation, length of intensive care unit stay, and length of hospital stay. Current studies highlight the lack of high-level evidence to guide the optimal timing of tracheostomy in acute traumatic SCI. Future research should seek to understand whether early tracheostomy improves patient comfort, decreases duration of sedation, and improves long-term outcomes. LEVEL OF EVIDENCE Systematic Review, level III.
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41
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Navarro JC, Kofke WA. Perioperative Management of Acute Central Nervous System Injury. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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42
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Wang TY, Park C, Zhang H, Rahimpour S, Murphy KR, Goodwin CR, Karikari IO, Than KD, Shaffrey CI, Foster N, Abd-El-Barr MM. Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature. Front Surg 2021; 8:698736. [PMID: 34966774 PMCID: PMC8710452 DOI: 10.3389/fsurg.2021.698736] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022] Open
Abstract
Traumatic spinal cord injury (TSCI) is a debilitating disease that poses significant functional and economic burden on both the individual and societal levels. Prognosis is dependent on the extent of the spinal injury and the severity of neurological dysfunction. If not treated rapidly, patients with TSCI can suffer further secondary damage and experience escalating disability and complications. It is important to quickly assess the patient to identify the location and severity of injury to make a decision to pursue a surgical and/or conservative management. However, there are many conditions that factor into the management of TSCI patients, ranging from the initial presentation of the patient to long-term care for optimal recovery. Here, we provide a comprehensive review of the etiologies of spinal cord injury and the complications that may arise, and present an algorithm to aid in the management of TSCI.
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Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Christine Park
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Hanci Zhang
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, United States
| | - Shervin Rahimpour
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Kelly R Murphy
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - C Rory Goodwin
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Isaac O Karikari
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Khoi D Than
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Christopher I Shaffrey
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
| | - Norah Foster
- Premier Orthopedics, Centerville, OH, United States
| | - Muhammad M Abd-El-Barr
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC, United States
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Jogia T, Kopp MA, Schwab JM, Ruitenberg MJ. Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury. Curr Opin Neurol 2021; 34:796-803. [PMID: 34608075 PMCID: PMC8631147 DOI: 10.1097/wco.0000000000000995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW To date, prognostication of patients after acute traumatic spinal cord injury (SCI) mostly relies on the neurological assessment of residual function attributed to lesion characteristics. With emerging treatment candidates awaiting to be tested in early clinical trials, there is a need for wholistic high-yield prognostic biomarkers that integrate both neurogenic and nonneurogenic SCI pathophysiology as well as premorbid patient characteristics. RECENT FINDINGS It is becoming clearer that effective prognostication after acute SCI would benefit from integrating an assessment of pathophysiological changes on a systemic level, and with that, extend from a lesion-centric approach. Immunological markers mirror tissue injury as well as host immune function and are easily accessible through routine blood sampling. New studies have highlighted the value of circulating white blood cells, neutrophils and lymphocytes in particular, as prognostic systemic indicators of SCI severity and outcomes. SUMMARY We survey recent advances in methods and approaches that may allow for a more refined diagnosis and better prognostication after acute SCI, discuss how these may help deepen our understanding of SCI pathophysiology, and be of use in clinical trials.
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Affiliation(s)
- Trisha Jogia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Marcel A. Kopp
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan M. Schwab
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Belford Center for Spinal Cord Injury, Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Marc J. Ruitenberg
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Bravar G, Luchesa Smith A, Siddiqui A, Lim M. Acute Myelopathy in Childhood. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1055. [PMID: 34828768 PMCID: PMC8618498 DOI: 10.3390/children8111055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022]
Abstract
Acute myelopathy presenting in childhood can be clinically classified based on the location of injury (with resulting spinal syndrome) or the cause (broadly traumatic or non-traumatic). Types of nontraumatic myelopathy include ischaemic, infectious, inflammatory, nutritional, and metabolic causes, some of which may be part of a systemic illness such as systemic lupus erythematosus or a demyelinating disease such as multiple sclerosis. Nonaccidental injury is an important consideration in cases of traumatic myelopathy, which may often be associated with other injuries. Assessment should include neuroimaging of the brain and spinal cord, with further investigations targeted based on the most likely differential diagnoses; for example, a child with suspected demyelinating disease may require specialist cerebrospinal fluid and serological testing. Management also will differ based on the cause of the myelopathy, with several of these treatments more efficacious with earlier initiation, necessitating prompt recognition, diagnosis, and treatment of children presenting with symptoms of a myelopathy. Important components of holistic care may include physiotherapy and occupational therapy, with multidisciplinary team involvement as required (for example psychological support or specialist bowel and bladder teams).
