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Debenham MIB, Franz CK, Berger MJ. Neuromuscular consequences of spinal cord injury: New mechanistic insights and clinical considerations. Muscle Nerve 2024; 70:12-27. [PMID: 38477416 DOI: 10.1002/mus.28070] [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: 10/20/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024]
Abstract
The spinal cord facilitates communication between the brain and the body, containing intrinsic systems that work with lower motor neurons (LMNs) to manage movement. Spinal cord injuries (SCIs) can lead to partial paralysis and dysfunctions in muscles below the injury. While traditionally this paralysis has been attributed to disruptions in the corticospinal tract, a growing body of work demonstrates LMN damage is a factor. Motor units, comprising the LMN and the muscle fibers with which they connect, are essential for voluntary movement. Our understanding of their changes post-SCI is still emerging, but the health of motor units is vital, especially when considering innovative SCI treatments like nerve transfer surgery. This review seeks to collate current literature on how SCI impact motor units and explore neuromuscular clinical implications and treatment avenues. SCI reduced motor unit number estimates, and surviving motor units had impaired signal transmission at the neuromuscular junction, force-generating capacity, and excitability, which have the potential to recover chronically, yet the underlaying mechanisms are unclear. Furthermore, electrodiagnostic evaluations can aid in assessing the health lower and upper motor neurons, identify suitable targets for nerve transfer surgeries, and detect patients with time sensitive injuries. Lastly, many electrodiagnostic abnormalities occur in both chronic and acute SCI, yet factors contributing to these abnormalities are unknown. Future studies are required to determine how motor units adapt following SCI and the clinical implications of these adaptations.
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Affiliation(s)
- Mathew I B Debenham
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin K Franz
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Lewis MJ. Electrodiagnostic testing in dogs with disorders of the spinal cord or cauda equina. Vet J 2024; 304:106082. [PMID: 38360137 DOI: 10.1016/j.tvjl.2024.106082] [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: 09/12/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
Electrodiagnostic (EDX) testing is uncommonly utilized in dogs other than for investigation of disorders of the neuromuscular system. In dogs with diseases affecting the spinal cord or cauda equina, EDX testing can provide functional data complementary to imaging information that together can guide therapeutic and management approaches. Additionally, in some clinical scenarios, EDX testing prior to advanced imaging is integral to identifying if there is spinal cord or cauda equina involvement and can aid in determining the appropriate diagnostic path. This review will outline EDX testing methods that have been reported in dogs relating to the diagnosis, monitoring or prognosis of various conditions affecting the spinal cord and cauda equina. The various tests will be briefly outlined regarding how they are performed and what information is provided. The main focus will be on clinical applications including highlighting situations where EDX testing is useful for differentiating between neurologic and non-neurologic presentations. Additional ways these EDX techniques could be incorporated in the management of diseases of the spinal cord and cauda equina in dogs will be presented.
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Affiliation(s)
- M J Lewis
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr, Raleigh, NC 27607, USA.
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Shen X, Sun T, Li Z, Wu Y. Generation of locomotor‑like activity using monopolar intraspinal electrical microstimulation in rats. Exp Ther Med 2023; 26:560. [PMID: 37941590 PMCID: PMC10628655 DOI: 10.3892/etm.2023.12259] [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: 05/04/2023] [Accepted: 08/17/2023] [Indexed: 11/10/2023] Open
Abstract
Severe spinal cord injury (SCI) affects the ability of functional standing and walking. As the locomotor central pattern generator (CPG) in the lumbosacral spinal cord can generate a regulatory signal for movement, it is feasible to activate CPG neural network using intra-spinal micro-stimulation (ISMS) to induce alternating patterns. The present study identified two special sites with the ability to activate the CPG neural network that are symmetrical about the posterior median sulcus in the lumbosacral spinal cord by ISMS in adult rats. A reversal of flexion and extension can occur in an attempt to generate a stepping movement of the bilateral hindlimb by either reversing the pulse polarity of the stimulus or changing the special site. Therefore, locomotor-like activity can be restored with monopolar intraspinal electrical stimulation on either special site. To verify the motor function regeneration of the paralyzed hindlimbs, a four-week locomotor training with ISMS applied to the special site in the SCI + ISMS group (n=12) was performed. Evaluations of motor function recovery using behavior, kinematics and physiological analyses, were used to assess hindlimb function and the results showed the stimulation at one special site can promote significant functional recovery of the bilateral hindlimbs (P<0.05). The present study suggested that motor function of paralyzed bilateral hindlimbs can be restored with monopolar ISMS.
