Neurogenic bladder following myelopathies: Has it any correlation with neurological and functional recovery?

ABSTRACT Objectives: To observe neurogenic bladder pattern in patients with myelopathy by performing urodynamic study (UDS) and to observe whether it has any correlation with functional and neurological recovery. Patients and Methods: This prospective study was conducted with 90 patients with myelopathy, both traumatic and non-traumatic (males = 65) in a university tertiary research hospital in India between January 2011 and December 2013. Mean age was 33.5 ± 13.2 years (range 15-65 years), mean duration of injury was 82.63 ± 88.3 days (range 14-365 days) and mean length of stay (LOS) in the rehabilitation unit 42.5 ± 23.3 days (range 14-130 days). The urodynamic study was performed in all the patients to assess the neurogenic bladder pattern. Management was based on the UDS findings. Functional recovery was assessed using Barthel index (BI) scores and spinal cord independence measures (SCIM) scores. Neurological recovery was assessed using ASIA impairment scale (AIS). We tried to correlate neurogenic bladder patterns with recovery. Results: Fifty patients (55.6%) had overactive detrusor with 25 each had detrusor sphincter dyssynergia (DSD) and synergic sphincter. Thirty-eight patients had hypoactive/acontractile detrusor and two had normal studies. No significant correlation observed between neurogenic bladder pattern and change in BI scores (P = 0.696), SCIM scores (P = 0.135) or change in ASIA status (P = 0.841) in the study. Conclusions: More than half of the patients with myelopathies had overactive detrusor with or without dyssynergic sphincter according to the urodynamic study. Neurogenic bladder patterns had no significant correlation with functional and neurological recovery in these patients.

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Detrusor Arreflexia as an End Stage of Neurogenic Bladder in HAM/TSP?

Case Reports in Medicine ◽

10.1155/2011/289389 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Matheus Tannus ◽

Davi Tanajura ◽

Michael A. Sundberg ◽

Paulo Oliveira ◽

Neviton Castro ◽

...

Keyword(s):

Nervous System ◽

Neurogenic Bladder ◽

Clinical Course ◽

Case Series ◽

Subsequent Development ◽

Overactive Detrusor ◽

Initial Development ◽

Detrusor Sphincter Dyssynergia ◽

End Stage ◽

Over Time

The HTLV-1 virus is a known agent involved in the development of HAM/TSP. Past studies have typically observed patients with autonomic dysfunction consisting of detrusor overactivity and detrusor-sphincter dyssynergia, with the occasional observation of underactive detrusor or detrusor arreflexia. However, studies have not yet evaluated the progression of neurogenic bladder over time. In this paper, we describe a HAM/TSP patient with the initial development of overactive detrusor, and subsequent development of detrusor arreflexia. Given a paucity of studies characterizing the effects of HTLV-1 on the autonomic nervous system, particularly aspects controlling continence, this patient's clinical course may represent one type of end point for patients with HAM/TSP and neurogenic bladder. Further cohort or case-series studies, with particular emphasis on the progression of neurogenic bladder, are needed to evaluate the significance of this described case in relation to typical disease progression patterns.

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Evaluation of a Ketogenic Diet for Improvement of Neurological Recovery in Individuals with Acute Spinal Cord Injury: study protocol for a randomized controlled trial

10.21203/rs.2.23366/v1 ◽

2020 ◽

Author(s):

