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Çankaya Ö, Zengin Y, Bilgin S, Önal B, Işıkay İ, Köse N. Predictors of Functional Independence in Children with Spinal Cord Tumors After Surgery: From Physiotherapist Perspective. Dev Neurorehabil 2024:1-10. [PMID: 38982750 DOI: 10.1080/17518423.2024.2374535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
Knowledge of the factors affecting functional outcomes has an important role in the development of the care plan in children with spinal cord tumors. Retrospective study was planned to determine predictors of functional independence in children with spinal cord tumors. Data from 80 children treated for spinal cord tumors over 2001-2020-year period was analyzed. Results showed that key predictors such as younger age, higher KPS, and better initial WeeFIM scores were strongly associated with improved functional outcomes. Further multicenter prospective studies are recommended to validate these findings and explore long-term functional outcomes to enhance rehabilitation strategies for this patient population.
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Zama D, Candela E, Pagano G, Venturelli F, Melchionda F, Toni F, Zucchelli M, Pession A. Pediatric non-Hodgkin lymphoma as a rare cause of spinal cord injury: When lymphoma hides in the canal. Clin Case Rep 2024; 12:e7789. [PMID: 38523827 PMCID: PMC10959824 DOI: 10.1002/ccr3.7789] [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: 12/14/2022] [Revised: 06/09/2023] [Accepted: 07/25/2023] [Indexed: 03/26/2024] Open
Abstract
Key Clinical Message Spinal cord compression from non-Hodgkin lymphoma (NHL) should be considered as a potential diagnosis in cases of acute signs of myelopathy in pediatric patients. Abstract Spinal cord compression in pediatric non-Hodgkin lymphoma (NHL) is a rare presentation with potential diagnostic challenges. We report on two pediatric patients with NHL who exhibited myelopathy signs as initial presentation. Considering NHL as a differential diagnosis in pediatric patients presenting with spinal cord compression is crucial for optimizing the outcome of these patients.
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Affiliation(s)
- Daniele Zama
- Pediatric Emergency UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
| | - Egidio Candela
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
- Pediatric UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Gennaro Pagano
- Specialty School of Paediatrics ‐ Alma Mater StudiorumUniversity of BolognaBolognaItaly
| | - Francesco Venturelli
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli"IRCCS Azienda Ospedaliera‐Universitaria di BolognaBolognaItaly
| | - Fraia Melchionda
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli"IRCCS Azienda Ospedaliera‐Universitaria di BolognaBolognaItaly
| | - Francesco Toni
- Neuroradiology UnitIRCCS Istituto delle scienze Neurologiche di BolognaBolognaItaly
| | - Mino Zucchelli
- Pediatric Neurosurgery, Institute of Neurological ScienceIRCCS Bellaria HospitalBolognaItaly
| | - Andrea Pession
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
- Pediatric UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
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Berla E, Kerzhner O, Caspi T, Shaklai S, Michaeli D. Acute Presentation and Long-Term Rehabilitation Follow-Up of Ischemic Myelopathy Due to Clinically Suspected Fibrocartilaginous Embolism in an Adolescent Male: A Case Report and Review. Neurol Int 2023; 15:1273-1289. [PMID: 37873837 PMCID: PMC10594434 DOI: 10.3390/neurolint15040080] [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: 09/12/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023] Open
Abstract
Ischemic myelopathy is uncommon in the pediatric population, with fibrocartilaginous embolism (FCE) being one of its rarest causes. We present the case of an otherwise healthy 17-year-old student who experienced sudden onset of severe low-back pain amidst intensive physical training, which rapidly deteriorated to complete sensory-motor paralysis of his lower limbs. He was treated with IV Methylprednisolone and anticoagulation after the initial work-up suggested spinal cord infarction. After eight days, sufficient clinical-radiological correlation was achieved to support FCE diagnosis as the most likely cause of infarction. He subsequently received inpatient rehabilitation treatment for four months, after which he was followed as an outpatient for a total period of 16 months. While significant neurological and functional gains were achieved during this period, he also experienced some worsening. This case highlights the importance both of performing a thorough assessment and being familiar with FCE as a possible differential diagnosis of spinal cord infarction in children, to facilitate its timely identification and proper acute and long-term management. This case report was prepared following CARE guidelines after obtaining the patient's written informed consent.