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Affiliation(s)
- Xiaoyan Shen
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu 226019, P.R. China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226019, P.R. China
| | - Tinghui Sun
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu 226019, P.R. China
| | - Zhiling Li
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu 226019, P.R. China
| | - Yan Wu
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu 226019, P.R. China
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Paredes-Cruz M, Grijalva I, Martínez-López YE, Guizar-Sahagún G, Colín-Ramírez E, Rojano-Mejía D. Functional improvement in individuals with chronic spinal cord injury treated with 4-aminopyridine: A systematic review. Front Neurol 2022; 13:1034730. [DOI: 10.3389/fneur.2022.1034730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
Study designSystematic review.ObjectiveTo provide current evidence on the efficacy of 4-aminopyridine (4-AP) to bring about functional improvement in individuals with chronic traumatic spinal cord injury (SCI).MethodsThe Medline (PubMed), Web of Science and SCOPUS databases were systematically searched for relevant articles on the efficacy of 4-AP to treat SCI, from the dates such articles were first published until May 2022. Full-text versions of all the articles selected were examined independently by two reviewers. Methodological quality was rated using the Modified Jadad Scale, and risk of bias was assessed with the RoB-2 test. Data extracted included human models/types, PRISMA assessment protocols, and the results of each study. Descriptive syntheses are provided.ResultsIn total, 28 articles were initially identified, 10 of which were included after screening. Most of the studies reviewed reported some degree of patient improvement in one or more of the following parameters: motor, sensitivity and sexual function, sphincter control, spasticity, ability to function independently, quality of life, central motor conduction, pain, and pulmonary function.ConclusionsThis review confirms the efficacy of 4-AP in improving several conditions resulting from SCI but further research on this topic is warranted. Additional randomized clinical trials with 4-AP involving larger sample sizes are needed, as are consistent outcome measures in order to obtain adequate data for analysis with a view to enhance treatment benefits.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=334835, PROSPERO CRD42022334835.
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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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Lewis MJ, Bowditch J, Laflen B, Perry N, Yoquelet R, Thomovsky SA. Pilot Study on Feasibility of Sensory-Enhanced Rehabilitation in Canine Spinal Cord Injury. Front Vet Sci 2022; 9:921471. [PMID: 35774972 PMCID: PMC9237616 DOI: 10.3389/fvets.2022.921471] [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: 04/15/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022] Open
Abstract
Physical rehabilitation is frequently recommended in dogs recovering from acute thoracolumbar intervertebral disc extrusion (TL-IVDE), but protocols vary widely. The objective of this study was to evaluate the feasibility of incorporating sensory-integrated neurorehabilitation strategies into a post-operative rehabilitation protocol in dogs with TL-IVDE. Non-ambulatory dogs with acute TL-IVDE managed surgically were prospectively recruited to this unblinded cross-over feasibility study. Eligible dogs were randomized to start with tactile-enhanced (artificial grass) or auditory-enhanced (floor piano) basic rehabilitation exercises performed twice daily for the first 4 weeks before switching to the opposite surface for the subsequent 4 weeks. Neurologic examination, open field gait scoring, girth measurements and an owner-completed feasibility questionnaire were performed at baseline and 2, 4, 6, and 8 weeks post-operatively. Twenty-four dogs were enrolled, 12 randomized to each order of exercises. Gait scores did not differ between the two groups at baseline, 4 or 8 week visits. All modified exercises could be performed and compliance was high. Adverse events potentially attributable to the study surface were mild, self-limiting and occurred in 2/24 dogs. The most common surface-related limitations were that the piano was slippery and that both surfaces were too short. The artificial grass was preferred by owners and dogs compared to the floor piano surface, but this was influenced by which surface was utilized first. Auditory and tactile modifications were feasible and safe to incorporate into a standardized rehabilitation protocol. This pilot study could prompt larger efficacy studies investigating the benefit of sensory-integrated rehabilitation in dogs with TL-IVDE.