Aynur DEMIREL ◽

Jia LI ◽

Casey MORROW ◽

Stephen BARNES ◽

Jan JANSEN ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Total Energy ◽

Acute Care ◽

Ketogenic Diet ◽

Motor Function ◽

Functional Recovery ◽

Functional Independence ◽

Neurological Recovery ◽

Cord Injury

Abstract Background: Therapies that significantly improve the neurological and functional recovery of individuals with spinal cord injury (SCI) are still urgently needed. The ketogenic diet (KD) has been shown to improve forelimb motor function in a rat model of SCI, likely by reducing inflammation and cell death in the spinal cord. Furthermore, our recent pilot study in patients with SCI showed that, compared with a standard hospital diet (SD), 5 weeks of KD, started during acute care, improved upper extremity motor function and reduced serum levels of a neuroinflammatory blood protein. The primary goals of our proposed study are to 1) show the safety and feasibility of administering a KD during acute care for SCI; 2) determine if consuming 5 weeks of a KD significantly improves motor and sensory function, functional independence, and glycemic control; and 3) quantify serum biomarkers that are linked to improvements in neurological recovery and functional independence via targeted proteomics.Methods/Design: In a single-masked, longitudinal, randomized parallel controlled study design, 60 participants with acute SCI will be randomly assigned to KD or SD in a 1:1 ratio. We intend to recruit 24 participants for each group with traumatic SCI (C5–T12, American Spinal Injury Association impairment scale A–C, and aged 18–60 years). Patients will be taken to acute care after their injury. Neurological and functional examinations, resting energy expenditure, blood, urine, stool collection and protein analyses related to neuro recovery will be done within 72 h of injury, as baseline measures. Patients received five weeks of KD or SD according to their allocation. The KD is a high-fat, low-carbohydrate diet (3:1 ratio of fat: carbohydrate + protein) that includes ~75% total energy as fat, ~20% as protein, and ~5% as carbohydrate and fiber. The SD includes ~45-50% total energy as carbohydrate and fiber, ~30% total energy as fat, and ~20% total energy as protein. All baseline examinations will be repeated at discharge from the hospital at week 5 (discharge measure). Discussion: The proposed diet intervention is practical and safe and is expected to translate into efficacious early nutritional interventions. Intervention with a more neuroprotective diet during acute care of SCI can be implemented anywhere in the world at low cost and without major regulatory hurdles. Better functional recovery will lead to a better quality of life and long-term health outcomes in individuals with SCI. While this study targets SCI, if successful it has the potential to improve neurological outcomes for individuals with various traumatic injuries such as traumatic brain injury and stroke.

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Evaluation of a Ketogenic Diet for Improvement of Neurological Recovery in Individuals with Acute Spinal Cord Injury: study protocol for a randomized controlled trial

10.21203/rs.2.23366/v2 ◽

2020 ◽

Author(s):

Aynur DEMIREL ◽

Jia LI ◽

Casey MORROW ◽

Stephen BARNES ◽

Jan JANSEN ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Acute Care ◽

Ketogenic Diet ◽

Motor Function ◽

Functional Recovery ◽

Functional Independence ◽

Neurological Recovery ◽

Controlled Study ◽

Cord Injury

Abstract Background: Therapies that significantly improve the neurological and functional recovery of individuals with spinal cord injury (SCI) are still urgently needed. The ketogenic diet (KD) has been shown to improve forelimb motor function in a SCI rat model, likely by reducing inflammation and cell death in the spinal cord. Furthermore, our recent pilot study in patients with SCI showed that, compared with a standard hospital diet (SD), 5 weeks of KD started during acute care, improved upper extremity motor function, and reduced serum levels of a neuroinflammatory blood protein. The primary goals of the current study are to: 1) show the safety and feasibility of administering a KD during acute care for SCI; 2) determine if consuming 5 weeks of a KD significantly improves motor and sensory functions, functional independence, and glycemic control; and 3) quantify serum biomarkers that are linked to improvements in neurological recovery and functional independence via targeted proteomics. Methods/Design: In a single-masked, longitudinal, randomized parallel controlled study, a total of 60 eligible participants ranging in age from 18 to 60 years with acute traumatic SCI (cervical 5 – thoracic 12) American Spinal Injury Association impairment scale (AIS A-C): AIS-A, sensorimotor complete; AIS-B, sensory incomplete/motor complete; and AIS-C, non-functional motor incomplete, are being enrolled. Neurological and functional examinations, resting energy expenditure, blood, urine, and stool collections, and protein analyses related to neurological recovery will be performed within 72 h of injury (baseline measure) and repeated after 5 weeks of KD or SD (discharge measure). We anticipate a completion rate of 80% with a total of 48 participants. Discussion: Intervention with a more neuroprotective diet during acute care of SCI can be implemented anywhere in the world at low cost and without major regulatory hurdles. Better functional recovery will lead to a better quality of life and long-term health outcomes in individuals with SCI. While this study targets SCI, if successful it has the potential to improve neurological outcomes for individuals with various traumatic injuries. Trial registrations: ClinicalTrials.gov, NCT03509571. Registered in April 2018.