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Affiliation(s)
- Giulia Bravar
- Department of Paediatrics, Hospital Santa Maria della Misericordia, 33100 Udine, Italy;
| | | | - Ata Siddiqui
- Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
- Department of Neuroradiology, King’s College Hospital, London SE5 9RS, UK
| | - Ming Lim
- Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9NU, UK
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45
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Hogg FRA, Kearney S, Solomon E, Gallagher MJ, Zoumprouli A, Papadopoulos MC, Saadoun S. Acute, severe traumatic spinal cord injury: improving urinary bladder function by optimizing spinal cord perfusion. J Neurosurg Spine 2021; 36:145-152. [PMID: 34479207 DOI: 10.3171/2021.3.spine202056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to investigate the effect of acute, severe traumatic spinal cord injury on the urinary bladder and the hypothesis that increasing the spinal cord perfusion pressure improves bladder function. METHODS In 13 adults with traumatic spinal cord injury (American Spinal Injury Association Impairment Scale grades A-C), a pressure probe and a microdialysis catheter were placed intradurally at the injury site. We varied the spinal cord perfusion pressure and performed filling cystometry. Patients were followed up for 12 months on average. RESULTS The 13 patients had 63 fill cycles; 38 cycles had unfavorable urodynamics, i.e., dangerously low compliance (< 20 mL/cmH2O), detrusor overactivity, or dangerously high end-fill pressure (> 40 cmH2O). Unfavorable urodynamics correlated with periods of injury site hypoperfusion (spinal cord perfusion pressure < 60 mm Hg), hyperperfusion (spinal cord perfusion pressure > 100 mm Hg), tissue glucose < 3 mM, and tissue lactate to pyruvate ratio > 30. Increasing spinal cord perfusion pressure from 67.0 ± 2.3 mm Hg (average ± SE) to 92.1 ± 3.0 mm Hg significantly reduced, from 534 to 365 mL, the median bladder volume at which the desire to void was first experienced. All patients with dangerously low average initial bladder compliance (< 20 mL/cmH2O) maintained low compliance at follow-up, whereas all patients with high average initial bladder compliance (> 100 mL/cmH2O) maintained high compliance at follow-up. CONCLUSIONS We conclude that unfavorable urodynamics develop within days of traumatic spinal cord injury, thus challenging the prevailing notion that the detrusor is initially acontractile. Urodynamic studies performed acutely identify patients with dangerously low bladder compliance likely to benefit from early intervention. At this early stage, bladder function is dynamic and is influenced by fluctuations in the physiology and metabolism at the injury site; therefore, optimizing spinal cord perfusion is likely to improve urological outcome in patients with acute severe traumatic spinal cord injury.
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Affiliation(s)
| | - Siobhan Kearney
- 1Academic Neurosurgery Unit, St. George's, University of London
| | - Eskinder Solomon
- 2Department of Urology, Guy's and St. Thomas' NHS Foundation Trust; and
| | | | - Argyro Zoumprouli
- 3Neuro-Intensive Care Unit, St. George's Hospital, London, United Kingdom
| | | | - Samira Saadoun
- 1Academic Neurosurgery Unit, St. George's, University of London
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Who recovers independent bowel management during the first year following a traumatic spinal cord injury? A case-control study. Am J Phys Med Rehabil 2021; 101:307-313. [PMID: 34483265 DOI: 10.1097/phm.0000000000001871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 1) document the characteristics of patients with impaired bowel functioning during the subacute and chronic phases; 2) identify factors associated with recovery of independent bowel functioning during the first year following TSCI in patients who present impaired bowel functioning during the subacute phase, when bowel rehabilitation is completed. DESIGN Case-control study on 123 adult TSCI patients. Bowel function assessments using item 7 of the SCIM-III were obtained 3-months following TSCI and during the early chronic phase. Univariate and multivariate analyses were conducted to identify predictors associated with recovery of independent bowel functioning between the initial assessment and follow-up. RESULTS Of the 110 patients available for analysis, 54 (49%) displayed impaired bowel functioning 3-months following TSCI. Of these, 19 (35%) recovered independent bowel functioning over the following 9 months. The total motor score (TMS) was the only significant predictor of this outcome. A TMS lower than 42 was 100% predictive of absence of recovery. CONCLUSION Recovering independent bowel management 1-year after TSCI was possible in 35% of patients despite impaired bowel functioning during the subacute phase. TMS measured 3-months post-injury could be useful for prognosticating potential for bowel functioning recovery since patients with TMS < 42 are unlikely to recover.