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Affiliation(s)
- Melissa J. Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
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Prager J, Fenn J, Plested M, Escauriaza L, Merwe TVD, King B, Chari D, Wong LF, Granger N. Transplantation of encapsulated autologous olfactory ensheathing cell populations expressing chondroitinase for spinal cord injury: A safety and feasibility study in companion dogs. J Tissue Eng Regen Med 2022; 16:788-798. [PMID: 35686704 PMCID: PMC9542194 DOI: 10.1002/term.3328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/08/2022] [Accepted: 05/24/2022] [Indexed: 11/08/2022]
Abstract
Spinal cord injury (SCI) can cause irreversible paralysis, with no regenerative treatment clinically available. Dogs with natural SCI present an established model and can facilitate translation of experimental findings in rodents to people. We conducted a prospective, single arm clinical safety study in companion dogs with chronic SCI to characterize the feasibility of intraspinal transplantation of hydrogel-encapsulated autologous mucosal olfactory ensheathing cell (mOEC) populations expressing chondroitinase ABC (chABC). mOECs and chABC are both promising therapies for SCI, and mOECs expressing chABC drive greater voluntary motor recovery than mOECs alone after SCI in rats. Canine mOECs encapsulated in collagen hydrogel can be matched in stiffness to canine SCI. Four dogs with complete and chronic loss of function caudal to a thoraco-lumbar lesion were recruited. After baseline measures, olfactory mucosal biopsy was performed and autologous mOECs cultured and transduced to express chABC, then hydrogel-encapsulated and percutaneously injected into the spinal cord. Dogs were monitored for 6 months with repeat clinical examinations, spinal MRI, kinematic gait and von Frey assessment. No adverse effects or significant changes on neurological examination were detected. MRI revealed large and variable lesions, with no spinal cord compression or ischemia visible after hydrogel transplantation. Owners reported increased pelvic-limb reflexes with one dog able to take 2-3 unsupported steps, but gait-scoring and kinematic analysis showed no significant improvements. This novel combination approach to regeneration after SCI is therefore feasible and safe in paraplegic dogs in a clinical setting. A randomised-controlled trial in this translational model is proposed to test efficacy.
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Affiliation(s)
- Jon Prager
- Clinical Science and Services, The Royal Veterinary College, London, UK.,Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Joe Fenn
- Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Mark Plested
- Clinical Science and Services, The Royal Veterinary College, London, UK
| | | | | | - Barbora King
- Clinical Investigation Centre, The Royal Veterinary College, London, UK
| | - Divya Chari
- Neural Tissue Engineering Group, Keele School of Medicine, Keele University, Keele, UK
| | | | - Nicolas Granger
- Clinical Science and Services, The Royal Veterinary College, London, UK.,Highcroft Veterinary Referrals, CVS, Bristol, UK
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Martins Â, Gouveia D, Cardoso A, Carvalho C, Silva C, Coelho T, Gamboa Ó, Ferreira A. Functional Neurorehabilitation in Dogs with an Incomplete Recovery 3 Months following Intervertebral Disc Surgery: A Case Series. Animals (Basel) 2021; 11:ani11082442. [PMID: 34438900 PMCID: PMC8388785 DOI: 10.3390/ani11082442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary A non-invasive neurorehabilitation multimodal protocol (NRMP) may be applicable to chronic T3-L3 dogs 3 months after undergoing surgery for acute Intervertebral Disc Disease (IVDD) Hansen type I; this protocol has been shown to be safe, feasible, and potentially effective at improving ambulation in both open field score (OFS) 0 and OFS 1 dogs. The specific sample population criteria limit the number of dogs included, mainly due to owners withdrawing over time. Thus, the present case series study aimed to demonstrate that an NRMP could contribute to a functional treatment possibly based on synaptic and anatomic reorganization of the spinal cord. Abstract This case series study aimed to evaluate the safety, feasibility, and positive outcome of the neurorehabilitation multimodal protocol (NRMP) in 16 chronic post-surgical IVDD Hansen type I dogs, with OFS 0/DPP− (n = 9) and OFS 1/DPP+ (n = 7). All were enrolled in the NRMP for a maximum of 90 days and were clinically discharged after achieving ambulation. The NRMP was based on locomotor training, functional electrical stimulation, transcutaneous electrical spinal cord stimulation, and 4-aminopyridine (4-AP) pharmacological management. In the Deep Pain Perception (DPP)+ dogs, 100% recovered ambulation within a mean period of 47 days, reaching OFS ≥11, which suggests that a longer period of time is needed for recovery. At follow-up, all dogs presented a positive evolution with voluntary micturition. Of the DPP− dogs admitted, all achieved a flexion/extension locomotor pattern within 30 days, and after starting the 4-AP, two dogs were discharged at outcome day 45, with 78% obtaining Spinal Reflex Locomotion (SRL) and automatic micturition within a mean period of 62 days. At follow-up, all dogs maintained their neurological status. After the NRMP, ambulatory status was achieved in 88% (14/16) of dogs, without concurrent events. Thus, an NRMP may be an important therapeutic option to reduce the need for euthanasia in the clinical setting.