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Functional Recovery after Decompressive Spine Operation for Cervical Spine Fractures

Neurosurgery ◽

10.1227/00006123-198705000-00012 ◽

1987 ◽

Vol 20 (5) ◽

pp. 742-746 ◽

Cited By ~ 53

Author(s):

Edward C. Benzel ◽

Sanford J. Larson

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Functional Recovery ◽

Spinal Canal ◽

Neurological Recovery ◽

Spine Fractures ◽

Functional Scale ◽

Effect Relationship ◽

Average Interval ◽

Cervical Spine Fractures

Abstract Ninety-nine patients with cervical spine fractures from C-4 through C-7 were operated upon from 1975 to 1981. Operation was performed to restore normal relationships between the spinal cord and roots and the spinal canal and foramina and to maintain these relationships by fusion when necessary. Neurological function was recorded pre- and postoperatively using a functional scale. Satisfactory fusion without adverse change in vertebral alignment was achieved in each patient. The average interval between injury and operation was 29 days. When neurological recovery was observed, it began promptly after operation, suggesting a cause and effect relationship.

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Urodynamic profile in acute transverse myelitis patients: Its correlation with neurological outcome

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.193547 ◽

2017 ◽

Vol 08 (01) ◽

pp. 044-048 ◽

Cited By ~ 2

Author(s):

Anupam Gupta ◽

Sushruth Nagesh Kumar ◽

Arun B. Taly

Keyword(s):

Neurological Outcome ◽

Bladder Dysfunction ◽

Transverse Myelitis ◽

Inpatient Rehabilitation ◽

Neurological Status ◽

Rehabilitation Unit ◽

Overactive Detrusor ◽

Acute Transverse Myelitis ◽

Acontractile Detrusor ◽

Bladder Management

ABSTRACT Objective: The objective of this study was to observe urodynamic profile of acute transverse myelitis (ATM) patients and its correlation with neurological outcome. Patients and Methods: This prospective study was conducted in the neurorehabilitation unit of a tertiary university research hospital from July 2012 to June 2014. Forty-three patients (19 men) with ATM with bladder dysfunction, admitted in the rehabilitation unit, were included in this study. Urodynamic study (UDS) was performed in all the patients. Their neurological status was assessed using ASIA impairment scale and functional status was assessed using spinal cord independence measure. Bladder management was based on UDS findings. Results: In total, 17 patients had tetraplegia and 26 had paraplegia. Thirty-six patients (83.7%) had complaints of increased frequency and urgency of urine with 26 patients reported at least one episode of urge incontinence. Seven patients reported obstructive urinary complaints in the form of straining to void with 13 patients reported both urgency and straining to void and 3 also had stress incontinence. Thirty-seven (86.1%) patients had neurogenic overactive detrusor with or without sphincter dyssynergia and five patients had acontractile detrusor on UDS. No definitive pattern was observed between neurological status and bladder characteristics. All patients showed significant neurological and functional recovery with inpatient rehabilitation (P< 0.05 and P< 0.001, respectively). Conclusions: The problem of neurogenic bladder dysfunction is integral to ATM. Bladder management in these patients should be based on UDS findings. Bladder characteristics have no definitive pattern consistent with the neurological status.

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THE EFFECT OF OXYBUTYNIN ON NEUROGENIC DETRUSOR OVERACTIVITY IN SPINAL CORD INJURY PATIENT: A HOSPITAL BASED INTERVENTIONAL STUDY

10.36106/pijr/8501736 ◽

2021 ◽

pp. 42-44

Author(s):

Vineet Bharti ◽

Nikhil Agarwal ◽

Mrinal Joshi

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neurogenic Bladder ◽

Detrusor Overactivity ◽

Anticholinergic Drug ◽

Bladder Capacity ◽

Spinal Cord Injury Patient ◽

Detrusor Sphincter Dyssynergia ◽

Bladder Compliance ◽

Cord Injury

Neurogenic bladder dysfunction is one of prominent impairments following Spinal Cord Injury (SCI) and is seen in 90% of patients.This study has been undertaken to correlate the effect of anticholinergic drug (oxybutynin) on urodynamic parameters in neurogenic bladder of SCI patients.This is a hospital based non randomized prospective interventional study.After initial baseline urodynamic study,patients with detrusor areflexia were excluded from the study group and thirty patients showing detrusor overactivity and detrusor sphincter dyssynergia were treated with oral oxybutynin 5 mg for 7 days followed by repeat urodynamic evaluation thereafter.Our study concluded that mean bladder compliance improved from 6.114 to 17.95 ml/cmH2O after intervention and mean bladder capacity also increased after intervention (229.7ml) from (165.3ml) and changes were statistically significant.Antimuscarinic (Oxybutynin) is an effective drug in management of neurogenic bladder in SCI patients increases bladder compliance and capacity and results are objectively achieved within seven days