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Affiliation(s)
- Einat Berla
- Israel Defense Forces Medical Corps, Ramat Gan 02149, Israel
| | - Oleg Kerzhner
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
| | - Tomm Caspi
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
| | - Sharon Shaklai
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Pediatric Rehabilitation Unit, Department of Physical Medicine and Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
| | - Dianne Michaeli
- Loewenstein Rehabilitation Medical Center, Ra’anana 43100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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Furlan JC, Furlan DT, Marquez-Chin C. A Scoping Review of Registered Clinical Studies on Management of Individuals With Acute Spinal Cord Injury (2000-2020): Trends and Characteristics of the Research Initiatives. Am J Phys Med Rehabil 2022; 101:184-190. [PMID: 35026781 DOI: 10.1097/phm.0000000000001811] [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: 11/25/2022]
Abstract
ABSTRACT This scoping review examined the current trends and characteristics of the clinical research initiatives on the management of acute spinal cord injury. This review included all clinical studies on the acute treatment of spinal cord injury that were registered in the ClinicalTrials.gov website from February 2000 to December 2020. The search strategy combined the terms "acute spinal cord injury" and "treatment." There has been a gradual increase in the number of registered clinical studies on acute treatment of spinal cord injury over the past two decades. Of the 116 studies, there were 103 interventional studies, 12 observational studies, and 1 registry. While 115 clinical studies recruited male and female participants, most of the registered clinical studies included only adults with an upper age limit after spinal cord injury. Most of the registered clinical studies were interventional studies led by single institutions in North America (n = 70), Europe (n = 29), and Asia (n = 15). Most of the research initiatives were interventional studies on new therapies for management of individuals with spinal cord injury (n = 91). In conclusion, the results of this scoping review suggest that although there has been an increase in the amount and diversity of the research initiatives on treatment of acute spinal cord injury over the past two decades, their generalizability remains relatively limited.
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Affiliation(s)
- Julio C Furlan
- From the Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada (JCF); KITE-Research Institute, University Health Network, Toronto, Ontario, Canada (JCF, DTF, CM-C); Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (JCF); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (JCF); Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada (JCF); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (JCF); and Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (CM-C)
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Ramos E, Ortiz-Santiago A, Correa-Mendoza A. Spinal cord dysfunction secondary to a sports/exercise event: Two case reports. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm-000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tederko P, Middleton J, Mycielski J, Joseph C, Pagliacci MC, Rapidi CA, Tarnacka B, Kujawa J. Relationship Between Level of Economic Development, Age, and Etiology of Spinal Cord Injury: A Cross-Sectional Survey From 22 Countries. Arch Phys Med Rehabil 2021; 102:1947-1958.e37. [PMID: 34119460 DOI: 10.1016/j.apmr.2021.04.024] [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: 01/11/2021] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine relationships between age and spinal cord injury (SCI) and cause of SCI and how this depends on economic development. DESIGN Cross-sectional survey. SETTING Community, 22 countries representing all stages of economic development. PARTICIPANTS A total of 12,591 adults with SCI (N=12,591). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interactions between age at injury and gross domestic product per capita based on purchasing power parity (GDP PPP) quartiles calculated with the application of logistic regression with the Maximum Likelihood estimator. Independence between SCI cause and age was assessed with the Wald test. RESULTS In persons with traumatic SCI, younger age was associated with a higher likelihood of injury in motor vehicle collisions, whereas older individuals had a greater chance of SCI due to falls. Associations between increased likelihood of high-energy traumatic SCI and younger age, low-energy traumatic SCI with older age, nontraumatic SCI with older age in persons injured in adulthood, and a higher prevalence of incomplete SCI lesions in individuals injured at an older age were revealed. Higher GDP PPP influenced positively the likelihood of low-energy SCI in older individuals and was negatively associated with the chance of sustaining SCI in motor vehicle collisions and the likelihood of having nontraumatic SCI at an older age. CONCLUSIONS SCI in older age is predominantly because of falls and nontraumatic injuries. Higher country income is associated with an increased proportion of SCI sustained later in life because of low-energy trauma involving cervical injury and a lower chance of being because of motor vehicle collisions. An increased prevalence of nontraumatic SCI in older individuals associated with lower country income may reflect a higher exposure to socially preventable conditions and lower access to or efficacy of health care. Future studies on etiology of SCI should make the distinction between low and high falls and overcome underrepresentation of older persons.