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Affiliation(s)
- Ângela Martins
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1300-477 Lisboa, Portugal
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
- Correspondence:
| | - Débora Gouveia
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
| | - Ana Cardoso
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Carla Carvalho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Cátia Silva
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Tiago Coelho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
| | - António Ferreira
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
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Olby NJ, da Costa RC, Levine JM, Stein VM. Prognostic Factors in Canine Acute Intervertebral Disc Disease. Front Vet Sci 2020; 7:596059. [PMID: 33324703 PMCID: PMC7725764 DOI: 10.3389/fvets.2020.596059] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
Knowledge of the prognosis of acute spinal cord injury is critical to provide appropriate information for clients and make the best treatment choices. Acute intervertebral disc extrusions (IVDE) are a common cause of pain and paralysis in dogs with several types of IVDE occurring. Important prognostic considerations are recovery of ambulation, return of urinary and fecal continence, resolution of pain and, on the negative side, development of progressive myelomalacia. Initial injury severity affects prognosis as does type of IVDE, particularly when considering recovery of continence. Overall, loss of deep pain perception signals a worse outcome. When considering Hansen type 1 IVDE, the prognosis is altered by the choice of surgical vs. medical therapy. Concentration of structural proteins in the plasma, as well as inflammatory mediators, creatine kinase, and myelin basic protein in the cerebrospinal fluid (CSF) can provide additional prognostic information. Finally, cross-sectional area and length of T2 hyperintensity and loss of HASTE signal on MRI have been associated with outcome. Future developments in plasma and imaging biomarkers will assist in accurate prognostication and optimization of patient management.
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Affiliation(s)
- Natasha J. Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Ronaldo C. da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Jon M. Levine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Veronika M. Stein
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Zhao B, Zhou X, Liu C, Wu S, An L. The effects of walking training onset on motor evoked potentials after acute spinal cord injury. Neurosci Lett 2020; 739:135338. [PMID: 32947005 DOI: 10.1016/j.neulet.2020.135338] [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: 04/03/2020] [Revised: 07/29/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
AIM The purposes of this study were to explore the optimal time for starting walking training in the first month after spinal cord injury (SCI) in rats and to discuss the relationship between changes in motor function and transcranial electrical motor evoked potentials (tceMEPs). METHODS Four groups of rats with SCI (BSWTT-3, 7, 14, 12) performed body-weight-supported treadmill training (BWSTT) for three weeks beginning at 3, 7, 14, and 21 days after SCI, respectively. The Basso, Beattie, and Bresnahan (BBB) score and tceMEPs were assessed weekly. Weekly repeated measures and multiple comparisons between groups were performed to identify differences in motor function and tceMEPs. Correlation analysis was performed to clarify the relationship between BBB scores and tceMEPs over time. RESULTS Although there was no significant difference between the BWSTT-14 group and the other three BWSTT groups at the end of the experiment in terms of BBB scores and the latency of tceMEPs, the BWSTT-14 group obtained the best trends in improvement of BBB scores and the latencies and amplitudes of tceMEPs over time. The BBB scores of rats with SCI were strongly negatively correlated with tceMEPs latency. The BBB scores of rats with SCI, except for the rats in the BWSTT-3 group, were strongly positively correlated with the tceMEPs amplitude. CONCLUSIONS The preliminary conclusion was that based on a rat model, 14 days after SCI was the optimal time for starting BWSTT. tceMEPs were an objective indicator of spinal cord nerve function, which was strongly correlated with motor function recovery. However, one limitation of this study was that the rats in the Sham group did not undergo BWSTT, which made the training itself a confounding factor for the results.
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Affiliation(s)
- Bolun Zhao
- School of Nursing, Dalian University, Dalian, Liaoning, China.
| | - Xiaohua Zhou
- School of Nursing, Dalian University, Dalian, Liaoning, China.
| | - Changhong Liu
- Jiamusi College, Heilongjiang University Of Chinese Medicine, Heilongjiang, China.
| | - Suqian Wu
- Railway Health School, Dalian University, Liaoning, China.
| | - Libin An
- School of Nursing, Dalian University, Dalian, Liaoning, China.