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Tang F, Tang J, Zhao Y, Zhang J, Xiao Z, Chen B, Han G, Yin N, Jiang X, Zhao C, Cheng S, Wang Z, Chen Y, Chen Q, Song K, Zhang Z, Niu J, Wang L, Shi Q, Chen L, Yang H, Hou S, Zhang S, Dai J. Long-term clinical observation of patients with acute and chronic complete spinal cord injury after transplantation of NeuroRegen scaffold. SCIENCE CHINA-LIFE SCIENCES 2021; 65:909-926. [PMID: 34406569 DOI: 10.1007/s11427-021-1985-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
Spinal cord injury (SCI) often results in an inhibitory environment at the injury site. In our previous studies, transplantation of a scaffold combined with stem cells was proven to induce neural regeneration in animal models of complete SCI. Based on these preclinical studies, collagen scaffolds loaded with the patients' own bone marrow mononuclear cells or human umbilical cord mesenchymal stem cells were transplanted into SCI patients. Fifteen patients with acute complete SCI and 51 patients with chronic complete SCI were enrolled and followed up for 2 to 5 years. No serious adverse events related to functional scaffold transplantation were observed. Among the patients with acute SCI, five patients achieved expansion of their sensory positions and six patients recovered sensation in the bowel or bladder. Additionally, four patients regained voluntary walking ability accompanied by reconnection of neural signal transduction. Among patients with chronic SCI, 16 patients achieved expansion of their sensation level and 30 patients experienced enhanced reflexive defecation sensation or increased skin sweating below the injury site. Nearly half of the patients with chronic cervical SCI developed enhanced finger activity. These long-term follow-up results suggest that functional scaffold transplantation may represent a feasible treatment for patients with complete SCI.
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Affiliation(s)
- Fengwu Tang
- Characteristics Medical Center of the Chinese People's Armed Police Forces (CAPF), Tianjin, 300162, China
| | - Jiaguang Tang
- Fourth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, 100048, China.,Department of Orthopaedics, Beijing Tongren Hospital, Beijing, 100730, China
| | - Yannan Zhao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.,Beijing ZhongKeZaiKang Biotechnology Co., Ltd, Beijing, 101407, China
| | - Jiaojiao Zhang
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China
| | - Zhifeng Xiao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.,Beijing ZhongKeZaiKang Biotechnology Co., Ltd, Beijing, 101407, China
| | - Bing Chen
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China
| | - Guang Han
- Characteristics Medical Center of the Chinese People's Armed Police Forces (CAPF), Tianjin, 300162, China
| | - Na Yin
- Characteristics Medical Center of the Chinese People's Armed Police Forces (CAPF), Tianjin, 300162, China.,Department of Rehabilitation, the 983rd Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Tianjin, 300141, China
| | - Xianfeng Jiang
- Characteristics Medical Center of the Chinese People's Armed Police Forces (CAPF), Tianjin, 300162, China
| | - Changyu Zhao
- Characteristics Medical Center of the Chinese People's Armed Police Forces (CAPF), Tianjin, 300162, China
| | - Shixiang Cheng
- Characteristics Medical Center of the Chinese People's Armed Police Forces (CAPF), Tianjin, 300162, China
| | - Ziqiang Wang
- Fourth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, 100048, China
| | - Yumei Chen
- Fourth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, 100048, China
| | - Qiaoling Chen
- Fourth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, 100048, China
| | - Keran Song
- Fourth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, 100048, China
| | - Zhiwei Zhang
- Fourth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, 100048, China
| | - Junjie Niu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Lingjun Wang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Qin Shi
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Liang Chen
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Huilin Yang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Shuxun Hou
- Fourth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, 100048, China.
| | - Sai Zhang
- Characteristics Medical Center of the Chinese People's Armed Police Forces (CAPF), Tianjin, 300162, China.
| | - Jianwu Dai
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.
