Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent dysreflexic episodes

✓ A total of 93 patients with intractable spasticity due to either spinal cord injury (59 cases), multiple sclerosis (31 cases), or other spinal pathology (three cases) were entered into a randomized double-blind placebocontrolled screening protocol of intrathecal baclofen test injections. Of the 88 patients who responded to an intrathecal bolus of 50, 75, or 100 µg of baclofen, 75 underwent implantation of a programmable pump system for chronic therapy. Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration. Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7. Muscle spasms were reduced from a mean preoperative score of 3.1 (on a fourpoint scale) to a mean postoperative score of 1.0. Although the dose of intrathecal baclofen required to control spasticity increased with time, drug tolerance was not a limiting factor in this study. Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an intrathecal baclofen overdose because of a human error in programming the pump. The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis.

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Nimodipine Promotes Functional Recovery After Spinal Cord Injury in Rats

Frontiers in Pharmacology ◽

10.3389/fphar.2021.733420 ◽

2021 ◽

Vol 12 ◽

Author(s):

Fangliang Guo ◽

Xiaolong Zheng ◽

Ziyu He ◽

Ruoying Zhang ◽

Song Zhang ◽

...

Keyword(s):

Spinal Cord ◽

Motor Neurons ◽

Hind Limb ◽

Term Treatment ◽

Bladder Function ◽

Lumbar Spinal Cord ◽

Long Term Treatment ◽

Cord Injury ◽

Lumbar Spinal

Spinal cord injury (SCI) is a devastating condition that results in severe motor, sensory, and autonomic dysfunction. The L-/T-type calcium channel blocker nimodipine (NMD) exerts a protective effect on neuronal injury; however, the protective effects of long-term administration of NMD in subjects with SCI remain unknown. Thus, the aim of this study was to evaluate the role of long-term treatment with NMD on a clinically relevant SCI model. Female rats with SCI induced by 25 mm contusion were subcutaneously injected with vehicle or 10 mg/kg NMD daily for six consecutive weeks. We monitored the motor score, hind limb grip strength, pain-related behaviors, and bladder function in this study to assess the efficacy of NMD in rats with SCI. Rats treated with NMD showed improvements in locomotion, pain-related behaviors, and spasticity-like symptoms, but not in open-field spontaneous activity, hind limb grip strength or bladder function. SCI lesion areas and perilesional neuronal numbers, gliosis and calcitonin gene-related peptide (CGRP+) fiber sprouting in the lumbar spinal cord and the expression of K+–Cl− cotransporter 2 (KCC2) on lumbar motor neurons were also observed to further explore the possible protective mechanisms of NMD. NMD-treated rats showed greater tissue preservation with reduced lesion areas and increased perilesional neuronal sparing. NMD-treated rats also showed improvements in gliosis, CGRP+ fiber sprouting in the lumbar spinal cord, and KCC2 expression in lumbar motor neurons. Together, these results indicate that long-term treatment with NMD improves functional recovery after SCI, which may provide a potential therapeutic strategy for the treatment of SCI.

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Unlike Brief Inhibition of Microglia Proliferation after Spinal Cord Injury, Long-Term Treatment Does Not Improve Motor Recovery

Brain Sciences ◽

10.3390/brainsci11121643 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1643

Author(s):

Gaëtan Poulen ◽

Sylvain Bartolami ◽

Harun N. Noristani ◽

Florence E. Perrin ◽

Yannick N. Gerber

Keyword(s):

Spinal Cord ◽

Ex Vivo ◽

Spinal Injury ◽

Oral Treatment ◽

Term Treatment ◽

Motor Recovery ◽

Beneficial Effects ◽

Long Term Treatment ◽

Cord Injury

Microglia are major players in scar formation after an injury to the spinal cord. Microglia proliferation, differentiation, and survival are regulated by the colony-stimulating factor 1 (CSF1). Complete microglia elimination using CSF1 receptor (CSF1R) inhibitors worsens motor function recovery after spinal injury (SCI). Conversely, a 1-week oral treatment with GW2580, a CSF1R inhibitor that only inhibits microglia proliferation, promotes motor recovery. Here, we investigate whether prolonged GW2580 treatment further increases beneficial effects on locomotion after SCI. We thus assessed the effect of a 6-week GW2580 oral treatment after lateral hemisection of the spinal cord on functional recovery and its outcome on tissue and cellular responses in adult mice. Long-term depletion of microglia proliferation after SCI failed to improve motor recovery and had no effect on tissue reorganization, as revealed by ex vivo diffusion-weighted magnetic resonance imaging. Six weeks after SCI, GW2580 treatment decreased microglial reactivity and increased astrocytic reactivity. We thus demonstrate that increasing the duration of GW2580 treatment is not beneficial for motor recovery after SCI.

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Optimising patients with long-term spinal cord injury for nephrectomy: A review of pre-, peri- and post-operative factors to safeguard outcomes

Journal of Clinical Urology ◽

10.1177/2051415820921089 ◽

2020 ◽

pp. 205141582092108

Author(s):

J Donati-Bourne ◽

Z Kasmani ◽

WGE Mohamed ◽

P Pillai ◽

J O’Dair ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Dysreflexia ◽

Level Of Evidence ◽

Comprehensive Literature Review ◽

Urinary Infections ◽

Distended Bowel ◽

Cord Injury ◽

Hospital Acquired

Objectives: To review the potential challenges a urologist may encounter when embarking on simple/partial/radical nephrectomy in patients with long-term spinal cord injury and propose strategies to pre-empt and manage these. Materials and methods: Comprehensive literature review via PubMed, MEDLINE® and Google™ Scholar searching for relevant scientific articles published to date in English. Recommendations for strategies to safeguard surgical outcomes discussed with a panel of experienced upper-tract urologists. Results: Pre-operative considerations: - urethral assessment via flexible cystoscopy due to higher incidence of urethral pathology in spinal cord injury; - assessing for chronic constipation and distended bowel; and - considering glomerular filtration rate assessment by radio-isotope techniques, such as 51chromium-EDTA Peri-operative considerations: - adequate theatre staffing for safe patient transfer; and - planned choice of incision, due to higher incidence of previous abdominal surgery, stoma bags and/or foreign body devices. Post-operative considerations: - ensuring attending medical staff are trained to recognise autonomic dysreflexia; - early re-mobilisation with physiotherapists experienced in treating spinal cord injury; and - attentive antibiotic stewardship due to higher risk of hospital-acquired or urinary infections Conclusions: Patients with long-term spinal cord injury pose significant potential challenges in the pre-, peri- and post-operative stages of nephrectomy. Familiarisation and optimisation of such factors is recommended to safeguard outcomes. Level of evidence: Not applicable for this multicentre audit.

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1232: Long-Term Urodynamic Follow-Up in Patients with Spinal Cord Injury: Is it Really Necessary

The Journal of Urology ◽

10.1016/s0022-5347(18)35377-1 ◽

2005 ◽

Vol 173 (4S) ◽

pp. 334-334

Author(s):

Juergen Pannek ◽

Michael Nosseir

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cord Injury

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