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Lewis MJ, Jeffery ND, Olby NJ. Ambulation in Dogs With Absent Pain Perception After Acute Thoracolumbar Spinal Cord Injury. Front Vet Sci 2020; 7:560. [PMID: 33062648 PMCID: PMC7479830 DOI: 10.3389/fvets.2020.00560] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
Acute thoracolumbar spinal cord injury (SCI) is common in dogs frequently secondary to intervertebral disc herniation. Following severe injury, some dogs never regain sensory function to the pelvic limbs or tail and are designated chronically "deep pain negative." Despite this, a subset of these dogs develop spontaneous motor recovery over time including some that recover sufficient function in their pelvic limbs to walk independently without assistance or weight support. This type of ambulation is commonly known as "spinal walking" and can take up to a year or more to develop. This review provides a comparative overview of locomotion and explores the physiology of locomotor recovery after severe SCI in dogs. We discuss the mechanisms by which post-injury plasticity and coordination between circuitry contained within the spinal cord, peripheral sensory feedback, and residual or recovered supraspinal connections might combine to underpin spinal walking. The clinical characteristics of spinal walking are outlined including what is known about the role of patient or injury features such as lesion location, timeframe post-injury, body size, and spasticity. The relationship between the emergence of spinal walking and electrodiagnostic and magnetic resonance imaging findings are also discussed. Finally, we review possible ways to predict or facilitate recovery of walking in chronically deep pain negative dogs. Improved understanding of the mechanisms of gait generation and plasticity of the surviving tissue after injury might pave the way for further treatment options and enhanced outcomes in severely injured dogs.
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Affiliation(s)
- Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Nick D Jeffery
- Department of Small Animal Clinical Sciences, Texas a & M College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States
| | - Natasha J Olby
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, United States
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Vikartovska Z, Kuricova M, Farbakova J, Liptak T, Mudronova D, Humenik F, Madari A, Maloveska M, Sykova E, Cizkova D. Stem Cell Conditioned Medium Treatment for Canine Spinal Cord Injury: Pilot Feasibility Study. Int J Mol Sci 2020; 21:ijms21145129. [PMID: 32698543 PMCID: PMC7404210 DOI: 10.3390/ijms21145129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) involves nerve damage and often leads to motor, sensory and autonomic dysfunctions. In the present study, we have designed a clinical protocol to assess the feasibility of systemic delivery of allogenic canine bone marrow tissue-derived mesenchymal stem cell conditioned medium (BMMSC CM) to dogs with SCI. Four client-owned dogs with chronic SCI lasting more than six months underwent neurological and clinical evaluation, MRI imaging and blood tests before being enrolled in this study. All dogs received four intravenous infusions with canine allogenic BMMSC CM within one month. Between the infusions the dogs received comprehensive physiotherapy, which continued for three additional months. No adverse effects or complications were observed during the one, three and six months follow-up periods. Neither blood chemistry panel nor hematology profile showed any significant changes. All dogs were clinically improved as assessed using Olby locomotor scales after one, three and six months of BMMSC CM treatment. Furthermore, goniometric measurements revealed partial improvement in the range of joint motion. Bladder function improved in two disabled dogs. We conclude that multiple delivery of allogenic cell-derived conditioned medium to dogs with chronic SCI is feasible, and it might be clinically beneficial in combination with physiotherapy.
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Affiliation(s)
- Zuzana Vikartovska
- Center of Experimental and Clinical Regenerative Medicine, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (Z.V.); (F.H.); (M.M.)
- University Veterinary Hospital, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (M.K.); (J.F.); (T.L.); (A.M.)
| | - Maria Kuricova
- University Veterinary Hospital, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (M.K.); (J.F.); (T.L.); (A.M.)
| | - Jana Farbakova
- University Veterinary Hospital, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (M.K.); (J.F.); (T.L.); (A.M.)
| | - Tomas Liptak
- University Veterinary Hospital, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (M.K.); (J.F.); (T.L.); (A.M.)
| | - Dagmar Mudronova
- Department of Microbiology and Immunology, Institute of Immunology, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia;
| | - Filip Humenik
- Center of Experimental and Clinical Regenerative Medicine, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (Z.V.); (F.H.); (M.M.)
| | - Aladar Madari
- University Veterinary Hospital, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (M.K.); (J.F.); (T.L.); (A.M.)
| | - Marcela Maloveska
- Center of Experimental and Clinical Regenerative Medicine, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (Z.V.); (F.H.); (M.M.)
| | - Eva Sykova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dubravska cesta 9, 845 10 Bratislava, Slovakia;
| | - Dasa Cizkova
- Center of Experimental and Clinical Regenerative Medicine, University of Veterinary Medicine and Pharmacy, Komenskeho 73, 04181 Kosice, Slovakia; (Z.V.); (F.H.); (M.M.)