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Affiliation(s)
- Piotr Tederko
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jerzy Mycielski
- Department of Econometrics and Statistics, Faculty of Economics, University of Warsaw, Warsaw, Poland
| | - Conran Joseph
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | | | - Beata Tarnacka
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Kujawa
- Department of Medical Rehabilitation, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
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Menezes FTL, Alencar JMD, Oliveira da Cruz A, Candeias da Silva C, Oliveira EML, Bichuetti DB. Myelopathies in patients older than 50: not to miss inflammatory etiologies. Mult Scler Relat Disord 2021; 50:102826. [PMID: 33618122 DOI: 10.1016/j.msard.2021.102826] [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: 10/27/2020] [Revised: 12/31/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Inflammatory myelopathies are primarily associated with younger age, and there are few studies in the elderly. Longitudinally extensive spinal cord lesions (LECL) are common in inflammatory myelopathies, but when the first event occurs in older age may have a broader differential diagnosis. OBJECTIVES To identify all non-traumatic myelopathies' etiologies in patients older than 50 years in a tertiary care hospital and to evaluate characteristics that differentiate inflammatory from non-inflammatory etiologies, focusing on the late-onset (≥50 years old) longitudinally extensive spinal cord lesions (LO-LECL) group. METHODS Retrospective study of patients admitted between 2008 to 2019. Demographic, clinical, laboratory, and magnetic resonance imaging (MRI) data of all patients were analyzed to identify predictors that could more easily identify inflammatory from non-inflammatory etiologies and further identify the etiologies of LO-LECL. RESULTS One hundred and three patients 50 years or older diagnosed with non-traumatic myelopathy were included, despite the lesion extension. Five were vascular (5%), 10 spondylotic (10%), 16 other etiologies (16%), 22 inflammatory (21%) and 50 neoplastic myelopathies (49%). Among 23 LO-LECL, 3 were vascular (13%), 4 neoplastic (17%), 7 other etiologies (30%) and 9 inflammatory (39%). The inflammatory LO-LECL had the median time to nadir significantly different from the neoplastic and the other etiologies groups and had the median EDSS at last visit (3.5) significantly lower than the non-inflammatory LO-LECL (7.0-7.5). CONCLUSIONS Inflammatory etiologies are not to be disregarded in older adults with non-traumatic myelopathies. The symptoms' temporal profile is critical to differentiate inflammatory LO-LECL from other etiologies and it has better functional recovery after adequate treatment.
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Affiliation(s)
- Felipe Toscano Lins Menezes
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Jéssica Monique Dias Alencar
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Anisse Oliveira da Cruz
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Carolina Candeias da Silva
- Movement Disorders Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Enedina Maria Lobato Oliveira
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Denis Bernardi Bichuetti
- Neuroimmunogy Clinic, Neurology Discipline, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil.
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Spinal cord dysfunction after COVID-19 infection. Spinal Cord Ser Cases 2020; 6:92. [PMID: 32999271 PMCID: PMC7525226 DOI: 10.1038/s41394-020-00341-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020. CASE PRESENTATION We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4-C6 spinal epidural abscess (SEA) requiring a C3-C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1-T7 SEA. He underwent a T3-T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ). DISCUSSION To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.