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48
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Koda M, Hanaoka H, Fujii Y, Hanawa M, Kawasaki Y, Ozawa Y, Fujiwara T, Furuya T, Ijima Y, Saito J, Kitamura M, Miyamoto T, Ohtori S, Matsumoto Y, Abe T, Takahashi H, Watanabe K, Hirano T, Ohashi M, Shoji H, Mizouchi T, Kawahara N, Kawaguchi M, Orita Y, Sasamoto T, Yoshioka M, Fujii M, Yonezawa K, Soma D, Taneichi H, Takeuchi D, Inami S, Moridaira H, Ueda H, Asano F, Shibao Y, Aita I, Takeuchi Y, Mimura M, Shimbo J, Someya Y, Ikenoue S, Sameda H, Takase K, Ikeda Y, Nakajima F, Hashimoto M, Hasue F, Fujiyoshi T, Kamiya K, Watanabe M, Katoh H, Matsuyama Y, Hasegawa T, Yoshida G, Arima H, Yamato Y, Oe S, Togawa D, Kobayashi S, Akeda K, Kawamoto E, Imai H, Sakakibara T, Sudo A, Ito Y, Kikuchi T, Takigawa T, Morita T, Tanaka N, Nakanishi K, Kamei N, Kotaka S, Baba H, Okudaira T, Konishi H, Yamaguchi T, Ito K, Katayama Y, Matsumoto T, Matsumoto T, Kanno H, Aizawa T, Hashimoto K, Eto T, Sugaya T, Matsuda M, Fushimi K, Nozawa S, Iwai C, Taguchi T, Kanchiku T, Suzuki H, Nishida N, Funaba M, Sakai T, Imajo Y, Yamazaki M. Randomized trial of granulocyte colony-stimulating factor for spinal cord injury. Brain 2021; 144:789-799. [PMID: 33764445 PMCID: PMC8041047 DOI: 10.1093/brain/awaa466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 12/03/2022] Open
Abstract
Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. The present trial failed to show a significant effect of G-CSF in primary end point.
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Affiliation(s)
- Masao Koda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Correspondence to: Masao Koda, MD, PhD Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City Ibaraki 305-8575 Japan E-mail:
| | - Hideki Hanaoka
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasushi Ijima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Junya Saito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuhiro Kitamura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuya Miyamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukei Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kei Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Hirokazu Shoji
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Tatsuki Mizouchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Norio Kawahara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Kawaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Yugo Orita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Takeshi Sasamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Yoshioka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masafumi Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Katsutaka Yonezawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Daisuke Soma
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Hiroshi Taneichi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daisaku Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Satoshi Inami
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Moridaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Haruki Ueda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Futoshi Asano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Shibao
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Ikuo Aita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Yosuke Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Masaya Mimura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Jun Shimbo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yukio Someya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Sumio Ikenoue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Hiroaki Sameda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Kan Takase
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yoshikazu Ikeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumitake Nakajima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Mitsuhiro Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumio Hasue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Takayuki Fujiyoshi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Koshiro Kamiya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Masahiko Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Katoh
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Yukihiro Matsuyama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Togawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kindai University, Nara Hospital, Nara, Japan
| | - Sho Kobayashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Koji Akeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Eiji Kawamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hiroshi Imai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Toshihiko Sakakibara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Akihiro Sudo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Yasuo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takeshi Kikuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Tomoyuki Takigawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takuya Morita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Nobuhiro Tanaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nihon University, Tokyo, Japan
| | - Naosuke Kamei
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hideo Baba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Tsuyoshi Okudaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Hiroaki Konishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Takayuki Yamaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Keigo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Yoshito Katayama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Taro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Tomohiro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Haruo Kanno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimi Aizawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Ko Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimitsu Eto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Takehiro Sugaya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Michiharu Matsuda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Kazunari Fushimi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Chizuo Iwai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Toshihiko Taguchi