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dubravska cesta 9, 845 10 Bratislava, Slovakia;
- Correspondence:
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Fenn J, Ru H, Jeffery ND, Moore S, Tipold A, Soebbeler FJ, Wang-Leandro A, Mariani CL, Early PJ, Muñana KR, Olby NJ. Association between anesthesia duration and outcome in dogs with surgically treated acute severe spinal cord injury caused by thoracolumbar intervertebral disk herniation. J Vet Intern Med 2020; 34:1507-1513. [PMID: 32418346 PMCID: PMC7379036 DOI: 10.1111/jvim.15796] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022] Open
Abstract
Background Retrospective research recently identified a possible relationship between duration of surgery and outcome in severely affected dogs treated surgically for acute thoracolumbar intervertebral disk herniation (TL‐IVDH). Hypothesis That increased duration of surgery is associated with poorer outcome in dogs with absent pain perception treated surgically for TL‐IVDH. Animals Two hundred ninety‐seven paraplegic dogs with absent pain perception surgically treated for acute TL‐IVDH. Methods Retrospective cohort study. Medical records of 5 institutions were reviewed. Inclusion criteria were paraplegia with absence of pain perception, surgical treatment of TL‐IVDH, and 1‐year postoperative outcome (ambulatory: yes or no). Canine data, outcome, and surgery and total anesthesia duration were retrieved. Results In this study, 183/297 (61.6%) dogs were ambulatory within 1 year, 114 (38.4%) dogs failed to recover, including 74 dogs (24.9%) euthanized because of progressive myelomalacia. Median anesthesia duration in dogs that regained ambulation within 1 year of surgery (4.0 hours, interquartile range [IQR] 3.2‐5.1) was significantly shorter than those that did not (4.5 hours, IQR 3.7‐5.6, P = .01). Multivariable logistic regression demonstrated a significant negative association between both duration of surgery and total anesthesia time and ambulation at 1 year when controlling for body weight and number of disk spaces operated on. Conclusions and Clinical Importance Findings support a negative association between increased duration of anesthesia and outcome in this group of dogs. However, the retrospective nature of the data does not imply a causal relationship.
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Affiliation(s)
- Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom.,The Canine Spinal Cord Injury Consortium (CANSORT-SCI)
| | - Hongyu Ru
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
| | - Nick D Jeffery
- The Canine Spinal Cord Injury Consortium (CANSORT-SCI).,Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Sarah Moore
- The Canine Spinal Cord Injury Consortium (CANSORT-SCI).,Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Andrea Tipold
- The Canine Spinal Cord Injury Consortium (CANSORT-SCI).,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Franz J Soebbeler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Adriano Wang-Leandro
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Christopher L Mariani
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Peter J Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Karen R Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- The Canine Spinal Cord Injury Consortium (CANSORT-SCI).,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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14
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Katoh H, Yokota K, Fehlings MG. Regeneration of Spinal Cord Connectivity Through Stem Cell Transplantation and Biomaterial Scaffolds. Front Cell Neurosci 2019; 13:248. [PMID: 31244609 PMCID: PMC6563678 DOI: 10.3389/fncel.2019.00248] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/17/2019] [Indexed: 12/20/2022] Open
Abstract
Significant progress has been made in the treatment of spinal cord injury (SCI). Advances in post-trauma management and intensive rehabilitation have significantly improved the prognosis of SCI and converted what was once an “ailment not to be treated” into a survivable injury, but the cold hard fact is that we still do not have a validated method to improve the paralysis of SCI. The irreversible functional impairment of the injured spinal cord is caused by the disruption of neuronal transduction across the injury lesion, which is brought about by demyelination, axonal degeneration, and loss of synapses. Furthermore, refractory substrates generated in the injured spinal cord inhibit spontaneous recovery. The discovery of the regenerative capability of central nervous system neurons in the proper environment and the verification of neural stem cells in the spinal cord once incited hope that a cure for SCI was on the horizon. That hope was gradually replaced with mounting frustration when neuroprotective drugs, cell transplantation, and strategies to enhance remyelination, axonal regeneration, and neuronal plasticity demonstrated significant improvement in animal models of SCI but did not translate into a cure in human patients. However, recent advances in SCI research have greatly increased our understanding of the fundamental processes underlying SCI and fostered increasing optimism that these multiple treatment strategies are finally coming together to bring about a new era in which we will be able to propose encouraging therapies that will lead to appreciable improvements in SCI patients. In this review, we outline the pathophysiology of SCI that makes the spinal cord refractory to regeneration and discuss the research that has been done with cell replacement and biomaterial implantation strategies, both by itself and as a combined treatment. We will focus on the capacity of these strategies to facilitate the regeneration of neural connectivity necessary to achieve meaningful functional recovery after SCI.