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Urodynamic study of Bladder Behaviour in Traumatic Spinal Cord Injury Patients in Response to Rehabilitation

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-24-4-87 ◽

2013 ◽

Vol 24 (4) ◽

pp. 87-91

Author(s):

Singh Ningthoujam Jungindro ◽

Keshkar Sanjay, ◽

Singh Naorem Ajit ◽

Kumar Ratnesh

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Neuron ◽

Neurogenic Bladder ◽

Traumatic Spinal Cord Injury ◽

Urodynamic Study ◽

Rehabilitation Intervention ◽

Cord Injury ◽

Bladder Rehabilitation

Abstract Objective To study the bladder behaviour in response to rehabilitation intervention in traumatic spinal cord injury (SCI) patients using urodynamic study (UDS) and to compare the nature of the bladder in a rehabilitated and nonrehabilitated neurogenic bladder of traumatic SCI. Study design Prospective follow-up study. Setting Rehabilitation ward of National Institute for the Orthopaedically Handicapped. Material and Method Thirty traumatic SCI patients mean age 31.4±7.9 years, 26 males and 4 females, admitted for rehabilitation were done UDS to see the bladder behaviour in response to rehabilitation intervention and compare the nature of bladder of the rehabilitated and that of the non-rehabilitated neurogenic bladder. Rehabilitation of the bladder was done at least for three months. The study lasted for 2 years with a minimum of one year follow-up. Result In upper motor neuron (UMN) neurogenic bladders there were significant changes in the max. cystometric capacity (p=0.018) after rehab intervention. The compliance, Pdet. at first desire to void and Pdet. at max. cystometric capacity of these patients were also found to have significant correlations (p=0.012, 0.010 and 0.014 respectively). But the volume at the first desire to void does not show must significant changes after rehab intervention (p=0.45). Significant reduction of amplitude and frequency was found in involuntary contractions (detrusor hyper-reflexia). In similar comparison of the lower motor neuron (LMN) neurogenic bladder significant changes after rehab intervention, could be found only in the max. cystometric capacity (p=0.018). Other variables like compliance, volume at first desire to void, Pdet. at first desire to void, and Pdet. at max. cystometric capacity were found to have no significant changes after rehab intervention (p=0.168, 0.194, 0.324, 0.302 respectively). Conclusion The change in the nature of the rehabilitated neurogenic bladder is different with the type of bladder.

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Neuropathic Bladder Caused by Caudal Regression Syndrome without Any Other Neurogenic Symptoms

Case Reports in Medicine ◽

10.1155/2012/982418 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Yoshinobu Moritoki ◽

Yoshiyuki Kojima ◽

Hideyuki Kamisawa ◽

Kentaro Mizuno ◽

Kenjiro Kohri ◽

...

Keyword(s):

Spinal Cord ◽

Present Report ◽

Delayed Diagnosis ◽

Ct Scanning ◽

Clean Intermittent Catheterization ◽

Urodynamic Study ◽

Caudal Regression Syndrome ◽

Neuropathic Bladder ◽

Detrusor Sphincter Dyssynergia ◽

Caudal Regression

Caudal regression syndrome (CRS) is a rare congenital vertebral anomaly, which occurs most often in combination with spinal cord malformations and morphologic dysfunctions of the lower extremities; these signs are useful for both patients and clinicians in the diagnosis of this syndrome. However, in certain cases, clinicians have failed to identify the syndrome due to the lack of apparent anomalies, resulting in the progression of renal dysfunction caused by neuropathic bladder when CRS is eventually identified. Here, we report a case of a 2-year-old girl who was referred to our hospital for vesicoureteral reflux. At examination, she presented no neurological symptoms; however, on cystourethrography and CT scanning we found that the sacral bone was absent, through which CRS was diagnosed. A urodynamic study indicated detrusor-sphincter dyssynergia, and clean intermittent catheterization was initiated. In the present report, we describe a case of CRS with no neurologic symptoms other than a neuropathic bladder. The lack of outward signs can result in delayed diagnosis. Thus, urological examinations, including a urodynamic study, might be the only clue for identifying an underlying neurologic injury involving the lower spinal cord.

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