- G-SPIRIT Study Group, Chiba, Japan
- Yamaguchi Rosai Hospital, Japan Organization of Occupational Health and Safety, Japan
| | - Tsukasa Kanchiku
- G-SPIRIT Study Group, Chiba, Japan
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, Japan
| | - Hidenori Suzuki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuaki Imajo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masashi Yamazaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
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Mendonça T, Brito R, Luna P, Campêlo M, Shirahige L, Fontes L, Dias R, Piscitelli D, Monte-Silva K. Repetitive transcranial magnetic stimulation on the modulation of cortical and spinal cord excitability in individuals with spinal cord injury. Restor Neurol Neurosci 2021; 39:291-301. [PMID: 34334434 DOI: 10.3233/rnn-211167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been applied for modulating cortical excitability and treating spasticity in neurological lesions. However, it is unclear which rTMS frequency is most effective in modulating cortical and spinal excitability in incomplete spinal cord injury (SCI). OBJECTIVE To evaluate electrophysiological and clinical repercussions of rTMS compared to sham stimulation when applied to the primary motor cortex (M1) in individuals with incomplete SCI. METHODS A total of 11 subjects (35±12 years) underwent three experimental sessions of rTMS (10 Hz, 1 Hz and sham stimulation) in a randomized order at 90%intensity of the resting motor threshold and interspersed by a seven-day interval between sessions. The following outcome measures were evaluated: M1 and spinal cord excitability and spasticity in the moments before (baseline), immediately after (T0), 30 (T30) and 60 (T60) minutes after rTMS. M1 excitability was obtained through the motor evoked potential (MEP); spinal cord excitability by the Hoffman reflex (H-reflex) and homosynaptic depression (HD); and spasticity by the modified Ashworth scale (MAS). RESULTS A significant increase in cortical excitability was observed in subjects submitted to 10 Hz rTMS at the T0 moment when compared to sham stimulation (p = 0.008); this increase was also significant at T0 (p = 0.009), T30 (p = 0.005) and T60 (p = 0.005) moments when compared to the baseline condition. No significant differences were observed after the 10 Hz rTMS on spinal excitability or on spasticity. No inter-group differences were detected, or in the time after application of 1 Hz rTMS, or after sham stimulation for any of the assessed outcomes. CONCLUSIONS High-frequency rTMS applied to M1 was able to promote increased cortical excitability in individuals with incomplete SCI for at least 60 minutes; however, it did not modify spinal excitability or spasticity.
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Affiliation(s)
- Thyciane Mendonça
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil.,NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Plínio Luna
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Mayara Campêlo
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil.,NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Luís Fontes
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Rebeca Dias
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil.,NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Brazil
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50
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Everaert DG, Okuma Y, Abdollah V, Ho C. Timing and dosage of FES cycling early after acute spinal cord injury: A case series report. J Spinal Cord Med 2021; 44:S250-S255. [PMID: 34292125 PMCID: PMC8604517 DOI: 10.1080/10790268.2021.1953323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To understand the progression in parameters of functional electrical stimulation (FES) cycling dosage (including duration, velocity, stimulation amplitudes, power output), and the resulting changes in muscle mass early after acute spinal cord injury (SCI). METHODS Three participants, 24-38 years old, with neurological injury level C4-T4, severity AIS (American Spinal Injury Association Impairment Scale) A-C, started FES cycling 16-20 days post injury while admitted at a level-1 trauma center in Canada, and continued for 8-13 weeks in a rehabilitation hospital. They performed three sessions/week of 15-45 min FES cycling, supine or sitting. FES parameters, cycling performance, and muscle cross-sectional area (CSA) in thighs and calves were measured every 2 weeks. RESULTS Progression in power output, but not in session duration, was limited in two participants who experienced stimulation-associated referred pain or apprehension, requiring limitation of stimulation amplitudes for up to 65 days after the start of FES cycling. Participants started with 15 min cycling at 20 RPM with no resistance (0 W), and progressed to 30-45 min at 30 RPM producing 8.8-19.0 W average power/session after 2-3 months. Initially, muscle CSA decreased in all 3 participants (up to 16% after 6 weeks), and recovered later after a variable period of FES cycling (up to 16% at 13.3 weeks). CONCLUSION Progression of FES cycling in the first 3 months after injury required a highly individualized approach, guided by participant response, rather than standardized increments in stimulation intensity or duration. Changes in muscle CSA did not always correspond with the dose of FES cycling.
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Affiliation(s)
- Dirk G. Everaert
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Yoshino Okuma
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Vahid Abdollah
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Chester Ho
- Faculty of Medicine and Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
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