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Affiliation(s)
- Hiroyuki Katoh
- Division of Genetics and Development, Krembil Research Institute, Toronto, ON, Canada.,Department of Orthopaedic Surgery - Surgical Sciences, School of Medicine, Tokai University, Tokyo, Japan
| | - Kazuya Yokota
- Division of Genetics and Development, Krembil Research Institute, Toronto, ON, Canada.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.,Spine Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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15
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Olby NJ, Lim J, Wagner N, Zidan N, Early PJ, Mariani CL, Muñana KR, Laber E. Time course and prognostic value of serum GFAP, pNFH, and S100β concentrations in dogs with complete spinal cord injury because of intervertebral disc extrusion. J Vet Intern Med 2019; 33:726-734. [PMID: 30758078 PMCID: PMC6430936 DOI: 10.1111/jvim.15439] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/18/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND A noninvasive biomarker is needed to predict recovery from severe spinal cord injury (SCI) because of thoracolumbar intervertebral disc extrusion (TL-IVDE). Proteins released from neural and glial cells can be detected in the blood and show promise as prognostic tools, but their concentration is influenced by time after injury. HYPOTHESIS/OBJECTIVES Serum concentrations of glial fibrillary acidic protein (GFAP), phosphorylated neurofilament heavy chain (pNFH), and S100β will follow different time courses; measurement of combinations of these proteins will predict outcome. ANIMALS Thirty-one dogs with TL-IVDE causing paralysis with no pain perception. METHODS Prospective study. Serum samples were taken at presentation and intervals over 56 days and banked at -80°C. Glial fibrillary acidic protein, pNFH, and S100β concentrations were measured using ELISA tests and plotted against time from onset of nonambulatory status. Outcome was established at 6 months. The association between biomarker concentration and outcome was examined using logistic regression, receiver operator characteristics curve analysis, and model development. RESULTS Thirty-one dogs participated, 3/31 (10%) developed progressive myelomalacia and 19/31 (62%) recovered ambulation. Glial fibrillary acidic protein and S100β concentrations rose for the first 1 to 3 days, and were undetectable by 14 and 28 days, respectively. Phosphorylated neurofilament heavy chain concentrations peaked at 14 days and were detectable at 56 days. Glial fibrillary acidic protein concentrations in the first 72 hours after onset of nonambulatory status predicted recovery with an accuracy of 76.7%-89% depending on sample timing. CONCLUSIONS AND CLINICAL IMPORTANCE Serum GFAP concentrations can be used to predict outcome in clinically complete SCI. A rapid inexpensive bedside test is needed.
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Affiliation(s)
- Natasha J. Olby
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth Carolina
| | - Ji‐Hey Lim
- Department of Veterinary Medicine and SurgeryCollege of Veterinary Medicine, University of MissouriColumbiaMO
| | - Nikki Wagner
- Department of Microbiology and ImmunologyUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Natalia Zidan
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth Carolina
| | - Peter J. Early
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth Carolina
| | - Christopher L. Mariani
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth Carolina
| | - Karen R. Muñana
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth Carolina
| | - Eric Laber
- Department of StatisticsNorth Carolina State UniversityRaleighNorth Carolina
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Lewis MJ, Laber E, Olby NJ. Predictors of Response to 4-Aminopyridine in Chronic Canine Spinal Cord Injury. J Neurotrauma 2018; 36:1428-1434. [PMID: 30235970 DOI: 10.1089/neu.2018.5975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
4-Aminopyridine (4AP), a potassium channel antagonist, can improve hindlimb motor function in dogs with chronic thoracolumbar spinal cord injury (SCI); however, individual response is variable. We hypothesized that injury characteristics would differ between dogs that do and do not respond to 4AP. Our objective was to compare clinical, electrodiagnostic, gait, and imaging variables between dogs that do and do not respond to 4AP, to identify predictors of response. Thirty-four dogs with permanent deficits after acute thoracolumbar SCI were enrolled. Spasticity, motor and sensory evoked potentials (MEPs, SEPs), H-reflex, F-waves, gait scores, and magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) were evaluated at baseline and after 4AP administration. Baseline variables were assessed as predictors of response; response was defined as ≥1 point change in open field gait score. Variables were compared pre- and post-4AP to evaluate 4AP effects. Fifteen of 33 (45%) dogs were responders, 18/33 (55%) were non-responders and 1 was eliminated because of an adverse event. Pre-H-reflex threshold <1.2 mA predicted non-response; pre-H-reflex threshold >1.2 mA and Canine Spasticity Scale overall score <7 were predictive of response. All responders had translesional connections on DTI. MEPs were more common post-4AP than pre-4AP (10 vs. 6 dogs) and 4AP decreased H-reflex threshold and increased spasticity in responders. 4-AP impacts central conduction and motor neuron pool excitability in dogs with chronic SCI. Severity of spasticity and H-reflex threshold might allow prediction of response. Further exploration of electrodiagnostic and imaging characteristics might elucidate additional factors contributing to response or non-response.