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D’Amico S, Pavone P, Testa G, Greco F, Marino L, Smilari P, Pavone V. Secondary Scoliosis as a Complication of Acute Transverse Myelitis in a Child. J Funct Morphol Kinesiol 2020; 5:jfmk5020039. [PMID: 33467256 PMCID: PMC7739325 DOI: 10.3390/jfmk5020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022] Open
Abstract
Acute transverse myelitis (ATM) is a rare neurological condition that affects the spinal cord. Several events, including infections, autoimmune conditions, inflammatory, and drug-induced factors, may cause this disorder. Correct and rapid etiological diagnosis is necessary in order to start appropriate treatment that mainly consists of immunomodulating therapy, high dose intravenous corticosteroids, and in plasma exchange in noninfectious cases. The outcome is varied and depends on several factors. In children, the prognosis is usually good. We report a case of an 11-year-old boy who presented with interscapular pain, right leg steppage, homolateral hyposthenia of the upper limb, and signs of autonomic dysfunction. After performing specific and instrumental exams, a diagnosis of transverse myelitis was reached, and appropriate therapy was performed. A few days post-treatment, the child developed a secondary scoliosis, involving a thoracolumbar curve with loss of cervical and lumbar lordosis. After rehabilitative treatment was undertaken for 12 months, a complete recovery and normal restoration of spinal physiological curves was obtained. The pediatric cases of ATM have a good response to steroid therapy combined with physiotherapy. Collaboration among the various specialists is worthwhile, in order to lead to a correct and rapid diagnosis.
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Affiliation(s)
- Silvia D’Amico
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Gianluca Testa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy;
| | - Filippo Greco
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Lidia Marino
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Pierluigi Smilari
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Vito Pavone
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy;
- Correspondence: ; Tel.: +39-095-378-2273; Fax: +39-095-378-2320
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Wu Q, Zhang Y, Zhang Y, Zhang W, Zhang W, Liu Y, Xu S, Guan Y, Chen X. Riluzole improves functional recovery after acute spinal cord injury in rats and may be associated with changes in spinal microglia/macrophages polarization. Neurosci Lett 2020; 723:134829. [PMID: 32057920 DOI: 10.1016/j.neulet.2020.134829] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/08/2020] [Accepted: 02/06/2020] [Indexed: 02/08/2023]
Abstract
Spinal cord injury (SCI) triggers pronounced inflammatory responses that are accompanied by neuronal disruption and functional deficits. SCI treatment remains an unmet clinical need. Emerging evidence suggests that riluzole may exert a neuroprotective effect due to its anti-inflammatory properties. However, details of the underlying mechanisms remain poorly defined. The polarization of microglial/macrophages has an important role in neuroinflammation. Here, we examined whether riluzole can exert a neuroprotective effect after acute SCI, and whether this effect is associated with changes in microglia/macrophages polarization. Riluzole (4 mg/kg) or vehicle were injected intraperitoneally (i.p.) in female rats immediately following SCI and repeated for 7 consecutive days (b.i.d.). Compared with vehicle treatment, riluzole-treated SCI rats showed significant higher locomotor scores (Basso, Beattie, and Bresnahan score, Inclined Plane test score, n = 18/group). Riluzole-treated rats also developed smaller spinal cavities, showed higher levels of myelin basic protein (MBP) and neurofilament (NF)200 immunoreactivities, and lower levels of proinflammatory cytokines in the spinal cord at 7 days post-SCI. Immunofluorescence study revealed more CD206+ cells and less iNOS+ cells in the injured spinal cord of riluzole-treated SCI rats, as compared to vehicle control. Using real-time PCR, we found that riluzole upregulated the mRNA levels of M2 markers, but downregulated that of M1 markers, as compared to the vehicle treatment. Current findings suggest that systemic administration of riluzole after acute SCI facilitated motor function recovery and inhibited inflammatory responses, which may be associated with polarization of M2 microglia/macrophages.
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Affiliation(s)
- Qichao Wu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Yan Zhang
- Central Laboratory, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Yanjun Zhang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Wenkai Zhang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Wenxiu Zhang
- Central Laboratory, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Yadong Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Songjie Xu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, 21205, USA; Department of Neurological Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland, 21205, USA
| | - Xueming Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China; Central Laboratory, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China.
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