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Affiliation(s)
- Melissa J Lewis
- 1 Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Eric Laber
- 2 Department of Statistics, College of Sciences, North Carolina State University, Raleigh, North Carolina
| | - Natasha J Olby
- 3 Department of Clinical Sciences, College of Veterinary Medicine, and North Carolina State University, Raleigh, North Carolina.,4 Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
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17
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Hu H, Jeffery N, Granger N. Somatosensory and motor evoked potentials in dogs with chronic severe thoracolumbar spinal cord injury. Vet J 2018; 237:49-54. [DOI: 10.1016/j.tvjl.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/07/2018] [Accepted: 05/21/2018] [Indexed: 01/03/2023]
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18
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Lewis MJ, Yap PT, McCullough S, Olby NJ. The Relationship between Lesion Severity Characterized by Diffusion Tensor Imaging and Motor Function in Chronic Canine Spinal Cord Injury. J Neurotrauma 2017; 35:500-507. [PMID: 28974151 DOI: 10.1089/neu.2017.5255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Lesion heterogeneity among chronically paralyzed dogs after acute, complete thoracolumbar spinal cord injury (TLSCI) is poorly described. We hypothesized that lesion severity quantified by diffusion tensor imaging (DTI) is associated with hindlimb motor function. Our objectives were to quantify lesion severity with fractional anisotropy (FA), mean diffusivity (MD), and tractography and investigate associations with motor function. Twenty-two dogs with complete TLSCI in the chronic stage were enrolled and compared with six control dogs. All underwent thoracolumbar magnetic resonance imaging (MRI) with DTI and gait analysis. FA and MD were calculated on regions of interest (ROI) at the lesion epicenter and cranial and caudal to the visible lesion on conventional MRI and in corresponding ROI in controls. Tractography was performed to detect translesional fibers. Gait was quantified using an ordinal scale (OFS). FA and MD values were compared between cases and controls, and relationships between FA, MD, presence of translesional fibers and OFS were investigated. The FA at the epicenter (median: 0.228, 0.107-0.320), cranial (median: 0.420, 0.391-0.561), and caudal to the lesion (median: 0.369, 0.265-0.513) was lower than combined ROI in controls (median: 0.602, 0.342-0.826, p < 0.0001). The MD at the epicenter (median: 2.06 × 10-3, 1.33-2.96 × 10-3) and cranially (median: 1.52 × 10-3, 1.03-1.87 × 10-3) was higher than combined ROI in controls (median: 1.28 × 10-3, 0.81-1.44 × 10-3, p ≤ 0.001). Four dogs had no translesional fibers. Median OFS was 2 (0-6). The FA at the lesion epicenter and presence of translesional fibers were associated with OFS (p ≤ 0.0299). DTI can detect degeneration and physical transection after severe TLSCI. Findings suggest DTI quantifies injury severity and suggests motor recovery in apparently complete dogs is because of supraspinal input.
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Affiliation(s)
- Melissa J Lewis
- 1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University , Raleigh, North Carolina.,2 Comparative Medicine Institute, North Carolina State University , Raleigh, North Carolina
| | - Pew-Thian Yap
- 3 Department of Radiology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Susan McCullough
- 4 Animal Scan Advanced Veterinary Imaging , Raleigh, North Carolina
| | - Natasha J Olby
- 1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University , Raleigh, North Carolina.,2 Comparative Medicine Institute, North Carolina State University , Raleigh, North Carolina
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